Bone metastases continue to be a major cause of morbidity in cancer patients, but improved understanding of the biology of bone metastases has led to the identification of drugs that are of potential value in not only their treatment but also their prevention. This book, written by recognized experts in the field, provides a detailed overview of current knowledge on this subject. One important focus of the book is the efficacy of bisphosphonates in preventing bone metastases in patients with breast, lung, and prostate cancer and disease progression in cases of multiple myeloma. The combined use of bisphosphonates and cytostatics is also discussed, with a report on first clinical data. Further topics addressed include the significance of the bone microenvironment, special issues in the elderly patient, the use of bone turnover markers, and initial findings obtained with denosumab.

As the population ages, clinicians are facing an increasing number of elderly patients with colorectal cancer. These patients pose unique challenges as they have more comorbidities and lower functional reserves. In addition, the treatment goals may differ from those in younger patients. This book discusses in depth the different aspects of management of colorectal cancer in the elderly. After the provision of pertinent background information on the normal physiology of aging, screening and diagnosis are discussed. Subsequent chapters focus on a range of issues associated with the surgical and perioperative care of these patients and with adjuvant treatment and palliative care. Each chapter provides helpful take-home messages in bullet point form, and numerous informative figures and tables are also included. The authors are surgeons, physicians, anesthetists, geriatricians, oncologists, and allied health professionals with extensive experience in the field.

Steven A. Rosenberg, MD In the past two decades significant progress has quality of life. The use of local radiation therapy has occurred, in the management of patients with mus- had a profound impact on the ability to achieve local loskeletal cancers, that has improved both the survival control. Cooperation between surgeons and radiation and the quality of life of afflicted patients. Changes in therapists often results in the tailoring of surgical p- the management of these patients have mirrored cedures to maximize the combined application of these trends in the entire field of oncology. two effective treatment modalities. Although impact on The most significant change has been improvement overall survival has not been demonstrated due to the in the surgical techniques for the resection of musculo- addition of radiation therapy, important advances in skeletal cancers based on a detailed understanding of improving the quality of life of patients receiving this the anatomic features of each particular tumor site, as combined-modality treatment have been evident. well as an appreciation of the natural biology that affects A third change impacting on the survival of patients the local spread of these tumors. The current volume of with musculoskeletal cancers has been the aggressive Musculoskeletal Cancer Surgery: Treatment of Sarcomas and resection of metastatic deposits.

This book presents our experience in the operative treatment of bone and soft-tissue tumors arising in and around the pelvis, from 1970 to 1999 in the Department of Orthopedic Surgery at the Niigata University Medical Hospital. Histological diagnoses included both benign and malignant tumors. Surgical plan ning was difficult to perform in our early experience in operative treatment, when only angiography and barium enemas were in use. In the meantime, computed tomog raphy scanning and magnetic resonance imaging became available. Subsequent improvement in the quality of these images made three-dimensional surgical plan ning for pelvic tumor removal much easier. Such progress in diagnostic methodolo gies, together with advancements in microsurgical techniques, methods of irradiation, and various adjuvant chemotherapies has led to significant improvements in the treat ment of pelvic tumors. Furthermore, these advancements were enhanced by the avail ability of various conventional and custom-made endoprostheses, plates and screws, spinal instruments, and external fixators made of 3161 stainless steel, titanium, high density polyethylene, and ceramics. Because sacral tumors are so silent and symptomless, they may grow to a large size and be difficult to excise. Removal of sacral tumors might make subjective symptoms worse because the sacrum contains the cauda equina. Excision of a tumor that involves the ilium and sacroiliac joint may interrupt the structural stability of the pelvic ring. A tumor affecting the hip joint may require reconstruction to re-establish the func of the hip and to provide stability for gait after operative treatment."

Liver metastases are a frequent and often fatal occurrence in cancer patients, particularly those with malignancies of the gastrointestinal (GI) tract. While recent improvements in surgical techniques and a more aggressive approach to resection of liver metastases have improved long term survival for some patients, most patients with hepatic metastases still succumb to their disease. To improve these dismal statistics, a better understanding of the biology of liver metastasis, particularly the early stages that can be targeted for prevention, is essential.

