Current Problems in Cancer RSS feed: Articles in Press. Each bimonthly issue of Current Problems in Cancer presents a single-topic, in-depth discussion, usually focused on the integrated management of a particular type of cancer or on a problem faced in a wide variety of malignancies. Issues may explore a particular category of drugs, an emerging interventional technique, or rehabilitation/reconstruction. Extensive bibliographies allow readers to easily locate additional information on related topics. Current Problems in Cancer serves the wide spectrum of physicians who treat patients with neoplastic disease. 2012 Topics , Volume 36 Multidisciplinary Management of Intracranial Ependymoma Michael D. Chan, Kevin P. McMullen Isolated Hepatic Perfusion David Bartlett, Amer Zureikat Small Cell Lung Cancer Benjamin Movsas Working with SEER Data: Opportunities and Cautions James Yu Management of the Axilla in Breast Cancer Elin Sigurdson Cancer of the Oropharynx Beth Beadle, Chris Holsinger http://www.cpcancer.com//inpress?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. Current Problems in Cancer0147-02722012-04-12 © 2012 Published by Elsevier Inc. healthpermissions@elsevier.comhttp://www.cpcancer.com/article/PIIS0147027212000396/abstract?rss=yesLung cancer remains the most common cause of cancer death in the United States. Small cell lung carcinoma (SCLC) compromises approximately 13% of lung cancer diagnoses, a decline from approximately 17% 2 decades ago. Nevertheless, it is estimated that >30,000 patients will be diagnosed with SCLC in 2011 with a similar incidence in men and women. About one-third of all patients with SCLC will be found to have disease limited to the chest and regional lymph nodes after routine staging evaluation. The impact of functional imaging on stage determination has not been well studied, but a median 13% rate of stage migration (9% upstaging and 4% downstaging) was reported in a recent overview of series looking at the impact of adding F-deoxyglucose positron emission tomography (FDG-PET) imaging to conventional imaging.Thoracic Radiotherapy for Limited Stage Small Cell Lung Carcinoma - Corrected ProofPaul D. Aridgides, Benjamin Movsas, Jeffrey A. Bogart10.1016/j.currproblcancer.2012.03.001Current Problems in Cancer (2012)2012-04-12Current Problems in Cancer2012-04-12http://www.cpcancer.com/article/PIIS0147027212000414/abstract?rss=yesThe body of literature investigating the rational for surgery as an integral part of the treatment of small cell lung cancer (SCLC) centers around one main question “Is there a benefit?” The supporting evidence in most studies is based on the stages of the disease. It is clear in the literature for extensive-stage disease that surgery does not provide a benefit to treatment. However, there is evidence that patients with a solitary pulmonary nodule (SPN) or limited-stage disease (T1-2, N0) may derive benefit from surgical resection as opposed to chemotherapy and radiation alone. According to the National Comprehensive Cancer Network (NCCN), the stage classification for SCLC consists of 2 stages: (1) Limited-stage disease: disease confined to the ipsilateral hemithorax, which can be safely encompassed within a tolerable radiation field. (2) Extensive-stage disease: disease beyond ipsilateral hemithorax, which may include malignant pleural or pericardial effusion or hematogenous metastases. T1-2, N0 disease is defined as T1-tumor 3 cm or less in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus. T2 – tumor >3 cm, but ≤7 cm or involves the main bronchus, 2 cm or more distal to the carina or invades the visceral pleura.Role of Surgery for Small Cell Lung Cancer - Corrected ProofVincent E. Lotano, Joe Friedberg10.1016/j.currproblcancer.2012.03.003Current Problems in Cancer (2012)2012-04-12Current Problems in Cancer2012-04-12http://www.cpcancer.com/article/PIIS0147027212000438/abstract?rss=yesThirty thousand patients are diagnosed with small cell lung cancer (SCLC) in the United States each year. Tobacco exposure is strongly associated with the development of this disease. SCLC has a unique natural history with a much shorter doubling time, higher growth fraction, and earlier development of widespread metastases than any of the non-small cell histologies. Although SCLC is characterized by a superior initial response rate to chemotherapy and radiation, even responsive disease is typically associated with relapse within months after treatment, with the rapid development of chemoresistance, leading to a dismal 5-year survival rate of 5%.Novel Therapeutic Approaches for Small Cell Lung Cancer: The Future has Arrived - Corrected ProofM. Catherine Pietanza, Charles M. Rudin10.1016/j.currproblcancer.2012.03.005Current Problems in Cancer (2012)2012-04-12Current Problems in Cancer2012-04-12http://www.cpcancer.com/article/PIIS0147027212000463/abstract?rss=yesThe study of rare cancers has been a particularly active area of investigation with Surveillance, Epidemiology, and End Results (SEER) Program data. Although the definition of a rare cancer can be described broadly as a cancer with a low incidence or prevalence, the study of rare cancers is not limited to obscure histologic types that are diagnosed infrequently. It can also include cancers that constitute a rare or difficult-to-study subtype of a more common cancer, such as T4N0 breast cancer. Alternately, rare cancers can be rare occurrences of relatively common histologic types occurring in uncommon locations, such as adenoid cystic carcinoma of the breast. Finally, rare occurrences of common cancers occurring in uncommon hosts, such as male breast cancer, also lend themselves to population-based study using SEER.Using the Surveillance, Epidemiology, and