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Research and Reviews for the Practicing Oncologist
One process, two perspectives
Eight months into my fellowship, and my first patient is still alive. Starting a fellowship at a new institution has been similar to starting my residency, however with a slightly hardened exterior that an inner city internal medicine residency program provides. As with my first patient, it was also my first time in the cancer center when I met her—for me, as a clinician; for her, as a patient. She presented the way many lung cancer patients do; a pneumonia that wouldn’t go away. She thought it was just a cold, but her extensive smoking history, weight loss, and persistent symptoms indicated something much more sinister was lurking beneath the surface. Imaging suggested what she feared, and a biopsy proved it. She had metastatic lung adenocarcinoma. Her next few weeks were a crash course in oncology- PET/CT’s, chemotherapy, and enrollment in clinical trials and plowing through with their lengthy consent forms. We were going through the same process from different perspectives...
*For a PDF of the full article, click on the link to the left of this introduction.
Eight months into my fellowship, and my first patient is still alive. Starting a fellowship at a new institution has been similar to starting my residency, however with a slightly hardened exterior that an inner city internal medicine residency program provides. As with my first patient, it was also my first time in the cancer center when I met her—for me, as a clinician; for her, as a patient. She presented the way many lung cancer patients do; a pneumonia that wouldn’t go away. She thought it was just a cold, but her extensive smoking history, weight loss, and persistent symptoms indicated something much more sinister was lurking beneath the surface. Imaging suggested what she feared, and a biopsy proved it. She had metastatic lung adenocarcinoma. Her next few weeks were a crash course in oncology- PET/CT’s, chemotherapy, and enrollment in clinical trials and plowing through with their lengthy consent forms. We were going through the same process from different perspectives...
*For a PDF of the full article, click on the link to the left of this introduction.
Eight months into my fellowship, and my first patient is still alive. Starting a fellowship at a new institution has been similar to starting my residency, however with a slightly hardened exterior that an inner city internal medicine residency program provides. As with my first patient, it was also my first time in the cancer center when I met her—for me, as a clinician; for her, as a patient. She presented the way many lung cancer patients do; a pneumonia that wouldn’t go away. She thought it was just a cold, but her extensive smoking history, weight loss, and persistent symptoms indicated something much more sinister was lurking beneath the surface. Imaging suggested what she feared, and a biopsy proved it. She had metastatic lung adenocarcinoma. Her next few weeks were a crash course in oncology- PET/CT’s, chemotherapy, and enrollment in clinical trials and plowing through with their lengthy consent forms. We were going through the same process from different perspectives...
*For a PDF of the full article, click on the link to the left of this introduction.
Creating a community-based, patient-centered cancer survivorship program
A report from the Institute of Medicine in 20051 marked a watershed in the thinking about cancer patients and their long-term needs as survivors when it argued for oncology programs in the United States to address the unmet needs of cancer survivors at the community practice level. Cancer care in the United States has tended to focus on the more immediate aspects of the active treatment, limiting our long-term concerns for the patient’s well-being. Indeed, as a community oncologist in the early part of my career,2 decades ago, I considered cancer patients “finished” with their cancer and back to “normal” soon after their last acute toxicity ended.2 These days, our profession as well as patients and society as a whole have come to understand that the needs of cancer patients continue into well into survivorship, which can span years or even decades. These concerns should be addressed and accommodated through comprehensive, community-based survivorship programs.
*For a PDF of the full article, click on the link to the left of this introduction.
A report from the Institute of Medicine in 20051 marked a watershed in the thinking about cancer patients and their long-term needs as survivors when it argued for oncology programs in the United States to address the unmet needs of cancer survivors at the community practice level. Cancer care in the United States has tended to focus on the more immediate aspects of the active treatment, limiting our long-term concerns for the patient’s well-being. Indeed, as a community oncologist in the early part of my career,2 decades ago, I considered cancer patients “finished” with their cancer and back to “normal” soon after their last acute toxicity ended.2 These days, our profession as well as patients and society as a whole have come to understand that the needs of cancer patients continue into well into survivorship, which can span years or even decades. These concerns should be addressed and accommodated through comprehensive, community-based survivorship programs.
*For a PDF of the full article, click on the link to the left of this introduction.
