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The article, “Management of Hepatocellular Carcinoma,” by Drs. Nakakura and Choti, is an excellent, comprehensive overview of the treatment modalities used for one of the most challenging cancers. The thoroughness of this review underscores the current frustration of the clinician in the management of this disease and the inadequacies of available therapies. The authors list more than 17 treatments for the various stages of this disease. However, if any one of the therapies mentioned offered cure to a majority of patients, there would be little need for more review articles or randomized controlled trials. There are few cancers that command such a vast array of differing therapies from so many different specialties.

Despite advances in the treatment of many malignancies, a large number of cancer patients will require evaluation and possible surgical intervention for lesions that have metastasized or directly invaded the spinal column. The need for heightened awareness of and aggressive early intervention for spinal metastases is underscored by many studies that have reported a relationship between pretreatment and posttreatment neurologic function in these patients. Recommendations for operative intervention should be made following an evaluation of the patient by multiple specialties, both medical and surgical. In the last decade, advances in surgical techniques for tumor decompression and spine stabilization, neurophysiologic monitoring, and anesthetic expertise have allowed surgeons to perform more extensive procedures with improved outcomes and reduced morbidity. This article will review the factors favoring an operative recommendation in patients with metastatic spinal disease, preoperative evaluation, and available surgical options. Patients with symptomatic spinal metastases should receive early surgical consultation as part of a multidisciplinary approach to their disease process. [ONCOLOGY 14(7):1013-1024, 2000]

As Drs. Nakakura and Choti point out, the incidence of hepatocellular carcinoma (HCC) is rising in many countries including the United States, mainly as the result of a steady increase in hepatitis C infections. Unfortunately, it now seems that the hepatitis C virus is more carcinogenic than the hepatitis B virus, judging from the frequency with which HCC develops among patients with hepatitis C- vs hepatitis B-induced cirrhosis.[1] Numerous studies have demonstrated changes in various oncogenes and tumor suppressor genes, but no consistent sequence of genetic changes has emerged similar to the adenoma-carcinoma sequence in colon cancer.

Hepatocellular carcinoma (HCC) is the most common solid organ tumor worldwide. In recent decades, diagnosis and treatment of this cancer has evolved significantly. The article by Drs. Nakakura and Choti summarizes many of the advances in this field, delineates the current evidence-based treatment options, and defines promising areas for future study.

FORT LAUDERDALE, Fla-Despite the prevalence of fatigue in cancer patients and survivors, a number of obstacles have stood in the way of its successful treatment, said Barbara F. Piper, DNSc, RN, associate professor, University of Nebraska Medical Center College of Nursing. Patients have been reluctant to bring the symptom to their doctor’s attention out of a concern that they may look like “complainers” or that attending to the symptom will somehow interfere with their cancer treatment.

SOUTH SAN FRANCISCO-Genentech Inc. has issued a “Dear Doctor” letter to alert physicians to 62 postmarketing reports of serious adverse events related to the use of trastuzumab (Herceptin), the company’s anti-HER-2 monoclonal antibody for use in treating HER-2-positive breast cancer. To date, about 25,000 women have been treated with Herceptin worldwide.

WASHINGTON-Eric S. Berger, vice president of planning and public policy, US Oncology, Inc., Houston, has a word of advice for cancer care providers seeking to influence legislators: “Speak from the heart.”

WASHINGTON-Four members of Congress received the Paul E. Tsongas Award from the Lymphoma Research Foundation of America during a Capitol Hill ceremony. The award is presented annually “to recognize outstanding legislative leadership and commitment in support of the health care issues that result in improving the quality of life for all Americans.”

WASHINGTON-In an effort to better understand and deal with the unequal burden of cancer among various subgroups of US residents, the National Cancer Institute has launched a program to engage members of these minority and underserved populations in community-based cancer control, prevention, research, and training projects.

NEW ORLEANS- The “deprofessionalization” of medicine is the greatest challenge faced by physicians today, Glenn D. Steele, Jr., MD, PhD, said in his presidential address at the Society of Surgical Oncology (SSO) Cancer Symposium. He implored his colleagues to get back on the “high road of first principles” in order to tackle the problems generated by managed care and and other aspects of the current health care climate.

MIAMI, Florida-Two separate multicenter trials suggest that dose titration in patients with chronic, moderate to severe pain can be achieved as readily with controlled-release (CR) oral oxyco-done (OxyContin) given once every 12 hours as with an oral intermediate-release (IR) formulation given four times a day.

NEW YORK-Preliminary findings from a study of long-term cancer survivors suggest a linkage of cognitive deficits to standard-dose chemotherapy, Timothy Ahles, PhD, reported at the Pan American Congress of Psychosocial and Behavioral Oncology.

A new book, Me and My Marrow: A Kid’s Guide to Bone Marrow Transplants, helps guide children with cancer through the transplant procedure. The book was inspired by 13-year-old Christina Cuzzone, of Northbrook, Illinois, who was diagnosed with leukemia at age 9 and underwent a BMT. After recovering from the transplant, Christina recognized the need for a book to help other children.

WASHINGTON-Scientific studies provide insufficient evidence that consuming high doses of antioxidants in the diet and as supplements can prevent chronic diseases, according to a new report by the Institute of Medicine (IOM), a part of the National Academy of Sci-ences. Indeed, megadoses of some antioxidants may lead to ill health rather than benefits, the report warned.

NEW ORLEANS-Positive/negative purging of peripheral blood stem cell (PBSC) grafts allows preparation of highly purified CD34+ fractions and up to 6 log of tumor cell depletion in patients with chronic lymphocytic leukemia (CLL), according to a study conducted at the University of Kiel, Germany. Peter Dreger, MD, reported the results at the 41st annual meeting of the American Society of Hematology (ASH).

ASCO-The American Society of Clinical Oncology (ASCO) has embarked upon “one of the most important and far reaching initiatives ever undertaken by any medical specialty society-the National Initiative on Cancer Care Quality (NICCQ),” Joseph S. Bailes, MD, outgoing ASCO president, said at the Society’s 36th annual meeting held in New Orleans.

NEW ORLEANS-A nonmagnetic method of depleting B cells during purging before autologous peripheral blood stem cell (PBSC) transplantation greatly decreases the nonspecific cell loss that can occur when cells cross a magnet, as in other techniques. The nonmagnetic method is also simple and quick, John Gribben, MD, of Dana-Farber Cancer Institute, said at the 41st annual meeting of the American Society of Hematology.

FT. LAUDERDALE, Fla-Palliative care, broadly defined, can benefit cancer patients who are newly diagnosed and who are in active treatment, as well as those who are near death. In creating guidelines for palliative care, the National Comprehensive Cancer Network (NCCN) Palliative Care Panel members found agreement on this point.