Current opinion in oncology
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With the development of newer forms of technology such as low-dose spiral computed tomography, there has been a resurgent interest in screening for lung cancer. The purpose of this review is to highlight recent advances in screening for lung cancer. Articles published since September 2002 are reviewed here. ⋯ A high percentage of stage IA lung cancers were detected by screening with low-dose helical computed tomography. The characteristics of the nodules detected by low-dose spiral computed tomography have been clarified. There have been many controversial discussions about cost effectiveness and overdiagnosis. There is still no evidence that screening tests reduce the rate of cancer-specific mortality. Several studies of screening for lung cancer are under way.
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Renal cell carcinoma (RCC) continues to present a diagnostic and therapeutic challenge. The increased use of abdominal imaging studies does not appear to completely account for the rising incidence of RCC. ⋯ An alternative staging system shows promise, and two randomized clinical trials clarify the role of removing the primary tumor in the setting of metastatic RCC. New agents have shown promise in early clinical trials such as CCI-779, pegylated interferon, thalidomide, and anti-VEGF antibody.
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This paper covers the outcome of previously conducted clinical trials on chemotherapy for malignant pleural mesothelioma and presents data from recent phase II and phase III trials. In contrast to conventional cytotoxic drugs, which have barely produced response rates exceeding 30%, recently introduced chemotherapeutic agents and their combinations promise to be more effective. ⋯ Furthermore, raltitrexed-oxaliplatin has shown promising activity and gemcitabine was found to improve quality of life in patients with malignant pleural mesothelioma when applied as a single agent or in combination with cisplatin. Based on robust phase III study results, pemetrexed-cisplatin may soon be considered with chemotherapy for this aggressive disease.
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Retroperitoneal soft tissue sarcomas are rare tumors estimated to account for 15%of all patients with soft tissue sarcoma seen in referral populations. The standard of care for patients with localized, resectable retroperitoneal sarcomas is surgical resection with gross and microscopically negative margins. However, owing to the large size and locally advanced nature of these tumors, this goal is difficult to achieve in most patients. ⋯ Over the past decade, there has been considerable research into combined modality treatment of these tumors. The present report outlines current concepts relating to the diagnosis, staging, and management of retroperitoneal sarcomas. Emphasis is placed on evolving combined modality treatment approaches and current investigational strategies.
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The management of dyspnea is a challenge even for the most experienced palliative medicine teams. In the absence of effective treatment for the underlying disease, therapeutic options are limited to the supplementation of oxygen, the use of opioids, and multidisciplinary nonpharmacologic interventions. ⋯ Hopefully, this research will lead to improved therapy in the future. This article reviews current literature on dyspnea with a focus on publications in 2001.