bluuebunny/crossref_metadata_2025 huggingface dataset:
The self as a moral concept
Authors: Lewis Yvette
Published: July 2003

A case is made for the epistemological and ontological premises of social constructionism against arguments that it is subjectivist. From this, questions about the ‘status’ of the self, and its centrality (or not) to experience, emerge. Arguments for the de‐centralization and centralization of the self are discussed, with particular attention to the embodied‐embedded quality of the self, from which the spatiotemporal metaphors of ‘positioning’, ‘narrative’ and ‘voicedness’ have arisen. It is argued that communication is inherently evaluative and that the self is a ‘special case’ of evaluation (in terms of moral agency): the self and morality are, therefore, conceptually linked. The concept of a relational self‐of‐selves is one that, it is argued, emerges from dialogic processes ‐ processes that draw upon these metaphors of embodiment and generate high orders of reflexivity. Thus, social constructionism yields a sophisticated account of self‐hood, agency and responsibility.
Bill and Monica: Memory, emotion and normativity in Clinton's Grand Jury testimony
Authors: Locke Abigail , Edwards Derek
Published: July 2003

We examine links between factual recall, emotion and constructions of normativity in narrative accounts, using as an empirical case President Clinton's descriptions of his relationship with Monica Lewinsky. We analyse those accounts in the sequences of talk in which they occurred, under Grand Jury cross‐examination. Clinton's accounts of Lewinsky were part of how he attended to issues alive in court concerning himself, including his possible exploitation and abuse of power in an asymmetrical relationship; his motives, sincerity, credibility and intentions; and, indirectly, his fitness for office as President. Analysis focuses on how Clinton's portrayal of Lewinsky accomplished a reflexive portrayal of himself, not as mendacious and exploitative, but as caring, responsible, sincere, rational and consistent, while reducing the scope and implications of their admitted sexual relationship. This study is linked to a broader discursive psychology of factual description, memory, mental and emotional states, and their relevance to the larger business of institutional settings.
Thinking about gender types: Cognitive organization of female and male types
Authors: Vonk Roos , Ashmore Richard D.
Published: July 2003

We examined the content and dimensional structure of a large and representative sample of gender types. In Study 1, using an open‐ended procedure, participants generated 306 different labels for female types (e.g. housewife, feminist, femme fatale, secretary, slob) and 310 for male types (e.g. workaholic, family man, sissy, womanizer, labourer). In Study 2A, a multidimensional configuration of 229 of these male and female types was derived from a free sorting task among a new set of participants. In Study 2B, a subset of types was judged on several dimensions of meaning, which were then fitted into the configuration of types. The most important dimensions in describing the structure of gender types were: young‐old, masculine‐feminine and traditional‐modern. The masculine‐feminine dimension showed that the male and female types were largely separated from each other; within each gender category, the types were ordered by their position on the masculine‐feminine dimension. Several other aspects of current thinking about men and women are discussed.
Doing cognitive distortions: A discursive psychology analysis of sex offender treatment talk
Authors: Auburn Timothy , Lea Susan
Published: July 2003

Theories of sex offending have for several years relied upon the notion of cognitive distortions as an important cause of sexual offending. In this study we critique this notion and suggest that the sort of phenomenon addressed by cognitive distortions is better understood by adopting a discursive psychology approach. In this approach, talk is regarded as occasioned and action oriented. Thus ‘cognitive distortions’ are conceptualized as something people do rather than something that people have. Sessions from a prison‐based sex offender treatment programme were taped and transcribed. A discursive psychology analysis was conducted on those sessions relating to offenders' first accounts of their offences. Our analysis suggests that offenders utilize a particular narrative organization to manage their blame and responsibility for the offence. This organization is based on a first part which is oriented to quotidian precursors to the offence and an immediately following second which is oriented to a sudden shift in the definition of the situation. The implications of this analysis are discussed, in relation to the status of cognitive distortions and treatment.
Who wants to know? The effect of audience on identity expression among minority group members
Authors: Barreto Manuela , Spears Russell , Ellemers Naomi , Shahinper Khosrow
Published: July 2003

Statements of social identification among ethnic minority members were examined as a function of group membership of the participants, group membership of the audience, and personal identifiability. In Study 1, Turkish migrants and Iranian refugees in the Netherlands expressed their identification with native and host groups as a function of the audience implicit in the language of the questionnaire (native, host). Turks stressed identification both with native and with the host group more to the host audience, whereas Iranians did not. Both groups, but particularly the Turks, emphasized the adaptation problems and associated stress, to the host culture and to the host audience. In Study 2, identification with native and host group was examined among Portuguese migrants in the Netherlands, as a function of audience (native, host) and personal identifiability (anonymous, identifiable). Degree of identification with native and host groups depended both on the audience and on personal identifiability. Results from both studies are explained primarily in terms of strategic self‐presentation of identities, determined by the relation between the group and the audience. In general, participants address identity claims to audiences that might question these claims (or are in a position to redress grievances), although because of reality constraints, this is easier when anonymous.
Population‐based patterns of human immunodeficiency virus‐related Hodgkin lymphoma in the Greater San Francisco Bay Area, 1988–1998
Authors: Glaser Sally L. , Clarke Christina A. , Gulley Margaret L. , Craig Fiona E. , DiGiuseppe Joseph A. , Dorfman Ronald F. , Mann Risa B. , Ambinder Richard F.
Published: July 2003

BACKGROUND

Epidemiologic characteristics of human immunodeficiency virus (HIV)‐related Hodgkin lymphoma (HL) have not been examined in the Greater San Francisco Bay Area, a center of the HIV/acquired immunodeficiency syndrome (AIDS) epidemic, for a decade, despite changes in AIDS‐associated diseases after the availability of highly active antiretroviral therapies (HAART).

