ONCOLOGY Vol 9 No 5

The environment for medical practice is changing very rapidly. Much greater accountability is being demanded of all health-care providers, including oncologists. Issues related to the philosophy of care, financial management, and ethics are all being

Researchers at University of Texas Southwestern Medical Center at Dallas reported that alterations in the genes of a section of chromosome 3p may reveal the earliest stages of lung cancer.

Researchers at University of Texas Southwestern Medical Center at Dallas reported that alterations in the genes of a section of chromosome 3p may reveal the earliest stages of lung cancer

he development and testing of a new method of high quality clinical fat/water separated 3D breast MR images was recently announced by Advanced NMR Systems Inc., with its subsidiary, Advanced Mammography Systems Inc.

Although several recently published textbooks and handbooks have some variation of "Surgical Oncology" in the title, a new text, Cancer Surgery, edited by McKenna and Murphy, shifts the emphasis from oncology to surgery. This focus is explicitly

Unlike some animal, ecologic, case-control, and prospective studies that have associated higher selenium levels with reduced cancer risk, a large cohort study recently reported in the Journal of the National Cancer Institute found that selenium intake

A phase II study intended to provide histological evidence of clinical response to a new injectable gel product for prostate cancer patients was recently announced by Matrix Pharmaceuticals, Inc. IntraDose-CDDP injectable gel is designed to

After much anticipation regarding health care reform, 1994 ended without passage of any national legislation. The debate will probably resurface in the new Congress, since the issues and concerns surrounding the U.S. health care system still exist.

Dr. Varterasian presents a broad overview of the biology and treatment of multiple myeloma. It is reassuring to notice her enthusiasm for the new developments in the biology of the disease, because advances in this area should lead eventually to

The authors have nicely reviewed many of the issues surrounding laparoscopic colon cancer surgery. However, we would like to offer a slightly different perspective on several points which they make.

Laparoscopic intestinal resection is a relatively new application of endoscopic technology that has evolved as a direct result of the successes and benefits seen with laparoscopic gallbladder surgery. Currently acceptable and

This article compares the results of radical retropubic prostatic surgery done by a group of urologists at the Mayo Clinic during a recent 3-year period with results obtained in a similar group of patients operated on prior to 1987. The authors show that when a surgical procedure is done often, with modern techniques and attention paid to surgical and anatomic detail, very good results can be achieved.

Complication rates in 1,000 consecutive patients who underwent radical retropubic prostatectomy for clinically localized prostate cancer between November 1989 and January 1992 were assessed and compared to complication rates in a historical group of patients operated on by primarily the same surgeons prior to 1987. In the contemporary series, there were no operative deaths, only 22% of patients required blood transfusion, and only six (0.6%) patients suffered rectal injuries. Early complications, including myocardial infarction, pulmonary embolism, bacteremia, and wound infection, occurred in less than 1% of patients. Vesical neck contracture, the most common late complication, developed in 87 patients (8.7%). At 1 year post-surgery, 80% of patients were completely continent, and fewer than 1% were totally incontinent. [ONCOLOGY 9(5):379-389, 1995]

Recent advances in our understanding of the cellular and molecular derangements involved in multiple myeloma are beginning to be translated into novel therapeutic approaches. Growth factors, specifically interleukin-6,

Drs. Milsom and Hammerhofer review some of the controversies surrounding the use of laparoscopic procedures in the management of colorectal cancers. They detail the approach followed in the development of their technique, and outline the phase 3 clinical trials that they are currently conducting, which are aimed at demonstrating the usefulness and appropriateness of laparoscopic colon resection for the treatment of colorectal cancers.

Ong and Larson provide an excellent review of acute lymphoblastic leukemia (ALL) in adults. They thoroughly discuss such basic issues as the diagnosis and classification of ALL, prognostic factors, and the principles of treatment. They also discuss specific problems that arise, such as the treatment of ALL in the elderly and in those with Philadelphia chromosome-positive ALL. In addition, the authors comment on areas that do not yet have fully defined roles in treatment, such as the detection of minimal residual disease and various methods of admin-istering high-dose chemotherapy supported by allogeneic or autologous progenitor cells obtained from blood or marrow. Their views, as expressed in this paper, are reasonable and supported by appropriate references. This review will therefore expand on and underline comments made by the authors in several areas.

Radical prostatectomy is not only the most common operation performed by most urologic oncologists, but also probably now represents the most common open operative procedure performed by all urologists in the United States. Much of this dramatic increase is due to the use of prostate-specific antigen (PSA) as a method for early diagnosis. My own experience is not unusual, in that approximately 50% of my male patients who underwent a radical prostatectomy last year had clinical stage T1c prostate cancer, meaning that the digital rectal exam was normal. The diagnostic biopsy was performed because of an elevated PSA.

During the past decade, there has been an increase of over 300% in the incidence of prostate cancer and a 150% increase in the death rate from this dreaded cancer. It is estimated that more than 244,000 men will be diagnosed with this neoplasm during 1995, and at least 42,000 will die as a direct result of the disease [1]. Challenged by this dramatically rising incidence and mortality, three strategies can be implemented: (1) attempt to prevent the disease; (2) find the disease early, treat it, and cure it; and (3) discover a cure for the disease once it has escaped the bounds of the prostate.

Intensive remission chemotherapy followed by post-remission consolidation and maintenance therapies has achieved complete remission rates of 75% to 90% and 3-year survival rates of 25% to 50% in adults with acute lymphoblastic leukemia (ALL). These results, although promising, are still less favorable than those achieved in childhood ALL. However, various novel experimental and clinical approaches show promise for improving cure rates. Also, specific therapies directed at high-risk subgroups with ALL are beginning to emerge. Detection of specific chromosomal abnormalities at diagnosis identifies patients who are at risk of failing to achieve remission, as well as those who are likely to have short, intermediate, or prolonged disease-free intervals after successful remission induction. Such prognostic information may, ultimately, be used to assign risk categories and to individualize post-remission therapy. [ONCOLOGY 9(5):433-450, 1995]

The article by Milsom and Hammerhofer reviews the promising aspects of laparoscopic colon resection as well as the controversies surrounding it. Laparoscopic cholecystectomy ushered in a new era of abdominal surgery. This minimally invasive surgical technique has been applied to other benign diseases, such as appendicitis and reflux esophagitis.

Acute lymphoblastic leukemia (ALL) in adults is clearly a "different disease" than ALL in children-a fact that is well documented in the article by Ong and Larson. As they indicate, more than half of adult patients relapse despite modern therapy, most within the first 2 years. It should be pointed out, however, as is mentioned at the beginning of the article, that "modern" induction was defined by Cancer and Leukemia Group B study 7612--a study begun in 1976 [1]. Thus, induction therapy has not changed substantially in 20 years. The addition of consolidation therapy and prolonged maintenance therapy has resulted in modest increases in response duration, but despite many variations on current regimens, there has been little change in outcome during the past decade.

British researchers reporting in a recent issue of the Journal of the National Cancer Institute offer a study-based explanation of why levamisole and fluorouracil (5-FU), used together, can lengthen survival for certain colon cancer patients,