ONCOLOGY REVIEW (US) – VOLUME 1 ISSUE 2 – FALL 2005

Cancer is the second leading cause of death in developed countries, accounting for nearly one in five deaths. The costs of such a widespread killer are staggering, affecting both the individual and society as a whole.The US National Institutes of Health (NIH) estimated the overall annual costs for cancer in 2003 at US$189.5 billion. This […]

Cancer is largely a disease of elderly people (see Figure 1), while its risk increases significantly with age (see Figure 2). Moreover, the Western population is aging rapidly (see Figure 3). Although 60% of new cancer cases and over 70% of cancer deaths occur in patients aged 65 and older in Europe, standard cancer treatment […]

“accurate and precise delivery using robotically controlled linear accelerators and collimation systems; ” imaging modalities capable of providing accurate volumetric anatomical and physiological data for treatment planning; ” software systems that exploit imaging to construct virtual patient models; ” numerical algorithms for simulating and optimizing dose distributions during planning; and ” data and networking standards […]

Data from the Surveillance Epidemiology and End Results (SEER) registry demonstrate that the percentage of patients receiving appropriate breast-conserving therapy declined from 1983 to 1995.7 Barriers to appropriate RT treatment appear to be multifactorial including distance to RT centers, decreased socioeconomic status, insurance coverage, and older age.8–14 More convenient and less costly RT regimens may […]

Implanting Tumors with Permanent Radiation Sources Brachytherapy refers to the procedure of physically placing radiation sources into, next to, or through malignant tumors. Its history dates back to the very discovery of radiation, and since then has become established as a successful treatment in many organs. The most common uses today involve the prostate, uterine, […]

The combination of external beam radiotherapy (EBRT) with brachytherapy boost has become a common treatment approach for prostate cancer patients over the past 15 years.The concept of prostate brachytherapy was first introduced in the early 20th century at Johns Hopkins Hospital under the tutelage of Hugh Hampton Young with the use of transurethral sources for […]

The on-board imager (OBI) has been in routine clinical use at the Karolinska University Hospital since June 2004. The OBI consists of a diagnostic X-ray tube and a kV flat panel imager, which are both mounted on robotic arms and designed for three main functions – orthogonal radiographs for three-dimensional (3-D) patient set-up, CB kVCT […]

External beam radiotherapy (EBRT) is the most common form of radiation treatment offered to cancer patients. Currently, different types of EB therapy techniques are used. The goal of three-dimensional conformal RT (3-D CRT) is to deliver a full dose of irradiation to the target structure with as little radiation as possible affecting the surrounding normal […]

Changing Paradigms in Loco-regional Management of Breast Cancer

Over the last decade the ability to precisely deliver radiotherapy (RT) treatments has advanced dramatically. Imaging technology has evolved to facilitate better target delineation during treatment planning. Treatment delivery techniques have advanced to enable intensity modulated RT (IMRT) treatments that provide radiation doses, tightly conforming to the target volumes. These advancements have been driven by […]

Current Status Intensity modulated radiotherapy (IMRT) has been widely adopted as a new tool in RT for the delivery of high doses of radiation to the tumor while providing maximal sparing of surrounding critical structures.

This article outlines the current status of this imageguided intervention for treatment of HCC and introduces some new concepts and advances in the era of minimally invasive therapy of HCC. Chemoembolisation Technique The technique of transcatheter arterial chemoembolisation (TACE) exploits HCC preferential blood supply from the hepatic artery to deliver the anti-tumor therapy, while sparing […]

Introduction Hepatocellular carcinoma (HCC) is the fifth most common cancer, and its incidence is increasing worldwide due to the dissemination of hepatitis B and C virus infection. Patients with cirrhosis are at the highest risk of developing HCC and should undergo surveillance programmes to detect the tumour at an early, asymptomatic stage.1

Lung cancer is the most common cancer worldwide, with an estimated five-year survival rate of 15% for the majority of histologies (e.g. non-small cell). Surgery is the primary treatment for resectable non-small cell lung cancer (NSCLC). The five-year survival rates after surgical treatment are 63–67% in stage IA, 46–57% in stage IB, 52–55% in stage […]

5-Fluorouracil 5-Fluorouracil (5-FU) is a fluoropyrimidine analog that is inactive in its parent form, and requires metabolic activation to generate the active metabolites responsible for cytotoxicity.The cytotoxic metabolites of 5-FU are incorporated into ribonucleic acid (RNA) and DNA, respectively, and they interfere with the processes of RNA and DNA biosynthesis. In addition, the 5-FU metabolite, […]

