Curing patients with locally advanced esophageal cancer: an update on multimodality therapy

Combining different treatment modalities--such as surgery, radiation, and chemotherapy--is often utilized to treat patients with locally advanced esophageal cancer. However, it remains controversial how best to combine these modalities to provide patients with the greatest chance of cure. This review discusses recent studies in this field and outlines promising versus less promising therapeutic strategies.     

Chemotherapy of advanced non small cell lung cancer in the elderly: an update

In the last years there has been a growing awareness in the oncological community about the size of the problem of cancer in the elderly. More than 30% of lung cancers arise in patients aged 70 years or more. Elderly patients tolerate chemotherapy poorly and are not considered eligible for aggressive cisplatin based chemotherapy in clinical practice. A few papers have been published on chemotherapy of elderly NSCLC patients. Cisplatin based chemotherapy seems to be tolerated poorly. Vinorelbine as a single agent showed active and good tolerance. A phase III randomized trial, named ELVIS (Elderly Lung Cancer Vinorelbine Italian Study), showed a survival and quality of life benefit of vinorelbine versus supportive care. Among the new drugs gemcitabine can be considered more promising. Future trials should attempt to improve the results of vinorelbine chemotherapy and include geriatric and quality of life evaluations.     

Active surveillance for low-risk prostate cancer: an update

Active surveillance is now an accepted management strategy for men with low-risk localized prostate cancer, in recognition of the knowledge that the majority of men with such cancers are likely to die from other causes. The most obvious benefit of active surveillance is the reduction of morbidity associated with surgery by delaying or avoiding radical gland therapy. Other advantages include lower overall costs to the health-care system and potentially a better quality of life. These advantages should be balanced against the risks of delayed therapy, the most considerable of which being development of more-aggressive disease. Appropriate selection criteria and the definition of triggers for intervention with radical therapy are critical components of an active surveillance protocol. The ability to accurately identify and cure the men whose cancers will progress using clinical, biopsy and imaging data is yet to be resolved, as is the psychological burden of living with an untreated cancer. The benefit of 5α-reductase inhibitors as secondary chemoprevention in men on active surveillance is a new avenue of research. Focal therapy, which has the similar aim of reducing morbidity while maintaining oncological control, is an emerging competitor for active surveillance. Nevertheless, active surveillance is an appealing management option for selected men with prostate cancer.     

Chemoprevention of colorectal cancer: an update

Colorectal cancer (CRC) is the leading cause of cancer-related mortality in western countries. Adjuvant treatment does not seem to be highly effective and recurrent or metastatic disease occurs in half of the new cases within one year of diagnosis and median survival does not exceed 18 months. CRC represents an optimal model for primary and secondary prevention, given the availability of effective screening procedures and of a well defined multi-step carcinogenic pathway. Colon cancer is supposed to arise as the result of a series of genetic mutations, which parallel histopathologic and molecular changes, from normal colonic epithelium to invasive carcinoma, with adenomatous polyps as an intermediate step. A growing body of evidence has shown a wide variety of effective compounds, in vitro in animal models and in human clinical trials. The more studied agents are the non-steroidal anti-inflammatory drugs. Among those, aspirin has been shown, in two recent randomised trials, to lower the incidence on polyps vs. placebo. Intervention studies on diet showed disappointing results, but diet micronutrients are promising agents in CRC prevention. Calcium, vitamin D and folic acid in different proportions in different populations have been shown to have a certain degree of action in preventing cancer development in epidemiological studies and in randomised trials. Also oestrogens or, rather, hormone replacement therapy for the menopause can protect against CRC. In conclusion, the rapid growth of information and knowledge in chemoprevention, especially for CRC, is very encouraging and gives us hope that soon this approach will be applicable in a larger scale population.     

常规镇痛与自控镇痛对晚期肺癌患者镇痛效果的对比观察

目的对比常规镇痛与自控镇痛对晚期肺癌患者镇痛的效果。方法选择33例在我院住院治疗的晚期肺癌伴疼痛患者，分为两组，常规组（15例）采用肌注芬太尼0．05mg＋曲马多50mg，可重复给药；PCA组（18例）采用芬太尼0．4mg＋曲马多400mg＋2．5rag氯哌啶＋生理盐水100mL，通过静脉系统电子泵给药。采用自我报告的形式完成疼痛症状及缓解满意度的量表评分，比较两组患者的疼痛症状及疼痛缓解满意度。结果在接受镇痛治疗2d及3d后，PCA组患者的疼痛症状轻于常规组（P〈0．05），PCA组患者的疼痛缓解满意度高于常规镇痛组（P〈0．05）。结论与传统的常规镇痛方法比较，自控镇痛术能更有效地控制晚期肺癌患者的疼痛发作症状。     

