Devita, Hellman, and Rosenberg's Cancer

LWBK1006-40 LWW-Govindan-Review December 12, 2011 20:33

514 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Answer 40.8. The answer is D.

Presence of extra-cranial metastases is associated with a decreased median

survival in these patients, while the other factors listed are associated with

improved median survival times.

Answer 40.9. The answer is C.

Approximately half of all pericardial effusions that require intervention

are due to malignant effusions. Like pleural effusions due to malignancy,

malignant pericardial effusion is indicative of advanced, incurable malig-

nancy. Symptoms include dyspnea, cough, chest pain, and fever. Treat-

ment options include simple pericardiocentesis, pericardial window, peri-

cardiectomy, and percutaneous tube pericardiostomy with or without

installation of sclerosing agents like bleomycin. Radiation therapy is use-

ful to control malignant pericardial effusions due to lymphoma/leukemia

and breast cancers.

Answer 40.10. The answer is D.

Tumor deposits less than 10 mm result in better drug absorption. In fact,

this has served as the rationale for aggressive surgical cytoreduction. Using

hyperthermic intraperitoneal therapy, Ben-Ari et al. reported complete

resolution of malignant ascites in 38 of 41 patients with varying histolo-

gies.

Answer 40.11. The answer is D.

All of the above factors have independent prognostic significance in

patients with colorectal cancer undergoing ablative therapy for liver

metastases. Additional factors include successful cryotherapy of all hep-

atic lesions and metachronous (vs. synchronous) liver metastases.

Answer 40.12. The answer is C.

Myelosuppression, especially thrombocytopenia is the main toxicity with

radionuclide treatment of bone metastases. As opposed to standard

chemotherapy, radionuclide-induced thrombocytopenia is delayed with

a nadir 4 to 6 weeks after treatment which may take 6 to 10 weeks for

complete recovery.

Answer 40.13. The answer is D.

The use of RSR13 in breast cancer primaries with brain metastases

was associated with improved median survival of 8.7 months compared

with 4.6 months in the control arm of WBRT alone. (Suh et al. Neuro-

Oncology. 2003;5(4):345) Other responses are correct.

Answer 40.14. The answer is C.

Rectal primary is associated with a shorter overall and disease-free sur-

vival in patients with liver metastases undergoing neoadjuvant therapy

followed by resection. Other poor prognostic factors include disease