The cancer journal from Scientific American最新文献

{"title":"Importance of hypoxic cells to radiation treatment: further considerations.","authors":"H D Suit","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79462,"journal":{"name":"The cancer journal from Scientific American","volume":"5 6","pages":"334-5"},"PeriodicalIF":0.0,"publicationDate":"1999-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21464926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oncology specialties at the turn of the century: a workforce analysis.","authors":"D H Hussey","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79462,"journal":{"name":"The cancer journal from Scientific American","volume":"5 6","pages":"315-24"},"PeriodicalIF":0.0,"publicationDate":"1999-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21464925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Janeway lecture. Hodgkin's disease--finding the balance between cure and late effects.","authors":"S S Donaldson,&nbsp;S L Hancock,&nbsp;R T Hoppe","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this review is to summarize the Stanford experience in Hodgkin's disease, the late effects of treatment, and strategies to improve management to maximize cure and decrease late effects in these patients.</p><p><strong>Patients and methods: </strong>Between 1960 and 1999, 2617 consecutive patients with Hodgkin's disease have been seen, treated, and rigorously followed at Stanford. This population includes patients of all ages and stages of disease. The database summarizing this experience serves as the source of survival and mortality data over 4 decades. Two thousand two hundred thirty-two of the population comprise the group evaluated for secondary cardiac disease. Two thousand one hundred sixty-two patients have been evaluated for risk of secondary leukemia, non-Hodgkin's lymphoma, and solid tumors. Eight hundred eighty-five women were evaluated for secondary breast cancer, prompting a subsequent analysis of risk of secondary cancer among 694 pediatric patients.</p><p><strong>Results: </strong>The probability of cure of Hodgkin's disease has dramatically improved over the past 40 years. Today, 94% of patients are expected to survive. Among those who do not survive, approximately half die of Hodgkin's disease, 20% of new cancers, and 14% of cardiovascular complications. Modifications in patient management and treatment have greatly reduced the serious late effects observed from prior therapy. With current combined-modality therapy using moderate doses of involved field of radiation and limited cycles of multiagent, risk adapted chemotherapy, serious cardiac complications and development of secondary cancers are expected to be greatly reduced. The Stanford 25-year pediatric Hodgkin's disease experience reveals that survival in favorable early-stage disease exceeds 95%. Newer protocols for children with advanced-stage disease continue to show these excellent survival rates and promise less late morbidity. Adult protocols using the risk-adapted Stanford V combined-modality program now parallel the pediatric experience, with greater than 90% survival in these patients.</p><p><strong>Discussion: </strong>Thus today the likelihood of cure of Hodgkin's disease greatly exceeds the risk of late effects, a goal both Dr. Henry Janeway and Madame Marie Curie emphasized and taught from first-hand experience.</p>","PeriodicalId":79462,"journal":{"name":"The cancer journal from Scientific American","volume":"5 6","pages":"325-33"},"PeriodicalIF":0.0,"publicationDate":"1999-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21464929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paclitaxel, carboplatin, and hexamethyl-melamine (taxchex) as first-line therapy for ovarian cancer.","authors":"E M Hartenbach,&nbsp;L S Harris,&nbsp;H H Bailey,&nbsp;E A Grosen,&nbsp;E Larrison,&nbsp;D Chen,&nbsp;L B Twiggs,&nbsp;J C Schink","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The addition of hexamethylmelamine to therapy with cisplatin, cyclophosphamide, and doxorubicin significantly enhanced outcomes of patients with advanced ovarian cancer. Hexamethylmelamine, also known as altretamine, has potent antineoplastic activity when used as a single agent in patients who have failed to respond to both platinum-based and paclitaxel therapy. We have conducted a pilot study to evaluate the efficacy and safety of adding this drug to the popular ovarian cancer regimen of paclitaxel plus carboplatin.