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The title of the article by Dr. Stephen Sagar, "Carcinomatous Meningitis: It Does Not Have to Be a Death Sentence" is very provocative. Most oncology specialists consider leptomeningeal dissemination of cancer as an indication of end-stage disease, particularly in patients with solid malignancies. More than 70% of patients found to have neoplastic meningitis have evidence of concurrent progressive systemic disease.[1] Although neoplastic meningitis is thought to have less of an impact on survival in patients with lymphomas or leukemias, the presence of tumor cells in the cerebrospinal fluid (CSF) of these patients significantly complicates the treatment regimen.

The association between HIV infection and the development of cancer was noted early in the acquired immunodeficiency syndrome (AIDS) epidemic. The AIDS-defining malignancies are Kaposi’s sarcoma, intermediate- or high-grade B-cell non-Hodgkin’s lymphoma (NHL), and cervical cancer. All of these cancers feature specific infectious agents in their etiology. These agents are human herpesvirus 8/Kaposi’s sarcoma-associated herpesvirus, or HHV-8/KSHV (implicated in Kaposi’s sarcoma), Epstein-Barr virus, or EBV (in primary central nervous system lymphoma and a subset of systemic B-cell NHL) and human papillomavirus, or HPV (in cervical cancer).[1]

With this insightful manuscript, Drs. Termuhlen and Kemeny shed some light on the surgical management of older cancer patients. The authors highlight pitfalls in patient selection and offer proposals to improve the surgical oncologist’s approach to patient care. They review the role of curative surgical management of the most common forms of cancer in the elderly, while emphasizing the role of surgical palliation to improve the quality of life of older cancer patients.

Leptomeningeal metastases are a growing problem, particularly among patients whose solid tumors have been controlled with increasingly effective systemic therapies. The central nervous system (CNS) can represent a sanctuary where disease can persist even if it is eradicated or controlled systemically. This is due to the blood-brain barrier that prevents most water-soluble chemotherapeutic agents from reaching tumor cells sequestered in the CNS.

Each year, tobacco use kills nearly 500,000 Americans (430,000 smokers and 53,000 from secondhand smoke)[1]-more than the combined annual number of national deaths from the acquired immunodeficiency syndrome, alcohol, automobile accidents, murders, suicides, and fires. The annual cost of treating tobacco-related diseases is about $89 billion.[2]

The elderly population in the United States increased by a factor of 11 in the past century, while the under age 65 population tripled in that same period.[1] Given that the majority of cancers occur in patients over 65 years old, there is an increasing need for surgical interventions in the elderly.

The review by Drs. Shacter and Weitzman is an excellent and timely contribution to the field of carcinogenesis. The issue of chronic inflammation as a progenitor of cancer development has been a controversial one. To prove the importance of chronic inflammation (and the factors released in the process) to carcinogenesis, the authors provide a thorough and logical presentation of the experimental results described in the literature, including their own work. This compilation of the existing data should dispel any doubts about the association of chronic inflammation to cancer. I will review the main points discussed by the authors.

Surgery is still the most important treatment for solid tumors, regardless of the age of the patient. In this article, we discuss the physiology of aging as it relates to risk assessment in the elderly surgical oncology patient. A brief review of the role of surgery in the treatment of breast, colorectal, pancreatic, and gastric cancer is provided, because these solid tumors primarily affect elderly patients.

LILLE, France-As front-line treatment for chronic lymphocytic leukemia (CLL), the combination of fludarabine (Fludara) and cyclophosphamide (Cytoxan, Neosar) administered orally "could be a good compromise with a good efficacy and an acceptable tolerance," reported Bruno Cazin, MD, of the Hôpital Claude Huriez in Lille, France, and his colleagues at the French Cooperative Group for CLL. An intermediate analysis of 59 of 76 patients that were enrolled in a multicenter phase II trial supports this claim, producing an overall response rate of 78% and mostly manageable toxicities.

Every 3 years, the National Cancer Institute (NCI) asks cancer researchers, advisory groups, and advocacy organizations to recommend important areas to which it should devote additional resources.

This and future reports are written by oncologists from Pacific Shores Medical Group (a large group practice in Long Beach, California). The reports are primarily based on notes taken at the American Society of Clinical Oncology

ORLANDO, Florida-Rituximab (Rituxan) shows promise in the treatment of immune thrombocytopenic purpura (ITP), according to two poster presentations at the 43rd Annual Meeting of the American Society of Hematology (ASH). Nichola Cooper, MRCP, fellow, and James B. Bussel, MD, professor of pediatrics, both at Weill Medical College of Cornell University, and Mansoor N. Saleh, MD, professor of medicine at the University of Alabama at Birmingham, reported the results of separate studies investigating the efficacy and toxicity of rituximab in adults with refractory ITP. Rituximab binds to the antigen CD20 and depletes circulating B-lymphocyte cells. "In theory," Dr. Cooper said, "if you get rid of the B cells, it decreases the autoimmune response."

TORONTO-Monoclonal antibodies directed against red blood cells can be used to inhibit immune forms of thrombocytopenia, according to the results of studies with mice. These results were reported by Alan H. Lazarus, PhD, assistant professor of medicine, Department of Hematology, St. Michael’s Hospital, University of Toronto.

