Current oncology reports
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Current oncology reports · Jul 2003
ReviewTreatment options for brain metastases in patients with non-small-cell lung cancer.
Brain metastases are a common complication for patients with non-small-cell lung cancer and a significant cause of morbidity and mortality. In the past, treatment of brain metastases and lung cancer focused on symptom palliation with whole-brain radiotherapy (WBRT) and steroids because of the grim outlook for patients. However, recent advances in technology and surgical techniques have created more options for the management of brain metastases, which include surgery, irradiation, stereotactic radiosurgery, and chemotherapy. ⋯ For patients with multiple metastases, WBRT is recommended. For patients with oligometastatic disease and those with multiple metastases, recent evidence indicates that systemically effective chemotherapy may produce responses and can be instituted safely before radiotherapy. The treatment timing of chemotherapy and radiotherapy should be individualized.
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Low-dose CT screening for lung cancer is a complex and controversial topic. This article reviews the history of lung cancer screening trials and addresses the principles and confounding biases associated with screening. Chest radiography was initially used for lung cancer screening in the 1970s. ⋯ Results from prevalence studies and a few single-arm incidence studies have raised concerns about overdiagnosis and the high rate of nodule detection. Follow-up studies and further investigation are needed. To this end, a randomized, controlled trial sponsored by the National Cancer Institute is underway to evaluate disease-specific mortality.
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The alarming rise in the incidence of esophageal adenocarcinomas in the Western world has focused interest on so-called Barrett's esophagus. Barrett's esophagus is characterized by specialized intestinal epithelium replacing the normal squamous epithelium in the distal esophagus and is considered a consequence of long-lasting and severe gastroesophageal reflux disease. A metaplasia-dysplasia-carcinoma sequence links Barrett's esophagus with adenocarcinoma of the distal esophagus (Barrett's cancer). ⋯ Based on current data, the malignant progression of Barrett's esophagus cannot be substantially prevented by medical or surgical therapy for reflux. Although no firm data are available to show that surveillance strategies can reduce overall mortality from Barrett's cancer, early detection and cure are possible. Management of Barrett's esophagus and carcinoma is reviewed with reference to the sequence of disease from metaplasia to carcinoma.
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Current oncology reports · Nov 2002
ReviewGastrointestinal stromal tumors: rationale for surgical adjuvant trials with imatinib.
Gastrointestinal stromal tumors (GISTs) constitute the majority of mesenchymal tumors involving the gastrointestinal tract. Over the past decade, it has been recognized that these tumors have distinctive immunohistochemical and genetic features. ⋯ Promising preclinical results have provided the driving force for the rapid clinical development of imatinib mesylate, a selective tyrosine kinase inhibitor of c-Kit. This novel molecularly targeted therapy has produced impressive clinical responses in a large proportion of patients with advanced GISTs and is under study as an adjuvant therapy in patients with localized resectable GISTs.
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Current oncology reports · Nov 2002
ReviewGastrointestinal stromal tumors: chemotherapy and imatinib.
Gastrointestinal stromal tumors (GISTs), previously thought to arise from the smooth muscles of the gastrointestinal tract, have recently been identified as a separate clinicopathologic entity. This new entity was revealed when investigations using more refined techniques suggested that GISTs had neural rather than smooth muscle differentiation and expressed the cell surface receptor Kit (CD117). Ensuing research led to development of a new molecularly targeted therapy, imatinib mesylate, which showed significant response among GIST patients in initial clinical trials. This review describes treatment of GIST before and after imatinib and the significance of this accomplishment.