bluuebunny/crossref_metadata_2025 huggingface dataset:
Filtration mit kompressiblen Kuchen: Effiziente Konzeptefür eine anspruchsvolle Trennaufgabe
Authors: Alles C.M. , Anlauf H.
Published: September 2003

Die Filtration mit kompressiblen Kuchen ist eine anspruchsvolle Trennaufgabe, die nicht selten für den Erfolg oder Misserfolg eines Verfahrens ausschlaggebend ist. Methoden, die sich zur Prozessauslegung bei inkompressiblen Filterkuchen bewährt haben, können nicht ohne weiteres übernommen werden. Statt dessen sind neue Konzepte gefragt, die auf die Besonderheiten kompressiblen Materialverhaltens eingehen. In diesem Beitrag werden effiziente Prozessstrategien für die Filtration mit kompressiblen Kuchen vorgestellt. Dazu wurde ein physikalisch‐mathematisches Modell in eine Prozesssimulation umgesetzt, mit der bei minimiertem experimentellen Aufwand Haufwerksstrukturen und Trennergebnisse bei verschiedenen Betriebszuständen im Voraus berechnet werden können. Zur Bestimmung der erforderlichen Materialdaten sind standardisierte Versuchsmethoden an einer neuen Laborapparatur entwickelt worden.
Erweiterung der Modellvorstellung der Zentrifugalentfeuchtung – Berücksichtigung der mechanisch‐thermischen Entfeuchtung
Authors: Peuker U.A.
Published: September 2003

No abstracts.
Waschverfahren partikulär‐disperser Systeme – Verfahrensspektrum und Aspekte der Verfahrensauswahl
Authors: Hoffner B. , Fuchs B. , Heuser J.
Published: September 2003

Die Waschung disperser Feststoffsysteme ist ein weit verbreiteter und komplexer Verfahrensschritt. Durch die Tatsache, dass er meist in andere Prozessoperationen eingebunden ist, unterliegt er vielfältigen Anforderungen, die deutlich über die primären Ansprüche eines hohen Abtrenngrades und niedrigen Waschflüssigkeitsbedarfs hinausgehen. Aufgrund der Wirkungsweise und Grenzen unterschiedlicher Waschverfahren ist die Auswahl eines geeigneten Waschverfahrens schwierig, da die dominierenden Wirkmechanismen z. T. nicht ausreichend bekannt sind. Dieser Beitrag gibt einen Überblick über bestehende Waschverfahren, deren zahlreiche Einflussgrößen und über Anforderungen, die an sie gestellt werden. Eine Kategorisierung von Waschprozessen, zusammen mit der Einordnung der Verfahren hinsichtlich makroskopischer Transporteigenschaften, führt zur Entwicklung eines Bewertungsschemas, das bestehende Waschprozesse bewertet, vergleicht und Grenzen der einzelnen Verfahren aufzeigt. Die Arbeit dient als grober Leitfaden für die Auswahl eines geeigneten Waschverfahrens.
Hochdruckbehandlung mit Gas als Trocknungsverfahren
Authors: Stahl M. , Bentz M.
Published: September 2003

No abstracts.
Kuchen bildende Filtration von Suspensionen und Filterberechnung
Authors: Nicolaou I.
Published: September 2003

Bei der Kuchen bildenden Filtration von Suspensionen zielt man auf eine optimale Trennung der Feststoffteilchen von der Mutterflüssigkeit. Der durch eine Druckdifferenz gebildete Filterkuchen wird nach der Filtrationsphase entfeuchtet und eventuell vorher gewaschen. Wichtigste Zielgrößen bei der Beurteilung der Filterleistung sind der Feststoffdurchsatz, die Kuchenrestfeuchte und bei Kuchenwaschung der Restgehalt an Auszuwaschendem im Kuchen und die dafür erforderliche Waschflüssigkeitsmenge. Bedingt durch die komplexen Vorgänge bei der Kuchenbildung, ‐waschung und ‐entfeuchtung wird bei der Auslegung und Optimierung von Filterapparaten empirisch vorgegangen. Diese Vorgehensweise und deren Nachteile werden dargestellt. Anschließend werden praxisgerechte mathematische Modelle für alle Filtrationsphasen und deren Vorteile bei der Charakterisierung des Filtrationsverhaltens präsentiert. Schließlich wird an einem Beispiel die Vorgehensweise gezeigt, wie man auf der Basis weniger Versuche und der dargestellten Modelle eine Filterdimensionierung mit Hilfe eines innovativen Computerprogramms erhalten kann.
Serum vascular endothelial growth factor‐C level in patients with primary nonsmall cell lung carcinoma
Authors: Tamura Masaya , Ohta Yasuhiko
Published: September 2003

BACKGROUND

The authors measured circulating vascular endothelial growth factor‐C (VEGF‐C) and vascular endothelial growth factor (VEGF) levels in patients with primary nonsmall cell lung carcinoma and assessed its usefulness as a diagnostic tool for determining lymph node metastasis.

METHODS

Ninety‐two patients with nonsmall cell lung carcinoma and 58 patients with benign tumors of the lung were included in the current study, as well as 42 healthy control patients. Circulating VEGF‐C and VEGF levels were assessed by enzyme‐linked immunosorbent assay.

RESULTS

Serum VEGF‐C concentration was higher in patients with lung carcinoma than in patients with benign tumors or in healthy control patients. Patients with lymph node metastasis revealed higher serum VEGF‐C and VEGF concentrations than those without. The median level of VEGF‐C and VEGF according to lymphatic vessel invasion and venous invasion was higher in the group with invasion than in the group without. These differences were most significant among patients with VEGF‐C with lymphatic vessel invasion (P = 0.0066 vs. P = 0.026) and in patients with VEGF with venous invasion (P = 0.19 vs. P = 0.011). Serum VEGF‐C levels reached a sensitivity of 79% and a specificity of 72% with a cutoff value of 1756.0 pg/mL, whereas VEGF levels reached 68% sensitivity and 70% specificity at 327.8 pg/mL. If 92 patients were divided into 4 groups according to the combination of VEGF‐C and VEGF levels, the positive predictive value was 84.2%, the negative predictive value was 95.8%, and accuracy was 93.1%.

