Pub Date : 2002-05-01DOI: 10.1097/00130404-200205000-00011
H. A. Rossi, Qin Liu, B. Banner, C. Hsieh, L. Savas, D. Savarese
BACKGROUNDCurrent methods to predict outcome for patients with curatively resected colorectal cancer are not ideal. The combined use of molecular markers and clinicopathologic features may better identify patients who are at risk for recurrence. The Her-2/neu and invariant chain molecules may be important in cancer development and progression, but their usefulness as clinical predictors of outcome in colorectal cancer has not been well studied. METHODSWe used immunohistochemistry to determine the expression of Her-2/neu, invariant chain, p27, and p53 in primary tumor samples from 156 patients with curatively resected stage l-lll colorectal cancer. The association between expression and clinical outcomes was assessed by univariate and multivariate analysis. RESULTSHer-2/neu expression was detected in only 24% of cases, and high levels of invariant chain were detected in only 15%. Although patients whose tumors over expressed Her-2/neu survived longer than those with non-overexpressing tumors, neither Her-2/neu nor invariant chain were independently associated with survival. Consistent with previous reports, high p27 expression was associated with improved outcome, whereas overexpression of p53 was associated with worse outcome. CONCLUSIONSOur study did not reveal a statistically significant association between Her-2/neu or invariant chain expression and clinical outcomes in patients with curatively resected colorectal cancer. However, the data suggest that Her-2/neu could be a favorable prognostic variable. Because of the low frequency of Her-2/neu expression, larger numbers of patients need to be studied for this question to be adequately answered.
{"title":"The Prognostic Value of Invariant Chain (Ii) and Her‐2/neu Expression in Curatively Resected Colorectal Cancer","authors":"H. A. Rossi, Qin Liu, B. Banner, C. Hsieh, L. Savas, D. Savarese","doi":"10.1097/00130404-200205000-00011","DOIUrl":"https://doi.org/10.1097/00130404-200205000-00011","url":null,"abstract":"BACKGROUNDCurrent methods to predict outcome for patients with curatively resected colorectal cancer are not ideal. The combined use of molecular markers and clinicopathologic features may better identify patients who are at risk for recurrence. The Her-2/neu and invariant chain molecules may be important in cancer development and progression, but their usefulness as clinical predictors of outcome in colorectal cancer has not been well studied. METHODSWe used immunohistochemistry to determine the expression of Her-2/neu, invariant chain, p27, and p53 in primary tumor samples from 156 patients with curatively resected stage l-lll colorectal cancer. The association between expression and clinical outcomes was assessed by univariate and multivariate analysis. RESULTSHer-2/neu expression was detected in only 24% of cases, and high levels of invariant chain were detected in only 15%. Although patients whose tumors over expressed Her-2/neu survived longer than those with non-overexpressing tumors, neither Her-2/neu nor invariant chain were independently associated with survival. Consistent with previous reports, high p27 expression was associated with improved outcome, whereas overexpression of p53 was associated with worse outcome. CONCLUSIONSOur study did not reveal a statistically significant association between Her-2/neu or invariant chain expression and clinical outcomes in patients with curatively resected colorectal cancer. However, the data suggest that Her-2/neu could be a favorable prognostic variable. Because of the low frequency of Her-2/neu expression, larger numbers of patients need to be studied for this question to be adequately answered.","PeriodicalId":22430,"journal":{"name":"The Cancer Journal","volume":"36 1","pages":"268–275"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87210019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-05-01DOI: 10.1097/00130404-200205000-00013
S. Wadler, C. Brain, P. Catalano, A. Einzig, D. Cella, A. Benson
PURPOSEThe Eastern Cooperative Oncology Group conducted a randomized phase II trial to determine the objective response rates, toxicities, and overall survival and to assess effects on quality of life for two combination regimens in patients with advanced gastric cancer. PATIENTS AND METHODSAll patients had biopsy-proven, untreated metastatic gastric cancer with measurable disease. The FHIG arm employed infusional fluorouracil (F), 2.6 g/m2, given intravenously over 24 hours once per week for 6 weeks; infusional hydroxyurea (H), 4.3g/m2, given intravenously over 24 hours once per week for 6 weeks; and interferon-a-2a (I), 9 MU given subcutaneously three times per week, once perweekfor6weeks. The AD arm employed doxorubicin (A), 50 mg/m2, and docetaxel (D), 75 mg/m2, both given intravenously every 21 days. Quality of life was measured by the FACT-Fatigue scale and a novel questionnaire assessing interferon-mediated fatigue. RESULTSTwenty-nine patients were enrolled; 23 were eligible and evaluable. Twelve were enrolled on FHIG and 11 on AD. The major grade ≥ 3 toxicities were neuromotor (46%) in patients receiving FHIG and granulocytopenia (91%) in those receiving AD. There were two fatalities in the AD arm. There was one partial responder on FHIG (8.3%) and none on AD. The median survival was 6.6 months for FHIG and 10.1 months for AD. Quality-of-life analysis did not show substantial cumulative fatigue in patients treated with FHIG. CONCLUSIONSNeither regimen demonstrated enough activity to serve as a platform for the development of further clinical regimens against gastric carcinoma. A subset of patients receiving interferon was able to tolerate therapy without deterioration in quality of life.
