Gastrointestinal Cancer

HOUSTON--A new tumor-selective agent may permit delivery of higher levels of 5-fluorouracil (5-FU) with lower toxicity, said Richard Pazdur, MD, of M.D. Anderson Cancer Center. A phase III trial of capecitabine is ongoing in colorectal cancer, and it is also under study for the treatment of breast cancer.

ROCKVILLE, Md--In the first report issued under its new Evidence-based Practice Initiative, the Agency for Health Care Policy and Research (AHCPR) has reaffirmed that early detection and treatment provide the primary means of preventing death from colorectal cancer.

Dr. Rich presents a comprehensive overview of adjuvant therapy for advanced operable rectal cancer. He emphasizes the roles of infusional chemoradiation in both the adjuvant setting and as sole therapy. Unless otherwise specified, the following comments pertain to clinically resectable B2-C (T3, N0-N1) adenocarcinoma of the rectum.

The use of adjuvant irradiation combined with systemic chemotherapy, or "chemoradiation," in the management of patients with operable rectal cancer has enabled more conservative surgery to be performed. Chemoradiation

CHICAGO--With an overall response rate of only 2.8% to drugs tested on more than 1,200 colorectal cancer patients over the last 20 years, new drug development has given gastrointestinal oncologists little to be enthusiastic about.

Until 1980, the greatest advances in the management of rectal cancer were technical ones. Whereas in the past most patients with rectal cancer underwent an abdominoperineal resection, it became possible in the 1980s to maintain intestinal continuity in the majority of patients with a low anterior resection and colorectal anastomosis and, more recently, with a low anterio resection and coloanal anastomosis. These advances were due, in part, to the development of stapling devices, which allowed surgeons to perform anastomoses that were technically difficult to perform by hand. More importantly, it became clear that in tumors identified at a relatively early stage, retrograde tumor spread was uncommon, and a 2-cm distal margin was generally adequate.

Dr. Enker offers an orderly presentation of many of the factors related to sphincter-preserving operations, quality of life, and outcome in the surgical management of the patient with rectal cancer. From the practical perspective of a very experienced surgeon, he provides broad guidelines for sphincter-conservation surgery that both the surgeon and nonsurgeon should find useful.

This review nicely summarizes the current state of combined-modality therapy for resectable rectal cancer, largely covering trials currently in progress in the United States. Although the article's title is "Multidisciplinary management of resectable rectal cancer," it really doesn't emphasize how multiple specialists manage rectal cancer patients per se, and thus, the article would probably be more appropriately titled, "Combined-modality therapy in resectable rectal cancer." It would have been interesting if the article had included more details on how radiation oncologists, medical oncologists, and surgeons can cooperate to deliver combined-modality therapy in higher proportions of patients with resectable rectal cancer, but this is a minor criticism.

The standard adjuvant therapy for resectable T3 and/or N1-2 rectal cancer is pelvic radiation therapy plus fluorouracil (5-FU)-based chemotherapy. Two randomized intergroup trials, INT 0114 and INT 0144, will help

In his excellent, thorough review of the current status of multidisciplinary treatment for rectal cancer, Dr. Minsky appropriately emphasizes the role that data from prospective clinical trials have played in providing the foundation for adjuvant therapy for patients with this disease. The principal therapeutic options discussed by Dr. Minsky are preoperative therapy and postoperative therapy.

Based on our experience and a review of the literature, we conclude that superficial, well- to moderately differentiated T1 cancers of the anal margin may be successfully treated with radiotherapy alone or local

Sphincter-preserving operations represent an important model for integrating the goals of surgery for rectal cancers. These goals--the achievement of cure and local control and the preservation of autonomic visceral

BUFFALO, NY--New analysis of familial colorectal cancer data suggests that the disease is not associated with genetic anticipation--the earlier onset of disease in successive generations--said Gloria M. Petersen, PhD, at the Eighth Annual Meeting of the ICG-HNPCC (International Collaborative Group-Hereditary Nonpolyposis Colorectal Cancer).

During our medical training, we were often reminded that our purpose is not just to take care of a disease, but rather, to take care of the person with that disease. We learned that a patient's physical condition represents only one aspect of that disease

A month of postoperative radiotherapy preceded by radiosensitizing boluses of fluorouracil (5-FU) slashed the recurrence rate and markedly improved survival in patients with Dukes B and C rectal cancer in a study from the Norwegian Adjuvant Rectal Cancer Project Group, presented at the European Cancer Conference (ECCO-8).

Most patients who have pancreatic cancer present with advanced disease that is not amenable to surgery. For patients whose disease is amenable to surgery and who are managed with surgical resection alone, local

The past 20 years have witnessed important changes in the manner in which many people with cancer are opting to deal with their disease. In the past, patients yielded to their physicians' treatment choices and assumed that they

Alleviation of tumor-related symptoms may be a more appropriate basis for judging drug efficacy in pancreatic cancer than is tumor shrinkage. Clinical benefit response (CBR), a new

Many people who are diagnosed with pancreatic cancer react with a normal level of sadness. In others, however, depression represents a concomitant illness, perhaps with a biologic basis. Regardless of their origin, these mood

The treatment of patients with pancreatic cancer requires the expertise of medical oncologists, radiation oncologists, radiologists, and surgical oncologists. The surgeon's role

The goals of oncology social work are to facilitate patient and family adjustment to the diagnosis and treatment of the disease; to promote psychosocial recovery and rehabilitation

For the patient with advanced pancreatic cancer, curative strategies may not be appropriate, and palliative symptom management may be the best approach to patient care. Oncologists,

The oncology nurse attends not only to the physiologic needs of the patient with pancreatic cancer but also to the educational, economic, logistic, and psychosocial factors that impact on quality of care. Managing patient care

The interval between follow-up colonoscopies may be increased from 1 to 3 years for colorectal cancer patients whose examinations are negative after 2 years, concludes a study of 389 patients at the Ochsner Clinic, New Orleans, Louisianna,

With the maturation of several clinical trials in the late 1990s, oncology researchers are on the verge of determining which types of nutritional interventions will be effective in the primary prevention of colon cancer, David S. Alberts, md, said at the

PHILADELPHIA--The addition of trimetrexate (NeuTrexin) to the standard chemotherapeutic regimen of fluorouracil and leucovorin in patients with metastatic colorectal cancer resulted in an improved response rate with no greater toxicity in a study reported at the Oncology Nursing Society meeting.

INDIANAPOLIS--Eli Lilly and Company's Gemzar (gemcitabine) is now available for use in the treatment of advanced pancreatic cancer.

FORT LAUDERDALE, Fla--The frequency of surveillance after colectomy, particularly CEA testing, was a major topic of discussion after the presentation of the National Comprehensive Cancer Network's (NCCN) preliminary guidelines on colorectal cancer, one of eight such guidelines introduced at the coalition's first annual conference.

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.

Irinotecan {Campo} a new anticancer agent developed by Rhone -Poulenc Rorer Inc, demonstrates significant activity in the treatment of advanced colorectal cancer, according to research presented at the Eighth Annual European Cancer Conference (ECCO-8) in Paris.