Increase In 5-year Survival Rate Research Articles

Cancer epidemiological situation near nuclear facilities

Relevance. Development of nuclear technologies and their wide application in medicine, power engineering and industry is always associated with health risks both for employees of nuclear facilities and for the population living in the vicinity of such facilities. Adequate assessment of such risks is possible only on the basis of the results of health monitoring of the personnel of potentially hazardous nuclear facilities and the population living in the vicinity of such facilities. One of the topical directions of research within the framework of such monitoring is assessment of specific morbidity and mortality from malignant neoplasms (MN) (C00-C97 according to ICD-10). Intention. To analyze the main medico-statistical indicators of MN-related morbidity and mortality over time among the personnel of nuclear industry and nuclear power plants and the population living near such facilities, as well as the general population of Russia in 2012-2018. Methodology. We analyzed basic medical and statistical indicators of the morbidity among the personnel of potentially hazardous nuclear facilities and the population with MN living in the vicinity of such facilities; the data was obtained from the Federal Center for Information Technologies of Extreme Problems of the Federal Medical and Biological Agency (FMBA) of Russia. The results were compared with MN incidence in Russia using data from P.A. Herzen Moscow Cancer Research Institute, a branch of the National Medical Research Center for Radiology of the Russian Ministry of Health. Results and Discussion. There is an increase in MN primary incidence rate in the medical institutions of the FMBA and the Ministry of Health of Russia. The congruence of the trends is strongly positive and statistically significant (r = 0.932; p < 0.001), which may indicate a unidirectional influence of factors contributing to MN development in patients of FMBA and Russian Ministry of Health institutions. The average annual rates of primary morbidity (354.2 8.9) per 100,000 people, mortality (158.5 ± 4.2) per 100,000 people and one-year mortality (19.6 ± 0.5) % of patients registered in FMBA medical organizations were statistically significantly lower than those in Russia - (398.0 ± 8.5) per 100,000 population, (200.5 ± 0.6) per 100,000 population and (24.0 ± 0.6) %, respectively. The trend of MN-related mortality rate in the Russian population approached a straight horizontal line, i.e. showed a tendency to stability, in patients of FMBA indicators increased. There was a decrease in one-year MN-related mortality rate and an increase in 5-year survival rate in the departments under consideration. Conclusion. The results of the study may become the basis for developing medical and social rehabilitation measures for employees of the enterprises serviced by FMBA medical organizations, as well as for attached contingents. Continuous monitoring and analysis of oncological morbidity on a personal level using registry technologies are necessary in the areas with potentially hazardous nuclear facilities.

Changes in chronic disease medication adherence following oral anticancer agent initiation in patients with multiple myeloma.

e18760 Background: Improvements in treatment options for multiple myeloma (MM) have led to double-digit increases in 5-year survival rates over the past 40 years. Such extended survival has increased emphasis for the management of comorbid chronic conditions. Initial analyses suggest that oral anticancer agent (OAA) initiation for MM may correspond to significant reductions in adherence to chronic disease medications. Methods: This was a retrospective cohort study of adults diagnosed with and being treated for MM between 2013-2018 using data from the IBM MarketScan Commercial Claims and Encounters databases and a 20% sample of Medicare claims data. Adults (18 years and older) were included if they were diagnosed with and had at least two claims for an OAA indicated for MM, had continuous enrollment for 12 months both before and after OAA initiation, and were previously diagnosed with two chronic conditions and had prescription fills for select chronic conditions. Medication adherence was determined using the proportion of days covered (PDC) metric and was compared for the 12 months before and after the OAA initiation by Wilcoxon signed-rank tests, McNemar’s tests, and difference-in-differences (DinD) models. Results: A slight majority of the 2,765 patients (total N from both databases) were male (52.3%), and hypertension (94.5%) and hyperlipidemia (69.2%) were the most common comorbid conditions. Mean OAA adherence in the first year of therapy was 55.8% (SD: 23.5) and 63.5% (SD: 26.9) for commercial and Medicare patients, respectively. PDCs for comorbid therapies declined in the first year after OAA initiation, irrespective of payer (table), and the proportion adherent to these therapies (PDC > 80%) also declined consistently. OAA adherence tended to align with the direction of changes in comorbid therapy adherence with those nonadherent to their OAA (PDC < 80%) demonstrating general declines in comorbid therapy PDCs post-OAA initiation (p<0.05 in 4 of 6 DinD models). Conclusions: Among adults with MM and multiple chronic conditions, the pre-OAA initiation level of adherence appears to dictate chronic disease medication use patterns after OAA initiation. The starting of OAA therapy facilitates an opportunity for providers to reinforce the need for total regimen adherence to improve the odds of positive cancer- and non-cancer-related outcomes. [Table: see text]

