Volume 3, Number 10 (October 2006)

Letter from the Editor

616

Spotlighting radiation therapy

David H. Henry, MD, FACP, Editor

Pennsylvania Hospital, Philadelphia, PA

Because radiation plays such an important role in cancer treatment, we are devoting our October issue to this topic. It’s an especially good time to focus on this subject as the major radiation oncology meetings are about to convene, and the January 1, 2007 deadline looms for medical imaging reimbursement cuts by Medicare. This issue is packed with practical information on dealing with the side effects of radiation, specifically oral mucositis, vaginal stenosis, and mucositis in the vaginal/rectal area. Included is a downloadable guide for women, 88% of whom experience vaginal stenosis as a result of pelvic radiation for colorectal or gynecologic cancers.

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Community Dialogue

634

The coming convergence of imaging and cancer treatment

Community Oncology interviews Brian Baker, Vice President of Regents Health Resources in Brentwood, Tennessee. An adviser for practices that are opening new outpatient imaging centers, Mr. Baker peers into the future for us to talk about “Buck Rogers” imaging technology, much of which has already arrived. Coming on the scene now: with real time monitoring of treatment, an oncologist can locate a malignancy, watch as the precise amount of medication is delivered to it, and see the tumor begin to die onscreen. Mr. Baker explains how, even with high costs, private practitioners can compete.

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Original Contribution

644

Selected topics in head and neck cancer

Mitchell Machtay, MD

Jefferson Medical College, Philadelphia, PA

Using four short vignettes, the author discusses different aspects of radiotherapy for head and neck cancer. The most widely used modality for this disease, radiotherapy, can be used for early-stage cancer as the definitive treatment, as part of organ preservation for intermediate to moderately advanced stage cancer, and as radical or palliative therapy for locally advanced cancer.

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Nursing Management

653

Managing mucositis in head and neck cancer patients undergoing radiation therapy

Suzanne McGettigan, MSN, CRNP, AOCN^®, and Carrie Tompkins Stricker, MSN, CRNP, AOCN^®

University of Pennsylvania Health System, Philadelphia, PA

Oral mucositis is a common complication of cancer treatment and is often the dose-limiting toxicity in treating head and neck cancers. This condition affects patients’ quality of life, increases the risk for systemic infection, and impairs nutrition. The authors review strategies for assessing, preventing, and treating oral mucositis, and include a short discussion of additional therapies under investigation: palifermin, velafermin, granulocyte-macrophage colony-stimulating factor, L-glutamine, and other cytokines.

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Original Contribution

659

IMRT for prostate cancer: improving the therapeutic ratio

Courtney Bui, MD, MSPH, and John Glassburn, MD, FACR

Pennsylvania Hospital and the University of Pennsylvania School of Medicine, Philadelphia, PA

This review article outlines the rationale and indications for intensity-modulated radiation therapy (IMRT) in the treatment of prostate cancer, discussing some of the pivotal studies supporting its increasing role in the management of patients with localized disease. By improving the conformance of the radiation fields, IMRT offers a major technical advance.

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Managing Side Effects

665

Prevention and treatment of vaginal stenosis resulting from pelvic radiation therapy

Judith K. Wolf, MD

The University of Texas M. D. Anderson Cancer Center, Houston, TX

As a consequence of pelvic radiation, as many as 88% of women develop vaginal stenosis, which can result in long-term sexual dysfunction. Although there is no definitive treatment or preventive, several measures are available to counter this toxicity.

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patient guide

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COMMUNITY EXPERIENCE
Strategies for helping patients manage the side effects of pelvic radiation therapy

Linda D. Bosserman, MD

Wilshire Oncology Medical Group, Inc., La Verne, CA

Challenging Cases/Rare Cancers

678

Glioblastoma multiforme: advances in postsurgical management

Geetika Mohin, MD, Stefan Madajewicz, MD, James Manzione, MD, and Dinko Franceschi, MD

University of Southern California, Los Angeles, CA, and Stony Brook University Medical Center, Stony Brook, NY

Glioblastoma multiforme is the most common and aggressive form of primary brain tumor in adults, striking 8,000 to 10,000 people per year in North America alone. Even under the most favorable circumstances, patients die within the first 2 years of diagnosis. Recent advances in diagnostic imaging, microsurgical techniques, and medical management of this rare malignancy have led to more accurate diagnoses, staging, improvement in quality of life, and overall survival.

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COMMENTARY
Inroads in managing malignant gliomas renew hope

Myrna R. Rosenfeld, MD, PhD

University of Pennsylvania School of Medicine, Philadelphia, PA

Having Your Say

625

Why aren’t community radiation oncologists adhering to evidence-based guidelines?

Margaret M. Barnes, MD

Campbell County Memorial Hospital, Gillette, WY

Radiation oncologists are ripping off their patients—and the system. It’s bad ethics and bad medicine.

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629

Don’t be so quick to indict

Michael L. Steinberg, MD, FACR, and Paul E. Wallner, DO, FACR, FAOCR

Santa Monica, CA, and Moorestown, NJ

As a field, radiation oncology has stepped up to the plate when it comes to disseminating and promoting guidelines.

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Washington Update

673

Medicare cuts jeopardize imaging access

Dan Cohen

As of January 1, 2007, Congress will make the first in a series of $8 billion reimbursement cuts over 10 years for medical imaging. Unless pending legislation passes to delay the cuts so their impact can be assessed, the next decade, radiation oncologists say, will see a downturn in access and quality care.

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Technology

674

Synchronized swimming: coordinating schedules and calendars with your colleagues

John J. Fried

Unless you run your practice all by yourself, you’ll need to coordinate your calendar with your colleagues. Some technology tips that can help.

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© 2006 by Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher.

The opinions expressed herein are those of the authors or advertisers. The authors, editors, and publishers make every effort to ensure that no inaccurate or misleading data, opinion, or statement is published in this journal and that drug names, dosages, and recommendations are accurate. However, readers should confirm all dosage schedules against the manufacturer’s package information data. The Publisher, Editorial Board, and their employees accept no liability whatsoever for the consequences of any inaccurate or misleading data, opinion, or statement.