{"title":"Randomized Phase II Trial of Either Fluorouracil, Parenteral Hydroxyurea, Interferon‐αt‐2a, and Filgrastim or Doxorubicin/Docetaxel in Patients with Advanced Gastric Cancer with Quality‐of‐Life Assessment: Eastern Cooperative Oncology Group Study E6296","authors":"S. Wadler, C. Brain, P. Catalano, A. Einzig, D. Cella, A. Benson","doi":"10.1097/00130404-200205000-00013","DOIUrl":"https://doi.org/10.1097/00130404-200205000-00013","url":null,"abstract":"PURPOSEThe Eastern Cooperative Oncology Group conducted a randomized phase II trial to determine the objective response rates, toxicities, and overall survival and to assess effects on quality of life for two combination regimens in patients with advanced gastric cancer. PATIENTS AND METHODSAll patients had biopsy-proven, untreated metastatic gastric cancer with measurable disease. The FHIG arm employed infusional fluorouracil (F), 2.6 g/m2, given intravenously over 24 hours once per week for 6 weeks; infusional hydroxyurea (H), 4.3g/m2, given intravenously over 24 hours once per week for 6 weeks; and interferon-a-2a (I), 9 MU given subcutaneously three times per week, once perweekfor6weeks. The AD arm employed doxorubicin (A), 50 mg/m2, and docetaxel (D), 75 mg/m2, both given intravenously every 21 days. Quality of life was measured by the FACT-Fatigue scale and a novel questionnaire assessing interferon-mediated fatigue. RESULTSTwenty-nine patients were enrolled; 23 were eligible and evaluable. Twelve were enrolled on FHIG and 11 on AD. The major grade ≥ 3 toxicities were neuromotor (46%) in patients receiving FHIG and granulocytopenia (91%) in those receiving AD. There were two fatalities in the AD arm. There was one partial responder on FHIG (8.3%) and none on AD. The median survival was 6.6 months for FHIG and 10.1 months for AD. Quality-of-life analysis did not show substantial cumulative fatigue in patients treated with FHIG. CONCLUSIONSNeither regimen demonstrated enough activity to serve as a platform for the development of further clinical regimens against gastric carcinoma. A subset of patients receiving interferon was able to tolerate therapy without deterioration in quality of life.","PeriodicalId":22430,"journal":{"name":"The Cancer Journal","volume":"143 1","pages":"282–286"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78583512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-05-01DOI: 10.1097/00130404-200205000-00003
Jeffrey M. Pugsley, R. Schmidt, H. Vesselle
PURPOSEWe reviewed the current literature to discover the range of studies covering tissue-based and noninvasive methods for determining tumor stage and the prognostic value of staging in non-small cell lung cancer. DESIGNDespite refinements in staging of non-small cell lung cancer, each stage remains heterogeneous because each stage contains patients who are at higher risk for recurrence than other patients within the same stage. Tissue-based and noninvasive methods have been investigated to complement tumor stage in assessing non-small cell lung cancer prognosis. The prognostic significance of tumor proliferation assessed by Ki-67 protein expression has been demonstrated in non-small cell lung cancer. RESULTRecent positron emission tomography studies have also shown both prognostic value in non-small cell lung cancer uptake of [F-18] fluorodeoxyglucose (FDG) and correlation between non-small cell lung cancer FDG uptake and tumor proliferation. DISCUSSIONWe reviewed the prognostic significance of Ki-67 expression in non-small cell lung cancer and related it to positron emission tomography.
