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Microscopic deposits of tumor cells in regional lymph nodes can be detected using immunohistochemical techniques in patients without conventional histopathological evidence of lymph-node involvement. In the case of bile duct cancer, these micrometastases have an intermediate prognostic significance between that of positive and negative conventional pathology.
Rituximab has become the mainstay of systemic therapy for patients with follicular lymphoma and is associated with an improved outcome at both diagnosis and relapse, either as induction or maintenance therapy. The challenge lies in maximizing the benefit of this drug in a condition characterized by multiple relapses.
Survival of patients with high-risk early-stage breast cancer has been improved by chemotherapy administration at shorter dose intervals: 'dose-dense' therapy. Validation for this approach is provided by the AGO trial, which demonstrated the biggest survival advantage of any study of dose-dense chemotherapy to date.
The optimal chemotherapy regimen to be used concurrently with thoracic radiation for locally advanced non-small-cell lung cancer remains uncertain. Studies investigating this question are ongoing.
Incorporating hematopoietic growth factors into chemotherapy regimens is a common method for mitigating toxicity of dose-intensive regimens. A clinical trial has shown that G-CSF can counteract acute toxicities, permitting further dose intensification of induction chemotherapy. However, the effects of these strategies on long-term toxicities and overall survival remain undefined.
There has been a growing interest in focal treatment for prostate cancer, although this remains a controversial area. Criticism of focal prostate therapy has been based on the fact that prostate cancer is a multifocal disease. The authors of this Review discuss the clinical and biological implications of multifocal prostate cancer in the context of focal therapy patient selection and treatment planning.
One of the seven ongoing trials of accelerated partial breast irradiation (APBI) has concluded that single-dose intraoperative radiotherapy should be considered as an alternative to protracted whole-breast irradiation. With a median follow up of 2 years, such conclusions seem premature. Until the risk and pattern of breast recurrence is reported at longer follow up, TARGIT APBI should remain an experimental approach.
BRCAmutation carriers have an increased risk of developing breast cancer. Modern technology has made it possible to move genetic screening into the mainstream setting, which is important asBRCA status can influence treatment decisions. The authors of this Review discuss the assessment of familial cancer risk and the criteria for targeting BRCAmutation testing in women with breast cancer. They also examine how this genetic knowledge impacts on optimal patient management.
MicroRNAs (MiRNAs) can act as oncogenes or tumor-suppressor genes and have differential expression in tumor progression and metastasis. MiRNAs are involved in a number of pathways that contribute to metastasis, including migration, invasion, cell proliferation, epithelial-to-mesenchymal transition, angiogenesis and apoptosis. This Review provides a summary of the existing data documenting these functions and describes the clinical utility of miRNAs as prognostic and predictive biomarkers and their potential therapeutic applications in advanced cancer.