Integrated cancer management : surgery, medical oncology, and radiation oncology

672 Pages·1999·6.065 MB·English

by  Michael Torosian

BASICANDCLINICALONCOLOGY
Editor
BruceD.Cheson,M.D.
NationalCancerInstitute
NationalInstitutesofHealth
Bethesda,Maryland
1. Chronic Lymphocytic Leukemia: Scientific Advances and Clinical Devel-
opments,editedbyBruceD.Cheson
2. Therapeutic Applications of Interleukin-2, edited by Michael B. Atkins
andJamesW.Mier
3. CanceroftheProstate,editedbySaktiDasandE.DavidCrawford
4. RetinoidsinOncology,editedbyWaunKiHongandReubenLotan
5. Filgrastim (r-metHuG-CSF) in Clinical Practice, edited by George
MorstynandT.MichaelDexter
6. Cancer Prevention and Control, edited by Peter Greenwald, Barnett S.
Kramer,andDouglasL.Weed
7. Handbook of Supportive Care in Cancer, edited by Jean Klastersky,
StephenC.Schimpff,andHans-JörgSenn
8. PaclitaxelinCancerTreatment,editedbyWilliamP.McGuireandEricK.
Rowinsky
9. Principles of Antineoplastic Drug Development and Pharmacology,
editedbyRichardL.Schilsky,GérardA.Milano,andMarkJ.Ratain
10. Gene Therapy in Cancer, edited by Malcolm K. Brenner and Robert C.
Moen
11. Expert Consultations in Gynecological Cancers, edited by Maurie Mark-
manandJeromeL.Belinson
12. Nucleoside Analogs in Cancer Therapy, edited by Bruce D. Cheson,
MichaelJ.Keating,andWilliamPlunkett
13. DrugResistanceinOncology,editedbySamuelD.Bernal
14. Medical Management of Hematological Malignant Diseases, edited by
EmilJFreireichandHagopM.Kantarjian
15. Monoclonal Antibody-Based Therapy of Cancer, edited by Michael L.
Grossbard
16. Medical Management of Chronic Myelogenous Leukemia, edited by
MosheTalpazandHagopM.Kantarjian
17. Expert Consultations in Breast Cancer: Critical Pathways and Clinical
Decision Making, edited by WilliamN.Hait,David A.August,and Bruce
G.Haffty
18. Cancer Screening: Theory and Practice, edited by Barnett S. Kramer,
JohnK.Gohagan,andPhilipC.Prorok
19. Supportive Care in Cancer: A Handbook for Oncologists: Second Edi-
tion, Revised and Expanded, edited by Jean Klastersky, Stephen C.
Schimpff,andHans-JörgSenn
20. Integrated Cancer Management: Surgery, Medical Oncology, and Rad-
iationOncology,editedbyMichaelH.Torosian
21. AIDS-Related Cancers and Their Treatment, edited by Ellen G. Feigal,
AlexandraM.Levine,andRobertJ. Biggar
22. Allogeneic Immunotherapy for Malignant Diseases, edited by John
BarrettandYin-ZhengJiang
23. CancerintheElderly,editedbyCarrieP.Hunter,KarenA.Johnson,and
HymanB.Muss
24. Tumor Angiogenesis and Microcirculation,edited by Emile E.Voestand
PatriciaA.D’Amore
25. Controversies in Lung Cancer: A Multidisciplinary Approach, edited by
BenjaminMovsas,CoreyJ.Langer,andMelvynGoldberg
26. Chronic Lymphoid Leukemias: Second Edition, Revised and Expanded,
editedbyBruceD.Cheson
27. TheMyelodysplasticSyndromes:PathobiologyandClinicalManagement,
editedbyJohnM.Bennett
ADDITIONALVOLUMESINPREPARATION
Integrated
Cancer
Management
Surgery, Medical Oncology,,
and Radiation Oncology
edited by
Michael H. Torosian
Fox Chase Cancer Center
PhiladeEphiu, Pennsylvania
MARCELD EKKERIN, C. NEWY ORK BASEL
DEKKER
-
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 1999 by Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Version Date: 20130305
International Standard Book Number-13: 978-0-203-90998-0 (eBook - PDF)
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To T.J.