METHODS

With population‐based cancer registry data for 1988–1998, the authors examined risk factors, Epstein–Barr virus (EBV) association, incidence rates, and survival probabilities for 1752 patients with HL who were classified as HIV‐positive or HIV‐negative by a cancer registry‐based method.

RESULTS

One hundred twenty‐eight patients with HL (7%) were classified with HIV/AIDS; 95% were male. Among males, multivariate analysis (n = 514 patients) found that HIV‐related HL was associated strongly at diagnosis with ages 30–49 years, San Francisco residence, late‐stage disease, lymphocyte depletion and unspecified histologic subtypes, and tumor cell EBV but not with other clinical features or mixed cellularity histology. Survival among patients with HIV‐related HL, although it was poor, did not differ by race/ethnicity but was worse for patients with the nonnodular sclerosis histologic subtypes. Patients who were HIV‐positive with HAART era (1996–1998) diagnoses were slightly older, were less likely to live in San Francisco, and were much more likely to be Hispanic compared with HIV‐positive patients who were diagnosed before the HAART era; they had somewhat less aggressive disease and better survival. Incidence rates were higher for patients with HL overall compared with patients who had HIV‐unrelated HL by 11% for white patients, 22% for black patients, and by 14% for Hispanic patients; excesses were greater in young adults.

CONCLUSIONS

Among males in the San Francisco Bay Area, HIV‐related HL had distinctive demographic features, more aggressive clinical characteristics, stronger EBV association, and poorer survival and contributed to elevated regional HL incidence rates, particularly in young adults. Patients with HIV‐related HL who were diagnosed after HAART was introduced appeared to have less aggressive disease and better survival. Cancer 2003;98:300–9. © 2003 American Cancer Society.

DOI 10.1002/cncr.11459
Insights into the mechanisms of lymph node metastasis
Authors: Nathanson S. David
Published: July 2003

The mechanisms by which malignant tumors leave the primary tumor site, invade lymphatics, and metastasize to regional lymph nodes (RLNs) are complex and interrelated. Although the phenomenon of lymph node metastasis has been recognized for over 200 years, the exact mechanisms have only recently been the subject of intense interest and sophisticated experimentation. Sentinel lymph node biopsy has rapidly entered the clinical mainstream for melanoma and breast carcinoma, and this technique has provided confirmation of the orderly anatomic progression of tumor cells from primary site to the RLNs through lymphatic capillaries and trunks. Exciting studies involving the pathophysiology of interstitial fluid pressure in tumors and the peritumoral extracellular matrix have focused on lymphatic flow and tumor microenvironment and microcirculation. Molecular techniques have led to the definition of unique markers found on lymphatic endothelial cells. These markers have enabled scientists to identify peritumoral and intratumoral lymphatics and to visualize the ingrowth of tumor cells into the lumena of lymphatic capillaries. Tumor‐secreted cytokines, such as vascular endothelial growth factors (VEGF)‐C and ‐D, bind to VEGF receptors on lymphatic endothelial cells and induce proliferation and growth of new lymphatic capillaries; this process is similar to the well‐known mechanism of angiogenesis, which results from the proliferation of new blood vessel capillaries. Lymphangiogenesis is associated with an increased incidence of RLN metastasis, and it is possible that this step is essential to the metastatic process. Directional movement toward lymphatics and lymph nodes appears to follow a chemokine gradient, and it is likely that some tumor cells that express certain types of chemokine receptors are more likely to metastasize to the RLNs. In contrast, tumor cells that do not express specific receptors that are responsive to lymphatic chemokines may not metastasize. New knowledge regarding the molecules involved in these processes should enable improvements in prognostic and possibly therapeutic approaches to the management of malignant tumors. Cancer 2003;98:413–23. © 2003 American Cancer Society.

DOI 10.1002/cncr.11464
Fulvestrant versus anastrozole for the treatment of advanced breast carcinoma in postmenopausal women
Authors: Robertson John F. R. , Osborne C. Kent , Howell Anthony , Jones Stephen E. , Mauriac Louis , Ellis Matthew , Kleeberg Ulrich R. , Come Steven E. , Vergote Ignace , Gertler Stan , Buzdar Aman , Webster Alan , Morris Charles
Published: July 2003

BACKGROUND

Fulvestrant (ICI 182,780) is a new type of estrogen receptor (ER) antagonist that down‐regulates the ER and has no known agonist effects. The authors report the prospectively planned combined analysis of data from 2 Phase III trials comparing fulvestrant 250 mg monthly (n = 428) and anastrozole 1 mg daily (n = 423) in postmenopausal women with advanced breast carcinoma (ABC) who previously had progressed after receiving endocrine treatment.

METHODS

The primary endpoint was time to progression (TTP). Secondary endpoints included objective response (OR), duration of response (DOR), and tolerability. The trials were designed to demonstrate superiority of fulvestrant over anastrozole. Noninferiority of fulvestrant versus anastrozole was determined using a retrospectively applied statistical test.

