ONCOLOGY Vol 10 No 11

Leukemia Society of America (LSA) scientist Dr. Brian Druker has described a drug that may be useful for combatting chronic myelogenous leukemia (CML). The new drug may be able to target leukemia cells, a much sought-after approach to cancer treatment.

A team of researchers at Ohio State University's Comprehensive Cancer Center have isolated and cloned a gene that may play a role in breast cancer.

The option of reconstruction after mastectomy for breast cancer is often not discussed with indigent patients, according to a study presented at the 65th Annual Meeting of the American Society of Plastic and Reconstructive Surgeons (ASPRS) held in Dallas, Texas.

Until 1980, the greatest advances in the management of rectal cancer were technical ones. Whereas in the past most patients with rectal cancer underwent an abdominoperineal resection, it became possible in the 1980s to maintain intestinal continuity in the majority of patients with a low anterior resection and colorectal anastomosis and, more recently, with a low anterio resection and coloanal anastomosis. These advances were due, in part, to the development of stapling devices, which allowed surgeons to perform anastomoses that were technically difficult to perform by hand. More importantly, it became clear that in tumors identified at a relatively early stage, retrograde tumor spread was uncommon, and a 2-cm distal margin was generally adequate.

A controversial treatment for melanoma, elective lymph node dissection (ELND), has again been shown to provide important prognostic information, according to a study presented at the 65th Annual Meeting of the American Society of Plastic and Reconstructive Surgeons (ASPRS) held in Dallas, Texas. Although the retrospective study did not demonstrate that ELND makes a difference in patient survival, it indicated that the information gained from the removal and testing of the lymph nodes could be crucial in predicting the patient's prognosis.

Researchers at Duke University Medical Center have found that the very population most likely to be affected by legalizing physician-assisted suicide is the group that favors it the least.

A typical glandular cells detected on cervical Pap smears indicate significant cervical pathology in 17% of cases and require an immediate work-up and biopsy, according to research reported in the October issue of Gynecologic Oncology, the scientific publication of the Society of Gynecologic Oncologists (SGO).

Researchers report that depleting bone marrow of contaminating malignant cells with anticancer drugs prior to transplantation (purging) may increase long-term survival in certain leukemia patients. This was the conclusion of a comparative study of purged vs nonpurged marrow in patients with acute myelogenous leukemia (AML). The findings were presented at the annual meeting of the American Society of Clinical Oncology (ASCO).

Patients with advanced non-small-cell lung cancer (NSCLC) who are treated with chemotherapy and radiation therapy live longer, on average, than patients treated with radiation therapy alone, according to results of a long-term follow-up study by Robert O. Dillman, md, and colleagues at the Hoag Cancer Center, Newport Beach, California. In the study report appearing in the September 4th issue of the Journal of the National Cancer Institute, the authors recommend that cisplatin (Platinol)-based chemotherapy followed by radiation therapy be considered the current standard treatment for advanced (stage III) disease.

Dr. Enker offers an orderly presentation of many of the factors related to sphincter-preserving operations, quality of life, and outcome in the surgical management of the patient with rectal cancer. From the practical perspective of a very experienced surgeon, he provides broad guidelines for sphincter-conservation surgery that both the surgeon and nonsurgeon should find useful.

A cancer vaccine developed by Duke University Comprehensive Cancer Center researchers is showing promise in mice for treating brain tumors that had been thought "off limits" for the immune system.

In a surprising finding that suggests radical changes in the way prostate cancer is managed, researchers at the University of Chicago Medical Center have shown in laboratory experiments that the male hormone testosterone, which fuels prostate cancers early in their growth, can in later stages cause tumors to stop growing or even shrink.

Superficial bladder cancer can be a frustrating disease for both the patient and physician. It has been referred to as a "nuisance disease" because of its propensity for recurrence, necessitating frequent cystoscopies and trips to the operating room for resection of recurrent disease. In addition, however, there looms for the patient and physician the 10% to 15% probability of disease progression, often requiring cystectomy to achieve local control and placing the patient at much greater risk for disease mortality. The challenge is to predict which patients will benefit from adjuvant therapy in order to avoid disease progression and, secondarily, disease recurrence.

The article by Moore provides an example of much needed research evaluating clinical outcomes in head and neck oncology. Measuring the quality of life (QOL) of patients with head and neck cancer presents some unique challenges. First, head and neck cancer profoundly influences some of the most fundamental functions of life, including breathing, eating, and communication. Second, treatment of head and neck cancer does not always improve these functional deficits, and in many instances, the treatment itself results in further deterioration of these functions. Finally, "traditional" outcome measures (disease-free survival, overall survival, local and regional control, response rates) do not adequately assess the global impact of this disease and/or its treatment on patients' perception of life satisfaction.

Dr. Grossman's article provides a well-organized review of the literature on the treatment of superficial bladder cancer. At the time of diagnosis, approximately 80% of patients with bladder cancer have superficial tumors (limited to the urothelial lining of the bladder or the underlying lamina propria). In such patients, the risk of distant disease is low, and the natural history of bladder cancer is based on two separate, but related processes: tumor recurrence and progression to a higher stage of disease.

This review nicely summarizes the current state of combined-modality therapy for resectable rectal cancer, largely covering trials currently in progress in the United States. Although the article's title is "Multidisciplinary management of resectable rectal cancer," it really doesn't emphasize how multiple specialists manage rectal cancer patients per se, and thus, the article would probably be more appropriately titled, "Combined-modality therapy in resectable rectal cancer." It would have been interesting if the article had included more details on how radiation oncologists, medical oncologists, and surgeons can cooperate to deliver combined-modality therapy in higher proportions of patients with resectable rectal cancer, but this is a minor criticism.

Drs. Mason and Levesque thoroughly review data from intervention trials and epidemiologic studies that suggest a role for folate in preventing cancer of the colorectum and, to a lesser degree, cancers of the uterine cervix, lung, esophagus, and stomach. The authors also provide a comprehensive discussion of the possible mechanisms by which folate may prevent cancer, in particular, the relationship between folate status and DNA methylation.

Quality-of-life (QOL) research in patients treated for head and neck cancer is in its infancy. Early research focused on psychosocial issues related to extensive surgical resection and its consequences. Many advances

The standard adjuvant therapy for resectable T3 and/or N1-2 rectal cancer is pelvic radiation therapy plus fluorouracil (5-FU)-based chemotherapy. Two randomized intergroup trials, INT 0114 and INT 0144, will help

A provocative array of observations from both laboratory and clinical investigations indicates that alterations in folate status modulate the process of neoplastic transformation in selected epithelial tissues. Diminished folate

In his excellent, thorough review of the current status of multidisciplinary treatment for rectal cancer, Dr. Minsky appropriately emphasizes the role that data from prospective clinical trials have played in providing the foundation for adjuvant therapy for patients with this disease. The principal therapeutic options discussed by Dr. Minsky are preoperative therapy and postoperative therapy.

Sphincter-preserving operations represent an important model for integrating the goals of surgery for rectal cancers. These goals--the achievement of cure and local control and the preservation of autonomic visceral