Once cancer cells enter the liver, several different scenarios may occur. The cancer cells may be immediately destroyed by local defence mechanisms, they may enter a state of dormancy as solitary cells and never produce a metastasis, initiate a short-lived process of proliferation that is aborted before a metastasis is established or actively proliferate to form macrometastases. The chapters in Part I of this book provide insight into the cellular/molecular mechanisms that determine which of these scenarios prevails. Written by experts researchers in the filed of metastasis, these chapters provide state-of-the art reviews on the cellular and molecular processes that impact the early stages of the metastatic process. The unique microenvironment of the liver, its various anatomical, cellular and molecular features and the impact they have on metastasis are highlighted. In addition, the role of inflammation (pre-existing and tumor-induced), host innate and adaptive immune responses, cytokines, chemokines, growth factors and the unique molecular signatures of metastatic tumor cells are reviewed with an underscoring of the translational implications of the current state of knowledge.

Against this background, the chapters in Part II of the book provide critical reviews on major aspects of the clinical management of hepatic metastases. These include imaging strategies, surgical and chemotherapeutic treatment approaches and the use of targeted biological therapeutics such as anti-angiogenic drugs as treatment modalities.

By combining information on biological and clinical aspects of liver metastasis, this volume will serve as an excellent resource for scientists, clinicians, clinician/ scientists and trainees in the domains of oncology, surgical oncology, hepatobiliary physiology and radiology. "

Colorectal cancer is the third most commonly diagnosed cancer in the US and the third most recently linked to cancer deaths. The national annual incidence rate of colorectal cancer is approximately 148,000+, striking slightly more females than males. The lifetime risk of colorectal cancer is 5-6%, however patients with a familial risk (with two or more first or second degree relatives) make up 20% of the patients. Persons who carry genetic mutations linked to hereditary colorectal cancer are the most likely to develop the disease.

MRI is assuming a dominant role in imaging of the larynx. Its superior soft tissue contrast resolution makes it ideal for differentiating invasion of tumors of the larynx from normal or more sharply circumscribed configuration of most of the benign lesions. Over ten years ago CT made a major impact on laryngeal examination because it was the first time that Radiologists were beginning to look at submucosal disease. All of the previous examinations duplicated the infor mation that was available to the clinician via direct and in-direct laryngo scopy. With the advent of rigid and flexible endoscopes, clinical examination became sufficiently precise that there was little need to perform studies such as laryngography which merely showed surface anatomy. The status of deep structures by these techniques was implied based on function. Fortunately laryngography is now behind us together with all of the gagging and contrast reactions which we would all like to forget. CT is still an excellent method of examining the larynx but it is unfortunately limited to the axial plane. With presently available CT techniques motion deteriorates any reformatting in sagittal or coronal projections. The latter two planes are extremely helpful in delineating the vertical extent of submucosal spreads. MRI has proven extremely valuable by producing all three basic projections, plus superior soft tissue contrast. Although motion artifacts still degrade the images in some patients, newer pulsing sequences that permit faster scanning are elimi nating most of these problems."

Endoanal and endorectal ultrasound represents considerable progress in the field of anorectal imaging. Its importance in the staging of rectal and anal cancer, in identifying perianasto- motic neoplastic recurrences, in defining acute and chronic suppurative disease and in assessing sphincteral anatomical integrity, is now a confirmed reality. The evidence provided by endoanal and endorectal ultrasonography guides the colorectal surgeon in his choice among the various therapeutic approaches and helps in assessing the effects of the treatments applied. The great flexibility and high degree of reliability make this exploratory method an indispensable tool at all stages of the clinical course in the majority of patients with anorectal problems, including the fundamental follow-up stage. The publication of this excellent volume on intraanal and intrarectal ultrasonog- raphy is therefore to be appreciated, especially since it is in the form of an atlas. As we are dealing with imaging, it is particularly appropriate that it is the images that tell the story. Like all important things, this volume does not come out of nothing. It is the result of many years of skilled work by Drs. G.A. Santoro and G. Di Falco and is based on the experience of internationally renowned professional experts. The ten sections of the atlas begin with general information on ultrasonography, gradually progressing to the technical problems of the method and the aspects rela- tive to anorectal tumors.This last section leads to a review of traditional and mod- ern therapeutic possibilities.