Epidemiology of pancreatic cancer: an update

Pancreatic cancer, although infrequent, has a very poor prognosis, making it one of the 4 or 5 most common causes of cancer mortality in developed countries. Its incidence varies greatly across regions, which suggests that lifestyle factors such as diet, and environmental factors, such as vitamin D exposure, play a role. Because pancreatic cancer is strongly age-dependent, increasing population longevity and ageing will lead to an increase of the global burden of pancreatic cancer in the coming decades. Smoking is the most common known risk factor, causing 20-25% of all pancreatic tumors. Although a common cause of pancreatitis, heavy alcohol intake is associated only with a modest increased risk of pancreatic cancer. While viruses do not represent a major risk factor, people infected with Helicobacter pylori appeared to be at high risk of pancreatic cancer. Many factors associated with the metabolic syndrome, including overweight and obesity, impaired glucose tolerance, and long-standing diabetes also increase the risk disease, while atopic allergy and use of metformin as a treatment for diabetes have been associated with a reduced risk of pancreatic cancer. A family history of pancreatic cancer is associated with an increased risk of pancreatic cancer and it is estimated that 5-10% of patients with pancreatic cancer have an underlying germline disorder. Having a non-O blood group, another inherited characteristic, has also been steadily associated with an increased risk of pancreatic cancer. While many risk factors for pancreatic cancer are not modifiable, adopting a healthy lifestyle could substantially reduce pancreatic cancer risk.     

Prophylaxis and treatment of venous thromboembolism in patients with cancer: an update

The close correlation between venous thromboembolism (VTE) and cancer has been known for some time, and numerous reports in the literature have highlighted the epidemiological significance. Moreover, VTE has a substantial impact on morbidity and mortality in oncological patients. The prevention and treatment of VTE are important aspects of the clinical management of patients with cancer. The presence of a tumour is often associated with thrombotic complications that are more difficult to diagnose, and sometimes make the treatment of VTE less effective and more likely to cause haemorrhages.     

Aspirin and urologic cancer risk: an update

Aspirin has been associated with a reduced risk of colorectal cancer. With specific reference to urological cancers, a protective role for aspirin has been suggested for prostate cancer, but data for cancers of the bladder and kidney have been limited and inconsistent. Epidemiological evidence suggests that prostate cancer risk is reduced by 10% in regular aspirin users, with similar risk reductions reported in both case-control and cohort studies, and for both slow-growing and aggressive cancers. However, risk estimates were significantly heterogeneous and there was no relationship between risk reduction and frequency, dose or duration of use. Thus, inference for causality and public health implications remain far from conclusive. Although a few case-control studies have reported a favorable effect of aspirin on bladder cancer, most investigations did not find any meaningful association. A modest nonsignificant increased risk was reported for kidney cancer. Such excess risk, however, might be due to exposure to phenacetin-containing analgesics, which have been reported to increase renal cell cancer risk.     

Obesity,adipokines and cancer: an update

Obesity causes dysfunction of adipose tissue, with resultant chronic inflammation and adverse interplay of various adipokines, sex steroids and endocrine hormones. All these drive tumourigenesis and explain the epidemiological link between obesity and cancer. Over the past decade, the associations among obesity, adipokines and cancer have been increasingly recognized. Adipokines and their respective signalling pathways have drawn much research attention in the field of oncology and cancer therapeutics. This review will discuss the recent advances in the understanding of the association of several adipokines with common obesity‐related cancers and the clinical therapeutic implications.     

布比卡因联合吗啡连续蛛网膜下隙注入用于晚期癌性疼痛临床观察

目的 探讨连续蛛网膜下隙注药用于晚期癌痛患者的镇痛疗效.方法 将32例晚期癌痛患者随机分为观察组与对照组各16例,观察组采用布比卡因联合吗啡连续蛛网膜下隙镇痛,对照组采用布比卡因联合吗啡硬膜外镇痛,测定镇痛前、镇痛后1、4周的T细胞免疫功能指标的变化.分别观察镇痛前、镇痛后24h、72 h、1周的VAS评分,吗啡的用量,不良反应发生情况.结果 镇痛后4周观察组与对照组CD3+水平分别为58.37±4.16、54.51 ±2.55,CD4+水平分别为35.76±2.97、30.03±2.33,CD4+/CD8+分别为1.47 ±0.15、1.35±0.13,两组比较,P ＜0.05;VAS评分分别为(2.00±0.89)、(2.12±0.96)分,两组比较,P＜0.05;吗啡用量分别为(9.38±2.44)、(64.79±13.47) mg,两组比较,P＜0.01.观察组与对照组恶心呕吐发生率分别为25％、62.5％,呼吸抑制发生率为0、12.5％,皮肤瘙痒发生率为18.75％、50％,两组比较,P均＜0.05.结论 连续蛛网膜下隙注药用于晚期癌性疼痛患者可明显减轻患者疼痛,改善患者免疫功能,且不良反应发生率低.     

