Cancer

Understanding of the mechanisms underlying the activity and limitations of biochemotherapy remains inadequate. The design of new regimens should based on emerging knowledge regarding molecular mechanisms of oncogenesis, cancer cell proliferation and survival, and control apoptosis.

See also pages 596–603.

The rate of participation among a diverse, population-based sample of breast cancer survivors was found to be influenced by ethnicity, age, and site of recruitment. Despite important recruitment and measurement challenges, this study obtained acceptable participation rates and good internal consistency of the measures. The results demonstrate the utility of a culturally responsive approach to health disparities research.

Approximately 35% of women with breast carcinoma exhibited impaired cognitive function before receiving chemotherapy. The authors examined potential demographic, disease-related, and clinical factors associated with impaired cognitive function and discussed the implications for chemotherapy trial design.

Assessment of the management of early breast carcinoma before and after the introduction of clinical practice guidelines demonstrated that management practices became more in line with guideline recommendations.

Urokinase-type plasminogen activator (uPA) and uPA inhibitor type 1 (PAI-1) have been proven to have prognostic value in patients with primary breast carcinoma in the absence of adjuvant systemic therapy. In the current study, the authors investigated whether the complex of uPA with PAI-1 is also associated with the natural course of breast carcinoma and found that tumor levels of this complex do in fact have prognostic value.

Analysis of the pattern of screening utilization reveals a disappointingly low level of screening use, with potentially negative health consequences, among women of all racial, ethnic, socioeconomic, insurance, language, age, medical history, and previous screening-use categories. Improving the promptness of return to screening appears to have the potential to lead to considerable reductions in breast cancer death.

The authors assessed the feasibility of breast-conserving surgery (BCS) in 48 cases of breast carcinoma associated with nipple discharge. Patients in the study cohort presented primarily with early-stage breast carcinoma associated with ductal carcinoma in situ. Although occult nipple-areola complex involvement is not an uncommon finding in such patients, BCS can be performed safely if negative margins are achieved and if appropriate adjuvant radiotherapy or systemic therapy is administered.

Cancer-directed surgery and lymph node involvement ratio were independent predictors of overall survival for patients with adenocarcinoma of the small bowels.

In the current study, the authors found that the highest percentage of adenocarcinoma in any biopsy site, the percentage of adenocarcinoma in the biopsy site with the highest Gleason score, the number of positive biopsy sites, the bilaterality of the tumor, and the percentage of biopsy sites positive for disease were useful preoperative predictors of tumor volume in radical prostatectomy specimens. Although these preoperative biopsy parameters were significant in linear regression models, none was sufficient as a single predictor of tumor volume.

Based on the results from this randomized Phase II study, the survival-prolonging efficacy of the combination of interferon α with 13-cis retinoic acid should be assessed in a Phase III trial. Considerable interobserver variability of objective response evaluation warrants central review of claimed responses in patients with metastatic renal cell carcinoma.

Men with prostate carcinoma are at risk for adverse bone effects from both the disease and the treatment. The longitudinal data in the current study revealed that fractures are common in this patient population and appear to be linked to the duration of androgen deprivation therapy.

This prospective, randomized, controlled trial was performed to determine whether aerobic exercise would reduce the incidence of fatigue and prevent deterioration in physical functioning during radiotherapy for localized prostate carcinoma. The outcome measures were fatigue and distance walked before and after radiotherapy. Moderate-intensity walking appeared to produce a significant improvement in physical functioning and to prevent any significant increase in fatigue.

The authors reported that patients with monoclonal gammopathy of undetermined significance and multiple myeloma had an increased risk of venous thromboembolic disease. This risk needs to be studied further to understand and define the mechanism involved.

The authors proposed a risk model for predicting outcome in patients with hematologic malignancies who develop pulmonary infiltrates. Using parameters that were available at the onset of pulmonary infiltrates, univariate and multivariate analyses were performed to assess factors influencing outcome in a 110-patient historical cohort. The proposed model accurately predicted survival for patients with fever and pulmonary infiltrates and, once prospectively validated, may be used to select patients for trials involving novel diagnostic and therapeutic strategies.

The authors retrospectively assessed 63 patients with hepatocellular carcinoma (HCC), cholangiocarcinoma (CCA), or gallbladder carcinoma (GBC) who were treated with oral capecitabine. The antitumor activity of single-agent capecitabine was most evident in patients with GBC, modest in patients with HCC, and poor in patients with CCA. With regard to toxicity, capecitabine was found to be relatively safe for all patients, including those with cirrhosis.

The underpinning model for the Lung Cancer Symptom Scale (LCSS)-Meso, a quality-of-life measure for patients with malignant pleural mesothelioma, was tested with good results. Further support for the content validity and construct validity of the LCSS-Meso were obtained in the current study, which involved 495 patients.

Recent clinical studies using less dose-intensive biochemotherapy regimens reported decreased clinical efficacy in patients with advanced melanoma. The current pilot study demonstrated that dosing of concurrent biochemotherapy can be intensified cautiously in an inpatient ward.

See also pages 435–8.

Overexpression of laminin-8 in glioblastoma multiforme was found to be significantly associated with a shorter time to tumor recurrence (P < 0.0002) and a decreased patient survival time (P < 0.015). Laminin-8 may be used as a predictor of tumor recurrence and patient survival and as a potential molecular target for glioma therapy.

Given the high frequency of pituitary adenomas and their potential for causing clinical pathologies, the findings of the current study suggested that early diagnosis and treatment of pituitary adenomas should have far-reaching benefits.

Brain metastases are rare in pediatric germ cell tumors, and their incidence appears to be declining. In the current study, brain involvement occurred more frequently in pediatric patients with advanced-stage or extragonadal tumors, and in patients whose tumor contained a component of choriocarcinoma.

The optimal treatment strategy for synovial sarcoma (SS) is subject to debate, and different strategies have been used for pediatric and adult patients. The authors retrospectively examined a large group of patients of all ages who were treated for SS at a single institution over a 30-year period. Although more convincing proof of the efficacy of adjuvant chemotherapy in the treatment of adult soft tissue sarcoma is required, the current study suggests that patients with high-risk SS be the first to be considered for this type of treatment.

Pediatric patients who have undergone chemotherapy are prone to lose the protective serum antibody titer acquired from previous vaccinations, with different rates of loss associated with different types of vaccination.

A nationwide survey of liver tumors in South Africa showed that the incidence of hepatocellular carcinoma was lower in children compared with adults but was higher than in industrialized countries. This results in a lower ratio of hepatoblastoma to hepatocellular carcinoma in children.