{"title":"The Ki‐67 Index and Survival in Non‐‐‐Small Cell Lung Cancer: A Review and Relevance to Positron Emission Tomography","authors":"Jeffrey M. Pugsley, R. Schmidt, H. Vesselle","doi":"10.1097/00130404-200205000-00003","DOIUrl":"https://doi.org/10.1097/00130404-200205000-00003","url":null,"abstract":"PURPOSEWe reviewed the current literature to discover the range of studies covering tissue-based and noninvasive methods for determining tumor stage and the prognostic value of staging in non-small cell lung cancer. DESIGNDespite refinements in staging of non-small cell lung cancer, each stage remains heterogeneous because each stage contains patients who are at higher risk for recurrence than other patients within the same stage. Tissue-based and noninvasive methods have been investigated to complement tumor stage in assessing non-small cell lung cancer prognosis. The prognostic significance of tumor proliferation assessed by Ki-67 protein expression has been demonstrated in non-small cell lung cancer. RESULTRecent positron emission tomography studies have also shown both prognostic value in non-small cell lung cancer uptake of [F-18] fluorodeoxyglucose (FDG) and correlation between non-small cell lung cancer FDG uptake and tumor proliferation. DISCUSSIONWe reviewed the prognostic significance of Ki-67 expression in non-small cell lung cancer and related it to positron emission tomography.","PeriodicalId":22430,"journal":{"name":"The Cancer Journal","volume":"19 1","pages":"222–233"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79869903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-05-01DOI: 10.1097/00130404-200205000-00012
R. Heimann, Melissa A. Munsell, R. McBride
PURPOSEIn early breast cancer the knowledge of the risk of axillary node involvement is important in determining local as well as systemic therapy. Because of the increased acceptance of mammography, there has been an increase in the diagnosis of small, mammographically detected tumors. The objective of this study is to determine whether mammographically detected breast cancers have a lower risk of axillary node involvement compared to those detected clinically. PATIENTS AND METHODSFrom our patient database of stage I and II breast cancer we identified 980 patients with tumors <2cm whom had axillary node dissection. Four hundred thirty-five (44%) patients presented with abnormal mammograms without clinically palpable tumors; 545 (56%) patients had clinically detected tumors. The median size of the mammographically detected tumors is 1.0 cm, and the median size of the clinically detected tumors is 1.5 cm. The median age of the patients with mammographically detected tumors is 61 (range: 29–87) compared to 53 (range: 27–88) in those with palpable tumors. RESULTSFourteen percent of the patients with mammographically detected tumors had positive axillary nodes compared to 26% of those with clinically detected tumors. Eight percent of patients with mammographically detected tumors had a single positive, while the clinically detected tumors 11% had a single positive node. Thirteen percent of patients with ≤1 cm tumors and 25% with tumors 1.1 cm to 2 cm had positive axillary nodes. Because the smaller size of the mammographically detected tumors could explain the lower proportion of positive axillary nodes, we analyzed separately the ≤ 1 cm tumors. In the group of ≤ 1 cm tumors, 9% had positive axillary nodes if they were mammographically detected compared to 19% if clinically detected. Four percent had a single positive node while 5% had multiple positive nodes. If the tumors were palpable and ≤ 1 cm 9% had a single positive node and 10% had multiple positive nodes. Mammographically detected tumors ≤ 1 cm had similargrade to clinically detected tumors. In multivariate analysis, method of detection remains a significant variable impacting on the risk of axillary node involvement even in tumors ≤ 1 cm. DISCUSSIONThe risk of axillary node involvement is lower in mammographically detected tumors compared to clinically detected tumors independent of tumor size or grade. Mammography detects tumors early in their metastatic progression. The majority of the axillary node-positive patients who are mammographically detected have a single positive axillary node. Method of detection may need to be considered when assessing the risk of axillary node involvement and incorporated in the staging.
目的在早期乳腺癌中，了解腋窝淋巴结受累的风险对于确定局部和全身治疗是很重要的。由于乳房x光检查的接受度越来越高，乳房x光检查发现的小肿瘤的诊断率也在增加。本研究的目的是确定乳房x光检查发现的乳腺癌是否比临床发现的乳腺癌有更低的腋窝淋巴结累及风险。患者和方法从我们的I期和II期乳腺癌患者数据库中，我们确定了980例肿瘤<2cm的患者进行腋窝淋巴结清扫。435例(44%)患者表现为乳房x线检查异常，但临床未见明显肿瘤;临床检出肿瘤545例(56%)。乳房x线检查肿瘤的中位尺寸为1.0 cm，临床检查肿瘤的中位尺寸为1.5 cm。乳房x线检查发现肿瘤患者的中位年龄为61岁(范围29-87岁)，而可触及肿瘤患者的中位年龄为53岁(范围27-88岁)。结果乳房x线检查发现的肿瘤患者腋窝淋巴结阳性的比例为14%，而临床发现的肿瘤患者腋窝淋巴结阳性的比例为26%。在乳房x光检查发现的肿瘤患者中，8%的患者有一个单一的阳性淋巴结，而在临床检测到的肿瘤中，11%的患者有一个单一的阳性淋巴结。≤1cm的患者腋窝淋巴结阳性占13%，1.1 cm ~ 2cm的患者腋窝淋巴结阳性占25%。由于乳房x线检查发现的肿瘤体积较小可以解释腋窝淋巴结阳性比例较低的原因，因此我们将≤1 cm的肿瘤单独分析。在≤1cm肿瘤组中，9%的乳房x线检查发现腋窝淋巴结阳性，而19%的临床检查发现腋窝淋巴结阳性。4%的人有一个阳性节点，5%的人有多个阳性节点。如果肿瘤可触及且≤1cm，则9%为单个阳性结，10%为多个阳性结。乳房x线检查发现的≤1cm的肿瘤与临床发现的肿瘤分级相似。在多变量分析中，即使肿瘤≤1 cm，检测方法仍然是影响腋窝淋巴结受累风险的重要变量。与临床发现的肿瘤相比，乳房x线检查发现的肿瘤腋窝淋巴结累及的风险较低，与肿瘤大小或分级无关。乳房x光检查可以在肿瘤转移进展的早期发现肿瘤。大多数腋窝淋巴结阳性的患者在乳房x光检查中只有一个腋窝淋巴结阳性。在评估腋窝淋巴结受累的风险和分期时，可能需要考虑检测方法。
