ONCOLOGY Vol 10 No 9

Responding to the need for more efficacious and less toxic treatments for chronic myelogenous leukemia (CML), researchers at the University of Pennsylvania are exploring a novel form of gene therapy. By interfering with the transmission of a crucial message, they hope to prevent malignant cell growth without affecting normal hematopoietic cells.

This text, originally published as Dameshek and Gunz's textbook Leukemia (1958), is now edited by an international team consisting of Dr. Henderson, Dr. Lister, and Dr. Greaves. This continues to be an outstanding text in its field, covering virtually all aspects of the acute and chronic leukemias.

For persons with AIDS, current health status does not necessarily affect their desire to be revived if their heart stops, according to a study supported by the Agency for Health Care Policy and Research (HS06239).

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

Both physicians and public health specialists can learn valuable lessons about communicating cancer risks from the experiences of those engaged in environmental risk communications, said Frank Baker, phd, a senior official of the American Cancer Society (ACS).

Gemcitabine (Gemzar), recently approved by the FDA as a treatment IND for patients with advanced or metastatic pancreatic cancer, has shown promise in the treatment of non-small-cell lung cancer (NSCLC), both as a single agent and in combination with other chemotherapy drugs, Alan Sandler, md, reported at a symposium held at the Chemotherapy Foundation meeting last year.

Following unmodified allogeneic bone marrow transplantation (BMT), up to 60% of patients with chronic myelogenous leukemia (CML) will relapse. The management of relapsed CML has proven especially difficult, because cytotoxic drugs and interferon-alfa (Intron A, Roferon-A) seldom cure the disease, and a second bone marrow transplant is associated with high mortality.

When organizers asked Tim Byers, MD, MPH, to speak at the American Cancer Society's National Conference on Cancer Prevention and Early Detection, he liked their proposed title for his talk--"Nutrition: The Data Are There."

Polymerase chain reaction (PCR) testing, which is much more expensive than AIDS antibody tests, should be used routinely to detect HIV infection in infants but not in adults, according to two new studies from Veterans Affairs and Stanford researchers.

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).

Thomas Jefferson University in Philadelphia has received a patent for a molecular-based blood test that provides a novel approach to diagnosing prostate cancer. Jefferson has given exclusive licensing rights to the test to UroCor, Inc., for the United States and Canada, and to the Italian-based biotechnology firm Raggio-Italgene, for Europe and Japan.

Rapid advances in biomedical research and technology are producing a continuous stream of new, and often expensive, medical devices, drugs, and therapies. Health insurers' decisions about whether and when to provide coverage for these new

Drs. Ilson and Kelsen present an excellent review of the current investigations and treatment recommendations for patients with esophageal cancer. In a comprehensive and concise fashion, they detail controversies in surgical and nonsurgical management, neoadjuvant therapies, and regimens for treating metastatic disease. Their review provides an opportunity to further highlight several research questions.

The paper by Drs. Moul and Heidenreich provides a very nice review of prognostic factors for metastasis in patients with clinical stage I nonseminoma. Risk-adapted management--ie, the management of patients at low risk for metastasis by surveillance and patients at high risk for metastasis by retroperitoneal lymph node dissection (RPLND)--is very reasonable, and we are now at a point where a paradigm can be developed to accurately classify clinical stage I patients as either low or high risk and manage them accordingly.

The treatment of advanced prostate cancer continues to be an enigma. Every few years, it seems, a new variation in treatment is espoused and offered to the public. To date, two trends seem to have emerged: For men under 70 years of age, there seems to be a consensus that definitive treatment should be pursued for low-grade, low-stage, localized tumors. Prostatectomy or radiation therapy may cure or at least increase survival; for men over age 70, less vigorous treatment is often the preferred choice [1,2]. Nevertheless, outside of these two points of agreement, many other controversial questions remain and will persist for some time.

Quality of life of patients undergoing androgen deprivation is an issue that has received limited attention in the past but is currently being actively evaluated in clinical trials. This issue becomes more important as patients with longer life expectancy and no metastatic disease are treated for longer durations.

Over the last 10 years, we have learned more about not only the natural history of untreated locally advanced prostate cancer but also the ways in which we can effectively modify radiation therapy to treat this disease. There are now sufficient data to suggest that patients with prostate cancer that is considered locally advanced (stages T2b to T4) have a propensity for the development of lymph node metastasis and occult distant spread. In these patients, there also is a recognized difficulty in controlling the disease locally with radiation, due to the bulk of tumor present and the surrounding dose-limiting, late-reacting normal tissues.

Although therapy for esophageal cancer has generated a profusion of research programs and clinical trials, difficult issues and important questions remain to be addressed and answered. The scholarly, balanced review of esophageal cancer by Drs. Ilson and Kelsen explores these issues and questions in a state-of-the art summary of treatments for this disease. The authors hold impressive credentials in this field: almost all clinical research in esophageal cancer for the past two decades owes some debt to Dr. Kelsen and his colleagues at Memorial Sloan-Kettering Cancer Center. In this commentary, we will utilize a few of the key points raised by the authors to suggest a slightly different perspective on approaches to esophageal cancer treatment and directions for future research endeavors.

Prognostic Factors in Low-Stage Nonseminomatous Testicular Cancer

A diagnosis of cancer evokes a patient's ultimate existential and spiritual concerns. These concerns can be quite pronounced in the patient with pancreatic cancer due to the generally advanced stage of the disease at diagnosis

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 staging and treatment of prostate cancer are complex, particularly in patients with clinical disease that has advanced locally beyond the confines of the gland. Management choices are made more difficult by a paucity of

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 standard approaches of surgery or radiotherapy cure only a minority of patients with esophageal cancer. Because of these poor results and the frequent systemic pattern of recurrences, combined-modality therapy

Progressive weight loss and nutritional deterioration are commonly found in the patient with pancreatic cancer. The combined effects of the central anatomic location of the pancreas,

Endocrine manipulation plays a crucial role in the treatment of advanced prostate carcinoma. Recent enthusiasm for earlier use of endocrine therapy has increased the significance of diminishing treatment-related side effects,

Whether patients with clinical stage I nonseminomatous testicular germ-cell cancer (NSGCT) should be treated with orchiectomy and retroperitoneal lymph node dissection (RPLND) or orchiectomy and surveillance remains