Cancer

Stereotactic core needle biopsy (SCNB) did not alter the pathologic measurement of small breast tumors detected as mammographic masses compared with similar cases with an initial surgical biopsy. Except in the circumstance of complete removal of the tumor by SCNB, the pathologic size and stage of the excised tumor after SCNB was not significantly altered.

Women with Paget disease of the breast without evidence of a palpable mass or mammographic density who received breast-conserving surgery (BCS) and radiotherapy (RT) had excellent results at 5 years. The combination of BCS and RT has been confirmed as an appropriate alternative to mastectomy, with excellent rates of local control and cause-specific and overall survival demonstrated at 10 and 15 years.

The authors found a strong association between increased age and a decline in the use of adjuvant chemotherapy for patients with breast carcinoma. This finding suggests that, despite consensus guidelines and clinical trial data supporting the use of this therapy, physicians remain reluctant to recommend it to all potentially eligible patients, even among patients age ≤ 70 years, for whom efficacy data are most compelling.

Genes that play a role in risk factors for breast carcinoma, such as the age of onset of menarche, might be breast carcinoma risk genes. Using this hypothesis, the authors evaluated the additive effect of six genes (leptin, leptin receptor, catecol-o-methyltransferase, dopamine D₂ receptor, estrogen receptor, and androgen receptor) in 67 women with sporadic breast carcinoma and in 145 sex and gender-matched controls. An additive breast carcinoma risk score also was evaluated by receiver operator characteristic plots.

In a survey of physicians who care for patients with prostate carcinoma in New England, 87% of respondents had recommended cytotoxic chemotherapy to patients with hormone-refractory prostate carcinoma. The likelihood of recommending chemotherapy varied by specialty, gender, and percentage of patients in the practice with hormone-refractory disease.

Gemcitabine and carboplatin achieve a similar result to doublets using cisplatin. This combination has an acceptable toxicity profile and enables patients with impaired renal function and/or poor performance status and elderly patients to be treated.

Jewish patients with BRCA-associated ovarian carcinoma had improved survival compared with Jewish patients who had sporadic ovarian carcinoma. This improvement in survival was the result of an enhanced response to platinum-based chemotherapy.

See also pages 2127–9.

Adenosquamous histology predicts poor outcome for patients with advanced-stage cervical carcinoma but not for patients with early-stage disease.

Tumors that maintain expression of human leukocyte antigen (HLA) processing machinery preferentially escape apoptotic cell death through up-regulation of the antiapoptotic protein, Survivin. Therefore, for tonsillar squamous cell carcinomas that maintain the expression of HLA Class I antigen, overexpression of the antiapoptosis gene, Survivin, may provide an alternative explanation for tumor progression.

Significantly elevated telomerase activity has been found in samples from patients with almost all malignant hematologic diseases. In this report, the results suggest that, for pediatric patients with acute myeloid leukemia, bone marrow telomerase activity is a highly significant prognostic factor.

The authors present the experience at The M. D. Anderson Cancer Center with the use of arsenic trioxide in patients with acute promyelocytic leukemia who developed recurrent disease after therapy with all-trans retinoic acid.

A total of 261 patients with Philadelphia chromosome (Ph)-positive, chronic-phase chronic myelogenous leukemia (CML) after interferon therapy failure who were treated with imatinib were analyzed based on the prediction of these patients achieving a complete cytogenetic response. Persistence of 100% Ph-positive cells after ≥ 6 months of imatinib therapy was found to be associated with a subsequent complete cytogenetic response rate of only 0–4%. However, any cytogenetic response after 3–12 months of therapy still was associated with high complete cytogenetic response rates of 35–54%. Thus, patients with Ph-positive CML who have not achieved a cytogenetic response after ≥ 6 months of imatinib should consider alternative therapeutic options.

Since 1973, the incidence of leukemia in the United States has been declining. However, incidence rates are modestly but significantly increasing for individuals younger than 20 years old. In contrast to children, there has been little overall improvement in leukemia survival among adults.

Patients with mucosa-associated lymphoid tissue lymphoma of the head and neck area are at a high risk for early dissemination and subsequent distant disease recurrence when only local therapies are applied. Clinical trials with application of systemic treatment are warranted in these patients.

A weekly paclitaxel and gemcitabine regimen, allowing optimal dose delivery, resulted in good efficacy with minimal toxicity. For selected patients, this regimen could be considered as an alternative to platinum treatments.

