ONCOLOGY Vol 10 No 7

Until recently, newly diagnosed patients with prostate cancer were faced with one of four basic management options: observation, radiation therapy, radical prostatectomy, or hormonal manipulation. The exact option chosen by an individual

Drs. Eulau and Corn comprehensively review the emerging use of combined androgen suppression and local therapies in locally advanced carcinoma of the prostate. These strategies have been developed since the recognition of the inadequacy of

Locally advanced adenocarcinoma of the prostate (American Urological Association stages B2, C; American Joint Committee on Cancer stages T2c, T3) has been difficult to control by either external-beam irradiation or

Dr. Roach initiates his discussion with the relevant statement that how we detect, stage, and treat carcinoma of the prostate, as well as subsequently evaluate treatment efficacy, has forever been dramatically altered by the availability of prostate specific antigen (PSA), which has been labeled "the most useful tumor marker available" [1]. However, as Dr. Roach also notes, new information and insights generate new questions and uncertainties about the best applications of this valuable tumor marker.

Pretreatment prostate-specific antigen (PSA) level is the single most important prognostic factor for patients undergoing radiotherapy for clinically localized prostate cancer. When combined with Gleason score and T-stage, pretreatment PSA enhances our ability to accurately predict pathologic stage. Patients with pretreatment PSA levels more than 10 ng/mL are at high risk for biochemical failure when treated with conventional radiation alone. A PSA nadir of more than 1 ng/mL and a post-treatment PSA more than 1.5 ng/mL are associated with a high risk of biochemical failure. Postoperative radiotherapy delivered while the tumor burden is low (eg, PSA less than 1 ng/mL) predicts a favorable outcome. Many of these conclusions about the usefulness of pretreatment PSA are based on the assumption that PSA can be used as a surrogate end point for disease-free and overall survival from prostate cancer. However, this assumption still remains to be validated by phase III trials. [ONCOLOGY 10(8):1143-1153, 1996]

Radical radiation therapy and radical prostatectomy are the two most commonly employed therapeutic alternatives for clinically localized (T1-T2,NX,M0) prostate cancer. A vigorous debate is ongoing about the relative efficacy of each modality. This debate centers around the percentage of patients who cannot be cured by one method or the other, suggesting that some patients may be better served by one treatment, or by some form of combined-modality therapy employing radiation after surgery or neoadjuvant androgen suppression before radiation.

Every day thousands of babies are born in hospitals across America. These births offer opportunities to cure patients of leukemia and other life-threatening diseases. The opportunities lie in the routinely disposed placentas and umbilical cords.

(Name of company), in order to encourage the best business practices in the industry, and to assist sellers of life insurance in assessing viatical options, agrees to abide by the following standards and practices:

In their article, von Gunten et al lucidly define palliative care and analyze the status of this discipline within the current American health-care delivery system. They make a series of excellent points, a few of which deserve emphasis and clarification:

The full effects of the breast-implant controversy are far-reaching, and will probably not be entirely felt for years. They certainly extend beyond the question of whether breast implants are safe, important though that question is. The narrow

The authors provide a timely review of the components of hospice/palliative care programs and an informative historical perspective on the development of these programs overseas and in the United States. They also review the current mechanisms that fund hospice care and explain how the skills for delivering hospice/palliative care have been incorporated into oncology education at Northwestern University. This articles highlights the many positive aspects of hospice programs, which currently provide expert multidisciplinary care by committed and knowledgeable professionals to almost 30% of patients with cancer in this country. However, the discussion should serve to focus attention on several additional aspects of the symptomatic care of patients with cancer.

It is ironic that the issue of aggressive local therapy for breast cancer has re-emerged as a controversial issue in the early 1990s, almost 100 years after Halsted proposed this theory in the early 1890s [1]. Since that time, both survival and quality of life seemed to have improved for patients with breast cancer, due to more sophisticated and effective treatments. Nonetheless, as Drs. Pierce and Lichter point out in their article, the precise balance between the benefits and risks of aggressive local therapy still remains to be defined.