The impact of pharmaceutical innovation on the longevity and hospitalization of New Zealand cancer patients, 1998–2017

ABSTRACT Background We investigate whether the cancer sites that experienced more pharmaceutical innovation in New Zealand had larger subsequent declines in premature mortality and hospitalization rates and larger subsequent increases in 5-year survival rates, controlling for changes in incidence. Research design and methods We estimate the effects of the number of WHO ATC5 chemical substances and ATC4 chemical subgroups approved on the number of years of potential life lost before ages 85, 75, 65, 5-year relative survival rates, and the number of inpatient hospital discharges, by estimating difference-in-differences (2-way fixed-effects) models using aggregate longitudinal data on 23 cancer sites. Results Substances/subgroups approved during 1985-2001 reduced the number of years of potential life lost before age 85 (YPLL85) in 2017 by 67%. Those substances/subgroups reduced YPLL75 and YPLL65 in 2017 by similar percentages. The odds of surviving at least 5 years after diagnosis are significantly positively related to the number of substances previously approved. Conclusions The cost per life-year before age 85 gained in 2017 from previous drug approvals did not exceed 1719 USD. The WHO considers interventions whose cost per quality-adjusted life-year gained is less than per capita GDP to be highly cost-effective; New Zealand’s per capita GDP in 2017 was 42,260 USD. capita GDP in 2017 was 42,260 USD. Expert Opinion Pharmaceutical innovation—the introduction and use of new drugs—substantially increased cancer survival rates in New Zealand, and substantially reduced premature (before ages 85, 75, and 65) cancer mortality there during the period 1998–2017. Moreover, overall the new cancer drugs were highly costeffective. The drugs approved during 1985–2001 are estimated to have reduced the number of years of potential life lost before age 85 in 2017 by 244,876. Even if previous drug approvals increased the cost of hospital discharges and other medical costs, the cost per life-year before age 85 gained in 2017 from those approvals could not have exceeded 1719 USD.

Maintenance treatment in metastatic colorectal cancer: in search of the best strategy.

Over the last 2decades, the standard fluoropyrimidine-based chemotherapy backbone for metastatic colorectal cancer has been complemented by the addition of novel biological agents, achieving impressive increases in 5-year survival rates. Nonetheless, these new combinations have also entailed increases in toxicity, leading to evaluation of de-escalated chemotherapy regimens and "drug holiday" periods in attempts to reduce side effects and optimise quality of life without impairing efficacy. Here, we review the current and emerging evidence for maintenance schedules with chemotherapy and targeted agents, versus continuous treatment after induction treatment, in metastatic colorectal cancer patients.

ALINA: A phase III study of alectinib versus chemotherapy as adjuvant therapy in patients with stage IB–IIIA anaplastic lymphoma kinase-positive (ALK+) non-small cell lung cancer (NSCLC).

