Osteosarcoma: oncologic and functional results. A single institutional report covering 22 years

BACKGROUND AND OBJECTIVES: The oncologic and functional results in patients treated because of osteosarcoma (OS) were evaluated. METHODS: Fifty-one patients with high-grade OS were treated between 1974 and 1996 at our hospital. All patient records were studied, and the surviving patients were evaluated according to the American Musculoskeletal Tumor Society functional rating system. The majority of patients received adjuvant chemotherapy (prior to 1983) or neoadjuvant chemotherapy (from 1983). Until 1987, all patients with extremity OS had ablative surgery; from 1987, the majority had limb-saving surgery. Lung metastases were resected in most cases. RESULTS: Overall 2-year and 5-year disease-free survival (DFS) rates were 27 of 51 and 16 of 42, respectively. Patients with vertebral or pelvic OS or contaminated margins after resection had a very bad outcome. In all other subgroups, including patients with various types of chemotherapy, response to chemotherapy, diameter of tumor, presence or absence of metastatic spread, and location of tumor, a 5-year DFS of about 50% was found. Recurrent disease in patients who had achieved a 2-year disease-free interval was relatively low (4/23 patients). CONCLUSIONS: Survival in our series was worse than in most other studies. A very bad outcome was found in patients with vertebral or pelvic OS or with contaminated margins after resection.     

A monoclonal antibody with reaction spectrum covering acute leukemia and T-lineage cells

A mouse monoclonal antibody (MA-10) was raised using cells of a patient with AML (M2). MA-10 reacted with leukemic cells in 44 out of 60 AML cases. Intense reaction was observed especially in 32/38 cases with M1 and M2, as well as 9/9 with common ALL and 2/2 with T-ALL. No appreciable reaction was observed with mature blood cells with only exception of T cells. In-vitro addition of MA-10 did not affect the growth of GM-CFC and BFU-e from two patients with CML in chronic phase. MA-10 identified three polypeptides of approximate mol. wt of 74,000, 50,000 and 30,000.     

胸腹体罩对呼吸器官运动的影响

目的观察胸腹体罩对中下肺及膈肌呼吸器官运动在X,Y,Z轴上的影响,为中下肺癌和肝癌确定计划靶区(PTV)提供参考数据。方法对20例胸腹部肿瘤病人在同一参考点下分为用胸腹体罩组和无胸腹体罩组通过模拟机观测参考点在X,Y,Z轴上的运动范围。结果二组对比X轴(P=0.166),Y轴(P=0.129)上的运动范围无明显差异,Z轴(P=0.000)上的运动范围有明显差异。结论用胸腹体罩可减少呼吸所产生的器官上下(Z轴)移动的范围,对减少PTV范围有显著意义。     

Prostate cancer mortality predictions for Ireland up to 2015.

The objective of this analysis was to predict average world age-standardized mortality rates per person-years (100,000 person-years) and numbers of prostate cancer deaths in Ireland for the years 2005, 2010 and 2015. Poisson linear and log-linear regression models of Irish prostate cancer mortality data for the years 1950-2002 were used to predict trends for the whole population, for men aged 0-64 and 50-74 years. The prostate cancer world age-standardized mortality rate in 2015 is predicted to remain unchanged from the average recorded in 1998-2002, while, because of population growth, the number of deaths is predicted to increase. In persons under 65 years of age, the world age-standardized mortality rate is expected to increase, but the number of deaths in this age group is expected to nearly double between 2002 and 2015. Similarly, the world age-standardized mortality rate for men aged 50-74 years is predicted to rise with the number of deaths in this age group expected to increase sharply. The historical evidence predicts a small increase of age-adjusted prostate cancer mortality rates in Ireland and only in the age groups of 0-64 and 50-74 years in the next 10 years, along with a continuing marked increase in number of deaths due to demographic change.     

French abortion drug RU 486: U.S. research battles heat up.

With increasing evidence that the controversial French-made abortifacient RU-486 may serve as a treatment to some diseases, Congress and researchers have stopped up the pressure on the Food and Drug Administration to make the drug more available for clinical trials. The FDA has banned the import of RU-486 for personal use, and has placed strict restrictions on importations for clinical studies, having approved only 10 Investigational New Drug applications as of December 1990. Legislators and researchers say that RU-486's maker, Roussel-UCLAF, has also kept tight control of the drug because its parent company, Hoechst, fears reprisals from anti-abortion groups. Nonetheless, preliminary clinical results have shown the drug to have positive results in the treatment of unresectable meningioma, breast cancer. Cushing's syndrome, and endometriosis. A clinical trial conducted at the University of Southern California showed that a daily dose of RU-486 led to minor tumor regressions in 6 of 24 patients with the normally untreatable unresectable meningioma. These results have not gone unnoticed by Congress; the House Small Business Subcommittee on Regulation held a meeting to discuss the issue. The Subcommittee heard from researchers who say that their studies have been affected by the FDA's actions. An FDA representative explained the tight control over the drug by saying the possibility exists that a black market for the drug might arise. Nonetheless, he said that the FDA is not trying to prevent legitimate research. But Subcommittee Chairman Ron Wyden, who favors abortion rights, criticized the FDA's ban as politically motivated.     