CONCLUSIONS

Circulating VEGF‐C levels may provide additional information for distinguishing between the absence and presence of lymph node metastasis in patients with lung carcinoma. Cancer 2003;98:1217–22. © 2003 American Cancer Society.

DOI 10.1002/cncr.11529
Neoadjuvant chemotherapy for breast carcinoma
Authors: Buchholz Thomas A. , Hunt Kelly K. , Whitman Gary J. , Sahin Aysegul A. , Hortobagyi Gabriel N.
Published: September 2003

BACKGROUND

The majority of patients with breast carcinoma receive chemotherapy as a component of multimodality treatment. Over the past decade, it has become increasingly more common to deliver chemotherapy first, but this has raised new questions within all disciplines of cancer management.

METHODS

The authors reviewed published studies on the effect of neoadjuvant chemotherapy for breast carcinoma on the practice of medical oncology, surgical oncology, radiation oncology, pathology, and radiology.

RESULTS

Treating breast carcinoma with neoadjuvant chemotherapy has several advantages, such as providing the earliest possible treatment against preexisting micrometastases, offering selected patients breast conservation therapy, and allowing for measurement of disease response, which can then be used to customize subsequent chemotherapy. However, neoadjuvant chemotherapy affects the practice not only of medical oncology, but also has important implications for the specialties of surgery, radiology, pathology, and radiation oncology. The current review addressed the new opportunities and challenges within the multidisciplinary care of breast carcinoma provided by neoadjuvant chemotherapy.

CONCLUSIONS

The complexity of the issues led the authors to conclude that patients who receive neoadjuvant chemotherapy are likely to benefit from a coordinated multidisciplinary approach to their care. Cancer 2003;98:1150–60. © 2003 American Cancer Society.

DOI 10.1002/cncr.11603
The effect of a low‐fat, high fiber, fruit and vegetable intervention on rectal mucosal proliferation
Authors: Pfeiffer Ruth , McShane Lisa , Wargovich Michael , Burt Randall , Kikendall Walter , Lawson Michael , Lanza Elaine , Schatzkin Arthur
Published: September 2003

BACKGROUND

Because studies of diet and colorectal carcinoma tend to be large and complex, researchers have long been interested in the investigation of dietary exposures in relation to putative intermediate markers of large bowel malignancy, such as colorectal epithelial cell proliferation. The basic hypothesis underlying these investigations is that specific dietary components may reduce or increase the rate of cell proliferation, which, in turn, may reduce or increase neoplastic changes in the large bowel.

METHODS

The authors assessed the effects of a 4‐year, low‐fat, high‐fiber, fruit and vegetable‐enriched dietary intervention on colorectal epithelial cell proliferation among 399 participants from the Polyp Prevention Trial, a randomized multicenter trial with adenoma recurrence as the primary endpoint. Rectal biopsies were taken from flat, normal appearing mucosa on patients at baseline, after 1 year, and after 4 years. Two assays, bromodeoxyuridine (Brd U) and proliferating cell nuclear antigen (PCNA), were used to evaluate two summary measures of proliferation: the labeling index (LI) and the proliferative height (PH).

RESULTS

There were no significant differences between changes in LI and PH over the 4‐year period for the intervention and control groups. This finding parallels the finding in the larger primary study, in which the dietary intervention did not alter adenoma recurrence rates.

CONCLUSIONS

A low‐fat, high‐fiber, fruit and vegetable‐enriched dietary intervention did not alter rectal mucosal cell proliferation rates. Cancer 2003;98:1161–8. Published 2003 by the American Cancer Society.

DOI 10.1002/cncr.11608
Non‐Hodgkin lymphoma in elderly patients
Authors: Bai Li‐Yuan , Yang Muh‐Hwa , Chiou Tzeon‐Jye , Liu Jin‐Hwang , Yen Chueh‐Chuan , Wang Wei‐Shu , Hsiao Liang‐Tsai , Chao Ta‐Chung , Chen Po‐Min
Published: September 2003

BACKGROUND

The annual incidence of non‐Hodgkin lymphoma (NHL) has increased over the past two decades in all age groups, including the elderly. Establishing guidelines for proper care for this segment of the population requires further information.

METHODS

Between January 1993 and April 2002, 187 consecutive patients with NHL who were age 70 years or older were examined as part of the current study. Potential factors implicated in prognosis were analyzed for indolent lymphoma group and aggressive lymphoma group separately.

RESULTS

The median patient age was 75 years (range, 70–90 years), and 83% of the patients examined were male. Fifty‐two patients (28%) had indolent lymphoma, and 135 patients (72%) had aggressive lymphoma. The complete remission rate was 33.3% for patients with indolent lymphoma and 35.9% for patients with aggressive lymphoma. Median overall survival was 41.5 months and 23.7 months for the indolent and aggressive lymphoma groups, respectively. The 1‐year and 5‐year survival rates were 76% and 32%, respectively, for patients with indolent lymphoma and 62% and 29%, respectively, for patients with aggressive lymphoma. Among patients with indolent lymphoma, poor prognosis was correlated with poor performance status (P = 0.0107), advanced disease stage (P = 0.0222), initial bone marrow involvement (P = 0.0069), and age greater than 80 years (P = 0.0486); however, none of these variables remained statistically significant after multivariate Cox regression. Among patients with aggressive lymphoma, the only prognostic factors that remained after multivariate analysis were performance status (P = 0.018) and age greater than 80 years (P = 0.029). For patients who received at least 2 courses of systemic chemotherapy, an anthracycline‐containing regimen did not affect the survival rate in either the indolent lymphoma group (P = 0.81) or the aggressive lymphoma group (P = 0.34). After stratification, it was found that patients with aggressive lymphoma who were in the high‐intermediate‐risk group (as determined by International Prognostic Index [IPI] score) benefited most from the anthracycline‐containing regimen (P = 0.0148).

