Endocrine therapy with or without radical prostatectomy for T1b-T3N0M0 prostate cancer

BACKGROUND: We retrospectively compared the 5-year survival rates of T1b-T3N0M0 prostate cancer patients treated either by endocrine therapy plus radical prostatectomy or endocrine therapy alone. METHODS: Clinical T1b-T3N0M0 prostate cancer patients were enrolled at 104 institutions in Japan. They were assigned to study 1 (n = 176), if they were indicated to prostatectomy, if not indicated, they were assigned to study 2 (n = 151). The indication of prostatectomy was based on the clinical judgement of physicians and/or patients. Those assigned to study 1 underwent prostatectomy and adjuvant endocrine therapy with or without preoperative androgen deprivation. Those assigned to study 2 were treated with leuprorelin acetate with or without chlormadinone acetate. They were followed-up every 3 months until death or for 5 years and over. RESULTS: Those assigned to study 1 were younger (mean age 67.2 vs 75.7 years), less advanced in clinical stage, and had lower prostate specific antigen levels (mean 43.8 vs 103.6 ng/mL). Death for any reason was observed less frequently in study 1 (n = 29, 16%) than study 2 (n = 50, 33%), and the 5-year overall survival rate was higher in study 1 (87 vs. 68%). However, prostate cancer deaths were comparatively seldom (9% in study 1 and 7% in study 2), resulting in the identical 5-year cause specific survival rate in both study groups (91%). In both study groups the overall survival was almost equal to the natural survival of age-matched men. CONCLUSIONS: Endocrine therapy offers a reasonable survival rate in T1b-T3 prostate cancer patients within a 5-year follow-up. Observation will be extended to determine 10-year outcomes.     

Phase II Study of Co-Administration of Uracil and Tegafur (UFT) in Hepatocellular Carcinoma

A Phase II study of co-administration of uracil and tegafur(UFT) was performed in 32 patients with unresectable hepatocellularcarcinoma. A dose of 400 mg/m²/day of UFT was administered orally,three times a day, for more than 4 weeks. Of 26 patients evaluablefor response, one (3.8%) showed a partial response of 9 months'duration. There were no complete responders. A dose-limitingtoxicity was gastrointestinal tract disturbance. Six patients(18.8%) had to discontinue UFT treatment because of gastrointestinaltoxicity. The clinical advantage of tegafur in the treatmentof hepatocellular carcinoma was not enhanced by co-administrationof uracil.     

下胸段硬膜外阻滞在单肺通气期间对肺内分流的影响

目的探讨全麻下下胸段硬膜外阻滞对单肺通气期间肺内分流(Qs/Qt)的影响。方法术中需行单肺通气的30例择期开胸手术患者,ASAⅡ～Ⅲ,随机分为全麻组(GA组,n=15),全麻复合下胸段硬膜外组(GE组,n=15)。两组病人分别于麻醉前、双肺通气30min、单肺通气5、15、30min时采动脉血及混合静脉血,行血气分析,并计算出Qs/Qt等。结果两组患者在单肺通气后5、15、30min,Qs/Qt均增加(P<0.01),动脉氧分压(PaO2)较双肺通气时下降(P<0.01)。但在各时间点两组Qs/Qt以及PaO2无显著性差异。结论下胸段硬膜外阻滞对单肺通气期间肺内分流和动脉氧合无明显影响,可安全用于开胸单肺通气患者的麻醉。     

Survival of cervical cancer patients in Germany in the early 21st century: A period analysis by age, histology, and stage

Abstract Purpose. Population-based studies on cervical cancer providing survival estimates by age, histology, and stage have been sparse. We aimed to derive most up-to-date and detailed survival estimates for cervical cancer patients in Germany. Methods. We used a pooled German national dataset including data from 11 cancer registries covering a population of 33 million people. Included were 15 685 patients diagnosed with cervical cancer from 1997 to 2006. Period analysis was performed to calculate the five-year relative survival (RS) 2002-2006. Trends in survival between 2002 and 2006 were examined using model-based period analysis. Age-adjustment was done using five age groups (15-44, 45-54, 55-64, 65-74, and 75 + years). Results. Overall, age-adjusted five-year relative survival in 2002-2006 was 64.7%. A strong age gradient was observed, with five-year RS decreasing from 81.7% in age group 15-49 years to 46.3% in age group 70 + years. Prognosis furthermore strongly varied by stage, with age-adjusted five-year RS reaching 84.6% for localized, 48.2% for regional, and 17.9% for distant stage. From 2002 to 2006, a significant improvement (4.7 percent units) in overall age-adjusted five-year RS was seen. The improvement was most pronounced for age groups 55-64 years (from 54.2 to 65.6%) and 65-74 years (from 50.0 to 58.1%). Conclusion. In this first comprehensive population-based study from Germany, prognosis of cervical cancer strongly varied by age and stage. Prognosis continued to improve, in particular in age range 55-74 years, in the five-year period assessed.     

