Cancer

In the absence of clinical context, current definitions of insignificant prostate carcinoma are not useful in assessing the need for definitive treatment. Nonetheless, the findings of Bastian and colleagues, which are reported in the current issue of Cancer, strongly suggest that the Epstein criteria select for a subset of patients who may not require immediate therapy and who, at least initially, may be followed safely. The remaining challenge for the urologic community is to design clinical trials aimed at prospectively identifying individuals who require further intervention and determining when such intervention is necessary. Only after the completion of trials such as these can an accurate definition of ‘insignificant’ prostate carcinoma be put forth.

See pages 2001–5.

Using six different complementary in vivo and in vitro approaches, the authors determined the number, distribution, and anatomic properties of the ductal systems of the breast that extend from the nipple orifices to the terminal duct lobular units. More than 90% of all nipples examined contained 5–9 ductal orifices, which generally were arranged into a central group and a peripheral group. Each nipple orifice communicated with separate, nonanastomosing ductal systems, which extended to the terminal duct lobular units.

The current study presented the results of a survey of radiation oncologists in North America and Europe regarding the treatment of ductal carcinoma in situ (DCIS). It quantified and highlighted areas of agreement and controversy regarding radiotherapy and tamoxifen in the treatment of low and high-grade DCIS.

The current study did not show a positive relationship between bone mineral density (BMD) and breast density despite an expectation that both were reflective of estrogen exposure. This suggested that either breast density was not a good marker of lifetime estrogen exposure (if BMD is truly a good marker of lifetime estrogen exposure) or that organ-specific responses obscured the relation to cumulative exposure. BMD and breast density are both products of complex biology and each organ's unique response to estrogen appeared to leave these density measures unrelated to each other as indicators of estrogen exposure.

This retrospective analysis demonstrated that contralateral prophylactic mastectomy was associated with a low risk of subsequent development of breast carcinoma. Histologic findings in the ipsilateral breast, such as invasive lobular histology and estrogen and progesterone receptor positivity, and additional ipsilateral moderate to high-risk pathology may help to predict the likelihood of significant disease in the contralateral breast and assist in risk stratification.

The authors performed a retrospective review of 98 patients with metastatic carcinoid who were treated with iodine-131 metaiodobenzylguanidine (¹³¹I-MIBG) over a 15-year period. Symptomatic responses to ¹³¹I-MIBG treatment were associated with improved survival. The data from this study support ¹³¹I-MIBG treatment in select patients with metastatic carcinoid.

The presence of matrix metalloproteinase-2 (MMP-2) and its inducer, CD147, in cancerous esophageal lesions and surrounding tissue was investigated to determine if they are prognostic factors. Data were drawn from tissue samples from 101 patients with esophageal squamous cell carcinoma. Measurement of CD147 and MMP-2 expression may enhance understanding of the pathophysiology of invading tumor cells and, when used with cancer staging, may increase the ability of investigators to predict prognosis in patients with esophageal squamous cell carcinoma.

The Epstein criteria were developed in 1994 to facilitate the identification of insignificant prostate carcinoma. In the current contemporary analysis, the authors verify that the Epstein criteria remain a useful tool in the process of making decisions regarding prostate carcinoma treatment.

See pages 1923–5.

At times, it is difficult for pathologists and oncologists to ascertain the histogenesis and origin of certain neoplasms. The determination of tumor type is critical for patient management, and it is especially important when the differential diagnosis includes metastatic germ cell tumor, which is a highly treatable condition. Current data indicate that immunohistochemical detection of OCT4 is highly sensitive and specific for the diagnosis of metastatic seminoma and embryonal carcinoma.

Men with localized prostate carcinoma had substantial declines in sexual and urinary function compared with an age-matched and ethnicity-matched control group. Bowel function and general health-related quality of life remained stable.

The clinicopathologic features of lymphoepithelial carcinoma (LEC) and large cell undifferentiated carcinoma (LCUC) of the major salivary glands differed significantly. LEC was associated with Epstein–Barr virus, and patients who had LEC had a much better prognosis compared with patients who had LCUC.