TPS8569 Background: Patients with early-stage NSCLC (stage IA–IIIA) account for ~40% of cases at diagnosis; despite surgery, 5-year survival rates are low. Platinum-based adjuvant chemotherapy is the standard of care (SoC) for stage II–IIIA disease. Although patients with stage IA NSCLC do not benefit from adjuvant chemotherapy, patients with stage IB disease and large tumors (≥4cm) do. Adjuvant chemotherapy produces a 4–5% increase in 5-year survival rates, leaving significant unmet need for improved treatments. Approximately 5% of patients with NSCLC harbor an oncogenic fusion of the ALK gene. Treatment of advanced ALK+ NSCLC with ALK inhibitors improves efficacy and safety compared with chemotherapy. Alectinib, a potent ALK inhibitor, is the SoC first-line treatment for advanced ALK+ NSCLC. The ongoing ALINA trial will compare alectinib versus chemotherapy as adjuvant treatment for patients with stage IB–IIIA ALK+ NSCLC. Methods: ALINA is a randomized, multicenter, open-label phase III study investigating the efficacy and safety of adjuvant alectinib versus chemotherapy in ALK+ NSCLC (confirmed by an FDA-approved and CE-marked test). Adult patients (≥18 years) with completely resected stage IB (tumors ≥4cm) to IIIA disease and ECOG PS 0–1 are eligible for inclusion. Patients (N=255) from ~170 centers across ~30 countries will be randomized 1:1 to receive twice-daily alectinib 600mg for 24 months or four 21-day cycles of platinum-based chemotherapy (cisplatin 75mg/m2 [day 1] plus vinorelbine 25mg/m2 [days 1 and 8] or gemcitabine 1250mg/m2 [days 1 and 8] or pemetrexed 500mg/m2 [day 1]) according to local prescribing information. Stratification factors are disease stage (stage IB [≥4cm] vs stage II vs stage IIIA) and race (Asian vs non-Asian). Treatment will continue until planned completion, disease recurrence, unacceptable toxicity, withdrawal of consent, or death, whichever occurs first. The primary endpoint is disease-free survival per investigator; secondary endpoints are overall survival, safety, and pharmacokinetics. Clinical trial information: NCT03456076.

Targeting of Lung Cancer Stem Cell Self-Renewal Pathway by a Small Molecule Verrucarin J

Despite considerable advances made in understanding of lung cancer biology, there has been meek improvement in lung cancer treatment outcome with 4% to 5% increase in 5-year survival rates in the last four decades. Underlying problem of lung cancer recurrence and poor prognosis is attributed to the presence of cancer stem cells (CSCs) which possess the potential to differentiate, proliferate and trigger chemo-resistance, tumor progression and metastasis, despite initial elimination of the tumor. To address specific targeting of CSCs, we investigated the effects of a small molecule Verrucarin J (VJ) on lung cancer cell lines A549 and H1793. VJ significantly inhibited cell proliferation of both cell lines, with IC50 values of approximately 10nM for A549 and 20nM for H1793 respectively after 48h of treatment. A549 cell line when treated with VJ, induced cell apoptosis with concomitant down regulation of key CSC specific genes- ALDH1, LGR5, OCT4 and CD133 in a dose-dependent manner. To delineate the molecular mechanism by which VJ targets lung cancer cells and CSCs, we determined the effects of VJ on CSC self-renewal pathways Wnt1/β-catenin and Notch1. Treatment of A549 cell line with VJ inhibited significantly both the signalling pathways, suggesting inhibition of expression of CSC genes by VJ through the inhibition of CSC self-renewal signalling pathways. Taken together, our results suggest that VJ may serve as a potent anticancer drug to target cancer cells and CSCs.

