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Gastrointestinal Cancer

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In this extensive review of the literature, Weber and Petrelli have nicely placed into perspective and documented the methods used in and results of most of the studies on local excision for rectal cancer. Although I agree with many of their conclusions, it is difficult for me to agree with the title of their article, "Local excision for rectal cancer: An uncertain future."

BETHESDA, Md--When it comes to avoiding colon cancer, Grandma was right: Eat your vegetables, take vitamins, and forget that burger, for goodness sakes. Edward Giovannucci, MD, conveyed this basic message at a workshop on preventing colon cancer, held in conjunction with the American Society of Preventive Oncology (ASPO) annual meeting.

BETHESDA, Md--Understanding the complex association of lifestyle and colon cancer risk requires evaluating a number of different behavioral factors, and these may best be studied as clusters rather than individual items, Martha Slattery, PhD, MPH, said at the American Society of Preventive Society (ASPO) meeting.

BETHESDA--Diet, physical activity, obesity, and aspirin use all influence the risk of colon cancer, according to both the underlying biology and evidence from epidemiologic studies, Graham Colditz, MD, DrPH, associate professor of medicine, Harvard Medical School, said at the American Society of Preventive Oncology (ASPO) annual meeting.

WASHINGTON--The advent of Medicare-funded colorectal cancer screening this year followed on the heels of new colorectal screening guidelines issued last year. Some of the physicians and researchers who developed those guidelines gathered in Washington to celebrate the new Medicare benefit.

COLUMBUS, Ohio--Rectal cancer is treated with a wide variety of operations and adjuvant therapy. This variety makes extensive preoperative evaluation mandatory, said Karamjit Khanduja, MD, chief of the Division of Colon and Rectal Surgery, Mt. Carmel Health, Columbus, Oho.

PARIS--Hepatic intraarterial (HIA) chemotherapy coupled with aggressive resection may improve the outlook for patients with liver metastases from colorectal cancer, Nancy Kemeny, MD, of Memorial Sloan-Kettering Cancer Center, said at the Eighth International Congress on Anti-Cancer Treatment (ICACT).

ORLANDO--A new high dose rate/intraoperative radiation therapy (HDR-IORT) delivery system utilizing the Harrison, Anderson, Mick (HAM) applicator is proving effective in treating primary unresectable and locally advanced, recurrent rectal cancer.

Scientists at the American Health Foundation’s Nutritional Carcinogenesis Division, under the direction of Dr. Bandaru S. Reddy, division chief and associate director of the Foundation’s Naylor Dana Institute, Valhalla, New York, and Dr. Karen Seibert of Searle Research & Development, St. Louis, Missouri, described an exceptionally strong inhibitor of colon cancer development in an animal model assay in the February 1, 1998, issue of Cancer Research.

PHILADELPHIA-Thomas Jefferson University’s new Familial Colorectal Cancer Registry is collecting information and blood and tissue samples from families with a higher-than-normal risk of colon cancer, to aid researchers looking for genetic markers of the disease and to provide genetic counseling and genetic testing, if appropriate, to participants.

Researchers from the University of Wurzburg in Germany have determined that a simple antibody test may be as effective in detecting Helicobacter pylori infection as the more invasive procedures that are currently used. They reported their findings

The enormous influence of the surgeon on outlook in cancer was stressed by Professor Cornelis van de Velde of the Department of Surgery, Leiden University Medical Center, the Netherlands, during the 1997 European Cancer Conference.

CHICAGO-Recent clinical evidence clearly indicates that primary care physicians should offer colon cancer screening to all patients over age 50. “If you are not having this discussion, if you are not making this offer, you will be viewed as providing incomplete care,” said Steven H. Woolf, MD, MPH, professor of family practice, Medical College of Virginia, Richmond.

HAMBURG-The challenge in the treatment of pancreatic cancer “is to take systemic therapy one step further, whether it’s with new drugs or with novel approaches based on new biologic information,” Margaret Tempero, MD, of the University of Nebraska Medical Center, Omaha, said at the Ninth European Cancer Conference (ECCO 9), sponsored by the Federation of European Cancer Societies.

HAMBURG-A 10-center phase III trial from the Netherlands has revealed that adjuvant vaccine therapy not only reduces the risk of recurrence but also prolongs relapse-free survival in patients with Duke’s B2, B3, or C colon cancer, Dr. J.B. Vermorken reported at the Ninth European Cancer Conference (ECCO 9).

Therapeutic options for patients with advanced colorectal cancer who have failed treatment with fluorouracil (5-FU) are limited. Responses have been reported in this setting with a protracted venous infusion of 5-FU. Daily oral therapy with tegafur and uracil (UFT) plus leucovorin (LV) has the potential to mimic the pharmacology of continuous infusion 5-FU. Therefore, we undertook a phase II study of a 28-day schedule of a combination chemotherapy regimen containing oral UFT/leucovorin in patients with measurable metastatic colorectal cancer who had failed treatment with bolus 5-FU. In addition, we sought to determine whether coadministration of UFT and leucovorin alters the bioavailability of these agents. In a pretreatment phase, each patient underwent sequential pharmacokinetic sampling following a single dose of UFT alone, leucovorin alone, and the combination of UFT plus leucovorin. The preliminary results of this trial suggest that tegafur pharmacokinetics are not affected by coadministration of leucovorin and that folate pharmacokinetics are not affected by UFT. [ONCOLOGY 11(Suppl 10):22-25, 1997]

To evaluate the significance of postoperative adjuvant chemotherapy using mitomycin C (MMC) and UFT (tegafur and uracil) in combination, the Japanese Foundation for Multidisciplinary Treatment of Cancer conducted a prospective randomized controlled trial with 834 patients who had undergone curative resection for rectal cancer (T3 or T4 tumors and/or N1, N2, or N3 disease). The patients were randomly allocated to a treatment group (MMC/UFT, 416 patients) and a control group (surgery only, 418 patients). For patients in the treatment group, 20 mg of MMC was sprinkled on the operating field upon completion of surgery. MMC was intravenously injected at 6 mg/m2 on day 7, and then each month after surgery for 6 months. UFT was administered orally at 400 mg/day for 1 year. Although no difference was observed in the 5-year survival rate between the two groups, the 5-year disease-free survival rate in the MMC/UFT group was 69.1%, which was significantly higher than in the control group (59.3%, P = .005). The 5-year cumulative local recurrence rate was significantly lower in the MMC/UFT group (11.6%) than in the control group (19.0%) (P = .0071). We conclude that the adjuvant use of long-term oral UFT and intermittent intravenous MMC improves the disease-free survival rate of patients with curatively resected rectal cancer. [ONCOLOGY 11(Suppl 10):40-43, 1997]

The oral fluoropyrimidines have proved to be active in colorectal cancer in Japan and, recently, in the United States and Europe. Continuous oral administration simulates protracted fluorouracil (5-FU) continuous