Zytiga Eliminates Some High-Risk Prostate Tumors

Neoadjuvant therapy has never panned out in prostate cancer. But one looks good now.
Medscape Medical News

Pazopanib in Sarcoma: Clinically Significant Benefit?

The clinical trial in soft tissue sarcoma that was the basis for the recent approval of this indication has now been published.
Medscape Medical News

Surgery Plus Brachytherapy for Bladder Cancer: Organ Sparing

The approach has outcomes similar to cystectomy while sparing function.
Medscape Medical News

Should HIFU Be Presented as 'Experimental'?

A new study provides interesting data on HIFU for prostate cancer, but there are still not enough data to recommend HIFU beyond offering it as an 'experimental therapy', says Dr. Gerald Chodak.
Medscape Urology

Crossing Boundaries in Molecular Therapy: HER2 in ALL

Looking at a recent report describing the use of trastuzumab in HER2-positive ALL, Dr. Maurie Markman considers what this means for the future of molecular-targeted cancer therapy.
Medscape Hematology-Oncology

[Correspondence] Placebo effect in hot flush research

We commend Eleanor Mann and colleagues for their excellent Article about the use of cognitive behavioural therapy (CBT) to decrease the negative and debilitating effects of hot flushes and night sweats (HFNS) in patients who had been treated for breast cancer. The methods for this study were strong and well described, including both physiological and self-report measures, and they represent a novel approach to management of a challenging side-effect. Two large meta-analyses did not specifically identify any studies using CBT for management of hot flushes.

[Comment] Personalised medicine in oncology: questions for the next 20 years

Molecular characterisation of tumour cells enables refinement of classifications for many cancers and can sometimes guide treatment. Rare cancers can also be fragmented into subtypes. Gastrointestinal stromal tumours comprise at least ten different subtypes, which need distinct treatments for advanced or adjuvant phases. Complexity grows with recognition that heterogeneity can arise within one tumour and patient. Complex branched evolution of mutations is taking place, from primary tumour cells to metastatic cells.

[Comment] Treatment of brain metastases in patients with melanoma

Kim Margolin and colleagues' phase 2 trial of the anti-CTLA-4 antibody ipilimumab for patients with advanced melanoma and brain metastases is one of the first to specifically and prospectively address this important clinical problem, and is a result of progress made in the past 2 years. Previous phase 3 trials have shown that both ipilimumab and the BRAF inhibitor vemurafenib improve survival in metastatic melanoma. Furthermore, preliminary evidence suggests that vemurafenib and another BRAF inhibitor being assessed in clinical trials, dabrafenib (GSK2118436), have activity against brain metastases.

[News] States and US Government spar over medical marijuana

A week after the New Hampshire state legislature passed a bill allowing cancer patients and others with “debilitating medical conditions” to cultivate marijuana for pain management, federal agents raided state-sanctioned medical marijuana dispensaries in California.

[Comment] Is benefit of maintenance therapy for NSCLC best defined by progression-free survival?

Maintenance therapy for non-small-cell lung cancer (NSCLC) has gained acceptance in selected patients after the approval of pemetrexed and erlotinib for such use by the US Food and Drug Administration and European Medicines Agency. Both registration trials Furthermore, it has not been definitively established as a valid surrogate endpoint for overall survival or clinical benefit in NSCLC. In maintenance treatment, the activity of the intervention is known and would be expected to improve progression-free survival, although improvements in overall survival and quality of life are necessary to show a true benefit to patients and justify additional costs.

Improved surgical safety after laparoscopic compared to open surgery for apparent early stage endometrial cancer: Results from a randomised controlled trial