When politicians really decide that nation health is a top priority: the Danish model

Roennegaard et al. from Odense University Hospital, Denmark report their institutional experience, as tertiary cancer centre, on a nation-based head and neck cancer (HNC) fast-track programme, taking care of patients from the general practitioner (GP) suspicion of HNC to the start of initial treatment when the diagnosis of cancer is confirmed [ [1] Roennegaard A.B. Rosenberg T. Bjørndal K. Sørensen J.A. Johansen J. Godballe C. The Danish head and neck cancer fast-track program: a tertiary cancer centre experience. Eur J Cancer. 2017; Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar ]. The Danish Head and Neck Cancer fast-track program: a tertiary cancer centre experienceEuropean Journal of CancerVol. 90PreviewDuring the 1990s, all Nordic countries except for Denmark experienced a general increase in 5-year survival rates for cancer patients. In 2007, the Danish National Board of Health in collaboration with national multidisciplinary cancer groups and the Danish regions initiated fast-track clinical pathway solutions. Full-Text PDF

The Danish Head and Neck Cancer fast-track program: a tertiary cancer centre experience

IntroductionDuring the 1990s, all Nordic countries except for Denmark experienced a general increase in 5-year survival rates for cancer patients. In 2007, the Danish National Board of Health in collaboration with national multidisciplinary cancer groups and the Danish regions initiated fast-track clinical pathway solutions. ObjectivesThe objectives of this study were 1) to present the setup of the head and neck cancer (HNC) fast-track program at Odense University Hospital (OUH) as an example of the Danish model and 2) to present patient characteristics, diagnostic outcome, cancer detection rate, and duration of the fast-track patient courses. Materials and methodsFrom 1st July 2012 to 1st September 2015, all patients referred to the HNC fast-track program at OUH for diagnostics and treatment were consecutively included in the study resulting in 3165 patient courses. ResultsThe overall malignancy detection rate was 40.6% and for HNC it was 29.2%. The overall median fast-track course duration was 12 days (range 0–74). Overall 2990 (94.5%) of 3165 patients completed their fast-track course within the maximally permitted course duration. Discussion and conclusionBased on our findings, it was concluded that: 1) a HNC fast-track program build on pre-booked slots for diagnostics and treatment is feasible and can secure acceptable course durations for more than 90% of patient courses, 2) by using private ENT specialists as a ‘filter-function’, an acceptable detection rate can be achieved.

On the validity of using increases in 5-year survival rates to measure success in the fight against cancer.

BackgroundThe 5-year survival rate of cancer patients is the most commonly used statistic to reflect improvements in the war against cancer. This idea, however, was refuted based on an analysis showing that changes in 5-year survival over time bear no relationship with changes in cancer mortality.MethodsHere we show that progress in the fight against cancer can be evaluated by analyzing the association between 5-year survival rates and mortality rates normalized by the incidence (mortality over incidence, MOI). Changes in mortality rates are caused by improved clinical management as well as changing incidence rates, and since the latter can mask the effects of the former, it can also mask the correlation between survival and mortality rates. However, MOI is a more robust quantity and reflects improvements in cancer outcomes by overcoming the masking effect of changing incidence rates. Using population-based statistics for the US and the European Nordic countries, we determined the association of changes in 5-year survival rates and MOI.ResultsWe observed a strong correlation between changes in 5-year survival rates of cancer patients and changes in the MOI for all the countries tested. This finding demonstrates that there is no reason to assume that the improvements in 5-year survival rates are artificial. We obtained consistent results when examining the subset of cancer types whose incidence did not increase, suggesting that over-diagnosis does not obscure the results.ConclusionsWe have demonstrated, via the negative correlation between changes in 5-year survival rates and changes in MOI, that increases in 5-year survival rates reflect real improvements over time made in the clinical management of cancer. Furthermore, we found that increases in 5-year survival rates are not predominantly artificial byproducts of lead-time bias, as implied in the literature. The survival measure alone can therefore be used for a rough approximation of the amount of progress in the clinical management of cancer, but should ideally be used with other measures.

