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In This Issue of JAMA Oncology
July 2018


JAMA Oncol. 2018;4(7):905. doi:10.1001/jamaoncol.2017.3233


The Bone Scan Index (BSI) is a quantitative assessment of bone scan data that represents the tumor burden as a fraction of total skeleton weight. Armstrong et al questioned whether it could be an independent prognostic determinant of survival in men with metastatic castration-resistant prostate cancer. Automated BSI (aBSI) was used in a randomized clinical trial, and of 1245 men enrolled, 721 had evaluable aBSI data. In a multivariable survival model, higher aBSI remained associated with overall survival, time to symptomatic progression, and time to opiate use for cancer pain. This is the largest prospectively analyzed study to validate the aBSI for this purpose. Saad provides an Invited Commentary.

Invited Commentary

Smoking has been shown to influence the growth of prostate cancer. Foerster et al performed a systematic review and meta-analysis to analyze the association of smoking status with biochemical recurrence, metastasis, and cancer-specific mortality among men with localized prostate cancer undergoing prostatectomy or radiotherapy. Studies included were observational and nonrandomized and comprised a total of 22 549 patients. Current and former smokers had a higher risk of biochemical recurrence. Current smokers were also at a higher risk of metastasis and cancer-specific mortality. These data may encourage patients with prostate cancer to stop smoking. Freedland provides an Invited Commentary.

Invited Commentary

Continuing Medical Education

Can pancreatic cancer be down-staged to the point of complete surgical resection following neoadjuvant therapy? Murphy et al enrolled 48 patients in a single-arm phase 2 study of FOLFIRINOX for 8 cycles, restaging, and then short-course chemoradiotherapy (5 Gy × 5 with protons) with capecitabine in patients with resolved vascular involvement. Patients with persistent vascular involvement received long-course chemoradiotherapy with fluorouracil or capecitabine. R0 resection was achieved in 31 of 48 eligible patients. These data support ongoing phase 3 trials of this regimen.

Early detection of cancer can result in successful surgery, leading to long-term survival. Markar et al developed a breath test for the diagnosis of esophagogastric cancer measuring volatile organic compounds. They validated the accuracy of testing in a multicenter study of 335 patients, including 163 with esophageal or gastric cancer and 172 controls. The breath test had a sensitivity of 80% and specificity of 81% for the diagnosis of esophagogastric cancer. The breath test compares favorably to endoscopy for early detection.

Ho et al evaluated the association of total nodal burden of disease with outcomes in 8351 patients with hypopharyngeal and laryngeal malignant neoplasms. Mortality risk escalated continuously as the number of metastatic lymph nodes increased. Extranodal extension was also associated with increased mortality. The authors found that the number of metastatic nodes was an independent factor associated with mortality in hypopharyngeal and laryngeal cancers. Standard staging factors such as lymph node size and location have no independent prognostic value when accounting for positive lymph node number. Orosco and Cohen provide an Invited Commentary.

Invited Commentary