Cancer mortality trends in the EU and acceding countries up to 2015.

BACKGROUND: Examination of trends in cancer mortality in Europe over the past 30 years has shown that, after long-term rises, age-standardised mortality from most common cancer sites has fallen in the EU since the late 1980s. This study aimed to examine trends in the age-specific and age-standardised cancer mortality rates and numbers of cancer deaths up to 2020 for all cancers and various specific sites for all 15 EU countries, the 10 acceding countries, Bulgaria and Romania (currently applicant countries, along with Turkey), and Iceland, Norway and Switzerland of the four EEA countries. PATIENTS AND METHODS: Mortality rates were modelled as a function of age, calendar period and birth cohort. Birth cohort was calculated as age subtracted from calendar period. RESULTS: As a consequence of the generally decreasing trends in the age-standardised rates, the best estimate is that there will be approximately 1.25 million cancer deaths in 2015, which is almost 130,000 (11%) more deaths than in 2000, but 155,000 (11%) fewer deaths than the 1.4 million projected in 2015 on the basis of demographic changes alone. The increases in the forecast numbers of cancer deaths in 2015 are proportionally larger in males than in females (13% and 10%, respectively) and proportionally larger in the acceding countries than in the current EU member countries (14% and 11%, respectively). CONCLUSIONS: Our forecasts are conservative best estimates of future cancer mortality. There is clearly scope for large improvements in survival, and hence reductions in cancer mortality, in some countries, through eliminating these differences using existing knowledge and treatment regimes.     

My get up and go got up and went: fatigue in people with cancer

Many gaps remain in understanding fatigue across the phases of the cancer experience. These include determining the extent to which fatigue is a presenting or continuing symptom of cancer or a side effect of cancer treatment, identifying those at highest risk of fatigue, defining factors that differentiate between those who do and do not experience fatigue, and characterizing fatigue in special populations such as those with advanced cancer, children, and elders. This article reviews current knowledge of who experiences fatigue, the relationship of fatigue to cancer treatment, and the phenomenon of persistent fatigue following treatment. Critical elements in the research agenda that need to be addressed include the relationship of fatigue to other symptoms of cancer or side effects of treatment, mechanisms underlying fatigue and the development of mechanism-specific approaches to preventing and managing this troublesome symptom.     

覆盖物对胸部肿瘤放射剂量影响的研究

目的 胸部肿瘤患者在放疗时,基于人性化治疗原则会给予覆盖物.本研究探讨覆盖物对胸部肿瘤放疗计量学的影响.方法 选取上海交通大学胸科医院放疗科收治的10例胸部肿瘤患者,年龄57～68岁;包括局限期中上段食管癌7例(锁骨上淋巴结转移),胸腺瘤3例.比较测量和计算条件下不同大小射野模体不同深度处覆盖物对点剂量和面剂量影响,研究覆盖物对模体内剂量建成影响,评价覆盖物对10例胸部肿瘤治疗计划计算剂量影响.结果 测量条件下,SAD=100 cm,覆盖物使5 cm×5 cm、10 cm×10 cm和20 cm×20 cm射野固体水模体板表面下1 cm处剂量分别增加2.5％、2.14％和1.61％;2、3、4、5和10 cm深度处,覆盖物降低剂量约-0.18％～-0.47％.计算条件下,覆盖物对剂量影响与测量情况基本相当.覆盖物对模体表面到1.4 cm深度TPS计算剂量有不同程度提升,1.5～1.6 cm深度是覆盖物对组织剂量的平衡区,超过1.6 cm深度剂量稍微降低.测量及计算条件下覆盖物降低模体2、3、4和5 cm深度处平面各点剂量在-0.61％左右.覆盖物使PTV平均剂量和D95分别减小-0.77％ (P＜0.001)和-0.93％(P＜0.001).结论 覆盖物对肿瘤患者体内剂量影响随深度而变化,特别对胸部肿瘤会造成靶区照射剂量偏差.     

Evaluation of nurse-led follow up for patients undergoing pelvic radiotherapy.

