Cancer

The German Society of Senology has done a remarkable job in developing standardized guidelines on a national scale for the implementation of sentinel lymph node biopsy in patients with breast carcinoma.

See also pages 451–61.

The author outlines his personal experience treating hundreds of patients with head and neck carcinoma using combined high-dose intraarterial cisplatin chemotherapy and concomitant, radiation therapy, and he also highlights the published experience of other investigators, all of whom concluded that the high-dose intensity approach is feasible and highly efficacious. This differs from the results reported in this issue by a group of investigators from the Mayo Clinic.

See referenced original article on pages 559–68, this issue.

The German Society of Senology appointed an interdisciplinary consensus committee to work out guidelines for a the standardized performance and quality-assured implementation of sentinel lymph node biopsy in patients with breast carcinoma on a nationwide, homogeneous standard. Relevant questions related to the procedure were evaluated with respect to clinical evidence, objectivity, reproducibility, and the definition of clinical pathways.

See related editorial on pages 444–6, this issue.

Long-term data from a population-based program demonstrated that mammographic screening reduced the risk of breast carcinoma recurrence. The risk of recurrence for patients with screen-detected breast carcinoma was only approximately half of the corresponding risk for patients with non-screen-detected disease. Nonetheless, in cases of recurrence, the prognosis was comparable regardless of how the original malignancy was detected.

After accounting for patient and health system characteristics, the authors found that low socioeconomic status (SES) was related inversely to breast cancer trial enrollment. They also found that SES was a stronger predictor of trial enrollment than race and that, in multivariate analysis, black race was unrelated to trial enrollment (compared with white race).

In the current study, the risk for axillary sentinel lymph node (SLN) metastasis from breast carcinoma was predicted by primary tumor size and type, peritumoral vascular invasion, and multifocality. The subset of patients with the most favorable combination of the above factors, however, still had an approximate 10% risk for SLN metastasis.

The authors examined age-specific risks of breast carcinoma incidence and disease-related mortality among Hong Kong women. Although risk estimates for Hong Kong women were lower than those for their U.S. Asian/Pacific Islander and white counterparts, the absolute lifetime probability of developing breast carcinoma increased from 1 in 26 during the period 1976–1980 to 1 in 17 during the period 1996–2000. Based on these results from Hong Kong, the most Westernized Chinese community, the authors conclude that as China becomes more Westernized, Chinese women's risks of developing and dying of breast carcinoma will become more similar to the corresponding risks for Western women.

Among 129 patients with multiple endocrine neoplasia type 1 (MEN 1), 6 patients (5%) had a clinical diagnosis of bronchopulmonary carcinoid. However, thoracic computed tomographic imaging in a subgroup of 32 patients with MEN 1 demonstrated pulmonary nodules in 12 patients (38%). The majority of these lesions were small and asymptomatic. The findings of this study suggest that bronchopulmonary carcinoid is more prevalent in MEN 1 than was recognized previously. Furthermore, the diagnosis does not appear to portend a poor prognosis in the majority of affected patients.

DNA sequences of the human polyomavirus JC virus (JCV) were detected in normal and malignant human esophageal tissues. Some malignant samples showed JCV protein expression, suggesting a potential role of JCV in the development of upper digestive tract carcinomas.

The authors investigated the effect of the number of CAG repeats in exon 1 of the androgen receptor on progression of prostate carcinoma after prostatectomy. Among men who were at high risk of developing recurrent disease, men with > 18 CAG repeats developed recurrent disease more frequently than men with ≤ 18 CAG repeats.

Treatment trends over the period 1992–1999 for patients with localized/regional prostate carcinoma among white, Hispanic, and African-American men indicated that certain patient-level and provider-level variables may influence racial and ethnic treatment decisions.

Elderly patients undergoing radical cystectomy for transitional cell carcinoma had higher pathologic stage than younger patients, were less likely to receive adjuvant chemotherapy, and had worse disease recurrence-free survival rates compared with younger patients.