For her love, kindness, compassion,
and her beautiful spirit
SeriesIntroduction
The current volume, Integrated Cancer Management: Surgery, Medical Oncol-
ogy,andRadiationOncology,isVolume20intheBasicandClinicalOncology
series. Many of the advances in oncology have resulted from close interaction
between the basic scientist and the clinical researcher. The current volume fol-
lows,expandson,andillustratesthesuccessofthisrelationshipasdemonstrated
by new and promising areas for scientific research.
As editor of the series, my goal has been to recruit volume editors who
notonlyhaveestablishedreputationsbasedontheiroutstandingcontributionsto
oncology, but also have an appreciation for the dynamic interface between the
laboratory and the clinic. To date, the series has consisted of monographs on
topicssuchaschroniclymphocyticleukemia,nucleosideanalogsincancerther-
apy,therapeuticapplicationsofinterleukin-2,retinoidsinoncology,genetherapy
ofcancer,andprinciplesofantineoplasticdrugdevelopmentandpharmacology.
IntegratedCancerManagementiscertainlyamostimportantadditiontothese-
ries.
VolumesinprogressincludeworksonAIDS-relatedmalignancies,second-
arymalignancies,chroniclymphoidleukemias,andcontroversiesingynecologic
oncology.Ianticipatethatthesevolumeswillprovideavaluablecontributionto
the oncology literature.
Bruce D. Cheson, M.D.
v
Preface
Cancerisadevastatingdiseaseprocesswiththepotentialtoexertclinicaleffects
at the local, regional, and systemic levels. Extensive physical, metabolic, nutri-
tional,immunological,andpsychologicalalterationsoccurincancerpatientsthat
mayadverselyaffectclinicaloutcomeandfunctionalrecovery.Criticalendpoints
suchastumorremissionrates,disease-freeandoverallsurvival,toxicityofanti-
neoplastictherapy,surgicalmorbidityandmortality,andqualityoflifeareinflu-
enced by these physiological and functional abnormalities. To achieve optimal
outcome results, the cancer patient requires an integrated, multidisciplinary ap-
proach to treat local, regional, and distant disease. This fundamental concept in
cancertherapyisexploredthroughoutthisbook,IntegratedCancerManagement:
Surgery, Medical Oncology, and Radiation Oncology.
Thisbookisaunique,state-of-the-artreferencethatemphasizestheclinical
approach to the cancer patient—it is neither a treatise on cancer research nor a
compendium of published literature. Effective integration of multidisciplinary
managementofcanceristheunifyingthemethroughoutthistext,andmostchap-
ters are coauthored by a surgeon, medical oncologist, and radiation oncologist
withrecognizedclinicalexpertiseincancertherapy.Clear,concise,andpertinent
summaries of oncological therapy are presented, with an emphasis on critical
decisionpointsinthemanagementofcancerpatients.Tumorbiologyisdiscussed
intermsofclinicalrelevanceasitimpactsontheformationofamultidisciplinary
treatment plan. Surgical treatment options are fully described along with in-
sightful comparisons and critical distinctions among surgical alternatives based
vii
viii Preface
on tumor stage and biology. Systemic treatment with chemotherapy, hormone
therapy,andotheragentsisreviewed,withanalysisofclinicalprognosticfactors,
treatmentindications,toxicity,andtumorresponse.Radiationtherapytechniques,
treatmentplanning,doseanddurationoftherapy,morbidity,andresultsarealso
critically reviewed.
My concept of the disease-management approach to cancer is the basis
for the organization of this text. Treatment of breast, esophageal, gastric, small
intestine, appendiceal, colorectal, and anal carcinomas is thoroughly reviewed.