Publication year: 2012
Source:European Journal of Cancer, Volume 48, Issue 8
Andreas Obermair, Monika Janda, Jannah Baker, Srinivas Kondalsamy-Chennakesavan, Alison Brand, Russell Hogg, Thomas W. Jobling, Russell Land, Tom Manolitsas, Marcelo Nascimento, Deborah Neesham, James L. Nicklin, Martin K. Oehler, Geoff Otton, Lewis Perrin, Stuart Salfinger, Ian Hammond, Yee Leung, Peter Sykes, Hextan Ngan, Andrea Garrett, Michael Laney, Tong Yow Ng, Karfai Tam, Karen Chan, David H. Wrede, Selvan Pather, Bryony Simcock, Rhonda Farrell, Gregory Robertson, Graeme Walker, Anthony McCartney, Val Gebski
Aim To compare Total Laparoscopic Hysterectomy (TLH) and Total Abdominal Hysterectomy (TAH) with regard to surgical safety. Methods Between October 2005 and June 2010, 760 patients with apparent early stage endometrial cancer were enroled in a multicentre, randomised clinical trial (LACE) comparing outcomes following TLH or TAH. The main study end points for this analysis were surgical adverse events (AE), hospital length of stay, conversion from laparoscopy to laparotomy, including 753 patients who completed at least 6weeks of follow-up. Postoperative AEs were graded according to Common Toxicity Criteria (V3), and those immediately life-threatening, requiring inpatient hospitalisation or prolonged hospitalisation, or resulting in persistent or significant disability/incapacity were regarded as serious AEs. Results The incidence of intra-operative AEs was comparable in either group. The incidence of post-operative AE CTC grade 3+ (18.6% in TAH, 12.9% in TLH, p 0.03) and serious AE (14.3% in TAH, 8.2% in TLH, p 0.007) was significantly higher in the TAH group compared to the TLH group. Mean operating time was 132 and 107min, and median length of hospital stay was 2 and 5days in the TLH and TAH group, respectively (p <0.0001). The decline of haemoglobin from baseline to day 1 postoperatively was 2g/L less in the TLH group (p 0.006). Conclusions Compared to TAH, TLH is associated with a significantly decreased risk of major surgical AEs. A laparoscopic surgical approach to early stage endometrial cancer is safe.

Quality indicators for testicular cancer: A population-based study

Publication year: 2012
Source:European Journal of Cancer, Volume 48, Issue 8
Joan Vlayen, France Vrijens, Stephan Devriese, Koen Beirens, Elizabeth Van Eycken, Sabine Stordeur
Purpose This study aimed at developing and measuring an indicator set to monitor the quality of testicular cancer care, to make comparisons over time and to support quality improvement for all practitioners and centres involved in the care of testicular cancer patients. Methods Quality indicators were identified from a systematic literature search and from the 2010 Belgian evidence-based clinical practice guidelines. The selection process involved an expert panel evaluating reliability, relevance, interpretability and actionability of each indicator. The quality indicators were pilot tested using the Belgian Cancer Registry (BCR) data linked with claims data for 1307 men with testicular cancer diagnosed between 2001 and 2006. The variability between centres was displayed using funnel plots. Results Of the 12 finally selected indicators, 5 were fully and 1 was partly measurable, while 2 indicators were measurable using proxy information. Five-year relative survival was 97%, 95% and 76% for pStage I–III, respectively. Overall 5-year survival slightly improved from 91% in 2001 to 94% in 2004. Between 2004 and 2006, 14 of 97 centres performed ⩾10 orchidectomies. Large variability was found between centres. The nine centres with a 5-year observed survival below the lower limit treated less than 20 patients between 2001 and 2006. Conclusions The present study demonstrates the feasibility to develop a multidisciplinary set of quality indicators for testicular cancer. Using national cancer registry data linked to claims data, eight indicators were measurable, showing a mixed picture of the quality of care for testicular cancer patients in Belgium.

Clear cell sarcoma of the kidney: A review

Publication year: 2012
Source:European Journal of Cancer
S.L.M. Gooskens, R. Furtwängler, G.M. Vujanic, J.S. Dome, N. Graf, M.M. van den Heuvel-Eibrink
Clear cell sarcoma of the kidney (CCSK) is a rare renal tumour that is observed most often in children under 3years of age. Only a few large series of CCSK have been reported and patients with CCSK are often included among patients with other types of childhood renal tumours. The purpose of this paper is to review the published series and case reports of CCSK and to create an up-to-date overview of clinical and histological features, genetics, treatment, and outcome.

