ONCOLOGY Vol 13 No 10 | Oncology

Radiation Effective in Treating Early Prostate Cancer

October 01, 1999

Large Study Confirms Radiation therapy not only destroys prostate cancer in patients with early disease but keeps it from returning, a very large study of patients from six medical centers has found.

Laparoscopic Surgery Offers Important Benefits for Patients With Colorectal Disease

October 01, 1999

Laparoscopic operating techniques are gaining wider acceptance among colorectal surgeons, as their efficacy is proven. These techniques offer patients the advantages of fewer complications, decreased need for postoperative narcotics, faster

Book Review: Comprehensive Management of Head and Neck Tumors, 2nd edition

October 01, 1999

Tumors of the head and neck continue to pose challenges for afflicted patients and their treating physicians. Because the complex and vital anatomy often involved affects the ability to communicate and interact socially, head and neck tumors can have a devastating effect on the patient’s quality of life. Due to the inherently complex nature of such tumors and their rarity, a comprehensive textbook devloted to their management is certain to be useful.

Participants in Chemotherapy Trials Incur Minimal Excess Cost

October 01, 1999

Cancer patients enrolled in chemotherapy clinical trials at the Mayo Clinic in Rochester, Minnesota, incurred a 5-year average cost of $46,424, compared to $44,133 for matched control patients who were not trial participants, suggesting that

Roswell Park Researchers Studying Health Effects of Chernobyl Accident

October 01, 1999

Researchers from Roswell Park Cancer Institute, Buffalo, New York, are part of an international group studying the long-term health effects caused by the 1986 destruction of the nuclear reactor at the power plant in Chernobyl, Ukraine. The

Medical Records and Privacy

October 01, 1999

ASCO just stated its policy on the privacy of medical records, which is a hot issue in Congress, especially because the House and Senate are in the midst of a conference committee on a financial services modernization bill. Medical records

Trichloroethylene Exposure Linked to Genetic Changes in Patients With Kidney Cancer

October 01, 1999

Many patients with kidney cancer who had been exposed to high levels of trichloroethylene have a unique pattern of genetic mutations within their cancerous cells. These findings were reported by Hiltrud Brauch, PhD, of the University of Hamburg,

Radiofrequency Ablation Shows Promise for Inoperable Liver Tumors

October 01, 1999

Kim Jessup, MD, professor of surgery and director of the Gastrointestinal Oncology Program at the University of Pittsburgh Cancer Institute, is using radiofrequency ablation to dissolve tumors that have spread from the colon to the liver. According

Interferon Significantly Affects Metabolism of Other Drugs Given to Cancer Patients

October 01, 1999

Given to Cancer Patients Cancer patients undergoing therapy with interferonalfa-2b (IFN-a-2b [Intron A]) are possibly being overmedicated with the narcotics and antidepressants commonly administered with this agent, according to a University

Axillary Dissection May Be Unnecessary for Many Breast Cancer Patients

October 01, 1999

A new decision-making model developed by Dr.Giovanni Parmigiani and colleagues at Duke University has shown that the routine use of axillary lymph node dissection may not be necessary for many breast cancer patients. Recently, the use of

Paclitaxel/Carboplatin Effective, Less Toxic Option for Advanced Ovarian Cancer

October 01, 1999

A landmark study showed that a new drug combination-paclitaxel (Taxol) and carboplatin (Paraplatin)-is better for the treatment of advanced ovarian cancer because it is significantly less toxic in patients. The combination also maintained the

More Experienced Centers Achieve Higher Survival Rates in Poor-Prognosis Testicular Cancer Patients

October 01, 1999

Patients with poor-prognosis testicular cancer have a better chance of surviving if they are treated at an institution that cares for five or more such patients during an approximate 4-year period than if treated at an institution that sees fewer than five

Quality-of-Life End Points in Oncology Drug Trials

October 01, 1999

Measurement of the quality of life (QOL) of patients, particularly those with cancer, has recently become a major scientific endeavor. The rapid growth of the hospice movement throughout the world during the past half-century has underscored the importance of palliation when a cure no longer seems possible.