{"title":"Mammographically Detected Breast Cancers and the Risk of Axillary Lymph Node Involvement: Is It Just the Tumor Size?","authors":"R. Heimann, Melissa A. Munsell, R. McBride","doi":"10.1097/00130404-200205000-00012","DOIUrl":"https://doi.org/10.1097/00130404-200205000-00012","url":null,"abstract":"PURPOSEIn early breast cancer the knowledge of the risk of axillary node involvement is important in determining local as well as systemic therapy. Because of the increased acceptance of mammography, there has been an increase in the diagnosis of small, mammographically detected tumors. The objective of this study is to determine whether mammographically detected breast cancers have a lower risk of axillary node involvement compared to those detected clinically. PATIENTS AND METHODSFrom our patient database of stage I and II breast cancer we identified 980 patients with tumors <2cm whom had axillary node dissection. Four hundred thirty-five (44%) patients presented with abnormal mammograms without clinically palpable tumors; 545 (56%) patients had clinically detected tumors. The median size of the mammographically detected tumors is 1.0 cm, and the median size of the clinically detected tumors is 1.5 cm. The median age of the patients with mammographically detected tumors is 61 (range: 29–87) compared to 53 (range: 27–88) in those with palpable tumors. RESULTSFourteen percent of the patients with mammographically detected tumors had positive axillary nodes compared to 26% of those with clinically detected tumors. Eight percent of patients with mammographically detected tumors had a single positive, while the clinically detected tumors 11% had a single positive node. Thirteen percent of patients with ≤1 cm tumors and 25% with tumors 1.1 cm to 2 cm had positive axillary nodes. Because the smaller size of the mammographically detected tumors could explain the lower proportion of positive axillary nodes, we analyzed separately the ≤ 1 cm tumors. In the group of ≤ 1 cm tumors, 9% had positive axillary nodes if they were mammographically detected compared to 19% if clinically detected. Four percent had a single positive node while 5% had multiple positive nodes. If the tumors were palpable and ≤ 1 cm 9% had a single positive node and 10% had multiple positive nodes. Mammographically detected tumors ≤ 1 cm had similargrade to clinically detected tumors. In multivariate analysis, method of detection remains a significant variable impacting on the risk of axillary node involvement even in tumors ≤ 1 cm. DISCUSSIONThe risk of axillary node involvement is lower in mammographically detected tumors compared to clinically detected tumors independent of tumor size or grade. Mammography detects tumors early in their metastatic progression. The majority of the axillary node-positive patients who are mammographically detected have a single positive axillary node. Method of detection may need to be considered when assessing the risk of axillary node involvement and incorporated in the staging.","PeriodicalId":22430,"journal":{"name":"The Cancer Journal","volume":"11 1","pages":"276–281"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89698898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-05-01DOI: 10.1097/00130404-200205000-00007
M. R. Mosbacher, P. Schiff, K. Otoole, M. Benson, C. Olsson, R. Brody, R. Ennis
PURPOSEA subgroup of prostate cancer patients who have experienced biochemical relapse after radical retropubic prostatectomy (RRP) can benefit from radiation therapy to the prostate fossa. These patients demonstrate biochemical relapse secondary to local failure in the absence of distant failure. In order to define this subgroup, we investigated the impact of pathological and biochemical variables and pre-radiation therapy biopsy of the prostate fossa on biochemical disease-free survival (bNED) and initial prostate-specific antigen response. METHODSSixty-two patients with localized prostate cancer who had biochemical relapse after RRP were treated with post-RRP radiation therapy localized to the prostate fossa (median dose, 6120 cGy) and were subsequently followed up for a median time of 47 months. Cox regression analyses and Kaplan-Meier estimates for bNED were used to identify prognostic variables. The Fisher's exact test was used to test the interaction of initial prostate-specific antigen response with identified prognostic variables. RESULTSCox regression analysis of bNED as a function of pathological and biochemical parameters showed that only Gleason's score was a significant predictor of bNED. On univariate analysis, seminal vesicle involvement was also found to be a significant predictor. Prostate fossa biopsy result was not significantly related to bNED. Because of the overall high rates of biochemical failure, we wished to identify a high-risk subgroup that did not have local relapse as a component of biochemical relapse after RRP. We assessed initial biochemical response following radiation therapy as a surrogate for local relapse. A complete biochemical response was observed in 50% of patients, and a partial biochemical response was observed in an additional 34%, yielding an overall biochemical response rate of 84%. When stratified by Gleason's score, seminal vesicle, pre-radiation therapy prostate-specific antigen, and biopsy result, response rates greater than 50% were seen for all subgroups. CONCLUSIONSGleason's score and seminal vesicle involvement predicted bNED after post-RRP radiation therapy in our cohort. Overall biochemical response rates were high in all subgroups, suggesting that all subgroups demonstrated a high likelihood of residual local disease as a component of failure. Pre-radiation therapy biopsy was predictive of neither bNED nor overall biochemical response.