A report from the Institute of Medicine in 20051 marked a watershed in the thinking about cancer patients and their long-term needs as survivors when it argued for oncology programs in the United States to address the unmet needs of cancer survivors at the community practice level. Cancer care in the United States has tended to focus on the more immediate aspects of the active treatment, limiting our long-term concerns for the patient’s well-being. Indeed, as a community oncologist in the early part of my career,2 decades ago, I considered cancer patients “finished” with their cancer and back to “normal” soon after their last acute toxicity ended.2 These days, our profession as well as patients and society as a whole have come to understand that the needs of cancer patients continue into well into survivorship, which can span years or even decades. These concerns should be addressed and accommodated through comprehensive, community-based survivorship programs.
*For a PDF of the full article, click on the link to the left of this introduction.
Erwinia asparaginase for acute lymphoblastic leukemia in children with hypersensitivity to E coli-derived asparaginase
With related Commentary
Erwinia chrysanthemi, an asparaginase derived from the bacterium E chrysanthemi, was recently approved by the Food and Drug Administration as a component of multiagent chemotherapy in patients with acute lymphoblastic leukemia (ALL) who have developed hypersensitivity to Escherichia coli (E coli)-derived asparaginase and pegaspargase.1 Hypersensitivity to E coli-derived asparaginase may occur in up to 30% of patients2 with ALL, a common childhood cancer. Leukemic cells are not able to synthesize the amino acid asparagine, which is required for protein metabolism and survival, because of a lack of asparagine synthetase activity. Erwinia-derived asparaginase reduces circulating levels of asparagine by catalyzing the deamidation of asparagine to aspartic acid and ammonia. The reduction of circulating asparagine results in cytotoxicity specific for leukemic cells by depriving them of their source of the amino acid.
*For PDFs of the full report and accompanying Commentary, click on the links to the left of this introduction.
With related Commentary
Erwinia chrysanthemi, an asparaginase derived from the bacterium E chrysanthemi, was recently approved by the Food and Drug Administration as a component of multiagent chemotherapy in patients with acute lymphoblastic leukemia (ALL) who have developed hypersensitivity to Escherichia coli (E coli)-derived asparaginase and pegaspargase.1 Hypersensitivity to E coli-derived asparaginase may occur in up to 30% of patients2 with ALL, a common childhood cancer. Leukemic cells are not able to synthesize the amino acid asparagine, which is required for protein metabolism and survival, because of a lack of asparagine synthetase activity. Erwinia-derived asparaginase reduces circulating levels of asparagine by catalyzing the deamidation of asparagine to aspartic acid and ammonia. The reduction of circulating asparagine results in cytotoxicity specific for leukemic cells by depriving them of their source of the amino acid.
*For PDFs of the full report and accompanying Commentary, click on the links to the left of this introduction.
With related Commentary
Erwinia chrysanthemi, an asparaginase derived from the bacterium E chrysanthemi, was recently approved by the Food and Drug Administration as a component of multiagent chemotherapy in patients with acute lymphoblastic leukemia (ALL) who have developed hypersensitivity to Escherichia coli (E coli)-derived asparaginase and pegaspargase.1 Hypersensitivity to E coli-derived asparaginase may occur in up to 30% of patients2 with ALL, a common childhood cancer. Leukemic cells are not able to synthesize the amino acid asparagine, which is required for protein metabolism and survival, because of a lack of asparagine synthetase activity. Erwinia-derived asparaginase reduces circulating levels of asparagine by catalyzing the deamidation of asparagine to aspartic acid and ammonia. The reduction of circulating asparagine results in cytotoxicity specific for leukemic cells by depriving them of their source of the amino acid.
*For PDFs of the full report and accompanying Commentary, click on the links to the left of this introduction.
AIP: PEER VIEWPOINT: The Toxicity of Chemotherapy and Radiotherapy on the Central Nervous System
The Toxicity of Chemotherapy and Radiotherapy on the Central Nervous System
- Available online 26 April 2012.
- http://dx.doi.org/10.1016/j.suponc.2012.04.001,
Central neurotoxicity of chemotherapy and radiotherapy is so frequent that every clinician should recognize and treat this complication, preferably with a neurologist experienced in these cases. Unfortunately, in most neurology and oncology training programs in the United States, there is very little exposure to the central neurotoxicity of anticancer drugs and other modalities. Yet, the importance of the topic is high and will always be.
