ONCOLOGY Vol 10 No 12

About one in three newly diagnosed cancer patients in the United States receives radiation treatment, which is being used increasingly as the first line of cancer therapy, according to Dr. Steven Leibel, president of the American Society for Therapeutic Radiology and Oncology (ASTRO).

Women who take sex hormones before and during pregnancy are three times more likely to have children who develop cancer, according to researchers at Roswell Park Cancer Institute.

In August, AIDS researchers received some good news when two teams of scientists reported that people born with changes in both copies of a gene called CKR5 seem to have a natural resistance to HIV-1 infection.

After increasing sharply from 1989 through 1992, US prostate cancer incidence rates dropped by 16% for white men and nearly stabilized for African-American men (2% increase) in the latest period available for analysis, 1992 to 1993. These findings, based on the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) cancer registry information and US Census population estimates, are reported in the November 20th issue of the Journal of the National Cancer Institute.

Moving into the final recruitment phase, the researchers of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) are seeking 75,000 more men and women ages 55 to 74 to help them determine whether medical tests to detect some of the most common cancers reduce the number of deaths from these diseases. This largest-ever US cancer screening trial will include a total of 148,000 men and women in 10 cities: Denver, Colorado; Washington, DC; Honolulu, Hawaii; Detroit, Michigan; Minneapolis, Minnesota; St Louis, Missouri; Brooklyn, New York; Pittsburgh, Pennsylvania; Salt Lake City, Utah; and Marshfield, Wisconsin.

Although radiation therapy following lumpectomy for lymph node-negative breast cancer significantly reduces both local and distant disease recurrence, overall mortality is not substantially better in women who receive radiation than in those who do not, according to a Canadian study update report in the November 20th Journal of the National Cancer Institute.

Breast cancer is the most commonly diagnosed nondermatologic cancer and the second leading cause of cancer-related deaths among women in the United States. In 1996, a total of 184,300 new cases of and 44,300 deaths from invasive breast cancer are projected among women. To assess trends in incidence and death rates for breast cancer among US women, the CDC analyzed national incidence data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program and death-certificate data from the CDC's National Center for Health Statistics (NCHS).

Dr. William Brose, director of the Pain Management Center for Stanford University, reported detailed study results from a chronic pain study with SNX-111 at the American Pain Society on November 16, 1996.

Combining two widely known anticancer drugs with radiation therapy can dramatically improve the survival of patients with nasopharyngeal carcinoma, a new clinical trial has shown. In most cases, physicians now recommend only radiation therapy for such patients.

Using antiseptic-impregnated catheters reduces the risk of catheter-related infection, according to a study authored by Dr. Joseph Civetta in the October 1996 issue of Critical Care Medicine.

Intense lobbying by the Intercultural Cancer Council (ICC) resulted in Congress providing $600,000 for a study on "the status of research into cancer among minorities and the medically underserved at the National Institutes of Health." The study will be carried out by an advisory committee expected to be established in early 1997 by the Institute of Medicine. The committee will examine a laundry list of issues, some of them already the subject of analysis by the new NCI office of special populations headed by Otis Brawley, md, an oncologist. Brawley says he is trying to come up with a research agenda that gets beyond some of the myths that have politicized the cancer field. For example, he notes that contrary to conventional wisdom, blacks in many cases form a disproportionately high percentage of participants in cancer treatment trials. Lovell Jones, phd, director of experimental gynecology-endocrinology at the Univeristy of Texas M.D. Anderson Cancer Center, and co-founder of the ICC, says, "Our hope is that the IOM's findings will reveal new research directions and opportunities, and help overcome research shortcomings of earlier years when minority scientists were only on the fringes of U.S. medicine." The IOM will be reporting their findings back to Congress by January, 1998

A national study underway at Virginia Commonwealth University (VCU) will determine whether breast cancer patients can benefit from a biopsy procedure that has been successfully used for skin cancer patients. Patients with melanoma, the most serious kind of skin cancer, have benefited from an advance that has reduced the pain and complications of surgery performed to ascertain whether their cancer has spread.

Using positron emission tomography (PET) scanning may improve the treatment of patients with cancer of the esophagus, potentially resulting in lower morbidity, according to surgeons at the University of Pittsburgh Medical Center.

Researchers at Roswell Park Cancer Institute have cast doubt on the widely held belief that the mutation of the p53 gene triggers the chain reaction of cancer development.

A new 20-member National Cancer Policy Board (NCPB) is being set up within the National Academy of Sciences. Just as we went to press, it was announced that Peter Howley, chairman of pathology at Harvard, had been named chairman and Joseph Simone of the Huntsman Cancer Institute in Utah had been named vice-chairman. Bob Cook-Deegan, the executive director of the NCPB, said that other members will be appointed soon and the first meeting is scheduled for mid-February. Joe Harford, associate director of special projects at the National Cancer Institute, says the new Board hopes to provide a common meeting ground for all interested in furthering cancer research and treatment, including governmental bodies-- federal, state, and local--and private organizations. The Board is not meant to replace but rather supplement other advisory groups already in existence. Its function will be to make recommendations on various aspects of cancer policy. These might be issues such as how managed care affects payment for patients in cancer clinical trials, or the advisability of restrictions on tobacco advertising. The Board may also lend its recommendations to various groups as to how research monies might best be spent. Richard Klausner, Director of the National Cancer Institute, has been an enthusiastic advocate for the new Board, according to Harford. Of course, there already is a three-member President's Cancer Panel. But its members are presidential appointees, and the executive secretary is a member of Klausner's office. The NCI will not have a representative on the NCPB, Harford says. Susan Polan, director of government relations for the American Cancer Society, says the ACS "supports the idea of coordination of all agencies involved in the fight against cancer."

