European Journal Of Cancer Research Articles

Is there a future in psychosocial predictive factors in breast cancer?

The potential role of psychosocial factors in cancer survival has fascinated clinicians and researchers for several decades. Unfortunately it is an area that has generated a limited number of quality empirical investigations and inconclusive reviews [1–4]. In this issue of the European Journal of Cancer a substantial piece of epidemiological work from this field is presented. The study is a simple 10 year follow-up of a 578 women diagnosed with early breast cancer (stage I and II) aged 18–75 years consecutively recruited from a single centre. At baseline, information was collected on mental adjustment to cancer, anxiety and depression, in addition to standard biological determinants of survival. The study presents new data showing that a high helplessness/hopelessness (HH) response reported at diagnosis was associated with decreased likelihood of disease free survival. At baseline, 91 (16%) of the patients had high HH and 49 (53.8%) of these had a recurrence or died by 10 years compared with 39.9% of those with low HH. The adjusted hazards ratio (HR) for disease free survival at 10 years is 1.53 [1.11–2.11], P = 0.009. This is a sizable effect, although only about one sixth of the women in this sample had low HH at baseline. Through application of criteria for meaningfulness based on statistical significance, the authors dismiss a finding which may well be the most interesting outcome of their endeavours [5]. A baseline depression score of >11 on the Hospital Anxiety and Depression scale (i.e., high probability of psychological morbidity) was associated with a HR for death between 0.97 and 6.10 (i.e., 95% CI), while the point estimate was 2.43 and the P-value was greater than 0.05. This finding may indeed be the most important. The wide and probably

The happy destiny of frozen haematopoietic stem cells: from immature stem cells to mature applications

Forty years ago, van Putten described in the European Journal of Cancer (see this issue) quantitative studies on the optimal storage techniques of mouse and monkey bone marrow suspensions. Survival of the animals after irradiation following injection with stored bone marrow cell suspensions was the endpoint. He observed some species differences, but based on the data obtained considered a careful trial of the glycerol-polyvinylpyrrolide (PVP) combination for storage of marrow in man was indicated. In spite of this, dimethyl sulphoxide has become the `standard' cryopreservant for human marrow stem cells. Over the last 40 years, there has been a tremendous increase in knowledge about haematopoietic stem cells and their use in the clinic. Haematopoietic stem cells are now known to travel between the bone marrow and peripheral blood and are the best-characterised adult stem cells. These cells are currently widely used for transplantations in the clinic and are obtained from a wide variety of sources. These include the bone marrow, peripheral blood, cord blood, autologous as well as allogeneic stem cells from related or unrelated donors. Increasingly, data has become available that adult haematopoietic stem cells can generate differentiated cells belonging to other cell types, a process called “developmental plasticity”. Thus, they may contribute to non-haematopoietic tissue repair in multiple organ systems. This has created a whole new potential therapeutic armamentarium for the application of haematopoietic stem cells outside of the area of malignancies and haematopoietic disorders.

Five-year change in statistical designs of phase II trials published in leading cancer journals

This study compares the evolution in statistical design reporting for phase II cancer clinical trials published in the six following leading journals: American Journal of Clinical Oncology, Annals of Oncology, British Journal of Cancer, Cancer, European Journal of Cancer and Journal of Clinical Oncology. Only articles where tumour response was considered as the primary endpoint were selected. A total of 393 phase II trials published in 1995 (n=185) and 2000 (n=208) were reviewed. Neither sample size nor design parameters were specified in 157 (85%) and 113 (46%) papers in 1995 and 2000, respectively. 28 (15%) and 95 (46%) papers included at least some information on the statistical designs used: Gehan (4.3% and 3.3%), Fleming (2.2% and 4.3%), and Simon (2.7% and 11.0%). Ad hoc, non-referenced methods were used in 5.9% and 27.3% articles in 1995 and 2000, respectively. Although there is an increase in the mention of at least some statistical design parameters in phase II cancer clinical trials over a 5-year period in these selected cancer journals, the use of referenced methods is still short or often inadequate.

