What Is the Best Preoperative Imaging for Endometrial Cancer?

Although endometrial cancer is surgicopathologically staged, preoperative imaging is recommended for diagnostic work-up to tailor surgery and adjuvant treatment. For preoperative staging, imaging by transvaginal ultrasound (TVU) and/or magnetic resonance imaging (MRI) is valuable to assess local tumor extent, and positron emission tomography-CT (PET-CT) and/or computed tomography (CT) to assess lymph node metastases and distant spread. Preoperative imaging may identify deep myometrial invasion, cervical stromal involvement, pelvic and/or paraaortic lymph node metastases, and distant spread, however, with reported limitations in accuracies and reproducibility. Novel structural and functional imaging techniques offer visualization of microstructural and functional tumor characteristics, reportedly linked to clinical phenotype, thus with a potential for improving risk stratification. In this review, we summarize the reported staging performances of conventional and novel preoperative imaging methods and provide an overview of promising novel imaging methods relevant for endometrial cancer care.     

What is New in Supportive Care in Cancer?

The Annual Symposium of the Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO) was held in Vancouver, Canada,June 24-26, 2010. The symposium brought together health care professionals from many countries and many fields of expertise for an excellent forum of ideas, lectures and collegial interactions,and discussed methods to minimize cancer-induced side effects, the symptoms and complications of its treatment, and psychosocial issues facing cancer patients and their families. Some ideas and studies selected from the presentations of different fields of supportive care in cancer presented in this symposium are introduced in this paper.     

Newer Agents in Colon Cancer: What’s Next?

Colorectal cancer (CRC) was the third leading cause of cancer deaths in the United States in 2012, and most patients eventually develop metastatic disease. The use of cytotoxic chemotherapy, the antiangiogenesis drug bevacizumab, and the anti-EGFR monoclonal antibodies cetuximab and panitumumab have led to an improvement in median OS for metastatic CRC. Despite this improvement in survival, few agents have activity against CRC. Between 2006 and 2012, the FDA approved no new agents for patients with metastatic CRC (mCRC). Recently, the FDA has approved aflibercept and regorafenib for use in the treatment of patients with mCRC, and several new agents are currently in development. This paper reviews the use of new agents and new uses for established agents in mCRC.     

Pancreatic Neuroendocrine and Carcinoid Tumors: What’s New,What’s Old,and What’s Different?

Well-differentiated neuroendocrine tumors (NETs) can be subdivided into carcinoid and pancreatic NETs (panNETs). Recently, two therapies have been FDA approved for progressive well-differentiated pancreatic NETs but have not been submitted for use in carcinoid tumors (Yao, Shah, Ito, et al. N Engl J Med 364:514–23, 2011??; Raymond, Dahan, Raoul, et al. N Engl J Med 364:501–13, 2011??). The first is sunitinib (Sutent®, Pfizer, Inc.), an orally administered, multitargeted receptor kinase inhibitor. The second targeted agent is everolimus (Afinitor®, Novartis Pharmaceuticals), a mammalian target of rapamycin (mTOR) inhibitor (Yao, Shah, Ito, et al. N Engl J Med 364:514–23, 2011??). Both agents demonstrated improved progression-free survival but can also result in non-trivial toxicities and therefore, should only be considered in patients with progressing or symptomatic pancreatic NET. This review will discuss “new” NET therapies and provides an overview of liver directed and “older” cytotoxic treatment options. We also briefly outline “what’s different” by describing a recent genetics report identifying genetic mutations in panNETs. Such a discovery could potentially be used to stratify treatment and such studies are currently being investigated.     

What Are the Most Important New Targets in Breast Cancer?

Breast cancer is a remarkably heterogeneous disease. Data clearly demonstrate the presence of multiple molecular subtypes of breast cancer, and alterations in cell physiology shared by most tumors have been identified. These recent developments in our understanding of the molecular events involved in breast cancer have led to the identification of novel targets as well as anticancer therapies based on these targets. These therapies are referred to as targeted therapy in that the agent has a high specificity for molecules involved in molecular events responsible for the cancer phenotype. This review highlights some of the most promising future targets in breast cancer.     

New developments in immunotherapy for non-Hodgkin’s lymphoma

The clinical development of immunotherapy with rituximab (chimeric anti-CD20 monoclonal antibody) has markedly affected the treatment approach for patients with B-cell non-Hodgkin’s lymphoma (NHL). Rituximab was initially evaluated in relapsed indolent lymphoma and has substantial activity in this setting both alone and in combination with chemotherapy. Ongoing efforts in indolent NHL are seeking to optimize the dose and schedule of rituximab through ‘maintenance’ strategies exploring chemotherapyrituximab combinations and the use of other biologic agents or antibodies that may enhance activity when employed together with rituximab. Other studies in indolent NHL suggest that radiolabeled anti-CD20 antibodies (such as I-131 tositumomab and Y-90 ibritumomab tiuxetan) may be useful in relapsed and refractory disease and have potential utility as part of initial treatment as well. In diffuse large B-cell lymphoma, the addition of rituximab to CHOP chemotherapy can improve survival, though benefits are more limited in mantle cell lymphoma. Further studies of unlabeled and radiolabeled immunotherapies are ongoing in order to optimize their use for maximal clinical benefit.     

