Gastrointestinal Cancer

CHICAGO--Over the last decade, increasing attention has been paid to the palliative care of patients whose colon cancer has not responded to curative treatment so that they may achieve the best possible quality of life.

NEW YORK--A novel nucleoside analog has demonstrated clinical benefits measured by reduction in pain, weight gain, and an improvement in performance status in patients with advanced pancreatic cancer.

Menko and colleagues review the genetic counseling that occurs after the presymptomatic diagnosis of hereditary nonpolyposis colorectal cancer (HNPCC) is made. The discovery of the mechanism by which tumors develop in this setting and the cloning of the genes responsible for the disease have made possible the DNA-based diagnosis of a disease, which, less than 5 years ago, was a controversial entity. In a remarkably short period, the nature of HNPCC has been greatly elucidated, its relationship to defective DNA mismatch repair has become manifest, and the means to diagnose it in a presymptomatic state has been developed [1].

Recent identification of gene mutations responsible for hereditary nonpolyposis colorectal cancer (HNPCC) has made possible the presymptomatic diagnosis of at-risk family members. If DNA testing shows that a family member is a gene carrier, that individual's lifetime cancer risk is approximately 90%. If the test is negative, the family member's cancer risk drops to that of the general population.

BOSTON--Aspirin appears to reduce the risk of colorectal cancer in women, but only if taken regularly for 10 years or more, report Edward Giovannucci, MD, and his colleagues from Harvard Medical School.

MIAMI BEACH--Patients treated for Hodgkin's disease are at moderately increased risk of developing secondary gastrointestinal (GI) cancer, Sandra H. Birdwell, MD, said at the American Society for Therapeutic Radiology and Oncol-ogy (ASTRO) meeting.

The endoscopic diagnosis, staging, and therapy of gastrointestinal (GI) malignancies has advanced rapidly and dramatically over the past 15 years. Video-endoscopy has generally replaced fiberoptic endoscopy, and the digitally based fidelity, sharper resolution, and improved magnification of the video-endoscopic image offers a potentially better approach for the evaluation of mucosal abnormalities.

ROCKVILLE, Md--Because advanced pancreatic cancer is a devastating disease with no effective treatment, members of the FDA Oncologic Drugs Advisory Committee (ODAC) voted to recommend approval of the nucleoside analog Gemzar (gemcitabine hydrochloride, Eli Lilly) as a first-line treatment for patients with nonresectable stage II, stage III, or metastatic (stage IV) adenocarcinoma of the pancreas.

MONTREAL, Canada--Tomudex (ZD1694), a new direct and specific thymidylate synthase (TS) inhibitor, has been shown to be especially promising for the treatment of patients with advanced colorectal cancer, David Cunningham, MD, said at the 19th International Congress of Chemotherapy.

PARIS, France--Biochemical modulators have brightened the prospects for patients with advanced gastrointestinal cancer, Scott Wadler, MD, reported at the American Radium Society annual meeting.

BOSTON--A radiolabeled monoclonal antibody (MoAb) currently under investigation may improve detection of recurrent colorectal cancer, said Dr. Frederick Moffat, associate professor of surgery, University of Miami Medical School.

Intraoperative radiation therapy (IORT) has the obvious advantage of maximally irradiating the tumor bed while eliminating surrounding normal organs from the field of radiation. This approach has been especially useful when the required radiation dose exceeds the tolerance dose of the surrounding normal tissues. However, the application of IORT has been significantly limited by cost, logistic issues, and technical problems related to delivering treatment to difficult anatomic areas. We have developed a new approach to IORT that obviates the need for patient transport: In a dedicated, shielded operating room, the surgery is performed and IORT is delivered via HDR remote afterloading. We have found this approach to be cost effective, logistically sound, and suitable for a wide range of anatomic sites. The technical aspects of the procedure, as well our preliminary results in colorectal cancer, will be presented. Lastly, the authors present the technical aspects of delivering HDR intraoperative brachytherapy, their dosimetry atlas, and their results using HDR-IORT in the treatment of patients with colorectal cancer[ONCOLOGY 9(7):679-683, 1995]

FORT LAUDERDALE, Fla--Because colon cancer develops in a stepwise progression that occurs over 10 to 15 years, physicians have a "tremendous window of opportunity for prevention," Sidney Winawer, MD, of Memorial Sloan-Kettering Cancer Center, said in a presentation at the second annual Industries' Coalition Against Cancer (ICAC) conference. He believes that colorectal cancer screening is "no longer controversial," based on available data.

The authors have nicely reviewed many of the issues surrounding laparoscopic colon cancer surgery. However, we would like to offer a slightly different perspective on several points which they make.

INDIANAPOLIS--Eli Lilly and Company has received FDA approval to provide gemcitabine (Gemzar) to advanced pancreatic cancer patients through a Treatment Investigational New Drug program.

LISBON, Portugal--Although folinic acid and interferon have been shown to heighten the efficacy of 5-fluorouracil (5-FU) in colorectal cancer, the ability of these biochemical modulators to prolong survival is less certain. Now a prospective randomized trial conducted in Germany has revealed that patients with advanced, symptomatic colorectal cancer who are treated with 5-FU and folinic acid live longer and have a better quality of life than do those who receive 5-FU and interferon.

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