bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of extent of disease, histology, and demographic factors on lung cancer survival in the seer population‐based data
Authors: Ries Lynn A. Gloeckler
Published: February 2007

Rates calculated from the Surveillance, Epidemiology, and End Results (SEER) Program are used to show variations in lung cancer survival by prognostic factors with an emphasis on the extent of disease and demographic variables. The analysis is based on 52,755 histo‐logically confirmed cases of invasive lung cancer diagnosed from 1983 through 1987 and 51,377 cases diagnosed from 1977 through 1982.

Females survived better than males. In general, white patients survived better than blacks. However, if both race and sex are considered together, black females survived better than white males and white females had the highest rates and black males the lowest. Age, however, proved to be the strongest predictor of survival of the demo‐graphic variables. Young females (< 45 years) with non‐small cell lung cancer had an 81% 5‐year relative survival rate compared to 44% for those 75 years and over.

Survival for small cell lung cancer was lower than that for any other histologic type even when stratified on stage of disease (stages I and II, all stages). Survival for stages III and IV did not vary by histologic type. The histologic grade showed prognostic value only for patients assigned stage I.

More detailed extent of disease information was used to show how often specific sites of distant metastases are seen at diagnosis. It also demonstrated the inter‐relationship of the different extent of disease variables and their effect on outcome. © 1994 Wiley‐Liss, Inc.

This article is a U.S. Government work, and, as such, is in the public domain in the United States of America.
Staging and survival of patients with renal cell carcinoma
Authors: Guinan Patrick , Frank Walter , Saffrin Robert , Rubenstein Marvin
Published: February 2007

The staging of renal cell carcinoma was initiated in the United States with the systems of Flocks and Robson. The development of the TNM system began in Europe, evolved through several stages and is now being employed throughout the world. The predictive value of the current TNM system is supported by patient survival data. Practitioners treating renal cell carcinoma are encouraged to utilize the TNM classification. © 1994 Wiley‐Liss, Inc.
Staging of prostate cancer
Authors: Bostwick David G. , Myers Robert P. , Oesterling Joseph E.
Published: February 2007

The clinical and pathologic staging of prostate cancer involves determination of the anatomic extent and burden of tumor based on the best available data. Two major classification schemes are currently used: the modified American system and the TNM system [primary tumor (T), regional lymph node (N), and metastases (M)]. Both systems stratify patients according to the method of tumor detection, separating nonpalpable “incidental” prostate cancers detected during transurethral resection for clinically benign prostatic hyperplasia (BPH) and palpable cancers detected by digital rectal examination. These staging systems also recognize nonpalpable tumors detected by an elevated serum prostate‐specific antigen (PSA) level or an abnormal transrectal ultrasound image. Current staging is limited by a significant level of clinical understaging (up to 59%, in our experience) and over‐staging (up to 5%) according to comparison with pathologic examination of resected specimens. Proposed improvements in staging include preoperative systematic sextant biopsies to assess tumor volume, volume‐based prognostic index, and a multiple prognostic index. In this report, we evaluate the current aspects of clinical and pathologic staging of prostate cancer with emphasis on the early stages in which there is the greatest chance of cure. © 1994 Wiley‐Liss, Inc.
Artificial neural networks for cancer research: Outcome prediction
Authors: Burke Harry B.
Published: February 2007

The use of artificial neural networks in biological and medical research has increased tremendously in the last few years. Artificial neural networks are being used in cancer research for image processing, the analysis of laboratory data for breast cancer diagnosis, the discovery of chemotherapeutic agents, and for cancer outcome prediction. A neural network generalizes from the input data to patterns inherent in the data, and it uses these patterns to make predictions or to classify. This paper explains how neural networks work, and it shows that a neural network is more accurate at predicting breast cancer patient outcome than the current staging system. © 1994 Wiley‐Liss, Inc.
Activation of oncogene c‐Ha‐ras in gastric cancer of chinese patients
Authors: Deng Guoren , Eh Zheng , Xu Yi , Lu Youyong
Published: February 2007

A transforming gene was cloned from a focus of rat fibroblast cell line Rat 1 transfected with DNA of a gastrocarcinoma cell line. The transforming gene is the activated form of oncogene c‐Ha‐ras, and the lesion was identified as a single nucleotide substitution at codon 12 by sequencing. We further used polymerase chain reaction (PCR)‐restriction analysis to detect the mutations at codon 12 of c‐Ha‐ras. By using this method, 11 cases out of 24 solid tumors and 3 cell lines of gastric cancer were shown to contain mutations, and there was a strong correlation between mutations and metastasis and survival of the patients. The role of the activated c‐Ha‐ras in tumorigenesis of stomach cancer was further proved through the assay in which the malignant phenotypes of the c‐Ha‐ras‐transformed cells were partially inhibited by blocking the c‐Ha‐ras expression with antisense oligonucleotides or exogenous plasmid expressing antisense RNA. © 1994 Wiley‐Liss, Inc.
Radioimmunoguided surgery in gastric cancer using 131‐I labeled monoclonal antibody 3H11
Authors: Xu Guangwei , Zhang Meiying , Liu Baoguo , Li Zhenfu , Lin Baohe , Xu Xiaobao , Jin Maolin , Li Jiyou , Wu Jian , Dong Zhiwei
Published: February 2007