Radioembolization in the Treatment of Unresectable Liver Tumors: Experience Across a Range of Primary Cancers

Radioembolization is a proven treatment to slow disease progression and improve survival in patients with colorectal cancer liver metastases and hepatocellular carcinoma. Accumulating evidence supports its use in metastases from neuroendocrine tumors and breast cancer. Cancers with radiobiologic profiles similar to those of colorectal and breast cancer, including melanoma, lung cancer, and nodular cholangiocarcinoma, are being studied as candidates for radioembolization. This treatment modality has also been shown to downsize hepatic tumors for potentially curative ablation in patients with breast, pancreatic, and colorectal cancer. Radioembolization using either yttrium-90 (90Y)-labeled resin or glass microspheres represents a promising therapy for liver-only or liver-predominant tumors in patients with 1 or more variables, including adequate or sufficient functional liver reserve, good performance status, and absence of other significant comorbidities. Therapeutic efficacy and safety can be best achieved by use of careful dosimetric techniques and treatment planning. Radioembolization could be considered after progression of liver metastases during treatment hiatus, at an early therapeutic line in tumors that respond poorly to chemotherapy, or in treatment-refractory disease.

Risk Factors for Local Recurrence and Metastasis in Soft Tissue Sarcomas of the Extremity

Objectives: We reviewed our institution's experience in treating soft tissue sarcomas of the extremity to identify factors associated with local recurrence, metastasis, and overall survival, to identify patients who may benefit from intensification of therapy. Methods: A retrospective analysis was performed for patients who underwent both limb-sparing surgery and external beam radiotherapy for extremity sarcoma. Those who had gross residual disease or who presented with recurrent or metastatic disease were excluded. The Kaplan-Meier product limit and multivariate Cox regression were used to estimate local failure-free probability, distant failure-free probability, and overall survival along with associations with patient, tumor, and treatment characteristics. Results: One hundred eighty-eight patients were included in the analysis. Twenty-five (13%) and 46 (24%) experienced local and distant recurrence, respectively. Patients with high/intermediate-grade tumors [hazard ratio (HR)=5.63, 95% confidence interval (CI): 1.27-24.89, P=0.023] or with multifocally positive margins (HR=4.27, 95% CI: 1.20-15.24, P=0.026) were more likely to fail locally. Those with a preceding local recurrence (HR=8.58, 95% CI: 3.87-19.04, P<0.0001), high/intermediate-grade tumors (HR=5.68, 95% CI: 1.28-25.25, P=0.023), or no secondary reexcision (HR=2.5, 95% CI: 1.09-5.74, P=0.031) were more likely to develop metastasis. Patients with local recurrence (HR=3.6, 95% CI: 1.77-7.29, P<0.001), metastasis (HR=16.0, 95% CI: 7.93-32.31, P<0.0001), or without secondary reexcision (HR=3.2, 95% CI: 1.27-8.09, P=0.014) had decreased overall survival. Conclusions: Patients whose tumor grade or margin status put them at high risk for local failure should be considered for intensification of therapy. Those with a local recurrence should be considered for increased surveillance or systemic therapy, as local failure is associated with subsequent metastasis and decreased survival.

Efficacy and Tolerability of long-acting Octreotide in the Treatment of Thymic Tumors: Results of a Pilot Trial

Objectives: Octreotide is a somatostatin analog, long-acting formulations of which have been used experimentally for the treatment of patients with invasive tumors and/or residual disease after conventional therapies. The objective of this retrospective study was to evaluate the efficacy of long-acting octreotide (Sandostatin LAR) for the treatment of thymic tumors, with a primary efficacy end point of progression-free survival. Methods: Between 1994 and 2010, 44 patients with thymic malignancies were evaluated. Twenty-seven patients underwent an OctreoScan, and 12 OctreoScan-positive patients were treated with long-acting octreotide at a dose of 20 mg, given as an intramuscular injection, every 2 weeks. Results: Treatment with long-acting octreotide gave the following results: 3 cases of partial response (25%), 5 cases of stable disease (42%), and 4 cases of progressive disease (33%), with an average progression-free survival of 8 months (range, 3 to 21). Treatment compliance and tolerability were good for all evaluated patients. Conclusions: The results of this study confirm the somatostatin receptor as a valid target for the treatment of thymic malignancies. Overall, therapy with long-acting somatostatin analogs seems to be safe and effective.