One of the main forces driving the knowledge behind this area began at the Memorial Sloan-Kettering Cancer Center with Posner [1] and [2] and in Europe with Hildebrand. [3] Others have understood that the effective management of CNS toxicity is as important as the treatment of brain tumors in neuro-oncology and are now making efforts in spreading the message: we must learn to recognize, treat, or prevent the neurotoxicity of anticancer therapies. In the past 10 years, there have been reviews on neurological complications; [4] and [5] and yet there is still little interest, and research is a low priority.
In this issue of The Journal of Supportive Oncology, Rinne and collaborators present a welcome update on this often neglected aspect of neuro-oncology. They present a complex problem in an easy flow of ideas, beginning with the neurotoxicity of radiotherapy, then including the contribution of chemotherapy and novel therapies targeted to CNS morbidity. This review is thorough, up to date, and one of the few published by a nonneurological journal. Enjoy.1
References2
- J.B. Posner. Neurological complications of systemic cancer. Med Clin North Am. 1979;63(4):783–800.
- R.A. Patchell, J.B. Posner. Neurologic complications of systemic cancer. Neurol Clin. 1985;3(4):729–750.
- J. Hildebrand. Neurological Complications of cancer chemotherapy. Curr Opin Oncol. 2006;18(4):321–324.
- C. Soussain, D. Ricard, J.R. Fike, J.J. Mazeron, D. Psimaras, J.Y. Delattre.
CNS complications of radiotherapy and chemotherapy. Lancet. 2009;374(9701):1639–1651.
Commentary on “Central Nervous System Complications of Cancer Therapy” by Rinne, Lee, and Wen (page ___)
Published Online:
- Corresponding Author: Ivo W. Tremont-Lukats, MD, Neuro-Oncology Department, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030
Conflict of Interest Disclosures: The author has completed and submitted the ICMJE for Disclosure of Potential Conflicts of Interest and none were reported.
PubMed ID in brackets
Vitae
Copyright © 2012 Published by Elsevier Inc.
The Toxicity of Chemotherapy and Radiotherapy on the Central Nervous System
- Available online 26 April 2012.
- http://dx.doi.org/10.1016/j.suponc.2012.04.001,
Central neurotoxicity of chemotherapy and radiotherapy is so frequent that every clinician should recognize and treat this complication, preferably with a neurologist experienced in these cases. Unfortunately, in most neurology and oncology training programs in the United States, there is very little exposure to the central neurotoxicity of anticancer drugs and other modalities. Yet, the importance of the topic is high and will always be.
One of the main forces driving the knowledge behind this area began at the Memorial Sloan-Kettering Cancer Center with Posner [1] and [2] and in Europe with Hildebrand. [3] Others have understood that the effective management of CNS toxicity is as important as the treatment of brain tumors in neuro-oncology and are now making efforts in spreading the message: we must learn to recognize, treat, or prevent the neurotoxicity of anticancer therapies. In the past 10 years, there have been reviews on neurological complications; [4] and [5] and yet there is still little interest, and research is a low priority.
In this issue of The Journal of Supportive Oncology, Rinne and collaborators present a welcome update on this often neglected aspect of neuro-oncology. They present a complex problem in an easy flow of ideas, beginning with the neurotoxicity of radiotherapy, then including the contribution of chemotherapy and novel therapies targeted to CNS morbidity. This review is thorough, up to date, and one of the few published by a nonneurological journal. Enjoy.1
References2
- J.B. Posner. Neurological complications of systemic cancer. Med Clin North Am. 1979;63(4):783–800.
- R.A. Patchell, J.B. Posner. Neurologic complications of systemic cancer. Neurol Clin. 1985;3(4):729–750.
- J. Hildebrand. Neurological Complications of cancer chemotherapy. Curr Opin Oncol. 2006;18(4):321–324.
- C. Soussain, D. Ricard, J.R. Fike, J.J. Mazeron, D. Psimaras, J.Y. Delattre.
CNS complications of radiotherapy and chemotherapy. Lancet. 2009;374(9701):1639–1651.
Commentary on “Central Nervous System Complications of Cancer Therapy” by Rinne, Lee, and Wen (page ___)
Published Online:
- Corresponding Author: Ivo W. Tremont-Lukats, MD, Neuro-Oncology Department, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030
Conflict of Interest Disclosures: The author has completed and submitted the ICMJE for Disclosure of Potential Conflicts of Interest and none were reported.
PubMed ID in brackets
Vitae
Copyright © 2012 Published by Elsevier Inc.
The Toxicity of Chemotherapy and Radiotherapy on the Central Nervous System
- Available online 26 April 2012.
