Cancer

The current study reports on the clinicopathologic characteristics associated with the presence of metastasis in nonsentinel lymph nodes of patients with sentinel lymph node-positive breast carcinoma. Based on a meta-analysis of studies published between 1999–2003, five pathologic characteristics are identified that are most strongly associated with nonsentinel lymph node metastasis.

A worldwide survey on skin-sparing mastectomy (SSM) to assess knowledge level and bias was performed. Responses of individuals from 52 countries demonstrated a significant variation in opinion and a lack of understanding of SSM. Literature skepticism was highest among radiation oncologists.

The authors undertook a retrospective study to gain insights into the spectrum of clinicopathologic characteristics, patterns of failure, and optimal management of patients with nonsinonasal neuroendocrine carcinomas of the head and neck (NSNEC). The results indicated that the best treatment strategy for patients with NSNEC is sequential chemotherapy and radiation, with full-dose radiotherapy alone recommended for patients who achieve a complete clinical response to induction chemotherapy.

Survival and disease recurrence analysis was performed for patients with renal cell carcinoma who underwent radical nephrectomy. The data showed that the 1997 TNM cutoff of 7.0 cm that was used to separate Stage I from Stage II was too high. A size-related survival difference was found among patients with organ-confined 1997 Stage I disease. A 5.0-cm cutoff best stratified this difference.

One hundred patients with prostate carcinoma participated in a prospective, repeated-measures study that explored urinary, bowel, and sexual symptoms and health-related quality of life. These patients were receiving primary three-dimensional conformal radiotherapy with or without neoadjuvant hormonal therapy at a regional cancer center. Patients reported higher health-related quality of life scores and fewer urinary symptoms compared with age-related general population norms. However, they experienced increased bowel symptoms, sexual dysfunction, and decreased vitality postradiotherapy. Ratings reported at a 5–10-month follow-up indicated that patients regained some lost vitality but a longer follow-up was suggested by the authors.

The authors compared the total percentage of biopsy cores that were positive for prostate carcinoma with the percentage of cores from the more involved or dominant side of the prostate for their ability to predict PSA recurrence among men undergoing radical prostatectomy. Percent of cores positive from the dominant side was a slightly better predictor of PSA recurrence than the total percent of cores positive and when combined with PSA and biopsy Gleason score provided significant risk stratification for PSA failure.

The utility-adjusted survival achieved by adding hormone therapy to external beam radiotherapy for locally advanced prostate carcinoma was analyzed using the number-needed-to-treat method. Even after adjustment for complications, the results indicate an advantage associated with the addition of short-term and long-term hormone therapy. This encouraging finding is robust over the range of parameters that are likely to be encountered in clinical practice.

Patients who present with metastatic prostate carcinoma and serum prostate-specific antigen (PSA) levels < 10 ng/mL have a pattern of disease similar to that seen in patients who have high PSA levels. However, both response duration to first-line hormone therapy and overall survival are much shorter for patients with lower PSA levels, and second-line hormone treatment is ineffective.

In patients with Stage IB-II endometrial carcinoma, age ≥ 70 years has been found to be an independent predictor of poor outcome. The complications from adjuvant radiation were similar between those patients age ≥ 70 years and those age < 70 years. Older age is an intrinsically poor prognostic factor in endometrial carcinoma, mandating further improvement in the management of this subset of patients.

Patients with parathyroid carcinoma have a significant risk of locoregional progression of disease after treatment with surgery alone. In the current study, the authors attempted to determine risk factors associated with postoperative progression of parathyroid carcinoma within the neck (locoregional) and to assess the efficacy of postoperative adjuvant radiation therapy in the prevention of locoregional disease progression.

In this investigation, expression of the Epstein–Barr virus-encoded latent membrane protein 1 gene was examined in nasopharyngeal swab specimens from patients with treated nasopharyngeal carcinoma (NPC). This detection method provided high sensitivity and specificity for forecasting mucosal recurrences in patients with NPC.

The vinblastine, bleomycin, and methotrexate chemotherapy regimen is effective in patients with early-stage Hodgkin lymphoma. Administration of all chemotherapy cycles before radiotherapy improves tolerance, and pulmonary toxicity probably is mitigated further by reducing the bleomycin dose, mild prednisone therapy, and a more prolonged resting interval before radiotherapy.

Among patients with non-Hodgkin lymphoma receiving cyclophosphamide, doxorubicin, vincristine, and prednisone or similar chemotherapy regimens, an increased risk of hospitalization for febrile neutropenia was significantly associated with the following characteristics: age 65 years or older, serum albumin level at presentation less than or equal to 3.5 g/dL, planned greater than or equal to 80% average relative dose intensity, baseline absolute neutrophil count less than 1500/mm³, and the presence of hepatic disease. These data suggested that patients who are at increased risk of hospitalization for febrile neutropenia can be identified and potentially targeted for therapy.