A clinical trial of radioimmunoguided surgery (RIGS) using 131‐I labeled monoclonal antibody (MAb) 3H11 was performed on 25 cases with gastric cancer in this study. The results showed that the route of the administration of radiolabeled MAb is the key point of successful RIGS for gastric cancer. The RIGS in 19 cases in the group of submucosal injection via endoscope was very satisfying. For the detection of metastatic lymph nodes, the sensitivity rate of RIGS was 99.2% (118/119), the specificity, 97.7% (43/44), and the accuracy 98.8% (161/163). The accuracy rate in detecting tumor infiltration of the gastric wall was 95.9% (94/98), the sensitivity 94.6% (35/37), and the specificity 96.7% (59/61). Thus, the use of RIGS may improve the radical resectability rate and possibly the overall survival rate in patients with gastric cancer. © 1994 Wiley‐Liss, Inc.
Photodynamic therapy for upper gastrointestinal tumours over the past 10 years
Authors: Jin Maolin , Yang Boqin , Zhang Wei , Wang Yanmeng
Published: February 2007

A total of 207 patients with advanced upper gastrointestinal tumors were treated with photodynamic therapy (PDT) from 1982 to 1992. This paper reports on the effectiveness and evaluates the follow‐up survey of the results. The patients were aged 29‐91 years, of whom 189 were men and 18 women. Forty‐eight to 72 hr prior to irradiation, 5 mg/kg of HpD was injected intravenously. An argon pumped dye laser was used with an output beam of 630 nm. The entire tumour received an estimated energy dose of 200‐250 J/cm2. The diagnosis of cancer was confirmed by biopsy and histological examination. Of the 207 cases treated, 45 had cancer of the esophagus, 123 had cancer of the cardia, and 39 had cancer of the stomach. Response to PDT was seen in 146 patients (70.5%), with CR in 31 patients who were followed up for 6 months to 10 years. Seven of the latter patients (22.6%) survived more than 5 years and are still under close follow‐up. © 1994 Wiley‐Liss, Inc.
Peritoneal dissemination after a curative gastrectomy in patients with undifferentiated adenocarcinoma of the stomach
Authors: Ohno Shinji , Maehara Yoshihiko , Ohiwa Hisao , Oshiro Tatsuo , Kakeji Yoshihiro , Baba Hideo , Furusawa Motonosuke , Sugimachi Keizo
Published: February 2007

Peritoneal dissemination is the major pattern of recurrence in patients with gastric cancer. Among the 1,337 patients with gastric cancer who underwent a curative resection, a multivariate analysis showed that the independent risk factors for the occurrence of peritoneal dissemination were an undifferentiated tissue type and serosal invasion. We focus our attention on 477 patients with undifferentiated type tumor, in which the postoperative prognosis and the pattern of recurrence after curative resection were evaluated with regard to the depth of the cancerous invasion in the gastric wall. Patients with tumors limiting to the subserosal layer had a satisfactory post‐operative course, with five‐year survival rates of 98.5%, 97.4%, and 82.5% in patients with tumors limiting to the submucosal layer, the muscularis propria and subserosal layer, respectively. In 179 patients with tumors invading to the subserosal layer, however, the five year survival rate was only 48.2%. Seventy‐one died of peritoneal dissemination, while 24 and 15 were due to hematogenous and local recurrences, respectively. Only 50 (27.9%) survived over 5 years without any recurrence. © 1994 Wiley‐Liss, Inc.
Prognosis of patients with gastric cancer and pyloric stenosis: Histological differentiation
Authors: Watanabe Akihiro , Oshiro Tatsuo , Oiwa Hisao , Ohno Shinji , Adachi Yosuke , Anai Hideaki , Sugimachi Keizo
Published: February 2007

The clinicopathology of gastric cancer with pyloric stenosis was examined with special reference to histological differentiation. One hundred sixteen patients treated in Department of Surgery II, Kyushu University Hospital, were classified into differentiated (DT: n = 47) and undifferentiated types (UT: n = 69). The UT group was significantly younger than the DT group (P < 0.05). There were no differences in the incidence of serosal invasion, liver metastasis, lymph node metastasis, and the clinical stage between the groups. The incidence of peritoneal dissemination of the UT group was 41% (28/69), a value significantly higher than the 23% (11/47) for the DT group (P < 0.05). The 5‐year survival rates of the DT and UT groups were 27% and 16%, respectively, with survival time for the UT group being significantly less than that of the DT group (P < 0.05).

In patients with pyloric stenosis and an undifferentiated adenocarcinoma with the risk of peritoneal dissemination, intensive adjuvant chemotherapy seems essential to improve the prognosis. © 1994 Wiley‐Liss, Inc.
Helix pomatia agglutinin binding activity and lymph node metastasis in patients with gastric cancer
Authors: Kakeji Yoshihiro , Maehara Yoshihiko , Tsujitani Shunichi , Baba Hideo , Ohno Shinji , Watanabe Akihiro , Sugimachi Keizo
Published: February 2007