- http://dx.doi.org/10.1016/j.suponc.2012.04.001,
Central neurotoxicity of chemotherapy and radiotherapy is so frequent that every clinician should recognize and treat this complication, preferably with a neurologist experienced in these cases. Unfortunately, in most neurology and oncology training programs in the United States, there is very little exposure to the central neurotoxicity of anticancer drugs and other modalities. Yet, the importance of the topic is high and will always be.
One of the main forces driving the knowledge behind this area began at the Memorial Sloan-Kettering Cancer Center with Posner [1] and [2] and in Europe with Hildebrand. [3] Others have understood that the effective management of CNS toxicity is as important as the treatment of brain tumors in neuro-oncology and are now making efforts in spreading the message: we must learn to recognize, treat, or prevent the neurotoxicity of anticancer therapies. In the past 10 years, there have been reviews on neurological complications; [4] and [5] and yet there is still little interest, and research is a low priority.
In this issue of The Journal of Supportive Oncology, Rinne and collaborators present a welcome update on this often neglected aspect of neuro-oncology. They present a complex problem in an easy flow of ideas, beginning with the neurotoxicity of radiotherapy, then including the contribution of chemotherapy and novel therapies targeted to CNS morbidity. This review is thorough, up to date, and one of the few published by a nonneurological journal. Enjoy.1
References2
- J.B. Posner. Neurological complications of systemic cancer. Med Clin North Am. 1979;63(4):783–800.
- R.A. Patchell, J.B. Posner. Neurologic complications of systemic cancer. Neurol Clin. 1985;3(4):729–750.
- J. Hildebrand. Neurological Complications of cancer chemotherapy. Curr Opin Oncol. 2006;18(4):321–324.
- C. Soussain, D. Ricard, J.R. Fike, J.J. Mazeron, D. Psimaras, J.Y. Delattre.
CNS complications of radiotherapy and chemotherapy. Lancet. 2009;374(9701):1639–1651.
Commentary on “Central Nervous System Complications of Cancer Therapy” by Rinne, Lee, and Wen (page ___)
Published Online:
- Corresponding Author: Ivo W. Tremont-Lukats, MD, Neuro-Oncology Department, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030
Conflict of Interest Disclosures: The author has completed and submitted the ICMJE for Disclosure of Potential Conflicts of Interest and none were reported.
PubMed ID in brackets
Vitae
Copyright © 2012 Published by Elsevier Inc.
Community Oncology Podcast - Aflibercept plus FOLFIRI for metastatic colorectal cancer
Join Editor-in-Chief Dr. David Henry for an audio discussion of the April issue, featuring aflibercept plus FOLFIRI for metastatic colorectal cancer, original research on depression and quality of life during chemotherapy, and the FDA's biosimilars guidelines.
Join Editor-in-Chief Dr. David Henry for an audio discussion of the April issue, featuring aflibercept plus FOLFIRI for metastatic colorectal cancer, original research on depression and quality of life during chemotherapy, and the FDA's biosimilars guidelines.
Join Editor-in-Chief Dr. David Henry for an audio discussion of the April issue, featuring aflibercept plus FOLFIRI for metastatic colorectal cancer, original research on depression and quality of life during chemotherapy, and the FDA's biosimilars guidelines.
Aflibercept plus FOLFIRI improves survival in second-line treatment of metastatic colorectal cancer
Aflibercept is a recombinant human fusion protein that acts as a decoy receptor to prevent vascular endothelial growth factor (VEGF)-A, VEGF-B, and placental growth factor (PlGF) from interacting with their native receptors, thereby inhibiting angiogenesis (Figure 1). Currently, the humanized monoclonal antibody bevacizumab, which binds to VEGF-A, is the only agent targeting the VEGF pathway that is approved for use in colorectal cancer (CRC). It is used in combination with FOLFOX (5- fluorouracil, leucovorin, and oxaliplatin) or FOLFIRI (5-fluorouracil, leucovorin, and irinotecan). Findings from the recent multinational phase III EFC10262-VELOUR trial have shown that aflibercept is effective in prolonging survival when it is used in combination with FOLFIRI in the second-line treatment of metastatic CRC (mCRC).1
*For a PDF of the full article and accompanying Commentary, click on the links to the left of this introduction.