CONCLUSIONS

Performance status was identified as the major prognostic determinant for elderly patients with aggressive NHL. In addition, it was found that an anthracycline‐containing treatment regimen may be especially beneficial for patients in the high‐intermediate‐risk category as determined by IPI score. Cancer 2003;98:1188–95. © 2003 American Cancer Society.

DOI 10.1002/cncr.11609
Lymphoblastic lymphoma of childhood and the LSA2‐L2 protocol
Authors: Mora Jaume , Filippa Daniel A. , Qin Jing , Wollner Norma
Published: September 2003

BACKGROUND

Until the 1970s, diffuse lymphoblastic lymphoma (DLBL) was considered incurable. With intensive multidrug regimens, the majority of patients can now be cured. In the current study, the authors present what to their knowledge is the longest follow‐up presented to date (median, 20 years for survivors) of the largest group of DLBL patients treated with a single protocol at a single institution.

METHODS

Between 1971–1990, a total of 95 consecutive patients (age < 21 years) with DLBL were treated with the LSA2‐L2 protocol at the Memorial Sloan‐Kettering Cancer Center (MSKCC). Patients with Stage I‐II disease were treated for 2 years. In 1980, the protocol was modified and patients with Stage III and IV disease were treated for 3 years. In addition, before the modification, patients with Stage IV disease received a cumulative dose of 15,600 mg/m2 of cyclophosphamide for 3 years; after 1980, these patients received the same dosage as the other patients (i.e., 8400 mg/m2 for 2 years). Radiation therapy initially was administered to all patients with bulky disease in the primary tumor site. Until 1977, the dose of radiation was 20–55 grays (Gy); from 1977 to 1989, the dose was 20 Gy. After the fifth year of completion of treatment, all patients were evaluated comprehensively every 2 years.

RESULTS

The overall survival (OS) of the patients was 79% with a median follow‐up of 20 years. The overall event‐free survival (EFS) was 75% (71 of 95 patients). Seventeen patients developed a disease recurrence and 15 died of disease. The OS and EFS rates for patients with Stages I‐II disease (n = 8) were 87% and 87%, respectively, and the OS and EFS rates for patients with Stage III disease (n = 41) were 90% and 85%, respectively. The OS and EFS for patients with Stage IVA disease (with bone marrow [BM] involvement of < 25%) (n = 19) were 79% and 73%, respectively, whereas the OS and EFS for patients with Stage IVB disease (BM involvement of > 25%) (n = 27) were 74% and 70%. Of the 29 patients with Stage IV disease who were treated with the original protocol, 7 died of disease (1 of 8 patients with Stage IVA disease and 6 of 21 patients with Stage IVB disease). Of the 17 patients with Stage IV disease who were treated with the modified protocol, 3 died of disease (2 of 11 patients with Stage IVA disease and 1of 6 patients with Stage IVB disease). Six patients developed secondary malignancies, four of whom died.

CONCLUSIONS

Long‐term EFS can be achieved in the majority of patients with widely disseminated pediatric DLBL. Chemotherapy alone appears to be sufficient prophylaxis against disease recurrence in the central nervous system. No disease‐related or treatment‐related deaths were reported to occur > 4.5 years after diagnosis in the current study. Cancer 2003;98:1283–91. © 2003 American Cancer Society.

DOI 10.1002/cncr.11615
Genetic alterations in poorly differentiated endocrine carcinomas of the gastrointestinal tract
Authors: Pizzi Silvia , Azzoni Cinzia , Bassi Daniela , Bottarelli Lorena , Milione Massimo , Bordi Cesare
Published: September 2003

BACKGROUND

The molecular pathogenesis of poorly differentiated endocrine carcinomas of the gastrointestinal tract (GI PDECs) remains unclear. It has been suggested that these lesions either originate from multipotent stem cells that also can serve as the origin of nonendocrine adenocarcinomas or arise due to the dedifferentiation of well‐differentiated endocrine carcinomas (WDECs).

METHODS

Ten gastric and 9 colorectal PDECs, 9 gastric WDECs, and 12 colorectal carcinomas (CRCs) were analyzed for loss of heterozygosity (LOH) at 11q13 (MEN1), 17p13.1 (p53), 3p14.2 (FHIT), 3p21.3 (RASSF1A), and 18q23 (DCC/DPC4/Smad2), and for immunohistochemical expression of p53, FHIT, Rb, and p16.

RESULTS

PDECs exhibited high fractional allelic loss (FAL; 0.49), with frequent (> 40%) alterations in p53, Rb, MEN1, FHIT, and 18q. No significant differences were found between gastric and colorectal PDECs. Gastric WDECs also exhibited high FAL (0.44), with frequent alterations in Rb and/or p16, MEN1, and 3p21. CRCs exhibited a low level of FAL (0.23), with frequent (> 50%) p16 and p53 alterations. When gastric PDECs and WDECs were compared, substantial similarities were found with respect to FAL (0.42 vs. 0.44) and with respect to individual gene alterations, except in p53, which was consistently altered only in PDECs. CRCs, which were characterized by a lower FAL (0.56 vs. 0.23) and which lacked alterations in both 3p and Rb, were found to be significantly different from colorectal PDECs.

CONCLUSIONS

GI PDECs demonstrated a high level of chromosomal instability; consistent inactivation of both the p53 and p16/Rb pathways; and frequent LOH at 3p (possibly involving FHIT), the MEN1 locus, and 18q. The profile of genetic alterations in PDECs was more consistent with the profile in WDECs than with the profile in CRCs. Cancer 2003;98:1273–82. © 2003 American Cancer Society.