Exploring SEER‐Medicare for Changes in Frequency of Different Treatments for Laryngeal Cancer

Objectives: Explore the change in frequency of different treatment modalities and its association with change in 5-year survival rate over a 15-year period among Medicare enrollees with squamous-cell carcinoma of the larynx (SCCL). Methods: Retrospective data analysis of the SEER-Medicare dataset of elderly patients diagnosed with SCCL between 1992 and 2007. Main treatment modalities were identified, and the change in frequency by year of cancer diagnosis was explored. Multivariate Cox regression was used to calculate the adjusted 5-year survival by year of diagnosis. Results: There were 5159 cases of primary SCCL diagnosed between 1992 and 2007. The majority of patients were male (4033, 78%), Caucasian (4466, 87%), and between 66 and 75 years of age (2873, 56%). Stage distribution at diagnosis was local 3241 (63%), regional 1060 (20%), and distant 608 (12%). Between 1992 and 2007, there was a significant trend for increased use of chemo-radiation therapy (5% to 15%, P = 0.0255) and a significant trend for decreased use of combined surgery and radiation (47% to 32%, P < 0.0001). No treatment was identified for 474 (9%) patients. There was a significant increase in 5-year survival rate by year of diagnosis (42.2% in 1992 to 46.7% in 2005, P < 0.0001), which was negatively correlated only to changes in incidence of radiation-only treatment (Spearman rho = -0.6). Conclusions: Between 1992 and 2007, there were significant increases in the frequency of use of chemoradiation and concomitant decrease in combined surgery and radiation for SCCL among Medicare beneficiaries. The implications of these trends will be discussed.

Outcomes of lymphoma in South Australia, 1977–2007

To determine survival rates of patients with lymphoma in South Australia. De-identified data from the SA Cancer Registry on all patients with lymphoma were analysed, as well as the subgroup treated at the Royal Adelaide Hospital (RAH). For non-Hodgkin lymphoma (NHL), we used the International Working Formulation (IWF) grading. SA and RAH data on survival rates were compared with those for the whole of Australia and the United States. All patients diagnosed with lymphoma and treated in SA in 1977-2007. 5-year survival rates for patients with lymphoma, by type of lymphoma and age. Of the total of 8651patients with lymphoma, 939were classified as having Hodgkin lymphoma (HL) and 7712as having NHL. Of those with NHL, 1805had low-grade, 3576intermediate-grade, and 510high-grade NHL. In another 1821patients, the data were insufficient to make an IWF grading. There was a substantial increase in 5-year survival rates for patients with lymphoma between 1977and 2007in SA. While the increase in 5-year survival rates for HL was 7.6percentage points, survival rates peaked at 88%. For NHL, there was an 18.7percentage points increase in 5-year survival rates. The first significant increase of 7percentage points was associated with the introduction of bone marrow transplantation; this was maintained with the increase in 5-year survival rates reaching 14percentage points by 1995-1999. Since 1999, there has been a further increase of 5percentage points in 5-year survival rates with the introduction of rituximab. Outcomes in patients with NHL have improved significantly, most likely because of the use of bone marrow transplantation and rituximab. Hospital- and state-based cancer registry data reflect the reality of population outcomes and the impact of new technologies.

Randomized clinical trial on preoperative radiotherapy 25 Gy in rectal cancer—treatment results at 5-year follow-up