Recombinant Human Thyroid Stimulating Hormone in Thyroid Remnant Ablation With 1.1 GBq 131Iodine in Low-Risk Patients

Objective: To evaluate the efficacy of recombinant human thyroid stimulating hormone [rhTSH (versus hypothyroidism)] in thyroid ablation with an activity of 1.1 GBq (30 mCi) 131I. Methods: A total of 102 patients with thyroid cancer who fulfilled the following criteria were studied: submitted to total thyroidectomy with complete tumor resection; tumor ≤4 cm without extrathyroid invasion or lymph node metastases; negative anti-thyroglobulin (anti-Tg) antibodies. Thirty-two patients (group A) received 0.9 mg of rhTSH for 2 consecutive days followed by 131I administration and 70 patients (group B) were prepared by levothyroxine withdrawal for 4 weeks. The groups were similar in sex, age, and tumor characteristics. Results: Ablation was successful (stimulated Tg<1 ng/mL and negative diagnostic whole-body scanning and neck ultrasonography 9 to 12 mo after ablation) in 27 patients of group A (84.3%) and in 58 of group B (83%). Considering patients with Tg greater than 1 ng/mL immediately before 131I administration, the rates were 72.2% in group A and 75% in group B. In group A, the ablation rate was similar for patients who discontinued levothyroxine-T4 3 days before 131I administration and those maintained on hormone therapy. The mean follow-up was 29.6 months in group A and 55 months in group B. Stimulated Tg (after rhTSH) was undetectable in 29 patients of group A (90.6%) and in 61 of group B (87%) and 1 patient of group B presented cervical metastases at the last assessment. Conclusions: Low 131I activity after rhTSH is effective for remnant ablation in patients who are at low risk of recurrence.

Intravenous Contrast Agent Influence on Thoracic Computed Tomography Simulation Investigated Through A Heterogeneous Dose Calculation Method Using 5-Bulk Densities

Objective: Using 5-bulk-density heterogeneous dose calculation, we investigated whether contrast-enhanced (CE+) computed tomography (CT) will affect dose-calculation accuracy in the thoracic area. Methods: We analyzed 17 radiation-oncology patients who underwent thoracic CE+ CTs. Full-resolution CT and 5-bulk-density plans were generated using an adaptive convolution algorithm. Bulk densities for air, lung, fat, soft tissue, and bone were applied to regions identified by an isodensity segmentation tool. The population-averaged physical density of each region was calculated and compared with the reference value calculated from 66 noncontrast-enhanced (CE−) thoracic CT images. Using the 5-bulk densities, we created a new plan in which the physical densities of each area were forced to be the same as the CE− reference value, and we compared the dose-volume histograms (DVH). Results: Average physical density for the segmented air, lung, fat, soft tissue, and bone for CE+ were 0.14, 0.29, 0.90, 1.03, and 1.13 g/cm3, and the reference values for CE− were 0.14, 0.26, 0.89, 1.02, and 1.12 g/cm3, respectively. In all the cases, the normal-tissue DVH agreed to better than 1%. In 15 cases, DVH of the planning target volume (PTV) agreed to better than 3%. In 2 patients, >3% difference in the PTV dose was observed. Conclusions: Only 2 patients with a strong injection artifact in the PTV or beam showed >3% discrepancy in the target dose. When using CE+ CT for treatment planning, strong injection artifacts must be excluded.

Assessing the Impact of a Cooperative Group Trial on Breast Cancer Care in the Medicare Population [Breast Cancer]

Purpose

The Cancer and Leukemia Group B (CALGB) C9343 trial found that adjuvant radiation therapy (RT) provided minimal benefits for older women with breast cancer. Although treatment guidelines were changed to indicate that some women could forego RT, the impact of the C9343 results on clinical practice is unclear.

Patients and Methods

We used the Surveillance, Epidemiology, and End Results (SEER) –Medicare data set to assess the use of adjuvant RT in a sample of women ≥ 70 years old diagnosed with stage I breast cancer from 2001 to 2007 who fulfilled the C9343 inclusion criteria. We used log-binomial regression to estimate the relation between publication of C9343 and use of RT in the full sample and across strata of patient and health system characteristics.

Results

Of the 12,925 Medicare beneficiaries in our sample (mean age, 77.7 years), 76.5% received RT. Approximately 79% of women received RT before study publication compared with 75% after (adjusted relative risk of receiving RT postpublication v prepublication: 0.97; 95% CI, 0.95 to 0.98). Although use of RT was lower after the trial within all strata of age and life expectancy, the magnitude of this decrease did not differ significantly by strata. For instance, among patients with life expectancy less than 5 years, RT use decreased by 3.7%, from 44.4% prepublication to 40.7% postpublication. Among patients with life expectancy ≥ 10 years, RT use decreased by 3.0%, from 92.0% to 89.0%.

