摘要:

After decades of research into its prevention and treatment, lung cancer remains the leading cause of cancer death in North America and Europe. Approximately 75% of all new lung cancer diagnoses are of the nonsmall-cell subtype, and less than 25% of these patients are potentially operable upon first detection. First-generation cisplatin-based chemotherapy regimens for patients with metastatic disease achieved a median survival of 175 days, with 15 to 20% of patients alive at 1 year.In recent years, vinorelbine, gemcitabine, paclitaxel, and docetaxel have emerged as promising agents in the treatment of advanced nonsmall-cell lung cancer. Evidence from randomized trials demonstrates that when these agents are combined with cisplatin, the objective tumor response is 25 to 40%, with a median overall survival approaching 300 days. In addition, recent studies have shown that single-agent docetaxel improves survival and quality of life in patients with platinum-refractory nonsmall-cell lung cancer. Since these modest but important improvements in the management of nonsmall-cell lung cancer are achieved at a significant cost, cost has emerged as a major consideration in health policy decision-making. This article reviews the pharmacoeconomic literature to provide guidance on the cost-effective use of chemotherapy in the treatment of advanced nonsmall-cell lung cancer.

ISSN:1040-8746    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The incidence of lung cancer continues to rise. The need and demand for more effective treatment to improve survival and palliate symptoms increases at a great rate. The most recent evidence for the use of chemotherapy in the palliative setting is summarized in this review of the literature from the last few years. It indicates that in advanced nonsmall-cell lung cancer survival, symptom control and physical functioning can be improved with the use of chemotherapy not only in the first-line but also in the second-line setting, in the elderly, and at disease relapse.

ISSN:1040-8746    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

It has now become clear that chemotherapy for advanced nonsmall-cell lung cancer, compared with best supportive care only, improves survival, even if the amplitude of the benefit remains disappointing. However, some clinicians are still reluctant to prescribe chemotherapy in this patient population, arguing that the survival gain is too small to counterbalance the side effects. Therefore, randomized trials using quality of life as an endpoint and comparing best supportive care with or without chemotherapy were reviewed. Although there are difficulties in the methodology of quality of life assessments and in the analysis of quality of life data, most of the selected trials showed an improvement for quality of life in various components in the chemotherapy arm. Therefore, even if some of the reported results might be biased and should be interpreted with caution, the data analyses constitute a further argument to stop denying chemotherapy for patients with advanced nonsmall-cell lung cancer, at least for those who might be eligible for inclusion in a clinical trial.

ISSN:1040-8746    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The management of dyspnea is a challenge even for the most experienced palliative medicine teams. In the absence of effective treatment for the underlying disease, therapeutic options are limited to the supplementation of oxygen, the use of opioids, and multidisciplinary nonpharmacologic interventions. There is increased research into both the physiology of dyspnea and the correlates of the symptom in advanced disease. Hopefully, this research will lead to improved therapy in the future. This article reviews current literature on dyspnea with a focus on publications in 2001.

ISSN:1040-8746    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1040-8746    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Retroperitoneal soft tissue sarcomas are rare tumors estimated to account for 15%of all patients with soft tissue sarcoma seen in referral populations. The standard of care for patients with localized, resectable retroperitoneal sarcomas is surgical resection with gross and microscopically negative margins. However, owing to the large size and locally advanced nature of these tumors, this goal is difficult to achieve in most patients. As a result, the disease is characterized by a high propensity for local recurrence and a grade-specific risk for distant metastasis.Over the past decade, there has been considerable research into combined modality treatment of these tumors. The present report outlines current concepts relating to the diagnosis, staging, and management of retroperitoneal sarcomas. Emphasis is placed on evolving combined modality treatment approaches and current investigational strategies.

