Surgical oncology clinics of North America
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Although melanoma is generally considered a relative radioresistant tumor, radiation therapy (RT) remains a valid and effective treatment option in definitive, adjuvant, and palliative settings. Definitive RT is generally only used in inoperable patients. ⋯ RT is highly effective in providing symptom palliation for metastatic melanoma. RT combined with new systemic options, such as immunotherapy, holds promise and is being actively evaluated.
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Immunotherapy is now recognized as a viable option for patients with metastatic melanoma. The field of immunotherapy now offers treatments with the potential for a long-term cure. As the field moves forward, studies will focus on improving the response rates with new immunotherapy agents or novel treatment combinations.
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Neuroimaging plays a crucial role in diagnosis of brain tumors and in the decision-making process for therapy. Functional imaging techniques can reflect cellular density (diffusion imaging), capillary density (perfusion techniques), and tissue biochemistry (magnetic resonance [MR] spectroscopy). ⋯ Familiarity with conventional and advanced imaging findings facilitates accurate diagnosis, differentiation from other processes, and optimal patient treatment. This article is a practical synopsis of pathologic, clinical, and imaging spectra of most common brain tumors.
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Computed tomography (CT) is the primary imaging modality for the diagnosis, staging, and follow-up of most thoracic cavity tumors. Fluorine-18 fluorodeoxyglucose positron emission tomography/CT has established itself as a supplementary tool to CT in lung cancer staging and in the assessment for distant metastases of many thoracic tumors. Magnetic resonance imaging is an important adjunctive imaging modality in thoracic oncologic imaging and is used as a problem-solving tool to assess for chest wall invasion, intraspinal extension, and cardiac/vascular invasion. Imaging can facilitate minimally invasive biopsy of most thoracic tumors and is vital in the pretreatment planning of radiation therapy.
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The laparoscopic approach for benign and malignant lesions in the tail of the pancreas is becoming a more widely used approach. Multiple prospective studies have shown the feasibility and safety of laparoscopic distal pancreatectomy in single-center and multi-center settings. ⋯ Pancreatic fistula remains a common complication in the laparoscopic approach. Distal pancreatic aggressive tumors may not be appropriate for the laparoscopic approach due to the lack of oncologic safety studies.