Cancer

There are two reasons why women who survive breast carcinoma may be at a lower risk of developing coronary heart disease (CHD) compared with women without a history of breast carcinoma. First, estrogens may be etiologic in the development of breast carcinoma and protective of CHD. Second, a common therapy for breast carcinoma (tamoxifen) may be associated with cardiac protection. This possibility should be evaluated further with individual-level data containing information on patient cardiac risk factors and tamoxifen use to help clarify the mechanism behind the risk reduction.

Although complete disease remission is possible for most breast carcinoma patients with isolated supraclavicular recurrence, the prognosis remains poor. Involved field radiotherapy appears to play an important role in achieving local control of disease and may even improve the distant recurrence–free survival rate.

For 38 primary breast tumors, the authors examined expression levels of 18 malignancy-related genes located on 20q using a quantitative real-time reverse transcription–polymerase chain reaction assay. Patients whose tumors showed elevated expression of NCOA3 (AIB1) had significantly shorter postsurgery disease-free and overall survival times than did other patients. Reduced disease-free survival, but not reduced overall survival, was associated with high expression of TOP1 and TFAP2C.

Candidemia was diagnosed in 3.4% of women who underwent high-dose chemotherapy and autologous bone marrow transplantation for multiple lymph node positive or metastatic breast carcinoma. The mortality rate attributable to this life-threatening complication is 24% and is greater among patients infected by Candida albicans compared with patients infected with other Candida, non-albicans species.

Despite their excellent prognosis, patients with papillary microcarcinoma develop recurrent disease and have disease-related mortality. If the diagnosis is made before surgery, then total or near-total thyroidectomy is indicated, and radioiodine ablation should be considered for patients who have lymph node metastases and multifocal disease.

Discordant serum thyroglobulin results between two commonly used classes of assays were found in 20.4% of patients with differentiated thyroid carcinoma. Defined by the clinical status of patients 3 years later, false-negative results were encountered with both assays. Surprisingly, the false-negative results were more common with the radioimmunoassay than with the immunoradiometric method. This was most likely due to antithyroglobulin antibody interference.

Most colorectal carcinomas in patients with synchronous tumors probably are sporadic. The concordance in microsatellite instability or microsatellite stability status among tumors in the same individual suggests that these tumors develop along the same molecular pathway.

The authors retrospectively reviewed the efficacy of endoscopic monitoring of upper urinary tract transitional cell carcinoma (TCC) and found that this type of management can provide accurate information regarding tumor grade. Endoscopic management of upper urinary tract TCC is safe, provided that vigilant follow-up is performed.

In the current Phase II trial, irinotecan was tolerated well and had limited activity in patients with disseminated renal cell carcinoma. A high percentage of disease stabilization and an elevated 1-year overall survival rate were observed in cytokine-pretreated patients.

Ovarian carcinoma (OC) is the fifth most frequent type of female malignancy and the fourth most frequent cause of death from cancer among women in Denmark. The aim of the current study was to analyze the presence of HER-2 overexpression in tissue from 181 Danish OC patients and correlate the distribution of HER-2 overexpression with clinical and biochemical data and patient survival.

The authors observed that patients with Stage I nasopharyngeal carcinoma, as classified according to the 1997 American Joint Committee on Cancer criteria, had an excellent outcome after radiotherapy alone. Patients with Stage II disease, especially if they had T1–T2N1 disease, had a relatively worse outcome; and more aggressive therapy, such as combined-modality treatment, may be indicated for those patients.

A sudden onset of the blastic phase of chronic myelogenous leukemia (CML) is a worrisome event that reduces the curative potential of allogeneic stem cell transplantation (SCT) in patients who have received nonallogeneic SCT frontline strategies. Among 1093 patients analyzed between 1981–2001, 183 patients developed a blastic phase, which was of sudden onset in 46 patients (25%; 4% of the total). The incidence of sudden blastic phase was 2.2% during the first 2 years. No poor-prognosis factors were found to predict for sudden blastic phase. However, the sudden onset of blastic-phase disease was found more often to be lymphoid in origin and was associated with a high response rate to blastic-phase therapy (response rate of 70% vs. 29%; P < 0.0001) and better survival (median of 12 months vs. 6 months; P < 0.012). Therefore, sudden blastic phase appears to be uncommon in CML.

