2012 EDUCATIONAL BOOK - American Society of Clinical Oncology

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GASTRIC CANCER LYMPHADENECTOMY AND OUTCOMES nated effort is required between the surgeon and pathologist if more extensive LADs are to result in improved staging of patients. In Japan and South Korea, following the en bloc dissection of the stomach and nodes, surgeons generally dissect out the individual nodal stations from the surgical specimen, allowing the pathologist to examine and report the number of positive and negative nodes for each nodal station. Thus more extensive LAD must be combined with more rigorous pathologic analysis to optimize the node staging of GC. There is some evidence that more extensive LADs result in lower rates of locoregional recurrence. Locoregional recurrence after potentially curative surgery for gastric adenocarcinoma can be quite high. In a 1982 series from the University of Minnesota, 107 patients with gastric adenocarcinoma underwent second-look laparotomy, and 80% had recurrence. 24 Of these recurrences, 88% were locoregional, 54% were peritoneal, and 29% were distant. More recently in the U.S. Intergroup 0116 trial, 177 of 275 patients (64%) in the surgery-only group developed recurrent disease. 9 In terms of the site of first relapse, 29% had local recurrence, 72% had regional recurrence, and only 18% had distant recurrence. Rates of locoregional recurrence are generally lower in reports from both Western and Eastern institutions that perform more extensive LADs. In a series of 367 patients with recurrent gastric adenocarcinoma from Memorial Sloan-Kettering Cancer Center over 15 years, 81% of patients had a D2 or greater LAD, and the median number of nodes removed was 22. 15 Of patients in whom disease recurred, locoregional recurrence was the initial and only site of recurrence in 26% of patients and was a component of initial recurrence in 54% of patients. Yoo and colleagues examined 508 patients in whom recurrent disease developed after curative gastrectomy at Yonsei University in South Korea. Nineteen percent of patients had locoregional recurrence only as the first site of recurrence, and 32.5% of patients had locoregional recurrence combined with peritoneal or distant recurrence as the initial site of recurrent disease. In the Japanese prospective randomized trial of adjuvant S-1 chemotherapy, 188 (35.5%) of 530 patients treated with surgery suffered a recurrence. 25 The site of first recurrence in these 188 patients was local in 7.9% and in nodes in 24.5%. The effect of more extensive LADs on OS for GC is still controversial. Two large, prospective randomized trials in Western countries have failed to identify a survival advantage for D2 over D1 LAD. 26,27 However, these two trials had fairly high morbidity (43% to 46%) and mortality rates (10% to 13%) for D2 LAD. In these trials, the distal pancreas and spleen were often resected during dissection of station 10 and 11 nodes, which likely increased morbidity. Of note in the Dutch trial, if patients with in-hospital mortality are excluded, patients with N2 disease had a survival advantage when treated with a D2 LAD. 28 Several studies have now demonstrated that D2 LADs can be performed without the need for distal pancreatectomy 29 or splenectomy. 30,31 Furthermore, a recent randomized trial in Taiwan demonstrated an OS advantage of more extensive LAD over D1 LAD, with the overall 5-year survival rate being 59.5% compared with 53.6%, respectively (p � 0.041). 32 However, the applicability of this trial to Western patients has been called into question. 33 The long-term follow-up of the Dutch trial was recently reported. 34 After a median follow-up of 15 years, D2 LAD was associated with lower locoregional recurrence and gastric cancer–related death rates (37% vs. 48%) than D1 LAD. Degiuli and colleagues in Italy have demonstrated that Western surgeons, following extensive training, can perform D2 LADs on Western patients with low morbidity and almost no mortality, 35,36 and survival results from a prospective randomized trial of D1 compared with D2 LAD from this group are pending. 37 Can Western Surgeons Perform More Extensive LADs Safely? Italian GC Study Group approached the issue of Western surgeons performing more extensive LADs in Western patients in a series of two prospective clinical trials. 