{"title":"Postprostatectomy Salvage Radiation Therapy for Prostate Cancer: Impact of Pathological and Biochemical Variables and Prostate Fossa Biopsy","authors":"M. R. Mosbacher, P. Schiff, K. Otoole, M. Benson, C. Olsson, R. Brody, R. Ennis","doi":"10.1097/00130404-200205000-00007","DOIUrl":"https://doi.org/10.1097/00130404-200205000-00007","url":null,"abstract":"PURPOSEA subgroup of prostate cancer patients who have experienced biochemical relapse after radical retropubic prostatectomy (RRP) can benefit from radiation therapy to the prostate fossa. These patients demonstrate biochemical relapse secondary to local failure in the absence of distant failure. In order to define this subgroup, we investigated the impact of pathological and biochemical variables and pre-radiation therapy biopsy of the prostate fossa on biochemical disease-free survival (bNED) and initial prostate-specific antigen response. METHODSSixty-two patients with localized prostate cancer who had biochemical relapse after RRP were treated with post-RRP radiation therapy localized to the prostate fossa (median dose, 6120 cGy) and were subsequently followed up for a median time of 47 months. Cox regression analyses and Kaplan-Meier estimates for bNED were used to identify prognostic variables. The Fisher's exact test was used to test the interaction of initial prostate-specific antigen response with identified prognostic variables. RESULTSCox regression analysis of bNED as a function of pathological and biochemical parameters showed that only Gleason's score was a significant predictor of bNED. On univariate analysis, seminal vesicle involvement was also found to be a significant predictor. Prostate fossa biopsy result was not significantly related to bNED. Because of the overall high rates of biochemical failure, we wished to identify a high-risk subgroup that did not have local relapse as a component of biochemical relapse after RRP. We assessed initial biochemical response following radiation therapy as a surrogate for local relapse. A complete biochemical response was observed in 50% of patients, and a partial biochemical response was observed in an additional 34%, yielding an overall biochemical response rate of 84%. When stratified by Gleason's score, seminal vesicle, pre-radiation therapy prostate-specific antigen, and biopsy result, response rates greater than 50% were seen for all subgroups. CONCLUSIONSGleason's score and seminal vesicle involvement predicted bNED after post-RRP radiation therapy in our cohort. Overall biochemical response rates were high in all subgroups, suggesting that all subgroups demonstrated a high likelihood of residual local disease as a component of failure. Pre-radiation therapy biopsy was predictive of neither bNED nor overall biochemical response.","PeriodicalId":22430,"journal":{"name":"The Cancer Journal","volume":"1 1","pages":"242–246"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88692821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-05-01DOI: 10.1097/00130404-200205000-00008
Siu-Fun Wong, P. Wilder-Smith
PURPOSEThe purpose of this study was to examine the effectiveness of laser therapy in the prevention and/or healing of chemotherapy-induced oral mucositis lesions. This study also evaluated the ease and feasibility of the laser therapy and the impact of the treatment on improving the patient's quality of life. PATIENTS AND METHODSFifteen patients with an episode of prior chemotherapy-induced grade 3 or 4 mucositis with 5-fluorouracil continuous infusion consented to participate in this study. All patients were provided with standardized mouth care instructions at the initiation of chemotherapy treatments. Enrolled patients received laser therapy treatments 24 hours before the chemotherapy and then recommenced weekly with evenly distributed exposure to the standardized designated areas by one operator during the entire cycle of chemotherapy at the same doses until the mucositis resolved or the chemotherapy cycle was completed. Intraoral perfusion was measured by laser Doppler technology. Patients were assessed for response to laser therapy according to standardized mucositis grading criteria by evaluating development of lesions, extent and duration of lesions, and time to healing. The effect of laser therapy on ability to continue planned chemotherapy, the reduction in dose, delays, and ability to maintain planned dose intensity were assessed. The impact of laser therapy on pain control was evaluated using the visual analogue score. A quality-of-life survey was completed by each patient at the initiation of chemotherapy and then weekly throughout the chemotherapy. RESULTSEleven of 15 patients experienced grade 0 mucositis, three patients experienced grade 1 to 2 mucositis, and one patient experienced grade 3 to 4 mucositis. Fourteen patients completed the laser therapy as planned, and none of the patients withdrew from the laser therapy treatments because of noncompliance. One patient continued to experience grade 4 mucositis that necessitated an interruption in the planned chemotherapy regimen and, consequently, the laser treatment. Patients tolerated the laser therapy very well and did not report any increased discomfort. No significant changes in perfusion were observed as a result of laser therapy. DISCUSSIONIn this pilot study, laser therapy significantly reduced the incidence and the severity of mucositis in chemotherapy patients. The laser therapy does not appear to promote wound healing by affecting the intraoral perfusion, as assessed by Doppler measurements. The mechanisms involved in the mediating of the observed effects remain unknown at this time. Continued research is warranted to determine the optimal laser wavelength and parameters.