DOI 10.1002/cncr.11621
Choroid metastases: Clinical features and treatments in 123 patients
Authors: d'Abbadie Isabelle , Arriagada Rodrigo , Spielmann Marc , Lê Monique G.
Published: September 2003

BACKGROUND

The current study was performed to analyze the effects of radiotherapy and chemotherapy on visual improvement in patients with choroid metastases (CM), and to determine the clinical factors potentially related to the risk of death.

METHODS

One hundred twenty‐three consecutive patients were diagnosed with CM at the Institut Gustave‐Roussy between 1966 and 1992. Treatment failure was defined as the absence of tumor regression or choroid tumor progression documented at the time of last ophthalmologic examination. The Cox proportional hazards model was used to estimate the risk of treatment failure associated with analyzed covariates.

RESULTS

Approximately 81% of the patients were women. The most frequent primary tumors were breast carcinoma (71%) and lung carcinoma (9%). Bilateral CM were found in 25% of patients. Sequential vinca alkaloid‐based chemoradiotherapy was reported to be significantly associated with a decreased rate of treatment failure compared with radiotherapy alone (relative risk [RR] = 0.3; 95% confidence interval [95% CI], 0.03–2.2). However, when considered separately, each type of treatment also decreased the risk of treatment failure (RR = 0.5 [95% CI, 0.3–0.8] for radiotherapy and RR = 0.4 [95% CI, 0.3–0.7] for chemotherapy). The total dose of radiotherapy (< 30 grays [Gy] vs. ≥ 30 Gy) was not found to modify treatment results. The 2‐year overall survival rate was 25% (95% CI, 17–34%). The risk of death was found to be correlated with the presence of metastases in the liver (P= 0.02) or lung pleura (P= 0.04) at the time of the diagnosis of CM.

CONCLUSIONS

Sequential combination radiotherapy and vinca alkaloid‐based chemotherapy appear to be the most beneficial treatment modality. However, because treatments were not prescribed randomly, the results of the current study should be interpreted with caution. Cancer 2003;98:1232–8. © 2003 American Cancer Society.

DOI 10.1002/cncr.11622
High incidence of thromboembolism in patients with central nervous system lymphoma
Authors: Goldschmidt Neta , Linetsky Eduard , Shalom Edna , Varon David , Siegal Tali
Published: September 2003

BACKGROUND

Venous thromboembolism (VTE) is a frequent complication in patients with cancer throughout the course of the disease. Patients with brain tumors are at particularly high risk for VTE, and several risk factors were found in patients with malignant glioma. To the authors' knowledge, the incidence of VTE in patients with central nervous system (CNS) lymphoma is not known, and possible risk factors have not been identified to date. The objective of this study was to evaluate the frequency and risk factors of VTE in patients with CNS lymphoma.

METHODS

The authors retrospectively evaluated the medical records of 42 patients with CNS lymphoma who were treated at their center between 1992 and 2001.

RESULTS

It was found that 25 patients (59.5%) had VTE, and, in 3 patients (7%), the VTE was fatal. The authors could not demonstrate that age or ambulatory status could predict VTE in this group of patients, but almost all VTE events occurred during the early period of intensive therapy.

CONCLUSIONS

The high incidence of VTE found in this study indicates that anticoagulant prophylaxis with low‐molecular‐weight heparin probably outweighs the risk and cost of such therapy. A prospective evaluation of newly diagnosed patients with CNS lymphoma is underway at the authors' center. Cancer 2003;98:1239–42. © 2003 American Cancer Society.

DOI 10.1002/cncr.11623
Prognosis for patients with thin cutaneous melanoma
Authors: McKinnon J. Gregory , Yu Xue Qin , McCarthy William H. , Thompson John F.
Published: September 2003

BACKGROUND

Estimates of long‐term survival for patients with thin (≤ 1 mm) primary cutaneous melanomas vary widely. Two separate methods were used to study the survival of patients with melanoma from New South Wales (NSW), Australia, and from the Sydney Melanoma Unit (SMU).

METHODS

The NSW Central Cancer Registry (NSWCCR) provided data on all patients who were diagnosed with cutaneous melanomas that measured ≤ 1 mm thick between 1983 and 1998, inclusive. Patients with metastases at the time of diagnosis were not included, leaving 18,088 patients for analysis. The SMU data base was analyzed to extract data for all patients with thin melanomas who met the same criteria from 1979 to 1998, inclusive. All patients who had their primary tumors treated definitively elsewhere were excluded, leaving 2746 patients for analysis. Ten‐year Kaplan–Meier survival rates were calculated, and significant differences were determined using log‐rank analysis. Prognostic factors were evaluated with Cox proportional hazards analysis.

RESULTS

The NSWCCR analysis revealed a 10‐year survival rate of 96.4%. The 10‐year survival rate for patients at SMU was 92.7%. Among the patients at SMU who died, the median time to recurrence was 49.8 months, and the median time to death was 65.9 months. The 10‐year survival for patients at SMU who had lesions that measured ≤ 0.75 mm was 96.9% compared with 84.3% for patients who had lesions that measured 0.76–1.0 mm. For patients who had ulcerated melanomas measuring ≤ 1 mm thick, the 10‐year survival rate was 83%, compared with 92.3% for patients who had nonulcerated melanomas.

CONCLUSIONS

The results of the current study confirmed the excellent survival rate for patients with thin melanomas. Higher‐risk subsets of patients who may warrant consideration for aggressive investigation and treatment are identifiable. Cancer 2003;98:1223–31. © 2003 American Cancer Society.

DOI 10.1002/cncr.11624
The risk of multiple primary breast and thyroid carcinomas
Authors: Adjadj Élisabeth , Rubino Carole , Shamsaldim Akhtar , Lê Monique G. , Schlumberger Martin , de Vathaire Florent
Published: September 2003

BACKGROUND

Some studies have suggested that there is an association between breast carcinoma and thyroid carcinoma. Because ionizing radiation is a well known risk factor for breast and thyroid carcinomas, the authors studied the effect of the radiation dose delivered for the treatment of each of these two malignancies on the risk of subsequently developing the other malignancy.