35,36 Following extensive training of 16 surgeons in D2 LAD, a phase II trial of D2 LAD was instituted in which all surgeries were performed by the two attending surgeons. Of the 191 patients enrolled in the study, 106 patients (55%) were ultimately found to be ineligible, usually as a result of more extensive disease. The mean number of nodes removed was 39 (range: 22 to 93). Overall postoperative morbidity and mortality were impressively low at 20.9% and 3.1%, respectively. Subsequent to this study, the surgeons from the five highest-volume centers performed a randomized trial of D1 compared with D2 LAD. 37 Of 267 randomly selected patients, total morbidity and mortality was 12.0% and 3.0%, respectively, in the D1 group and 17.9% and 2.2%, respectively, in the D2 group. Survival results are pending. The experience of the Italian GC Study Group clearly demonstrates that following a period of fairly rigorous training, Western surgeons can perform D2 LADs on Western patients with morbidity and mortality results similar to that of high-volume centers in Korea and Japan. Several tertiary referral centers in Western countries routinely perform D2 LADs for GC, 15 but as noted earlier, LADs for GC in Western countries are limited and often do not even reach the D1 LAD threshold. There are several reasons why more extensive LADs are not more commonly performed. First and foremost is the lack of a proven benefit in OS of D2 over D1 LAD based on the Dutch and U.K. trials. Unfortunately, many Western surgeons have interpreted the results of these trials to mean any LAD does not improve OS. Certainly some patients with node-positive disease are cured by surgical resection alone, and these patients would undoubtedly not have been cured if diseased nodes were left undissected without additional therapy. Another important obstacle to the performance of more extensive LADs is the relative paucity of gastric adenocarcinomas seen at any given institution. In order for more extensive LADs to benefit GC patients, they must be performed without excess morbidity and mortality, and this can only be achieved with adequate surgical training and adequate case volume. Contributing to the lack of high-volume centers for GC surgery is a potential reluctance of general surgeons to refer GC patients to tertiary referral centers given that gastric surgery has been historically the realm of the general surgeon. 38 Finally, there are geographical and language barriers between different countries that make dissemination of information and techniques on the surgical treatment of GC difficult. 253
Conclusion There are clear differences in the extent of LAD performed between Eastern and Western countries. D2 LAD is the standard LAD performed in Japan and South Korea for all resectable tumors except for T1 tumors. Significantly less extensive LADs are generally performed in the United States. How does this difference in extent of LAD affect GC patient outcomes? There is no doubt that less extensive LADs result in understaging of patients. 17 Many U.S. medical oncologists and radiation oncologists already factor this understaging into their medical decision making. For any patient in the SEER database who is stage IB or greater, the 5-year OS rate is 58% or less and adjuvant therapy is likely warranted. However, a patient treated at MSKCC who is stage IB has an 85% 5-year OS and may not warrant adjuvant therapy. Our analysis of the SEER database found wide variations in survival of each AJCC stage based on subgroup analysis, with more than half of patients being Authors’ Disclosures of Potential Conflicts of Interest Author Benjamin Schmidt* Sam S. Yoon* *No relevant relationships to disclose. Employment or Leadership Positions Consultant or Advisory Role 1. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011;61:69-90. 2. Lee J, Demissie K, Lu SE, et al. Cancer incidence among Korean- American immigrants in the United States and native Koreans in South Korea. Cancer Control. 2007;14:78-85. 3. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62:10-29. 4. Japanese Research Society for Gastric Cancer. The general rules for the gastric cancer study in surgery. Jpn J Surg. 1973;3:61. 5. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113-123. 6. Park DJ, Lee HJ, Kim HH, et al. Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg. 2005;92:1099-1102. 7. Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128-1137. 8. Smith DL, Elting LS, Learn PA, et al. Factors influencing the volumeoutcome relationship in gastrectomies: a population-based study. Ann Surg Oncol. 