Autografting for patients with CML in chronic phase: an update

Between 1984 and 1992, 21 patients with chronic myeloid leukaemia (CML) in chronic phase (CP) were treated with high-dose chemotherapy (or chemoradiotherapy) followed by autografting with unmanipulated peripheral blood stem cells (PBSC). 12 of these patients survive at a median of 82 months from the time of autografting (range 9–105 months). Nine patients died, six of leukaemia in transformation and three from other causes. Survival of these 21 autograft patients was compared to that of 636 age-matched controls on the Medical Research Council's (MRC) data base, who had been treated with conventional chemotherapy over the same period. Autografted patients had a significantly longer survival at 5 years post autograft than chemotherapy patients (56% v 28%) even after appropriate allowance for time at risk before autograft (Mantel-Byar, 2 P = 0·003). There was no difference in survival whether autografting was performed early in the disease or later or whether the PBSC had been harvested soon after diagnosis or later. If the benefits of autografting in chronic phase seen in this non-randomized series can be confirmed in a randomized study, autografting might be the treatment of choice for younger CML patients who do not have suitable donors for allogeneic transplant.     

Transfusion medicine in trauma patients: an update

In 2008, we reviewed the practical interface between transfusion medicine and the surgery and critical care of severely injured patients. Reviewed topics ranged from epidemiology of trauma to patterns of resuscitation to the problems of transfusion reactions. In the interim, trauma specialists have adopted damage control resuscitation and become much more knowledgeable and thoughtful about the use of blood products. This new understanding and the resulting changes in clinical practice have raised new concerns. In this update, we focus on which patients need damage control resuscitation, current views on the optimal form of damage control resuscitation with blood products, the roles of newer blood products, and appropriate transfusion triggers in the postinjury setting. We will also review the role of new technology in patient assessment, therapy and monitoring.     

Identifying an optimum treatment strategy for patients with advanced non-small cell lung cancer

Owing to the slow but sustained progress made in lung cancer treatment over the last 20 years, several therapeutic options are now available in the first-line setting as well as for patients who have progressed after one or more previous lines of treatment. Considering the growing array of choices currently confronting clinicians involved in the treatment of advanced non-small cell lung cancer (NSCLC), an effort should be made to define the optimal treatment option in each disease setting and to identify a logical therapeutic strategy after initial disease progression. This is especially crucial in the management of young, fit patients, who may be suitable candidates for two or more lines of therapy. At present, a rational treatment strategy for advanced NSCLC may be designed on the basis of patient clinicopathological features and rely on evidence from large, well-conducted clinical trials. In a near future the results of prospective validation studies will provide more sophisticated approaches for the classification of lung cancer patients, allowing clinicians to make individualised treatment decisions based on tumour molecular profile and on novel, more refined predictive/prognostic factors.     

Hepatoma with cardiac metastasis： An advanced cancer requiring advanced treatment

AIM. To investigate the clinical and pathologic findings, and to discuss the pathophysiology of hepatocellular carcinoma with cardiac metastasis.
METHODS： Eight hepatoma patients with cardiac metastasis, who were treated by surgical excision from 1993 to 2006, were retrospectively studied. Detailed clinical parameters were analyzed.
RESULTS： Of those eight patients, two （25%） were women and six （75%） were men, with the mean age of 50 years （range, 40-70 years）. The presentations included： asymptomatic （75%）, heart failure （25%）, and pulmonary embolism （12.5%）. All lesions involved the right atrium, and extended to the lung （12.5%）, inferior vena cava （25%）, and left atrium （12.5%）. The level of tumor marker, alpha-fetal protein, was not correlated with the severity of metastasis or disease prognosis. Moreover, the availably estimated doubling time was less than 3 mo. The pathological findings included variable hemorrhage and necrosis. The survival time following surgery also varied from one month to more than 30 mo.
CONCLUSION： Hepatoma metastasis to the heart was detected in all eight patients. This study demonstrates that surgery might help the outcome in such cases.     

Malaria: an update for physicians

Malaria remains the most important parasitic infection in humans. There have been significant advances in the treatment of both nonsevere and severe malaria with the advent of artemisinin combination therapies and parenteral artesunate, but the optimum supportive management of severe malaria is unclear. A broadly acceptable therapy for the prevention of relapses in Plasmodium vivax infection has not been discovered. Globally, the priority remains to prevent infection in the vulnerable, to move toward elimination where feasible, and to ensure that effective treatment is available to all. In developed settings, prevention of infection and its early recognition are crucial.