Cancer control : journal of the Moffitt Cancer Center
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Lung cancer is the leading cause of cancer death in the United States. Results from the National Lung Screening Trial (NLST) have shown that low-dose computed tomography (CT) is capable of detecting lung neoplasms in individuals at high risk. However, whether it is advantageous to perform lung cancer screening on these patients is a significant concern, as are the potential adverse outcomes from screening. ⋯ Lung cancer screening is controversial, but the NLST has demonstrated that such testing may reduce lung cancer deaths in high-risk individuals when performed with low-dose CT rather than chest radiography. Guidelines should be established to not only help identify an appropriate screening population, but also develop standards for radiological testing.
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The previous 2 years have been an exciting time in melanoma research, due in part to the approval of vemurafenib and ipilimumab for advanced melanoma. Increased knowledge of the molecular biology leading to melanoma has led to the development of several new agents that target specific oncogenes. ⋯ A recognition of the genetic diversity of melanoma and a better understanding of the immune system have resulted in improvements in overall survival in patients with metastatic melanoma. Refractory cases remain challenging, and combination therapies are being explored in an effort to overcome resistance mechanisms. New molecular targets need to be identified to help the subset of patients who do not harbor BRAF mutations.
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Clinical evaluation of the axilla is an area of controversy in current breast cancer research and management. Evidence of axillary metastasis on biopsy affects all modalities of cancer therapeutics and is central to breast cancer staging. Neoadjuvant chemotherapy is standard therapy for patients with locally advanced breast cancer and considered for patients with early-stage breast cancer. ⋯ Axillary ultrasonography (with or without biopsy) and SLN biopsy are safe and feasible options for breast cancer staging and may facilitate treatment decisions for surgery, chemotherapy, and radiation therapy. Multidisciplinary review may also significantly influence treatment and timing of staging and therapy. An integrated approach to diagnosis and treatment is beneficial for both patients and providers.
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Review Randomized Controlled Trial
Evolution of axillary nodal staging in breast cancer: clinical implications of the ACOSOG Z0011 trial.
Management of the axilla in breast cancer patients has evolved from routine axillary lymph node dissection (ALND) for all patients to a highly selective approach based on the assessment of the sentinel lymph nodes (SLNs) as well as tumor and patient characteristics. Although ALND continues to have an important role in staging and regional control for many breast cancer patients, recent trial results question the need for routine ALND in patients who have positive SLNs. ⋯ Although the findings of ACOSOG Z0011 are impressive, in clinical practice they are applicable to a limited number of women with breast cancer: those with T1-2 primary tumors with clinically negative axilla and 1 to 2 positive SLNs undergoing breast-conserving surgery and adjuvant whole-breast irradiation. The next generation of clinical trials may answer some of the remaining questions regarding how best to manage the axilla in additional subsets of patients undergoing treatment of breast cancer.