2007;14:1846-1852. 9. Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001;345:725-730. 10. Smith JK, McPhee JT, Hill JS, et al. National outcomes after gastric resection for neoplasm. Arch Surg. 2007;142:387-393. 11. Marcus SG, Cohen D, Lin K, et al. Complications of gastrectomy following CPT-11-based neoadjuvant chemotherapy for gastric cancer. J Gastrointest Surg. 2003;7:1015-1022. 12. Gotoda T, Yanagisawa A, Sasako M, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000;3:219-225. 13. Yoon SS, Yang HK. Lymphadenectomy for gastric adenocarcinoma: should west meet east? Oncologist. 2009;14:871-882. 14. Wang J, Dang P, Raut CP, et al. Comparison of a lymph node ratio-based staging system with the 7th AJCC System for Gastric Cancer: analysis of 18,043 patients from the SEER database. Ann Surg. In press. 15. D’Angelica M, Gonen M, Brennan MF, et al. Patterns of initial recurrence in completely resected gastric adenocarcinoma. Ann Surg. 2004;240: 808-816. 16. Karpeh MS, Leon L, Klimstra D, et al. Lymph node staging in gastric cancer: is location more important than number? An analysis of 1,038 patients. Ann Surg. 2000;232:362-371. 17. Bunt AM, Hermans J, Smit VT, et al. Surgical/pathologic-stage migra- 254 misclassified. 14 Thus there are inherent problems with inaccurately staged patients. Less extensive LADs also likely result in increased locoregional recurrence, making the decisions between adjuvant chemotherapy versus chemoradiation more difficult. GC patients are often limited in the extent of neoadjvuant and adjuvant treatment that can be delivered, and one must often choose between multiagent chemotherapy regimens versus 5-fluorouracil or capecitabine-based chemoradiation. In terms of OS, the effects of more extensive LAD are difficult to discern. The Dutch and U.K. trials of D1 compared with D2 LAD demonstrated that when D2 LAD is performed with excess morbidity and mortality, there is no survival benefit compared to D1 LAD. If D2 LAD is performed with low morbidity and mortality, there also may be a benefit in OS, at least in Chinese patients, 32 but this potential benefit needs to be demonstrated by future prospective, randomized trials of Western patients. Stock Ownership Honoraria REFERENCES Research Funding Expert Testimony SCHMIDT AND YOON Other Remuneration tion confounds comparisons of gastric cancer survival rates between Japan and Western countries. J Clin Oncol. 1995;13:19-25. 18. Verdecchia A, Mariotto A, Gatta G, et al. Comparison of stomach cancer incidence and survival in four continents. Eur J Cancer. 2003;39:1603-1609. 19. Strong VE, Song KY, Park CH, et al. Comparison of gastric cancer survival following R0 resection in the United States and Korea using an internationally validated nomogram. Ann Surg. 2010;251:640-646. 20. American Joint Committee on Cancer. AJCC Cancer Staging Manual. 7th edition. New York: Springer; 2010. 21. Bouvier AM, Haas O, Piard F, et al. How many nodes must be examined to accurately stage gastric carcinomas? Results from a population based study. Cancer. 2002;94:2862-2866. 22. Smith DD, Schwarz RR, Schwarz RE. Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database. J Clin Oncol. 2005;23:7114-7124. 23. Estes NC, Macdonald JS, Touijer K, et al. Inadequate documentation and resection for gastric cancer in the United States: a preliminary report. Am Surg. 1998;64:680-685. 24. Gunderson LL, Sosin H. Adenocarcinoma of the stomach: areas of failure in a re-operation series (second or symptomatic look) clinicopathologic correlation and implications for adjuvant therapy. Int J Radiat Oncol Biol Phys. 1982;8:1-11. 25. Sakuramoto S, Sasako M, Yamaguchi T, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007; 357:1810-1820. 26. Cuschieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet. 1996;347:995-999. 27. Bonenkamp JJ, Songun I, Hermans J, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995;345:745-748, 1995. 28. Jansen EP, Boot H, Verheij M, et al. Optimal locoregional treatment in gastric cancer. J Clin Oncol. 2005;23:4509-4517. 29. Maruyama K, Sasako M, Kinoshita T, et al. Pancreas-preserving total gastrectomy for proximal gastric cancer. World J Surg. 1995;19:532-536. 30. Uyama I, Ogiwara H, Takahara T, et al. Spleen- and pancreaspreserving total gastrectomy with superextended lymphadenectomy including dissection of the para-aortic lymph nodes for gastric cancer. J Surg Oncol. 1996;63:268-270.
