The paper by Salvatore et al discusses a very broad, complex subject, which, in some aspects, is quite controversial. The review touches on many different topics but not always in enough detail to provide clarity. Pertaining to the debated link between 50 to 60 Hz power line field exposure and cancer, the authors characterize their article as "... a review of the basic science that points to this possible association [with cancer]." However, the "basic science" that "points to" occupies much of their presentation, while some major types of evidence and reasoning that "points away" is not mentioned.
Drug-resistant strains of pneumonia-causing bacteria are becoming increasingly prevalent and dangerous among the elderly, new research suggests.
Early trials of an antibody engineered to target two different antigens suggest that the approach may improve the effectiveness of immunotherapy in selected malignancies.
Radiosurgery plus the radiation sensitizer etanidazole is being evaluated in a Radiation Therapy Oncology Group trial (RTOG 95-02) as a treatment for recurrent or persistent brain tumors or metastases.
Drs. Finlayson and Eisenberg provide a timely, in-depth review of total pelvic exenteration in the palliation of incurable pelvic cancer. The authors conclude that total pelvic exenteration has a role as a palliative treatment for patients with recurrent pelvic cancer-a conclusion that I believe remains unproven.
Adenocarcinoma of the prostate is now the most common tumor in males. The use of the digital rectal examination, prostate-specific antigen (PSA), and transrectal ultrasound of the prostate with biopsies has improved the detection of prostate cancer and has increased the percentage of patients with organ-confined disease who are treated with radical prostatectomy. It is critical for the practicing urologic and medical oncologist to have accurate and precise pathologic information in order to counsel patients for appropriate therapy. Ideal biopsy and clinical predictive criteria for tumor volume in prostates are not readily available in the literature.
Update: Mortality Attributable to HIV Infection Among Persons Age 25 to 44 Years--United States, 1994
During the 1980s, HIV infection emerged as a leading cause of death in the United States. In 1993, HIV infections became the most important cause of death among persons age 25 to 44 years. This report updates national trends in deaths caused by HIV infection in 1994.
Sequential dosing may improve the effectiveness of adjuvant chemotherapy regimens in node-positive breast cancer, by limiting overlapping toxicity while maximizing dose-intensity, Clifford A. Hudis, MD, said at the Chemotherapy Foundation's 13th annual symposium. At Memorial Sloan-Kettering Cancer Center, where Dr. Hudis is assistant attending physician in the Breast Cancer Medicine Service, researchers are testing a sequential dosing regimen that combines doxorubicin, paclitaxel (Taxol), and cyclophosphamide, supported by granulocyte-colony stimulating factor (G-CSF, Neupogen).
Combined treatment involving surgery and radiotherapy is a reasonable alternative to surgery alone in high-risk patients with dermato-fibrosarcoma protruberans (DFSP), Canadian researchers reported at the American Society for Therapeutic Radiology and Oncology (ASTRO) meeting.
The anticancer benefits of nonsteroidal anti-inflammatory drugs (NSAIDs), seen in studies of colon cancer risk, may extend to human breast cancer as well.
Approximately three-fourths of all skin cancer-associated deaths are caused by melanoma. During 1973 to 1991, the incidence of melanoma increased approximately 4% each year. In addition, the incidence of melanoma is increasing faster than that of any other cancer. To characterize the distribution of deaths from melanoma in the United States, the CDC analyzed national mortality data for 1973 through 1992. This report by the Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, summarizes the results of that analysis.
Dr. Epstein provides a comprehensive review of the pathology of prostatic carcinoma and its importance in guiding the clinical management of treatment for our patients with abnormal prostates and prostate cancer. Prostate cancer, its evaluation, screening, and treatment, remain in many aspects the most controversial for the urologic oncologist. Clearly, our decisions on how we treat patients with elevated PSA's, abnormal prostate exams, and a diagnosis of prostate cancer is influenced greatly by the interpretation of the pathologist of biopsies and radical prostatectomy specimens. In short, the oncologist and urologist are unable to make intelligent and accurate recommendations without accurate pathologic review.
The treatment of childhood leukemias and lymphomas is one of modern oncology's major success stories. Today, 80% to 85% of childhood cancer patients grow up free of their disease. But the very treatment that, in most cases, cured these young patients leaves many of them at risk for other problems later in life.