RESULTS

At a median follow‐up of 15.1 months, ≈ 83% of patients in each treatment arm had progressed. The median TTP was 5.5 months in the fulvestrant group and 4.1 months in the anastrozole group, and the OR rates were 19.2% and 16.5% for fulvestrant and anastrozole, respectively (although the difference between treatments was not statistically significant). In patients who responded, further follow‐up (median, 22.1 months) was performed to obtain more complete information on DOR; the median DOR (from randomization to disease progression) in patients who responded to treatment was 16.7 months in the fulvestrant group and 13.7 months in the anastrozole group. In a statistical analysis of DOR (using all randomized patients; from the start of response to disease progression), DOR was significantly longer for patients in the fulvestrant group compared with patients in the anastrozole group. Both drugs were tolerated well; withdrawals due to drug‐related adverse events were 0.9% and 1.2% in the fulvestrant group and the anastrozole group, respectively. The incidence of joint disorders was significantly lower in the fulvestrant group (P = 0.0036).

CONCLUSIONS

Fulvestrant was tolerated well and was at least as effective as anastrozole in the second‐line treatment of patients with ABC. This new hormonaltherapy may provide a valuable treatment option for ABC in postmenopausal women. Cancer 2003;98:229–38. © 2003 American Cancer Society.
Hyperthermia and its modern use in cancer treatment
Authors: Alexander H. Richard
Published: July 2003

In the current issue, Jones et al. have demonstrated that treatment of advanced cervical carcinoma with concurrent hyperthermia, chemotherapy, and radiotherapy is well tolerated and associated with significant efficacy. Although Jones et al. rightly speculate on the connection between experimental and clinical data regarding the antineoplastic role of hyperthermia, it is not clear that the experimental results are relevant to the clinical findings. More than 100 years after the discovery of hyperthermia's activity against advanced cervical carcinoma, the mechanism of this activity and the optimal strategy for harnessing it have yet to be uncovered.
Prospective study of the ability of serial measurements of serum chromogranin A and gastrin to detect changes in tumor burden in patients with gastrinomas
Authors: Abou‐Saif Alaa , Gibril Fathia , Ojeaburu Jeremiah V. , Bashir Showkat , Entsuah Laurence K. , Asgharian Behnam , Jensen Robert T.
Published: July 2003

BACKGROUND

Assessment of tumor burden changes is essential for the management of patients with neuroendocrine gastrointestinal (GI) tumors. Chromogranin A (CgA) is a tumor marker for such tumors; however, to the authors' knowledge, there is little information on whether serial assessments can assess changes in tumor burden. In this prospective study of patients with gastrinomas, serial changes in serum CgA levels were compared with changes in levels of the specific tumor marker gastrin to determine whether they reflected changes in tumor burden.

METHODS

In 72 consecutive patients, the mean CgA and gastrin levels from three determinations were measured on each visit. Changes in markers were correlated with changes in tumor burden determined by imaging. By assessing daily changes, significance changes in CgA and gastrin levels were determined.

RESULTS

During 103 follow‐up visits (mean, 9.6 months), an increased tumor size occurred in 25% of patients, no change occurred in 62% of patients, and a decrease occurred in 13% of patients. In patients who had increasing tumor size, CgA levels increased numerically in 77% of patients, gastrin levels increased in 54% of patients, and the increases were significant in 60–80% of patients. In patients who had tumor stabilization, CgA levels in 63% of patients and gastrin levels in 73% of patients did not show a significant change. Decreased tumor size postresection showed a significant decrease in CgA and gastrin levels in all patients. The sensitivity of CgA and gastrin was as follows: sensitivity for detecting an increase, 62% for CgA and 31% for gastrin; sensitivity for detecting no change, 42% for CgA and 75% for gastrin; and sensitivity for detecting a decrease in tumor size, 85% for CgA and 85% for gastrin. The specificity varied from 53% to 99% for CgA and from 49% to 93% for gastrin.

CONCLUSIONS

In patients with gastrinomas, serum CgA and gastrin levels varied considerably from day to day, and this must be taken into consideration. Both markers had low sensitivity and specificity for detecting tumor increases and stabilization. For large tumor decreases postresection, both markers had high sensitivity and specificity. The current results suggest that these markers do not have sufficient sensitivity to replace serial imaging studies for detecting important smaller changes in tumor burden in patients with gastrinomas. Cancer 2003;98:249–61. Published 2003 by the American Cancer Society.

DOI 10.1002/cncr.11473
A pilot Phase II trial of concurrent radiotherapy, chemotherapy, and hyperthermia for locally advanced cervical carcinoma
Authors: Jones Ellen L. , Samulski Thaddeus V. , Dewhirst Mark W. , Alvarez‐Secord Angeles , Berchuck Andrew , Clarke‐Pearson Daniel , Havrilesky Laura J. , Soper John , Prosnitz Leonard R.
Published: July 2003

BACKGROUND

Five randomized studies have demonstrated a benefit derived from adding cisplatin (CDDP)‐based chemotherapy to radiotherapy (RT) for treatment of cervical carcinoma. The Dutch Phase III pelvic tumor trial demonstrated a survival and local control benefit due to the addition of hyperthermia (HT) to RT. The authors evaluated response and toxicity in patients with locally advanced cervical carcinoma (LACC) who were treated with concurrent weekly CDDP, HT, and RT (whole pelvis [n = 7] and whole pelvis and paraaortic nodes [n = 5]).

METHODS

From August 1998 through December 2000, 12 patients with LACC or locally recurrent cervical carcinoma (LRCC) following hysterectomy were enrolled on a pilot study combining weekly CDDP, HT, and RT.

RESULTS

Ten patients were treated at initial diagnosis. All achieved clinical complete response and durable local control. Two of the 10 experienced recurrence outside the pelvis; 1 of these patients had pulmonary metastasis, and the other had isolated paraaortic nodal involvement. Two patients treated for LRCC experienced local and systemic progression and died of disease within 6 months.