This study reports results from a randomised controlled trial of nurse-led care and was designed to determine whether nurse-led follow up improved patients morbidity and satisfaction with care in men treated with radical radiotherapy for prostate and bladder cancer. The aim was to compare outcomes in terms of toxicity, symptoms experienced, quality of life, satisfaction with care and health care costs, between those receiving nurse-led care and a group receiving standard care. The study population was of men prescribed radical radiotherapy (greater than 60 Gy). Participants completed self-assessment questionnaires for symptoms and quality of life within the first week of radiotherapy treatment, at week 3, 6 and 12 weeks from start of radiotherapy. Satisfaction with clinical care was also assessed at 12 weeks post-treatment. Observer-rated RTOG toxicity scores were recorded pre-treatment, weeks 1, 3, 6 and 12 weeks from start of radiotherapy. The results presented in this paper are on 115 of 132 (87%) of eligible men who agreed to enter the randomised trial. 6 men (4%) refused and 11 (8%) were missed for inclusion in the study. Data were analysed as a comparison at cross-sectional time points and as a general linear model using multiple regression. There was no significant difference in maximum symptom scores over the time of the trial between nurse-led follow-up care and conventional medical care. Differences were seen in scores in the initial self assessment of symptoms (week 1) that may have been as a result of early nursing intervention. Those men who had received nurse-led care were significantly more satisfied (P < 0.002) at 12 weeks and valued the continuity of the service provided. There were also significant (P < 0.001) cost benefits, with a 31% reduction in costs with nurse-led, compared to medically led care. Evidence from this study suggests that a specialist nurse is able to provide safe follow up for men undergoing radiotherapy. The intervention focused on coping with symptoms, and provided continuity of care and telephone support. Further work is required to improve the management of patients during and after radiotherapy.     

Breast cancer takes up 99mTc bombesin. A preliminary report

BACKGROUND: Several tumors including lung, prostate, ovarian, colon, and exocrine pancreatic cancer show receptors for the amphibian neurotransmitter and growth factor bombesin (BN) and its mammalian counterparts gastrin-releasing peptide and neuromedin B. Also breast cancer has been reported to show such receptors: the presence of BN receptors in primary breast cancer has been demonstrated on cultured cells and by autoradiography on breast tissue samples. Authors who have studied BN receptors in breast cancer do not agree on their frequency in primary cancer, but indicate that 100% of metastatic breast cancers show such receptors. METHODS: We examined three primary breast cancer patients with 99mTc BN and 99mTc sestamibi one week before surgery. One of them showed axillary node invasion. The same acquisition technique was used for breast and chest imaging with both radiopharmaceuticals, whereas total body images were acquired only with 99mTc BN. Also the administered radioactivity was different: 20 mCi of 99mTc sestamibi and 5-8 mCi of 99mTc BN. Dynamic images were acquired for 20 mins after iv injection with the patient in ventral decubitus and the gamma camera positioned in a lateral view, as is generally done in Khakhali's prone scintimammography. Anterior chest images were acquired for 30 mins. Prone scintimammography was performed one hour after administration of both tracers. ROIs were drawn on tumors and surrounding breast with the same technique in order to calculate the tumor to breast ratio (T/B). In addition, total body scan was performed one hour and three hours after 99mTc BN administration. All three patients underwent breast conserving surgery with lymphadenectomy. Postoperative pathologic assessment showed the following T and N stages in the three patients: T1bN0, T1c-N0, and T1cN1. RESULTS: All three cancers were imaged with both tracers. The T/B of 99mTc BN was always higher than that of 99mTc sestamibi. Chest uptake was always much higher with 99mTc sestamibi than with 99mTc BN. Comparison between 99mTc BN and 99mTc sestamibi images gave other intriguing results: in the N1 patient both tracers clearly imaged the invaded node, but on the 99mTc BM image the primary tumor was larger than on the 99mTc sestamibi image and the node was smaller. It is known that 99mTc BN is not taken up by vessels and inflammatory tissue. The time activity curves of the two tracers were significantly different in all patients, with an increase in 99mTc BN uptake in the first three to five minutes, followed by a less sharp uprise of the curve, quite similar to a plateau. CONCLUSIONS: Our first impression is that 99mTc BN is a useful breast cancer seeking agent and very promising for lymph node staging.     

Community melanoma research: from start up to follow up

Most surgical oncologists receive exposure to clinical studies in their fellowships; however they receive little if any practical knowledge as to how to become a clinical researcher. This article will provide a broad introduction to setting up a community based surgical oncology research program with emphasis on the practical issues necessary to be successful. Topics to be discussed include choosing appropriate studies, setting up the team, IRB issues, financial concerns, helpful hints for enrolling patients, and much more. Getting a program going can seem daunting but ultimately will be very rewarding for both the surgeon and their patients.     

双原发恶性肿瘤的随访及细胞免疫功能变化

目的探讨双原发恶性肿瘤生存期相关因素及免疫功能变化。方法分析２５例随访资料,检测第一、第二原发恶性肿瘤Ｔ细胞亚群功能及分析皮肤超敏试验结果。结果１．双原发恶性肿瘤患者生存期除与病期、部位、病理类型有关外,亦与两原发恶性肿瘤发生间隔时间及治疗方式有关。２．第一、二原发恶性肿瘤后患者ＣＤ４无明显变化,而ＣＤ８升高,ＣＤ４／ＣＤ８下降。３．第二原发恶性肿瘤后患者的皮肤超敏试验阳性率较第一恶性肿瘤明显下降。结论１．两原发恶性肿瘤发生间隔时间长,根治性手术者,生存期长。２．恶性肿瘤患者的细胞免疫功能下降,且第二恶性肿瘤的细胞免疫功能下降较第一恶性肿瘤更明显。