PurposeThe purpose of this study was to establish the influence of time interval between preoperative hyperfractionated radiotherapy (5 × 5 Gy) and surgery on long-term overall survival (5 years) and recurrence rate in patients with locally advanced rectal cancer operated on according to total mesorectal excision technique.MethodsThe treatment group comprised 154 patients with locally advanced rectal cancer who were operated on between 1999 and 2006 in the 1st Department of General Surgery, Jagiellonian University, Cracow, Poland. The data on survival has been systematically collected until 31st of December 2010. In addition, the following aspects were analyzed: the significance of time interval between the end of radiotherapy and surgical treatment and its influence on downsizing, downstaging, rate of curative resections, and sphincter-sparing procedures. Patients were qualified to preoperative radiotherapy 5 × 5 Gy and then randomly assigned to subgroups with different time intervals between radiotherapy and surgery: one subgroup consisted of 77 patients operated on 7–10 days after the end of irradiation, and the second subgroup consisted of 77 patients operated on after 4–5 weeks. Both groups were homogenous in sex, age, cancer stage and localization, distal and circumferential resection margins, and number of resected lymph nodes.ResultsThe 5-year survival rate in patients operated on 7–10 days after irradiation was 63%, whereas in those operated on after 4–5 weeks, it was 73%—the difference was not statistically significant (log rank, p = 0.24). A statistically significant increase in 5-year survival rate was observed only in patients with downstaging after radiotherapy—90% in comparison with 60% in patients without response to neoadjuvant treatment (log rank, p = 0.004). Recurrence was diagnosed in 13.2% of patients. A lower rate of systemic recurrence was observed in patients operated on 4–5 weeks after the end of irradiation (2.8% vs. 12.3% in the subgroup with a shorter interval, p = 0.035). No differences in local recurrence rates were observed in both subgroups of irradiated patients (p = 0.119). The longer time interval between radiotherapy and surgery resulted in higher downstaging rate (44.2% vs. 13% in patients with a shorter interval, p = 0.0001) although it did not increase the rate of sphincter-saving procedures (p = 0.627) and curative resections (p = 0.132).Conclusions Improved 5-year survival rate is observed only in patients with downstaging after preoperative irradiation dose of 25 Gy.Longer time interval after preoperative radiotherapy 25 Gy does not improve the rate of sphincter-saving procedures and curative resections (R0) despite higher downstaging rate observed in this regimen.

If Not Us, Then Who?

“If not you, then who?” These words were spoken to me by a wise and deeply concerned mentor during a time of extreme doubt that I was experiencing as a medical intern. I was wondering whether I had anything of value at all to offer the patients under my care who were dying from far-advanced cancer. This simple but profound rhetorical rejoinder to my expressed sense of inadequacy turned me on my heel, actually and metaphorically, to return and attend to my patients as they lay dying, with conviction no longer to be demoralized by the absence of my ability to prescribe a cure but rather to be motivated to help reduce the burden imposed by their disease. Several years later, and seemingly a world apart from that linoleum-lined county hospital, I was sitting in an oak and gilded board room of a prestigious cancer center at a meeting to discuss cancer care. Upper echelon directors of the center were proudly reviewing the latest data demonstrating small but notable increases in 5-year survival rates for patients treated there with certain solid tumors. Ebullience and …

Molecular biological challenges in he treatment of esophageal adenocarcinoma

Despite improvements in detection and treatment, patients diagnosed with esophageal cancer continue to have a poor prognosis, with an increase in 5-year survival rates from 6 to 16% over the past 25 years. In the last decade there has been growing support for neoadjuvant therapy in patients with esophageal cancer. However, in approximately 30–60% of the patients no objective response is achieved after neoadjuvant chemotherapy and/or radiotherapy. These patients do not benefit from neoadjuvant therapy but do suffer from toxic side effects, and appropriate surgical treatment is delayed. Advances in molecular biology and new molecular technologies could possibly contribute to improvement of response to neoadjuvant therapy. This review categorizes the genetic and molecular alterations related to esophageal adenocarcinoma and links these changes to targeting therapy and prediction of tumor response to neoadjuvant chemotherapy and/or radiotherapy.

Improving survival in gastric cancer: review of 5-year survival rates in English language publications from 1970.