In the past, the mere mention that a patient with persistent or recurrent pelvic cancer might benefit from a palliative pelvic exenteration was met with vigorous opposition. This was due, in part, to the fact that the term "palliative pelvic exenteration" was new and not clearly defined. There was also concern that the mortality, morbidity, and overall cost previously associated with pelvic exenterative procedures were out of keeping with the concept of palliation for cancer. However, much experience with pelvic exenterative surgery has been gained during the past 40 years, and the mortality, morbidity, length of stay, and overall cost of the procedure have decreased significantly. This has made the concept of pelvic exenteration for palliation reconcilable in carefully selected patients in the 1990s.
For the oncology profession, the transition period to managed care will mean new relationships with other providers, some loss of control over patient care, and the need for practice and ethical guidelines, concluded panelists participating in a session on managed care at the Association of Community Cancer Centers' 1995 Oncology Symposium.
Graft-versus-host disease (GVHD) represents a significant, perhaps neglected, complication of unrelated bone marrow transplantation, stated Daniel Weisdorf, MD, Professor of Medicine at the University of Minnesota, and Associate Director of the Adult Bone Marrow Transplantation Program, at a symposium on "Clinical Issues in Unrelated Marrow Transplantation" held in association with the recent meeting of the American Society of Hematology. Prolonged immunocompromise is an additional hazard to recipients of unrelated bone marrow transplants.
Treatment of fever and neutropenia in cancer patients has been recognized for 30 years as a medical emergency, requiring prompt in-hospital evaluation and institution of broad-spectrum intravenous (IV) antibiotics. This action
For patients with either limited or extensive small-cell lung cancer (SCLC), dose intensification of VICE chemotherapy affords a significant survival advantage without increasing the danger of sepsis or drug-related death, W.P. Steward, MD, said at the Eighth Annual European Cancer Conference (ECCO-8).
We strongly agree with the authors that, although there is no compelling evidence to suggest that nonionizing electromagnetic fields represent a public health hazard, there is sufficient evidence of magnetic- and electric field-induced biologic effects to continue scientific investigation of this issue.
The discussion by Freifeld and Pizzo is a comprehensive summary of an important recent trend: the attempt to identify low-risk patients with fever and neutropenia and relax their therapy appropriately. It is not surprising that a summary from these authors would be definitive. Dr. Pizzo and his colleagues have defined many central elements of the therapy of fever and neutropenia: that broad-spectrum antibiotics should be continued after patients become afebrile while they remain neutropenic ; that an antifungal agent, amphotericin, should be added to prevent potentially serious fungal superinfection when patients remain febrile and neutropenic after 7 days ; and that monotherapy using ceftazidime alone is as effective as combination therapy with a semisynthetic penicillin and an aminoglycoside, particularly for low-risk patients . Their current review catalogs recent attempts to define less aggressive, costly, and restrictive therapy for low-risk patients with fever and neutropenia. I would add only a few comments based on our work at the Dana-Farber Cancer Institute.
Do not resuscitate (DNR) orders have become an integral part of the care of the terminally ill patient. Often, the decision whether or not to resuscitate a patient in the event of cardiopulmonary arrest must be made by the patient's family members. This is a difficult decision that is made at an emotionally trying time. Our study investigated the satisfaction, understanding, and feelings of families who sign DNR orders for their relatives. We are not aware of any other studies that have evaluated this aspect of the DNR order.
Fox Chase/Stanford Study: Radiation Therapy Effective in Treating Younger Men with Early-Stage Prostate Cancer
Researchers at two major medical centers have found that radiation therapy is just as successful as surgery in treating younger men with early-stage prostate cancer. Currently, men 60 years old or under with prostate cancer are far more likely to be treated with surgery than with radiation therapy.
Monoclonal antibodies (MoAbs) show promise as a prognostic as well as therapeutic tool in some minimal residual cancers, said Gert Riethmüller, MD, of the University of Munich's Institute for Immunology.
Low-frequency electromagnetic radiation had previously been thought to cause human injury only by generation of excess heat or by shock from direct contact with electric current. Information accumulating over the past few
Breast cancer incidence rates in the United States rose by 24% between 1973 and 1991. Mortality during this period, however, remained stable. Both the 5-year relative survival rate and the rates of in situ and stage I
There already is a strong body of evidence suggesting that long-term, consistent use of nonsteroidal anti-inflammatory agents (NSAIDs) reduces the relative risk of colon cancer. Questions recently have been raised, however, concerning the way in which these drugs exert their protective effect.