Throughout the world, head and neck cancer is a major threat to public health and a significant challenge to both clinicians and basic scientists. Despite extensive efforts in primary prevention, screening, early detection, and therapy, long-term survival rates have not improved substantially in the last three decades. This book covers a wide range of exciting new findings in both clinical and basic sciences as they are relevant to head and neck cancer. These findings have recently enhanced our understanding of head and neck carcinogenesis at the genetic and molecular levels, offering the promise of improved preventive and therapeutic strategies. This book will also present information on the important clinical advances that have been made in chemoprevention, organ preservation, and the simultaneous use of chemo therapy and radiotherapy. The first part provides an overview of the etiology and biology of head and neck cancer, including an examination of human papillomaviruses in both benign and malignant lesions. This section also discusses the carcinogenic process at the genetic and molecular levels, as well as aberrant squamous differentiation; increased understanding of these areas has great potential to translate into new strategies for cancer prevention. The second part describes recent advances in developing a risk model for head and neck cancer, as well as the application of genetic susceptibility data in chemoprevention. This section also includes overviews of the status of chemoprevention trials and of the process of invasion and metastasis in head and neck cancer."

Kidney cancer is a heterogenous disease. This book covers: -new surgical approaches which are becoming the standard, i.e., nephon sparing, laporascopic, minimally invasive techniques; -new staging and prognostic capabilities; -evolving therapeutic options include, cell based vaccine, gene and antibody therapy; -molecular genetics allow for a better understanding of the various types of kidney cancer. Kidney Cancer is a comprehensive review covering present and future surgical approaches, staging and prognostic factors, currently accepted and future plans for prevention, diagnosis and treatment. Contributing authors to this book are internationally recognized specialists in this disease. This book will be useful to the specialist (oncologist and urologist), primary care physicians, patients and family members dealing with kidney cancer.

In addition to surgery and radiotherapy, local treatment modalities for the management of brain tumours are increasingly being developed and clinically tested. This book describes for the first time basic tumour biology as well as all current procedures in progress at the most recent level of knowledge, presented by leading experts in the respective fields. Image guided resection procedures, fluorescence guided surgery, developments in interstitial radiosurgery are addressed, just as intracavitary chemotherapy and all current concepts and studies of interstitial targeted therapy. Owing to its topicality this book will remain for long the standard for this comprehensively treated subject.

Cancer is one of the major health problems of our time and liver cancer is responsible for over one million deaths per year world-wide, making it the fourth most common cause of death from cancer. Surgical resection of the tumour(s) is the treatment of choice and offers the only chance of prolonged survival. Yet the best attempts are often frustrated by either advanced or co-existent disease that renders the patient non-resectable. This book tackles the many options available to doctors and patients in an attempt to combat this desperate disease.

In the United States alone, the incidence of new cases of thoracic neoplasms is over 180,000. Each year, over 170,000 individuals are expected to die of their cancer. Lung cancer is the most common of the thoracic neoplasms. It is the leading cause of cancer death in both men and women, accounting for 28% of all cancer deaths in the United States. Thoracic Oncology provides an up-to-date and concise review of the various thoracic neoplasms and offers a better understanding of the biology, natural history, diagnosis and treatment of these malignancies. This book will be of particular interest to clinicians interested in thoracic neoplasms, to better understand and treat them.

Technical and Biological Components of Marrow Transplantation presents up to date information on the scientific and technological advances that will extend and improve the clinical application of bone marrow transplantation. The book includes the latest information on chronic myeloid leukemia and thalassemia; advances in supportive care: cytokines and progenitor expansion; and cord stem cell technology. Soon more of patients will receive marrow transplants as part of the therapy for solid tumors and metabolic disease than for the treatment of hematologic disease. The contributors to this volume describe some of these applications, hinting at yet further, exciting possibilities.

