ONCOLOGY Vol 10 No 4

Radiosurgery plus the radiation sensitizer etanidazole is being evaluated in a Radiation Therapy Oncology Group trial (RTOG 95-02) as a treatment for recurrent or persistent brain tumors or metastases.

During the 1980s, HIV infection emerged as a leading cause of death in the United States. In 1993, HIV infections became the most important cause of death among persons age 25 to 44 years. This report updates national trends in deaths caused by HIV infection in 1994.

Sequential dosing may improve the effectiveness of adjuvant chemotherapy regimens in node-positive breast cancer, by limiting overlapping toxicity while maximizing dose-intensity, Clifford A. Hudis, MD, said at the Chemotherapy Foundation's 13th annual symposium. At Memorial Sloan-Kettering Cancer Center, where Dr. Hudis is assistant attending physician in the Breast Cancer Medicine Service, researchers are testing a sequential dosing regimen that combines doxorubicin, paclitaxel (Taxol), and cyclophosphamide, supported by granulocyte-colony stimulating factor (G-CSF, Neupogen).

Combined treatment involving surgery and radiotherapy is a reasonable alternative to surgery alone in high-risk patients with dermato-fibrosarcoma protruberans (DFSP), Canadian researchers reported at the American Society for Therapeutic Radiology and Oncology (ASTRO) meeting.

The anticancer benefits of nonsteroidal anti-inflammatory drugs (NSAIDs), seen in studies of colon cancer risk, may extend to human breast cancer as well.

Approximately three-fourths of all skin cancer-associated deaths are caused by melanoma. During 1973 to 1991, the incidence of melanoma increased approximately 4% each year. In addition, the incidence of melanoma is increasing faster than that of any other cancer. To characterize the distribution of deaths from melanoma in the United States, the CDC analyzed national mortality data for 1973 through 1992. This report by the Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, summarizes the results of that analysis.

The treatment of childhood leukemias and lymphomas is one of modern oncology's major success stories. Today, 80% to 85% of childhood cancer patients grow up free of their disease. But the very treatment that, in most cases, cured these young patients leaves many of them at risk for other problems later in life.

For the oncology profession, the transition period to managed care will mean new relationships with other providers, some loss of control over patient care, and the need for practice and ethical guidelines, concluded panelists participating in a session on managed care at the Association of Community Cancer Centers' 1995 Oncology Symposium.

Graft-versus-host disease (GVHD) represents a significant, perhaps neglected, complication of unrelated bone marrow transplantation, stated Daniel Weisdorf, MD, Professor of Medicine at the University of Minnesota, and Associate Director of the Adult Bone Marrow Transplantation Program, at a symposium on "Clinical Issues in Unrelated Marrow Transplantation" held in association with the recent meeting of the American Society of Hematology. Prolonged immunocompromise is an additional hazard to recipients of unrelated bone marrow transplants.

For patients with either limited or extensive small-cell lung cancer (SCLC), dose intensification of VICE chemotherapy affords a significant survival advantage without increasing the danger of sepsis or drug-related death, W.P. Steward, MD, said at the Eighth Annual European Cancer Conference (ECCO-8).

Researchers at two major medical centers have found that radiation therapy is just as successful as surgery in treating younger men with early-stage prostate cancer. Currently, men 60 years old or under with prostate cancer are far more likely to be treated with surgery than with radiation therapy.

Monoclonal antibodies (MoAbs) show promise as a prognostic as well as therapeutic tool in some minimal residual cancers, said Gert Riethmüller, MD, of the University of Munich's Institute for Immunology.

There already is a strong body of evidence suggesting that long-term, consistent use of nonsteroidal anti-inflammatory agents (NSAIDs) reduces the relative risk of colon cancer. Questions recently have been raised, however, concerning the way in which these drugs exert their protective effect.

A new DNA-based sequencing technique-Sequence Based Diagnosis (SBD)-that determines p53 gene status in primary breast cancers, yields better prognostic information than standard immunohistochemistry, according to a study in the February 20, 1996, issue of the Journal of the National Cancer Institute. The findings may have important implications for some of the over 180,000 US women diagnosed annually with breast cancer.

The bulk of available evidence has made a persuasive case for early bone marrow transplantation as the treatment of choice for patients with relapsed Hodgkin's disease, Philip J. Bierman, MD, said at a lymphoma conference sponsored by the University of Texas M.D. Anderson Cancer Center.