WASHINGTON-The American Cancer Society (ACS) has offered a 13-point legislative agenda for 2002. The agenda backs President Bush’s request that Congress provide the National Institutes of Health $27.3 billion for fiscal year (FY) 2003, thus completing the doubling of the agency’s budget over 5 years.

A substantial body of evidence supports the conclusion that chronic inflammation can predispose an individual to cancer, as demonstrated by the association between chronic inflammatory bowel diseases and the increased risk of colon carcinoma. Chronic inflammation is caused by a variety of factors, including bacterial, viral, and parasitic infections, chemical irritants, and nondigestible particles.

PITTSBURGH-The Oncology Nursing Certification Corporation (ONCC) has announced the results of certification tests taken September 22, 2001. In a news release, the ONCC said that 154 registered nurses have earned their Advanced Oncology Certified Nurse (AOCN) credential. Of the 233 nurses who took the test, 66% earned a passing score, including 123 newly certified AOCNs and 31 renewals.

ORLANDO-Presentations at the 43rd Annual Meeting of the American Society of Hematology (ASH) showed increased survival for patients with aggressive and indolent non-Hodgkin’s lymphoma (NHL) who received the anti-CD20 monoclonal antibody rituximab (Rituxan) in addition to standard CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine, prednisone).

SILVER SPRING, Maryland-The FDA’s Oncologic Drugs Advisory Committee (ODAC) has unanimously recommended that the agency amend the labeling of Herceptin (trastuzumab, Genentech) to include a new gene-detection test to identify women with metastatic breast cancer who are likely to benefit from the therapy. The 16-to-0 vote backed adding the PathVysion HER-2 DNA Probe Kit to the labeling. The kit is made by Vysis, Inc., now owned by Abbott Laboratories.

ROCKVILLE, Maryland-Researchers at the Food and Drug Administration and the Veteran’s Administrations will join in an effort to determine whether HIV infection or certain drugs used to treat it cause avascular necrosis (AVN). The disorder,

SAN FRANCISCO-The rate of breast-conserving surgery with adjuvant radiation therapy increased at a North Carolina community hospital (Durham Regional) after Duke University Medical Center radiation oncologists opened an on-site clinic. The study results were presented at the 43rd Annual Meeting of the American Society for Therapeutic Radiology and Oncology (abstract 87).

OLYMPIA, Washington-The overwhelming approval of a significant tax increase on cigarettes by the residents of Washington State has raised hopes among public health groups that other states will follow suit. By a margin of 65% to 35%,

SAN DIEGO--The staff at the H. Lee Moffitt Cancer Center in Tampa has initiated new practices that allow immunocompromised patients to eat fresh fruits and vegetables without worrying about bacterial infection, said Linda Rice, RN, OCN, RN III, staff nurse at Moffitt’s Medical Oncology/Hematology unit.

BETHESDA, Maryland-In what it calls "a landmark initiative," the National Cancer Institute has established a large network of cancer advocates to provide insights and feedback to its researchers and staff. The new group-Consumer

SAN FRANCISCO-Survival rates are significantly higher for women who have outer quadrant breast cancer, when compared with patients who have an inner quadrant lesion, according to results presented at the 43rd Annual Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO abstract 198). At 20 years, the improvement in survival for women with outer quadrant lesions ranged from 2.2% to 9.4%, depending on age group.

Andrew C. von Eschenbach, MD, has been named director of the National Cancer Institute (NCI) by President Bush. This appointment follows his recent selection as president-elect of the American Cancer Society.

ALBUQUERQUE-"Ethnicity is a relatively understudied concept in pain medicine," David B. Morris, PhD, writes in his review of ethnicity and pain (Pain Clinical Updates vol. IX, no. 4, November 2001). Existing research, he said, has provided "few firm generalizations" about the relationship between ethnicity and pain. This is due, in part, to the fact that both pain and ethnicity are "multidimensional, malleable, and shaped by culture."

SILVER SPRING, Maryland-Due to concerns about the postmarketing safety of the bolus or Saltz regimen of Camptosar (irinotecan, Pharmacia) combined with fluorouracil (5-FU) and leucovorin (IFL) as a first-line treatment for metastatic colorectal cancer, the Food and Drug Administration asked its Oncologic Drugs Advisory Committee (ODAC) to review the issue.

In this article (the first of a two-part interview), Linda L. Emanuel, MD, PhD, discusses bioethics. Part I highlights end-of-life care and physician-assisted suicide, while part II, which will appear in an upcoming issue of ONI, focuses on organizational ethics and future issues in bioethics.

NEW ORLEANS-Transperitoneal laparoscopic radical prostatectomy achieves negative surgical margins comparable to those achieved with the open retropubic approach, according to a study from University of Massachusetts Medical School

ATLANTA-Health care personnel exposed to HIV should be evaluated within hours (rather than days) after their exposure and should be tested for HIV at baseline (ie, to establish infection status at the time of exposure), according to the latest HIV postexposure prophylaxis (PEP) guidelines from the US Public Health Service [MMWR 50:(RR11):1-42, 2001].