Blood Stem Cell Transplantation conveys the excitement that accompanies the newest developments in hematopoietic stem cell transplantation. Some of the applications that stand to impact this field most significantly are based on recent advances in the biological sciences, as demonstrated by the chapters on gene therapy, on the detection of minimal residual disease using molecular techniques, and on the use of radioimmunoconjugates targeting lymphoma and leukemia-associated antigens. Others are the results of clinical observations - e.g., the association between graft-versus-host- disease (GVHD) and durable remissions that have led to creative clinical experiments such as donor leukocyte infusions (DLI). Attempts to unravel the biological events that underlie the responses seen in patients with relapsed chronic myelogenous leukemia treated with DLI are likely to provide the basis for future refinements in this clinical approach. Hopefully, improved response rates and reduced toxicity will result. The power of the immunologic response in controlling malignant disease is underscored in the chapter on post-transplant immunotherapy. The complex immunologic process that results in clinical GVHD may be dissected and engineered to provide clinical benefits that include, in addition to its antineoplastic effects, the amelioration of its clinical manifestations. Better control of GVHD with less global immunosuppression will facilitate the use of mismatched and unrelated donors. This area of investigation perfectly illustrates the continued interplay between the laboratory and the clinic. The continued cross-fertilization of ideas between immunologists, molecular biologists and clinical investigators is likely to yield important advances in this field for years to come. Possible applications of stem cell transplantation continue to grow with the identification of alternative sources of stem cells and the potential to engineer and/or expand the graft. Although the use of unrelated and mismatched donors continues to increase, the possibilities associated with umbilical cord blood transplantation are legion, especially if stem cells can be expanded ex vivo to provide grafts for full-sized adults. Using techniques in which contaminating malignant cells may be eliminated from autografts through positive selection, autologous transplantation may prove highly effective, especially when coupled with post-transplant immunotherapy. Some of these same methodologies have helped facilitate the use of autologous grafts for transplantation in patients with chronic myelogenous leukemia without allogeneic donors. Advances in the supportive care of transplant patients, including the pretransplant identification of those at risk from pulmonary complications and the use of cytokines to speed engraftment, have reduced morbidity and mortality to such a degree that it is appropriate to consider high-dose therapy and stem cell reconstitution in patients with nonmalignant diseases. The impressive advances that have occurred in transplantation for thalassemia are described by pioneers in their area of investigation. The burgeoning field of transplantation for autoimmune disorders, including its immunobiologic basis and soon-to- be-realized clinical potential, is also summarized. Continued progress in the use of high-dose therapy with stem cell rescue for the treatment of pediatric tumors, which derives in part from improved supportive care, is detailed. The sobering voice of the health care economists underscores the necessary limitations to our seemingly unbridled imagination. Cost- consciousness and financial know-how will need to be reflected in future study designs. Given the seemingly endless applications of our technology, strategies to insure its cost-effectiveness will be necessary. Continued financial support for laboratory investigation and for the clinical experiments they generate will be required if we are to go forward. Blood Stem Cell Transplantation lays the foundation for many of these future advances; it is incumbent upon us all to insure its realization.

Atlas of Selective Lymphadenectomy for Melanoma, Breast Cancer and Colon Cancer emphasizes a multidisciplinary approach combining the experiences of a nuclear medicine physician, surgeon, and pathologist. This is an important reference also for researchers and clinicians who want to become familiar with sentinel lymph node mapping. The underlying thesis in solid tumor biology is that metastasis in general starts in an orderly progression with lymphatic spread first to the sentinel lymph node (SLN) in the nearest lymph node basin. Therefore, the logical approach is to harvest that specific SLN for thorough analysis.

