ONCOLOGY Vol 9 No 3

Radiation Therapy Oncology Group Study 91-11 offers patients with stage III and IV squamous cell carcinoma of the glottic and supraglottic larynx a chance to save their voice box.

As usual, Dr. Fox provides what the field needs: a tough-minded assessment of the state of knowledge regarding the possible influence of psychological and social factors on cancer incidence and progression.

Dr. Bernard Fox has served as the mentor and unbiased monitor of psychological, social, and behavioral research in cancer as it has evolved over the past 20 years. The thoughtful review in this issue of the current status of this research is extremely valuable for oncologists who must deal with patients' concerns as to whether their personality, emotions, or recent stresses caused their cancer or its progression. Media reports of psychological studies proposing new evidence of mind-body relationships and cancer are read by frightened patients who are trying to make some meaning out of their plight. The physician who has read Dr. Fox's article can provide a strong antidote to patients' inappropriate assumptions that they have somehow caused their cancer.

The relationships between psychological variables and the presence of cancer, its prediction, and the prediction of cancer mortality and course of disease have been studied extensively. From a limited list of about 50 such

This excellent, concise review of the status of lung cancer chemoprevention complements a benchmark review of the whole field of chemoprevention by Drs. Benner, Lippman, Hong and colleagues that appeared recently in the Journal of Clinical Oncology [1] Careful scrutiny of both these articles yields a number of issues for consideration.

Dr. Edward Halperin challenges the premise that the "standard of care" treatment for malignant glioma patients, 6 weeks of cranial irradiation and nitrosourea chemotherapy, is appropriate for all patients. In particular, he maintains, those with the most unfavorable prognosis-the elderly and impaired glioblastoma multiforme patients-may have an equivalent outcome when treated with a more cost-effective, shorter course of hypofractionated irradiation without chemotherapy. There are three lines of evidence used to support his position:

The median survival time of adults with supratentorial malignant glioma treated in clinical studies with surgery, 6 weeks of external-beam radiotherapy, and carmustine (BiCNU) is approximately 1 year. This poor survival time

The standards of care that issue from this alliance will almost certainly be viewed by many as the "gold standard" of cancer treatments.

Clinical trials have suggested that retinoid chemoprevention prevents the development of second primary tumors following head and neck or non-small-cell lung cancer. The findings of these initial studies are now being

The lack of effective treatments for advanced cancer has been one of the motivating forces in the field of cancer prevention. Nowhere is this approach more justified than in primary pulmonary neoplasms. In this article, Benner and his M.D. Anderson colleagues review trials investigating the prevention of lung cancer utilizing retinoids and carotenoids.

Dr. Halperin evaluates progress in the treatment of adults with malignant glioma, with emphasis on older patients and those with a poor prognosis. He provides a good review of past clinical trials in this area, including, among others, trials conducted by the Brain Tumor Study Group (subsequently called the Brain Tumor Cooperative Group [BTCG]), with which we have been involved.