ISSN:1040-8746    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1040-8746    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The interest in fatigue seems to be growing. A Medline search combining the key wordsfatigueandcanceryielded 248 entries compared with 72 entries 10 years previously. The studies published are mainly descriptive, augmenting the knowledge about the extent of fatigue associated with cancer, as well as during and after the various treatments used to fight it. New measurement instruments integrating the multidimensional concept of fatigue are being proposed. In 1998, the first study describing fatigue in children and adolescents with cancer was published. The knowledge of the causes of fatigue related to cancer remains extremely limited. In only a few studies are interventions and treatment possibilities for fatigue discussed. Hopefully, the refined knowledge about the characteristics of fatigue and its epidemiology will provide new etiologic understanding, resulting in effective treatment. This article provides a survey on the literature published in 1998.

ISSN:1040-8746    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Dyspnea is a common and devastating symptom of life-threatening disease. Approximately 90% of non–small cell lung cancer patients experience moderate to severe dyspnea by death. Currently, the pathology is ill-defined and measurement of this subjective symptom is imprecise. The treatment is directed at the underlying cause when appropriate. When specific therapies no longer exist, palliative interventions are necessary. This article outlines the current state of knowledge and standards of care for palliative interventions in dyspnea. These include nonpharmacologic interventions, oxygen supplementation, and medications. Further research is needed to clarify the role of each and to develop better pathophysiologic understanding.

ISSN:1040-8746    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Cancer anorexia/cachexia is a major clinical problem, especially in advanced cancer patients. Its pathogenesis is quite complex. Anorexia plays a central role, but cancer cachexia is more complex than pure chronic starvation. One of the key differences is the preferential mobilization of fat and the sparing of skeletal muscle in simple starvation compared with an equal mobilization of fat and skeletal muscle in cancer patients. An increase in basal energy expenditures seems to play a contributory role in many patients. Cytokines, essentially but not exclusively tumor necrosis factor &agr;, play an essential role, and the syndrome can be compared with a low-grade chronic inflammatory state. As it is in most fields in medicine, prevention is more efficacious than treatment, and, to avoid the final and dramatic stages of cancer cachexia, adequate nutritional advice and support must be provided sufficiently early. Parenteral nutrition could facilitate the administration of complete doses of chemotherapy or radiotherapy, but no significant survival benefit or decrease in treatment-induced toxicity have ever been demonstrated in prospective randomized trials. The gut should always be used if at all possible. Percutaneous endoscopic gastrostomy is used increasingly in patients who cannot eat but who have functionally intact gastrointestinal tracts, especially in patients with head and neck cancer. Eight randomized, double-blind, placebo-controlled studies have demonstrated that progestational drugs can somewhat stimulate appetite, food intake, and energy level; increase weight in many patients; and often decrease nausea and vomiting severity; however, pharmacologic treatment of cancer cachexia remains disappointing, and more trials with anticytokine drugs should be conducted.

ISSN:1040-8746    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Oral mucositis is a common toxicity of high-dose chemotherapy and upper mantle head and neck radiation. Published evidence from the past 14 months provides insight into the multiple possible mechanisms. In addition, the data highlight the clinical importance that this lesion exerts relative to infection risk, quality of life, and cost of care. Oral mucositis has emerged as a dose-limiting toxicity in selected cancer therapy models. Thus, it has direct impact on duration of disease remission, cure rates, and long-term survival. Because of its importance in the clinical setting, oral mucositis remains under extensive laboratory and clinical investigation. Advances in the 1980s relative to infection prevention and reduced duration of profound neutropenia via growth factors have elevated oral mucositis to a prominent toxicity of cancer therapy. A contemporary model for mucositis involving four principal phases was published in 1998. Future research will likely add further insight into this model relative to the roles of mucosal immune dysregulation, colonizing microflora, and wound-healing mechanisms. Basic and clinical studies directed to these several components may well lead to effective preventive strategies in the future, with positive impact on quality of life and survival of cancer patients.

ISSN:1040-8746    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Identification of genetic alterations has contributed greatly to the understanding of sarcoma biology. Additionally, detection of these abnormalities is providing new tools for the diagnosis of sarcomas. In this paper, three important new genetic findings from the past year are reviewed, including the t(12;15) translocation of congenital fibrosarcoma, mutation of the putative tumor suppressor gene hSNF5/INI1 in malignant rhabdoid tumor, and the association of c-kit mutations with gastrointestinal stromal tumor. Highlighted are important studies concerning mechanisms of chromosomal translocation, functions of sarcoma-specific fusion proteins, genetic abnormalities other than translocations, molecular diagnosis, and molecular profiling of gene expression. Particular emphasis is placed on information obtained with comparative genomic hybridization and microarray techniques, because these powerful technologies will facilitate the rapid acquisition of data that provide insight into the molecular genetic and biologic basis of sarcomas.

ISSN:1040-8746    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The ideal cancer therapy would accomodate the specific biology of a tumor and be based upon understanding the mechanisms of malignancy. This vision has been the driving force in cancer research. However, the story of success in clinical cancer management is a story of empirie largely independent from progress in basic research. For the Ewing family of tumors (EFT) comprising Ewing’s sarcoma and peripheral primitive neuroectodermal tumor, significant insights into the molecular basis have appeared recently. Some of last year’s discoveries may have taken us closer to the identification of the Achilles’ heel in this disease. The first clue has been obtained to the mechanism of chromosomal translocation, which constitutes a rate-limiting step in EFT pathogenesis. Also, researchers have progressed in understanding the control of EFT cell proliferation, differentiation, and death. A major role in these processes has been attributed to theEWS-etsgene rearrangement. Specific growth factor circuits appear to be involved in deregulated tumor cell growth. By analogy to heterologous cellular systems, it is possible to postulate an important functional role for CD99MIC2as it contributes to the malignant phenotype of EFT.In vitro, as well as the firstin vivo, experimental evidence suggests that tumor cell expansion and spread can be counteracted by breaking these physiological pathways. Still, we are far from a tailored biological therapy of EFT. Before this goal may be achieved, we must seek further improvements and diversification of today’s standard and intensified treatment regimens.

ISSN:1040-8746    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Soft tissue sarcomas are a heterogeneous group of tumors, consisting of numerous histiotypes that all share a putative common mesenchymal origin. Although prognosis of these tumors is determined by clinical parameters (size, location, and resection margin status) and pathologic features (mitotic activity and necrosis), the histologic subtype has never been shown to be a consistent independent prognostic factor. Some relevant differences among these histiotypes are emerging, in specific biological parameters such as proliferation indices, in integrin expression profiles, and with regard to drug sensitivity. Several biological factors are considered to be prognostically important. Most attention is directed to regulators of cell-cycle progression. The significance of p53 dysregulation is confirmed by the inhibition of cellular proliferation, both in in-vitro and in in-vivo sarcoma models, after reintroduction of wild type p53. A multidisciplinary approach is essential for the optimal treatment of soft tissue sarcomas. Multimodality treatment has led to a patient-tailored approach with limb-sparing resections integrated with external and/or interstitial irradiation. The value of chemotherapy both in the neoadjuvant and the adjuvant setting, although of critical value in other sarcomas such as Ewing’s sarcoma and osteosarcoma, remains to be established for soft tissue sarcomas.

ISSN:1040-8746    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1040-8746    

出版商:OVID    

年代:1999

数据来源: OVID