A Phase I trial was conducted with fixed dose rate gemcitabine in combination with capecitabine in metastatic renal cell carcinoma (RCC). Unacceptable toxicity and modest antitumor activity were observed.

This Phase I clinical trial was developed to assess the feasibility of combining high-dose intraarterial cisplatin chemotherapy with concurrent, concomitant boost accelerated radiation therapy for patients with previously untreated T4 and select T3,N0–N3,M0 squamous cell carcinoma of the upper aerodigestive tract. Results of this study suggest that concurrent intraarterial cisplatin chemotherapy at 150 mg/m² with concomitant boost accelerated radiation therapy is not feasible.

See also pages 447–50.

The results from a Phase II trial exploring the activity of paclitaxel, carboplatin, and gemcitabine in the treatment of metastatic nasopharyngeal cancer have shown promising efficacy.

Patients with advanced nasopharyngeal carcinoma (NPC) remained chemotherapy-sensitive after failing first-line treatment, with response rates > 30% to second-line and even third-line salvage regimens. Results from this Phase II trial suggest that irinotecan is an active salvage agent with modest toxicity in patients with advanced NPC who are refractory to platinum/taxane-based chemotherapy.

In the current study, the authors used oral melphalan, cyclophosphamide, and prednisone (MCP) to treat 72 newly diagnosed patients with Waldenström macroglobulinemia (WM), and they compared the results of treatment (and the associated costs) with those observed using more aggressive protocols. The MCP regimen was found to be a cost-effective and safe option for the treatment of patients with WM, and its efficacy did not appear to be inferior to that of more expensive, aggressive, and toxic intravenous protocols.

The authors analyzed the correlation between macrophage migration inhibitory factor (MIF) expression and prognosis in patients with hepatocellular carcinoma (HCC) and investigated the angiogenic potential of MIF in HCC. Their findings indicated that MIF may play a role in HCC progression, invasion, and angiogenesis and may be a therapeutic target in patients with HCC.

Repeat needle biopsies combined with clinical observation and repeat computed tomography (CT) scans can classify a solitary pulmonary nodule (SPN) as benign versus malignant with 100% accuracy (95% confidence interval, 96.1–100.0%). A diagnostic approach toward the patient who presents with an SPN that includes a transbronchial needle biopsy, then percutaneous needle biopsy, clinical observation, repeat CT scans, and repeat biopsies for continued suspicion of malignancy appears to reduce the patient's morbidity without increasing their mortality.

Aberrant methylation status of the p16 promoter region, the expression of its product, and loss of heterozygosity on 9p21 were examined in surgically resected specimens of small-sized lung adenocarcinomas from 57 patients. Aberrant methylation of the p16 gene and loss of expression of its product were in accord with the multistep progression of peripheral-type adenocarcinoma, and these alterations were associated closely with poor prognosis.

The data of 45,483 patients recorded by the German Central Malignant Melanoma Registry with incident cutaneous melanoma (CM) diagnosed between 1976 and 2000 showed a strong trend towards prognostically more favorable CM most likely due to earlier diagnosis. Men and older people in comparison to women and younger people still presented with more advanced disease and therefore should be the focus of health promotion activities.

Despite its low reproducibility as reported in the medical literature, the Fuhrman system is the most widely used nuclear grading system for renal cell carcinoma. Collapsing of the Fuhrman grading system to a two-grade scheme led to improved interobserver agreement while preserving the independent prognostic value of the scheme.

Epidermal growth factor receptor (EGFR) overexpression and amplification are important prognostic factors in many solid tumors and anti-EGFR antibody-based therapy is now available as a promising therapeutic modality. The potential role of EGFR in the pathogenesis of advanced-stage thymomas indicated that evolving anti-EGFR antibody therapy may be a treatment option.

Results of the current prospective study showed that Chinese women experienced considerable psychological morbidity, with 50% of women having moderate-to-severe distress 1 month after undergoing surgery for breast carcinoma. Psychological morbidity was linked to women's treatment decision-making difficulties, their inability to anticipate treatment effects accurately, and physical symptom distress, possibly exacerbated by symptom misattribution.