Cancer

The placement of radiopaque clips in patients with breast cancer who were receiving neoadjuvant chemotherapy and breast-conservation therapy was associated with better local control independent of stage and other clinicopathologic findings. The authors of this study concluded that such tumor-marker clip placement should be an integral part of the multidisciplinary approach in appropriate patients.

The disease-specific survival of patients with metastatic renal cell carcinoma was compared according to the type of surgery, nephron-sparing surgery (N = 45) versus radical nephrectomy (N = 732), in unmatched and matched analyses. The data were limited in size and completeness and may indicate that renal cell carcinoma-specific survival may not be undermined if nephron-sparing surgery is performed in properly selected cases.

In this study, we analyzed clinical outcomes from 49 patients with the diagnosis of urachal cancer who were seen at the Mayo Clinic from 1950 to 2003. The overall survival for all stages was 62 months. Stage at presentation by the TNM staging system is the main predictor of outcome after surgery for urachal cancer.

The authors established a nomogram with which to predict low-volume/low-grade prostate cancer. This nomogram had good performance with an area under the receiver operating characteristic curve of 0.727, and it may be used as a tool in selecting patients for active surveillance.

The use of goserelin and bicalutamide was not found to prolong the median progression-free survival of patients with epithelial ovarian cancer in a second or greater clinical disease remission. The number of patients remaining in disease remission at given time points is reported and may serve as a clinical trial endpoint for future consolidation studies if validated in sufficient numbers of patients.

Chordoma and chondrosarcoma of the skull base are frequently amalgamated because of similar anatomic location, clinical presentation, and radiologic findings. However, these tumors differ with regard to origin and histology, and differ markedly in outcome. Chondroid chordoma carries the same poor prognosis as chordoma. The optimal treatment for all groups involves radical resection followed by high-dose radiotherapy in patients with chordoma. Radiotherapy may not be necessary in patients with low-grade chondrosarcoma.

Subcutaneous interleukin-2 and/or interferon-alfa provide no survival benefit in metastatic renal cancers of intermediate prognosis, and they induce a significant risk of toxicity. Newly available angiogenesis inhibitors should be preferred for these patients.

Alemtuzumab therapy for the treatment of fludarabine-refractory chronic lymphocytic leukemia has been associated with cytomegalovirus reactivation. In this study, a low pretreatment serum albumin level predicted for symptomatic reactivation of cytomegalovirus in 113 patients with chronic lymphoproliferative disorders who received alemtuzumab-based therapy.

Data from the current study demonstrated that more aggressive surgical approaches that combine resection of primary pancreatic or periampullary adenocarcinoma with hepatic resection yield similar overall survival durations compared with palliative bypass alone yet have increased morbidity, hospital stay length, and mortality.

The authors evaluated the effect of interferon (IFN)-α/5-fluorouracil (5-FU) combination chemotherapy in 30 patients who underwent palliative hepatic resection for advanced hepatocellular carcinoma (HCC). The results indicated that combination IFNα/5-FU therapy is a promising modality for patients with advanced HCC, and response to this therapy was correlated with expression of the IFN-α type 2 receptor.

The authors describe a highly sensitive and simple particle agglutination immunoassay using superparamagnetic particles for capturing p53 autoantibodies, p53 protein, and p53 protein-antibody complexes from large volumes of serum samples (2 mL). The newly developed assay was easy to perform and had sensitivity superior to that of the currently available p53 enzyme-linked immunosorbent assays.

Adenoid cystic carcinomas of the lung are rare tumors that can exhibit poor survival and for which current adjuvant therapy remains ineffective. The aim of the current study was to evaluate KIT expression and KIT-activating mutations. Although KIT expression was identified in nearly all cases, no mutation was detected in a subset of these cases.

Partly as a result of the typically rapid progression and lethality of lung cancer, spending to treat nonsmall cell lung cancer in the elderly has increased greatly relative to the economy but not more so than spending on other diseases,. The cost-effectiveness ratio for nonsmall cell lung cancer is higher than traditional thresholds used to define cost-effective care.

The expression of vascular endothelial growth factor (VEGF) in melanocytic cells was low or absent in benign nevi, increased significantly in dysplastic melanocytic nevi (DN), and increased further in primary melanoma. The results from this study indicated that increased VEGF-A expression in DN may be a good indicator of preneoplastic change.

Three-dimensional brain dosimetry studies with indium-111 ibritumomab tiuxetan suggested the feasibility of delivering radiolabeled monoclonal anti-CD20 antibodies as a component of therapy for B-cell brain lymphomas.

The authors conducted an open-label, Phase II study of the farnesyl transferase inhibitor tipifarnib to evaluate its safety and efficacy in children with recurrent or refractory medulloblastoma/,primitive neuroectodermal tumor, high-grade glioma, and diffuse intrinsic brainstem glioma. Tipifarnib was tolerated well in children but had little activity as a single agent in children with recurrent central nervous system malignancies.

The results from this study indicated that the potential benefit of routine sentinel lymph node surgery in patients undergoing prophylactic mastectomy is outweighed by the potential complications associated with this approach. Axillary lymph node dissection after a diagnosis of occult invasive carcinoma, therefore, is a more favorable lymph node staging strategy in this patient population.

Breast carcinoma is a heterogeneous group of diseases that deviate from each other not only with regard to their clinical manifestations and outcome but also in their histologic appearance. The submacroscopic morphology of breast carcinomas, the distribution of the lesions, and the extent of the disease are seldom studied. The objective of the current study was to identify breast carcinoma growth patterns indicating increased metastatic potential of the tumor and a need for more aggressive therapy.

A series of patients with initially localized, unresected rhabdomyosarcoma (IRS Group III), who were undergoing diagnostic biopsy or surgical resection with macroscopic residual tumors (debulking operation [DO]) were analyzed. No significant advantages of DO versus biopsy were detected with regard to patient outcome. Biopsy, which is less aggressive, appears to be the best option for these patients.

The objective of the current study was to examine whether emotional well-being predicted survival in a large sample of patients with head and neck cancer who were participating in multicenter clinical trials. No statistically significant univariate or multivariate effects were observed for emotional well-being, and there were no effects limited to subgroups.

For patients with mediastinal Hodgkin lymphoma, contemporary involved-field radiation therapy is predicted to substantially reduce risk of secondary breast and lung cancer compared with mantle radiation therapy, with substantial variation in risk among individuals. Individualized prospective risk estimates could facilitate patient-specific counseling and the development of more effective radiation therapy techniques.

In 207 breast cancer patients with brain metastases, short-course (5 fractions of 4 grays [Gy] each) and long-course (10 fractions of 3 Gy each and 20 fractions of 2 Gy each) whole-brain radiotherapy were compared for survival and local control, as well as 6 additional potential prognostic factors. Karnofsky performance score, the presence of extracranial metastases, and recursive partitioning analysis class were found to be significantly associated with outcome. The radiotherapy schedule was found to have no significant impact on survival or local control. A dose of 5 fractions at 4 Gy each appears preferable because it is less time consuming and more convenient for patients.