CONCLUSIONS

In this small series, trimodality therapy resulted in an excellent clinical response and was well tolerated. The addition of HT to chemoradiotherapy represents a promising new strategy that warrants multiinstitutional collaborative efforts to confirm its efficacy. Cancer 2003;98:277–82. © 2003 American Cancer Society.

DOI 10.1002/cncr.11475
Management of brain metastases from thyroid carcinoma
Authors: McWilliams Robert R. , Giannini Caterina , Hay Ian D. , Atkinson John L. , Stafford Scott L. , Buckner Jan C.
Published: July 2003

BACKGROUND

Brain metastasis is an uncommon, morbid complication of metastatic thyroid carcinoma. Because of its rarity, management often is problematic. To help contribute to the management of this disease entity, the authors present herein what to their knowledge is the largest series reported to date in which all patients had biopsy proven confirmation of their brain metastases.

METHODS

The authors report a series of 16 patients with metastatic thyroid carcinoma to the brain who were treated between 1976–2000. The Mayo Clinic database was used to locate and review charts and radiology and pathology reports, and all biopsy specimens were reviewed by one pathologist. The histologic types of carcinoma included 10 papillary carcinomas, 2 follicular carcinomas, 1 Hürthle cell carcinoma, 1 medullary carcinoma, 1 insular carcinoma, and 1 anaplastic carcinoma. Given the small sample size, statistical analyses were not performed.

RESULTS

Surgical resection of brain metastases was associated with a trend toward longer survival (20.8 months vs. 2.7 months for no surgical intervention in selected patients) Whole brain external beam radiation therapy produced disease regression in three of the four evaluable patients. Gamma knife radiosurgery and radioactive iodine therapy appear to play limited, but beneficial, therapeutic roles. Overall, survival after the diagnosis of brain metastasis is reported to be longer than that noted with other solid tumors (17.4 months), and the majority of patients die of their extracranial disease (85% in the current series).

CONCLUSIONS

The results of the current study indicate that local therapies appear to control brain metastases in the large majority of thyroid carcinoma patients with metastases to the brain. Cancer 2003;98:356–62. © 2003 American Cancer Society.

DOI 10.1002/cncr.11488
Probably benign lesions at breast magnetic resonance imaging
Authors: Liberman Laura , Morris Elizabeth A. , Benton Catherine L. , Abramson Andrea F. , Dershaw D. David
Published: July 2003

BACKGROUND

The purpose of the current study was to determine the frequency of ‘probably benign’ interpretations at breast magnetic resonance (MR) imaging screening of high‐risk women and the frequency of subsequent malignancy in these women.

METHODS

The authors performed a retrospective review of the records of 367 asymptomatic women with normal mammograms who had a high risk of developing breast cancer and whose first breast MR imaging screening examinations occurred during a 2‐year period. The number of “probably benign” interpretations was determined, and follow‐up data were obtained.

RESULTS

A “probably benign” interpretation was given to 89 (24%) of 367 women. Follow‐up MR imaging was performed for 70 (79%) of 89 women, with a median follow‐up time of 11 months (range, 1–24 months). Twenty women subsequently underwent biopsy at a median of 9 months (range, 1–18 months) after MR imaging, due to progression on follow‐up MR imaging (n = 14) or for other reasons (n = 6). Malignancies were found in 9 women, constituting 45% of the 20 women who underwent biopsy and 10% of the 89 women with probably benign lesions. In 6 of the 9 women who developed malignant disease (7% of the 89 women in the study), the malignancy was detected by follow‐up MR imaging of an area that previously was interpreted as probably benign. Tumor histology was ductal carcinoma in situ (DCIS) in five patients and infiltrating ductal carcinoma in four.

CONCLUSIONS

A “probably benign” interpretation was given to 24% of high‐risk women at their first breast MR imaging screening examination. In 7–10% of women with “probably benign” interpretations, malignant disease subsequently developed in an area initially judged to be probably benign; of these malignancies, more than half were DCIS, and more than half were detected by MR imaging only. Cancer 2003;98:377–88. © 2003 American Cancer Society.

DOI 10.1002/cncr.11491
High expression of cathepsin B in transitional bladder carcinoma correlates with tumor invasion
Authors: Eiján Ana M. , Sandes Eduardo O. , Riveros María D. , Thompson Sebastián , Pasik Leonardo , Mallagrino Hector , Celeste Francisco , Casabé Alberto R.
Published: July 2003

BACKGROUND

Cathepsin B (CB) is a lysosomal cysteine proteinase synthesized as a zymogen of 39–47 kilodaltons (kD), which is subsequently converted into an active single‐ chain form of 33 kD (CB33) and, by additional processing, into the active 2‐chain form containing a heavy chain of 27–29 kD (CB27‐29) and a light chain of 4–6 kD. Increased or altered CB expression has been documented in a variety of tumor cells, but to the authors' knowledge only one study published to date has reported clinicopathologic significance for CB in transitional cell carcinoma (TCC) of the bladder.

METHODS

In this work, CB expression was determined by Western blot analysis in TCC bladder tissue from 30 patients. Nontumor bladder tissue was also analyzed for CB expression.

RESULTS

The study results demonstrate higher expression of CB in TCC invasive tumors than in superficial bladder carcinoma. Furthermore, whereas normal bladder only expressed the 29‐kD CB protein, tumor and peritumoral tissue demonstrated the 27‐ to 29‐kD CB form. Immunohistochemical staining did not evidence changes in CB localization between tumor and nontumor tissue.

CONCLUSIONS

According to the results of the current study, bladder tumor progression appears to be associated with quantitative changes in CB protein expression, as well as with qualitative changes related to the type of CB expressed. Cancer 2003;98:262–8. © 2003 American Cancer Society.