Conclusion

The C9343 trial had minimal impact on the use of RT among older women in the Medicare population, even among the oldest women and those with shorter life expectancies.

Risk Factors for Financial Hardship in Patients Receiving Adjuvant Chemotherapy for Colon Cancer: A Population-Based Exploratory Analysis [Gastrointestinal Cancer]

Purpose

Characteristics that predispose patients to financial hardship during cancer treatment are poorly understood. We therefore conducted a population-based exploratory analysis of potential factors associated with financial hardship and treatment nonadherence during and following adjuvant chemotherapy for colon cancer.

Patients and Methods

Patients diagnosed with stage III colon cancer between 2008 and 2010 were identified from a population-based cancer registry representing 13 counties in Washington state. Patients were asked to complete a comprehensive survey on treatment-related costs. Patients were considered to have experienced financial hardship if they accrued debt, sold or refinanced their home, borrowed money from friends or family, or experienced a 20% or greater decline in their annual income as a result of treatment-related expenses. Logistic regression analysis was used to investigate factors associated with financial hardship and treatment nonadherence.

Results

A total of 284 responses were obtained from 555 eligible patients (response rate, 51.2%). Nearly all patients in the final sample were insured during treatment. In this sample, 38% of patients reported one or more financial hardships as a result of treatment. The factors most closely associated with treatment-related financial hardship were younger age and lower annual household income. Younger age, lower income, and unemployment or disability (which occurred in most instances following diagnosis) were most closely associated with treatment nonadherence.

Conclusion

A significant proportion of patients undergoing adjuvant chemotherapy for stage III colon cancer may experience financial hardship, despite having health insurance coverage. Interventions to help at-risk patients early on during therapy may prevent long-term financial adverse effects.

Alemtuzumab in Combination With Methylprednisolone Is a Highly Effective Induction Regimen for Patients With Chronic Lymphocytic Leukemia and Deletion of TP53: Final Results of the National Cancer Research Institute CLL206 Trial [Hematologic Malignancy]

Purpose

In chronic lymphocytic leukemia (CLL), TP53 deletion/mutation is strongly associated with an adverse outcome and resistance to chemotherapy-based treatment. In contrast, TP53 defects are not associated with resistance to the anti-CD52 monoclonal antibody alemtuzumab or methylprednisolone. In an attempt to improve the treatment of TP53-defective CLL, a multicenter phase II study was developed to evaluate alemtuzumab and methylprednisolone in combination.

Patients and Methods

Thirty-nine patients with TP53-deleted CLL (17 untreated and 22 previously treated) received up to 16 weeks of treatment with alemtuzumab 30 mg three times a week and methylprednisolone 1.0 g/m² for five consecutive days every 4 weeks. Antimicrobial prophylaxis consisted of cotrimoxazole, itraconazole, and aciclovir (or valganciclovir for asymptomatic cytomegalovirus viremia). The primary end point was response as assigned by an end-point review committee. Secondary end points were safety, progression-free survival (PFS) and overall survival (OS).

Results

The overall response rate, complete response rate (including with incomplete marrow recovery), median PFS, and median OS were 85%, 36%, 11.8 months, and 23.5 months, respectively, in the entire cohort and 88%, 65%, 18.3 months, and 38.9 months, respectively, in previously untreated patients. Grade 3 to 4 hematologic and glucocorticoid-associated toxicity occurred in 67% and 23% of patients, respectively. Grade 3 to 4 infection occurred in 51% of the overall cohort and in 29% of patients less than 60 years of age. Treatment-related mortality was 5%.

Conclusion

Alemtuzumab plus methypredisolone is the most effective induction regimen hitherto reported in TP53-deleted CLL. The risk of infection is age related and, in younger patients, seems only marginally higher than that associated with rituximab, fludarabine, and cyclophosphamide.

Multicenter Randomized Phase II Clinical Trial Comparing Neoadjuvant Oxaliplatin, Capecitabine, and Preoperative Radiotherapy With or Without Cetuximab Followed by Total Mesorectal Excision in Patients With High-Risk Rectal Cancer (EXPERT-C) [Gastrointestinal Cancer]

Purpose

To evaluate the addition of cetuximab to neoadjuvant chemotherapy before chemoradiotherapy in high-risk rectal cancer.

