EUROPEAN ONCOLOGICAL DISEASE – VOLUME 3 ISSUE 1 – SUMMER 2007

Welcome to European Oncological Disease – Issue 1. The papers in this issue highlight some of the recent important developments in cancer management. The majority of the topics covered, listed below, were also high-priority items during the 2007 meeting of the American Society of Clinical Oncology. The focus in this edition is on individualised treatment […]

The median time to diagnosis of CNS metastatic disease is two years after the initial diagnosis of breast cancer, and it is unusual for it to be the only site of metastatic disease.8,9 Systemic disease used to be the leading cause of morbidity and mortality in these patients.2 There is only limited knowledge of the […]

Trastuzumab is a recombinant humanised monoclonal antibody directed against the extracellular domain of the HER-2 protein. There are several mechanisms by which trastuzumab exerts its action, including: induction of receptor downregulation/degradation;4 prevention of HER-2 ectodomain cleavage;5 inhibition of HER-2 kinase signal transduction via antibody-dependent cell-mediated cytotoxicity (ADCC);6 and inhibition of angiogenesis.7 As a single agent […]

Breast cancer remains the most common malignancy among women, with an average lifetime risk of approximately 10%. Despite the continued rise in incidence of the disease, with almost half a million deaths annually worldwide, mortality rates have fallen over the past two decades. This is testimony to the success of interventional strategies such as screening […]

The current standard treatment for early breast cancer includes conservative surgery followed by radiotherapy to the whole breast.1 Longterm follow-up of patients included in the Milan Three Trial (Quart versus Tart) showed that most local relapses occur in the area of the scar tissue,2 suggesting that total irradiation of the breast may not always be […]

Endocrine Treatments Late diagnosis and substandard local and systemic therapies are common in elderly breast cancer patients, which is only partially and indirectly ‘compensated’ by more indolent tumour behaviour due to more favourable biological characteristics. Of these, the higher frequency of tumours expressing oestrogen or progesterone receptors (OR or PgR) makes endocrine treatment an ideal […]

Surgery is the primary treatment of choice in early-stage breast cancer for patients of all ages. Older patients who do not undergo surgical removal of the tumor are at increased risk for breast cancer progression and mortality. This was demonstrated in a study of 455 women over the age of 70 who had operable, invasive […]

Aromatase inhibitors (AIs) block estrogen production in the peripheral tissues by preventing the last step in estrogen biosynthesis. The superior efficacy and more favorable side-effect profile demonstrated by AIs have allowed them to begin to replace tamoxifen as the adjuvant therapy of choice for post-menopausal women with ER+ breast cancer.2–5 However, one caveat of AI […]

In patients with early disease, a multimodal approach to treatment is essential for improving survival. Breast cancer recurrence, particularly distant recurrence, in women with early stage disease is associated with increased mortality.8 Treatments that can address the risk of breast cancer recurrence, especially distant metastases, have the potential to remain disease-free and improve overall survival […]

Lung Cancer – Attributable to Active Tobacco Smoking in Women Smoking habits vary within the different countries in Europe, with a significant decrease in tobacco consumption in the UK, Sweden and Finland between 1970 and 1994 and a significant increase in Portugal (+64.2%).5 Even if active tobacco smoking is the main cause of lung cancer […]

Chemotherapy versus Best Supportive Care Chemotherapy became a serious entity for NSCLC only in the mid- 1990s, particularly after a meta-analysis by the Non-small Cell Lung Cancer Collaborative Group who looked at all randomised controlled trials (RCTs) of chemotherapy or BSC in all treatment situations (i.e. surgery, radiotherapy or BSC).1 In trials of chemotherapy versus […]

Effective therapies include surgical resection, liver transplantation and techniques based on interventional radiology, such as thermal ablation or transarterial chemoembolisation. In addition to major advances in the application of these established interventions, major research has been performed to clarify the molecular mechanisms leading to malignant cell transformation and progression. This bench research means that the […]

TACE has been shown to reduce systemic toxicity and increase local effects and thus improve therapeutic results. There is no generally accepted TACE technique. The core concept includes selective embolisation of tumour-feeding arteries with a chemotherapeutic agent in an emulsion with idodised oil and subsequent embolisation with a particulate agent. The embolising material slows and […]

Unfortunately, only a small proportion – between 10 and 15% – of patients with liver metastases only are primary candidates for potentially curative liver resection, since surgery is limited to those with a good performance status, and those who fall within ‘limited disease criteria’ (generally four or fewer tumors in one lobe of In a […]

Materials and Methods One hundred and eighteen patients were selected for HIFU treatment of a histologically documented local recurrence after radiotherapy. All patients showed a biochemical recurrence according to the American Society for Therapeutic Radiology and Oncology (ASTRO) criteria. No patients had metastases on bone scan, abdominal computed tomography (CT) scan and/or pelvic magnetic resonance […]

Current Screening Practices Do Not Detect the Majority of Cancer Patients OAC arises from Barrett’s oesophagus,4,11 a metaplastic process that occurs in response to the caustic effects of chronic gastro-oesophageal disease (GORD).3,4,12,13 It is thought that OAC develops through a metaplasia– dysplasia–carcinoma sequence in the face of chronic GORD.14,15 The risk of developing OAC in […]