Cancer in the UK — a question of culture

In the European Journal of Cancer in December 1998, a group of European epidemiologists published the ®ndings of their second study comparing the frequency and outcomes of a wide range of cancers between their various countries [1]. This, the EUROCARE II Study includes cancers diagnosed between 1978 and 1989. England and Scotland and, therefore, the UK National Health Service (NHS), come out of this very poorly because the 5-year survival rates for all the common cancers fell well below the European average. That European average was reduced by the inclusion of several East European countries with less well developed health services, so for a service which claims to have provided comprehensive, accessible healthcare to every citizen of a relatively prosperous country this is a major failure. It has been argued that the disparities are an artefact of di€erent standards of registry data collection. Apart from the care that has been taken to avoid this, other comparisons suggest that the di€erences are real. For example, in a comparison of lung cancer cases recorded in the Eindhoven (The Netherlands) and Yorkshire (UK) registries, the di€erences in survival were associated with practice di€erences which produced di€erent rates of histological diagnosis [2]. The majority of patients cured of lung cancer are those with non-small cell disease treated by surgery and fewer tumours are resected in the UK than elsewhere in Europe [3]. The survival of patients who are not cured is so short that other sources of di€erence, such as lead time bias, are most unlikely to a€ect the 5-year survival. The cancer registry processes do not di€er between primary sites and The Netherlands data for survival consistently show superiority over the UK, so it is likely that di€erences in the other sites are equally real. The sites where the UK performance was worst, in that the 95% con®dence interval of the 5-year survival estimate did not overlap with that of the European average, are listed in Table 1. It is essential that we understand how this has come about. In my view, which has been formed from listening to the attitudes expressed by colleagues in the UK and elsewhere over the past three decades, there has been a culture among NHS doctors which has resulted in much of the progress that has been achieved in cancer management passing them by. England has had specialist centres providing expert treatment for cancer for over 40 years. The late Enoch Powell was the Minister for Health who realised that it would be more cost-ecient to deliver radiotherapy if the equipment was centrally located. A pattern of practice became established in which consultant radiotherapists, who acquired broad expertise in the nonsurgical treatment of cancer, were based in these centres and conducted clinics in general hospitals where new patients could be seen and those who had been treated followed-up. This approach, which is the mainstay of contemporary practice, means that every hospital specialist in the country knows which cancer specialist is designated to serve his or her patients. It has not produced a culture of specialist management of cancer. I was a student in the early 1970s when the Powell model for providing radiotherapy was well established, but when, apart from the interesting results being seen in haematological and childhood cancers, chemotherapy had little to o€er. Hormone-sensitive cancers were treated by destruction of the relevant gland or the administration of simple hormone preparations as appropriate. Our teaching re ected this; by and large, cancers that could not be excised or treated with local radiotherapy were beyond further help, so the services of a cancer specialist were not needed. As a consequence, once it had been concluded that advanced cancer was present, or even likely to be present, there was no need to investigate further.

Do oncologists have an increasing interest in the quality of life of their patients? A literature review of the last 15 years.

The aim of this review is to evaluate the extent to which Quality of Life (QoL) assessment has been incorporated into clinical oncological trials in the last 15 years. All phase II and III trials published in the Journal of Clinical Oncology, Cancer, The British Journal of Cancer and the European Journal of Cancer during the years 1980, 1985, 1990 and 1995 were reviewed (n = 827). During this period, while the number of studies assessing performance status (PS) increased from 15% in 1980 to 56% in 1995, the number of trials noting a QoL assessment increased only slightly, from 0% in 1980 to 3% in 1995. Moreover, only four of the 13 studies with a QoL evaluation met our criteria for adequate QoL assessment. Thus, despite an increasing interest in QoL, it is still rarely included as an objective in clinical trials, or adequately assessed.

Letters to the Editor: Comments on Does Age at Last Birth Affect Breast Cancer Risk?, Hsieh et al., European Journal of Cancer, 32A, No. 1, pp. 118–121, 1996

Letters to the Editor: Comments on Does Age at Last Birth Affect Breast Cancer Risk?, Hsieh et al., European Journal of Cancer, 32A, No. 1, pp. 118–121, 1996

Professor Michael Peckham retires as editor-in-chief of the European Journal of Cancer

Professor Michael Peckham retires as editor-in-chief of the European Journal of Cancer

Informed consent in European multicentre randomised clinical trials — Are patients really informed?

This study was designed to examine the standard of consent used by investigators in European randomised clinical trials (RCT). The participants of 12 multicentre RCTs published in the European Journal of Cancer in the years 1990–1992 were asked to complete a short questionnaire regarding their practice of obtaining consent in the trial reported. Anonymity was assured. Replies were received from 60 of 88 clinicians contacted. Data showed that 12% of clinicians did not inform their patients about the trial prior to randomisation. Thirty-eight per cent of clinicians did not always tell patients that they had been assigned to their treatment randomly. Only 32% of clinicians used written consent, 21% used written information without obligatory signing, 42% used verbal consent, and in 5% no consent was sought. Even when information was given, only 58% of clinicians gave full information on all aspects of the trial and 42% gave information on the proposed treatment arm only (27% revealing inclusion in an RCT). When examined by geographical origin, clinicians in northern Europe were more likely to obtain full consent than those from southern Europe. Similarly, the level of consent was higher in trials of supportive care than in trials testing curative or palliative antitumour therapies.

