Hematology/oncology clinics of North America
-
Hematol. Oncol. Clin. North Am. · Feb 2006
ReviewIntensity-modulated radiation therapy and image-guided radiation therapy: small clinic implementation.
In a small clinic with a small patient base, the implementation of IMRT/IGRT should be slow, measured, and meticulous. Most radiation oncologists in the United States have had no formal training in IMRT/IGRT because the modalities are so new. ⋯ The clinician in the small clinic can take comfort in remembering that the technologies are new, but the principles of good radiation medicine are not. With patient selection, a team approach, and publication of data and maturation of the literature, IMRT/IGRT will become the new standard of care in academic centers, large private clinics, and small clinics alike.
-
Sickle cell disease (SCD) is the most commonly inherited hemoglobinopathy in the United States. Blood transfusion is a critical part of the multidisciplinary approach necessary in the management of SCD; however, blood transfusions are not without complications. The successful use of transfusion as a treatment strategy in SCD requires the critical review and knowledge of transfusion methods, generally accepted indications, clinical situations in which transfusion generally is not considered, the selection of blood products, and strategies to prevent transfusion-related complications.
-
Hematol. Oncol. Clin. North Am. · Oct 2005
ReviewPulmonary hypertension in sickle cell disease: mechanisms, diagnosis, and management.
Pulmonary hypertension affects nearly one-third of adults with sickle cell disease and is related to hemolysis. Although pulmonary pressures are not as high as in other forms of pulmonary hypertension, sickle cell patients poorly tolerate even moderate elevations of pulmonary pressures, because this complication predicts short survival. ⋯ Because patients with pulmonary hypertension are older and often severely affected by other vaso-occlusive complications, optimizing their treatment with hydroxyurea or transfusions is important. Newer agents such as sildenafil and bosentan have demonstrated efficacy in other forms of pulmonary hypertension, and future clinical trials may prove them helpful in sickle cell patients.
-
Hematol. Oncol. Clin. North Am. · Jun 2005
ReviewEwing's sarcoma and primitive neuroectodermal family of tumors.
Ewing's sarcoma (ES) initially was believed to be of perivascular endothelial origin. The Ewing's sarcoma family of tumors (EFT) includes ES of bone (ESB), extraosseous ES (EES), peripheral primitive neuroectodermal tumor of bone (pPNET), and malignant small-cell tumor of the thoracopulmonary region, or Askin's tumor, all of which are now known to be neoplasms of neuroectodermal origin. The degree of neuronal differentiation has been used for histopathologic subclassification of the EFT as classical ES (ESB or EES), which is characterized by minimal evidence of neural differentiation, and pPNET, which displays evidence of neural differentiation by standard microscopy, electron microscopy, or immunohistochemistry. Because the behavior, prognosis, and treatment appear to be similar for all subsets of EFT, this histopathologic subclassification may not be clinically significant, though some debate remains whether neural differentiation predicts for inferior outcome.
-
Hematol. Oncol. Clin. North Am. · Feb 2004
ReviewRadiotherapy and chemotherapy in locally advanced non-small cell lung cancer: preclinical and early clinical data.
Over the past 20 years, combined treatment with radiotherapy and second-generation chemotherapy drugs was extensively studied in patients with locally advanced NSCLC and became the standard over radiotherapy alone in patients with good performance status. Radiosensitizing properties of cisplatin have been identified in the laboratory. Close temporal administration of cisplatin and radiation is mandatory for enhanced antitumor efficacy, but results in significant toxicity to normal tissues. ⋯ The respective benefits of either induction or consolidation full-dose chemotherapy with these drugs, before or after concurrent chemoradiotherapy with second- or third-generation chemotherapy, are presently being evaluated in phase III studies. As a result of improved survival and enhanced local control, most of these studies show a significant increase in the incidence of brain metastases. Because the brain is often the first site of relapse after concurrent chemoradiotherapy with or without surgery, the issue of prophylactic cranial irradiation is currently being addressed in a phase III trial.