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Myelodysplastic Syndromes

General Overview Myelodysplastic syndromes (MDSs) represent a heterogeneous group of myeloid neoplasms characterized by abnormal differentiation and maturation of myeloid cells, ineffective hematopoiesis, and increased risk of transformation to acute myeloid leukemia (AML). Peripheral blood (PB) cytopenias are common, with most patients having multilineage cytopenias. The diagnosis of MDS requires an integrated approach, including morphologic evaluation of PB and marrow smear and biopsy, immunohistochemistry and flow…

Mast Cell and Non-Myeloproliferative Myeloid Neoplasms

General Overview and Incidence Mastocytosis is no longer under the broad category of myeloproliferative neoplasm (MPN). Mastocytosis is a heterogeneous disease of clonal neoplastic proliferation and expansions of mast cells (MCs) that are CD117 + /CD25 + /CD2 + and CD34 negative or delete CD34, and involve the skin, bone marrow, spleen, gastrointestinal tract, liver, and lymph nodes with indolent to aggressive forms and can be…

Myeloproliferative Neoplasms

General Overview Myeloproliferative neoplasms (MPNs) are clonal stem cell disorders characterized by abnormal chronic proliferation of cells belonging to myeloid lineages that are often associated with elevated blood counts, splenomegaly, and a propensity for thrombosis. The World Health Organization (WHO) 2016 classification recognizes MPNs as myeloid neoplasms, and the three classic Philadelphia chromosome (Ph)–negative MPNs are polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF).…

Megaloblastic Anemia

In the workup of patients with suspected megaloblastic anemia, clinical findings, the complete blood count (CBC) with manual differential, and additional diagnostic studies are critical for narrowing the differential diagnosis ( Boxes 4.1 and 4.2 ). Beyond just the hemoglobin/hematocrit tests, the hematologist needs to scrutinize the red blood cell (RBC) indices, including the mean cell volume (MCV) and the red cell distribution width (RDW). The…

Hypochromic and Hemolytic Anemias

Introduction This chapter reviews two separate and partially overlapping types of anemia: hypochromic anemias, resulting from a decreased amount of hemoglobin in red blood cells, and hemolytic anemias, resulting from increased red blood cell destruction. Of the hypochromic anemias, iron deficiency is the most common cause, and indeed the most common overall cause of anemia worldwide. As such, concurrent iron deficiency anemia may complicate interpretation of…

Growth Factors

Hematopoietic Cytokines and Growth Factors Hematopoietic homeostasis is tightly controlled by a group of hematopoietic cytokines ( Fig. 2.1 ). Each cytokine performs unique and/or multiple actions mediated by receptors whose cytoplasmic domains contain specialized regions initiating their various responses, including survival, proliferation, apoptosis, differentiation commitment, maturation, and functional activation. Cytokines are protein molecules and, when regulating cell growth, they are also termed growth factors. Individual…

Normal Hematopoiesis and Blood Cell Maturation

Hematopoietic Development Hematopoiesis is the process by which the various cellular components of the blood are formed. The short-term need for these components can be highly variable, but evidence has accumulated that hematopoietic stem cells (HSCs) are capable of meeting even drastic changes in demand through a variety of differentiation paths. The development of this capacity is complex. It begins in the embryo with a series…

Appendix 2 MD Anderson cancer center head and neck proton case library

Case 1: Unknown primary squamous cell carcinoma T0N1, p16 positive a) Clinical scenario A 46-year-old woman, never smoker, with excellent performance status and otherwise healthy, with a new diagnosis of squamous cell carcinoma (SCC) from unknown primary stage T0N1 (as per the American Joint Commission on Cancer [AJCC] Staging Manual, 8th ed. ), p16 positive. She presented with a right cervical mass. Computed tomography (CT) scan…

The University of Texas MD Anderson cancer center’s recommended proton therapy indications

Recommended breast cancer proton therapy indications Indications 1) Accelerated partial breast irradiation ■ The safety and efficacy of proton partial breast irradiation (PBI) is established for early-stage breast cancer. Proton PBI provides a more homogeneous dose distribution and reduction in exposure to the normal breast, heart, and lung compared with photon and brachytherapy PBI techniques and has been associated with excellent local control and reduced toxicity.…