We made use of Helix pomatia agglutinin (HPA) staining to examine 218 gastric cancer tissues (163 primary tumors and 55 metastatic lymph nodes), using the avidin‐biotin‐peroxidase complex method. The positive HPA staining rate was 59% (96/163) for the primary tumors, and this positive staining correlated well (with statistical significance) with lymphatic invasion and metastasis (P < 0.01). In the metastatic lymph nodes, the majority of cancer cells (49/55: 89%) stained positively for HPA. Tumors with positive HPA staining often metastasized to lymph nodes. Patients with gastric cancer and positive HPA staining of their tumor tissues lived for a shorter time than did those with a negative staining, even in the absence of metastasis to the lymph nodes (P < 0.01). Careful follow‐up and aggressive therapy are required postoperatively for patients with an HPA‐positive gastric cancer. © 1994 Wiley‐Liss, Inc.
Gastric cancer in a general hospital in Japan
Authors: Ikeda Yoichi , Haraguchi Yukiaki , Mori Masaki , Kajiyama Kiyoshi , Yamagata Motoyuki , Adachi Yosuke , Sugimachi Keizo
Published: February 2007

During 20 years from 1971 to 1990, 605 patients with gastric cancer were treated by gastric resection at a medium‐size general hospital by one surgeon. The overall 5‐year survival rate was 61.9%. The 5‐year survival rates in the first 10 years (n = 261) and the second 10 years (n = 344) were 53.7% and 67.9%, respectively (P < 0.01). In the second 10 years there was a significant increase in the patients with early gastric cancer (P < 0.01). Meanwhile, operative procedure or R2 or R3 lymph node dissection did not show any improvement of the 5‐year survival rates. These results indicate that the prognosis for gastric cancer was relatively good at a general hospital which does not specialize in cancer research, and that much of the improvement in the prognosis could be attributed to the increase in the incidence of patients with early gastric cancer. © 1994 Wiley‐Liss, Inc.
Diet and adenomatous polyp risk
Authors: Nelson Richard L.
Published: February 2007

Studies of risk factors for colonic adenomatous polyps have been reported in greater numbers in 1993 than in all previous years combined. This explosion in interest in polyps has not arisen because polyps themselves cause serious illness. They are in the vast majority of cases asymptomatic. However, adenomas have become the surrogate for colon cancer in a number of phase III dietary intervention trials. These trials were undertaken at a time when very little was known of adenoma risk factors. Data accumulated in the past 18 months in general demonstrate a similarity in risk factors for cancer and polyp. Since it has also been recently established that polypectomy diminishes colon cancer risk, the adenomatous polyp has been established as an ethical and convenient surrogate for cancer of the colon. Prevention of colorectal cancer is the goal of all the above studies, and it is hoped that the dietary intervention trials currently under way will generate the data that will make prevention possible. © 1994 Wiley‐Liss, Inc.
Colorectal cancer recurrence and perioperative blood transfusions: A critical reappraisal
Authors: Busch Olivier R. C. , Marquet Richard L , Hop WIM C. J. , Jeekel Johannes
Published: February 2007

The last 2 decades the immunomodulatory effect of blood transfusions has been investigated intensively. The effect of blood transfusions on the prognosis of colorectal cancer patients is reviewed in this paper. We made an evaluation of the material from animal and from clinical studies present in the literature. The results from clinical randomized trials dealing with this subject, which have been published recently, are discussed as well. © 1994 Wiley‐Liss, Inc.
Causes of death and postsurgical survival in familial adenomatous polyposis: Results from the italian registry
Authors: Bertario Lucio , Presciuttini Silvano , Sala Paola , Rossetti Carlo , Pietroiusti Marcello
Published: February 2007

Causes of death were evaluated among 350 deceased patients with familial adenomatous polyposis (FAP) recorded in the Italian Polyposis Registry: 78.1% were due to colorectal cancer, 9.5% to extracolonic cancer (more than half of the upper gastrointestinal tract), 3.6% to desmoid tumors, and 8.8% to other causes. The age at diagnosis among 604 patients was studied in relation to presence of symptoms at presentation and presence of colonic cancer at surgery. In asymptomatic patients younger than 30 years the risk of colonic cancer was 3.3% and in symtomatic patients older than 40 it was 80%. A life‐table analysis showed that postsurgical survival among patients without cancer at colectomy was 68% after 30 years, whereas that of patients with cancer was 41% after 10 years. The alternative prophylactic treatments of total colectomy with ileorectal anastomosis versus total proctocolectomy (IRA vs. IAA) were compared in terms of postsurgical survival. Both treatments showed a survival of 83% after 10 years. The risk of cancer in the rectal stump after IRA was 14.5% after 15 years and 25.2% after 25 years; the corresponding risks of dying from it were 4.3% and 9.3%, respectively. © 1994 Wiley‐Liss, Inc.
Anal adenocarcinoma: A comprehensive review
Authors: Tarazi Raed , Nelson Richard L.
Published: February 2007

Adenocarcinoma of the anal canal is a rare form of a rare tumor. It remains less prevalent than both basaloid and keratinizing tumors of the anal canal. Within the category of anal adenocarcinomas, uniformity in histology, biology, or etiology is lacking. This makes subdivision of this rare entity by various parameters necessary. Several etiologic associations have been described, such as chronic fistula‐in‐ano, anal Crohn's disease, and anal sexual intercourse, raising the issue of cancer prevention and early detection.

Various available therapeutic options are also discussed with emphasis on the seemingly promising results of preoperative chemo‐ and radiation therapy. Because of the rarity and apparent heterogeneity of this tumor, no comparative or analytic epidemiologic studies have been conducted that might resolve these issues.

