EUROPEAN ONCOLOGICAL DISEASE – VOLUME 2 ISSUE 2 – WINTER 2006

Ironically, after several decades of intensive research but much criticism from the public at large for failure to progress the outcomes of cancer, we are now facing the problem of prioritising new methods of diagnosis and treatment – the very consequences of successful research that the world cannot afford!

The first large series reporting on biological differences in breast cancer among patients of various age groups originally reported on 9,228 patients, of whom 2,919 were aged 65 and over. The investigators showed that older women have a higher frequency of hormone receptor-positive tumours (84% oestrogen receptor (ER)-positive versus 67% in younger patients), and 58% […]

Anti-oestrogen therapy with tamoxifen has been the standard first-line treatment for postmenopausal women with hormone receptor-positive (HR+) ABC for over two decades, offering efficacy with minimal acute toxicity compared with chemotherapy. ³ Unfortunately, disease progression and resistance to tamoxifen develops in one half of those who respond by 18 months.⁴ The search for superior therapeutic […]

Aromatase Inhibitors In postmenopausal women – in whom hormone responsiveness is common – oestrogen is primarily synthesised peripherally in adipose tissue, muscle and breast tissue, rather than in the ovaries as in premenopausal women (see Figure 1). In this population, the most specific therapeutic effects are achieved by blocking the last step in biosynthesis – […]

However, even after primary therapy by surgery and/or chemotherapy, the risk of recurrence remains high.5 Although, classically, breast tumor biology has been classified on the basis of hormone receptor (HR) negativity or positivity, it is now becoming clear that multiple other subtypes exist within these broad categories.6 Indeed, a subset of HRpositive tumors may be […]

Yet several studies confirm that there is a significant and ongoing risk of recurrence of breast cancer that continues on in years 5–10 post-surgery.^4,5 The Oxford overview meta-analyses from the Early Breast Cancer Trialists’ Collaborative Group analysed a study population of patients who were at years ^5–10 following successful completion of five years of tamoxifen. […]

Cancer cells (the ‘seed’) appear to secrete factors, such as parathyroid hormonerelated peptide (PTHrP), potentiating the development of metastases in the skeleton, which constitutes a fertile ‘soil’ rich in cytokines and growth factors that stimulate cancer cell growth and their production of osteolytic factors. Osteoblasts targeted by cancer cell secretory products induce a marked increase […]

Devices Radioembolisation microspheres are minute beads that a carry a radionuclide. Two devices are so far available for liver radioembolisation, and they have distinctive properties that should warn against indiscriminate extrapolation of the clinical experience from one to the other (see Table 1). Both devices use yttrium-90 as a source of beta radiation, its main […]

This disease is diagnosed mostly in resectable stages; however, 35 40% of patients have clinically detectable metastatic disease at the time of first diagnosis. Owing to the relatively aggressive nature of colon cancer in a relevant fraction of patients, synchronous and metachronous metastases occur in 50% of cases, resulting in an overall mortality of 40 […]

A mutation in exon 11, 9, 13 and 17 of the KIT gene is observed in 66%, 13%, 1% and 0.6% of the tumours respectively. Within the PDGFR? gene, mutations of exon 18 or 12 are observed in 5% and 1.5% of the cases.2 GISTs occurring during childhood have a lower incidence of KIT and […]

In 2000, patients with metastatic GIST had only one viable treatment option – surgical resection. This was an appropriate option for a subset of patients; however, despite surgery, some patients were destined to relapse.6 Systemic therapy for GIST with standard chemotherapy was largely ineffective. Patients with metastatic disease had rapid progression of disease, with an […]

KIT is transmembrane protein that functions as the receptor of the stem cell factor (SCF) and as a tyrosine kinase. Most KIT mutations occur in untreated GISTs in exon 11 that encodes the intracellular juxtamembrane part of the protein, and only rarely in exons that encode the intracellular kinase domain. In imatinib-treated patients secondary mutations […]