Target Volume Definition in Rectal Cancer: What Is the Best Imaging Modality?

All patients with rectal cancer should undergo an accurate preoperative staging, including local staging for tumour extension and reliable staging for synchronous distant metastases. Imaging is of utmost importance as a basis for selecting the optimal treatment strategies and as an aid for precise target delineation. Anatomical imaging such as computed tomography (CT) and magnetic resonance imaging (MRI) have been the most commonly used pretreatment staging modalities, whereas endorectal ultrasonography may be useful for staging of smaller tumours (T2 or lower). MRI is the most accurate imaging technique for staging of T3 and T4 tumours. The role of fluorodeoxyglucose positron emission tomography (PET)/CT is under investigation, and diffusion-weighted MRI seems promising for prediction of pathological complete response. For target delineation, planning CT, preferably contrast-enhanced, is the most used imaging technique. For locally advanced tumours, coregistration with MRI or PET/CT may prove to be useful. In this article, the literature published on target delineation in rectal cancer radiotherapy is evaluated, with focus on the best imaging modality for volume definition and radiotherapy planning.     

Markov’s Modeling for Screening Strategies for Colorectal Cancer

Economic decision models are being increasingly used to assess medical interventions. Advances in this fieldare mainly due to enhanced processing capacity of computers, availability of specific software to perform thenecessary tasks, and refined mathematical techniques. We here estimated the incremental cost-effectiveness often strategies for colon cancer screening, as well as no screening, incorporating quality of life, noncomplianceand data on the costs and profit of chemotherapy in Iran. We used a Markov model to measure the costs andquality-adjusted life expectancy of a 50-year-old average-risk Iranian without screening and with screening byeach test. In this paper, we tested the model with data from the Ministry of Health and published literature. Weconsidered costs from the perspective of a health insurance organization, with inflation to 2011, the Iranian Rialbeing converted into US dollars. We focused on three tests for the 10 strategies considered currently being usedfor population screening in some Iranians provinces (Kerman, Golestan Mazandaran, Ardabil, and Tehran):low-sensitivity guaiac fecal occult blood test, performed annually; fecal immunochemical test, performedannually; and colonoscopy, performed every 10 years. These strategies reduced the incidence of colorectalcancer by 39%, 60% and 76%, and mortality by 50%, 69% and 78%, respectively, compared with no screening.These approaches generated ICER (incremental cost-effectiveness ratios) of $9067, $654 and $8700 per QALY(quality-adjusted life year), respectively. Sensitivity analyses were conducted to assess the influence of variousscales on the economic evaluation of screening. The results were sensitive to probabilistic sensitivity analysis.Colonoscopy every ten years yielded the greatest net health value. Screening for colon cancer is economical andcost-effective over conventional levels of WTP8.     

What is Important for the Introduction of Cancer Screening in the Workplace?

Although cancer screening has been introduced into physical checkup programs in the workplace, it has not ‍been regulated by the Occupational Health and Safety Law in Japan. In addition, the target age groups and strategy ‍for cancer screening have not been defined. To aid in development of better screening programs, we investigated ‍primary factors considered for introducing cancer screening in workplaces. A mail survey targeted 441 facilities of ‍the Kanto Occupational Health Management Association in June 2002. We received ninety-one responses (20.6%), ‍including 59 facilities of manufacturing companies. The implementations of gastric and colorectal cancer screening ‍were higher than other cancer screenings, exceeding 90% in the responding facilities. Thirty years old or over was ‍the target age in most facilities. The facilities were divided into two groups, A and B, except for two examples whose ‍strategies for cancer screening were not well-documented in their response. There were 35 facilities in group A and ‍54 in group B. In group A, cancer screening was conducted using strategies for all of which effectiveness has been ‍established. On the other hand, in group B, cancer screening was conducted using strategies whose effectiveness ‍were at least partially unestablished. We chose five items to evaluate important factors for introducing a cancer ‍screening program into the workplace: prevalence, screening strategy, effectiveness, efficacy and needs of workers. ‍The most important was the same in both groups, effectiveness. However, there was a tendency for neglect of this ‍aspect in actual conducted plans. Appropriate cancer screening should be carefully coordinated in accordance with ‍the guidelines of the Task Force for Cancer Screening in Japan in the workplace. ‍