{"title":"Pilot Study of Laser Effects on Oral Mucositis in Patients Receiving Chemotherapy","authors":"Siu-Fun Wong, P. Wilder-Smith","doi":"10.1097/00130404-200205000-00008","DOIUrl":"https://doi.org/10.1097/00130404-200205000-00008","url":null,"abstract":"PURPOSEThe purpose of this study was to examine the effectiveness of laser therapy in the prevention and/or healing of chemotherapy-induced oral mucositis lesions. This study also evaluated the ease and feasibility of the laser therapy and the impact of the treatment on improving the patient's quality of life. PATIENTS AND METHODSFifteen patients with an episode of prior chemotherapy-induced grade 3 or 4 mucositis with 5-fluorouracil continuous infusion consented to participate in this study. All patients were provided with standardized mouth care instructions at the initiation of chemotherapy treatments. Enrolled patients received laser therapy treatments 24 hours before the chemotherapy and then recommenced weekly with evenly distributed exposure to the standardized designated areas by one operator during the entire cycle of chemotherapy at the same doses until the mucositis resolved or the chemotherapy cycle was completed. Intraoral perfusion was measured by laser Doppler technology. Patients were assessed for response to laser therapy according to standardized mucositis grading criteria by evaluating development of lesions, extent and duration of lesions, and time to healing. The effect of laser therapy on ability to continue planned chemotherapy, the reduction in dose, delays, and ability to maintain planned dose intensity were assessed. The impact of laser therapy on pain control was evaluated using the visual analogue score. A quality-of-life survey was completed by each patient at the initiation of chemotherapy and then weekly throughout the chemotherapy. RESULTSEleven of 15 patients experienced grade 0 mucositis, three patients experienced grade 1 to 2 mucositis, and one patient experienced grade 3 to 4 mucositis. Fourteen patients completed the laser therapy as planned, and none of the patients withdrew from the laser therapy treatments because of noncompliance. One patient continued to experience grade 4 mucositis that necessitated an interruption in the planned chemotherapy regimen and, consequently, the laser treatment. Patients tolerated the laser therapy very well and did not report any increased discomfort. No significant changes in perfusion were observed as a result of laser therapy. DISCUSSIONIn this pilot study, laser therapy significantly reduced the incidence and the severity of mucositis in chemotherapy patients. The laser therapy does not appear to promote wound healing by affecting the intraoral perfusion, as assessed by Doppler measurements. The mechanisms involved in the mediating of the observed effects remain unknown at this time. Continued research is warranted to determine the optimal laser wavelength and parameters.","PeriodicalId":22430,"journal":{"name":"The Cancer Journal","volume":"8 1","pages":"247–254"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81960513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-03-01DOI: 10.1097/00130404-200203000-00013
M. Jensen, D. Kallmes
Percutaneous vertebroplasty is a minimally invasive, radiologically-guided interventional procedure originally developed in France for the treatment of painful vertebral hemangiomas. The technique consists of the percutaneous puncture of the affected vertebral body, followed by injection of an acrylic polymer to provide bone augmentation and prevent further collapse. The internal “casting” of the trabecular microfractures results in pain relief and vertebral consolidation. Vertebroplasty was quickly adopted for use in metastatic vertebral lesions and hematologic malignancies such as multiple myeloma and lymphoma. The major experience with malignant disease has remained primarily in the European realm; in the United States vertebroplasty is used mainly for the treatment of osteoporotic compression fractures. The reasons underlying this divergence in practice experiences remains unclear, although the explosion of vertebroplasty in the U.S. appears to be driven by an assertive, motivated and well-informed elderly population. In addition, malignant lesions are often challenging and practitioners may shy away from these clinically and technically more difficult patients. The purpose of this article is to introduce the principles of percutaneous vertebroplasty to the North American oncologic community with the hope that it may find a greater role in the treatment of malignant disease affecting the spine.