Epidemiology of GIST The mean age at the time of first diagnosis is 63 years,² with most patients between 40 and 80 years old.³ Men show slightly higher prevalence than woman, supported by the recent US study of 1,458 cases, with 54% and 46% incidence rate respectively.2 The stomach is the most common location for […]

The changes towards riskadapted therapy implied that accurate detection of these abnormalities was vital and, in routine screening, detection methods in addition to cytogenetic analysis had to be considered. Molecular Technologies Throughout the 1980s, advances in molecular technologies led to the discovery of the fusion genes resulting from these and other significant chromosomal changes in […]

Some patients are primary refractory or develop treatment resistance during the course of the disease, a situation with a particularly poor prognosis and median survival times in the range of only one year. Over the recent years, there has also been dramatic progress in our understanding of molecular pathogenesis and outcome prediction in CLL. Genetic […]

Some patients suffer from organomegaly, cytopenia or B-symptoms at diagnosis, or soon thereafter, necessitating therapy. Others have no or minimal signs and symptoms during their entire disease course and have a survival time similar to agematched healthy individuals. Over the recent years, innovative and highly effective approaches such as antibody-chemotherapy and targeted therapy have been […]

Chronic lymphocytic leukaemia (CLL) is the most common form of leukaemia in adults. It is caused by antigen-experienced B lymphocytes that either do not die and accumulate because of external survival signals or go into apoptosis and are replenished by proliferating precursors. The worldwide incidence of CLL is in the range of 0.5–5.5 cases per […]

Combination Chemotherapy with Purine Analogues Fludarabine has been evaluated in a variety of combination regimens. One of the most promising and most thoroughly studied combinations is fludarabine plus cyclophosphamide (FC).³ In preliminary, non-comparative trials, the overall response rates did not appear to be better than with fludarabine alone, but the addition of cyclophosphamide appeared […]

Treatment Options Follicular lymphoma is not curable with conventional chemotherapy alone, although initiating treatment provides very good early results with partial or even complete remission. The natural course of follicular lymphoma is characterised by spontaneous regressions in up to one-fifth of cases. Very aggressive treatments, such as myeloablative bone marrow transplantation, might cure some patients […]

The University of North Carolina has treated approximately 1,200 patients using compensator- IMRT since 1996 and has used both MLC and compensator for IMRT delivery since MLC became available in 2001.^1,2 Mail order compensator services in the US are gaining increasing acceptance and popularity, especially among smaller radiotherapy centres, by providing quality, easy-to-use and swift […]

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 […]

The use of computerised planning systems in conjunction with modern imaging studies, stereotactic patient positioning, multileaf collimation and, more recently, intensity-modulated beams have achieved highly conformal photon RT. The delivery of more conformal treatment can also be achieved with heavy particle beams, such as protons. Protons have superior dose-distributional qualities compared with photons, as dose […]

Treatment-associated factors may aggravate the incidence of anaemia and they may compromise patient’s tolerance of treatments, resulting in the need to reduce the duration or intensity of those treatments. Dose-intensified regimens and combined modality schedules of chemotherapy and intensified radiotherapy result in a higher degree of anaemia. The increase in the total radiation dose administered […]

Large-scale biobank collaborations between institutions face numerous challenges on different levels. In order for the samples to be comparable, similar technical procedures for collection, storage and quality control need to be followed. Rules of access and rules for the use of the tissues need to be clearly defined, and incentives are required for individual institutions […]

Cytokeratin-19 Fragment CYFRA 21-1 is a water-soluble cytokeratin-19 fragment. Histopathological studies have demonstrated that cytokeratin-19 is abundant in carcinomas of the lung.^{8,18–22,26,27} Abnormal serum levels (>3.3ng/ml) of this tumour marker have been found in several benign diseases, including liver pathologies and renal failure^.7–8 Likewise, CYFRA 21-1 is increased in several malignancies other than lung cancer, […]

Cancer cachexia is a multifactorial event and inflammation plays a relevant pathogenetic role. Studies have demonstrated that a variety of proinflammatory cytokines can lead directly to development of anorexia and metabolic changes and can be associated with the development of cachexia. In addition, the presence of a pro-inflammatory response (documented by an acute phase protein […]