End Results Database to Investigate Rare Cancers, Second Malignancies, and Trends in Epidemiology, Treatment, and Outcomes - Corrected ProofShane Lloyd, Henry S. Park, Roy H. Decker, Lynn D. Wilson, James B. Yu10.1016/j.currproblcancer.2012.03.008Current Problems in Cancer (2012)2012-04-12Current Problems in Cancer2012-04-12REGULAR ARTICLEhttp://www.cpcancer.com/article/PIIS0147027212000402/abstract?rss=yesSmall cell lung cancer is a clinically aggressive entity, with a high propensity for spread to the central nervous system. Therapy for both local and systemic diseases has improved during the past several decades with progress in modern chemotherapy and radiation, leaving more patients at risk for development of brain metastases as survival improves. The use of whole brain radiation as a method of preventing brain metastases was introduced in the 1970s, with early recognition of the prevalence of brain metastases in patients with small cell lung cancer, as well as the lack of efficacy of systemic therapy in their prevention or treatment; the brain has long been identified as a “sanctuary” from the therapeutic effects of cytotoxic chemotherapy agents, and radiation has been an established treatment for known brain metastases. Thus, prophylactic cranial irradiation (PCI) has been in use in the setting of small cell lung cancer for >4 decades.Prophylactic Cranial Irradiation: Do Benefits Outweigh Neurocognitive Impact? - Corrected ProofJean Wright, Aaron Wolfson10.1016/j.currproblcancer.2012.03.002Current Problems in Cancer (2012)2012-04-05Current Problems in Cancer2012-04-05REGULAR ARTICLEhttp://www.cpcancer.com/article/PIIS0147027212000451/abstract?rss=yesThe Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI) is a widely used and comprehensive source of cancer incidence, staging, treatment, and survival information. The program pools data from 17 population-based tumor registries, encompassing a nonrandom sample of 28% of the US population and capturing nearly 100% of cancer cases (except nonmelanoma skin cancers) within each registry (). With up to 36 years of longitudinal and ongoing data collection, a large and representative sample size of more than 6 million cancer cases, and a comprehensive and well-respected quality assurance process, the SEER public-use database has served as an easily accessible and invaluable resource for clinical researchers investigating a wide variety of epidemiologic and clinical questions related to federally reportable malignant tumors, in situ tumors, and benign/borderline central nervous system tumors in patients of all ages.Overview of the Surveillance, Epidemiology, and End Results Database: Evolution, Data Variables, and Quality Assurance - Corrected ProofHenry S. Park, Shane Lloyd, Roy H. Decker, Lynn D. Wilson, James B. Yu10.1016/j.currproblcancer.2012.03.007Current Problems in Cancer (2012)2012-04-05Current Problems in Cancer2012-04-05http://www.cpcancer.com/article/PIIS0147027212000475/abstract?rss=yesMany clinical researchers have devised prognostic models using the demographic and clinicopathologic variables included in SEER. The large number of patients available from the SEER database endows robustness and external validity to such models. Likewise, a relatively high level of internal validity is achievable by controlling for the demographic and clinicopathologic factors.Prediction Models, Nomograms, and Staging Validation with the Surveillance, Epidemiology, and End Results Database - Corrected ProofShane Lloyd, Henry S. Park, Lynn D. Wilson, Roy H. Decker, James B. Yu10.1016/j.currproblcancer.2012.03.009Current Problems in Cancer (2012)2012-04-05Current Problems in Cancer2012-04-05http://www.cpcancer.com/article/PIIS0147027212000487/abstract?rss=yesThe Institute of Medicine has defined CER 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.” In essence, CER requires the comparison of 2 different treatments, with the end point being clinically significant. Additionally, CER should be applicable to the individual and the population as a whole—meaning that although the treatment is ultimately individualized, the implications for the country as a whole are important to understand.Comparative Effectiveness Research and the Surveillance, Epidemiology, and End Results Database - Corrected ProofJames B. Yu, Shane Lloyd, Roy H. Decker, Lynn D. Wilson, Henry S. Park10.1016/j.currproblcancer.2012.03.010Current Problems in Cancer (2012)2012-04-05Current Problems in Cancer2012-04-05http://www.cpcancer.com/article/PIIS0147027212000499/abstract?rss=yesAlthough the Surveillance, Epidemiology, and End Results (SEER) database is an extremely valuable tool for clinical cancer research, several limitations should be taken into account when interpreting results from a SEER observational study, especially when there is an attempt to generate hypotheses regarding adjuvant therapy. In this section, we will discuss several limitations specific to this database, including, but not limited to, unrecorded variables, underreported and incomplete data regarding adjuvant therapy, variations in data coding and reporting, and migration of patients in and out of SEER registry areas. In the following section, we will explore various forms of confounding and selection bias that may affect the validity of SEER studies specifically and observational studies in general, including immortal time bias in the evaluation of adjuvant therapy effectiveness.Limitations and Biases of the Surveillance, Epidemiology, and End Results Database - Corrected ProofHenry S. Park, Shane Lloyd, Roy H. Decker, Lynn D. Wilson, James B. Yu10.1016/j.currproblcancer.2012.03.011Current Problems in Cancer (2012)2012-04-05Current Problems in Cancer2012-04-05