The use of antibodies as immunodelivery systems is still in its infancy, Sydney Welt, MD, said at a symposium on Monoclonal Antibodies and Cancer Therapy, sponsored by the Cancer Research Institute.

Breast-conserving surgery without radiation therapy is not an effective treatment for early-stage breast cancer, a Harvard Medical School study concludes.

Efforts to improve the rate of remission and reduce the risk of relapse in patients with advanced hematologic malignancies are focusing on interleukin-2 (IL-2, aldesleukin, Proleukin), said Alexander Fefer, MD, of the University of Washington Medical School and Fred Hutchinson Cancer Research Center, Seattle.

An experimental approach combining immunotherapy with conventional chemotherapy may succeed in delivering a "one-two punch" to many common tumors of epithelial origin.

Although most studies of the relationship between oral contraceptives (OCs) and breast cancer have focused on a possible causative role for OCs, new data suggest that breast cancer patients with a history of OC use may actually fare better than women who have never taken the pill.

As managed care grows, oncologists will have to decide who to "bond" with, then learn how to develop financially sound contracts with their new partners, Lee E. Mortenson, DPA, said at the 1995 Oncology Symposium of the Association of Community Cancer Centers (ACCC).

In the 30 years since the first Surgeon General's report, progress has been made in educating the public about the dangers of tobacco use.

Radiation Therapy Oncology Group (RTOG) trial 93-05 started slowly, but is now accruing on target, enrolling three patients per month, says Dr. Luis Souhami, chair of the study. To date, 40 patients are enrolled in the study.

African-American breast cancer patients survive as long as their Caucasian counterparts, a new study with up to a 40-year follow-up shows. The study, conducted at the University of Chicago, also found that African-American women do not have more aggressive cancer.

Drs. Finlayson and Eisenberg provide a timely, in-depth review of total pelvic exenteration in the palliation of incurable pelvic cancer. The authors conclude that total pelvic exenteration has a role as a palliative treatment for patients with recurrent pelvic cancer-a conclusion that I believe remains unproven.

Adenocarcinoma of the prostate is now the most common tumor in males. The use of the digital rectal examination, prostate-specific antigen (PSA), and transrectal ultrasound of the prostate with biopsies has improved the detection of prostate cancer and has increased the percentage of patients with organ-confined disease who are treated with radical prostatectomy. It is critical for the practicing urologic and medical oncologist to have accurate and precise pathologic information in order to counsel patients for appropriate therapy. Ideal biopsy and clinical predictive criteria for tumor volume in prostates are not readily available in the literature.

We strongly agree with the authors that, although there is no compelling evidence to suggest that nonionizing electromagnetic fields represent a public health hazard, there is sufficient evidence of magnetic- and electric field-induced biologic effects to continue scientific investigation of this issue.

Do not resuscitate (DNR) orders have become an integral part of the care of the terminally ill patient. Often, the decision whether or not to resuscitate a patient in the event of cardiopulmonary arrest must be made by the patient's family members. This is a difficult decision that is made at an emotionally trying time. Our study investigated the satisfaction, understanding, and feelings of families who sign DNR orders for their relatives. We are not aware of any other studies that have evaluated this aspect of the DNR order.

Dr. Epstein provides a comprehensive review of the pathology of prostatic carcinoma and its importance in guiding the clinical management of treatment for our patients with abnormal prostates and prostate cancer. Prostate cancer, its evaluation, screening, and treatment, remain in many aspects the most controversial for the urologic oncologist. Clearly, our decisions on how we treat patients with elevated PSA's, abnormal prostate exams, and a diagnosis of prostate cancer is influenced greatly by the interpretation of the pathologist of biopsies and radical prostatectomy specimens. In short, the oncologist and urologist are unable to make intelligent and accurate recommendations without accurate pathologic review.

In the past, the mere mention that a patient with persistent or recurrent pelvic cancer might benefit from a palliative pelvic exenteration was met with vigorous opposition. This was due, in part, to the fact that the term "palliative pelvic exenteration" was new and not clearly defined. There was also concern that the mortality, morbidity, and overall cost previously associated with pelvic exenterative procedures were out of keeping with the concept of palliation for cancer. However, much experience with pelvic exenterative surgery has been gained during the past 40 years, and the mortality, morbidity, length of stay, and overall cost of the procedure have decreased significantly. This has made the concept of pelvic exenteration for palliation reconcilable in carefully selected patients in the 1990s.