DOI 10.1002/cncr.11493
Phase II trial of paclitaxel, estramustine, etoposide, and carboplatin in the treatment of patients with hormone‐refractory prostate carcinoma
Authors: Smith David C. , Chay Christopher H. , Dunn Rodney L. , Fardig Jude , Esper Peg , Olson Karin , Pienta Kenneth J.
Published: July 2003

BACKGROUND

Preclinical data suggest that the combination of intravenous (i.v.) paclitaxel, carboplatin, oral etoposide, and oral estramustine (TEEC) has significant activity in patients with advanced, hormone‐refractory prostate carcinoma. The authors conducted this clinical trial to evaluate the addition of carboplatin to the three‐drug combination of paclitaxel, estramustine, and etoposide (TEE).

METHODS

Twenty patients with carcinoma of the prostate that was progressing despite hormone therapy were enrolled on this Phase II trial. Patients were treated with oral estramustine, 280 mg three times daily, and oral etoposide, 50 mg/m2, once daily on Days 1–7, with i.v. paclitaxel, 135 mg/m2, over 1 hour followed by carboplatin (area under the curve, 5) on Day 2 of each 21‐day treatment cycle. Patients were evaluated for response after three cycles, and three additional cycles were given to responding or stable patients.

RESULTS

Nineteen patients were evaluable for response, and 12 patients had measurable disease at baseline. The measurable response rate was 58% (7 of 12 patients; 95% confidence interval [95% CI], 28–85%), and all of those were partial responses. Eleven patients had decreases > 50% from their baseline prostate specific antigen levels during therapy, for a response rate of 58% (95% CI, 34–80%) by this criterion. The median time to disease progression was 5.5 months, with a median survival of 14.2 months. Major toxicities included Grade (according to version 2 of the National Cancer Institute Common Toxicity Criteria) 4 neutropenia in 4 patients, Grade 4 thrombocytopenia in 4 patients, and anemia ≥ Grade 3 in 4 patients. One patient had a deep vein thrombosis.

CONCLUSIONS

The combination of TEEC was active in patients with hormone‐refractory prostate carcinoma. The regimen was tolerable, with primarily hematologic toxicity. The addition of carboplatin to TEE did not appear to add to the efficacy of the three‐drug combination of antimicrotubule agents. Cancer 2003;98:269–76. © 2003 American Cancer Society.

DOI 10.1002/cncr.11494
Treatment and prognosis of patients with intracranial nongerminomatous malignant germ cell tumors
Authors: Ogawa Kazuhiko , Toita Takafumi , Nakamura Katsumasa , Uno Takashi , Onishi Hiroshi , Itami Jun , Shikama Naoto , Saeki Naokatsu , Yoshii Yoshihiko , Murayama Sadayuki
Published: July 2003

BACKGROUND

The relative roles of surgical resection, radiotherapy, and chemotherapy in the management of patients with intracranial nongerminomatous malignant germ cell tumors have been controversial. The authors retrospectively investigated the results of different treatment regimens in patients with these tumors.

METHODS

The records of 41 patients who were treated between 1981 and 2001 were reviewed. They were grouped into patients with a good prognosis (n = 3), an intermediate prognosis (n = 24), and a poor prognosis (n = 14) based on the histology of their tumors. Fifteen patients (37%) underwent surgical resection and received radiotherapy, and 26 patients (63%) also received chemotherapy. The median follow‐up of 18 patients who remained alive was 61 months (range, 14–194 months).

RESULTS

The 5‐year actuarial overall survival rates for patients in the good prognosis, intermediate prognosis, and poor prognosis groups were 100%, 68%, and 8%, respectively. In the analysis, histology alone had a statistically significant impact on overall survival (P < 0.0001). All 3 patients in the good prognosis group were treated successfully with surgical resection and radiotherapy. In the intermediate prognosis group, the 5‐year actuarial overall survival rate was 44% for patients who underwent surgical resection and received radiotherapy (n = 9) and 84% for patients who also received chemotherapy (n = 15; P = 0.01). Patients in the poor prognosis group who underwent surgical resection and received radiotherapy (n = 3) or who underwent incomplete resection and received both radiotherapy and chemotherapy (n = 8) all died of disease, whereas 2 of 3 patients who underwent macroscopic total resection and received both radiotherapy and chemotherapy survived free of disease.

CONCLUSIONS

The treatment of patients with intracranial nongerminomatous malignant germ cell tumors should be based on tumor histology. For patients who had a good prognosis (mature teratoma with germinoma), surgical resection and radiotherapy were sufficient; however, for patients in the intermediate prognosis group, multimodal treatment, including surgical resection, radiotherapy, and chemotherapy, was effective. Conversely, for patients in the poor prognosis group, more intensive multimodal treatment, including macroscopic total resection, may improve the survival rate. Cancer 2003;98:369–76. © 2003 American Cancer Society.

DOI 10.1002/cncr.11495
Hepatic cryotherapy and regional chemotherapy with or without resection for liver metastases from colorectal carcinoma
Authors: Yan Dong Bo , Clingan Philip , Morris David L.
Published: July 2003

BACKGROUND

The number of hepatic metastases for which resection or ablation is appropriate remains controversial.

METHODS

A retrospective analysis was performed of prospectively collected data from patients with liver metastases from colorectal carcinoma who underwent hepatic cryotherapy and hepatic arterial chemotherapy (HAC) with or without undergoing resection. Patients routinely had preoperative bone scans, chest computed tomography (CT) scans, and abdominal angio‐CT scans. Positron emission tomography scans were unavailable. All patients were followed until June 2002 or until death occurred. Kaplan–Meier and Cox regression methods were used to evaluate the impact of 17 potentially prognostic factors on survival.