Carcinoma of the Esophagus Part 2: Adjuvant Therapy

October 01, 1999

Dr. Minsky’s two-part review of primary and adjuvant treatment of esophageal cancer is current and comprehensive. In it, he details our present understanding of esophageal cancer management by reviewing the most important studies conducted over the past 2 decades.

The Department of Defense Center for Prostate Disease Research

October 01, 1999

In 1991, the United States Congress expressed a growing concern over the incidence of prostate cancer and the controversy over the optimal treatment of the various stages of the disease. Congress also supported the need for both basic

Management of Menopausal Symptoms in the Cancer Patient

October 01, 1999

The article by Castiel highlights the benefits and potential risks of estrogen replacement in cancer patients. For patients with malignancies that are not “estrogen sensitive,” adding hormone replacement therapy (HRT) to the therapeutic regimen can only improve quality of life.

Management of Menopausal Symptoms in the Cancer Patient

October 01, 1999

Symptoms related to estrogen deficiency are among the most common complaints that postmenopausal breast cancer patients bring to the attention of oncologists. Menopause develops in these patients either naturally or prematurely as a result of cancer chemotherapy and/or endocrine therapy.

Current Management of Unusual Genitourinary Cancers: Part I

October 01, 1999

Often overshadowed by more common genitourinary cancers, such as prostate, testicular, and kidney cancers, penile and urethral cancers nonetheless represent difficult treatment challenges for the clinician. The management

Radiosensitization by Gemcitabine

October 01, 1999

Gemcitabine is a potent radiosensitizer in both laboratory studies and in the clinic. Initial laboratory studies showed that gemcitabine radiosensitizes a wide variety of rodent and human tumor cells in culture. Maximum

Stereotactic Radiosurgery for Brain Metastases

October 01, 1999

Worldwide, approximately 100,000 patients have undergone stereotactic radiosurgery for a variety of intracranial lesions, of which brain metastases represent the most common treatment indication. This article summarizes the major issues surrounding the management of brain metastases, and also analyzes 21 independent reports of Gamma Knife– or linear accelerator–based radiosurgery, representing over 1,700 patients and more than 2,700 lesions. Variable reporting in the studies precludes a definitive, rigorous analysis, but the composite data reveal an average local control rate of 83% and median survival of 9.6 months, both of which are comparable to results in recent surgical reports. The most important prognostic factors for survival appear to be fewer than three lesions, controlled extracranial disease, and Karnofsky performance score (KPS). The exact impact of dose has not been clarified, but a dose-response relationship, especially for ³ 18 Gy, is emerging. The role of whole-brain radiotherapy remains unresolved. It may enhance local control but does not convincingly improve survival and, in some series, is associated with an increased risk of late complications. Chronic steroid dependence and increased intracranial edema do not appear to be common problems. This is an opportune time for the completion of ongoing randomized trials to validate these observations. [ONCOLOGY 13(10):1397-1409,1999]

p53 Tumor Suppressor Gene Therapy for Cancer

October 01, 1999

Gene therapy has the potential to provide cancer treatments based on novel mechanisms of action with potentially low toxicities. This therapy may provide more effective control of locoregional recurrence in diseases like non–small-cell lung cancer (NSCLC) as well as systemic control of micrometastases. Despite current limitations, retroviral and adenoviral vectors can, in certain circumstances, provide an effective means of delivering therapeutic genes to tumor cells. Although multiple genes are involved in carcinogenesis, mutations of the p53 gene are the most frequent abnormality identified in human tumors. Preclinical studies both in vitro and in vivo have shown that restoring p53 function can induce apoptosis in cancer cells. High levels of p53 expression and DNA-damaging agents like cisplatin (Platinol) and ionizing radiation work synergistically to induce apoptosis in cancer cells. Phase I clinical trials now show that p53 gene replacement therapy using both retroviral and adenoviral vectors is feasible and safe. In addition, p53 gene replacement therapy induces tumor regression in patients with advanced NSCLC and in those with recurrent head and neck cancer. This article describes various gene therapy strategies under investigation, reviews preclinical data that provide a rationale for the gene replacement approach, and discusses the clinical trial data available to date. [ ONCOLOGY 13(Suppl 5):148-154, 1999]

Principles of Chemoradiation: Theoretical and Practical Considerations

October 01, 1999

Chemotherapy agents known to enhance the effects of radiation in preclinical studies have been used concurrently with radiotherapy in numerous clinical trials with the prospect of further enhancing radiation-induced

Management of Menopausal Symptoms in the Cancer Patient

October 01, 1999

In the decades since hormone replacement therapy (HRT) was introduced, there has never been more controversy surrounding it than at present. Physicians and patients are faced with many questions regarding risk and few definitive answers.

