ONCOLOGY Vol 10 No 6 | Oncology

Comments on Bone Marrow Transplantation for Multiple Myeloma

June 01, 1996

Multiple myeloma is a malignant disease characterized by excess proliferation of monoclonal plasma cells. Its progression leads to bone marrow failure, increased risk of infection, and painful osteolytic bony lesions. Although patients are most often

AIDS-related Kaposi's Sarcoma: Options for Today and Tomorrow

June 02, 1996

Prior to 1981, Kaposi sarcoma (KS) was considered a rare human cancer occurring primarily among elderly Italian and Jewish men of eastern European ancestry. I wrote a review of KS research and clinical experiences that appeared in CA: A

New Aromatase Inhibitor Compared With Megestrol in Advanced Breast Cancer

June 01, 1996

Results of a phase III multicenter European study reported in a recent issue of the European Journal of Cancer demonstrate that anastrozole (Arimidex), a new aromatase inhibitor, in doses of 1 and 10 mg orally once daily, is an effective treatment for

Medicine as Business May Mean More Ethical Challenges for Physicians

June 01, 1996

Physicians today are facing more ethical dilemmas as patient decisions are being based less on beneficence and more on business models of success, says Sister Patricia Talone, ethics consultant, Mercy Health Corporation of Southeastern

US Public Health Service Guidelines for Testing and Counseling Blood and Plasma Donors for HIV-1 Antigen

June 01, 1996

In the United States, the implementation of antibody testing in 1985 of all donated blood for human immunodeficiency virus type 1 (HIV-1) resulted in a substantial decrease in the transmission of HIV through blood transfusions. To further decrease

Chemotherapy Plus Radiotherapy Superior to Radiotherapy Alone for Some Inoperable Head and Neck Cancers

June 01, 1996

Further follow-up of a randomized trial comparing combined chemotherapy and radiotherapy with radiotherapy alone for inoperable squamous cell cancers of the head and neck confirms the trial's initial finding of greater efficacy for the combined

DaunoXome Data Presented at International Cancer Meeting

June 01, 1996

NeXstar Pharmaceuticals made four DaunoXome-related presentations at the 9th NCI-EORTC Symposium on New Drugs in Cancer Therapy in Amsterdam, The Netherlands. Parkash S. Gill, MD, associate professor medicine and pathology at the

Status of Radiolabeled Monoclonal Antibodies for Diagnosis and Therapy of Cancer

June 01, 1996

Almost exactly one decade ago, in an editorial published in the New England Journal of Medicine [1], I noted that "progress is slow but sure" in the development of monoclonal antibodies for clinical use. At that time, only muromonab-CD3 (Orthoclone OKT3) was approved for human use to prevent rejection of kidney transplants. In the ensuing 10 years, only one oncologic monoclonal antibody product, satumomoab pendetide (OncoScint CR/OV, Cytogen, Princeton, New Jersey) [2] has been approved by the FDA. Progress surely has been slow.

Response of the Normal Eye to High Dose Radiotherapy

June 01, 1996

his excellent review analyzes ophthalmologic complications following high-dose irradiation of the orbit and surrounding structures as a necessary adjunct to the treatment of patients with carcinomas of the head and neck region. It confirms the critical importance of dose-fraction size in the production of radiation complications, especially in nerve tissue.

Role of Thoracoscopic Lymph Node Staging for Lung and Esophageal Cancer

June 01, 1996

Dr. Krasna provides a thoughtful review of thoracoscopy as an emerging technique for the staging of patients with lung and esophageal cancers. In lung cancer, thoracoscopy can be used as a complement to cervical mediastinoscopy in the evaluation of mediastinal and hilar lymph nodes. This is especially true in patients who have left-sided neoplasms with enlarged lymph nodes in the aortico-pulmonary window--a region typically inaccessible to cervical mediastinoscopy.

Response of the Normal Eye to High Dose Radiotherapy

June 01, 1996

Parsons and colleagues present an excellent summary of their clinical experience with ocular complications of radiotherapy for primary periocular malignancies, together with a retrospective review of the literature on this subject. The authors emphasize the roles of both total dose and dose-per-fraction in radiation-associated eye complications.

DNA Ploidy and Cell Cycle Analysis in Cancer Diagnosis and Prognosis

June 01, 1996

pplication of the techniques of flow cytometry and image analysis to quantitation of DNA and estimation of events in the cell cycle in human tumors has achieved considerable popularity as a laboratory procedure but so far has failed to be of practical clinical value. As brilliantly summarized by Dr. Ross, retrospective studies have repeatedly shown abnormal DNA values to be of prognostic significance in several organ systems, among them, tumors of the urothelium [1] and prostate [2] and, perhaps to a lesser extent, mammary carcinomas [3].

