Seminars in radiation oncology
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Older cancer patients-which make the majority of cancer patients-present with a highly heterogeneous health status. Therefore, a careful assessment of the individual's condition is important in the planning of their oncologic care. ⋯ Indeed, regular multidisciplinary meetings are key to optimal management of elderly patients, as they modify treatment plans in ¼ to ½ of patients. A practical way of implementing a multidisciplinary consultation is reviewed, and future directions are discussed.
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Approximately two-thirds of head and neck cancer (HNC) patients present with locoregionally advanced stage (III and IV) disease. This requires multimodality therapy, including surgery, radiation, and/or chemotherapy. Despite recent advances in treatments for HNC, the treatment paradigms in the elderly population have not been well defined. ⋯ The aim of this review is to highlight some of the pertinent issues in dealing with the increasing elderly HNC population, the increasing complexity and toxicities associated with combined modality treatments, and how comorbidity and age are considered during treatment selection decisions. The challenges being faced regarding potential interactions of older age and comorbidity, and their impact on prognosis and quality of life are reviewed, with a special emphasis on radiation therapy or combined modality therapy. Possible solutions to help delineate further areas of study addressing key questions in management of elderly HNC patients are discussed.
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Elective regional lymph nodal irradiation is controversial in patients with early stage breast cancer. Under the "Halstedian" model of tumor progression, elective nodal irradiation would be expected to provide some gain in both regional control and survival. ⋯ Similarly, in patients with a clinically negative axilla, the role of elective irradiation of the axilla and other nodal sites is also controversial. This article reviews data from trials that address the utility of elective regional nodal treatment, with regard to both tumor control (local control and survival) and morbidity.
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Gene expression profiling has led to the discovery of 4 distinct molecular subtypes of breast cancer: luminal A, luminal B, basal like, and HER2 enriched. Investigation of these subtypes in women with breast cancer has given insight into the heterogeneous biology and outcomes in patients with locally advanced disease. These subtypes have been found to be predictors for survival, response to systemic therapy, and locoregional recurrence. This review discusses the biology of locally advanced breast cancer and the available data on how molecular subtype may provide information regarding response to treatment and prognosis of women with locally advanced breast cancer.
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Glioblastoma, grade IV malignant glioma based on the World Health Organization classification, is the most common primary brain tumor in adults. The average survival time of less than 1 year has not improved notably over the last 3 decades. Surgery and radiotherapy, the traditional cornerstones of therapy, provide palliative benefit, whereas the value of chemotherapy has been marginal and controversial. ⋯ Monoclonal antibodies and low molecular-weight kinase inhibitors are the most common classes of agents in targeted cancer treatment. This review introduces these new targeted therapies in the context of current treatment options for patients with glioblastoma. It is hoped that this combined approach will overcome the current limitations in the treatment of patients with glioblastoma and result in a better prognosis for these patients.