Patients and Methods

Patients with operable magnetic resonance imaging–defined high-risk rectal cancer received four cycles of capecitabine/oxaliplatin (CAPOX) followed by capecitabine chemoradiotherapy, surgery, and adjuvant CAPOX (four cycles) or the same regimen plus weekly cetuximab (CAPOX+C). The primary end point was complete response (CR; pathologic CR or, in patients not undergoing surgery, radiologic CR) in patients with KRAS/BRAF wild-type tumors. Secondary end points were radiologic response (RR), progression-free survival (PFS), overall survival (OS), and safety in the wild-type and overall populations and a molecular biomarker analysis.

Results

One hundred sixty-five eligible patients were randomly assigned. Ninety (60%) of 149 assessable tumors were KRAS or BRAF wild type (CAPOX, n = 44; CAPOX+C, n = 46), and in these patients, the addition of cetuximab did not improve the primary end point of CR (9% v 11%, respectively; P = 1.0; odds ratio, 1.22) or PFS (hazard ratio [HR], 0.65; P = .363). Cetuximab significantly improved RR (CAPOX v CAPOX+C: after chemotherapy, 51% v 71%, respectively; P = .038; after chemoradiation, 75% v 93%, respectively; P = .028) and OS (HR, 0.27; P = .034). Skin toxicity and diarrhea were more frequent in the CAPOX+C arm.

Conclusion

Cetuximab led to a significant increase in RR and OS in patients with KRAS/BRAF wild-type rectal cancer, but the primary end point of improved CR was not met.

Radiotherapy in Older Women With Low-Risk Breast Cancer: Why Did Practice Not Change? [EDITORIALS]

Same-Day Discharge in Clinical Stage I Endometrial Cancer Patients Treated with Total Laparoscopic Hysterectomy, Bilateral Salpingo-Oophorectomy and Bilateral Pelvic Lymphadenectomy

Oncology 2012;82:321–326 (DOI:10.1159/000337573)

Front & Back Matter

Oncology 2012;82:X (DOI:10.1159/000339389)

Palliation of Symptomatic Malignant Ascites: An (Often) Unmet Need

Oncology 2012;82:313–314 (DOI:10.1159/000337690)

A Pilot Study of Long-Acting Octreotide for Symptomatic Malignant Ascites

Oncology 2012;82:315–320 (DOI:10.1159/000337246)

Detection of Activated Leukocyte Cell Adhesion Molecule in the Serum of Breast Cancer Patients and Implications for Prognosis

Oncology 2012;82:305–312 (DOI:10.1159/000337222)

Pulmonary Lymphangitic Carcinomatosis due to Renal Cell Carcinoma

Case Rep Oncol 2012;5:246–252 (DOI:10.1159/000339126)

Diffuse Large B-Cell Lymphoma Transformed from Mucosa-Associated Lymphoid Tissue Lymphoma Arising in a Female Urethra Treated with Rituximab for the First Time

Case Rep Oncol 2012;5:238–245 (DOI:10.1159/000333357)

Papillary Renal Carcinoma Presenting as a Cancer of Unknown Primary (CUP) and Diagnosed through Gene Expression Profiling

Case Rep Oncol 2012;5:229–232 (DOI:10.1159/000339130)

Remarkable Regression of an Osteolytic Lesion of Large Cell Lung Cancer Treated with Zoledronic Acid: A Case Report

Case Rep Oncol 2012;5:233–237 (DOI:10.1159/000339125)

Multiple Retroperitoneal Schwannomas Mimicking Adrenal Tumors

Case Rep Oncol 2012;5:222–228 (DOI:10.1159/000338973)

Table of Contents

Editorial Board

The importance of exposure rate on odds ratios by cigarette smoking and alcohol consumption for esophageal adenocarcinoma and squamous cell carcinoma in the Barrett's Esophagus and Esophageal Adenocarcinoma Consortium