Aflibercept is a recombinant human fusion protein that acts as a decoy receptor to prevent vascular endothelial growth factor (VEGF)-A, VEGF-B, and placental growth factor (PlGF) from interacting with their native receptors, thereby inhibiting angiogenesis (Figure 1). Currently, the humanized monoclonal antibody bevacizumab, which binds to VEGF-A, is the only agent targeting the VEGF pathway that is approved for use in colorectal cancer (CRC). It is used in combination with FOLFOX (5- fluorouracil, leucovorin, and oxaliplatin) or FOLFIRI (5-fluorouracil, leucovorin, and irinotecan). Findings from the recent multinational phase III EFC10262-VELOUR trial have shown that aflibercept is effective in prolonging survival when it is used in combination with FOLFIRI in the second-line treatment of metastatic CRC (mCRC).1
*For a PDF of the full article and accompanying Commentary, click on the links to the left of this introduction.
Aflibercept is a recombinant human fusion protein that acts as a decoy receptor to prevent vascular endothelial growth factor (VEGF)-A, VEGF-B, and placental growth factor (PlGF) from interacting with their native receptors, thereby inhibiting angiogenesis (Figure 1). Currently, the humanized monoclonal antibody bevacizumab, which binds to VEGF-A, is the only agent targeting the VEGF pathway that is approved for use in colorectal cancer (CRC). It is used in combination with FOLFOX (5- fluorouracil, leucovorin, and oxaliplatin) or FOLFIRI (5-fluorouracil, leucovorin, and irinotecan). Findings from the recent multinational phase III EFC10262-VELOUR trial have shown that aflibercept is effective in prolonging survival when it is used in combination with FOLFIRI in the second-line treatment of metastatic CRC (mCRC).1
*For a PDF of the full article and accompanying Commentary, click on the links to the left of this introduction.
Depression and Quality of Life in Cancer Patients Undergoing Chemotherapy: Relation between the Zung Self-Rating Depression Scale and Functional Assessment of Cancer Therapy-General
Objective: Although depression is prevalent among cancer patients, it remains underdiagnosed and undertreated. Quality of life is an important outcome in cancer patients and can be measured by questionnaires such as the Functional Assessment of Cancer Therapy-General version (FACT-G). The purpose of our study was to establish whether or not a group of items in FACT-G could be used as a screening tool for depression as well as for assessing quality of life.
Methods: A total of 62 chemotherapy patients (median age, 62 years [range, 22-81 years]; 55% women) completed Zung Self-Rating Depression Scale (ZSDS) and FACT-G questionnaires. Patients with ZSDS scores of 40 or more underwent clinical interviews for major depression. Pearson’s correlation was used to examine the relationship between the ZSDS and FACT-G scores. FACT-G score results were then analyzed to evaluate if subsets of the FACT-G can be used as a screening tool for major depression.
Results: In all, 30 of 62 patients (48%) had ZSDS scores less than 40 and were ruled out for major depression, and 30 of the 32 patients with ZSDS scores greater or equal to 40 participated in clinical interviews. Of those who were interviewed, 7 patients (23%) were confirmed to have major depression. Overall, the prevalence of major depression was 7 of 60 patients (12%; 95% CI: 5%-23%). The ZSDS and FACT-G scores had strong correlation (r -0.75). The composite score of six statements in FACT-G were found to have sensitivity of 100% and specificity of 81% in predicting major depression, using a cut-off value of 12 (range, 0-24). The six statements were, I have a lack of energy; I feel sad; I feel nervous; I am able to enjoy life; I am sleeping well; and I am enjoying the things I usually do for fun.
Conclusions: The prevalence of major depression among all participants was 12%. The ZSDS score and FACT-G score had strong correlation; the subsets of FACT-G may be useful as a screening tool for depression.
*For a PDF of the full article, click on the link to the left of this introduction.
Objective: Although depression is prevalent among cancer patients, it remains underdiagnosed and undertreated. Quality of life is an important outcome in cancer patients and can be measured by questionnaires such as the Functional Assessment of Cancer Therapy-General version (FACT-G). The purpose of our study was to establish whether or not a group of items in FACT-G could be used as a screening tool for depression as well as for assessing quality of life.
Methods: A total of 62 chemotherapy patients (median age, 62 years [range, 22-81 years]; 55% women) completed Zung Self-Rating Depression Scale (ZSDS) and FACT-G questionnaires. Patients with ZSDS scores of 40 or more underwent clinical interviews for major depression. Pearson’s correlation was used to examine the relationship between the ZSDS and FACT-G scores. FACT-G score results were then analyzed to evaluate if subsets of the FACT-G can be used as a screening tool for major depression.