RESULTS

One hundred seventy‐two patients who underwent hepatic cryotherapy and HAC with or without undergoing liver resection for in situ eradication of metastases formed the basis of this report. One patient (0.6%) died postoperatively from myocardial infarction. The morbidity rate was 27.9%. The median survival was 28 months (range, 0–98 months). The factors age ≤ 50 years, well‐differentiated or moderately differentiated primary tumor, small cryolesions (< 3.5 cm), complete eradication of extrahepatic metastases at cryotherapy, and low preoperative carcinoembryonic antigen (CEA) levels were associated independently with a favorable outcome. In addition, a univariate analysis showed that the absence of untreated extrahepatic disease at laparotomy, postoperative CEA normalization, and a large decline in CEA levels were significant statistically. The number of lesions was not prognostic. One hundred forty‐six patients (84.9%) who underwent a complete operation had 1‐year, 2‐year, 3‐year, 4‐year, and 5‐year survival rates of 89%, 65%, 41%, 24%, and 19%, respectively. The median survival of patients with 1 metastasis, 2 metastases, 3 metastases, 4 metastases, 5 metastases, 6 or 7 metastases, and 8–12 metastases were 32 months, 29 months, 30 months, 31 months, 27 months, 37 months, and 21 months, respectively (P = 0.7859). Twenty‐five patients had 6 or 7 lesions, and their 5‐year survival rate was 25%.

CONCLUSIONS

When all colorectal hepatic lesions were eradicated, the numbers of hepatic metastases were not prognostic of survival in patients with liver metastases from colorectal carcinoma. Cancer 2003;98:320–30. © 2003 American Cancer Society.

DOI 10.1002/cncr.11498
Prolonged gemcitabine infusion in advanced non–small cell lung carcinoma
Authors: Ceribelli Anna , Gridelli Cesare , De Marinis Filippo , Fabi Alessandra , Gamucci Teresa , Cortesi Enrico , Barduagni Maria , Antimi Mauro , Maione Paolo , Migliorino Maria R. , Giannarelli Diana , Cognetti Francesco
Published: July 2003

BACKGROUND

Preclinical and clinical evidence suggests that a fixed infusion rate of 10 mg/m2 per minute may be more effective than the standard 30‐minute infusion of gemcitabine. To investigate the activity and toxicity of the cisplatin plus gemcitabine combination with gemcitabine at a fixed infusion rate in patients with advanced non–small cell lung carcinoma (NSCLC), the authors conducted a randomized Phase II trial of cisplatin plus gemcitabine at the 30‐minute standard infusion (calibration arm) or cisplatin plus gemcitabine at a fixed infusion rate (experimental arm).

METHODS

A total of 112 chemonaive patients with advanced NSCLC entered the study: 57 patients in Arm A and 55 patients in Arm B. The patients were randomly assigned to receive gemcitabine at a dose of 1000 mg/m2 on Days 1, 8, and 15 over 30 minutes (Arm A) or at a rate of 10 mg/m2 per minute (Arm B). In both treatment arms, cisplatin at a dose of 80 mg/m2 was administered on Day 15 every 28 days.

RESULTS

The overall response rates in Arms A and B were 26% (95% confidence interval [95% CI], 10–42%) and 34% (95% CI, 17–52%) (intent‐to‐treat‐analysis), respectively. The median time to disease progression was 6 months (range, 1–26 months) and 8 months (range, 2–21 months), respectively, for Arms A and B and the median overall survival was 13 months (range, 2–26 months) for each arm. It is interesting to note that a high response rate (67%) of brain metastases was noted in the experimental arm. Toxicity was tolerable and comparable in the two arms.

CONCLUSIONS

The results of this randomized Phase II trial demonstrated that cisplatin plus gemcitabine with gemcitabine at fixed infusion rate (10 mg/m2 per minute) is active and well tolerated in patients with advanced NSCLC. Cancer 2003;98:337–43. © 2003 American Cancer Society.

DOI 10.1002/cncr.11501
Megestrol acetate in pediatric oncology patients may lead to severe, symptomatic adrenal suppression
Authors: Orme Lisa M. , Bond Jodie D. , Humphrey Maureen S. , Zacharin Margaret R. , Downie Peter A. , Jamsen Kris M. , Mitchell Susan L. , Robinson Jacqueline M. , Grapsas Natalie A. , Ashley David M.
Published: July 2003

BACKGROUND

Despite the widespread use of megestrol acetate (MA) among a growing number of pediatric oncology departments, there is only one published study on the use of MA in children with malignant disease. The objectives of the current study were to examine the effect of MA in improving the nutritional status of children with malignant disease and to describe and consider the implications of MA‐associated adrenal suppression that was found consistently.

METHODS

Medical records of 19 children with malignant disease who were treated with MA were reviewed. During MA therapy, clinical assessments every 4 weeks included anthropometrics, caloric intake, quality‐of‐life scores, and appetite scores. Serum cortisol levels, lipid profiles (including cholesterol levels) random blood glucose levels, and coagulation screening were measured at 4–6‐week intervals.

RESULTS

MA use was associated with significant increases in weight, weight z score, middle‐upper arm circumference, triceps skin‐fold thickness, appetite, and caloric intake. MA was extremely useful in aiding the efficient tapering of nasogastric feeds. However, a significant and potentially dangerous decrease in cortisol was seen in 10 of 11 patients tested, with 1 patient who manifested clinical hypoadrenalism with hemodynamic collapse, requiring inotropic support. This is the first report of MA‐associated clinical adrenal suppression in a child with malignant disease.

