Review Articles in 2015

Locally advanced breast cancer (LABC) constitutes a heterogeneous entity that includes advanced-stage primary tumours, cancers with extensive nodal involvement and inflammatory breast carcinomas—inoperable cancers with an unfavourable prognosis. The optimal management of LABC requires a multidisciplinary approach consisting of a well-coordinated treatment schedule and close cooperation between medical, surgical and radiation oncologists. In this Review, the authors discuss the current state of the art and possible future treatment strategies for patients with LABC.

A number of breast lesions that are associated with an increased risk of breast cancer and/or represent true precursors of breast tumours are increasingly detected in population screening programmes. At present, the clinicopathological and molecular characteristics that defined the risk of breast cancer in women with these lesions are unknown; nevertheless, management strategies ranging from active surveillance to surgery with adjuvant radiotherapy and endocrine therapy can be planned based on the risk of breast cancer at the population level. Herein, the contemporary approaches to the diagnosis and management of high-risk breast lesions are comprehensively reviewed.

Substantial improvements in the outcomes of patients with multiple myeloma have created a need for more sensitive diagnostic tests for minimal residual disease (MRD) in this patient population. This Review describes and compares the validity of current clinically used tests for MRD, and highlights the significantly improved outcomes of patients who are known to be MRD negative. Possible opportunities and challenges to the clinical use and widespread implementation of highly sensitive MRD testing are discussed.

The routes and timing of metastatic dissemination during cancer progression remain shrouded in mystery. However, phylogenetic studies are beginning to shed new light on this process and various models have been proposed. In this Review, Kamila Naxerova and Rakesh Jain discuss the hypothesized trajectories of metastasis, and examine the extent to which the current phylogenetic evidence support these models. In addition, the experimental techniques of lineage tracing, their strengths and weaknesses, and future directions for studies using such methods are discussed.

The use of image-guided ablation techniques—including radiofrequency and microwave ablation, cryoablation, and irreversible electroporation—is increasing, predominantly in the treatment of small hepatic and renal tumours (<5 cm). This Review describes the technical considerations for the various ablation modalities. In addition, the authors review the evidence that supports the clinical application of these minimally invasive techniques for the treatment of liver and kidney cancers, and discuss their potential as the standard-of-care first-line treatment, particularly for small, early stage tumours.

The perioperative timeframe is pivotal in determining long-term cancer outcomes. This Review covers the various aspects of surgery which could facilitate the metastatic process. Through understanding these processes and reviewing empirical evidence, the authors provide suggestions for potential new perioperative interventions aimed at attenuating deleterious processes and improving treatment outcomes. The measures described in this Review could transform the perioperative timeframe from a prominent facilitator of metastatic progression, to a window of opportunity for arresting and/or eliminating residual disease.