ONCOLOGY Vol 9 No 9

Gemzar (gemcitabine hydrochloride), an investigational nucleoside analog from Eli Lilly and Company, for the treatment of

A previously unrecognized biochemical mechanism by which the immune system reins in the tissue-destroying activities of T

Researchers at the John Wayne Cancer Institute at Saint John's Hospital in Los Angeles are studying a new blood test that

Combining bone marrow transplant with high-dose chemotherapy improves survival rates for women with advanced ovarian

The addition of cisplatin (Platinol) and oral etoposide (VePesid)to radiation therapy delays distant metastasis, thus increasing

An outpatient therapy for malignant pleural effusions can improvea cancer patient's quality of life while reducing hospital costs

Recent broad interest in euthanasia and assisted suicide by society at large has prompted this review of euthanasia. This fine,

A study published in Annals of Internal Medicine reportsthat early treatment with Famvir (famciclovir) significantly shortens

Ten-year survival data of patients with high-risk cervical cancer emphasize the need for extended-field irradiation, according to

The widespread use of the TNM staging system has helped standardize the classification of cancers. Despite its excellence in describing a tumor's size and extent of anatomic spread, the TNM system does not account for the clinical biology of the cancer.

Dr. Piccirillo presents an interesting concept. Although the knowledge that comorbidity and severity of symptoms have a bearing on the prognosis of a patient with cancer is not new, the attempt to measure this influence and include it into a reproducible staging system is commendable.

Minimizing oral manifestations of cancer treatment is a major concern for both dentists and physicians. This article, by dentists from the M. D. Anderson Cancer Center in Houston, Texas, addresses the prevention and minimization of oral complications by describing their observations and considerations for a wide range of oncologic treatments.

Aggressive cancer therapy places patients at greater risk for oral complications and treatment-related consequences. Unfortunately, prevention and/or treatment of such oral sequelae have become often overlooked priorities of the treatment team.

Toth and his colleagues present an increasingly important subject in their review; not only do oral complications adversely affect patients' quality of life, but also, as nonsurgical antineoplastic therapy becomes more aggressive, they represent an increasingly more common source of sepsis and local and distant-site infection.

Endocrine therapy has been shown to be effective therapy for women with all stages of breast cancer, and the nonsteroidal antiestrogen tamoxifen is being evaluated as a potential preventive agent for this disease. Kimmick and Muss review the use of endocrine therapy for the treatment of patients with metastatic breast cancer. They discuss the basis for endocrine therapy and potential mechanisms of endocrine resistance, currently available and new agents, as well as new areas of investigation. I would like to highlight a few practical points regarding the use of endocrine therapy in the treatment of patients with metastatic breast cancer and some key areas of research.

Widespread use of prostate-specific antigen (PSA) as a screening tool has led to an increased incidence of biopsy-proven prostate cancer, as well as a shift toward more cases with clinically confined disease (stage T1 to T2). The two traditional therapeutic modalities, radical prostatectomy and external-beam radiation therapy, have undergone technical refinements. Other modalities, such as brachytherapy and cryosurgery, are also being used to treat early-stage disease. Comparisons between treatment results are difficult. Biochemical failure, based on PSA findings, is currently used to measure treatment efficacy, but the precise definition and clinical relevance of biochemical failure have yet to be established. The author presents current analyses of biochemical failure, cause-specific survival, distant metastasis, and morbidity rates following various treatment modalities. [ONCOLOGY 9(9):803-816, 1995]

This year approximately 200,000 new cases of breast cancer will be diagnosed in the United States. Primary surgical treatment plus adjuvant therapy will cure two-thirds of these patients. The remainder, unfortunately, will experience disease recurrence at varying intervals after surgery.

Hormonal manipulation is currently the mainstay of palliative care for metastatic breast cancer because it is well tolerated and produces significant responses in approximately one-third of unselected patients. Tamoxifen, a nonsteroidal antiestrogen, is currently considered first-line therapy. Second-line agents include progestins and aromatase inhibitors.

Dr. Stock provides a thorough summary of recent data on the principal modes of treatment for early-stage prostate cancer. Prostatectomy, external radiation, and brachytherapy have all improved substantially over the last 15 years. Despite these improvements, however, it is still unclear how these modalities compare in terms of efficacy and morbidity. To provide some balance to his evenhanded approach, I will add a few remarks.

The article by Stock provides a comparison of outcomes following radiation therapy and radical prostatectomy in men with clinically localized prostate cancer. The reliability of this comparison is complicated by the lack of randomized trials and the obvious selection biases inherent in uncontrolled studies. Ultimately, however, the value of either therapy depends critically on the difference between radiation or surgery and watchful waiting--an issue that is not addressed in this article.

The tumor, node, metastases (TNM) cancer staging system is widely accepted by physicians as a predictor of prognosis and as a guide to therapy. Multiple national and international organizations, including the American Joint Committee on Cancer and the TNM Committee of the International Union Against Cancer have periodically evaluated and revised this international staging system since it was first proposed over four decades ago [1].