Whether histology differentiates anal adenocarcinoma from anal squamous or cloacogenic tumors in the determination of natural history and allocation to optimal therapy remains unclear. It may be that the gross anatomic location of the tumor alone determines the above and histology is superfluous. © 1994 Wiley‐Liss, Inc.
Evolution of screening for epithelial ovarian carcinoma: The quest for early diagnosis
Authors: Look Katherine Y.
Published: February 2007

Epithelial ovarian carcinoma remains the most fatal of gynecologic malignancies, causing approximately 13,300 deaths annually. This high mortality rate is due to the presence of advanced stage disease at time of diagnosis. Symptoms early in the course of the disease are frequently nonspecific and go unrecognized by both the patient and the physician. The cause‐specific mortality may decrease if a sufficiently sensitive screening modality can be developed to allow early diagnosis and curative therapy. The ideal screening tests or algorithm utilizing several tests must have sufficient specificity to minimize false positives, which contribute to patient anxiety and inefficient use of health care dollars. The development and refinement of the various methodologies used in screening of epithelial ovarian carcinoma will be the subject of this review. © 1994 Wiley‐Liss, Inc.
Second‐line chemotherapy for refractory cancer: Intraperitoneal chemotherapy
Authors: Markman Maurie
Published: February 2007

Over the past decade intraperitoneal therapy in the management of ovarian cancer has evolved from a pharmacokinetic concept into a rationale treatment strategy for a specific subset of patients with this disease. Patients with small‐volume residual ovarian cancer (microscopic disease only or macroscopic tumor with largest tumor nodule ≤ 0.5 cm in maximum diameter) when treatment is initiated are reasonable candidates to be considered for this therapeutic strategy. At least for salvage platinum‐based intraperitoneal therapy, a documented prior response to systemic cisplatin or carboplatin helps to define a patient population who would be anticipated to have the greatest opportunity to respond to a regional treatment approach. © 1994 Wiley‐Liss, Inc.
Role of radiotherapy in the treatment of cancer of the ovary
Authors: Morton Gerard , Thomas Gillian M.
Published: February 2007

The initial management of carcinoma of the ovary is surgical. The need for further treatment is determined by a consideration of tumor stage, grade, and the presence of residual disease. Approximately one‐third of patients are suitably managed by primary post‐operative radiotherapy directed to the entire abdomen and pelvis with curative intent. Patients are mainly derived from stages i and ii. Stage iii patients are also included if the tumor is of low grade and there is no pelvic residuum. The dose which can be safely delivered to the upper abdomen is limited by normal tissue tolerance. Curative radiation is inappropriate for patients with upper abdominal disease and/or more than small volume residuum in the pelvis. These patients are best managed with chemotherapy. Suitably selected patients have a ten‐year relapse‐free survival of 68% following radiotherapy. Acute gastrointestinal symptoms are common during the treatment, but are usually amenable to symptomatic management. Long term morbidity is infrequent, and with modern techniques the incidence of treatment‐related small bowel obstruction is around 5%. Radiotherapy to the abdomen and pelvis has also a potential role as consolidative treatment in patients with advanced disease, following a favourable response to chemotherapy © 1994 Wiley‐Liss, Inc.
Molecular determinants of soft tissue sarcoma proliferation
Authors: Pollock Raphael E.
Published: February 2007

Soft tissue sarcoma is an extremely rare malignant disease that includes more than 15 distinct histologic subtypes. While all share a propensity for metastasis to the lungs, the clinical presentation and pattern of spread for the specific subtypes are remarkably viable. Little is known about the etiology of soft tissue sarcoma other than several well described epidemiological associations between ionizing and other toxic agents and several of the soft tissue sarcoma histologic subtypes. The key to understanding the etiologic factors driving soft tissue sarcoma proliferation and dissemination lies in understanding the molecular mechanisms underlying these oncologic processes. Progress in this regard has been difficult because of the rarity of this disease. This report reviews the current state of knowledge for three of the most important considerations involving the molecular etiology of soft tissue sarcoma: growth factors and their receptors, nuclear and cytoplas‐mic oncogenes, and tumor suppressor genes. As we learn more about these molecular mechanisms leading to proliferation and dissemination of soft tissue sarcoma, molecularly based genetic therapies will become a reality for this all too devastating, albeit rare, disease. © 1994 Wiley‐Liss, Inc.
Operative management of soft tissue sarcomas: Impact of anatomic site
Authors: Lawrence Walter
Published: February 2007

Operative management of soft tissue sarcomas begins with the surgical biopsy. Incisional biopsy of an undiagnosed soft tissue mass allows optimal later definitive resection, this resection including the entire biopsy wound, as well as accomplishing an “adequate” margin around the sarcoma. The principles employed for this resection are those that lead to adequate gross and microscopic margins of normal tissue around the sarcoma while considering the limitations, in terms of physical disability, from the procedure itself. This operative strategy is described for various anatomic locations, such as the extremities, trunk, retroperitoneum, and head and neck; special problems with each of these primary sites are discussed. © 1994 Wiley‐Liss, Inc.
Retroperitoneal sarcomas
Authors: McGrath Patrick C.
Published: February 2007