Sequential interleukin 3 followed by granulocyte-macrophage–colony stimulating factor therapy is tolerated well in patients with chronic bone marrow failure. Biologic activity, including substantial improvement in platelets and durable multilineage responses, were observed in 26% and 16% of patients, respectively.

The authors microscopically evaluated the accumulation of chromium in 10 resected lung tissue specimens and 90 biopsy specimens from chromate workers. Chromium accumulation in the proximal bronchi was less than in the bronchioles or subpleural regions of the lung. In addition, chromium accumulation increased significantly according to the progression of malignant change of the bronchial epithelium.

The distribution pattern of tenascin-C (TN-C), a large extracellular matrix (ECM) glycoprotein with a molecular weight of 180–250 kilodaltons, was studied in normal human brain tissue and in a large variety of brain tumors (n = 485 tumors) using 3 different monoclonal antibodies (clones BC2, BC4, and TN2). The most constant TN-C immunopositivity was seen in the ECM of the fibrotic stroma in highly malignant brain tumors and along the tumor border, especially in high-grade astrocytomas, suggesting that TN-C expression may be correlated with the grade of malignancy in astrocytic tumors. Furthermore, a Kaplan–Meier analysis showed that patients who had glioblastoma without TN-C immunopositivity in the ECM had a significantly longer survival (median, 28 months) compared with patients who had tumors with TN-C immunopositivity (median, 12 months), indicating that the presence or absence of TN-C expression in the stroma of astrocytic tumors may play a not yet clearly understood role in shortening or prolonging, respectively, the survival time of patients.

The initiation of highly active antiretroviral therapy (HAART) before diagnosis of Kaposi sarcoma (KS) does not appear to have an impact on the natural history of KS or the outcome of patients with KS. Nonetheless, the authors found that KS exhibits less aggressive presentation characteristics in patients already receiving HAART compared with patients who are naive to HAART at diagnosis of KS.

The lung, either in isolation or in combination with other locations, is the most common site of treatment failure for osteosarcoma. In the current chemotherapy era, disease-free survival and overall survival remained poor after disease recurrence despite aggressive surgical excision with or without salvage chemotherapy.

With improvement in the cure rate, metachronous osteosarcoma should be recognized as an important sequela in long-term survivors with osteosarcoma. The etiology of this disease is unknown. Meticulous follow-up is required to permit early detection and successful therapeutic intervention.

The impact of race on prognosis was evaluated for 686 patients with squamous cell carcinoma of the head and neck who were treated with radiotherapy. Multivariate analysis revealed that African American patients had worse outcomes in terms of survival compared with white patients.

Palonosetron, a novel 5-HT₃ receptor antagonist, has a stronger binding affinity and longer plasma elimination half-life than the other pharmacologic agents in its class. In a Phase III, single-dose trial versus dolasetron 100 mg, palonosetron 0.25 mg and 0.75 mg were as effective in preventing acute chemotherapy-induced vomiting and emesis (CINV) and superior in preventing delayed CINV after moderately emetogenic chemotherapy.

In the current study, the authors report a case series of patients treated with imatinib mesylate who developed a unique skin depigmentation toxicity. A review of the literature determined that this mechanism of action may occur via MAP kinase activation of the microphthalmia transcription factor of the tyrosine pigmentation gene promoter.

Children older than age 1 year with Stage III or Stage IV recurrent or refractory neuroblastoma were treated with topotecan at an intravenous dose of 1.5 mg/m² per day for 5 days followed by 48-hour intravenous infusions of 2 mg/m² of vincristine and 45 mg/m² of doxorubicin. This combination proved to be active, with a response rate of 56% after 2 courses. Toxicity generally was limited to the hematopoietic system, with no deaths due to infectious or toxic causes.

In a sample of 901 current smokers who participated in a low-dose, fast spiral chest computed tomography lung carcinoma screening project, the authors found that 14% were abstinent from smoking at a 1-year of follow-up. Therefore, it is possible that lung carcinoma screening can be used as an opportunity to provide effective nicotine interventions.

The European Society of Medical Oncology (ESMO) surveyed its membership regarding oncologists' involvement in and attitudes toward palliative care for patients with advanced cancer as part of a quality improvement program. Although most ESMO oncologists recognized the importance of palliative and supportive care for patients with advanced disease, many were not prepared adequately for those tasks, and actual participation levels commonly were suboptimal.

The authors demonstrated that Indole-3-carbinol (I3C), a naturally occurring component of Brassica vegetables, such as broccoli, induced a G1 cell cycle arrest of prostate carcinoma cells. The cell cycle arrest was accompanied by specific alterations in the expression and activity of G1-acting cell cycle components and by the inhibition of prostate-specific antigen (PSA) production. Moreover, I3C acted cooperatively with the antiandrogen flutamide to arrest the growth of the LNCaP tumor cells and reduce PSA levels, implicating I3C as a potential chemotherapeutic agent for controlling the growth of human prostate carcinoma cells.