CONCLUSIONS

Although the results of this study support the ability of MA to improve nutritional status, its use was complicated by severe adrenal suppression in almost all patients tested, with a serious clinical adverse event occurring in one patient. Routine hydrocortisone supplementation throughout MA treatment should be considered as well as larger doses for patients with acute illness and patients who undergo surgery. Cancer 2003;98:397–405. © 2003 American Cancer Society.

DOI 10.1002/cncr.11502
Evaluation of pain associated with oral mucositis during the acute period after administration of high‐dose chemotherapy
Authors: Cella David , Pulliam Janis , Fuchs Henry , Miller Carole , Hurd David , Wingard John R. , Sonis Stephen T. , Martin Paul J. , Giles Francis
Published: July 2003

BACKGROUND

No single oral mucositis (OM) assessment scale is universally accepted; the most commonly used scales are deficient because they combine subjective and objective measures and do not capture the patient's perspective. Because pain is the hallmark symptom of OM, the authors sought to determine whether a simple measure of patient‐reported pain was correlated with objective, physician‐assessed measures of OM. The findings of the current study may provide a clinical context for understanding the relation between objective indicators and patients' perceptions of OM.

METHODS

Three hundred twenty‐three patients receiving stomatotoxic chemotherapy and randomized to receive either iseganan or placebo for treatment of OM underwent periodic objective and subjective evaluations of OM. Objective measures included clinician scoring of stomatitis and dysphagia using the National Cancer Institute Common Toxicity Criteria scales. A subjective measure was obtained by having patients complete a questionnaire (with questions based on an 11‐point numeric scale) regarding oral pain.

RESULTS

More than 90% of scheduled oral assessments were obtained. Mouth pain scores were closely related to stomatitis and dysphagia; peak mouth pain coincided with peak stomatitis and dysphagia. Analgesic use increased by 0.7 days for each unit rise on the pain scale. Patients receiving iseganan had a significantly lower level of peak mouth pain than did patients receiving placebo (P = 0.041).

CONCLUSIONS

A separate measurement of patient‐reported pain was useful for capturing the patient's perspective on OM and was correlated with the physician's objective assessment. These findings support the use of a simple, patient‐reported rating of mouth pain as a clinically relevant and responsive endpoint in clinical trials. This rating system also may provide a straightforward method of following OM in clinical practice. Cancer 2003;98:406–12. © 2003 American Cancer Society.

DOI 10.1002/cncr.11505
Reduced bikunin gene expression as a factor of poor prognosis in ovarian carcinoma
Authors: Tanaka Yoshiko , Kobayashi Hiroshi , Suzuki Mika , Kanayama Naohiro , Suzuki Mitsuaki , Yamakawa Toru , Morishita Hideaki , Terao Toshihiko
Published: July 2003

BACKGROUND

In previous studies, the authors showed that various types of cultured tumor cells treated with exogenous bikunin protein or ovarian carcinoma cells transfected with bikunin cDNA have low invasiveness and diminished metastatic potential. This study was carried out to clarify the relation between the expression of individual bikunin mRNA and tumor progression.

METHODS

Forty‐one newly diagnosed ovarian carcinomas were investigated using a semiquantitative reverse transcriptase‐polymerase chain reaction.

RESULTS

The authors found that 24 patients had tumors that overexpressed bikunin and that gene expression was reduced in the tumors of the remaining 17 individuals. Bikunin mRNA expression was independent of age, surgical stage, tumor size, degree of differentiation, histologic subtype, and serum CA 125 levels. There was a significant correlation between low expression of bikunin mRNA and lymph node status (P = 0.035) or peritoneal status (P = 0.042). Multivariate analysis indicated that bikunin was an independent prognostic marker (P = 0.013; hazard ratio, 2.30; 95 % confidence interval, 1.13–4.19), even after controlling for lymph node metastasis and the degree of peritoneal dissemination. In addition, low expression was a significant predictor for poor prognosis compared with high expression (2‐year survival rate; 75.0 % vs. 47.1 %, respectively; P < 0.05).

CONCLUSIONS

The data suggest that low bikunin mRNA expression by ovarian cacinoma cells may be associated with poor prognosis. It is conceivable that testing for bikunin mRNA may identify patients with ovarian carcinoma who are at high risk for early disease recurrence and a poor prognosis. Cancer 2003;98:424–30. © 2003 American Cancer Society.

DOI 10.1002/cncr.11506
Outcome predictors of 84 patients with hematologic malignancies and Fusarium infection
Authors: Nucci Marcio , Anaissie Elias J. , Queiroz‐Telles Flavio , Martins Carlos A. , Trabasso Plínio , Solza Cristiana , Mangini Claudia , Simões Belinda P. , Colombo Arnaldo L. , Vaz Jorge , Levy Carlos E. , Costa Silvia , Moreira Vaneusa A. , Oliveira José Salvador , Paraguay Nestor , Duboc Gisele , Voltarelli Julio C. , Maiolino Angelo , Pasquini Ricardo , Souza Cármino A.
Published: July 2003

BACKGROUND

Invasive infection by Fusarium sp. is associated with high mortality in patients with hematologic cancer. Yet to the authors' knowledge, little is known regarding predictors of adverse outcome.

METHODS

The authors conducted a retrospective review of the records of patients with hematologic carcinoma and invasive fusariosis who were treated at one institution in the U.S. and at 11 centers in Brazil.