METHODS

The risk of developing thyroid carcinoma subsequent to treatment for breast carcinoma was analyzed in 8 patients (cases) and 192 matched control patients (controls) nested in a cohort of 7711 women who were treated at Institut Gustave Roussy between 1954 and 1983. The risk of developing breast carcinoma after treatment for thyroid carcinoma was studied in a cohort of 2365 women who were treated in 3 French cancer centers between 1934 and 1995.

RESULTS

Six of 8 patients with breast carcinoma (75%) who developed thyroid carcinoma and 71% of patients in the control group received radiation therapy during their treatment. The median dose to the thyroid was 6.6 grays (Gy) in the case group and 9.4 Gy in the control group. The overall relative risk of thyroid carcinoma associated with radiation therapy was 1.2 (95% confidence interval, 0.2–6.2). No relation was observed between the radiation dose and the risk of thyroid carcinoma (P = 0.8). Among 2365 women who were treated for thyroid carcinoma, 48 women developed a subsequent breast carcinoma. A significant excess of breast carcinoma was observed among women younger than 59 years at the time of diagnosis of breast carcinoma compared with women in the same age group in the general population. The mean absorbed dose delivered to the breasts by 131I and external radiation therapy was 0.7 Gy. No relation was found between the radiation dose and the risk of breast carcinoma (P = 0.8).

CONCLUSIONS

The previously reported excess incidence of breast carcinoma after thyroid carcinoma was not related to radiation treatment with 131I and/or external radiation therapy. Radiation therapy for breast carcinoma did not increase the risk of subsequent thyroid carcinoma. Cancer 2003;98:1309–17. © 2003 American Cancer Society.

DOI 10.1002/cncr.11626
Intensive chemotherapy with cyclophosphamide, doxorubicin, high‐dose methotrexate/ifosfamide, etoposide, and high‐dose cytarabine (CODOX‐M/IVAC) for human immunodeficiency virus–associated Burkitt lymphoma
Authors: Wang Eunice S. , Straus David J. , Teruya‐Feldstein Julie , Qin Jing , Portlock Carol , Moskowitz Craig , Goy Andre , Hedrick Eric , Zelenetz Andrew D. , Noy Ariela
Published: September 2003

BACKGROUND

In the era of highly active antiretroviral therapy (HAART), standard‐dose chemotherapy for human immunodeficiency virus (HIV)‐associated diffuse large B‐cell lymphoma is becoming the standard of care. In contrast, the safety and efficacy of intensive regimens have not been established for Burkitt lymphoma (BL), a highly aggressive lymphoma for which moderate‐dose chemotherapy is substandard in the HIV‐negative population.

METHODS

To evaluate the feasibility of intensive chemotherapy in HIV‐associated BL, the authors retrospectively reviewed 14 HIV‐positive adults with BL treated at their center between 1988 and 2000. Eight patients were treated between 1996 and 2000 with cyclophosphamide, doxorubicin, high‐dose methotrexate/ifosfamide, etoposide, and high‐dose cytarabine (CODOX‐M/IVAC), one of the currently preferred intensive‐dose chemotherapy regimens for BL. Six received other chemotherapy. Outcomes were compared with those of 24 HIV‐negative adult patients with BL who had similar patient characteristics and were treated concomitantly (13 with CODOX‐M/IVAC; 11 with other regimens).

RESULTS

Of the 14 HIV‐positive patients, 63% had a complete response after CODOX‐M/IVAC treatment, compared with 67% of patients receiving other chemotherapy. The 2‐year event‐free survival (EFS) rates were 60% and 60% after CODOX‐M/IVAC or other regimens, respectively. Similar outcomes were seen despite the fact that 88% of CODOX‐M/IVAC‐treated HIV‐positive patients had Stage IV disease, compared with one‐third of HIV‐positive patients treated with other chemotherapy. HIV status did not adversely affect long‐term EFS independent of the treatment regimen (P = 0.88). When EFS was evaluated according to chemotherapy regimen independent of HIV status, CODOX‐M/IVAC was found to be associated with improved EFS (P = 0.05) in all patients, and particularly those at high risk. HIV‐positive patients treated with CODOX‐M/IVAC tolerated chemotherapy well with similar rates of myelosuppression and infectious complications as HIV‐negative patients.

CONCLUSIONS

The current nonrandomized retrospective study suggested that intensive chemotherapy with CODOX‐M/IVAC is feasible and well tolerated in HIV‐positive adults with BL. In the post‐HAART era, intensive chemotherapy such as CODOX‐M/IVAC may be appropriate in all adult patients with BL, and especially those with poor prognostic factors, regardless of HIV status. Cancer 2003;98:1196–205. © 2003 American Cancer Society.

DOI 10.1002/cncr.11628
Craniofacial surgery for malignant skull base tumors
Authors: Patel Snehal G. , Singh Bhuvanesh , Polluri Ashok , Bridger Patrick G. , Cantu Giulio , Cheesman Anthony D. , deSa Geraldo M. , Donald Paul , Fliss Dan , Gullane Patrick , Janecka Ivo , Kamata Shin‐etsu , Kowalski Luiz P. , Kraus Dennis H. , Levine Paul A. , dos Santos Luiz R. M. , Pradhan Sultan , Schramm Victor , Snyderman Carl , Wei William I. , Shah Jatin P.
Published: September 2003

BACKGROUND

Malignant tumors of the skull base are rare. Therefore, no single center treats enough patients to accumulate significant numbers for meaningful analysis of outcomes after craniofacial surgery (CFS). The current report was based on a large cohort that was analyzed retrospectively by an International Collaborative Study Group.