ISSN:1040-8746    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Sequencing of the human genome and rapidly evolving microarray technology have combined to provide investigators with the ability to analyze individual tumors and groups of tumors for global patterns of gene expression. Few of these types of studies have been performed on rhabdomyosarcomas and osteogenic sarcomas, including cell lines and animal models. Groups of expressed genes that may characterize rhabdomyosarcomas and their subgroups and separate them from other types of tumors have been identified. More specifically, genes involved in myogenesis or the inhibition of myogenesis have been identified, as have genes that may play a role in metastatic activity in osteogenic sarcomas. Also, a study documenting the consistent and specific gene expression profile of gastrointestinal stromal tumors has been published. While the data regarding gene expression patterns in sarcomas is accruing, numerous investigators are working on developing and enhancing bioinformatic skills and tools such that the vast amount of data can be converted into knowledge regarding biology, therapeutic responsiveness or resistance, and prognosis.

ISSN:1040-8746    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This review examines how the identification of tumor-specific translocations and fusion proteins has advanced the basic scientific and clinical understanding of sarcomas. Recent genetic advances, including the ASPL-TFE3 fusion of alveolar soft part sarcoma, the JAZF1-JJAZ1 fusion of endometrial stromal sarcoma, and HMGIC fusions in liposarcoma, are discussed. Next, the review addresses the ways in which molecular genetic data have influenced diagnostic and prognostic paradigms. For example, recent studies describe the detection of occult tumor cells and the identification of primary renal neoplasms that are genetically related to alveolar soft part sarcoma. In addition, the review discusses potential therapies based on the targeting of sarcoma-specific fusion proteins. These reports describe the potential use of Gleevec (STI571) for dermatofibrosarcoma protuberans and the use of tumor-specific fusion proteins as potential targets for immunotherapy. Finally, basic scientific findings are reviewed that elucidate, for example, the aberrant functions of SYT-SSX in chromatin remodeling and of EWS-FLI1 in transcription and mRNA splicing. These and other emerging models of tumorigenesis will help identify new therapeutic targets.

ISSN:1040-8746    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Surgical resection is now well accepted as the standard treatment in 10 to 20% of patients with liver metastases. Tumor ablative techniques have been developed in recent years. The basic idea is to use them in patients with a limited number of intrahepatic deposits that are not totally resectable. Several papers published in 2001 have addressed cryotherapy. Cryotherapy can be considered an effective method for local destruction of liver metastases up to 3 to 4 cm in diameter but is also associated with a significant rate of complications. In many centers, cryoablation has now been replaced by radiofrequency ablation, the most widely used method for ablation of unresectable liver metastases. It can be performed during laparotomy, at laparoscopy, or percutaneously. Tumors less than 3 cm in their greatest diameter can be destroyed with one placement of the needle electrode. Metastases larger than 3 cm require several placements. Both cryotherapy and radiofrequency ablation are effective methods to induce necrosis of liver metastases. It is likely that in the near future, most patients with liver metastases will receive a multimodality treatment: a local treatment such as surgical resection or tumor ablation, and a general treatment such as hepatic infusional or systemic chemotherapy. Trials published in 2001 have shown that oral prodrugs of fluorouracil were probably equivalent to fluorouracil bolus administration. Regimens containing oxaliplatin or irinotecan have also been evaluated for efficacy and tolerance and by the intravenous route alone or in combination with hepatic artery infusion. Effective systemic chemotherapy regimens have resulted in increased survival rates and improved quality of life and in some cases have allowed resection of initially unresectable liver metastases.

ISSN:1040-8746    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Pancreatic cancer remains the fourth leading cause of cancer deaths in males and females in the beginning of this new millennium. The 5-year survival for all stages remains less than 5%. The frequent diagnosis at late stages of the disease limits the role of surgery as a curative modality in pancreatic cancer. Despite recent advances, systemic treatment continues to have a limited role in the adjuvant setting, and chemotherapy is mostly palliative in advanced and metastatic pancreatic cancer patients. The differential diagnosis of pancreatic cancer and other gastrointestinal malignancies is, many times, challenging. Advances in the understanding of the disease biology may help in better diagnosis and treatment approaches. Clinical trials with molecular targeting agents are starting to emerge.

ISSN:1040-8746    

出版商:OVID    

年代:2002

数据来源: OVID