RESULTS

The records of 84 patients were evaluated. Neutropenia was present in 83% and 33 patients had undergone stem cell transplantation. Only 18 patients (21%) were alive 90 days after the diagnosis of fusariosis. Multivariate predictors of poor outcome were persistent neutropenia (hazard ratio [HR] of 5.43; 95% confidence interval [95% CI], 2.64–11.11) and use of corticosteroids (HR of 2.18; 95% CI, 1.98–3.96). The actuarial survival rate of patients without any of these factors was 67% compared with 30% for patients who recovered from neutropenia but were receiving corticosteroids and 4% for patients with persistent neutropenia only. None of the patients with both risk factors survived (P < 0.0001).

CONCLUSIONS

Measures to reduce the duration of neutropenia, as well as the judicious use of corticosteroids, may reduce the high mortality rate of fusariosis in patients with hematologic cancer. Cancer 2003;98:315–9. © 2003 American Cancer Society.

DOI 10.1002/cncr.11510
A pilot study of rituximab in patients with recurrent, classic Hodgkin disease
Authors: Younes Anas , Romaguera Jorge , Hagemeister Frederick , McLaughlin Peter , Rodriguez Maria Alma , Fiumara Paolo , Goy Andre , Jeha Sima , Manning John T. , Jones Dan , Abruzzo Lynne V. , Medeiros L. Jeffrey
Published: July 2003

BACKGROUND

To explore the potential role of infiltrating benign B cells in classic Hodgkin disease (HD) lesions in supporting the survival of malignant Hodgkin and Reed–Sternberg (H/RS) cells, the authors initiated a pilot study of rituximab. Rituximab is used to primarily deplete normal B cells from HD lesions.

METHODS

Patients with recurrent, classic HD who had received a minimum of two prior treatment regimens, regardless of whether H/RS cells expressed CD20, were treated with 6 weekly doses of 375 mg/m2 rituximab to selectively deplete infiltrating benign B cells. Objective tumor response was determined 3 weeks after completion of the last dose of rituximab and every 3 months thereafter. Serum samples were collected from patients before they started rituximab therapy and 3 weeks after the final course of rituximab. Serum cytokine levels of interleukin 6 (IL‐6), IL‐10, IL‐12, IL‐13, and interferon γ were determined using commercially available enzyme‐linked immunosorbent assay kits.

RESULTS

Twenty‐two patients with nodular sclerosis histology were evaluable for treatment response. Five patients (22%) achieved partial or complete remission that lasted for a median of 7.8 months (range, 3.3–14.9 months). Remissions were observed in patients only at lymph node and splenic sites, but not at extranodal sites, and were irrespective of CD20 expression by H/RS cells. Furthermore, systemic (B) symptoms resolved in six of seven patients after therapy. In two patients, partial remissions were associated with a decline in serum IL‐6 levels.

CONCLUSIONS

The current data suggest that rituximab therapy in patients with recurrent, classic HD can alter serum IL‐6 cytokine levels, can improve B symptoms, and may result in clinical remissions. Cancer 2003;98:310–4. © 2003 American Cancer Society.

DOI 10.1002/cncr.11511
High‐dose ifosfamide with mesna and granuloctye–colony‐stimulating factor (recombinant human G‐CSF) in patients with unresectable malignant mesothelioma
Authors: Talbot Susan M. , Rankin Cathryn , Taub Robert N. , Balcerzak Stanley P. , Bhoopalam Nirmala , Chapman Robert A. , Baker Laurence H. , Middleman Edward L. , Antman Karen H.
Published: July 2003

BACKGROUND

The current study was conducted to assess the activity and toxicity of high‐dose ifosfamide and mesna with recombinant human granulocyte–colony‐stimulating factor (rhG‐CSF), given in an outpatient setting, in the treatment of patients with unresectable malignant mesothelioma.

METHODS

Between September 1994 and September 1996, 41 patients with histologically verified, unresectable malignant mesothelioma were registered, 38 of whom were analyzable (2 were ineligible and 1 was nonanalyzable). Patients received intravenous ifosfamide at a dose of 2.8 g/m2 over 3 hours (total dose of 14 g/m2), plus mesna at a dose of 0.56 g/m2 prior to and at 4 hours and 8 hours after ifosfamide infusion daily for 5 days every 21 days. rhG‐CSF at a dose of 5 μg/kg/day was administered subcutaneously on days 6–15.

RESULTS

Response assessment could be determined adequately in 21 patients. Two patients obtained responses; 1 was a confirmed partial response (3%; 95% confidence interval [95% CI], 0–14%) and 1 was an unconfirmed response (3%; 95% CI, 5–14%). Eleven patients had stable disease (29%), 7 patients developed disease progression (18%), 1 patient had an early death (3%), and 17 patients had inadequate assessment (45%). At the time of last follow‐up, 36 of the 38 eligible patients had developed disease progression, with a median progression‐free survival of 5 months (95% CI, 3–7 months) and 34 patients had died with a median survival of 7 months (95% CI, 6–9 months). Twenty‐four patients (63%) and 7 patients (18%), respectively, had Grade (according to Southwestern Oncology Group Toxicity Criteria) 4 hematologic toxicities and Grade 4 nonhematological toxicities. There was one treatment‐related death, the result of infection, pulmonary edema, and renal failure.

CONCLUSIONS

This regimen demonstrated a low overall objective response rate with substantial toxicity, and in the opinion of the authors does not warrant further investigation in the treatment of patients with unresectable malignant mesothelioma. Cancer 2003;98:331–6. © 2003 American Cancer Society.

DOI 10.1002/cncr.11512