While it is true that certain types of neoplasms, such as those of the pancreas and brain, are still lesions with a grave prognosis, there are many other common cancers for which appropriate treatment can be curative in substantial numbers of patients .. This hopeful aspect of cancer is insufficiently appreciated, even by the medical profession itself; too many pessimistic patients find themselves consulting equally pessimistic physicians. WHO Expert Committee on Cancer Treatment *. The aim of this monograph is to present the latest information on the treatment of cancer, and the words quoted above from the report of a WHO Expert Committee on Cancer Treatment form an appropriate introduction to the subject. The pessimism to which they refer is still all too often characteristic of the attitude towards cancer and its treatment. The various chapters have been specially written for this monograph by specialists of international repute, and it will be noted that some of them were participants in the meeting of the WHO Expert Committee on Cancer Treatment mentioned above."

While this world eagerly awaits the ideal contraceptive technique that could efficiently, safely, and esthetically save this planet from the starvation and squalor of over crowding and offer women control over their reproductive capacity, the individual faced with the frustration, even des peration, induced by infertility begs for help in achieving the desired conception. The discipline of gynecology and obstetrics, recogniz ing the importance of these problems and the need for spe cial expertise in reproductive endocrinology and its atten dant clinical challenges in fertility and infertility, has now formalized the training of specialists in this area of scientific knowledge in a further effort to advance the skills of diag nosis and treatment attendant on these complex problems. Slowly but steadily, as befits the complexity of the endocrine and metabolic pathways involved, the scientific basis of reproductive physiology has been revealed by the research of physicians, biochemists, and physiologists. It is clear that no significant clinical advance can be made with out the foundation of such new knowledge. Indeed, the successful treatment of infertility resulting from failure of ovulation was based on just such a scientific advance.

Among the standard oncology modalities, surgical oncology is singular in that it lacks a separate board certification or even an added qualification mecha nism. 'Card-carrying' surgical oncologists are certified by the American Board of Surgery, as are all other general surgeons. What distinguishes the surgical oncologist is a set of cognitive skills rather than a specific armamentarium of surgical techniques. This different conceptual framework is derived from ex tensive additional training that leads to an in-depth understanding of the natural history and biologic behavior of the various solid tumor systems. Equipped with this perspective, the surgical oncologist is particularly well positioned to integrate the various available therapeutic modalities into a coherent care program for the solid tumor patient. As a central theme, the chapters of this book demonstrate that increasingly sophisticated diagnostic and staging approaches are helping to move chemo therapy and radiotherapy into the preoperative neoadjuvant setting. This fundamental alteration is based on the awareness that even early-stage solid tumor disease is frequently systemic at the time of presentation, at least on a subclinical level. And although the primary tumor may be controllable by surgery with radiotherapy, the uncontrolled (and initially clinically unappar ent) distant disease ultimately determines patient survival. The other perspec tive driving the neoadjuvant approach is an emerging awareness that for most solid tumor systems, neoadjuvant treatment responses can facilitate less muti lating surgery with comparable levels of local disease control.

Where do you begin to look for a recent, authoritative article on the diagnosis or management of a particular malignancy? The few general oncology textbooks are generally out of date. Single papers in specialized journals are informative, but seldom comprehensive; these are more often preliminary reports on a very limited number of patients. Certain general journals frequently publish good in-depth reviews of cancer topics, and published symposium lectures are often the best overviews available. Unfor tunately, these reviews and supplements appear sporadically, and the reader can never be sure when a topic of special interest will be covered. Cancer Treatment and Research is a series of authoritative volumes that aim to meet this need. It is an attempt to establish a critical mass of oncology literature covering virtually all oncology topics, which is revised frequently to keep the coverage up to date, and which is easily available on a single library shelf or by a single personal subscription. We have approached the problem in the following fashion: first, by dividing the oncology literature into specific subdivisions, such as lung can cer, genitourinary cancer, pediatric oncology, etc.; and second, by asking eminent authorities in each of these areas to edit a volume on the specific topic on an annual or biannual basis. Each topic and tumor type is covered in a volume appearing frequently and predictably, discussing current diag nosis, staging, markers, all forms of treatment modalities, basic biology, and more."

