The Clinical Utility of Biomarkers in the Management of Pancreatic Adenocarcinoma
Pancreatic cancer is the fourth leading cause of cancer-related deaths in the United States and survival rates have seen minimal improvement over the past few decades. Although results are poor, surgical resection is considered the only curative therapeutic intervention for pancreatic cancer, thereby emphasizing the significance of effective diagnostic and prognostic tools to improve outcomes. As such, biomarkers play a promising role in the development of personalized treatments for patients with pancreatic cancer. Prognostic biomarkers, such as serum carbohydrate antigen 19-9 in particular, as well as cancer stem cell ma...
Source: Seminars in Radiation Oncology - March 13, 2014 Category: Cancer & Oncology Authors: Khalid A. Jazieh, Michael B. Foote, Luis A. Diaz Source Type: research
Pancreaticobiliary Malignancies: Past, Present, and Future
Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less.—Marie Curie This issue of Seminars in Radiation Oncology is dedicated to providing oncologists with an updated review of the roles and controversies surrounding radiation therapy in duodenal, ampullary, gall bladder, bile duct, and pancreatic cancers. Multidisciplinary management of pancreaticobiliary malignancies is needed to decrease treatment-related toxicity and improve quality of life. Paired with innovations in diagnostic imaging, surgical techniques, systemic drug delivery, symptom manageme...
Source: Seminars in Radiation Oncology - March 13, 2014 Category: Cancer & Oncology Authors: Joseph M. Herman Source Type: research
Comparative Effectiveness Research in Practice and Policy for Radiation Oncology
Interest in comparative effectiveness research (CER) has increased dramatically over the past decade, yet perceptions about what comprises CER varies. CER has several attributes relevant to practice and policy: (1) The goal of CER is to inform decisions about health care. (2) Literature synthesis is used in addition to primary research. (3) CER evaluates not only overall outcomes for the population but also evaluates subgroups that may have heterogeneous outcomes. (4) Research places an emphasis on outcomes in the “real-world” settings. (5) Outcomes studied should be relevant to patients. In radiation oncology, where m...
Source: Seminars in Radiation Oncology - December 5, 2013 Category: Cancer & Oncology Authors: William F. Lawrence Source Type: research
Comparative Effectiveness Research: Moving Medical Oncology Forward
Comparative effectiveness research (CER) is critically needed in medical oncology to improve the care being delivered to oncology patients. As medical oncologists are forced to rely on insufficient data as a part of daily treatment decision making, and as the cancer treatment landscape evolves quickly relative to other areas of medicine, CER is particularly pressing in our field. Continued reliance on randomized clinical trials is a part of the solution, but it cannot be the sole answer. As new and richer data sources become available addressing quality of life, resource utilization, and other critical elements, the implem...
Source: Seminars in Radiation Oncology - December 5, 2013 Category: Cancer & Oncology Authors: Bradford R. Hirsch, S. Yousuf Zafar Source Type: research
Comparative Effectiveness Research: Opportunities in Surgical Oncology
Comparative effectiveness research (CER) is especially applicable to surgical oncology because of the numerous challenges associated with conducting surgical randomized controlled trials, and the opportunity to apply various CER methodologies to answer surgical questions. In this article, several past randomized trials or attempted trials are described to demonstrate challenges related to feasibility, patient selection and generalizability, and timeliness trial results to inform clinical practice. Thus, there is a gap between these “efficacy” studies (ie, randomized trials) and “effectiveness” research, which is pe...
Source: Seminars in Radiation Oncology - December 5, 2013 Category: Cancer & Oncology Authors: Heather B. Neuman, Caprice C. Greenberg Source Type: research
Comparative Effectiveness Research in Radiation Oncology: Stereotactic Radiosurgery, Hypofractionation, and Brachytherapy
Radiation oncology encompasses a diverse spectrum of treatment modalities, including stereotactic radiosurgery, hypofractionated radiotherapy, and brachytherapy. Though all these modalities generally aim to do the same thing—treat cancer with therapeutic doses of radiation while relatively sparing normal tissue from excessive toxicity, the general radiobiology and physics underlying each modality are distinct enough that their equivalence is not a given. Given the continued innovation in radiation oncology, the comparative effectiveness of these modalities is important to review. Given the broad scope of radiation oncolo...
Source: Seminars in Radiation Oncology - December 5, 2013 Category: Cancer & Oncology Authors: Sanjay Aneja, James B. Yu Source Type: research
Comparative Effectiveness Research in Radiation Oncology: Assessing Technology
This article outlines the elements of effective technology assessment, identifies key challenges to comparative effectiveness studies of new radiation oncology technologies, and reviews several examples of comparative effectiveness studies in radiation oncology, including studies on conformal radiation, IMRT, proton therapy, and other concurrent new technologies. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - December 5, 2013 Category: Cancer & Oncology Authors: Aileen B. Chen Source Type: research
Decision Analysis and Cost-Effectiveness Analysis for Comparative Effectiveness Research—A Primer
Although the analysis of real-world data is the foundation of comparative effectiveness analysis, not all clinical questions are easily approached with patient-derived information. Decision analysis is a set of modeling and analytic tools that simulate treatment and disease processes, including the incorporation of patient preferences, thus generating optimal treatment strategies for varying patient, disease, and treatment conditions. Although decision analysis is informed by evidence-derived outcomes, its ability to test treatment strategies under different conditions that are realistic but not necessarily reported in the...