The clinical management of pancreatic and periampullary cancers, hepatic and
biliary tumors, and endocrine tumors, which include carcinoids and pancreatic,
adrenal, thyroid, and parathyroid tumors, is clearly summarized. Lymphomas,
soft-tissue sarcomas, melanomas, lung and pleural tumors, mediastinal tumors,
oncological emergencies, tumor vaccines, nutrition, and molecular biology are
criticallyreviewed.Thechaptersofthisbookareorganizedaccordingtoclinical
classificationbasedontumorbiology,anatomy,pathophysiology,andprognostic
factors relevant to making therapeutic decisions. For example, proximal gastric
tumorsarecategorizedwithesophagealtumorsbutseparatefrommidanddistal
gastric tumors. This particular clinical classification is based on common treat-
ment strategies designed for proximal gastric and esophageal tumors, in accor-
dancewithsimilaritiesinregionalanatomy,local/regionalrecurrence,andmeta-
static potential; different diagnostic and treatment strategies exist for the
management ofpatients with mid and distal gastric tumors.Similar clinicaland
biological considerations are used to classify pancreatic adenocarcinomas, with
obstructingperiampullarytumors,livertumorswithproximalbiliarytumors,and
pancreaticendocrinetumorsinaseparatecategory.Clinicalrelevanceisthekey
determinant in the organization of this text and provides a rational framework
for understanding cancer therapy based on clinical tumor biology.
Effective management of the cancer patient is complex and requires the
coordinated and integrated efforts of the surgeon, medical oncologist, radiation
oncologist,andmanyotherphysiciansandhealthcareproviders.Theaimofthis
textistoprovidepracticingclinicianswithcomprehensivemanagementstrategies
forofferingthehighestqualityofcaretocancerpatients.Greatprogresshasbeen
made in the treatment of cancer over the past 50 years. Current cancer therapy
is summarized in this text by expert clinicians who will lead us into the next
millenniumwhenexcitingdiscoveriesinmolecularbiologyandinnovativetech-
nology are anticipated to treat, cure, and eventually prevent cancer.
Michael H. Torosian
Contents
Series Introduction v
Preface vii
Contributors xiii
1. Breast Cancer 1
Michael H. Torosian, Lawrence J. Solin, Halle C.F. Moore,
and Kevin R. Fox
2. Esophagus and Proximal Gastric Tumors 49
Noel N. Williams, David J. Vaughn, Richard Whittington,
Michael L. Kochman, and Ernest F. Rosato
3. Mid and Distal Gastric Cancers 82
Lawrence E. Harrison, Eileen M. O’Reilly, Bruce D. Minsky,
Gary K. Schwartz, and Martin S. Karpeh, Jr.
4. Small Bowel Tumors 106
Michael Bouvet, Nora A. Janjan, Dennie V. Jones, Jr.,
and Lee M. Ellis
ix
x Contents
5. Appendiceal Tumors 133
Mahmoud B. El-Tamer, Thomas P. Bradley,
and Alan Schulsinger
6. Colon Cancer 146
Harold J. Wanebo, Li Liu, and Arvin S. Glicksman
7. Rectal Cancer 172
Peter W.T. Pisters, Nora A. Janjan, Jean-Pierre Ayoub,
and Richard Pazdur
8. Cancer of the Anal Canal 195
Paul J. McMurrick, Heidi Nelson, Richard M. Goldberg,
and Michael G. Haddock
9. Pancreatic and Periampullary Tumors 221
Blair M. Rowitz, Douglas Brown, Barry C. Lembersky,
and Mark S. Roh
10. Pancreatic Endocrine Tumors 241
H. Richard Alexander, Jr., Robert T. Jensen,
and John L. Doppman
11. Liver and Proximal-Mid Biliary Cancer 269
Michael A. Choti, Ross A. Abrams, Seamus O’Reilly,
and Floyd A. Osterman, Jr.
12. Adrenal Gland Carcinoma 294
David L. Bartlett, Brian Fuller, and Antonio T. Fojo
13. Thyroid and Parathyroid Cancer 322
Douglas L. Fraker and Monica Skarulis
14. Carcinoid Tumors 345
Linda S. Callans, Brenda E. Haynes, David J. Vaughn,
R. Alex Hsi, and Eli Glatstein
15. Hodgkin’s and Non-Hodgkin’s Lymphomas 360
Brian J. Czerniecki, Hung Q. Nguyen, Kevin R. Fox,
R. Alex Hsi, and Eli Glatstein