Results: In all, 30 of 62 patients (48%) had ZSDS scores less than 40 and were ruled out for major depression, and 30 of the 32 patients with ZSDS scores greater or equal to 40 participated in clinical interviews. Of those who were interviewed, 7 patients (23%) were confirmed to have major depression. Overall, the prevalence of major depression was 7 of 60 patients (12%; 95% CI: 5%-23%). The ZSDS and FACT-G scores had strong correlation (r -0.75). The composite score of six statements in FACT-G were found to have sensitivity of 100% and specificity of 81% in predicting major depression, using a cut-off value of 12 (range, 0-24). The six statements were, I have a lack of energy; I feel sad; I feel nervous; I am able to enjoy life; I am sleeping well; and I am enjoying the things I usually do for fun.
Conclusions: The prevalence of major depression among all participants was 12%. The ZSDS score and FACT-G score had strong correlation; the subsets of FACT-G may be useful as a screening tool for depression.
*For a PDF of the full article, click on the link to the left of this introduction.
Objective: Although depression is prevalent among cancer patients, it remains underdiagnosed and undertreated. Quality of life is an important outcome in cancer patients and can be measured by questionnaires such as the Functional Assessment of Cancer Therapy-General version (FACT-G). The purpose of our study was to establish whether or not a group of items in FACT-G could be used as a screening tool for depression as well as for assessing quality of life.
Methods: A total of 62 chemotherapy patients (median age, 62 years [range, 22-81 years]; 55% women) completed Zung Self-Rating Depression Scale (ZSDS) and FACT-G questionnaires. Patients with ZSDS scores of 40 or more underwent clinical interviews for major depression. Pearson’s correlation was used to examine the relationship between the ZSDS and FACT-G scores. FACT-G score results were then analyzed to evaluate if subsets of the FACT-G can be used as a screening tool for major depression.
Results: In all, 30 of 62 patients (48%) had ZSDS scores less than 40 and were ruled out for major depression, and 30 of the 32 patients with ZSDS scores greater or equal to 40 participated in clinical interviews. Of those who were interviewed, 7 patients (23%) were confirmed to have major depression. Overall, the prevalence of major depression was 7 of 60 patients (12%; 95% CI: 5%-23%). The ZSDS and FACT-G scores had strong correlation (r -0.75). The composite score of six statements in FACT-G were found to have sensitivity of 100% and specificity of 81% in predicting major depression, using a cut-off value of 12 (range, 0-24). The six statements were, I have a lack of energy; I feel sad; I feel nervous; I am able to enjoy life; I am sleeping well; and I am enjoying the things I usually do for fun.
Conclusions: The prevalence of major depression among all participants was 12%. The ZSDS score and FACT-G score had strong correlation; the subsets of FACT-G may be useful as a screening tool for depression.
*For a PDF of the full article, click on the link to the left of this introduction.
A patient with non-small cell lung cancer presenting with headaches and change in mental status
A 79-year-old woman with a history of non-small cell carcinoma of the right lung, stage IIB (T3, N0, M0) was treated with definitive chemoradiation, with 6,480 cGy given to the right upper lobe and mediastinum with concomitant chemotherapy. On a follow-up visit 3 months later, PET-CT imaging showed remarkable improvement in her tumor response, with evidence of tumor regression on CT. The patient was in her normal state of health until 4 months later, when she began complaining of headaches and her son noted that she was disoriented, confused, mildly aphasic, and unstable.
*For a PDF of the full article, click on the link to the left of this introduction.
A 79-year-old woman with a history of non-small cell carcinoma of the right lung, stage IIB (T3, N0, M0) was treated with definitive chemoradiation, with 6,480 cGy given to the right upper lobe and mediastinum with concomitant chemotherapy. On a follow-up visit 3 months later, PET-CT imaging showed remarkable improvement in her tumor response, with evidence of tumor regression on CT. The patient was in her normal state of health until 4 months later, when she began complaining of headaches and her son noted that she was disoriented, confused, mildly aphasic, and unstable.
*For a PDF of the full article, click on the link to the left of this introduction.