Retroperitoneal sarcomas are rare malignant tumors, accounting for approximately 10‐20% of all soft tissue sarcomas. Because of their anatomic location and indolent nature, these tumors are usually quite extensive when first detected with little hope of improvement in the early detection rate. Improved survival rates will therefore depend on obtaining better local control through an aggressive surgical approach, making every effort to achieve a complete resection with histologic negative margins, which in most cases will require the resection of adjacent organs or vascular structures. Even with such aggressive surgical approach, continued problems with local recurrence are reported and it is important to follow patients who had undergone surgical resection very carefully in order to identify those who would benefit from reresection. The results of postoperative adjuvant irradiation and/or chemotherapy have so far been discouraging. Until there is a national registry and a national intergroup study to develop strategies and innovative trials for the effective treatment of these tumors, it is unlikely that there will be much improvement in the current survival rates. © 1994 Wiley‐Liss, Inc.
Sarcomas related to the heart and vasculature
Authors: Raaf Heather N. , Raaf John H.
Published: February 2007

Soft tissue sarcoma is the most common malignant neoplasm of the heart, pericardium, and great vessels. Its presentation is infrequent, nonspecific, and subtle. For example, emboli from these tumors to the lungs or peripheral arteries may mimic thrombotic embolic disease. New noninvasive techniques such as echocardiography and magnetic resonance imaging (MRI) aid in diagnosis and preoperative assessment. Angiosarcoma, the most common cardiac sarcoma, is aggressive and usually arises in the right atrium. Kaposi's sarcoma of the heart has been found in patients with AIDS and in immunosuppressed organ transplant recipients. Most primary sarcomas of the aorta and pulmonary artery (the elastic arteries) show minimal differentiation and are classified as “intimal sarcomas,” whereas leiomyosarcomas predominate in the muscular arteries and great veins. Surgical resection of any sarcoma of the vasculature, when feasible, is technically challenging but may result in cure or palliation. Adjuvant chemotherapy and radiation therapy can also relieve symptoms and prolong survival. © 1994 Wiley‐Liss, Inc.
Laparoscopic surgery for colorectal neoplasms
Authors: Ambroze Wayne L. , Orangio Guy R. , Armstrong David , Schertzer Marion , Lucas George
Published: February 2007

Laparoscopy is being used to assist in an increasing number and variety of bowel procedures. However, when being used for neoplastic disease concerns of margins and adequacy of mesenteric dissection must be addressed. We've performed 110 laparoscopic‐assisted bowel procedures, with 45 of these performed for neoplastic disease. Ninety‐two bowel resections were performed including 24 subtotal, total, or proctocolectomies. In this chapter we review the results of our series, as well as other reported series, and discuss some of the controversies involved with laparoscopy for neoplastic disease. © 1994 Wiley‐Liss, Inc.
The role of laparoscopy in diagnosis and treatment of primary or metastatic liver cancer
Authors: Eubanks Steve
Published: February 2007

Laparoscopy is considered a modality complimentary to the current staging techniques. Radiology offers sophisticated evaluations such as CT, MRI, ultrasound, and invasive vascular radiologic procedures. Laparoscopy when applied appropriately can provide a diagnosis with increased accuracy and eliminate unnecessary delays in formulating a treatment plan. If a patient appears to have a resectable lesion or lesions and is deemed an acceptable surgical candidate, it is appropriate for laparoscopy to be performed just prior to opening the abdomen for purposes of hepatic resection. The techniques of biopsy, laparoscopic intra‐abdominal ultrasound, and the limitations of laparoscopy are discussed in detail. Lastly, the role of laparoscopic hepatic resection and its application, particularly in superficial or peripheral lesions, is presented. The role of laparoscopy in hepatic lesions is evolving where it is obvious that it offers benefits not available through other means in evaluating the liver tumor. © 1994 Wiley‐Liss, Inc.
Laparoscopic nephrectomy and adrenalectomy
Authors: Albala David M.
Published: February 2007

Laparoscopic surgery is a rapidly evolving technique in minimally invasive surgery. In the 1970s and 1980s, the greatest advances in laparoscopy were achieved by the gynecologists. Urologist, however, have used the laparoscope for many diagnostic as well as therapeutic procedures. The initial urological procedures performed included the localization of undescended testicles. Following this, procedures such as pelvic lymphadenectomy and varix ligation became common. This paper will review the current applications of laparoscopic nephrectomy and adrenalectomy. © 1994 Wiley‐Liss, Inc.
Laparoscopic staging of prostatic carcinoma
Authors: Schoborg Thomas W.
Published: February 2007

Current treatment of prostate cancer is highly controversial, however accurate assessment of pelvic lymph node status is important to determine early in the course of therapy if adjuvant hormonal ablation is necessary. Indications for laparoscopic assessment of pelvic lymph nodes are now better defined and the technique requires a high degree of technical skill and expertise. A series of 50 patients who underwent laparoscopic pelvic lymphadenectomy is presented. A greater than 40% chance of node positivity was found in a group of patients who had either a clinical stage B2, C, DO, or a prostate‐specific antigen level greater than 40 ng/dl, or a total Gleason score of 7, 8, 9, or 10. Laparoscopic pelvic lymphadenectomy remains the current method to accurately stage lymph node involvement in prostate carcinoma.©1994 Wiley‐Liss, Inc.
Radical prostatectomy or deferred treatment?
Authors: Studer Urs E.
Published: February 2007

