Volume 6 Issue 4, April 2009

The findings from a multicenter, screening trial of CT colonography for the detection of large adenomas demonstrated the benefit of this noninvasive technique for assessing patients with an average risk of colorectal cancer.

Patients with a immunohistochemically defined, germinal-center tumor subtype have an improved outcome compared with patients with the non-germinal-center phenotype when treated with CHOP only, according to a prospective study. The benefit was not observed in those treated with the rituximab combination therapy.

Comparison of circulating tumor cell numbers before and after treatment is predictive for overall survival in patients with metastatic castration-resistant prostate cancer; this comparison is more helpful than prostate-specific antigen detection, according to a recent study.

Zoledronic acid is effective in the prevention of bone loss in premenopausal women with breast cancer being treated with endocrine therapy. The benefit of zoledronic acid probably extends for some years after cessation of therapy.

Transurethral resection of the bladder and adjuvant chemoradiation can permit eradication of the tumor and micrometastases. Close monitoring by sequential cystoscopy and biopsy can achieve similar survival outcomes to radical cystectomy, and could avoid invasive treatment.

Substantial progress has been made in radical cystectomy in the past 25 years, and development of orthotopic lower urinary tract reconstruction has been an important step in the continued progress of urinary diversion. The orthotopic neobladder should be considered the gold standard with which other forms of diversion are compared.

The use of MRI for the management of prostate cancer is controversial; however, technological advances in the past few years indicate that this diagnostic approach should be utilized. The authors propose MRI could improve risk stratification not only for those diagnosed with prostate cancer but in men prior to a biopsy. They explain how MRI evaluation could help select those men who require intervention and avoid biopsy and unnecessary treatment in others.

For patients with metastatic colorectal cancer, various treatment options exist; however, all are associated with adverse events. Although the majority of these adverse events are minor, some adverse effects might be severe. This Review describes the toxic effects reported in key clinical trials of biologic and cytotoxic agents. The author discusses the strategies that can be implemented to manage toxicity and to minimize treatment interruption or discontinuation, and enhance quality of life.

Targeted therapies such as tyrosine kinase inhibitors (TKI) have been shown to induce hypothyroidism and thyroid dysfunction. The management of thyroid dysfunction and possible related symptoms, such as fatigue, represents a challenge to oncologists. The authors review the available data of TKI-related thyroid dysfunction and propose a diagnostic and therapeutic algorithm for the management of TKI-related hypothyroidism.

Most brain tumors secrete high levels of vascular endothelial growth factor, which can lead to an abnormally permeable tumor vasculature. This hyperpermeability causes vasogenic cerebral edema and increased interstitial fluid pressure, which can prevent adequate penetration of chemotherapy agents to the tumor. This Review focuses on the pathophysiology of vasogenic edema and the potential utility of agents that target angiogenesis, and particularly the vascular endothelial growth factor pathway.

Resistance to chemotherapy remains one of the major challenges in the treatment of patients with multiple myeloma. Chim et al. report the case of a 59-year-old woman with multiple myeloma, who progressed after treatment with conventional chemotherapeutic agents. Addition of bortezomib to her treatment regimen resulted in complete regression of her disease. The authors suggest that bortezomib can restore chemosensitivity of myeloma cells in heavily pretreated, chemorefractory patients with multiple myeloma.