In their comprehensive review of changing concepts in the management of endometrial cancer, Drs. Karasek and Faul highlight the contemporary approach to the management of patients with endometrial adenocarcinoma. The authors stress the evolution

The authors present the major issues and controversies surrounding the treatment of endometrial cancer. A variety of therapeutic approaches have been used in the past, including surgery alone, preoperative radiation and surgery, surgery and

Dr. Trimble's review of female genital tract melanomas provides a well-organized summary of the published information on these rare cancers. His inclusion of the two recent population-based samples from the United States and Sweden [1,2] is particularly useful because all of the available data on genital tract melanomas comes from long-term retrospective case reviews. The cited incidence rates calculated in the studies represent the first legitimate estimates of the incidence of these uncommon cancers.

I will briefly comment on two points discussed by Pierce and Lichter in their thorough review: (1) the recently published Oxford overview analysis of locoregional therapies [1], and (2) which patients may benefit from postmastectomy radiotherapy.

This article provides a nice overview of HIV-associated wasting. The paper makes a number of strong points. In particular, it focuses on anorexia and decreased oral intake as key to wasting. In this vein, both the discussion by Von Roenn and Knopf and Tables 1 and 2 offer a very valuable review of the multiple reasons why HIV-infected patients may eat less. Given the many medications that we often need to use in these patients, the text discussion about the ways in which medications can result in decreased oral intake, reinforced by Table 2, is particularly useful.

Von Roenn and Knopf provide a balanced review of the pathophysiology and treatment options for anorexia and cachexia associated with HIV and cancer. This is an important topic that cuts across subspecialty lines and typically frustrates clinicians. Fortunately, more has probably been learned about HIV-associated cachexia during the past decade than about cancer-associated cachexia during the previous three decades and a number of treatment options have emerged. The reader may therefore benefit from a summary of the practical implications of recent research on HIV-associated wasting. Several clinical guidelines can be recommended:

Eulau and Corn provide an excellent review of the current status of neoadjuvant androgen deprivation therapy combined with radiation therapy or surgery in the management of locally advanced prostatic cancer. They comprehensively describe the

would like to make several comments about the excellent review by Parsons et al, "Response of the Normal Eye to High-Dose Radiotherapy," which appeared in the June issue of ONCOLOGY (pp 837-852). In 1897, Chalupecky first described

In an early meta-analysis of the post-mastectomy radiotherapy trials, the use of obsolete radiotherapy techniques resulted in increased cardiac mortality. With maturation of these data and inclusion of more recent

Early intervention and attention to nutritional status are essential in patients with cachexia. Identification of reversible causes of decreased energy intake and/or weight loss is the first step in treatment. When such factors

Endometrial carcinoma was a clinically staged disease until the late 1980s, at which point, staging changed to a surgicopathologically defined system. This change in staging, in turn, altered the clinical management of this

With the renaissance of interest in how best to care for patients with terminal illness comes the need to recognize palliative care and hospice programs as the completion of comprehensive cancer care, not as its antithesis. In

The study of oncology and the management of patients with cancer are becoming increasingly complex. The amount of information necessary for clinicians to assimilate is staggering. This is particularly true for surgical oncologists, who must not only keep up with the most recent advances in cancer diagnosis and therapy but also with the most up-to-date surgical procedures. Cancer Surgery is a reference that provides this important material in a comprehensive and logically organized format.

With the goal of protecting the economic security of people with AIDS (PWAs) who decide to sell their life insurance policies to obtain cash, a group of leading advocates for PWAs met in Los Angeles on March 22 to draft a set of standards

Melanomas of the vulva and vagina comprise less than 2% of melanomas in women. Although their biologic behavior appears to be similar to that of cutaneous melanoma, vulvar and vaginal melanomas appear to have a