The role of bronchoscopy and esophagoscopy in the presence of a normal thoracic computed tomography scan has been questioned because of the relatively low incidence of a second esophageal and/or lung primary tumor. The objective of the current study was to analyze the results obtained by triple endoscopy during the initial evaluation of patients with a primary carcinoma of the head and neck.

Patients with aggressive non-Hodgkin lymphoma (NHL) who fail to respond to or develop a disease recurrence after initial chemotherapy require second-line therapy. High-dose therapy with peripheral blood stem cell support reportedly offers overall prolonged disease-free survival rates of approximately 25%. However, many patients are not candidates for high-dose therapy because of several factors. The current study was conducted to evaluate the efficacy of paclitaxel in combination with oral estramustine phosphate in patients with recurrent or refractory, aggressive NHL.

Baseline variables for 92 patients with indolent lymphoid malignancies treated with fludarabine-based combination chemotherapy were analyzed for their association with infectious complications. A predictive model based on six baseline variables identified patients at high risk of infections during such therapy.

Splenic marginal zone lymphoma with or without villous lymphocytes is an indolent neoplasm, and up to 20% of patients require no therapy on diagnosis. The disease always involves bone marrow, although the infiltration may be very fine and exclusively intrasinusoidal. Bone marrow examination, coupled with the morphologic and immunophenotypic evaluation of peripheral blood, can lead to the correct diagnosis.

The authors demonstrated that long-term survival for patients with lung adenocarcinoma was significantly worse compared with patients with squamous cell carcinoma but was independent of allogeneic perioperative blood transfusion. The current study reaffirmed the importance of tumor invasion and lymph node involvement in the overall poor prognosis of patients with lung adenocarcinoma.

During the period from 1990 to 1999, the incidence rate of cutaneous melanoma in Sweden was unchanged. Favorable histopathologic factors compared with earlier decades in Sweden led to an improved relative 5-year survival rate of 91.5%. Multivariate analyses of prognostic factors were in agreement with the 2002 findings of the American Joint Committee on Cancer.

In patients with recurrent anaplastic oligodendroglioma, the response rate was reported to be high and time to disease progression was prolonged after chemotherapy with procarbazine, lomustine, and vincristine. However, toxicity, even if not severe, was persistent.

In the current study, six patients with advanced chordoma showed signs of tumor response to treatment with imatinib mesylate. This response may be mediated by the tyrosine kinase platelet-derived growth factor receptor-β.

The current analysis revealed that addition of temozolomide (TMZ) to standard radiotherapy as first-line treatment for glioma prolonged survival but increased costs eightfold compared with radiotherapy alone. TMZ acquisition costs amounted to 53% of the total cost of treatment.

The autoregulatory circuit of the myc gene family was intact in both amplified and single-copy neuroblastoma cell lines. Furthermore, myc gene autoregulation occurred through histone deacetylation.

Parents of children ages 2–18 years who were diagnosed with brain tumors (BT) or acute lymphoblastic leukemia (ALL) evaluated their children's health-related quality of life (HRQOL) over the previous week using the parent proxy versions of the Pediatric Quality of Life Inventory (PedsQL™) 4.0 Generic Core scales, the PedsQL™ 3.0 Acute Cancer Module, and the PedsQL™ Multidimensional Fatigue scales. Pediatric patients and survivors of BT experienced more fatigue and HRQOL problems than patients with ALL, and HRQOL differed by treatment status.

Hepatitis B virus (HBV) carriers had a higher incidence of chemoradiation-induced liver disease (CRILD) after postgastrectomy adjuvant, concomitant chemoradiotherapy, probably related to HBV reactivation. Dosimetric parameters modulated the risk of CRILD in noncarriers, but not in carriers.

In the current retrospective study, the authors sought to determine the incidence and characteristics of bloodstream infections caused by two gram-negative bacterial organisms, Achromobacter and Alcaligenes, in immunosuppressed patients at a tertiary care comprehensive cancer center over the last 14.5 years.