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AMERICAN SOCIETY OF CLINICAL ONCOLO
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American Society of Clinical Oncolo
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American Society of Clinical Oncolo
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New Looks and Challenges for Cooper
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Genitourinary Cancer Best Use of Im
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Research and Standard of Care: Lung
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Practice Management and Information
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2012 ASCO Annual Meeting Disclosure
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Matti S. Aapro, MD Clinique De Geno
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Hedy Lee Kindler, MD The University
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Douglas E. Wood, MD University of W
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Mary Lou Smith, JD, MBA Research Ad
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ASCO and Conquer Cancer Foundation
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Letter from the Editor The theme of
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Adjuvant Therapy for Older Women wi
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TREATMENT FOR OLDER WOMEN WITH BREA
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MANAGEMENT OF T1 BREAST CANCERS the
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MANAGEMENT OF T1 BREAST CANCERS Tab
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MANAGEMENT OF T1 BREAST CANCERS Tab
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MANAGEMENT OF T1 BREAST CANCERS 93.
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MANAGEMENT OF T1 BREAST CANCERS 1 c
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ADJUVANT ENDOCRINE THERAPY reductio
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ADJUVANT ENDOCRINE THERAPY which ra
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ADJUVANT ENDOCRINE THERAPY assay is
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A DICKENS TALE OF THE TREATMENT OF
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TREATMENT OF ADVANCED BREAST CANCER
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A FRESH LOOK AT DUCTAL CARCINOMA IN
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DCIS: OPPORTUNITIES AND UNCHARTED W
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DCIS: OPPORTUNITIES AND UNCHARTED W
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Ductal Carcinoma In Situ, and the I
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DCIS AND INFLUENCE OF RISK FACTORS
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KEY QUESTIONS IN THE LOCO-REGIONAL
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POSTMASTECTOMY RADIATION AND PARTIA
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The Appropriate Extent of Surgery f
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SURGERY FOR EARLY-STAGE BREAST CANC
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BIOLOGY AND LOCAL THERAPY DECISIONS
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Clinical and Imaging Surveillance F
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SURVEILLANCE FOLLOWING BREAST CANCE
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SURVEILLANCE FOLLOWING BREAST CANCE
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Advanced Imaging Techniques for the
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IMAGING TECHNIQUES FOR BREAST CANCE
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IMAGING TECHNIQUES FOR BREAST CANCE
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Update of the Oxford Overview: New
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UPDATE OF THE OXFORD OVERVIEW Fig.
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UPDATE OF THE OXFORD OVERVIEW Overv
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Gene Patents and Personalized Medic
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GENE PATENTS AND EFFECTS ON PERSONA
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Chemoprevention for Breast Cancer:
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CHEMOPREVENTION FOR BREAST CANCER T
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CHEMOPREVENTION FOR BREAST CANCER C
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CONTROVERSIES IN PROSTATE CANCER: P
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PROSTATE CANCER RISK REDUCTION men
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PROSTATE CANCER RISK REDUCTION Auth
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PSA SCREENING: HARMS WITHOUT CLEAR
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PSA SCREENING: HARMS WITHOUT CLEAR
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GLIOBLASTOMA: TAKING THE STANDARD O
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GLIOBLASTOMA: BIOLOGY, GENETICS AND
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FUTURE DIRECTIONS IN GBM THERAPY pr
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FUTURE DIRECTIONS IN GBM THERAPY Ch
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ESTABLISHING TREATMENTS FOR GLIOBLA
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Current Concepts in Brain Tumor Ima
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CONCEPTS IN BRAIN TUMOR IMAGING tum
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CONCEPTS IN BRAIN TUMOR IMAGING Aut
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PERSPECTIVES ON HEADLINE-MAKING NEW
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TTF THERAPY IN GLIOBLASTOMA Fig. 1.
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TTF THERAPY IN GLIOBLASTOMA istics.