The Role of UFT in Combined- Modality Therapy

October 01, 1999

Fluorinated pyrimidines have long been used as radiosensitizers in combined-modality therapy for solid tumors. Nonetheless, the most commonly used drug, 5-fluorouracil (5-FU), is inconvenient to administer, particularly

Novel Radiation Sensitizers Targeting Tissue Hypoxia

October 01, 1999

That hypoxic tissues are more resistant to the effects of radiation than well-oxygenated tissues has been known for many decades, and repeated in vitro demonstrations have confirmed that to achieve the same degree of cytotoxicity, hypoxic cells require about three times the radiation dose that well-oxygenated cells need. Hypoxic cell sensitizers enhance the tissue response to standard radiation, generally by mimicking the effects of oxygen, which induces the formation and stabilization of toxic DNA radicals. Although many hypoxic cell sensitizers like the nitroimidazoles have been evaluated in combination with radiation, these agents have had no or only minimal therapeutic impact due to either their limited potency or their toxicity at biologically relevant concentrations. This article reviews several new modalities that either increase oxygen delivery or sensitize hypoxic tissues. These modalities, all currently in early clinical evaluations, include: (1) tirapazamine, a bioreductive agent; (2) gadolinium texaphyrin, a hypoxic cell sensitizer with biolocalization properties using magnetic resonance imaging; (3) RSR13, an allosteric modifier of hemoglobin; and (4) bovine hemoglobin modified by the attachment of polyethylene glycol polymers.[ONCOLOGY 13(Suppl 5):61-70,1999]

Quality-of-Life End Points in Oncology Drug Trials

October 01, 1999

Health-related quality of life (HRQL) is a multidimensional construct that represents the patient’s perspective on valued aspects of health and functioning. Over the last several years, the pharmaceutical industry, as well as health care providers and the patient advocacy community, have shown increasing interest in HRQL as an outcome measure. Pharmaceutical companies and other sponsors of cancer clinical trials are seeking novel approaches with which to establish the benefits of treatment and to differentiate their products from other marketed products. Health care providers hope to provide cancer patients with therapies that positively affect their quality of life. To date, however, most oncology drug approvals have been based on traditional end points, such as survival and tumor response rate. This article will focus on some of the lessons learned from recent reviews of HRQL data and will describe some of the many challenges that lie ahead. ONCOLOGY 13(10):1439-1442, 1999]

Molecular Modalities in the Treatment of Lung Cancer

October 01, 1999

Despite recent advances in the treatment of lung cancer, long-term survival remains rare. As more information pertaining to the biology of lung cancer is understood, it is hoped that improvements in outcome can be realized

Trimodality Therapy for Non–Small-Cell Lung Cancer

October 01, 1999

Prospects for the multimodality treatment of non–small-cell lung cancer have improved substantially with the demonstration of fairly dramatic results, in terms of 5-year survival, in several phase III trials that employed

DNA Topoisomerase I-Targeting Drugs as Radiation Sensitizers

October 01, 1999

Combination chemoradiation, alone or as an adjuvant to surgery, has been shown to improve treatment outcomes in a number of human malignancies, but may be limited by normal tissue toxicities. A primary challenge in

Combined Chemoradiation Therapy for Limited-Stage Small-Cell Lung Cancer

October 01, 1999

After nearly 4 decades of use in treating small-cell lung cancer (SCLC), thoracic radiation has become integral to the management of limited-stage disease. Many prospective randomized trials have demonstrated that adding

Drug-Radiation Interactions in Tumor Blood Vessels

October 01, 1999

Obliteration of the tumor vasculature is an effective means of achieving tumor regression. Antiangiogenic agents have begun to enter cancer clinical trials. Ionizing radiation activates the inflammatory cascade and increases the