{"title":"Percutaneous Vertebroplasty in the Treatment of Malignant Spine Disease","authors":"M. Jensen, D. Kallmes","doi":"10.1097/00130404-200203000-00013","DOIUrl":"https://doi.org/10.1097/00130404-200203000-00013","url":null,"abstract":"Percutaneous vertebroplasty is a minimally invasive, radiologically-guided interventional procedure originally developed in France for the treatment of painful vertebral hemangiomas. The technique consists of the percutaneous puncture of the affected vertebral body, followed by injection of an acrylic polymer to provide bone augmentation and prevent further collapse. The internal “casting” of the trabecular microfractures results in pain relief and vertebral consolidation. Vertebroplasty was quickly adopted for use in metastatic vertebral lesions and hematologic malignancies such as multiple myeloma and lymphoma. The major experience with malignant disease has remained primarily in the European realm; in the United States vertebroplasty is used mainly for the treatment of osteoporotic compression fractures. The reasons underlying this divergence in practice experiences remains unclear, although the explosion of vertebroplasty in the U.S. appears to be driven by an assertive, motivated and well-informed elderly population. In addition, malignant lesions are often challenging and practitioners may shy away from these clinically and technically more difficult patients. The purpose of this article is to introduce the principles of percutaneous vertebroplasty to the North American oncologic community with the hope that it may find a greater role in the treatment of malignant disease affecting the spine.","PeriodicalId":22430,"journal":{"name":"The Cancer Journal","volume":"20 1","pages":"194–206"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87774142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-03-01DOI: 10.1097/00130404-200203000-00006
C. Cohade, R. Wahl
Positron emission tomography (PET) scanning with F18-fluoro-deoxyglucose or FDG is a becoming a standard method for tumor staging. The prediction and evaluation of therapy response are newer applications of FDG-PET. PET often offers an early readout of treatment efficacy and is an attractive alternative to conventional anatomic assessments of treatment response. This article reviews the methods available with PET to monitor therapy response. Disease specific applications of PET imaging are then reviewed. While FDG is the most commonly used radiotracer for PET, many other radioligands could be applied in the future.
{"title":"PET Scanning and Measuring the Impact of Treatment","authors":"C. Cohade, R. Wahl","doi":"10.1097/00130404-200203000-00006","DOIUrl":"https://doi.org/10.1097/00130404-200203000-00006","url":null,"abstract":"Positron emission tomography (PET) scanning with F18-fluoro-deoxyglucose or FDG is a becoming a standard method for tumor staging. The prediction and evaluation of therapy response are newer applications of FDG-PET. PET often offers an early readout of treatment efficacy and is an attractive alternative to conventional anatomic assessments of treatment response. This article reviews the methods available with PET to monitor therapy response. Disease specific applications of PET imaging are then reviewed. While FDG is the most commonly used radiotracer for PET, many other radioligands could be applied in the future.","PeriodicalId":22430,"journal":{"name":"The Cancer Journal","volume":"4 1","pages":"119–134"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77460998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-03-01DOI: 10.1097/00130404-200203000-00012
N. M. Carroll, H. Alexander
Thousands of patients die annually from unresectable metastatic or primary hepatic cancers confined to liver. Isolated hepatic perfusion (IHP) is a regional treatment strategy in which the vascular supply to the liver is isolated and perfused with a therapeutic regimen using an extracorporeal circuit consisting of a reservoir, heat exchanger, and oxygenator. Drug doses that would cause severe toxicities if delivered systemically can be confined to the liver by isolated hepatic perfusion, resulting in the ability to intensify treatment to the cancer-burdened region of the body. Agents and mechanisms commonly used in IHP include melphalan, hyperthermia, and tumor necrosis factor. IHP appears to be efficacious for patients with advanced disease, as reflected by large tumor size, high number of lesions, or significant overall tumor burden in the liver. In addition, responses are observed for patients whose cancer is refractory to systemic and hepatic arterial infusion chemotherapy. Recent clinical trials have demonstrated that IHP has anti-tumor efficacy against primary hepatic neoplasms and metastases from various primary tumors, such as colorectal carcinoma, ocular melanoma, and neuroendocrine tumors. Current studies demonstrate that combining hepatic arterial infusion with floxuridine after IHP for patients with colorectal cancer metastases is associated with significant and durable response rates. Continued clinical evaluation is warranted for the use of IHP in the treatment of unresectable liver metastases.
