ONCOLOGY Vol 13 No 10

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 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

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.

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

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

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

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,

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

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

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

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

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

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.

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.

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

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.

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.

Drs. Boyd and Mehta provide a comprehensive yet concise overview of the role of radiosurgery in the management of selected patients with brain metastases.

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

Inoperable non–small-cell lung cancer has become the domain of combined-modality treatment based on several recent, large, phase III studies. Results of Radiation Therapy Oncology Group (RTOG) phase II studies have

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

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]

Traditionally, treatment for locally advanced resectable head and neck cancer has been surgical resection followed by postoperative radiation. In unresectable patients, primary radiation has been the mainstay of

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]

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

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.

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

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]

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]

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