Technological advancements and outlook in proton therapy

Introduction Intensity-modulated proton therapy (IMPT) using pencil beam scanning (PBS) technology has revolutionized the practice of particle therapy in recent years. , In PBS delivery, a particle pencil beam is magnetically scanned in the plane transverse to the beam direction, creating a large field without requiring scattering elements in the beam paths. Monoenergetic pencil beams with different energies from an accelerator are stacked to create the…

Lung cancer

Introduction Lung cancer is one of the most common malignancies, accounting for approximately 234,000 new cases and 160,000 deaths per year in the United States. Treatment for lung cancer depends on the disease stage at presentation, with disease at early stages treated by surgery or radiation alone and more advanced tumors receiving bi- or trimodality therapy. Several studies have shown dosimetric benefits from particle therapy over…

Esophagus cancer

Introduction Esophageal cancer (EC) is the sixth leading cause of cancer death worldwide and is responsible for 400,000 new cases (4.9% of all cancers) cancer deaths annually. The incidence of EC differs greatly according to geographic region, with the highest incidence in Asian and Middle Eastern countries. In most Western countries, such as the United States, adenocarcinoma has eclipsed squamous cell carcinoma as the predominant histologic…

Proton therapy and sarcomas

Introduction Sarcomas are a rare and heterogenous group of malignant tumors that arise from soft tissues or bone. They constitute less than 1% of all adult malignancies and approximately 12% of pediatric cancers. Approximately 80% to 84% of sarcomas originate from soft tissues, and the rest originate from bone. , Given the histopathologic spectrum and ability of sarcomas to arise anywhere in the body, treatment paradigms…

Pediatric considerations for proton therapy

Introduction Approximately 10,500 cases of childhood cancer are diagnosed each year, which represent about 1% of all new cancers in the United States. Nearly 45% of these cancers will either be acute lymphoblastic leukemia or brain and other central nervous system (CNS) tumors. More than 80% of patients afflicted with childhood cancer will be alive at 5 years from initial diagnosis. In 2014, an estimated 1350…

Proton therapy for hematologic malignancies

Introduction As early as the 1970s, proton therapy was considered a promising treatment for hematologic malignancies, specifically for use in total nodal irradiation, the historic standard of care treatment for Hodgkin lymphoma (HL). In one report, it was recognized that patients treated with 4000 to 4400 rad to the mantle and inverted Y fields experienced considerable morbidity when treated with standard photons, including, but not limited…

Head and neck

Introduction Radiation therapy, whether used as definitive treatment or as an adjuvant to surgery, is an essential component of treatment for many patients with head and neck cancer (HNC). Both photon (x-ray) therapy and proton therapy are standard forms of radiation therapy, and both have evolved over time with the advent of technological advances. Proton therapy has evolved from two-dimensional (2D) and three-dimensional (3D) passive scatter…

Proton therapy for prostate cancer

Introduction The use of proton therapy for the treatment of cancer was first proposed by Robert Wilson in 1946. A beam of protons gives most of its dose at a fixed depth in the tissue known as the Bragg peak, with very little dose deposited beyond that depth. As a result of this physical characteristic, protons are better able to deliver high doses of radiation therapy…

Proton therapy for gynecologic malignancies

Introduction Each year more than 90,000 women are diagnosed with a gynecologic (ovarian, vulvar, vaginal, cervical, uterine, fallopian tube, or primary peritoneal) cancer in the United States. Radiotherapy is often used with curative intent with or without concurrent chemotherapy for locally advanced vulvar, vaginal, or cervical cancer. Women with high-risk features after surgery for cervical, uterine, or vulvar cancer may also receive adjuvant radiotherapy. The standard…

Gastrointestinal

Introduction Proton beam radiation (PBR) has the potential to improve the therapeutic ratio in the treatment of several gastrointestinal malignancies by decreasing the dose to nontarget critical structures. In general, radiotherapy to the abdomen and pelvis is challenging because of the inherent sensitivity of gastrointestinal organs to radiation toxicity. Gastric The role of radiation therapy Postoperative radiotherapy for gastric cancer was once the established standard of…

Adult central nervous system tumors

Introduction For both primary and metastatic brain tumors, radiation therapy (RT) remains one of the standard treatment modalities. Although RT techniques using photons have greatly improved in recent decades, substantial concerns remain among both physicians and patients regarding the potential for long-term side effects after RT to the brain. Adverse effects after RT to the brain are numerous. In consenting when patients give consent for therapy,…