Screening for prostate cancer has intensified, due both to increased patient and physician awareness and to the availability of new, more sensitive diagnostic tools (prostate‐specific antigen [PSA], rectal ultrasound, etc.). Consequently, the number of newly diagnosed cases of prostatic cancer is rising rapidly, whereas the frequency of death due to prostate cancer remains almost stable. It must therefore be assumed that the number of patients in whom a diagnosed prostate cancer will not be fatal is also increasing. Consequently, not every prostatic carcinoma requires radical treatment when diagnosed. Also, it must be concluded that not every man who is a long‐term survivor after radical prostatectomy owes his survival to the treatment. Long‐term survival may reflect the relatively benign biological potential of this disease in an individual patient. Therefore there is an inherent risk of overtreat‐ing patients and this must be weighed against the costs, the postoperative morbidity, and the mortality, albeit low, of a radical prostatectomy. Nevertheless, as long as we do not have diagnostic tools which, at an early stage of prostatic cancer, enable us to determine whether a carcinoma will ultimately have a fatal outcome, we are obliged to offer a radical prostatectomy to younger patients (who have a life expectancy of more than 10 years) as long as they have organ‐confined disease. © 1995 Wiley‐Liss, Inc.
Radiotherapy of prostate cancer: Established results and new developments
Authors: Dearnaley David P.
Published: February 2007

Radical radiotherapy has been established as an effective modality for eradicating localised prostate cancer. No satisfactory comparisons have been made with patients treated by total prostatectomy, but in surgically staged patients with negative lymph nodes survival after radiotherapy exceeds that of an aged matched population, cancer deaths occurring in only 6–15% of patients and 85% remaining free of local recurrence after 10 years. Results are predictably less satisfactory in surgically unstaged cases and for more advanced localised presentations. Nevertheless, radical radiotherapy achieves local control of disease in the majority of patients. Improved local control may be obtained by increasing radiation dose but at the expense of increased radiation‐induced side‐effects. Conformai radiotherapy and combined modality treatment with the neoadjuvant or adjuvant androgen deprivation show considerable promise as novel methods to improve the therapeutic ratio, and prospective randomised studies are underway to test these approaches. © 1995 Wiley‐Liss, Inc.
European trials and the management of prostate cancer
Authors: Newling D. W. W.
Published: February 2007

Efforts continue to improve the outlook for patients with all stages of prostate cancer. The addition of adjuvant or neo‐adjuvant hormone therapy to radical prostatectomy may improve the curability of advanced localized disease. Various novel forms of maximal androgen blockade continue to be explored, including the reintroduction of safer forms of estrogen therapy. Chemotherapy remains largely experimental but its earlier introduction, when the patient's general condition remains good, may lead to improvement in the quantity and quality of life of patients with advanced disease. © 1995 Wiley‐Liss, Inc.
Pathobiology of cancer of the pancreas
Authors: Digiuseppe Joseph A. , Hruban Ralph H.
Published: February 2007

The diagnosis of infiltrating adenocarcinoma of the pancreas is associated with an overall 5‐year survival of less than 5%. Although surgical resection has improved the prognosis for patients with localized disease, in the absence of ancillary techniques, clinical and pathologic assessment of pancreas cancer fails to predict outcome in many patients. Recent work has focused on the genetic alterations in pancreas cancer, offering the promise of improving our ability not only to predict survival but also to select the most appropriate therapy. The study of genetic alterations in colon cancer, wherein mutations in the oncogene, K‐ras, and the loss of functional activity of several tumor suppressor genes is required for progression from small adenoma to invasive carcinoma, has served as a paradigm for the molecular analysis of pancreas cancer. A similar pattern is emerging for pancreas cancer, in that there is apparently progression from intraductal lesions to invasive cancer, and that K‐ras, and several tumor suppressor genes, including p53, deleted in colon cancer (DCC), and multiple tumor suppressor‐1 (MTS1), are frequent targets of mutation and/or deletion. Cytogenetic studies and molecular studies assessing allelic loss suggest that several additional oncogenes and tumor suppressor genes involved in the pathogenesis of pancreas cancer remain to be discovered. These recent findings enhance our understanding of the etiology of carcinoma of the pancreas, and serve as the basis for the early detection and, potentially, improved treatment of this typically fatal malignancy. © 1995 Wiley‐Liss, Inc.
Early diagnosis of pancreatic carcinoma—Reality or oxymoron?
Authors: Malik Amer
Published: February 2007

The greatest impact on survival in pancreatic carcinoma will most likely be from earlier diagnosis. Newer technologies have surfaced and dramatic improvements in existing diagnostic techniques have occurred in detecting smaller tumors. Fast spiral CT scans utilizing dynamic intravenous contrast have resulted in very high resolution of small masses while improving accuracy of vascular staging. Improved cytology brushes and biopsy forceps during ERCP should improve the preoperative diagnosis of malignancy. Endoscopic ultrasound similarly is proving very useful for detecting small lesions, depth of invasion, and vascular involvement. Specialized use, lengthy training, and cost may limit its dissemination though. Also remarkable has been vastly improved MR images with 3‐D reconstruction (Magnetic Resonance Cholangiopancreatography). Randomized controlled trials comparing these improved and new techniques are awaited. © 1995 Wiley‐Liss, Inc.
Pancreaticoduodenectomy: The Johns Hopkins experience
Authors: Cameron John L.
Published: February 2007