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TTF THERAPY IN GLIOBLASTOMA because
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Limitations of Adaptive Clinical Tr
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LIMITATIONS OF ADAPTIVE CLINICAL TR
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LIMITATIONS OF ADAPTIVE CLINICAL TR
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Capturing the Patient Perspective:
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PATIENT-REPORTED OUTCOMES AS TRIAL
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PATIENT-REPORTED OUTCOMES AS TRIAL
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NEW LOOKS AND CHALLENGES FOR COOPER
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NCI NATIONAL CLINICAL TRIALS NETWOR
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Successful Integration of Cooperati
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COG: GIVING NEW MEANING TO COOPERAT
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A Critical Review of the Enrollment
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BLACK PATIENTS AND CANCER CLINICAL
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BLACK PATIENTS AND CANCER CLINICAL
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Trastuzumab Emtansine (T-DM1): Hitc
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T-DM1 AND THERAPEUTIC ANTIBODIES ag
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TARGETING CD30 IN HODGKIN LYMPHOMA
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TARGETING CD30 IN HODGKIN LYMPHOMA
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EARLY DRUG DEVELOPMENT: CASTING A W
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Table 1. Response Rates in Expanded
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Drug Development in the Era of Pers
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that the core pathway is not comple
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This situation is not surprising, g
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Practical Management of Immune-Rela
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the anterior pituitary axis is invo
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TARGETING CRITICAL MOLECULAR ABERRA
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Abl suppression; and 3) the early e
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50% 50% 100% Change in Tumor Size m
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vanced solid tumors, even if they a
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Targeting Molecular Aberrations in
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date. With the advent of gene expre
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consortium to facilitate the testin
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ETHICAL CHALLENGES OF HEALTH CARE R
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HEALTH CARE REFORM AND ONCOLOGY dev
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HEALTH CARE REFORM AND ONCOLOGY aut
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INTERNATIONAL VARIATION IN UNDERSTA
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midcareer physician; in one cross-s
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Table 1. Recommendations for Person
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stances (e.g., stage of career, fam
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elationship” is also acknowledged
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Conclusion In more individualistic
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The Oncologist’s Duty to Provide
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an external observer, but to the pe
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MEDICAL ERRORS IN CANCER CARE: PREV
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DISCLOSING MEDICAL ERRORS Disclosur
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DISCLOSING MEDICAL ERRORS Author’
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PREVENTING MEDICAL ERRORS more diff
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“PERSONALIZED” ONCOLOGY FOR COL
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0.001), progression-free survival (
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mately 40% of patients with colorec
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Table 1. Tumor Marker Utility Gradi
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treatment (tx) for metastatic color
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Prognostic Factors in Advanced RCC
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cell immunotherapy in which a small
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New Developments in Urothelial Canc
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Novel Approaches in Advanced Urothe
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10. Albers P, Park SI, Niegisch G,
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700 at a dose of 400 mg twice daily
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therapy for nonmetastatic prostate
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ADJUVANT THERAPY FOR OLDER PATIENTS
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Adjuvant Systemic Therapy Adjuvant
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with early-stage breast cancer were
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clinical trials to generate additio
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Adjuvant Treatment of Older Patient
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OLDER PATIENTS WITH LUNG CANCER Fig
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OLDER PATIENTS WITH LUNG CANCER adj
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Considerations and Controversies in
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OLDER PATIENTS WITH ADVANCED CANCER
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RECENT CLINICAL HIGHLIGHTS IN GYNEC
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GLOBAL ADVANCES IN GYNECOLOGIC ONCO
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GLOBAL ADVANCES IN GYNECOLOGIC ONCO
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The European Society of Gynaecologi
