Oncology Ny
-
The evaluation and treatment of osteosarcoma have evolved considerably over the past 2 decades, with corresponding dramatic improvements in prognosis. In large part, the improved outlook is attributable to intensive multiagent adjuvant chemotherapy, with better imaging modalities and reconstructive techniques also playing an important role. The current standard treatment for nonmetastatic osteosarcoma includes neoadjuvant chemotherapy, limb-sparing "wide" surgical resection, and reconstruction of the defect. ⋯ Limb salvage should be considered when an adequate surgical margin is attainable without significant neurovascular compromise and the surgical reconstruction is likely to provide better function than amputation. Because a good chemotherapeutic response is an important favorable prognosticator, much recent attention has been focused on predicting response preoperatively to allow closer surgical margins. Aggressive surgical treatment of pulmonary metastases has also been of measurable benefit.
-
The presence and number of breast cancer micrometastases in the bone marrow at the time of diagnosis or initial treatment appear to predict early distant relapse. Immunologic techniques to detect such bone micrometastases, in combination with traditional prognostic variables, such as axillary lymph node status and tumor diameter, may allow for the identification of patients at high risk of systemic disease, who may benefit from adjuvant systemic chemotherapy. Immunofluorescent and immunochemical monoclonal antibody techniques have similar sensitivity in the detection of cancer cells in bone marrow. Future research is needed to develop more specific monoclonal antibodies and to determine the characteristics of the primary tumor that correlate with bone marrow micrometastasis, as well as the characteristics of micrometastases that correlate with recurrence.
-
Postoperative treatment with adjuvant chemotherapy with or without radiation has been extensively studied in cancers of the gastrointestinal tract. Clinical trials of adjuvant postoperative chemotherapy in gastric cancer have failed to show a survival benefit, and although studies in pancreatic cancer suggest a benefit for postoperative concurrent chemoradiotherapy, confirmatory trials have not been performed. ⋯ Recent studies suggest that adjuvant therapy with fluorouracil plus leucovorin also improves disease-free survival; longer follow-up is needed to assess effects on overall survival. For Dukes' B2 and C rectal cancer, standard therapy is postoperative treatment with fluorouracil-based chemotherapy and concurrent pelvic radiotherapy.