A 79-year-old woman with a history of non-small cell carcinoma of the right lung, stage IIB (T3, N0, M0) was treated with definitive chemoradiation, with 6,480 cGy given to the right upper lobe and mediastinum with concomitant chemotherapy. On a follow-up visit 3 months later, PET-CT imaging showed remarkable improvement in her tumor response, with evidence of tumor regression on CT. The patient was in her normal state of health until 4 months later, when she began complaining of headaches and her son noted that she was disoriented, confused, mildly aphasic, and unstable.
*For a PDF of the full article, click on the link to the left of this introduction.
Community Oncology Podcast - Targeted therapies in multiple myeloma
Join community Oncology's Editor-in-Chief Dr. David Henry for an audio tour of the March issue, featuring Dr. Kenneth C. Anderson's review of targeted therapies in multiple myeloma, Dr. Stuart M. Lichtman's commentary on treating cancer in elderly patients, and Dr. Jame Abraham's Community Translation article on vemurafenib for melanoma with the BRAF V600E mutation.
Join community Oncology's Editor-in-Chief Dr. David Henry for an audio tour of the March issue, featuring Dr. Kenneth C. Anderson's review of targeted therapies in multiple myeloma, Dr. Stuart M. Lichtman's commentary on treating cancer in elderly patients, and Dr. Jame Abraham's Community Translation article on vemurafenib for melanoma with the BRAF V600E mutation.
Join community Oncology's Editor-in-Chief Dr. David Henry for an audio tour of the March issue, featuring Dr. Kenneth C. Anderson's review of targeted therapies in multiple myeloma, Dr. Stuart M. Lichtman's commentary on treating cancer in elderly patients, and Dr. Jame Abraham's Community Translation article on vemurafenib for melanoma with the BRAF V600E mutation.
Neoplastic Meningitis
Neoplastic Meningitis
- Received 26 May 2011. Accepted 2 June 2011. Available online 23 September 2011.
- http://dx.doi.org/10.1016/j.suponc.2011.06.002
Abstract
Neoplastic meningitis occurs in approximately 5%–10% of all patients with cancer, and aggressive supportive measures are a critical component of comprehensive care. A literature review of the current diagnostic methods, randomized controlled trials, and available treatments was undertaken; and a comprehensive discussion of best-practice supportive care measures is provided. Although the prognosis for those diagnosed with neoplastic meningitis is poor, treatment and supportive care may allow stabilization of neurologic symptoms and afford protection from further neurologic deterioration, allowing patients to maximize their function and independence and adjust their expectations of treatment from cure to palliation.
*For a PDF of the full article and accompanying viewpoints by Alexis Demopoulos and Matthias Holdhoff along with Stuart Grossman, click in the links to the left of this introduction.
Neoplastic Meningitis
- Received 26 May 2011. Accepted 2 June 2011. Available online 23 September 2011.
- http://dx.doi.org/10.1016/j.suponc.2011.06.002
Abstract
Neoplastic meningitis occurs in approximately 5%–10% of all patients with cancer, and aggressive supportive measures are a critical component of comprehensive care. A literature review of the current diagnostic methods, randomized controlled trials, and available treatments was undertaken; and a comprehensive discussion of best-practice supportive care measures is provided. Although the prognosis for those diagnosed with neoplastic meningitis is poor, treatment and supportive care may allow stabilization of neurologic symptoms and afford protection from further neurologic deterioration, allowing patients to maximize their function and independence and adjust their expectations of treatment from cure to palliation.
*For a PDF of the full article and accompanying viewpoints by Alexis Demopoulos and Matthias Holdhoff along with Stuart Grossman, click in the links to the left of this introduction.
Neoplastic Meningitis
- Received 26 May 2011. Accepted 2 June 2011. Available online 23 September 2011.
- http://dx.doi.org/10.1016/j.suponc.2011.06.002
Abstract
Neoplastic meningitis occurs in approximately 5%–10% of all patients with cancer, and aggressive supportive measures are a critical component of comprehensive care. A literature review of the current diagnostic methods, randomized controlled trials, and available treatments was undertaken; and a comprehensive discussion of best-practice supportive care measures is provided. Although the prognosis for those diagnosed with neoplastic meningitis is poor, treatment and supportive care may allow stabilization of neurologic symptoms and afford protection from further neurologic deterioration, allowing patients to maximize their function and independence and adjust their expectations of treatment from cure to palliation.
*For a PDF of the full article and accompanying viewpoints by Alexis Demopoulos and Matthias Holdhoff along with Stuart Grossman, click in the links to the left of this introduction.