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ESGO EDUCATIONAL AND RESEARCH ACTIV
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UPFRONT TREATMENT OF OVARIAN CANCER
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ANTIANGIOGENICS AND PARP INHIBITORS
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ANTIANGIOGENICS AND PARP INHIBITORS
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Intraperitoneal Treatment in Ovaria
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INTRAPERITONEAL TREATMENT IN OVARIA
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Dose-Dense Chemotherapy and Neoadju
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CHEMOTHERAPY FOR OVARIAN CANCER Fig
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CHEMOTHERAPY FOR OVARIAN CANCER whi
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UTERINE SARCOMA: CHALLENGING CASES
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HISTOLOGIC FEATURES AND MANAGEMENT
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SURGICAL OPTIONS FOR UTERINE SARCOM
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SURGICAL OPTIONS FOR UTERINE SARCOM
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PATIENTS WITH HPV-POSITIVE OROPHARY
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HPV-INDUCED OROPHARYNX CANCER analy
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HPV-INDUCED OROPHARYNX CANCER fract
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Important Early Advances in Squamou
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EARLY ADVANCES IN SCCHN Fig 1. Targ
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Application of Genomic and Proteomi
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GENOMIC AND PROTEOMIC TECHNOLOGIES
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GENOMIC AND PROTEOMIC TECHNOLOGIES
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TREATMENT OF THYROID CANCERS: NEW I
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EVALUATION OF ADVANCED THYROID CANC
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EVALUATION OF ADVANCED THYROID CANC
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Systemic Therapeutic Approaches to
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APPROACHES TO ADVANCED THYROID CANC
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AVOIDING OVERDIAGNOSIS AND OVERTREA
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Table 1. Prevalence of Prostate Can
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Table 3. Potential Risks and Benefi
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Overdiagnosis and Overtreatment of
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een reached by other modeling effor
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east cancer community have FDA-appr
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COSTS OF CANCER CARE: AFFORDABILITY
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REDUCING THE COST OF CANCER CARE Fi
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REDUCING THE COST OF CANCER CARE Th
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REDUCING THE COST OF CANCER CARE de
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Why Hasn’t Genomic Testing Change
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tigators should develop prospective
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MANAGEMENT OF CHRONIC LYMPHOCYTIC L
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PREDICTIVE PARAMETERS IN CLL Table
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PREDICTIVE PARAMETERS IN CLL patien
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Transplant in Chronic Lymphocytic L
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WHEN TO OFFER TRANSPLANTATION IN CL
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WHEN TO OFFER TRANSPLANTATION IN CL
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NEW DEVELOPMENTS IN MYELOPROLIFERAT
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SMALL-MOLECULE INHIBITORS FOR MPN S
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SMALL-MOLECULE INHIBITORS FOR MPN L
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Insights into the Molecular Genetic
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GENETICS OF MYELOPROLIFERATIVE NEOP
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Classification of Myeloproliferativ
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CLASSIFICATION AND PROGNOSIS OF MPN
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CLASSIFICATION AND PROGNOSIS OF MPN
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AROUND THE WORLD IN ALMOST 80 MINUT
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LUNG CANCER IN BRAZIL Fig. 1. Relat
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LUNG CANCER IN BRAZIL Fig. 3. Chara
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LUNG CANCER IN BRAZIL Author’s Di
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LUNG CANCER IN CHINA Fig 1. Chinese
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LUNG CANCER IN CHINA well equipped
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Research and Standard of Care: Lung
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LUNG CANCER IN ROMANIA ● Protecti
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LUNG CANCER IN ROMANIA reimbursemen
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A New Model: Physician-Patient Coll
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PHYSICIAN ENGAGEMENT IN ONLINE PATI
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PHYSICIAN ENGAGEMENT IN ONLINE PATI
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LUNG CANCER SCREENING 101 CHAIR Chr
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LUNG CANCER SCREENING The concern i
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LUNG CANCER SCREENING Fig. 1. Guide
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LUNG CANCER SCREENING Fig. 2. Guide
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LUNG CANCER SCREENING 19. Montes RP
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Molecular Testing of Non-Small Cell
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MOLECULAR TESTING AND NSCLC Fig 1.