Some 60 years after Whipple popularized pancreaticoduodenectomy for carcinoma of the head of the pancreas, we have finally learned how to do the operation safely. When it is done before lymph node spread, the operative procedure can substantially prolong survival. The task for the immediate future is to identify a solid tumor marker that will facilitate earlier diagnosis of this disease at a stage prior to lymph node spread. In addition, adjuvant therapy which has clearly been shown to be effective, needs to be improved. © 1995 Wiley‐Liss, Inc.
Pancreatic cancer: An overview
Authors: Wanebo Harold J. , Vezeridis Michael P.
Published: February 2007

There are about 27,000 new cases of carcinoma of the pancreas each year and most afflicted patients will die of the disease. Although smoking is a common denominator, chronic pancreatitis is considered to be an important precursor lesion, but to a much lesser degree. Pancreatic cancer is primarily a disease of the pancreatic ducts. The molecular events are under intense study, but c‐K‐ras mutation is involved in about 80% of the cases and p53 to a slightly lesser degree (60–80%). Early manifestations are usually occult with jaundice being a relatively early manifestation. Diagnostic imaging with thin slice computerized tomography and portography, along with endoscopic retrograde cho‐langiopancreatography (ERCP), are currently the most sensitive detection techniques. The developing use of endoscopic ultrasound and laparoscopy appear to enhance detection and are under evaluation. In advanced disease, endoscopic bypass may eliminate the need for unnecessary surgery in many patients, although gastrointestinal bypass is still required in some (10–15%). Curative resection is possible in selected patients (perhaps 10–15%) with expectation of extended survival ranging from 6 to 20% in some series. The survival differences may be related to stage, patient selection, and the expertise of the operative team. Pre‐operative chemoradiation is under study and may improve outcome. Clinical trial participation is essential for improvement in treatment outcomes. © 1995 Wiley‐Liss, inc.
Advances in osseointegrated implants for dental and facial rehabilitation following major head and neck surgery
Authors: Beumer John , Roumanas Eleni , Nishimura Russell
Published: February 2007

Osseointegrated implants can be used to facilitate rentention stability and support for facial and intraoral prostheses used to restore head and neck defects. Preliminary studies indicate that in nonirradiated maxillectomy patients the success rates are about 75%. In the reconstructed mandible the results appear to be more favorable—over 90% for implants placed in free nonvascularized bone grafts and over 90% for free revascularized bone grafts. Similar high success rates have been observed for most sites used to support facial prostheses. Success rates for auricular sites exceed 95% and for floor of nose sites success rates exceed 90%. Success rates have been lower (77%) for implants placed in the frontal bone for retention of orbital prostheses. Success rates for irradiated bone sites have been lower and range from 60.4% in the maxilla to 68.6% in facial bone sites. Of greater concern is that most implants placed in irradiated sites are beginning to show signs of impending failure. © 1995 Wiley‐Liss, Inc.
Reconstruction of the pharynx and cervical esophagus
Authors: Coleman John Joseph
Published: February 2007

The recent twenty years have brought major advances in reconstruction of pharyngoesophageal defects. Early dependence on multiple staged procedures initially were replaced by colon interposition and gastric pull‐up. Subsequent elucidation of the musculocutaneous concept has added useful techniques such as the sternocleidomastoid and pectoralis major musculocutaneous flaps. Increasing experience with microsurgical reconstruction and a larger number of flaps available have made free tissue transfer a common and reliable method of reconstruction of significant defects.

The choice of reconstruction depends to greatest degree on the oncologic needs of the situation. If the entire esophagus or significant part of the thoracic esophagus is involved by tumor then total esopha‐gectomy and gastric pull‐up or colon interposition is indicated. For most hypopharyngeal and laryngopharyngeal tumors, and a significant number of cervical esophageal tumors, segmental resection of the area with the appropriate node dissection and replacement with a jejunal free autograft or radial forearm free flap gives a high likelihood of success. Thoracic musculocutaneous flaps may be useful if proper precautions are observed in the reconstructive technique. This article presents the accumulated experience with these techniques and management of the subsequent problems. © 1995 Wiley‐Liss, Inc.
Changing trends in the management of salivary tumors
Authors: Spiro Ronald H.
Published: February 2007

Fine‐needle aspiration biopsy (FNAB) and computed tomography (CT) or magnetic resonance imaging (MRI) are useful in the evaluation of salivary gland tumors, but they are not essential for treatment planning in every patient. The mainstay of therapy is a well‐planned and carefully executed surgical procedure which adequately excises the tumor. Disease‐free survival is very likely in patients with early stage malignant tumors. When treatment is delayed until the tumor is extensive (Stage 3,4), local recurrence and distant metastases are common and survival rates are low. Adjunctive postoperative radiation therapy can enhance locoregional control in the latter patients, but does not invariably lead to better survival. No consistently effective chemotherapy agents or combinations are presently available. Early diagnosis and consistent, high quality treatment offer the best hope for improved survival. © 1995 Wiley‐Liss, Inc.
Advances in radiotherapy for head and neck cancer
Authors: Mendenhall William M. , Parsons James T. , Buatti John M. , Stringer Scott P. , Million Rodney R. , Cassisi Nicholas J.
Published: February 2007