A new DNA-based sequencing technique-Sequence Based Diagnosis (SBD)-that determines p53 gene status in primary breast cancers, yields better prognostic information than standard immunohistochemistry, according to a study in the February 20, 1996, issue of the Journal of the National Cancer Institute. The findings may have important implications for some of the over 180,000 US women diagnosed annually with breast cancer.
The bulk of available evidence has made a persuasive case for early bone marrow transplantation as the treatment of choice for patients with relapsed Hodgkin's disease, Philip J. Bierman, MD, said at a lymphoma conference sponsored by the University of Texas M.D. Anderson Cancer Center.
The use of antibodies as immunodelivery systems is still in its infancy, Sydney Welt, MD, said at a symposium on Monoclonal Antibodies and Cancer Therapy, sponsored by the Cancer Research Institute.
Breast-conserving surgery without radiation therapy is not an effective treatment for early-stage breast cancer, a Harvard Medical School study concludes.
Efforts to improve the rate of remission and reduce the risk of relapse in patients with advanced hematologic malignancies are focusing on interleukin-2 (IL-2, aldesleukin, Proleukin), said Alexander Fefer, MD, of the University of Washington Medical School and Fred Hutchinson Cancer Research Center, Seattle.
The pathologist plays an integral role in the evaluation and treatment of many urologic cancers. Prostate cancer may be the best example of the importance of the pathologist in providing accurate clinical staging. Dr. Epstein has written an excellent review of the critical pathologic information available from prostate needle biopsy and radical prostatectomy specimens. The article highlights how to utilize this information in day-to-day clinical practice. Although the article is complete, some areas deserve special attention.
During the last few years, pathologists have assumed several important roles in the assessment of adenocarcinomas of the prostate. The establishment of postoperative serum prostate-specific antigen (PSA)
Total pelvic exenteration is a radical abdominoperineal operation designed to treat locally extensive pelvic malignancy. In the past, the morbidity and mortality has been such that this procedure was considered justified
The authors provide an excellent overview of the role of pelvic exenteration performed as a curative cancer operation or for palliation. They extend the customary definition of palliation, however, to include exenteration intended for cure when tumor is knowingly left behind or is discovered by pathologic review of the operative specimen. The added definitions are apparently based on observations indicating that these procedures can relieve or reduce symptoms related to the disease or its treatment in some patients, resulting in an improved "quality of life," and that some patients also enjoy an extended survival after exenteration
An experimental approach combining immunotherapy with conventional chemotherapy may succeed in delivering a "one-two punch" to many common tumors of epithelial origin.
Although most studies of the relationship between oral contraceptives (OCs) and breast cancer have focused on a possible causative role for OCs, new data suggest that breast cancer patients with a history of OC use may actually fare better than women who have never taken the pill.
As managed care grows, oncologists will have to decide who to "bond" with, then learn how to develop financially sound contracts with their new partners, Lee E. Mortenson, DPA, said at the 1995 Oncology Symposium of the Association of Community Cancer Centers (ACCC).
In the 30 years since the first Surgeon General's report, progress has been made in educating the public about the dangers of tobacco use.
Radiation Therapy Oncology Group (RTOG) trial 93-05 started slowly, but is now accruing on target, enrolling three patients per month, says Dr. Luis Souhami, chair of the study. To date, 40 patients are enrolled in the study.
It is widely accepted that the causation of cancer is the result of environmental exposures (including endogenous hormone exposure) and genetic susceptibility. Ultimately, to prevent breast cancer, we must understand both the environmental and genetic components.
U of Chicago Study Shows That African-American Breast Cancer Patients Have Same Survival as Their Caucasian Counterparts
African-American breast cancer patients survive as long as their Caucasian counterparts, a new study with up to a 40-year follow-up shows. The study, conducted at the University of Chicago, also found that African-American women do not have more aggressive cancer.
It is perhaps not surprising that the increased incidence of a disease that has a major impact on mortality in young women (even though the absolute risk of death from breast cancer in this age group is low) should create so much interest. Yet, despite decades of research, it is by no means clear that everyone would agree with King and Schottenfeld that the appropriate approach to breast cancer prevention is one that "focuses on the physiologic effects of the sex steroid hormones and their potential interactions with family history." However, this tantalizing statement appearing at the end of the abstract of their article fortunately is elaborated upon at the end of the article itself. This elaboration refers specifically to physical activity, energy consumption, obesity, pregnancy history and exogenous estrogens and their potential interactions with family history, with which many will agree.
Drs. King and Schottenfeld have provided an interesting review of the literature in their attempts to relate changes in breast cancer incidence over time to secular changes in postulated risk factors.