ONCOLOGICAL DISEASE (US) – VOLUME 3 ISSUE 1 – SPRING 2007

Welcome to Issue 1 of US Oncological Disease 2007. With so many advances being made in the treatment of all types of cancers and developments in drugs and technologies, we are living and working in a most exciting time for our patients and our profession. There are many exciting articles and advances within this issue […]

Patients with brain metastases do poorly, with median survival of only one month if treated with steroids only.5 In an effort to better stratify patients into prognostic groups, the Radiation Therapy Oncology Group (RTOG) conducted a recursive partitioning analysis and found age, Karnofsky Performance Status (KPS), and systemic disease status to be important.6 Even in […]

Astrocytic tumors have long been the bane of neurosurgeons, radiation therapists, and neuro-oncologists. Although they account for only 2.3% of all cancer-related deaths in the US,1 little if any substantial progress in brain imaging and treatment had been made until the first years of this millennium. Characteristics of high-grade glial tumors compared with other cancers […]

Unfortunately, such metastases are a common occurrence, representing approximately 250,000 cases per year in the US alone.3 Thus, even if only a fraction of these patients are referred for SRS, the management of brain metastases invariably represents a significant fraction of the workload of a radiosurgery practice. Until recently most reports supporting the use of […]

The treatment of patients with glioblastoma multiforme (GBM) is considered to be a palliative venture with no hope of cure. Traditionally, patients are treated with maximal surgical resection based on the premise that, although surgery is not a curative procedure, a major resection leads to longer survival and better quality of life.1 Radiotherapy increases the […]

Aromatase inhibitors (AIs) block estrogen production in the peripheral tissues by preventing the last step in estrogen biosynthesis. The superior efficacy and more favorable side-effect profile demonstrated by AIs have allowed them to begin to replace tamoxifen as the adjuvant therapy of choice for post-menopausal women with ER+ breast cancer.2–5 However, one caveat of AI […]

In patients with early disease, a multimodal approach to treatment is essential for improving survival. Breast cancer recurrence, particularly distant recurrence, in women with early stage disease is associated with increased mortality.8 Treatments that can address the risk of breast cancer recurrence, especially distant metastases, have the potential to remain disease-free and improve overall survival […]

Surgery is the primary treatment of choice in early-stage breast cancer for patients of all ages. Older patients who do not undergo surgical removal of the tumor are at increased risk for breast cancer progression and mortality. This was demonstrated in a study of 455 women over the age of 70 who had operable, invasive […]

Advanced stage appears to be a prognostic factor for decreased survival.4,9 However, few upstaged patients will receive adjuvant therapy because it has not been shown to improve clinical outcome.10,11 In a previous report of 93 women with ovarian LMP tumors, survival and recurrence rates were not significantly different between those who were staged and those […]

Doxil as a Single Treatment Regimen for Hormone-refractory Prostate Cancer A literature search identified six clinical trials in which liposomal doxorubicin was used as a single agent against prostate cancer. In the first pharmacokinetic study, published in 2000, 15 patients with hormonerefractory prostate cancer (HRPC) received Doxil either at 45mg/m2 every three weeks or 60mg/m2 […]

Bone loss in patients with prostate cancer may be attributed to the disease itself, which is a risk factor for osteoporosis, and to ADT. Bone loss associated with ADT has been shown to increase the risk for fractures.2,3 Moreover, approximately 70% of patients with advanced prostate cancer will develop bone metastases, which cause local decreases […]

By way of orientation, I-ELCAP type screening is a clinical activity; a positive test CT initiates a process that leads to early diagnosis. Such diagnostic activity, as it is pursued in an individual, is squarely in the domain of clinicians. In this context, we suggest that it is the responsibility of the individual clinician to […]

There are several reasons why these disappointing results are not unexpected. First, patients treated with definitive radiation have a lower overall performance status than their surgical counterparts by virtue of the comorbidities that rendered them inoperable. Second, the doses of radiation used to treat these patients are now recognized to yield only a modest rate […]

For the past 10 years, many cytotoxic and targeted agents have been pitted against or combined with gemcitabine in randomized phase III trials and no drug has been shown to be superior to single-agent gemcitabine. Luckily, in the past year, for the first time, two large, randomized phase III studies in APC—capecitabine plus gemcitabine versus […]

Unfortunately, only a small proportion – between 10 and 15% – of patients with liver metastases only are primary candidates for potentially curative liver resection, since surgery is limited to those with a good performance status, and those who fall within ‘limited disease criteria’ (generally four or fewer tumors in one lobe of In a […]

CML is a monoclonal stem cell disorder accounting for approximately 20% of adult leukemias.1 The median age at first diagnosis is 60 years and the male-to-female ratio is almost even (1:1.4). Typically, CML develops in three phases. The vast majority of patients (>80%) is diagnosed in the initial chronic phase, which—in the absence of any […]

The standard therapeutic options that were available before the imatinib era were recombinant interferon-alpha, chemotherapy with hydroxyurea, lowdose cytarabine, or busulfan and allogeneic bone-marrow transplantation (BMT). Allogeneic BMT has been recognized as the only potentially curative treatment of CML.4 It is, however, available to only 15% of newly diagnosed patients who are considered young enough […]

Unfortunately, AML patients classified as high-risk due to an unfavorable karyotype or secondary leukemia respond poorly to this chemotherapy.1 For these latter patients, the induction of complete remission is 80% of MDS patients will relapse after low-dose DAC therapy. The duration of second disease remissions for these MDS patients was inferior to the first treatment […]

Investigational approaches of significant potential include clofarabine, homoharringtonine, AMG531 (a thrombomimetic agent), and others. Treatment of MDS depends on patient age, prognostic risk, and comorbid conditions. The availability of these options has resulted in an increase in the documented incidence of MDS from 12,000 cases per year in the US to more than 20,000 cases. […]

Acetylation—A Dynamic Regulatory Process Acetylation is a type of post-translational modification that can induce structural and conformational changes in proteins in a manner analogous to phosphorylation. Much as kinases and phosphatases regulate the phosphorylation state of proteins, acetyltransferases and HDACs regulate their acetylation state.3 For example, lysine acetylation is analogous to tyrosine phosphorylation in that […]

Computed tomography (CT) utilizing kilovolt (kV) X-rays was not developed until the early 1970s. For the first time this imaging modality provided three-dimensional (3-D) information about tumor location and at the same time about the electron density distribution required to perform 3-D dose calculations. Therefore, it was a natural choice to develop CT-based radiation treatment […]

The detector is designed for daily in vivo dosimetry for megavoltage external beam radiation therapy. While other MOSFET detectors have been used clinically for surface measurements6–9 or temporarily placed into a body cavity during treatment,10–12 only the DVS detector is designed to be permanently implanted to measure dose over the entire course of treatment. The […]

Central to the success of any local therapy is the accurate diagnosis of tumor extent. Functional imaging, especially PET-CT, is being increasingly incorporated into the oncological management of a variety of cancer diagnoses. Its use in the modern radiation oncology practice is only now being realized. This review will focus on the implementation of PET-CT […]

Most patients who have experienced OM report that it is the most bothersome side effect of their cancer treatment. OM is a multifaceted problem that can lead to a number of clinical complications. It can manifest itself in various ways, but pain is the hallmark symptom and may be the first indication that OM is […]

However, widespread efforts to improve nutritional support for patients were not immediately implemented since many felt weight loss was merely an unavoidable consequence of aggressive disease. Almost two decades later, Andreyev offered an alternative explanation, exposing the fact that those with weight loss actually received less treatment.3 These patients developed more toxicity, resulting in dose […]