Abstract: Background: Cigarette smoking is associated with esophageal adenocarcinoma (EAC), esophagogastric junctional adenocarcinoma (EGJA) and esophageal squamous cell carcinoma (ESCC), and alcohol consumption with ESCC. However, no analyses have examined how delivery rate modifies the strength of odds ratio (OR) trends with total exposure, i.e., the impact on the OR for a fixed total exposure of high exposure rate for short duration compared with low exposure rate for long duration. Methods: The authors pooled data from 12 case–control studies from the Barrett's Esophagus and Esophageal Adenocarcinoma Consortium (BEACON), including 1242 (EAC), 1263 (EGJA) and 954 (ESCC) cases and 7053 controls, modeled joint ORs for cumulative exposure and exposure rate for cigarette smoking and alcohol consumption, and evaluated effect modification by sex, body mass index (BMI), age and self-reported acid reflux. Results: For smoking, all sites exhibited inverse delivery rate effects, whereby ORs with pack-years increased, but trends weakened with increasing cigarettes/day. None of the examined factors modified associations, except for ESCC where younger ages at diagnosis enhanced smoking effects (P<0.01). For EAC and EGJA, ORs with drink-years exhibited inverse associations in <5drinks/day consumers and no association in heavier consumers. For ESCC, ORs with drink-years increased, with trends strengthening with greater drinks/day. There was no significant effect modification, except for EAC and EGJA where acid reflux mitigated the inverse associations (P=0.02). For ESCC, younger ages at diagnosis enhanced drinking-related ORs (P<0.01). Conclusions: Patterns of ORs by pack-years and drink-years, delivery rate effects and effect modifiers revealed common as well as distinct etiologic elements for these diseases.

The descriptive epidemiology of female breast cancer: An international comparison of screening, incidence, survival and mortality

Abstract: Background: This paper presents the latest international descriptive epidemiological data for invasive breast cancer amongst women, including incidence, survival and mortality, as well as information on mammographic screening programmes.Results: Almost 1.4 million women were diagnosed with breast cancer worldwide in 2008 and approximately 459,000 deaths were recorded. Incidence rates were much higher in more developed countries compared to less developed countries (71.7/100,000 and 29.3/100,000 respectively, adjusted to the World 2000 Standard Population) whereas the corresponding mortality rates were 17.1/100,000 and 11.8/100,000. Five-year relative survival estimates range from 12% in parts of Africa to almost 90% in the United States, Australia and Canada, with the differential linked to a combination of early detection, access to treatment services and cultural barriers. Observed improvements in breast cancer survival in more developed parts of the world over recent decades have been attributed to the introduction of population-based screening using mammography and the systemic use of adjuvant therapies.Conclusion: The future worldwide breast cancer burden will be strongly influenced by large predicted rises in incidence throughout parts of Asia due to an increasingly “westernised” lifestyle. Efforts are underway to reduce the global disparities in survival for women with breast cancer using cost-effective interventions.

Analyzing the time trends of disease rates can help understand the etiology of the disease since a changing trend implies the changes of environmental risk factors while a constant trend may be explained by some genetic or stable environmental risk factors. Describing the gender difference in disease rates also has important etiological implications on risk factors with different distributions in males and females. As an integration of these two methodologies, Dyego Leandro Bezerra de Souza and colleagues provided a good example of presenting the changing epidemiology of two male predominant cancers, laryngeal and hypopharyngeal cancers, in Spain . In this recently published paper, the authors found the gap between genders in these two cancers has been narrowed in recent years and concluded that the observed trends might be explained by the different changes in tobacco and alcohol consumptions between genders.

Editorial Board

Geriatric thoracic oncology: Gaining momentum

Lung cancer accounts for the highest cancer associated mortality in the US. Of the 160,000 estimated deaths from lung cancer this year, the majority will be secondary to non-small cell lung cancer. Lung cancer is a disease of the older adult with over two-thirds of cases diagnosed in patients over the age of 65years and half of the cases diagnosed in patients over the age of 70years. With the rapid “graying” of the US population, akin to other age associated conditions, the overall incidence of lung cancer is expected to rise over the next 15–20years. With significant research in the field of lung cancer over the last 20years, the incidence and mortality from lung cancer decreased among individuals aged ≤50years, but increased among those aged ≥70years.

Perioperative care of the elderly oncology patient: A report from the SIOG task force on the perioperative care of older patients with cancer

Abstract: The increasing number of older cancer patients seen in daily practice demands reflection on how to optimize their care during the perioperative period. Optimally tailored surgical management, at present the most successful cancer treatment, firmly rests on an accurate and careful anesthesiological management.The unique peculiarities of anesthesia in older cancer patients prompted the International Society of Geriatric Oncology (SIOG) to put together a panel of international experts with the aim of reviewing the literature and drafting a consensus document. This article summarizes their views.