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MOLECULAR TESTING AND NSCLC logic d
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THYMOMA AND THYMIC CARCINOMA: UPDAT
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MANAGEMENT OF THYMIC CARCINOMA recu
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MANAGEMENT OF THYMIC CARCINOMA Refe
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The Creation of the International T
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ITMIG AS A MODEL FOR RARE DISEASES
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Thymoma: From Chemotherapy to Targe
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SYSTEMIC TREATMENT OF THYMOMA Study
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SYSTEMIC TREATMENT OF THYMOMA cance
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What Is the Best Strategy for Incor
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TREATMENT OF FOLLICULAR LYMPHOMA Fi
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TREATMENT OF FOLLICULAR LYMPHOMA me
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TREATMENT OF FOLLICULAR LYMPHOMA ou
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TREATMENT OPTIONS IN INDOLENT LYMPH
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Page 587 and 588:
Page 589 and 590:
ROLE OF HCT FOR INDOLENT LYMPHOMA T
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ROLE OF HCT FOR INDOLENT LYMPHOMA T
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ROLE OF HCT FOR INDOLENT LYMPHOMA e
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CONTROVERSIES IN MYELOMA: INDUCTION
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TRANSPLANTATION FOR MYELOMA Alterna
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TRANSPLANTATION FOR MYELOMA compare
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TRANSPLANTATION FOR MYELOMA autolog
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CURRENT STATUS OF MYELOMA THERAPY K
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CURRENT STATUS OF MYELOMA THERAPY F
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CURRENT STATUS OF MYELOMA THERAPY T
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Maintenance Therapy for Myeloma: Ho
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MAINTENANCE THERAPY FOR MULTIPLE MY
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Page 615 and 616:
Page 617 and 618:
NEW OPTIONS, NEW QUESTIONS: HOW TO
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THERAPIES FOR PATIENTS WITH METASTA
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Page 623 and 624:
Page 625 and 626:
ANTIEMETICS: CURRENT STANDARDS, EME
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ANTIEMETICS: ASCO GUIDELINE UPDATE
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Page 631 and 632:
Page 633 and 634:
Page 635 and 636:
Chemotherapy-Induced Nausea and Vom
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INCIDENCE AND PREVALENCE OF CHEMOTH
Page 639 and 640:
New Frontiers in Mucositis By Dougl
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MUCOSAL INJURY CAUSED BY CANCER THE
Page 643 and 644:
Page 645 and 646:
Page 647 and 648:
Short- and Long-term Cardiovascular
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Recent Advances in Cardiotoxicity o
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CARDIOTOXICITY OF ANTICANCER THERAP
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CARDIOTOXICITY OF ANTICANCER THERAP
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The Oncologist as the Patient with
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THE ONCOLOGIST AS THE PATIENT OR RE
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Prolonged Febrile Neutropenia in th
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FEBRILE NEUTROPENIA IN PEDIATRIC CA
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FEBRILE NEUTROPENIA IN PEDIATRIC CA
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TREATMENT APPROACHES IN CHILDREN wh
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TREATMENT APPROACHES IN CHILDREN th
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GENETIC COUNSELING OF THE PATIENT W
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CANCER PREDISPOSITION IN CHILDHOOD
Page 673 and 674:
Page 675 and 676:
Page 677 and 678:
Page 679 and 680:
HOW TO MANAGE VERY RARE PEDIATRIC C
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RARE CANCER IN CHILDREN Registries
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Genetic Alterations in Childhood Me
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GENETIC ALTERATIONS IN CHILDHOOD ME
Page 687 and 688:
Desmoid-Type Fibromatosis in Childr
Page 689 and 690:
CHEMOTHERAPY FOR DESMOID TUMOR Tabl
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CHEMOTHERAPY FOR DESMOID TUMOR 14.
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Targeting the Insulin-Like Growth F
Page 695 and 696:
TARGETING THE IGF SYSTEM Fig. 1. Th
Page 697 and 698:
TARGETING THE IGF SYSTEM malignanci
Page 699 and 700:
Hedgehog Pathway in Pediatric Cance
Page 701 and 702:
HEDGEHOG PATHWAY IN PEDIATRIC CANCE
Page 703 and 704:
HEDGEHOG PATHWAY IN PEDIATRIC CANCE
Page 705 and 706:
Development and Refinement of Augme
Page 707 and 708:
ABFM THERAPY FOR PEDIATRIC ALL than
Page 709 and 710:
ABFM THERAPY FOR PEDIATRIC ALL Auth
Page 711 and 712:
RADIOTHERAPY FOR PEDIATRIC HODGKIN
Page 713 and 714:
RADIOTHERAPY FOR PEDIATRIC HODGKIN
Page 715 and 716:
Role of Doxorubicin in Rhabdomyosar
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DOXORUBICIN IN RHABDOMYOSARCOMA 8.
