Devita, Hellman, and Rosenberg's Cancer

LWBK1006-29 LWW-Govindan-Review December 9, 2011 15:36

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

microscopic residual disease is 41 to 50 Gy. Tested in IRS IV, hyperfrac-

tionated radiation had no added benefit over conventional fractionated

radiation. Surgical resection should be attempted in the place of an inci-

sional biopsy upfront only if the tumor is completely resectable. No radi-

ation is necessary in the event of complete resection of the tumor without

microscopic residual or regional extension.

Answer 29.37. The answer is D.

All the other tumors have similar light microscopy features that group

them into this category.

Answer 29.38. The answer is B.

The lung, bones, and bone marrow are the most common sites of

hematogenous spread of Ewing sarcoma. Lesions that originate in

long bones characteristically involve the diaphysis. Parallel lamellated

periosteal new bone formation frequently presents with an “onion skin”

appearance. Radionuclide scans determine the presence of bone metas-

tases. CT or MRI scans detect the presence of associated soft tissue masses

and lung lesions.

Answer 29.39. The answer is B.

The main feature that distinguishes osteosarcoma from other tumors that

arise from primitive mesenchymal cells is the production of osteoid and

thus is the sine qua non for this tumor.

Answer 29.40. The answer is D.

Osteosarcomas are not very sensitive to radiation therapy. All other treat-

ment modalities are used. Adjuvant chemotherapy has increased osteosar-

coma survival rates to more than 60%. Juxtacortical osteosarcomas

(parosteal and periosteal) that do not invade the medullary cavity may be

treated with surgical resection alone.

Answer 29.41. The answer is B.

Pelvic tumors, even when nonmetastatic, herald a poor prognosis perhaps

because of poor resectability at this location. Patients with type 1 fusion

transcripts of EWS-FLI1 have a 5-year EFS of 70% in contrast with 20%

for all other types of fusion transcripts. Low lactate dehydrogenase levels

and good response to therapy are other predictors of a better prognosis

in Ewing sarcoma.

Answer 29.42. The answer is D.

Although it is still being explored, previous studies have shown no benefit

to adding myeloablative chemotherapy and stem cell rescue to standard

chemo/radiotherapy and surgery in patients with high-risk disease.

Answer 29.43. The answer is A.

Hepatoblastoma is the most common primary hepatic tumor in the young

with a median age at presentation of 1 year. In contrast, the median age at