Neuroendocrine gastroenteropancreatic (GEP) tumors constitute less than 2% of all gastrointestinal (GI) malignancies. The incidence of the largest group of patients, those with small intestinal carcinoid tumors, is two to 2.4 per 100,000 inhabitants.The true incidence is probably underestimated due to sometimes vague clinical presentation and low awareness among physicians. The incidence in autopsy series […]

The type I family of tyrosine kinase receptors (TKRs) plays an important role in the pathogenesis of a subset of breast cancers.This family consists of four receptors known as the epidermal growth factor receptor (EGFR) and human EGFRs 2 (HER-2), 3, and 4. Slamon et al.2 showed that HER-2 overexpression was associated with poor disease-free […]

Patients with advanced breast cancer are at high risk for developing bone metastases and ensuing skeletal complications. Since the mid 1990s, intravenous (IV) pamidronate has been the international standard of care for breast cancer patients with bone metastases. Recently, a large, randomized, phase III trial in this patient population demonstrated that 4mg zoledronic acid, a […]

Treatment Prospects have improved with the development of new drugs that interfere with unique biochemical pathways driven by cancer-causing mutations. The translation of molecular findings into practical treatments is exemplified by the recent approval and acceptance of Herceptin® in clinical practice.This antibody targets the cell surface marker for a particularly lethal subtype of breast cancer, […]

The History of Cryosurgery Cryosurgery has already been used successfully in treating primary and metastatic liver tumors3 and prostate cancer.4 Its efficacy has also been demonstrated in the treatment of ophthalmologic and dermatologic tumors.5 Historically, Dr James Arnott of the Middlesex Hospital first treated fungated tumors with a mixture of salt and ice, observing reduction […]

When mammography shows significant findings in women with SND, the likelihood of malignancy increases,2 but mammographic imaging is often unhelpful. Galactography has been used to evaluate women with SND with variable success.6,7 When SND is caused by peripheral intraductal lesions, galactography provides localizing information and can also assess the likelihood of malignancy,4 although definitive diagnosis […]

Until recently, most breast cancers were detected by palpation, and were often at a late stage in their natural history when they were brought to medical attention. The outcome of these late-stage, advanced breast cancers was equally poor, regardless of the method of therapy chosen, as these large tumours were most likely associated with systemic […]

To date, antibodies directed towards the CD20 antigen have dominated the field of mAb therapy and RIT of lymphoma. CD20 is highly expressed on mature B-cells and present on 95% of B-cell lymphomas.8,99 131I labelled Tositumomab (Bexxar™) and 90Y labelled ibritumomab tiuxetan (Zevalin®) are highly promising therapies with significantly increased overall and complete response rates […]

Miracle Treatments and Long-term Side Effects Modern cancer therapies, like all medical interventions, have their share of complications and long-term side-effects; some of these involve the brain. In recent years, with an increasing number of pediatric cancer patients surviving into adolescence and young adulthood, experts have been diagnosing cognitive deficits caused by some of the […]

Past The most common cancer arising from the brain is the glioblastoma multiforme (GBM). It is also the most deadly,1 representing the most aggressive subtype among the gliomas, a collection of tumors including astrocytomas and oligodendrogliomas (see Table 1). In 1926, Bailey and Cushing, in describing ‘spongioblastoma multiforme’, the label then used for GBM, noted […]

Mechanisms of Inflammation-induced Cancer Approximately 20% to 30% of the world’s cancer burden can be traced to infectious agents that are thought to act through the production of chronic infections and subsequent chronic inflammation. For example, adenocarcinoma of the stomach is characterized by a series of sequential events comprising Heliobacter pylori infection, resultant long- standing […]

Wilms’ Tumor Wilms’ tumor is the most common pediatric urologic tumor—75% of patients present between one and five years of age, with an equal incidence between boys and girls. Patients present with an abdominal mass, which rarely crosses the midline. Contrast computed tomography (CT) of the chest, abdomen, and pelvis is obtained to evaluate both […]

The prognosis of NSCLC is poor and is closely related to the stage of disease. NSCLC usually metastasizes first to hilar and mediastinal LNs. Subsequently, hematogenous metastasis to distant sites may occur. For staging of NSCLC, the TNM classification has been developed, in which T stands for local tumor extension, N for LN metastasis, and […]