Adjuvant treatment is administered prior to or as follow up to surgical procedures for breast cancer. Proven success in using medical therapies allowing for breast conserving procedures or reducing risk of occurrence. Although there has been much progress towards a cure, including the introduction of new targeted therapies, metastasizing cancer remains highly incurable.

Cancers of the head and neck are among the most morbid of cancers. Convention al surgery and/or radiation therapy have a high cure rate for patients with early stage disease. However, despite optimal treatment with surgery and radiotherapy, patients with nodal spread or extensive local disease have a low cure rate. Even if a cancer is cured, a patient is often left with long-term debilities from the treatment and/or cancer. The major causes for decreased survival in patients with advanced head and neck cancer include local recurrence, distant metastases, and second primaries. All of these need to be addressed if one is to improve upon the curability of advanced disease. There are several new techniques, surgical and radiotherapeutic, designed to improve local control. Brachytherapy, or interstitial implantation, delivers a high dose of localized radiation with minimal normal tissue injury. This technique as discussed by Goffinet, may be even more efficacious when combined with hyperthermia. New, creative methods of radiation therapy delivery, such as the use of multiple fractions per day, as discussed by Parsons and Million, are also contributing to long-term local control. Laser therapy, discussed by Ossoff and Nemeroff, provides another tool for treatment of local disease."

One of the major advances of the last decade concerning the treatment of patients with soft tissue sarcomas is that an increased number of patients are being discussed in multidisciplinary teams prior to the initial treatment. The present volume on soft tissue sarcomas in the series Cancer Treatment and Research reflects the multidisciplinary approach with a focus on recent developments. The availability of new histopathologic techniques has reduced the number of unclassified sarcomas and has furhter increased the importance of the histo pathologist in providing estimates of the prognosis of the patient as well as data for the planning of treatment strategy. Further data for this strategy will be provided by diagnostic imaging. In this field, the role of magnetic reson ance imaging has been further defined. Of utmost importance is the recent trend toward consensus in staging. The modification of the staging system of the American Joint Commission for Cancer Staging and End Results Report ing brings the possibility of a single staging system within reach in the next decade. As surgery still provides the only chance for cure, the importance of being the most sparing as possible is obvious. For this reason, radiotherapy has been applied with success. The introduction of relatively new radiation tech niques is therefore being observed with interest."

The last volume dealing with lung cancer in this series in Cancer Treatment and Research was published in 1986 and entitled Lung Cancer: Basic and Clinical Aspects. The present book continues the outline of the previous volume by presenting up-to-date information on lung cancer in critical reviews of new important basic and clinical concepts of lung cancer. The present volume has broadened the scope by also including chapters dealing with issues such as epidemiology, prophylaxis, and histopathology of lung cancer. The content of the book thus reflects the increasing awareness of a global disease that is more and more in focus, not only scientifically but also politically. The latter fact results increasingly in changes in health legisla tion, with prevention measures influencing everyday life. The great interest in the disease is natural, considering that more than one patient dies from lung cancer every minute globally. The first chapter is from the Cancer Unit, WHO, Geneva, and describes in detail the epidemiologic features of lung cancer, which is the second most frequent cancer in the world with 660,500 new cases annually; it will soon surpass stomach cancer as the leader. Thirty-one percent of the cases occur in developing countries, where the increase is especially dramatic."

This book is based on the proceedings of a successful Boerhaave International Symposium on colorectal cancer held at the University of Leiden, 6-9 June, 1979. I would like to offer grateful thanks to the eminent clinicians and scientists who contributed both to the Symposium and to this book. Colorectal cancer is a very common form of malignancy, particularly in the Western world, and there have been a number of recent developments in the management of this condition. This book has attempted to collate informa tion on the current methods of investigation and treatment and I believe that it will prove valuable to all those interested in oncology. The contents range widely, covering the entire field from epidemiology through screening methods, diagnostic approaches and therapy of both primary and secondary disease. Perhaps the most outstanding new areas discussed and reflected in the proceedings are the possible range and scope of screening techniques, the new possibilities both in treatment and in endoscopic surgery now available as a result of developments in fibre-optic endoscopy, and new approaches and important parameters in staging of the disease."