Source: Seminars in Radiation Oncology - December 5, 2013 Category: Cancer & Oncology Authors: David J. Sher, Rinaa S. Punglia Source Type: research
An Overview of Methods for Comparative Effectiveness Research
Comparative effectiveness research (CER) is a broad category of outcomes research encompassing many different methods employed by researchers and clinicians from numerous disciplines. The goal of cancer-focused CER is to generate new knowledge to assist cancer stakeholders in making informed decisions that will improve health care and outcomes of both individuals and populations. There are numerous CER methods that may be used to examine specific questions, including randomized controlled trials, observational studies, systematic literature reviews, and decision sciences modeling. Each has its strengths and weaknesses. To ...
Source: Seminars in Radiation Oncology - December 5, 2013 Category: Cancer & Oncology Authors: Anne-Marie Meyer, Stephanie B. Wheeler, Morris Weinberger, Ronald C. Chen, William R. Carpenter Source Type: research
Comparative Effectiveness Research in Oncology: The Promise, Challenges, and Opportunities
In this report, CER was defined as the “generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat and monitor a clinical condition, or to improve the delivery of care. The purpose of CER is to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels.” (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - December 5, 2013 Category: Cancer & Oncology Authors: Ronald C. Chen Source Type: research
Understanding the Tumor Microenvironment and Radioresistance by Combining Functional Imaging With Global Gene Expression
The objective of this review is to present an argument for performing joint analyses between functional imaging with global gene expression studies. The reason for making this link is that tumor microenvironmental influences on functional imaging can be uncovered. Such knowledge can lead to (1) more informed decisions regarding how to use functional imaging to guide therapy and (2) discovery of new therapeutic targets. As such, this approach could lead to identification of patients who need aggressive treatment tailored toward the phenotype of their tumor vs those who could be spared treatment that carries risk for more no...
Source: Seminars in Radiation Oncology - September 20, 2013 Category: Cancer & Oncology Authors: Mark W. Dewhirst, Jen-Tsan Chi Source Type: research
Cell Death–Stimulated Cell Proliferation: A Tissue Regeneration Mechanism Usurped by Tumors During Radiotherapy
The death of all the cancer cells in a tumor is the ultimate goal of cancer therapy. Therefore, much of the current effort in cancer research is focused on activating cellular machinery that facilitates cell death such as factors involved in causing apoptosis. However, recently, a number of studies point to some counterintuitive roles for apoptotic caspases in radiation therapy as well as in tissue regeneration. It appears that a major function of apoptotic caspases is to facilitate tissue regeneration and tumor cell repopulation during cancer therapy. Because tumor cell repopulation has been shown to be important for loca...
Source: Seminars in Radiation Oncology - September 20, 2013 Category: Cancer & Oncology Authors: Mary A. Zimmerman, Qian Huang, Fang Li, Xinjiang Liu, Chuan-Yuan Li Source Type: research
Inhibiting Vasculogenesis After Radiation: A New Paradigm to Improve Local Control by Radiotherapy
Tumors are supported by blood vessels, and it has long been debated whether their response to irradiation is affected by radiation damage to the vasculature. We have shown in preclinical models that, indeed, radiation is damaging to the tumor vasculature and strongly inhibits tumor angiogenesis. However, the vasculature can recover by colonization from circulating cells, primarily proangiogenenic CD11b+ monocytes or macrophages from the bone marrow. This secondary pathway of blood vessel formation, known as vasculogenesis, thus acts to restore the tumor vasculature and allows the tumor to recur following radiation. The sti...
Source: Seminars in Radiation Oncology - September 20, 2013 Category: Cancer & Oncology Authors: Brown J. Martin Source Type: research
Radiation as an Immune Modulator
Radiation therapy is currently one of the most widely utilized treatment strategies in the clinical management of cancer. Classically, radiation therapy was developed as an anticancer treatment on the basis of its capacity to induce DNA double strand breaks in exposed cancer cells, ultimately resulting in tumor cell death. Recently, our understanding of radiation effects has expanded widely in terms of the consequences of radiation-induced tumor cell death and the pertinent cells, signaling pathways, and molecular sensors that modify the tumor response to radiation. It is now well accepted that inflammation plays a complex...
Source: Seminars in Radiation Oncology - September 20, 2013 Category: Cancer & Oncology Authors: Byron Burnette, Ralph R. Weichselbaum Source Type: research
Optimization of Tumor Radiotherapy With Modulators of Cell Metabolism: Toward Clinical Applications
Most solid tumors are characterized by unstable perfusion patterns, creating regions of hypoxia that are detrimental to radiotherapy treatment response. Because postsurgical radiotherapy, alone or in combination with other interventions, is a first-line treatment for many malignancies, strategies aimed at homogeneously increasing tumor pO2 have been the focus of intense research over the past decades. Among other approaches of demonstrable clinical and preclinical utility, this review focuses on those directly targeting oxygen consumption to redirect oxygen from a metabolic fate to the stabilization of radiation-induced DN...
Source: Seminars in Radiation Oncology - September 20, 2013 Category: Cancer & Oncology Authors: Pierre Danhier, Christophe J. De Saedeleer, Oussama Karroum, Géraldine De Preter, Paolo E. Porporato, Bénédicte F. Jordan, Bernard Gallez, Pierre Sonveaux Source Type: research