In this review of English language publications from 1970, 5-year survival rates after surgery for gastric cancer have been analysed. While the proportion of patients coming to operation has fallen from 92 per cent before 1970 to 71 per cent by 1990, the proportion of operated patients undergoing resection has increased from 37 per cent before 1970 to 48 per cent before 1990. This change suggests improved preoperative staging leading to better patient selection for operation. The 5-year survival rate following all resections has increased significantly from 20.7 per cent before 1970 to 28.4 per cent before 1990, an increase of 7.7 per cent (95 per cent confidence interval 7.1-8.3 per cent). The 5-year survival rate following curative or radical resection has risen from 37.6 to 55.4 per cent over the same period, an increase of 17.8 per cent (95 per cent confidence interval 17.1-18.5 per cent). It is likely that this improvement has contributed to the decrease in the mortality rate from gastric cancer. Comparison of Japanese series with others suggests that diagnosis and treatment of the disease at an earlier stage will result in an even greater increase in 5-year survival rates outside Japan. Of the papers studied, 56 per cent were excluded from analysis, the majority because the data provided about 5-year survival rates were insufficient or the survival calculations inappropriate. Results of survival after operations for gastric cancer should be calculated and presented in a standardized manner.

Molecular markers in laryngeal squamous cell carcinoma: Towards an integrated clinicobiological approach

Of the most frequent malignancies in the United States, cancers of the larynx and of the uterine corpus are the only ones not to show an increase in 5-year survival rates over the last 30 years. The increasing use of chemo- and radiotherapy and conservative surgery to preserve organs and their functions has probably led to a better quality of life in patients with laryngeal cancer, but has definitely failed to improve survival, which remains the primary aim. In our opinion, to reduce laryngeal cancer-related mortality, a change in clinical approach is required. We have reviewed the literature on the potential role of molecular markers in the clinical management of laryngeal cancer. We believe that some of the most significant biological markers might be integrated with the evaluation of behavioural risk factors, clinical TNM staging and histopathological grading for a novel clinicomolecular approach to laryngeal cancer. We foresee the use of the most promising biological markers in the phases of prevention, diagnosis, prognostic assessment and drug design.

RECENT ADVANCES IN THE TREATMENT OF CHILDHOOD BRAIN TUMORS

Pediatric brain tumors are the commonest cause of cancer-related death in children. The last four decades have seen only a 35% increase in 5-year survival rate of children with these tumors. The therapeutic successes achieved are due to advances in neuroimaging, surgical techniques, radiotherapy, and induction of newer chemotherapeutic agents along with molecular targeted therapy. Neuroimaging advances include the use of MRA, MRS, DSA, and PET scans. With the use of stereotactic surgery, intraoperative mapping, and imaging, surgical resection has improved with significant decrease in morbidity. A major development has been the use of precision guided radiotherapy utilizing technologies like 3D-CRT, SRS, and IMRT, thereby decreasing radiation to normal tissues. Induction of newer drugs and high-dose chemotherapy with peripheral stem cell support has improved survival and delayed radiation in younger children and infants with brain tumors. Intense ongoing research is profiling novel molecular targets for therapeutic intervention. Newer therapeutic strategies like blood brain barrier disruption, immunotherapy, and gene therapy are in clinical trials. This review article intends to give the reader an overview of current therapeutic strategies and research involved in the treatment of children with brain tumors.

Diagnosis of early oral and oropharyngeal squamous carcinoma: obstacles and their amelioration.

