ONCOLOGY Vol 11 No 5

The American Urological Association (AUA) recently urged Congress to pass the Medicare Preventive Benefit Improvement Act of 1997, which would provide coverage for annual prostate cancer screening for Medicare-eligible men over the age of

The American Urological Association (AUA) feels that the article by Johansson et al in the February 12th issue of the Journal of the American Medical Association, indicating comparable survival rates

Researchers at the University of Queensland, Australia, have identified the receptor on human skin and mucosal cells that they believe allows papillomaviruses to attach to and infect those cells.

Mayo Clinic study of patient-physician communication found that patients frequently do not remember what their doctor tells them.

Data presented at the Fourth Conference on Retroviruses and Opportunistic Infections showed that the blood-brain barrier permeability of nevirapine (Viramune) is superior to that of other antiretrovirals in both in vitro and in vivo animal models.

Carcinoma of the cervix is one of the most common malignancies in women, accounting for 15,700 new cases and 4,900 deaths in the United States each year. Worldwide, cervical cancer is second only to breast cancer as the most common

This paper offers a very good overview of a large topic that encompasses a multitude of tumors, each with its own set of controversial issues in terms of diagnosis and management. The authors discuss the various diagnostic and therapeutic options available for these tumors in a general sense, rather than concentrating on the specifics of each pathology. Although this approach certainly provides a satisfactory overview, it does not delineate the many diagnostic and therapeutic dilemmas that may confront the practicing head and neck surgeon. However, given the space limitations for such a paper, a more detailed discussion probably was infeasible.

The Position Statement on the Use of Placebos for Pain Management in Patients with Cancer, developed recently by the Oncology Nursing Society (ONS), has been endorsed by 24 nursing and other healthcare organizations.

Androgen blockade has potential applications beyond late-stage metastatic cancer of the prostate, according to Nelson N. Stone, md, Professor of Urology and Radiation Oncology at Mt. Sinai

Men whose metastatic prostate cancer is maintained in remission by complete hormonal therapy (CHT) with flutamide (Eulexin) and a luteinizing-hormone-releasing hormone (LHRH) agonist have a health-related quality of life (QOL) equal to

A test measuring the status of DNA multiplication in tumor cells (ploidy), along with other known predictors of treatment response, could provide guidance in selecting chemotherapy for infants with neuroblastoma, the most common childhood

The article by Dr. Swift provides an excellent, comprehensive review of malignancies in the setting of HIV and their management with radiation. It is important for clinicians to have an understanding of the current antiviral management of HIV disease, as well as its implications for patient longevity. This information, in the context of an individual patient's history, is crucial in determining whether treatment will be "palliative" or "curative," and therefore, which radiation dose/fractionation schedule will be employed. With improved antiviral therapies and increasing longevity, the late effects of radiotherapy, as well as recall phenomena (recurrent radiation effects), with the subsequent use of chemotherapeutic agents, must now be considered.

Dr. Powell has written a comprehensive review of factors believed to contribute to the racial differences observed for prostate cancer incidence and mortality. Prostate cancer has a greater negative impact on African-Americans than on any other racial or ethnic group. However, the etiology of the striking racial variation in prostate cancer incidence and mortality remains enigmatic.

This paper is a very nice review of the history of the development of modern urologic surgical procedures for the treatment of testicular germ-cell tumors and their current indications. I agree with virtually everything the authors say. I will emphasize several points that they make and highlight a few small areas of disagreement.

Dr. Powell is to be congratulated for an outstanding review article on prostate cancer in African-American men. As he points out, the age-adjusted incidence of prostate cancer in African-American (black) males is 50% higher than that in Caucasian (white) men, and black men have the highest incidence of prostate cancer in the world.[1] Differences between blacks and whites in the probability of being diagnosed with prostate cancer (9.6% vs 5.2%), lifetime prostate cancer-specific mortality (3% vs 1.4%), and 5-year survival (65% vs 78%) are all indicative of a major public health problem in the black male population.[2]

The article by Drs. Steele and Richie is a well-written, extremely important review of the natural history, treatment options, and current role of surgery in the management of nonseminomatous germ cell tumors of the testis. The authors present their rationale for retroperitoneal lymph node dissection (RPLND) in a thoughtful and provocative way. Their philosophy mimics that practiced at the University of Southern California (USC), which is very similar to that espoused by Drs. John Donohue and Larry Einhorn, who pioneered the current management practices that have made germ cell testicular tumors the most curable solid tumor in humans.[1,2]

The first 15 years of the AIDS pandemic can be summarized simply by the oxymoron "constant change." The syndrome unfailingly has presented new challenges and demanded nearly continual refinement of our patterns of management. In the future, progressively more effective antiretroviral therapy paradoxically may permit infected patients to live longer and fall victim to more HIV-related and HIV-independent malignancies. Swift's review of the role of radiation therapy in the setting of HIV infection therefore provides a useful "snapshot" of current standards and a necessary warning of likely changes to come. Several points warrant emphasis.

The article by Powell highlights uncertainties about the relative contributions of diagnostic delay and tumor biology to racial disparities in stage at diagnosis among American men with prostate cancer, and explores a variety of factors that may discourage early cancer detection in African-American men. Observations derived from our ongoing prospective studies of prostate cancer diagnosis and treatment outcomes in black and white American veterans and from our experience with prostate cancer screening at the University of Mississippi Hospital and Clinics afford additional insights into these issues and provide a framework for this commentary.