METHODS

One thousand three hundred seven patients who underwent CFS in 17 institutions were analyzable for outcome. The median age was 54 years (range, 1–98 years). Definitive treatment prior to CFS had been administered in 59% of patients and included radiotherapy in 367 patients (28%), chemotherapy in 151 patients (12%), and surgery in 523 patients (40%). The majority of tumors (87%) involved the anterior cranial fossa. Squamous cell carcinoma (29%) and adenocarcinoma (16%) were the most common histologic types. The margins of surgical resection were reported close/positive in 412 patients (32%). Adjuvant postoperative radiotherapy was received by 510 patients (39%), and chemotherapy was received by 57 patients (4%).

RESULTS

Postoperative complications were reported in 433 patients (33%), with local wound complications the most common (18%). The postoperative mortality rate was 4%. With a median follow‐up of 25 months, the 5‐year overall, disease‐specific, and recurrence‐free survival rates were 54%, 60%, and 53%, respectively. The histology of the primary tumor, its intracranial extent, and the status of surgical margins were independent predictors of overall, disease‐specific, and recurrence‐free survival on multivariate analysis.

CONCLUSIONS

CFS is a safe and effective treatment option for patients with malignant tumors of the skull base. The histology of the primary tumor, its intracranial extent, and the status of surgical margins are independent determinants of outcome. Cancer 2003;98:1179–87. © 2003 American Cancer Society.

DOI 10.1002/cncr.11630
The prevalence of patients with colorectal carcinoma under care in the U.S.
Authors: Mariotto Angela , Warren Joan L. , Knopf Kevin B. , Feuer Eric J.
Published: September 2003

BACKGROUND

Prevalence usually is defined as the proportion of individuals alive who previously had a diagnosis of the disease, regardless of whether the individuals still are receiving treatment or are cured. The objective of this study was to estimate the proportion of elderly patients with colorectal carcinoma (CRC) in the U.S. that actually were receiving care for their disease as a better quantification of the burden of CRC.

METHODS

The authors used data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program linked to Medicare claims. Four phases of CRC care were defined: initial diagnosis and treatment, postdiagnostic monitoring, treatment for recurrent/metastatic disease, and terminal care. CRC care prevalence measures by phase were extrapolated to the U.S. population age 65 years and older.

RESULTS

For all patients with CRC who were diagnosed between 1975 and 1996, 62% received at least 1 service related to their CRC in 1996, and patients received an average of 2.1 months per person of CRC care. Among the U.S. population age 65 years and older, 1.81% had 1 diagnosis of CRC, and (1.81% × 0.62%) = 1.12% received at least 1 service related to their CRC. This translated to 380,783 individuals who received care and 1,210,121 person months of care during 1996.

CONCLUSIONS

To the authors' knowledge, this is the first report in which care prevalence has been estimated directly. The classification of CRC care by phases of care provides a very detailed picture of the amount of care delivered in the U.S. population. Person‐month estimates can be used to estimate the cost of CRC. Cancer 2003;98:1253–61. Published 2003 by the American Cancer Society.

DOI 10.1002/cncr.11631
Cancer rates among American Indians and Alaska Natives
Authors: Swan Judith , Edwards Brenda K.
Published: September 2003

BACKGROUND

Two important goals of cancer surveillance are to provide milestones in the effort to reduce the cancer burden and to generate observations that form the basis for cancer research and intervention for cancer prevention and control. Determination of the cancer burden among American Indians and Alaska Natives (AIAN) has been difficult largely due to lack of data collection efforts in many areas of the country and misclassification of racial data that results in undercounting of Native Americans. There is a revitalized commitment to improve data collection among the national agencies and organizations.

METHODS

Data on cancer trends from 12 areas covered by the Surveillance, Epidemiology and End Results (SEER) Program were reviewed for incidence and death rates for 1992–2000. AIAN trends were examined and compared with trends among other racial/ethnic population groups. Reference was made to studies of disease‐specific survival for nine of the SEER areas for 1988–1997.

RESULTS

In SEER areas, cancer incidence rates for AIAN populations appeared to be decreasing significantly for lung and breast cancers among women and for prostate cancer among men. However, death rates rose, although not significantly, over the same period, except for a significant decrease in prostate cancer. Among the cancers with rising death rates were lung cancer (AIAN women) and colorectal cancer (AIAN men). In addition, survival often was lower for AIAN populations.

CONCLUSIONS

Although the incidence was stable or decreased among AIAN populations, increased death rates and lower survival rates indicate the need for intensified application of cancer prevention and control measures, including screening and treatment. Difficulties in interpretation of data include small population size and substantial interregional differences in rates. Cancer 2003;98:1262–72. Published 2003 by the American Cancer Society.

DOI 10.1002/cncr.11633
Childbearing and survival after breast carcinoma in young women
Authors: Mueller Beth A. , Simon Michael S. , Deapen Dennis , Kamineni Aruna , Malone Kathleen E. , Daling Janet R.
Published: September 2003

BACKGROUND

Many young patients with breast carcinoma have not started, or completed, their desired families. How childbearing after a diagnosis of breast carcinoma affects survival is of importance to these women and their families. The authors measured relative mortality among young patients with breast carcinoma with and without births occurring after diagnosis.

METHODS

The authors conducted a cohort study using data from three population‐based cancer registries in the U.S. (Seattle, Detroit, and Los Angeles), linked to birth certificate data in each state. Four hundred thirty‐eight women younger than 45 years of age with primary invasive breast carcinoma were identified as having births after diagnosis. In addition, 2775 comparison women, matched on the basis of age at the time of diagnosis, race/ethnicity, diagnosis year, disease stage, and presence of previous nonbreast primary tumors, were identified among those with breast carcinoma without births after diagnosis. Relative mortality was assessed using multivariable statistical methods.

RESULTS

After adjustment for stage of disease, age at diagnosis, study region, diagnosis year, and race/ethnicity, women with births occurring 10 months or more after diagnosis had a significantly decreased risk of dying (relative Risk [RR] = 0.54, 95% confidence interval [CI], 0.41–0.71) compared to women without subsequent births. Women pregnant at the time of diagnosis had a mortality rate similar to those who did not give birth (RR = 1.10, 95% CI, 0.80–1.60).