These comments and observations are based on 25 years of clinical practice in oncology, and prospective research studies of oropharyngeal squamous carcinoma in high-risk populations; the review of innumerable publications related to squamous carcinoma (most of which have usually been based on retrospective analysis of data or anecdotal information) and my observations, as a clinician and a patient, of the behavior, beliefs, and practice of dental and medical clinicians. Although the oral cavity and oropharynx are as easily accessible for visualization, as is skin, and the population at high risk (development of squamous cancers of these sites has been identi®ed in a multitude of studies in the USA and Western Europe), early diagnosis has not been forthcoming with the resultant lack of increase in 5-year survival rates when compared to cancers of other sites. It is with dismay I observe that over the last 20±30 years, early diagnosis and survival rates for cancers of the breast, colon, prostate and melanoma have increased considerably, due primarily to an increase in early detection. However, survival rates for cancers of the oral cavity and oropharynx have remained constant during this period at approximately 40±50% with a small decrease in the black population. Paradoxically, even though the mucosa of the colon is internal and requires endocscopic examination for evaluation, 36% of colon cancers (US) are localized when diagnosed, identical to the number of localized oral/ oropharyngeal (O/OP) cancers diagnosed. Most of the O/OP cancers at time of diagnosis are symptomatic late-stage disease with at least 50% revealing regional cervical metastases. Survival is poor. We have an overwhelming responsibility to ameliorate this situation. I believe there are two areas of concern that are greatly responsible for this de®ciency in diagnosis. The ®rst deals with the split professional responsibility attendant to this anatomical region. Dentists who are, supposedly, in the ®rst line of defense and are responsible for the early diagnosis of these cancers have a con icted position. Their training, education, and experience in dealing with cancer as a concept and in practical terms is somewhat limited. The emphasis in their education and practice is primarily related to restoration and amelioration of dental and hard tissue problems. Although at home in the oral cavity and much more capable of performing a soft tissue examination than their physician counterparts, they re exly respond to the restoration mode. My experience as a patient, clinician, teacher and casual observer con®rms that few generalists or specialists evaluate the high-risk sites of occurrence as part of the standard dental examination. Literature disseminated by major dental organizations, government, non-pro®t, dental schools, etc., list programs and lectures in a variety of dental spheres. Cancer infrequently is listed as a topic. The physician, on the other hand, although trained to be concerned with oncology, has minimal or no training in the oral cavity. Sections of O/OP cancer and examination of this anatomical region in medical texts are woefully inadequate. Related lectures for medical students and trainees are few. A physician using a tongue blade with a pen ashlight for illumination, requesting the patient to say ``ah'', cannot possibly highlight the minimal mucosal changes which signify early asymptomatic squamous cancer. Among medical practitioners

Prognostic factors after surgical resection for pancreatic carcinoma.

Surgical resection offers the only potential cure for pancreatic carcinoma. Several recent series have reported an encouraging increase in 5-year survival rate exceeding 20% and have emphasized the importance of patient selection based on reproducible prognostic factors. The impact on survival of demographic, intraoperative, and histopatologic factors are investigated in this study. Seventy-three patients with adenocarcinoma of the pancreas, treated at the Department of Surgery of the Catholic University of Rome during 1988-1998, were retrospectively analyzed. Survival data were reviewed, and potential prognostic factors were compared statistically by univariate and multivariate analyses. There was no operative mortality, and the morbidity rate was 37%. Actuarial overall and disease-specific survival rates for all 73 patients were, respectively, 27% and 31% at 3 years and 13% and 21% at 5 years, with a median survival time of 16 months. T stage and nodal status significantly affected survival according to univariate analysis (P = 0.0017 and 0.04). An impact on survival, even if not of statistical significance, was shown for other pathologic or intraoperative factors. T and nodal stage are the strongest independent predictors of survival. Limited intraoperative transfusion, reduced operative time, and clear margins also may play a role, which requires further confirmation in a larger series.

Intermittent Cisplatin Therapy for Stage-III Ovarian Cancer Patients following Clinical Remission

Intermittent cisplatin (CDDP) administration as consolidation therapy for stage-III ovarian cancer was studied. No patients with residual disease at surgery or at second-look operation or patients with <8 U/ml of CA125 after remission induction chemotherapy were enrolled in this study. Fifteen subjects received intermittent chemotherapy, and 10 control patients did not. CDDP of 20 mg/m² for 5 days was administered every 3–4 months for 5 years. A significant increase in 5-year survival rate was found in the intermittent chemotherapy group when compared with the control group. Side effects from the intermittent chemotherapy were controllable. Intermittent CDDP therapy seems to be an effective consolidation therapy for stage-III ovarian cancer patients.