{"title":"Isolation Perfusion of the Liver","authors":"N. M. Carroll, H. Alexander","doi":"10.1097/00130404-200203000-00012","DOIUrl":"https://doi.org/10.1097/00130404-200203000-00012","url":null,"abstract":"Thousands of patients die annually from unresectable metastatic or primary hepatic cancers confined to liver. Isolated hepatic perfusion (IHP) is a regional treatment strategy in which the vascular supply to the liver is isolated and perfused with a therapeutic regimen using an extracorporeal circuit consisting of a reservoir, heat exchanger, and oxygenator. Drug doses that would cause severe toxicities if delivered systemically can be confined to the liver by isolated hepatic perfusion, resulting in the ability to intensify treatment to the cancer-burdened region of the body. Agents and mechanisms commonly used in IHP include melphalan, hyperthermia, and tumor necrosis factor. IHP appears to be efficacious for patients with advanced disease, as reflected by large tumor size, high number of lesions, or significant overall tumor burden in the liver. In addition, responses are observed for patients whose cancer is refractory to systemic and hepatic arterial infusion chemotherapy. Recent clinical trials have demonstrated that IHP has anti-tumor efficacy against primary hepatic neoplasms and metastases from various primary tumors, such as colorectal carcinoma, ocular melanoma, and neuroendocrine tumors. Current studies demonstrate that combining hepatic arterial infusion with floxuridine after IHP for patients with colorectal cancer metastases is associated with significant and durable response rates. Continued clinical evaluation is warranted for the use of IHP in the treatment of unresectable liver metastases.","PeriodicalId":22430,"journal":{"name":"The Cancer Journal","volume":"79 1","pages":"181–193"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78435764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-03-01DOI: 10.1097/00130404-200203000-00009
James C. Chen, L. Keltner, J. Christophersen, F. Zheng, M. Krouse, A. Singhal, Sy-shi Wang
Photodynamic therapy is one of several techniques developed for phototherapy for solid cancers and hematologic malignancies. Photodynamic therapy is a treatment that utilizes a molecular energy exchange between visible light and a photosensitive drug, which results in the production of 1O2, a highly reactive cytocidal oxygen species. The effect is limited to the region where light and drug are combined so that malignant tissue is destroyed and the usual side effects associated with standard cancer therapies are avoided.The light component of photodynamic therapy is customarily generated via dye-pumped or diode lasers. The cost and the complexity of lasers have seriously limited the clinical use of photodynamic therapy for malignancies. A new device technology, based on light-emitting diodes, has been developed (Light Sciences Corporation, Issaquah, WA) that allows light production inside the target tissue. This new technology will expand the current range of indications that are treatable with photodynamic therapy to include moderate-and large-volume refractory tumors.Conventional photodynamic therapy utilizes the delivery of intense light for seconds or minutes. The new approach differs from conventional photodynamic therapy in that it combines a novel interstitial light delivery system with prolonged photoactivation of photosensitive drugs. Prolonging photoactivation time in order to deliver a higher light dose results in an amplification effect, whereby the repeated activation of each photosensitive drug molecule leads to the generation of many thousands of 1O2 molecules. The production of overwhelming numbers of these powerful oxidants in individual cells and the vascular supply of tumors leads to irreversible damage and death of the targeted lesions. Results of preclinical studies have indicated a significant correlation between increased duration of photoactivation and increased volume and depth of photodynamic therapy-induced necrosis.The new developments will enable photodynamic therapy to be used effectively against refractory bulky disease as frontline therapy or in combination with chemotherapy, radiation therapy, or biologics. Perhaps most promising, many patients with advanced refractory disease may now be relieved of symptoms or may return to the treatable population.
{"title":"New Technology for Deep Light Distribution in Tissue for Phototherapy","authors":"James C. Chen, L. Keltner, J. Christophersen, F. Zheng, M. Krouse, A. Singhal, Sy-shi Wang","doi":"10.1097/00130404-200203000-00009","DOIUrl":"https://doi.org/10.1097/00130404-200203000-00009","url":null,"abstract":"Photodynamic therapy is one of several techniques developed for phototherapy for solid cancers and hematologic malignancies. Photodynamic therapy is a treatment that utilizes a molecular energy exchange between visible light and a photosensitive drug, which results in the production of 1O2, a highly reactive cytocidal oxygen species. The effect is limited to the region where light and drug are combined so that malignant tissue is destroyed and the usual side effects associated with standard cancer therapies are avoided.The light component of photodynamic therapy is customarily generated via dye-pumped or diode lasers. The cost and the complexity of lasers have seriously limited the clinical use of photodynamic therapy for malignancies. A new device technology, based on light-emitting diodes, has been developed (Light Sciences Corporation, Issaquah, WA) that allows light production inside the target tissue. This new technology will expand the current range of indications that are treatable with photodynamic therapy to include moderate-and large-volume refractory tumors.Conventional photodynamic therapy utilizes the delivery of intense light for seconds or minutes. The new approach differs from conventional photodynamic therapy in that it combines a novel interstitial light delivery system with prolonged photoactivation of photosensitive drugs. Prolonging photoactivation time in order to deliver a higher light dose results in an amplification effect, whereby the repeated activation of each photosensitive drug molecule leads to the generation of many thousands of 1O2 molecules. The production of overwhelming numbers of these powerful oxidants in individual cells and the vascular supply of tumors leads to irreversible damage and death of the targeted lesions. Results of preclinical studies have indicated a significant correlation between increased duration of photoactivation and increased volume and depth of photodynamic therapy-induced necrosis.The new developments will enable photodynamic therapy to be used effectively against refractory bulky disease as frontline therapy or in combination with chemotherapy, radiation therapy, or biologics. Perhaps most promising, many patients with advanced refractory disease may now be relieved of symptoms or may return to the treatable population.","PeriodicalId":22430,"journal":{"name":"The Cancer Journal","volume":"12 1","pages":"154–163"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89142485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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