Page 719 and 720:
Identification of Novel Biologic Ta
Page 721 and 722:
NOVEL TARGETS IN THE TREATMENT OF D
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Is Biopsy Safe in Children with New
Page 725 and 726:
SAFETY OF DIPG BIOPSY IN CHILDREN F
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SAFETY OF DIPG BIOPSY IN CHILDREN 1
Page 729 and 730:
CHILDREN WITH DIFFUSE INTRINSIC PON
Page 731 and 732:
Communication and Decision Support
Page 733 and 734:
COMMUNICATION AND DECISION SUPPORT
Page 735 and 736:
Page 737 and 738:
Page 739 and 740:
Planning for the Future: The Role o
Page 741 and 742:
present in the office suite but doe
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Summary and Care Plan are provided.
Page 745 and 746:
DOING IT RIGHT, AND FOR LESS: IMPLE
Page 747 and 748:
CLINICAL PATHWAYS STANDARDIZING PER
Page 749 and 750:
CLINICAL PATHWAYS STANDARDIZING PER
Page 751 and 752:
The Future of Oncology Care with Pe
Page 753 and 754:
quantity. Determining the appropria
Page 755 and 756:
THE ASCO QUALITY ONCOLOGY PRACTICE
Page 757 and 758:
IMPROVING VALUE OF CARE IN ONCOLOGY
Page 759 and 760:
Page 761 and 762:
Page 763 and 764:
PHYSICIAN WELLNESS: COPING WITH REP
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also provides insight on how clinic
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good resource for exploring the pri
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of death or following death and inc
Page 771 and 772:
telephone call to the family, sendi
Page 773 and 774:
New Insights in Cross-Cultural Comm
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CROSS-CULTURAL COMMUNICATION Sideba
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THE ONCOLOGIST, THE PATIENT, AND TH
Page 779 and 780:
estimate of the proportion of their
Page 781 and 782:
exactly the same treatment, even th
Page 783 and 784:
How to Decide Whether to Offer and
Page 785 and 786:
NONSTANDARD THERAPIES FOR ADVANCED
Page 787 and 788:
NONSTANDARD THERAPIES FOR ADVANCED
Page 789 and 790:
TARGETED THERAPIES IN TARGETED OR U
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TARGETED THERAPY IN SARCOMA rates a
Page 793 and 794:
TARGETED THERAPY IN SARCOMA seen in
Page 795 and 796:
TARGETED THERAPY IN SARCOMA recepto
Page 797 and 798:
Adjuvant Treatment of Gastrointesti
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ADJUVANT THERAPY IN HIGH-RISK GASTR
Page 801 and 802:
Management of Tyrosine Kinase Inhib
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TKI-RESISTANT GIST Primary Imatinib
Page 805 and 806:
TKI-RESISTANT GIST Table 2. Clinica
Page 807 and 808:
BIOLOGIC PRINCIPLES OF TARGETED COM
Page 809 and 810:
COMBINING TARGETED AGENTS IN CLINIC
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COMBINING TARGETED AGENTS IN CLINIC
Page 813 and 814:
Combination Therapies Building on t
Page 815 and 816:
COMBINATIONS FOR MELANOMA agents th
Page 817 and 818:
MECHANISMS OF RESISTANCE TO TARGETE
Page 819 and 820:
RESISTANCE MECHANISMS TO MAPK INHIB
Page 821 and 822:
RESISTANCE MECHANISMS TO MAPK INHIB
Page 823 and 824:
Mechanisms of Resistance to Targete
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RESISTANCE TO TARGETED THERAPIES IN
Page 827 and 828:
RESISTANCE TO TARGETED THERAPIES IN
Page 829 and 830:
Translating PI3K-Delta Inhibitors t
Page 831 and 832:
THE STORY OF CAL-101 6% of patients
Page 833 and 834:
PI3 Kinase in Cancer: From Biology
Page 835 and 836:
PI3 KINASE IN CANCER Fig. 1. The PI
Page 837 and 838:
PI3 KINASE IN CANCER Fig. 3. In viv
Page 840:
This publication is supported by an
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2012 EDUCATIONAL BOOK - American Society of Clinical Oncology

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