Infections remain a major cause of death in patients with aplastic anemia. Bacterial infections constitute the main cause of infectious episodes. Invasive mold infections, however, are the major cause of death in this patient population.

Single-agent polyethylene glycol-conjugated L-asparaginase (PEG-L-asparaginase) in patients with recurrent multiple myeloma appears to show activity. Responding patients continued to have therapeutic levels on Day 21. The administration of PEG-L-asparaginase at a dose of 1000 mg/m² on a more frequent schedule should be explored.

A multiinstitutional Phase II trial of α2 interferon (IFN) in symptomatic patients with essential thrombocythemia, polycythemia rubra vera, and agnogenic myeloid metaplasia achieved overall response rates of 88.2%, 41.7%, and 3.2%, respectively, in these 3 disease categories. Thrombocytosis and leukocytosis were controlled in nearly all patients, with reversal of splenomegaly and resorption of myelofibrosis achieved in a lesser number of patients. The toxicities attributed to IFN differed notably among the three disease groups.

Despite the recent discovery of interchromosomal telomere length variation, a role for heterogeneity in telomere maintenance has yet to be established. This study investigated the significance of telomere length variation between chromosomes with respect to the association of cancer progression and telomere length regulation. Telomere length varied through chronic liver diseases by preferentially increasing shorter telomeres, whose length is a good indicator for malignant potential of hepatocellular carcinoma. Telomere length variation may be a crucial code in telomere maintenance through hepatocarcinogenesis.

Osteopontin mRNA frequently was overexpressed in hepatocellular carcinoma. Overexpression was associated with portal vein metastasis, early tumor recurrence, and poor prognosis.

The authors evaluated the activity and safety of gemcitabine and cisplatin (GC) in the treatment of patients with unresectable Mountain Classification Stage IIIA-bulky N2 and Stage IIIB nonsmall cell lung carcinoma (NSCLC). The GC combination was a highly active and safe regimen in patients with primary, unresectable, locally advanced NSCLC.

Using Western blot analysis, expression of the 27-kilodalton (kD) bcl-2 protein was analyzed in 91 randomly selected nonsmall cell lung carcinoma tissue samples to assess the association between patient survival and positive 27-kD bcl-2 expression in uninvolved lung and in uninvolved lung and/or tumor. A statistical association was found between the expression of a 27-kD bcl-2 protein and shorter survival using Kaplan–Meier survival analysis (log-rank test, P = 0.001 and P = 0.008 respectively), and after adjusting for covariates in a Cox proportional hazards model (hazard ratios of 2.27 [P = 0.05] and 5.58 [P = 0.008], respectively).

Patients with metastatic melanoma were treated with a DNA plasmid vaccine that was administered intranodally by continuous infusion for 4 96-hour cycles. Toxicity was modest, and immune responses against a tyrosinase epitope appeared to correlate with overall survival.

Central nervous system (CNS) metastases occur at a rate of 8% in patients with Stage IV neuroblastoma 3 years after diagnosis. The CNS is the sole site of recurrence in 50% of patients who have CNS involvement, which nearly always is fatal, with risk factors including age 2–3 years, MYCN gene amplification, and lumbar puncture at the time of diagnosis.

Expectations expressed as beliefs in personal outcomes may be related more to quality of life and personality variables than to patients' knowledge or functional status. Whether such expectations are accurate reflections of knowledge has important implications for evaluating the informed consent process.

Incidence rates for aggressive histopathologic types of uterine tumors are higher among blacks compared with whites, and these tumors contribute more significantly to mortality among blacks.

Human endogenous retrovirus E (HERV-E) was expressed in specimens of prostate carcinoma tissue but not in specimens of normal prostate tissue. Novel variants were identified in the HERV-E genes of prostate carcinoma specimens.

Improvements in fatigue were associated significantly with reductions in anxiety and depression among anemic lung cancer patients who participated in a clinical trial. Managing anemia-related fatigue may reduce patients' anxiety concerning their ability to perform their usual activities and may improve patients' mood.

To assess the current level of intensity-modulated radiation therapy (IMRT) use in the United States, a survey was sent to randomly selected, practicing radiation oncologists. The results revealed that approximately one-third of the physicians surveyed currently use IMRT. However, this number appears to be growing rapidly. The current findings suggest an imperative need to ensure that this new technology is applied appropriately and safely.