Reduction of immunosuppression for transplant-associated skin cancer: expert consensus survey

BACKGROUND: Reduction of immunosuppression is considered a reasonable adjuvant therapeutic strategy in solid-organ transplant recipients experiencing multiple or high-risk skin cancers. However, the literature provides no guidance about what threshold of cancer development would warrant initiation of reduction of immunosuppression. OBJECTIVES: To develop expert consensus guidelines for initiation of reduction of transplant-associated immunosuppression for solid-organ transplant recipients with severe skin cancer. METHODS: An expert consensus panel was convened by the International Transplant Skin Cancer Collaborative and Skin Care for Organ Transplant Patients Europe Reduction of Immunosuppression Task Force. Thirteen hypothetical patient scenarios with graduated morbidity and mortality risks were presented and mean and mode expert opinions about appropriate level of reduction of systemic immunosuppression (mild, moderate, severe) were generated. RESULTS: Mild reduction of transplant-associated immunosuppression was considered warranted once multiple skin cancers per year developed or with individual high-risk skin cancers. Moderate reduction was considered appropriate when patients experienced > 25 skin cancers per year or for skin cancers with a 10% 3-year risk of mortality. Severe reduction was considered warranted only for life-threatening skin cancers. CONCLUSIONS: Reduction of immunosuppression is considered a reasonable adjuvant management strategy for transplant recipients with numerous or life-threatening skin cancers. Proposed guidelines are presented for the graduated reduction of immunosuppression coincident with the increasing skin cancer risks.     

Impact of evidence‐based medicine on the treatment of patients with unresectable hepatocellular carcinoma

Aliment Pharmacol Ther 31 , 493–501

Summary

Background A randomized controlled trial performed by the Barcelona Clinic Liver Cancer (BCLC) published in 2002 demonstrated that transcatheter arterial chemoembolisation (TACE) is an effective treatment for well‐selected patients with unresectable hepatocellular carcinoma (HCC). Aim To access whether this information has modified the use of TACE in clinical practice. Methods From 2042 HCC patients included in the Italian Liver Cancer database, we selected 336 cases diagnosed over two 4‐year periods (1999–2002, n = 161 and 2003–2006, n = 175), fulfilling the inclusion criteria of the BCLC study. These groups were compared for TACE application rate, patient characteristics and survival. Results Patients undergoing TACE increased in the 2003–2006 period (from 62% to 73%, P = 0.035), with an increase in of Child‐Pugh class A (from 64% to 77%, P = 0.048) and advanced HCC patients (from 54% to 69%, P = 0.041). In the 1999–2002 period, there was no significant difference in survival between TACE‐treated and untreated patients, while in the 2003–2006 period, TACE‐treated patients survived longer (P < 0.0001). Conclusions Following the publication of studies providing evidence of a survival benefit of TACE in selected patients with unresectable HCC, significantly more patients with well‐compensated cirrhosis underwent TACE within this very homogenous population, leading to an increased survival despite a more advanced tumour stage.     

Clinicopathological statistics on registered prostate cancer patients in Japan: 2000 report from the Japanese Urological Association

Abstract Background: The purpose of the present paper was to investigate etiology, diagnosis, initial treatment, pathological findings and final outcomes for prostate cancer in Japan. Methods: From 2001, the Japanese Urological Association initiated computer‐based registration of prostate cancer patients in Japan to estimate etiology, diagnosis, initial planed treatment, pathological findings and final outcome. Results: A total of 173 institutions responded and 4529 patients who were diagnosed with prostate cancer in 2000 were registered. In the first year, background factors, diagnostic procedures and initially planned treatment were recorded. The analysis of these registered cases is presented here. Nearly 30% of the cases demonstrated <10 ng/mL of prostate specific antigen. The six‐core biopsy was the most commonly used procedure. The clinical T staging distribution was as follows: T1c, 20.3%; T2a, 21.8%; T2b, 17.3%; T3a, 15.8%; T3b, 11.0%; and T4, 8%. More than 70% of cases were diagnosed as M0. Hormone therapy alone was the initial treatment plan in more than half of the cases. Conclusion: This is the first report on prostate cancer patients in Japan based on multi‐institutional registration. Pathological findings and final outcome will be surveyed later by the Japanese Urological Association. After 5 years, adopted treatment, pathological results and final outcome will be registered.     

Metronomic Capecitabine in Advanced Hepatocellular Carcinoma Patients: A Phase II Study

Background.

Anti-angiogenic treatment with targeted agents is effective in advanced hepatocellular carcinoma (HCC). This trial evaluated the safety and efficacy of metronomic capecitabine in patients with HCC.

Methods.

This single-institution phase II trial included 59 previously untreated patients with advanced HCC and 31 patients resistant to or intolerant of sorafenib. The treatment schedule was capecitabine 500 mg twice daily until progression of disease, unacceptable toxicity level, or withdrawal of informed consent. Progression-free survival (PFS) was chosen as the primary endpoint.

Results.

A total of 59 previously untreated and 31 previously treated patients with HCC were enrolled. The first cohort achieved a median PFS of 6.03 months and an overall survival (OS) of 14.47 months. Two patients achieved a complete response, 1 patient achieved partial response, and in 30 patients, stable disease was the best outcome. The second cohort achieved a median PFS of 3.27 months and a median OS of 9.77 months. No complete or partial responses were observed, but 10 patients had stable disease. An unscheduled comparison of the first cohort of patients with 3,027 untreated patients with HCC from the Italian Liver Cancer (ITA.LI.CA) database was performed. One-to-one matching according to demographic/etiologic/oncologic features was possible for 50 patients. The median OS for these 50 capecitabine-treated patients was 15.6 months, compared with a median OS of 8.0 months for the matched untreated patients (p = .043).

Conclusion.

Metronomic capecitabine is well tolerated by patients with advanced HCC and appears to have activity both in treatment-naive patients and in those previously treated with sorafenib.     

A lead cancer nurse role at Birmingham Children's Hospital National Health Service Trust

This paper reports on an innovative scheme and course developed as part of a Lead Cancer Nurse role based at the Birmingham Children's Hospital NHS Trust, UK. In doing so issues are raised which may be helpful to others should they consider adopting a similar scheme and the possibilities of the scope of the role are highlighted.