CONCLUSIONS

The results of the current study, in light of growing evidence from other studies using various methods, may provide some reassurance to young women with breast carcinoma that subsequent childbearing is unlikely to increase their risk of mortality. Cancer 2003;98:1131–40. © 2003 American Cancer Society.

DOI 10.1002/cncr.11634
Prostate carcinoma presentation, diagnosis, and staging
Authors: Miller David C. , Hafez Khaled S. , Stewart Andrew , Montie James E. , Wei John T.
Published: September 2003

BACKGROUND

Based on the 1998 Patient Care Evaluation (PCE) from the American College of Surgeons National Cancer Data Base (NCDB), the authors described contemporary nationwide patterns of prostate carcinoma presentation, diagnosis, and staging.

METHODS

The authors reviewed 54,212 cases from the 1998 PCE. Demographics, presenting signs and symptoms, tumor characteristics, prostate biopsy techniques, and use of staging modalities were evaluated.

RESULTS

The mean age of patients in the sample was 68 years. Among patients with available data, 87.5% had a prostate specific antigen (PSA) level of 4 ng/mL or higher, 83.1% had American Joint Committee on Cancer (AJCC) Stage I–II lesions, 80.2% had well or moderately differentiated cancers, and 68.7% of newly diagnosed patients were asymptomatic. Compared with symptomatic patients, asymptomatic patients were more likely to have localized disease (84.6% vs. 78.2%, P < 0.01) and well or moderately differentiated tumors (82.2% vs. 74.6%, P < 0.01). Transrectal ultrasound‐guided prostate biopsy was the most common method of tissue confirmation (45.4%). Radionuclide bone scintigraphy was the most frequently employed staging modality (48.7%). Use of various staging evaluations was more frequent among patients at increased risk for disseminated disease (PSA > 10 ng/mL and/or high‐grade tumors) versus patients at lower risk (PSA ≤ 10 and low to moderate‐grade tumors) for metastatic disease (P < 0.005).

CONCLUSIONS

Most newly diagnosed patients with prostate carcinoma are asymptomatic and have moderately differentiated and organ‐confined disease. Compared with symptomatic patients, tumors in asymptomatic men are associated with lower pretreatment PSA levels, AJCC stage, and tumor grade. Selective use of staging evaluations, based on risk of metastatic disease, may be relatively uncommon. The NCDB remains a unique and rich source of novel patient care information and serves as a national point of reference for prostate carcinoma presentation, diagnosis, and staging. Cancer 2003;98:1169–78. © 2003 American Cancer Society.

DOI 10.1002/cncr.11635
Internal tandem duplication and Asp835 mutations of the FMS‐like tyrosine kinase 3 (FLT3) gene in acute promyelocytic leukemia
Authors: Shih Lee‐Yung , Kuo Ming‐Chung , Liang Der‐Cherng , Huang Chein‐Fuang , Lin Tung‐Liang , Wu Jin‐Hou , Wang Po‐Nan , Dunn Po , Lai Chang‐Liang
Published: September 2003

BACKGROUND

The clinical relevance of mutations of the FMS‐like tyrosine kinase 3 (FLT3) gene in specific cytogenetic subgroups is not clear. The authors examined internal tandem duplication (ITD) and Asp835 mutations of FLT3 in patients with acute promyelocytic leukemia (APL) to determine the incidence of these mutations and to analyze the results for correlations with clinicohematologic features and outcome.

METHODS

Bone marrow samples from 107 patients with APL were analyzed. Isoforms of PML‐RARα were identified using a reverse transcription–polymerase chain reaction assay. A standard polymerase chain reaction (PCR) assay was used to detect FLT3/ITD mutations. Asp835 mutations were analyzed by PCR amplification of exon 20 followed by EcoRV digestion. All aberrant PCR products subsequently were sequenced.

RESULTS

Twenty‐two patients had FLT3/ITD mutations: 9 of 63 patients with L‐type PML/RARα, 13 of 34 patients with S‐type PML/RARα, and 0 of 10 patients with V‐type PML/RARα (P = 0.005). The incidence of FLT3/ITD mutations was significantly higher in patients with S‐type PML/RARα than in patients with L‐type PML/RARα or V‐type PML/RARα. Twenty patients had Asp835 mutations (L‐type PML/RARα: n = 11; S‐type PML/RARα: n = 8; V‐type PML/RARα: n = 1). The frequency of Asp835 mutations was not significantly different among patients with different PML/RARα isoforms (P = 0.582). Three patients had both ITD and Asp835 mutations. The microgranular variant (M3v) form of leukemia was found to be associated with a higher frequency of ITD (P = 0.002) but not with a higher frequency of Asp835 mutations (P = 1.000); analysis of clinicohematologic variables revealed no significant differences in FLT3 mutation incidence among other patient subgroups. There was no significant difference in complete remission rate, overall survival, or event‐free survival between patients with ITDs and those without ITDs or between patients with Asp835 mutations and those without Asp835 mutations.

CONCLUSIONS

The current study found that ITD or Asp835 mutations of the FLT3 gene were present in 36.4% of patients with APL; however, these mutations had no prognostic impact. FLT3/ITD frequently was associated with S‐type PML/RARα and with the M3v form of leukemia. Cancer 2003;98:1206–16. © 2003 American Cancer Society.

DOI 10.1002/cncr.11636
Outcome of children with centrally reviewed low‐grade gliomas treated with chemotherapy with or without radiotherapy on Children's Cancer Group high‐grade glioma study CCG‐945
Authors: Fouladi Maryam , Hunt Daniel L. , Pollack Ian F. , Dueckers Gregor , Burger Peter C. , Becker Laurence E. , Yates Allen J. , Gilles Floyd H. , Davis Richard L. , Boyett James M. , Finlay Jonathan L.
Published: September 2003

BACKGROUND

The objectives of the current study were to determine the outcome of children who were treated with chemotherapy and radiotherapy on the Children's Cancer Group (CCG) high‐grade glioma protocol (CCG‐945) who were diagnosed with low‐grade gliomas on post hoc central pathologic review and to identify clinical and biologic features associated with prognosis.