Management of Primary and Metastatic Tumors to the Liver

June 01, 1996

This comprehensive report summarizes the current management of primary liver cancer and of metastatic colorectal cancer in the liver. Numerous tests to help define the location and stage of disease have been evaluated. It now appears that spiral CT with arterial portography is superior to other nonoperative methods in evaluating liver tumors. Immunoscintography using monoclonal antibodies is currently under development and appears to be of potential great value. Subclinical, micrometastatic disease is the bane of all efforts at surgical control of cancer. An ability to detect this would have far-reaching consequences. Complete evaluation of patients with these diseases must include a medical evaluation, including liver function tests and a chest CT. Particular attention must also be paid to cardiac, pulmonary, and renal function.

Recent Advances in the Treatment of Refractory Advanced Breast Cancer

June 01, 1996

The incidence of breast cancer has risen steadily over the past several decades. Breast cancer is second only to lung cancer as a cause of cancer deaths among women; 46,000 women died of breast cancer in the United States alone in 1995. Despite efforts to improve the survival of women with metastatic breast cancer with currently available chemotherapeutic agents, results remain disappointing. The primary use of such agents continues to be for palliation, not cure.

DNA Ploidy and Cell Cycle Analysis in Cancer Diagnosis and Prognosis

June 01, 1996

That nucleic acids can be measured spectrophotometrically in intact, fixed, or viable single cells was demonstrated in a series of publications by Caspersson in the 1930s and '40s, culminating in his now classic monograph [1]. In that paper, Caspersson demonstrated an increase in nucleic acid content in proliferating vs resting cells and malignant vs benign cells. However, although his measurements of ultraviolet absorption were specific for nucleic acids, the absorption maximums for DNA and RNA were too close to be distinguished. Probably, he was measuring differences in RNA, which are more striking than differences in DNA.

DNA Ploidy and Cell Cycle Analysis in Cancer Diagnosis and Prognosis

June 01, 1996

The article by Dr. Ross provides an overview of the current status of the medical literature regarding the role of DNA ploidy and cell cycle analysis in cancer diagnosis and patient prognosis. The scope of the article is quite broad, covering virtually every organ system and, as such, provides only a brief summary of the data in each diagnostic category. From these data, there is general agreement about the value of detection of aneuploidy in tumor specimens but a lack of consensus about the importance of cell proliferation analyses, such as S-phase fraction (SPF) measurements. This conclusion reflects the inherent variability in the two determinations. Detection of aneuploidy by analytic cytometry is reliable; it is accurate and depends upon the specimen (frozen vs formaldehyde- fixed, presence of necrosis, cellularity) as well as the quality of specimen preparation. Thus, DNA ploidy analysis can easily be standardized, minimizing intralaboratory variation. Cell cycle analysis, however, is more complex and as yet is not standardized.

Management of Primary and Metastatic Tumors to the Liver

June 01, 1996

Dr. Sardi and colleagues lay out, in a clear and concise fashion, current alternatives for the management of primary and metastatic liver tumors. Their emphasis on "high-value" treatments is crucial. In this group of patients, unnecessary treatments not only are costly in terms of dollars but also reduce the quality of the short life remaining in patients with unresectable disease.

Role of Thoracoscopic Lymph Node Staging for Lung and Esophageal Cancer

June 01, 1996

Dr. Krasna provides a well-illustrated review of the applications of thoracoscopy in lung and esophageal tumors. These include: staging of tumors; diagnosis of indeterminate pulmonary nodules; definitive resections of various tumors, especially in cases of poor reserve; and diagnosis and treatment of malignant pleural disease [1]. However, there remains considerable disagreement among thoracic surgical oncologists over the proper applications of these techniques.

Role of Thoracoscopic Lymph Node Staging for Lung and Esophageal Cancer

June 01, 1996

Staging is extremely important in determining the proper treatment of patients with thoracic malignancies. Staging groups can be used to predict outcome after cancer treatment and allocate patients to appropriate treatment

Management of Primary and Metastatic Tumors to the Liver

June 01, 1996

Primary and metastatic liver tumors continue to be a significant health problem in the United States. Hepatic resection or, in selected cases, transplantation are the only curative therapies for patients with resectable

Combinations of New and Old Agents for Breast Cancer Treatment: Future Directions

June 01, 1996

Several new agents undergoing clinical development appear to be effective and tolerable in the management of metastatic breast cancer. In recent years, a number of new and exciting combinations have been described, with an efficacy similar or, in some cases, apparently superior to that of standard chemotherapeutic regimens, such as FAC and CMF. The next several years will witness a large number of comparative clinical trials, the major purpose of which will be to establish the role of these new drugs and combinations in the management of metastatic breast cancer. Almost simultaneously, similar strategies will be pursued for adjuvant therapy for primary breast cancer, with the goal of improving the curative efficacy of current regimens. These prospects are exciting; however, enthusiasm must be tempered with the knowledge that long-term toxicity is always a distinct possibility. Therefore, the development of new combinations, especially in the setting of adjuvant chemotherapy, should follow a systematic, conservative strategy. [ONCOLOGY 10(Suppl):30-36, 1996]