The FDA has granted orphan drug status to methylnaltrexone, a medication that blocks the side effects of morphine without interfering with pain relief.

A study presented at the annual meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO) found that taking Salagen tablets (pilocarpine hydrochloride) during radiation therapy reduces the symptoms of xerostomia more effectively than taking the drug after radiation therapy is completed.

Long-term exposure to estrogen, as measured by bone mineral density, can more than double the risk of breast cancer, according to a study led by researchers at the University of Pittsburgh and reported in the November 5th issue of The Journal of the American Medical Association. Estrogen replacement therapy is often prescribed in women during menopause to reduce hot flashes and other uncomfortable symptoms of this transitional period.

According to a new study published in the October 1, 1996, issue of Blood, Hycamtin (topotecan hydrochloride) offers a promising new treatment option for patients suffering from myelodysplastic syndrome (MDS) and chronic myelomonocytic leukemia (CMML). Patients treated with topotecan achieved a complete response rate of 28%, while currently used single-agent therapies have traditionally achieved a complete response rate of only 10% to 15% among this high-risk patient group. Topotecan, a topoisomerase I inhibitor marketed by SmithKline Beecham, is currently indicated for the treatment of patients with recurrent, metastatic ovarian cancer.

Keeping a daily record of sun-exposure behavior is the latest way for people to find out what they are doing wrong.

Results of a newly published study show that initial empiric monotherapy with the antibiotic meropenem (Merrem) has positive clinical benefits, is well-tolerated, and is a realistic alternative to standard combination therapy (ceftazidime plus amikacin) in the treatment of febrile episodes in neutropenic patients, including those with persistent, profound neutropenia who are at high risk of infection. The study was published in a recent issue of Antimicrobial Agents and Chemotherapy.

NeXstar Pharmaceuticals announced that a team of independent investigators has reported the findings of a phase II study in which DaunoXome (liposomal daunorubicin citrate for injection) was evaluated as a treatment for low- and intermediate-grade non-Hodgkin's lymphoma (NHL). The data, presented November 7, 1996, at the 16th Chemotherapy Foundation Symposium in New York City, included 14 patients whose disease was resistant to conventional chemotherapy or who had relapsed after prior therapy. DaunoXome is NeXstar's proprietary liposomal formulation of the anthracycline chemotherapy agent daunorubicin.

This paper consists of a review of the literature on carcinoma of the anal margin, as well as the authors' institutional experience with this uncommon malignancy. The authors offer recommendations for treatment based on the size of the tumor, which correlates with the T-stage from the TNM or Union Internationale Contre le Cancer (UICC) staging systems. They recommend radiation alone or local excision for T1 lesions, radiation and elective nodal irradiation for T2 lesions, and chemoradiation, including irradiation of the primary tumor and inguinal and pelvic nodes, for T3 and T4 lesions.

Soft-tissue sarcomas arising from the retroperitoneum are rare tumors, and their successful treatment is problematic. This group of tumors tends to be large at presentation, and they exist in a body cavity with few fascial planes to contain them. They frequently abut vital organs or major blood vessels, which further complicates their complete removal.

Soft-tissue sarcomas arising in the retroperitoneum represent an uncommon diagnosis, with approximately 600 new cases per year in the United States. Due to this small database, an assessment of the relative merits of different treatment strategies is not available. It is known is that patients with retroperitoneal sarcomas fare worse in terms of local control and disease-free survival than do patients with soft-tissue sarcoma of an extremity. The reasons for this are unclear but may be due, in part, to the large size of these tumors at diagnosis and the difficulty in obtaining adequate surgical margins.

Historically, patients with retroperitoneal sarcomas have had a poor prognosis. Surgical resection continues to be the standard treatment for these tumors. However, their anatomic location and large size at presentation often

Mendenhall and colleagues provide a useful review of the management of squamous cell carcinoma of the anal margin. Although I generally agree with their conclusions and recommendations for treatment, their paper highlights the continuing difficulties in developing a universally agreed-upon descriptive terminology for the anal region.

Treatment with Mohs micrographic surgery produces cure rates of 93% to 99% for the most common skin cancers, basal cell carcinomas and squamous cell carcinomas, Perry Robins, md, reported in The 1996 Skin Cancer Foundation Journal.

Based on our experience and a review of the literature, we conclude that superficial, well- to moderately differentiated T1 cancers of the anal margin may be successfully treated with radiotherapy alone or local