METHODS

Between 1985 and 1991, 250 children with institutionally classified high‐grade gliomas were enrolled on CCG‐945. Patients older than 24 months with intracranial lesions were assigned randomly to receive either lomustine, vincristine, and prednisone (control regimen) or the 8‐drugs‐in‐1‐day regimen (experimental regimen); younger patients and those with primary spinal cord tumors were assigned nonrandomly to the experimental regimen. Central independent review by 5 neuropathologists led to a reclassification of low‐grade glioma in 70 patients, who were the focus of the current study.

RESULTS

The study involved 42 males and 28 females (median age, 7.7 years) with a median follow‐up of 10.4 years. At 5 years, the progression‐free survival (PFS) rate was 63% ± 6%, and the overall survival (OS) rate was 79% ± 5%, compared with a PFS rate of 19% ± 3% (P< 0.0001) and an OS rate of 22% ± 3% (P< 0.0001) in the remainder of the cohort. Significantly poorer 5‐year PFS was seen in children younger than 24 months, those with fibrillary astrocytoma, and those with posterior fossa tumors. Patients demonstrated a modest improvement in PFS but no improvement in OS compared with children with low‐grade gliomas who were treated with contemporary chemotherapy‐alone approaches.

CONCLUSIONS

The current report calls attention to the importance of central pathologic review in large multiinstitutional trials of children with gliomas and suggests that aggressive front‐line combined chemoradiotherapy does not confer a survival advantage in this highly selected population of patients. Cancer 2003;98:1243–52. © 2003 American Cancer Society.

DOI 10.1002/cncr.11637
Older women with breast carcinoma are less likely to receive adjuvant chemotherapy
Authors: Woodard Stacy , Nadella Padma C. , Kotur Linda , Wilson John , Burak William E. , Shapiro Charles L.
Published: September 2003

BACKGROUND

Older women with breast carcinoma are less likely than younger women to receive adjuvant chemotherapy. The authors hypothesized that after controlling for confounders (i.e., variables related to both age and chemotherapy use) and effect modifiers (i.e., variables that have a significant interaction with age), age would become a less significant factor for predicting adjuvant chemotherapy use.

METHODS

Data on 480 women with localized breast carcinoma were entered into the National Comprehensive Cancer Network database at The Ohio State University Medical Center. Women were divided into 3 groups: women age < 50 years (n = 143 [30%]), women ages 50–65 years (n = 216 [45%]), and women age > 65 years (n = 121 [25%]). Chi‐square and Wilcoxon rank sum tests were used for univariate analyses of the variables of interest, and logistic regression was used for multivariate analyses.

RESULTS

After adjustment for confounders (stage, tumor size, progesterone receptor status, and lymph node involvement) and effect modifiers (namely, estrogen receptor [ER] status), the odds of not receiving chemotherapy for women ages 50–65 years and women age > 65 years with ER‐positive breast carcinoma were approximately 6 (odds ratio [OR], 6.4; 95% confidence interval [CI], 3.1–13.3; P < 0.001) and 62 (OR, 62.4; 95% CI, 21.8–178.7; P < 0.001) times greater, respectively, than the odds for women age < 50 years. Women ages 50–65 years with ER‐negative breast carcinoma were not significantly different from women age < 50 years with respect to chemotherapy use (OR, 1.9; 95% CI, 0.5–7.3; P = 0.374). However, the odds of not receiving chemotherapy for women age > 65 years with ER‐negative breast carcinoma were 7 times (OR, 6.7; 95% CI, 1.5–30.6; P = 0.013) greater than the odds for women age < 50 years.

CONCLUSIONS

The results of the current study indicate that based on older age alone, women are less likely to receive adjuvant chemotherapy. In addition, the results suggest that age bias may contribute to undertreatment and lack of accrual of older women into clinical trials. Cancer 2003;98:1141–9. © 2003 American Cancer Society.

DOI 10.1002/cncr.11640
Treatment of postmastectomy lymphedema with low‐level laser therapy
Authors: Carati Colin J. , Anderson Sandy N. , Gannon Bren J. , Piller Neil B.
Published: September 2003

BACKGROUND

The current study describes the results of a double blind, placebo‐controlled, randomized, single crossover trial of the treatment of patients with postmastectomy lymphedema (PML) with low‐level laser therapy (LLLT).

METHODS

Participants received placebo or one cycle or two cycles of LLLT to the axillary region of their affected arm. They were monitored for reductions in affected limb volume, upper body extracellular tissue fluid distribution, dermal tonometry, and range of limb movement.

RESULTS

There was no significant improvement reported immediately after any of the treatments. However, the mean affected limb volume was found to be significantly reduced at 1 month or 3 months of follow‐up after 2 cycles of active laser treatment. Approximately 31% of subjects had a clinically significant reduction in the volume of their PML‐affected arm (> 200 mLs) approximately 2–3 months after 2 cycles of treatment. There was no significant effect of placebo treatment, or one cycle of laser treatment, on affected limb volume. The extracellular fluid index of the affected and unaffected arms and torso were reported to be significantly reduced at 3 months after 2 cycles of laser therapy, and there was significant softening of the tissues in the affected upper arm. Treatment did not appear to improve range of movement of the affected arm.

CONCLUSIONS

Two cycles of laser treatment were found to be effective in reducing the volume of the affected arm, extracellular fluid, and tissue hardness in approximately 33% of patients with postmastectomy lymphedema at 3 months after treatment. Cancer 2003;98:1114–22. © 2003 American Cancer Society.

DOI 10.1002/cncr.11641