Impact of age, comorbidity and symptoms on physical function in long-term breast cancer survivors (CALGB 70803)

Abstract: Objective: The purpose of this study was to assess the impact of aging, comorbidities and symptoms on physical function in patients surviving 20years since adjuvant treatment for breast cancer.Patients and methods: Patients were originally treated on CALGB 7581 (from 1975 to 1980), a randomized trial of three adjuvant therapies and reassessed (153 of 193 eligible survivors) 20years from the onset of therapy for physical function and symptoms by the EORTC QLQ-C30 and comorbidities by the OARS questionnaire.Results: The average age at reassessment was 64.5years. 66% of patients had at least two comorbidities and 22% had four or more, but relatively little interference with activities. Older patients had greater multimorbidity. Physical function was generally high and comparable to matched population norms. Older patients had greater difficulty with strenuous activities. For every increase in number of comorbidities, physical function score decreased by 5.1 (p<.001). Symptoms were also frequent (80%) and correlated strongly with decreases in function (0–100u scale) (p<.001), to an even greater degree than comorbidities.Conclusion: Very long-term cancer survivors have changes in physical function and symptoms largely consistent with their aging suggesting that the impact of cancer and its treatment is attenuated over time and largely replaced by the impact of age-related comorbidities and functional decline.

Ageing and other factors behind recent cancer incidence and mortality trends in Italy

Abstract: Objective: The aim of this paper is to outline the age effect on cancer trends observed in Italy between 1998 and 2005.Methods: We analysed crude and age-adjusted cancer incidence and mortality trends for 36 sites and both sexes using data from 22 population-based registries of the Italian Network of Cancer Registries (AIRTUM). Some 818,017 incident cancers and 342,444 cancer deaths were analysed.Results: The population aged 65years and older increased from 19.0% to 20.6% between 1998 and 2005 with a significant effect on the cancer burden. The all-cancer, age-adjusted incidence rate was quite stable over the period (all sites excluding non-melanoma skin cancers: annual percent change (APC) men +0.3 CI +0.1/+0.5, women +0.2 CI −0.1/+0.4), but population ageing resulted in a growing number of new cases (crude rates: APC men +1.3 CI +1.0/+1.7, women +0.9 CI +0.6/+1.2). This effect was not evident for those cancer sites with high incidence rates among young subjects. The all-cancer, age-adjusted mortality rate decreased in both sexes but the crude rate changed in women only. Mortality increased for lung cancer among women (APC +1.5; CI +0.5/+2.5) and for melanoma among men (APC +2.7; CI +0.5/+4.8).Conclusions: Recent cancer trends in Italy are quite favourable, showing decreasing mortality rates for most sites (except for lung cancer among women and melanoma among men) and showing overall stable incidence. However, it follows that population ageing will have increased the cancer diagnostic and therapeutic needs and costs.

Dr. Elizabeth Poynor

Dr. Luke Nordquist of Omaha, Nebraska interviews Dr. Elizabeth Poynor. She specializes is Gynecologic Cancers and Hereditary Malignancies. Dr. Poynor was the previous Director of Translational Researc...

Author: canceropinions
Added: 05/14/2012

Jack Siemiatycki: Do Cells Phones Cause Brain Cancer?

Professor Jack Siemiatycki is a Professor, University of Montreal, Epidemiologist, University of Montreal Hospital Research Center -- Canada Research Chair and Professor,
Département de médecine soc...

Author: vitaloptions
Added: 05/11/2012

Diane Simeone, MD: Pancreatic Cancer Overview and Treatment Update from AACR 2012

Dr. Diane Simeone is the Lazar J. Greenfield Professor of Surgery and Professor of Molecular & Integrative Physiology -- Chief, Division of Hepatopancreatobiliary and Advanced Gastrointestinal Sur...

Author: vitaloptions
Added: 05/11/2012

Mr. Pradeep Jaisingh talks on need for setting up world class cancer centres in India

Mr. Pradeep K Jaisingh, CEO and MD - International Oncology Services Pvt. Ltd. shares the story behind forming International Oncology, a cancer care organization. International Oncology is a global ca...

Author: internationaloncology
Added: 05/11/2012

Mr. Pradeep K Jaisingh shares business model of International Oncology Services Pvt. Ltd.

Mr. Pradeep K Jaisingh, CEO and MD - International Oncology Services Pvt. Ltd. shares the unique business model of International Oncology, a cancer care organization. International Oncology is a globa...

Author: internationaloncology
Added: 05/11/2012