</p><p><strong>Methods: </strong>Patients with advanced ovarian, fallopian tube, or primary peritoneal cancer (International Federation of Gynecology and Obstetrics stages IIA, IIIC, and IV) were prospectively enrolled to receive six cycles, repeated every 4 weeks, of paclitaxel (150 mg/m2 i.v., day 1), carboplatin (AUC 5.0 i.v., day 1), and hexamethylmelamine (150 mg/m2 p.o., days 2-15). Colony stimulating factors were prohibited. Response and toxicity were monitored by use of Eastern Cooperative Oncology Group criteria.</p><p><strong>Results: </strong>Twenty patients were enrolled, 18 with ovarian cancer, one with fallopian tube cancer, and one with peritoneal cancer; 17 of these patients were evaluable for response and toxicity. At a median follow-up of 6.5 months, 13 of the patients had a complete response (76%), and four had progressive disease. Three of those with a complete response had a recurrence within 1 year of completing treatment. Toxicity was acceptable, with myelosuppression the most severe adverse effect; one patient had grade 3 anemia, one patient had grade 4 thrombocytopenia, and 12 patients had grade 4 neutropenia. Quality of life showed improvement over the course of therapy, particularly in the physical well-being subscale.</p><p><strong>Conclusion: </strong>The addition of hexamethylmelamine to paclitaxel and carboplatin is a well-tolerated multidrug combination for women with advanced ovarian cancer that deserves further testing in a phase III study.</p>","PeriodicalId":79462,"journal":{"name":"The cancer journal from Scientific American","volume":"5 6","pages":"348-55"},"PeriodicalIF":0.0,"publicationDate":"1999-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21464931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The phase I/II clinical study of carbon ion therapy for cancer of the uterine cervix.","authors":"T Nakano,&nbsp;M Suzuki,&nbsp;A Abe,&nbsp;Y Suzuki,&nbsp;S Morita,&nbsp;J Mizoe,&nbsp;S Sato,&nbsp;T Miyamoto,&nbsp;T Kamada,&nbsp;H Kato,&nbsp;H Tsujii","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>The phase I/II clinical study of carbon beam therapy was undertaken for 31 cases of advanced cervical cancer of stages IIIB and IVA from June 1995 to November 1997. The main purpose was to determine clinically useful fraction doses without severe acute reaction of normal tissues and to assess tumor control dose levels achievable without significant normal tissue toxicity.</p><p><strong>Patients and methods: </strong>The treatment was given with four fixed fractions per week (24 fractions over 6 weeks) and was initiated with a fraction dose of 2.2 Gray equivalent (GyE), and the dose was increased as 2.4 GyE, 2.6 GyE, 2.8 GyE, and 3.0 GyE. Consequently, the total dose initiated was 52.8 GyE, to increase up to 72.0 GyE in 4.8-GyE increments in the dose-escalation fashion. Thirty patients with eligible advanced cervical cancers consisting of 27 squamous cell carcinomas and three adenocarcinomas were analyzed.</p><p><strong>Results: </strong>Acute response of normal tissues was less than with photon treatment until fraction doses of 2.8 GyE were administered, and patients finished treatment with comfortable conditions. Severe late complications occurred in the two patients who received more than 67.2 GyE. The 2-year cumulative survival rate and the local control rate of 27 patients with squamous cell carcinoma were 61.5% and 59.3%, respectively. According to stages, the 2-year survival rates of stage IIIB and IVA patients were 54.4% and 75.0%, respectively. The 2-year local control rates of stage IIIB and IVA patients were 52.6% and 75.0%, respectively.</p><p><strong>Discussion: </strong>These results indicated that the disease control seems to be relatively better for very advanced disease and with dose escalation treatment. Local control was not significantly correlated with total dose and tumor volume. The results of the present study, despite small numbers and short observation, suggest that an adequate fraction dose for pelvis fields is 2.8 to 3.0 GyE and that the carbon beam therapy might be advantageous for advanced cervical cancer.</p>","PeriodicalId":79462,"journal":{"name":"The cancer journal from Scientific American","volume":"5 6","pages":"362-9"},"PeriodicalIF":0.0,"publicationDate":"1999-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21463734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiation therapy with hyperbaric oxygen at 4 atmospheres pressure in the management of squamous cell carcinoma of the head and neck: results of a randomized clinical trial.","authors":"B G Haffty,&nbsp;R Hurley,&nbsp;L J Peters","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to present the results of a randomized trial evaluating HBO-4 in combination with hypofractionated radiation therapy in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN).</p><p><strong>Methods and materials: </strong>Between April 1974 and December 1975, 48 patients with locally advanced unresected SCCHN, referred for primary radiation therapy, were randomized to radiation delivered in air in two fractions of 12.65 Gy over 21 days to a total of 25.30 Gy (air, n = 25); or radiation under HBO-4 in two fractions of 11.50 Gy over 21 days to at total of 23.00 Gy (HBO-4, n = 23). The HBO-4 was administered under general anesthesia to minimize patient discomfort and potential problems with seizures associated with rapid compression to 4 atmospheres. Patients were monitored regularly by the radiation oncologists for toxicity, response, local control, and survival. The original hospital records, radiation records, and hyperbaric treatment logs were recently reviewed, and all data were entered onto a computerized database for the current analysis. The results of this trial have not previously been published.</p><p><strong>Results: </strong>The air and HBO-4 arms were evenly matched with respect to age, sex, performance status, hemoglobin level, primary site, and stage of disease. Acute toxicities were acceptable with no significant differences between the two treatment arms. A trend toward excess severe late complications were noted in the hyperbaric arm (12 vs 7). There was a highly significant difference in complete clinical responses between the two arms, with 21/25 in complete dinical responses in the HBO-4 arm compared with 13/25 in complete clinical responses in the air arm, and a statistically insignificant trend toward improved 5-year local control in the HBO-4 arm (29% vs 16%). There were no significant differences between the two arms with respect to 5-year survival, distant metastasis, or second primary tumors.</p><p><strong>Conclusions: </strong>Long-term outcome from this historical randomized trial demonstrate substantial improvements in response rate with the use of HBO-4. The hypofractionation scheme used in the trial resulted in relatively low local control and high complication rates in this group of patients with very advanced SCCHN. However, these results support the theory that radioresistant hypoxic cells limit the radiocurability of SCCHN. Further investigations addressing the hypoxic cell problem with hypoxic cytotoxins or hypoxic cell sensitizers in combination with radiation therapy using more conventional fractionation schemes are warranted.</p>","PeriodicalId":79462,"journal":{"name":"The cancer journal from Scientific American","volume":"5 6","pages":"341-7"},"PeriodicalIF":0.0,"publicationDate":"1999-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21464930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative borderline elevated CEA predicts for earlier relapse in patients with rectal cancer receiving adjuvant postoperative therapy.","authors":"L A Dawson,&nbsp;E Franssen,&nbsp;P Davey","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to determine the impact of a borderline elevated postoperative carcinoembryonic antigen (CEA) on the duration of disease-free survival in patients with rectal cancer treated with postoperative adjuvant radiotherapy and chemotherapy.</p><p><strong>Patients and methods: </strong>A retrospective review was undertaken of 145 patients undergoing curative surgery for rectal adenocarcinoma (American Joint Committee on Cancer stages II and III) and treated with postoperative radiotherapy and chemotherapy from January 1994 to February 1997. Patients with known metastatic disease, with gross residual disease after surgery, or without an available postoperative CEA level before adjuvant therapy were not included. All patients were monitored for a minimum of 1 year or until death. The rates of relapse, disease-free survival and overall survival were estimated according to the Kaplan-Meier method. Univariate analyses for the endpoint time to relapse was carried out for the following potential prognostic factors: age, gender, American Joint Committee on Cancer stage, number of lymph nodes, perineural invasion, capillary-like space invasion, margin status, and postoperative CEA level (< or = 4.0 microg/L vs > 4.0 microg/L). A mulitvariate regression analyses was conducted with the Cox proportional hazards model.