This article contains errors and has been withdrawn. A corrected version will be published in a later issue of volume 29 of the European journal of cancer

This article contains errors and has been withdrawn. A corrected version will be published in a later issue of volume 29 of the European journal of cancer

Pediatric case of the day. Cavernous transformation of the portal vein due to tumor thrombus (hepatocellular carcinoma) in the main portal vein.

HomeRadioGraphicsVol. 11, No. 2 Previous Pediatric case of the day. Cavernous transformation of the portal vein due to tumor thrombus (hepatocellular carcinoma) in the main portal vein.K Nimkin, N T GriscomK Nimkin, N T GriscomK NimkinN T GriscomPublished Online:Mar 1 1991https://doi.org/10.1148/radiographics.11.2.1851317MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: 1991 FiguresReferencesRelatedDetailsCited ByPortal vein thrombosis during antineoplastic chemotherapy in children: Report of five cases and review of the literatureH.Brisse, D.Orbach, N.Lassau, V.Servois, F.Doz, D.Debray, S.Helfre, O.Hartmann, S.Neuenschwander2004 | European Journal of Cancer, Vol. 40, No. 18Thalassemia intermedia and cavernous transformation of portal vein thrombosis in pregnancyRinatHackmon-Ram, GershonHolcberg, AsherBashiri, OlgaSapir, Gal YomTov, TikvaYermiahu, MosheMazor2003 | European Journal of Obstetrics & Gynecology and Reproductive Biology, Vol. 107, No. 1Doppler Sonographic Findings in Children With Idiopathic Portal Vein Cavernous Deformity and Variceal HemorrhageMahaBarakat2002 | Journal of Ultrasound in Medicine, Vol. 21, No. 8HEPATIC CIRRHOSIS AND PORTAL HYPERTENSION IN NEUROBLASTOMAS. M.Yule, J.Anderson2000 | Pediatric Hematology and Oncology, Vol. 17, No. 6Cavernous transformation of the portal vein in a child with non-Hodgkin's lymphomaWilliam M.Kauffman, Raul C.Ribeiro1997 | Medical and Pediatric Oncology, Vol. 29, No. 2Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 11, No. 2 Metrics Altmetric Score PDF download

A Great European Steps Down as Editor of the European Journal of Cancer & Clinical Oncology

A Great European Steps Down as Editor of the <i>European Journal of Cancer &amp; Clinical Oncology</i>

Radical Irradiation of Localized Inoperable Lung Cancer with Concurrent Chemotherapy and Misonidazole: A Phase I/II Study: European Journal of Cancer and Clinical Oncology, Vol. 23, No. 7, July 1987, pp. 1081–1082

Radical Irradiation of Localized Inoperable Lung Cancer with Concurrent Chemotherapy and Misonidazole: A Phase I/II Study: European Journal of Cancer and Clinical Oncology, Vol. 23, No. 7, July 1987, pp. 1081–1082

Still less extensive surgery for breast cancer

IN THE European Journal of Cancer & Clinical Oncology, Umberto Veronesi published what he cautiously calls ‘long term’ results of his already well-known Q.U.A.R.T. versus Halsted study [l]. I, among many others, find those results to be highly significant and definitive. One must now pose the question: where do we go from here? It is perhaps important to remember where we come from. One century ago Halsted described his radical mastectomy (1894), the perfect surgical answer to what was known of breast cancer at that time: an aggressive form of tumor progressing centrifugally mostly along known lymphatic pathways. The generalization of this radical surgical practice resulted in a spectacular increase in cure rate and a decrease in local recurrences [2]. The answer to the remaining failures was ‘more is better’ until the early sixties. As young surgeons, we were disappointed by the results of one of the first large international randomized trials comparing the standard Halsted procedure to the en-bloc superradical mastectomy including the internal mammary nodes. No improvement was noted, the limited advantage of the largest procedure in a small subset of patients was negatively compensated by increased morbidity and mortality [3]. As young oncologists, we began to learn even more. Cancer of the breast was no longer considered a malignant process with a predictable behavior. The most important lesson was the knowledge that the metastatic process starts very early and remains mute for a variable and possibly very

Intraperitoneal chemotherapy: Belly-bath or pain-in-the-side?