3D Treatment Planning and Intensity-Modulated Radiation Therapy

October 01, 1999

Three-dimensional (3D) image-based treatment planning and new delivery technologies have spurred the implementation of external beam radiation therapy techniques, in which the high-dose region is conformed much

Taxanes in Combined- Modality Therapy for Solid Tumors

October 01, 1999

The taxanes, paclitaxel and docetaxel, are novel antimitotic agents that are under extensive investigation in clinical trials in patients with various solid tumors. The taxanes have demonstrated significant activity against

Carcinoma of the Esophagus Part 2: Adjuvant Therapy

October 01, 1999

Dr. Minsky provides an excellent review of the current status of primary and adjuvant therapy in patients with carcinoma of the esophagus. Although the treatment of esophageal cancer remains a hotly debated issue, recent results clearly show the superiority of combined-modality therapy, especially when surgical resection is not planned.

Coverage of Cancer Clinical Trials

October 01, 1999

The major political question for the cancer community this fall is whether the House follows the Senate’s lead and includes a “clinical trials” amendment in its managed care bill. One of the competing House bills (H.R. 2723), sponsored by Reps. John

Quality-of-Life End Points in Oncology Drug Trials

October 01, 1999

Many advances in the treatment and care of cancer patients have been closely linked to the availability of more effective pharmaceutical agents. As research continues to develop new and improved chemotherapeutic agents, it is heartening that the FDA maintains a flexible approach to the drug approval process and will consider an array of indicators of drug efficacy, including patient self-reports of health-related quality of life.

Postoperative Depression May Go Unrecognized and Untreated in Brain Tumor Patients

October 01, 1999

Depression is the most common postoperative complication seen in patients who have undergone surgery for brain tumors, but it is seldom recognized or treated, according to preliminary findings of a study presented at the annual meeting of the

Book Review: Comprehensive Management of Head and Neck Tumors, 2nd edition

October 01, 1999

Tumors of the head and neck continue to pose challenges for afflicted patients and their treating physicians. Because the complex and vital anatomy often involved affects the ability to communicate and interact socially, head and neck tumors can have a devastating effect on the patient’s quality of life. Due to the inherently complex nature of such tumors and their rarity, a comprehensive textbook devloted to their management is certain to be useful.

Adjuvant/Neoadjuvant Chemoradiation for Gastric and Pancreatic Cancer

October 01, 1999

Both gastric and pancreatic cancer remain leading causes of cancer death in the United States and worldwide. While surgical resection continues to be required for long-term cure of both these neoplasms, 5-year survival

The Role of Radiation, With or Without Chemotherapy, in the Management of NSCLC

October 01, 1999

Lung cancer is the leading cause of cancer death in the United States. Surgery is the treatment of choice for early stage patients. Despite radical surgery, patients with early stage lung cancer remain at risk for recurrence. The

Carcinoma of the Esophagus Part 2: Adjuvant Therapy

October 01, 1999

The two general treatment approaches for esophagel cancer are primary treatment (surgical or nonsurgical) or adjuvant treatment (preoperative or postoperative). Due to differences in the patient populations selected for surgical or nonsurgical therapies, which may bias the results against nonsurgical therapy, it is difficult to determine the best treatment approach for this disease. The standard of care is either surgery alone or primary combined-modality therapy. Based on a nonrandomized comparison of the data from recent intergroup trials, the results of these two approaches are similar. For patients treated without surgery, the intergroup INT 0123 trial will determine whether higher doses of radiation are of benefit. No clear survival advantage has been seen with preoperative or postoperative adjuvant radiation therapy alone or chemotherapy alone. The randomized trials comparing preoperative combined-modality therapy vs surgery alone reveal encouraging results for the combination approach but need further confirmation. For patients treated with combined-modality therapy, the ideal regimen remains to be determined. Part 1 of this two-part review, which appeared in last month’s issue, centered on primary therapy for esophageal carcinoma. This part explores the rationale for and results of adjuvant therapy. [ONCOLOGY 13(10):1415-1427,1999]

Chemoprevention of Lung Cancer

October 01, 1999

Chemoprevention is defined as the use of specific natural or pharmacologic agents to reverse, suppress, or prevent the carcinogenic process to the development of invasive cancer. The basic idea behind lung cancer