Response of the Normal Eye to High Dose Radiotherapy

June 01, 1996

Radiation therapy of tumors near the eye or optic nerves often requires incidental irradiation of these structures, even when they are not clinically involved by tumor. Depending on the radiation treatment volume and dose required, radiation injury to the lens, lacrimal apparatus, retina, or optic nerve may result. The time to expression and severity of injury are dose-dependent. This paper reviews the results of 157 patients who were followed for a minimum of 3 years after radiotherapy for primary extracranial tumors at the University of Florida, in which the lacrimal gland, lens, retina, and/or optic nerve(s) received irradiation. This review shows that, after treatment at approximately 1.8 to 2.0 Gy per fraction, the incidence of severe dry-eye syndrome, retinopathy, and optic neuropathy appears to increase steeply after doses of 40, 50, and 60 Gy, respectively. [ONCOLOGY 10(6):837-852, 1996]

Clinical Manifestations of Kaposi's Sarcoma

June 02, 1996

Major investigative studies have yielded considerable data on various aspects of Kaposi's sarcoma (KS), including cellular and molecular events leading to the development of HIV-associated KS, histopathologic features, clinical

New Cytotoxic Agents for the Treatment of Breast Cancer

June 01, 1996

Over the past 5 years, many new cytotoxic agents with activity against metastatic cancer have been discovered, and several are currently undergoing clinical trials. Whether their marked degree of activity represents a real

New Developments: A Look to the Future

June 02, 1996

Inflammatory cytokines plus the human immunodeficiency virus Tat protein apparently trigger the development of early Kaposi's sarcoma. Activated spindle cells provide a self-perpetuating, autocrine-supported mechanism for further development of hyperplastic lesions. In more advanced stages, a true neoplastic process may develop. [ONCOLOGY 10(Suppl):34-36, 1996]

The Epidemiologic Scope of Kaposi's Sarcoma

June 02, 1996

The unique epidemiology of Kaposi's sarcoma among patients with the acquired immunodeficiency syndrome suggests a multifactorial cause. Although the human immunodeficiency virus (HIV) plays a major role in the

Current Status of Salvage Chemotherapy for Refractory Advanced Breast Cancer

June 01, 1996

The definition of refractory advanced breast cancer remains elusive. Because of different definitions of objective response, frequent lack of precision in defining the number of prior chemotherapies, and differing interpretations

Pharmacology of Liposomal Daunorubicin and Its Use in Kaposi's Sarcoma

June 02, 1996

In the early 1980s, we first began to see cases of Kaposi's sarcoma (KS) in patients with the lymphadenopathy now known to be associated with infection by the human immunodeficiency virus (HIV). During that period, we

Treatment Options for Patients with Refractory Breast Cancer

June 01, 1996

The treatment of refractory metastatic breast cancer is complex and challenging. Practicing oncologists must choose from an array of therapuetic options. Palliation remains the primary goal of treatment, and the risks and

Current Therapeutic Options for Kaposi's Sarcoma

June 02, 1996

Treatment options for patients with acquired immune deficiency syndrome (AIDS)-related Kaposi's sarcoma (KS) have changed very little over the past decade. Research has been hampered by the absence of an accepted

Status of Radiolabeled Monoclonal Antibodies for Diagnosis and Therapy of Cancer

June 01, 1996

At first glance, the concept of using radionuclide-labeled monoclonal antibodies to target radioactivity to tumor sites for the detection and possible treatment of malignancies appears quite appealing in terms of its rationale and simplicity. However, as is apparent in Dr. Divgi's comprehensive review of the many clinical studies that have been performed to test this concept, there are a number of complexities that require further study and resolution so that this approach can be optimally and more widely applied in clinical medicine. Although Dr. Divgi touches on many of these issues, some points are worthy of emphasis and further discussion.

Cervical Cancer: Behavioral Changes Could Save Most Women

June 01, 1996

Cervical cancer's slow, noticeable growth makes it "an ideal disease" for screening, but poor choices--like not getting a Pap smear or having unprotected sex as young adults--give the disease a disastrous head start, a University of Wisconsin Medical

Discussion

June 02, 1996

Dr. Safai: Dr. Abrams, I am not convinced that the apparent drop in KS incidence is real. I see many referred patients who have developed KS, but whose KS has never been reported, since it was not the initial presentation of HIV infection. In many cases, the lesions are not even biopsied.

DNA Ploidy and Cell Cycle Analysis in Cancer Diagnosis and Prognosis

June 01, 1996

This review focuses on the clinical utility and potential value of cell cycle analysis and DNA ploidy interpretation in the diagnosis of human tumors, the application of these techniques to cytologic diagnosis, and their capability