THE ARTICLE published by Canal et al. in the European Journal of Cancer and Clinical Oncology demonstrates the pharmacologic and clinical utility of administering the epipodophyllotoxin, VM-26, in the peritoneal cavity [ 11. When given to mice bearing the Krebs II ascitic tumor, the pharmacologic advantage for this drug is 15-30 compared to intravenous (i.v.) administration. Furthermore, at the higher dose levels mice could be cured of their intraperitoneal tumors when given the drug by the intraperitoneal (i.p.), but not the iv. route. If this experience is verified in humans, it will be possible to add VM-26 to the growing list of chemotherapy drugs which can safely be administered by the i.p. route. Interest i.p. drug administration has been renewed since the late 1970s when it became evident that combination chemotherapy could frequently cause clinical complete remissions in ovarian cancer, but at “second-look” laparotomy many of these patients had residual microscopic disease. Previously, chemotherapy had been administered in the peritoneal cavity to patients with ascites in an attempt to cause sclerosis. In the 197Os, with advances in peritoneal dialysis for renal failure, better understanding of membranedialysis physiology, and development of indwelling peritoneal catheters, interest turned to i.p. drug administration as a kind of “reverse” dialysis. Dedrick and co-workers at the American National Cancer Institute proposed a model of i.p. drug administration in large volumes to ensure homo-

Physiological and Radiographic Assessment During the Development of Pulmonary Radiation Fibrosis

Repeated regional measurements of pulmonary blood flow and ventilation were performed in 25 patients irradiated for breast cancer. Patients were studied before and at varying times after (16 to 47 days) the start of radiotherapy. At the same time, chest radiographs were taken and symptoms recorded. Of all the parameters measured, blood flow showed the earliest and greatest decrease. Since changed in blood flow at 60 days are predictive of the changes at 300 days, we believe that earlier studies during the course of irradiation could be useful in predicting long-term effects.

Report on International Bladder Cancer Conference-Leeds 1971

Summary A bladder cancer conference sponsored by the U.I.C.C. and others was held in Leeds in September 1971, and considered both the clinical and scientific aspects of the disease. The more purely scientific contributions have been summarised elsewhere (European Journal of Cancer 1972). The papers of clinical interest emphasised the occupational hazards in the tailoring industry, in hairdressers, in nurses, in the leather industry and in certain Japanese silk painters. It seems likely that the overall incidence of bladder tumours is gradually increasing and that there is likely to be an association with smoking. Emphasis was given to the importance of medical surveillance not only of workers in the dye industry but also of those using the finished products. The role of bilharzia in the production of bladder cancer was considered and it is believed that this is associated with an increase in squamous but not in transitional cell carcinomas. The immunological consequences of radiotherapy were discussed and evidence was produced that high-energy radiation reduces the cellular response for the period of irradiation, though cytotoxic lymphocytes develop again soon after treatment ceases. If the cytotoxic response decreases again following radiotherapy it is usually associated with the appearance of metastases or local recurrence. Patients who maintain high levels of cytotoxicity remain clinically tumourfree. The clinical papers emphasised the diverse nature of the treatments available. In terms of 5-year survival they highlighted again the fact that many forms of treatment can be used to control the superficial (stage T1) tumours whilst, for the advanced (stage T4) lesions, no treatment is effective. The 3- and 5-year survivals for stage T2 and stage T3 lesions are so similar, despite the different forms of treatment used, that it seems likely that it is impossible clinically to differentiate these 2 stages. Since the 5-year survival following the different forms of treatment is so similar it may be thought unlikely that any of the treatments used significantly modifies the natural course of the disease. There is certainly no strong evidence to suggest that primary cystectomy for stage T, lesions when compared with the results following a radical course of high-energy radiation, justifies the high immediate surgical mortality and long-term morbidity. On the other hand, if the results following pre-operative radiotherapy and cystectomy reported by Bloom are maintained in a larger series, the picture may well change. In our opinion the results presented at the conference suggest that the best form of primary treatment yet available for invasive tumours of the bladder is external and/or interstitial radiotherapy, with the exception of those patients presenting with bilateral ureteric obstruction. One notable feature of this conference was the lack of any contribution relating to the use of cytotoxic chemotherapy in the management of bladder tumours.