Selected advances in radiotherapy for treatment of head and neck cancer are reviewed. These include the role of postoperative radiotherapy, planned postirradiation neck dissection, altered fractiona‐tion, neoadjuvant chemotherapy and radiotherapy for laryngeal preservation, three‐dimensional conformal treatment planning, charged particle irradiation for skull base tumors, and stereotactic radiosur‐gery. © 1995 Wiley‐Liss, Inc.
Chemotherapy advances in head and neck oncology
Authors: Liggett William , Forastiere Arlene A.
Published: February 2007

Chemotherapy has an expanding role in the treatment of squamous cell carcinoma of the head and neck. Patients with recurrent or meta‐static disease that have a good performance status should receive combination therapy with cisplatin and 5‐fluorouracil or enter investi‐gational protocols. Neoadjuvant chemotherapy should be offered to patients with laryngeal carcinoma as an alternative to surgery. Adjuvant chemotherapy should be considered in patients with an increased risk for relapse. Combined chemoradiotherapy may improve locore‐gional control and impact on survival. Chemoradiotherapy warrents further investigation through clinical trials and should be considered for patients at high risk for relapse. As the biology of these tumors becomes better defined, so too will our ability to define subsets of patients who may benefit from combined modality treatment. © 1995 Wiley‐Liss, Inc.
Basic science advances in head and neck oncology: The past decade
Authors: Schantz Stimson P.
Published: February 2007

Research advances over the past decade have led to a changing perception of the natural history of head and neck cancer. For instance, we now have the capacity to quantify and characterize various environmental carcinogens bound to mucosal DNA. These DNA adducts provide a quantitative measure of a disease process which exists long before clinically defined cancer is recognized. Similarly, histopathologically normal mucosa within head and neck cancer patients is currently known to express multiple genetic abnormalities including increased cellular DNA content, mutations in cell regulatory genes, as well as alterations in growth factors and their associated receptors. These subclinical events may, likewise, be associated with aberrant cellular proliferation and differentiation which provide a target for subsequent therapy. Disease invasion and metastases is now seen as a heterogenous process involving a complex of factors intrinsic to both the host as well as the cancer. Most significantly, advanced disease is not simply defined by its size and location. Rather, the progression of head and neck cancer is a dynamic process characterized by increasing genetic instability leading to an accumulation of critical mutational events. A biologic basis for resistance to treatment is thus being defined. Treatment strategies based on these laboratory advances are emerging and involve monoclonal antibody targeting, cytokines produced through recombinant molecular technology, and gene therapy. © 1995 Wiley‐Liss, inc.
Laser photochemotherapy: A less invasive approach for treatment of cancer
Authors: Saxton R. E. , Paiva M. B. , Lufkin R. B. , Castro D. J.
Published: February 2007

The effectiveness of combining surgery with chemo‐ and radiation therapy in treatment of human cancer provides a useful model for further development of new multimodality approaches including laser photochemotherapy. Laser endoscopy often is a useful treatment for obstructive tumors in airways, but interstitial laser fiberoptics is becoming a more precise, minimally invasive alternative for ablation of unresectable or recurrent neoplasms. Combining intratumor chemotherapy with laser energy delivery via interstitial fiberoptics should be most effective using drugs activated by photothermal energy. A number of investigators have shown that anthracyclines and cis‐platinum are likely candidates for light or heat activation in cancer cells. An advantage of anthracyclines is their dual role as antitumor drugs and as photosensitizers. Because they are effective chemotherapy agents without photoactivation, two approaches are possible to increase tumor responses. Maximum tolerated dose followed by photoillumina‐tion via laser fiberoptics can be used to obtain better tumor palliation. Improved treatment response to lower intratumor drug levels after laser activation also should reduce systemic toxicity. Preclinical studies and recent case reports from several groups suggest photochemotherapy with currently approved drugs and lasers may soon become an attractive alternative for treatment of recurrent tumors in cancer patients. © 1995 Wiley‐Liss, Inc.
Nd:YAG laser procedures in tumor treatment
Authors: Philipp Carsten M. , Rohde Ewa , Berlien H.‐Peter
Published: February 2007

Due to the wide variability of tissue interactions and the possibility of specific applications, the neodymium‐yttrium‐aluminum‐garnet (Nd:YAG) laser is the most important surgical laser. With the adequate choice of application mode and relationship between interaction time and power density, it can be used for precise cutting in the contact mode with the bare fiber, with either a wide or small coagulation seam. With a handpiece a precise focal coagulation for preparation and hemostatic purposes is possible, as well as cutting with the focussed noncontact beam where additionally a wide coagulation seam is necessary. Endoscopically guided coagulation, vaporization, and cutting are possible with bare fibers which can be introduced through nearly all endoscopes. With increasing importance, the possibility for wide and homogeneous volume coagulation is used to destroy diseased tissues either by noncontact irradiation or interstitial placement of the fiber. Thus, the field of laser application in tumor therapy ranges from the treatment of superficial tumors to endoscopie tumor ablation, resection of neoplastic tissue in parenchymatous organs, and interstitial thermotherapy with coagulation of deep‐seated primary and secondary malignancies. With its different application modes the laser can be used as a surgical instrument or as a central therapeutical method, whereby perfect control of tissue interactions is always possible by using either visual control for superficial and endoscopie procedures or magnetic resonance imaging and color‐coded duplex sonography as a control for interstitial procedures. During 12 years of clinical work we have developed several application modes and have proved the NdrYAG laser to be an effective instrument in tumor therapy. © 1995 Wiley‐Liss, Inc.