</p><p><strong>Results: </strong>With a median follow-up of 45 months, the disease-free and overall survival rates at 2 years were 78% and 90% respectively. Eight patients were identified who expressed an elevated postoperative CEA (4.1-10.2 microg/L). Two patients had T3N0 tumors; one tumor was T4N0, four tumors were T3N1, and one was T4N1. The median time to first relapse in these eight patients was 26 months, compared with 69 months for the 137 patients with a postoperative CEA in the normal range (0-4.0 microg/L), (log-rank Chi-squared test = 4.92). As determined by a proportional hazards model, an elevated CEA remained an independent predictor (along with number of positive nodes) for early relapse.</p><p><strong>Discussion: </strong>Postoperative CEA in patients undergoing curative surgery for rectal cancer provides additional prognostic information in those patients embarking on adjuvant postoperative therapy. An elevated CEA predicts for early relapse and may help define a high-risk subset of patients in whom more aggressive adjuvant therapies should be considered.</p>","PeriodicalId":79462,"journal":{"name":"The cancer journal from Scientific American","volume":"5 6","pages":"374-9"},"PeriodicalIF":0.0,"publicationDate":"1999-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21463647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neoadjuvant androgen deprivation prior to transperineal prostate brachytherapy: smaller volumes, less morbidity.","authors":"K R Blank,&nbsp;R Whittington,&nbsp;B Arjomandy,&nbsp;A J Wein,&nbsp;G Broderick,&nbsp;J Staley,&nbsp;S B Malkowicz","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>Prostate brachytherapy is becoming increasingly utilized in the definitive treatment of men with early-stage prostate cancer. Others have reported a close relation between total dose to the gland and genitourinary and gastrointestinal toxicity. We tested the hypothesis that 3 months of hormone deprivation would decrease gland size and decrease radioactivity implanted, which would result in less morbidity. Here, we report the toxicity associated with this novel treatment strategy.</p><p><strong>Methods: </strong>One hundred fifty-five prostate cancer patients underwent ultrasound-guided transperineal implantation of palladium-103 at the Hospital of the University of Pennsylvania between January 1994 and July 1998. All men received at least 3 months of neoadjuvant luteinizing hormone-releasing hormone (LHRH) agonist therapy and were registered in the study. This group of men were compared with 55 men treated at the Hospital of the University of Pennsylvania with brachytherapy alone between December 1991 and December 1993.</p><p><strong>Results: </strong>Compared with men treated with implant alone, men who received LHRH agonist therapy had significantly smaller glands at the time of implant (27.7 cm3 vs 36.3 cm3), required fewer seeds (47.9 vs 83.2), and had significantly less radioactivity implanted (76.3 mCi vs 117 mCi). The genitourinary and gastrointestinal morbidity in the men receiving hormone deprivation was minimal, with long-term side effects occurring in only three patients. In addition, potency was preserved in 83% of men.</p><p><strong>Discussion: </strong>Three months or more of neoadjuvant LHRH agonist therapy before transperineal brachytherapy is safe, significantly reduces the amount of radioactivity implanted, and is associated with very low rates of genitourinary and gastrointestinal toxicity. In addition, potency preservation after combined-modality therapy is excellent and is similar to that of implantation alone. Further studies of this treatment approach are warranted.</p>","PeriodicalId":79462,"journal":{"name":"The cancer journal from Scientific American","volume":"5 6","pages":"370-3"},"PeriodicalIF":0.0,"publicationDate":"1999-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21463730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chemotherapy for ovarian cancer: beyond paclitaxel plus carboplatin.","authors":"R F Ozols","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79462,"journal":{"name":"The cancer journal from Scientific American","volume":"5 6","pages":"336-8"},"PeriodicalIF":0.0,"publicationDate":"1999-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21464927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A promising technique for liver cancer?","authors":"Y Fong","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79462,"journal":{"name":"The cancer journal from Scientific American","volume":"5 6","pages":"339-40"},"PeriodicalIF":0.0,"publicationDate":"1999-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21464928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}