Clinical Trials Involving SLNMapping for Breast Cancer

Three prospective, randomized clinical trials are evaluating SLNB in women with breast cancer. The National Surgical Adjuvant Breast and Bowel Project (NSABP) B-32 opened in 1999 and randomized women with clinically node-negative early-stage breast cancer to undergo SLNB alone, or SLNB with mandatory ALND. For patients randomized to the SLNB-alone arm, if the node was positive then an ALND was offered.The goal of the NSABP B-32 trial is to determine the value of SLNB alone compared to SLNB followed by ALND for patients with a histologically negative SLN.

Conclusion

Sentinel lymph node mapping and biopsy is a relatively new technique for staging and treating patients with melanoma or breast cancer.With tremendous benefits and minimal risk, SLNB has become so widely adopted that elective lymph node dissections are practically antiquated. Although this procedure has a learning curve, most surgeons who treat breast cancer and melanoma have been able to incorporate this technique into their practice.

Results from the clinical trials presented in this article will answer many questions about SLN mapping and will likely change the management of these diseases significantly over the next few years.A multidisciplinary team approach will certainly help physicians evolve as novel therapies and treatment algorithms are developed.

ACRO Meeting Focuses on Successes and Challenges for Radiation Oncologists`

The American College of Radiation Oncology (ACRO) held its 16th annual meeting at Disney’s Contemporary Resort in Orlando from February 23–25, 2006. The meeting’s program reflected the state of the field, including recent advances and current challenges.

Educational Program

Brian Kavanagh, MD, from the Anschutz Cancer Pavilion in Aurora, CO, explained the historical development and basic concepts of stereotactic body radiation therapy. John Kresl, MD, PhD, from St Joseph’s Hospital in Phoenix, AZ, followed with a review of robotic radiosurgery, pointing out its ability to correct continuously for patient and target motion. Then Anjit Singh, PhD, from Siemens Medical Solutions, gave an overall perspective of adaptive radiotherapy, showing how radiation oncologists must approach the problem of treating a tumor that changes its location and shape.

Intensity-modulated radiation therapy (IMRT) was also a hot topic. Arno Mundt, MD, from the University of Chicago, IL, suggested that gynecologic IMRT could be an alternative to brachytherapy for cervical and endometrial cancers. Seymour Levitt, MD, from the University of Minnesota, extolled advances in targeting radiotherapy, but warned ACRO members to be aware of the limitations of IMRT. He and Clifford Chao, MD, from the M D Anderson Cancer Center in Houston, TX, reminded meeting attendees that they needed to have the proper expertise to handle the targeting. In addition, the University of Alabama’s Ruby Meredith, MD, PhD, described clinical trials to evaluate radiolabeled antibody therapy, especially as it relates to non-Hodgkin lymphoma. Roger Macklis, MD, from the Cleveland Clinic, OH, noted how radioimmunotherapy must involve cooperative efforts between radiation oncologists and those in nuclear medicine.

Other procedures discussed were Y-90 miscrosphere brachytherapy for liver malignancies (by Andrew Kennedy,MD, of Wake Radiology Oncology in Cary, NC), the integration of antiangiogenic therapy (by Michael O’Reilly,MD, from the M D Anderson Cancer Center), and heat shock proteins as a model for new molecular targets (by David Gius,MD, PhD, of the National Cancer Institute, Bethesda, MD). The future of radiation oncology was previewed by Lajos Balogh,PhD, from the Roswell Park Cancer Institute in Buffalo, NY, who told the ACRO attendees about nanotechnology and its potential application for radiation therapy.

Economics and Regulations

Tim Williams, MD, from Boca Raton Community Hospital, FL, focused the meeting on economic issues when he described reimbursement as it pertains to targeted therapies. Further, Michael Kuettel, MD, PhD, MBA, also from the Roswell Park Cancer Institute, gave ACRO members a healthcare economics update. He also introduced Jennifer Dreyfus, MBA, a Washington consultant from Competitive Health Systems, who is being retained by ACRO to help members understand federal regulatory language. Andrew Woods, Esq., a long-time legal consultant for ACRO, from the Washington, DC, firm of King & Spalding, gave a sobering statement that Americans elect politicians who promise to cut taxes yet expect the highest quality healthcare. He emphasized that ACRO must work to convince government officials to continue funding for new technologies.

In addition, David Diamond, MD, from the Florida Oncology Network, talked about nuclear regulatory activities, and Robert Keenan, Esq., also from King & Spalding, talked about updates in the Stark antireferral laws.

Exhibitor Support

Nearly 50 technical exhibitors were in an adjacent hall to show off their latest wares and practice-management strategies.Vendors also funded breakfasts or lunches that featured speakers discussing subjects such as respiratory gating, radioprotection, and highdose- rate brachytherapy for cervical cancer.

The ACRO meeting is also a time to honor those in the field.The organization’s Gold Medal was given to former ACRO president and chairman A Robert Kagan, MD, who continues to serve as the editor-in-chief of the organization’s newsletter. Ralph Dobelbower, MD, PhD, who was instrumental in the development of the ACRO practice accreditation program, was given the prestigious Simon Kramer Award, named after one of the founders of ACRO.An additional three dozen physicians were inducted as new Fellows of the College.

ACRO Chairman James Rubenstein, MD, reminded meeting attendees of the many activities of ACRO, including a practice review and accreditation program, sponsorship of coding workshops, lobbying efforts, publication of a practice management guide, and the annual meeting. He added that ACRO would be featuring a new malpractice insurance program for radiation oncologists, and he announced that the American Journal of Clinical Oncology had recently been designated the organization’s official journal. The next annual ACRO meeting, he said, would be held at the Hotel del Coronado in San Diego, CA, from February 22–24, 2007.