Anal carcinomas are an uncommon group of heterogeneous lesions that have represented a therapeutic enigma for many years. The mere rarity of these cancers alone has proven to be a major impediment to the formulation of a standardized

Carcinoma of the testis is the most common malignancy in males 15 to 35 years of age. Testicular cancer has become one of the most curable solid neoplasms and, as such, serves as a paradigm for the multimodality treatment of malignancies. The cure rate for patients with clinical stage I disease is nearly 100%, and patients with advanced disease now achieve complete remission rates of over 90%. The markedly improved outlook for patients with this cancer over the past 15 years has led to a reassessment of management options, especially in patients with clinical stage I disease. The realization that platinum-based chemotherapy could cure most patients with an advanced nonseminomatous germ cell tumor (NSGCT), especially those with minimal disease, led to the introduction of various strategies to decrease the morbidity associated with surgical management. These strategies include surveillance protocols, chemotherapy for clinical stage II disease, and observation protocols for a subset of patients with advanced disease who have had a partial response to chemotherapy. Retroperitoneal lymph node dissection (RPLND) has an important place in the management of both low- and high-stage testicular cancer. It offers the patient two basic benefits: accurate staging and the possibility of a surgical cure, even in the presence of metastatic disease. [ONCOLOGY 11(5):717-729, 1997]

Benign and malignant tumors can arise from any of the structures contained within the parapharyngeal space. Such tumors are very rare, however. Also, malignant tumors from adjacent areas (eg, the pharynx) can extend into the parapharyngeal space by direct growth, or distant tumors may metastasize to the lymphatics within the space. Although the history and physical examination can provide clues to the site of origin and nature of a parapharyngeal space tumor, imaging studies are more useful for defining the site of origin and extent of the mass, as well as its vascularity and relationship to the great vessels of the neck and other neurovascular structures. Surgery is the mainstay of treatment. The surgical approach chosen should facilitate complete tumor extirpation with minimal morbidity. Irradiation is administered as primary therapy in patients with unresectable tumors, poor surgical candidates, and selected other patients. Radiation therapy is also used after surgery for high-grade malignancies or when wide surgical margins cannot be achieved. [ONCOLOGY 11(5):633-640, 1997]

Mortality from prostate cancer is two to three times greater among African-American men between the ages of 50 and 70 than among American Caucasian men of similar ages. Also, African-Americans tend to present with more advanced tumors than their American Caucasian counterparts. This article explores differences between the two races that may account for the disproportionately high mortality among African-Americans and their more advanced disease stage at presentation. These include epidemiologic and histologic features of prostate cancer; clinical, biologic, and environmental factors; and barriers to health care. Various important issues that warrant further investigation are also highlighted. [ONCOLOGY 11(5):599-605, 1997]

With the introduction of increasingly effective antiretroviral agents for the management of AIDS, the life expectancy of appropriately treated patients will continue to lengthen, as will the length of time during which infected patients may develop malignancies, both HIV-related and non-HIV-related. The management of such patients will require careful consideration of the impact of all oncologic therapy on the immune system's ability to hold the virus at bay. Radiation therapy, with its recognized immunosuppressive effects, plays an important role in the management of the major AIDS-defining neoplasms, Kaposi's sarcoma, primary central nervous system lymphoma, and cervical carcinoma, and is used in approximately 50% of patients with non-HIV-related malignancies at some point in the disease course. The judicious use of radiation therapy and proper integration of aggressive antiretroviral therapy can result in control of malignancies without contributing to the rapid progression of HIV disease. [ONCOLOGY 11(5):683-694, 1997]

Head and neck cancer and its treatment frequently cause changes in both speech and swallowing, which affect the patient's quality of life and ability to function in society. The exact nature and severity of the post-treatment changes depend on the location of the tumor, the choice of treatment, and the availability and use of speech and swallowing therapy during the first 3 months after treatment. This paper reviews the literature on speech and swallowing problems in various types of treated head and neck cancer patients. Effective swallowing rehabilitation depends on the inclusion of a video-fluorographic assessment of the patient's oropharyngeal swallow in the post-treatment evaluation. Pilot data support the use of range of motion (ROM) exercises for the jaw, tongue, lips, and larynx in the first 3 months after oral or oropharyngeal ablative surgical procedures, as patients who perform ROM exercises on a regular basis exhibit significantly greater improvement in global measures of both speech and swallowing, as compared with patients who do not do these exercises. [ONCOLOGY 11(5):651-659, 1997]

This paper is an excellent overview of speech and swallowing rehabilitation in head and neck cancer patients. Dr. Logemann and co-workers are clearly leaders in this field and, as such, are eminently qualified to summarize the topic. This subject is of great importance, as the effects of head and neck cancer and its treatment can be economically, psychologically, and socially devastating to patients. Quality-of-life issues continue to be critical in this patient population.

Does thoracoscopic treatment offer any advantages over closed chest tube drainage for the management of malignant pleural effusion? This controversial question was debated by Dr. Henri

Logemann and colleagues highlight an aspect of the treatment of patients with head and neck cancer that is frequently ignored; ie, the importance of rehabilitation efforts and evaluations of post-therapy quality of life. As oncologists, whether surgical, radiation, or medical, our studies and publications have traditionally focused on overall survival, disease-free survival, and, particularly in the management of head and neck cancer, local control of disease. More recently, investigators have begun to address quality of life when constructing studies for patients with all kinds of malignancies, and newer performance outcome instruments have been designed specifically for patients with head and neck cancer.[1]

Progress in managing testicular cancer over the last 2 decades has produced survival rates of well over 90% using a multidisciplinary approach that serves as a model for other tumors. Improved imaging techniques permit more accurate clinical staging, allowing the clinician to select, for each patient, the sequence of surgical and chemotherapeutic modalities that maximizes survival while keeping morbidity within tolerable limits. Current investigators are attempting to refine treatment protocols so as to maintain or improve survival while reducing morbidity and costs.