CML is a monoclonal stem cell disorder accounting for approximately 20% of adult leukemias.1 The median age at first diagnosis is 60 years and the male-to-female ratio is almost even (1:1.4). Typically, CML develops in three phases. The vast majority of patients (>80%) is diagnosed in the initial chronic phase, which—in the absence of any […]

Clinically, CML progresses through three distinct phases of increasing refractoriness to therapy: chronic phase (median duration three to four years; median survival five to seven years with interferon), accelerated phase (median duration three to nine months; median survival eight to 18 months) and blast crisis (median survival three to six months). Blast crisis can be […]

This latter observation is largely due to the ability to successfully re-treat relapsed patients. However, patients who become refractory to alkylator- and fludarabine-based treatments have traditionally had a poor response (

Chemoimmunotherapy with Rituximab as an Initial Cytoreductive Regimen Chemoimmunotherapy is a widely accepted first-line approach as rituximab increases response rate (RR) and prolongs PFS. In a German lymphoma study group (LSG) randomised comparison of CHOP with CHOP-R (with rituximab), CHOP-R increased RR from 72 to 92%, CR from 9 to 32% and PFS from 14 […]

Elderly patients are at particular risk of treatment-induced bone loss and for a given bone mineral density (BMD) are more likely to sustain a fracture. Assessment of BMD before and at occasional intervals during endocrine treatments is recommended, with intervention with bisphosphonates if BMD falls into the osteoporotic range. Doses and agents used in this […]

Wait for the Target This concept means that we can expect the target to be at a certain position during a specific interval of the respiratory cycle. The exact portion of the respiratory cycle is determined at the time of computed tomography (CT) imaging. The same interval is used for the delivery of radiation, thus […]

Scientific Background It is generally accepted that low-intensity (1V/cm), medium-frequency (100-300kHz) alternating electric fields have no meaningful biological effects. This assumption is based on the fact that the evidence collected to date suggests they do not cause significant temperature elevation or stimulate excitable tissues such as nerves, muscles in general, the heart muscle or cardiac […]

The systematic error is generally considered more important, because if uncorrected it would propagate throughout the treatment course and lead to a deleterious effect on local control. Day-to-day variations may be substantial and require safety margins that limit the maximum dose administered to the tumour volume due to possible toxicity to surrounding healthy tissue. With […]

Patients and Methods Between 1993 and 1998, 52 patients with advanced oral-cavity tumours were treated. There were 44 males and 8 females at a mean age of 63 years. The most frequent tumour sites were the floor of the mouth (16) and mandibula (10), and 15 patients had polytopic manifestations. Thirtynine patients (75%) had a […]

Despite the addition of tumour-site-specific planning margins to target volumes defined on conventional CT scans, inadequate coverage of lung tumours and/or excessive irradiation of normal tissues are commonly observed.2–4 As such, individualised or ‘patient-specific’ planning margins are recommended instead of standard or ‘population-based’ margins.5,6 Different approaches have been used to determine individualised margins, but 4-D […]

Workflow in a Radiotherapy Department (as Opposed to a Radiology Department) Workflow in a diagnostic radiology department is a comparatively linear, straightforward process centred on imaging studies. Tools to organise diagnostic workflow electronically are readily available. In essence, three major components are necessary: • basic scheduling functionality for managing patient appointments based on digital imaging […]

The present trend in surgical subspecialisation is mainly organ-based, treating malignant, benign and functional conditions of the involved organ. During the last decades, general surgery has been divided up in several subspecialities such as gastrointestinal surgery, hepatopancreaticobiliary surgery, coloproctology and endocrine surgery. Organbased cancer surgery lacks a thorough knowledge of cancer disease and the risk […]

The Epidermal Growth Factor Receptor Family EGFR was the earliest of four receptors discovered in the ErbB family of receptor tyrosine kinases.1,2 Furthermore, it was this receptor that first identified a relationship between an activated oncogene and malignant transformation.3 This 170kDa glycoprotein comprises an extracellular portion made up of four distinct sub-domains capable of conformational […]

Malnutrition and Cachexia Viewed as a physical state, malnutrition is a disorder of body composition characterised by macro- and/or micro-nutrient deficiencies resulting from insufficient intake of, increased demand for and/or altered use of nutrients.5 Malnutrition is related to several disease states, as well as situations of famine, and can be reversed by providing nutritional therapy. […]

Furthermore, the incidence of DVT in solid tumours is difficult to establish because most clinical studies presented in current literature show a great variability based on the type of diagnostic procedure performed (clinical alone or clinical and objective testing as venography), the most frequent tumour histotype, the medical or surgical procedure and, finally, the presence […]

Underdiagnosis of Anaemia in Cancer Approximately 20 60% of cancer patients have anaemia at presentation2 and several factors may induce or exacerbate the condition, influencing incidence rates in specific patient groups. These factors include tumour type,3,4 disease stage,4,5 duration, intensity and type of treatment1,2,3,6 8 and patient age.9 Despite the high incidence of cancer-related anaemia, […]

The Rationale for Hyperthermic Intraperitoneal Chemotherapy The drug concentration attainable through an IPEC instillation approach allows the intrinsic or acquired drug resistance to be overcome, simultaneously minimising the systemic toxicity. Loco-regional drug delivery under hyperthermia offers several advantages over the same procedure performed at normal temperature. At 40 42ºC, neoplastic cells become more chemosensitive due […]