Pregnancy does not appear to have an adverse affect on the prognosis of patients with clinically localized, invasive melanoma.

See also pages 2130–3.

Analysis of the correlation between genetic alteration and long-term clinical outcome of patients with oligodendroglial tumors revealed that both loss of 1p and loss of 19q independently and significantly predict survival. A high-resolution deletion map, which displayed unusually narrow deletions, revealed a new, 10.11-megabase region of deletion between D1S513 and D1S458 (1p34.3–36.11).

Analysis of the correlation between genetic alteration and long-term clinical outcome of patients with oligodendroglial tumors revealed that both loss of 1p and loss of 19q independently and significantly predict survival. A high-resolution deletion map, which displayed unusually narrow deletions, revealed a new, 10.11-megabase region of deletion between D1S513 and D1S458 (1p34.3–36.11).

Bladder carcinoma is reported to account for approximately 2% of all malignant tumors. The tumor usually spreads by both local invasion and hematogenous dissemination. Although involvement of the nervous system is believed to be relatively uncommon, to the authors' knowledge, the frequency of neurologic complications associated with bladder carcinoma is unknown. In the current study, the authors reviewed a large series of patients to determine the nature and frequency of neurologic complications.

In this study, the correlation between the expression of the hMSH2 and hMLH1 proteins and the survival of soft tissue sarcoma (STS) patients was investigated. A multivariate Cox proportional hazards regression model revealed a significant correlation between the reduced expression of the hMSH2 protein and poor survival. Reduced expression of the hMSH2 protein is an independent negative prognostic factor for STS patients.

In the current study, the authors present six patients who underwent sentinel lymph node biopsy for various histologic types of sweat gland carcinoma. The detection of lymph node tumor deposits in four patients supports the clinical utility of sentinel lymph node biopsy for the staging of patients with these tumors.

See also pages 2134–6 and 2285–9.

Sweat gland carcinomas are rare malignant tumors of eccrine origin that not uncommonly metastasize to regional lymph nodes and extranodal sites. Sentinel lymph node biopsy detects early subclinical metastases and aids in guiding treatment.

See also pages 2134–6 and 2279–84.

In this randomized, controlled clinical trial in patients who received high-dose cisplatin chemotherapy, different 5-day regimens of the neurokinin-1 antagonist aprepitant were given in combination with a standard therapy regimen consisting of a serotonin-3 antagonist (ondansetron) plus dexamethasone. The trial determined that aprepitant 125 mg on Day 1 of chemotherapy followed by aprepitant 80 mg once daily on Days 2–5 was the dose with the most favorable benefit:risk ratio.

Three patients are described who experienced hypersensitivity or idiosyncratic reactions during or shortly after the ninth or 11th infusion of oxaliplatin. Their clinical features are described. A review of the literature suggests that the reported incidence of these reactions is approximately 0.5%.

Detection by allelotyping of simultaneous allelic imbalance but at alternative alleles (AA) was demonstrated in paired samples of either lung primary tumor and plasma or primary colorectal carcinomas and synchronous liver metastasis. In both types of cancer, AA were observed frequently in several chromosomes, indicating that independent events occurred. Alternative alleles are original markers of tumor heterogeneity.

The management of patients who have Wilms tumor with nuclear unrest presents a clinical dilemma, because these tumors share morphologic features with both favorable histology and anaplastic Wilms tumor. In this study, the authors showed that Wilms tumor with nuclear unrest more closely resembles favorable histology than anaplastic histology, both clinically and biologically.

Screening questions offer a potentially valuable way to identify patients who are willing to participate in research. Further study is needed to define the advantages and disadvantages of this method compared with standard recruitment techniques.

Dextromethorphan (90 mg once daily for 3 days) was administered to patients undergoing surgery for bone malignancy under combined general and epidural anesthesia. This was followed by postoperative patient-controlled epidural analgesia (PCEA) in a random, double-blind manner. The use of dextromethorphan and PCEA afforded better postoperative pain control and reduced PCEA and rescue drug requirements and sedation compared with placebo.

The authors demonstrated that the expression of E-cadherin in high-grade ductal carcinomas is correlated with the presence of prominent lymphatic tumor emboli. This finding, taken in conjunction with the knowledge that intralymphatic emboli in lobular carcinoma (which is characteristically E-cadherin-negative) are rare, suggests that these adhesion molecules (E-cadherins) have a role in tumor development and growth within the lymphatics.