bluuebunny/crossref_metadata_2025 huggingface dataset:
Significance of residual tumor at the esophageal stump after resection for carcinoma
Authors: Lin Xunshenc , Wu Xia , Chen Baotian , Wu Yingkai
Published: February 2007

Residual tumor at the esophageal stump was found in 103, or 14.3%, of a series of 719 resected esophageal specimens for carcinoma. The residual tumor pathologically presented as basal epithelial‐cell carcinomatous change in 16 (15.5%), carcinoma in situ in 26 (25.5%), invasive carcinoma in 51 (49.5%), and cancerous emboli in 6 (5.8%) cases. A follow‐up study of the 719 patients showed that the long‐term survival rate of those with residual tumor was significantly lower than that of those without. Factors of occurrence besides inadequate resection were ana‐layzed, and indications of surgical treatment were recommended. The presence of residual tumor is not an important factor in the development of anastomotic leakage.
Historical developments in familial polyposis coli
Authors: Bussey H. J. R.
Published: February 2007

The emergence of familial polyposis coli from the general group of conditions with multiple polyps of the large intestine into a well‐defined separate entity started when histopathology became a science. The recognition of its two main features — inheritance as a Mendelian dominant characteristic and its high incidence of associated colorectal cancer — greatly helped in establishing a policy of treatment designed to prevent cancer. The removal of all or most of the large intestine before cancer had supervened has had considerable success in reducing the cancer incidence. However, the more recent awareness that the adenomas can frequently be found also in the upper gastrointestinal tract has introduced new problems, the solution of which is currently a matter of investigation.
Genetic markers of colonic neoplasia
Authors: Wolman Sandra R.
Published: February 2007

Adenomas and polyposis syndromes can be viewed as stages preceding the development of colonic cancer. Genetic markers of these stages have potential value in diagnosis and in investigation of biological mechanisms and consequences of cancer‐predisposing genes. No reliable markers for premalignant states are yet available, but unambiguous gene markers for familial polyposis will probably be identified in the near future. They will clarify relationships among the hereditary colon cancer syndromes and possibly help to define the sequence of malignant transformation in sporadic cancers as well.
Chromosomal abnormalities in patients with familial polyposis and colorectal cancer
Authors: Sandberg Avery A.
Published: February 2007

A search for chromosomal (cytogenetic, karyotypic) changes with specificity for familial polyposis coli (FPC) and related conditions has not been successful. The cytogenetic anomalies described to date (chromosomal instability, tetraploidy, structural anomalies) are not only nonspecific and inconsistent but may also be seen in other congenital conditions predisposing to cancer of various organs. However, this does not mean that some (eg, tetraploidy) of the changes cannot be used as indices in the study and evaluation of affected individuals and their family members. Future application of DNA probes may be more successful in establishing genetic anomalies unique to FPC and related disorders.
Counseling families with hereditary gastrointestinal polyposis syndromes
Authors: Krush Anne J.
Published: February 2007

Counseling for families with one of the hereditary polyposis and/or colon cancer syndromes can be offered by a number of different professional persons depending upon the emotional needs of the counselee. It is sometimes difficult to persuade at‐risk persons in polyposis families to institute a medical surveillance plan with their physicians because of their reactions to knowledge (or lack of it) of the family diagnosis. Counseling may reveal both emotional and financial problems as deterrents to needed medical planning. Support organizations and explanatory literature are helpful in allaying fears and promoting compliance.
The role of the oncogene c‐myc in sporadic large bowel cancer and familial polyposis coli
Authors: Rothberg Paul C.
Published: February 2007

The human myc gene is homologous to the v‐myc gene, which was discovered in the avian oncogenic retrovirus MC29. Abnormally high expression of the cellular oncogenes is suspected to be involved in nonviral carcinogenesis. This article reviews the evidence that elevated expression of the human myc gene is involved in sporadic colon carcinoma and familial polyposis coli. The abundance of myc RNA and protein is frequently higher in colorectal cancer than in normal mucosa. The mechanism of this altered expression is obscure because the structure and quantity of myc DNA are very rarely disturbed. The COL0320 cell line is discussed as one unusual example of myc DNA rearrangement and amplification. There is a correlation between tumor‐specific elevated myc RNA level and location in the bowel; tumors distal to the transverse colon are more likely to have elevated myc expression. The site distribution of unselected colorectal malignancies with an elevated myc RNA level is similar to the site distribution of familial polyposis coli tumors. With this observation it is suggested that elevated myc RNA may be a marker of a distinct type of colorectal cancer that involves the same genetic events as precede familial polyposis coli cancer.
Planned simple carotid resection in surgery of paraganglioma fixed to the carotid artery
Authors: Li Shu‐Ling
Published: February 2007

Of 25 surgically treated cases (1956‐1986) of paraganglioma, eleven underwent simple carotid resection. The collateral cerebral crossflow was promoted preoperatively with the use of compressing exercises of the carotid artery and controlled by rheoencephalography. There was no operative mortality. One died with a malignant lesion, and nine survived 3 months to 21 years without cerebrovascular complications. It appears that this procedure is worthwhile in selected cases.
Carcinoma of the salivary gland: A clinicopathologic study of 405 cases
Authors: Yu Guang‐Yan , Ma Da‐Quan
Published: February 2007

Four hundred five cases with carcinoma of salivary glands were analyzed clinicopathologically; 181 tumors were located in parotid, 52 were in submandibular, 21 were in sublingual, and 151 were in minor salivary glands. Mucoepidermoid carcinoma and adenoid cystic carcinoma were the most common histologic types. The overall 3‐, 5‐, lo‐, and 15‐year survival rates were 77.8%, 69.6%, 55.8%, and 36.7%, respectively. The difference between survival and recurrence‐free survival rate was 9%. The prognosis of acinic cell carcinoma and mucoepidermoid carcinoma was much better than that of squamous cell carcinoma, adenocarcinoma, and undifferentiated carcinoma. The survival rates of minor salivary gland tumors was the highest, and those of submandibular gland tumors were the lowest. Postoperative radiotherapy improved the prognosis of adenoid cystic carcinoma. The overall recurrence rate was 40.2%; the cervical lymph node metastases rate was 15.3%, and the distant metastases rate was 11.1%.
Interscapulo‐mammothoracic amputation for advanced breast cancer
Authors: Ariel Irving M.
Published: February 2007

The technique for a major amputation for far‐advanced breast cancer is described. The indications are those patients who have exhausted all accepted forms of treatment and who have a fixed large and often ulcerated cancer affecting the axilla and usually making the arm useless. Several examples of patients on whom this operation was performed are presented.
Prognostic factors for local recurrence and survival in patients with localized extremity soft‐tissue sarcoma
Authors: Collin Charles F. , Friedrich Claudia , Godbold James , Hajdu Steven , Brennan Murray F.
Published: February 2007

The charts of 423 patients with localized extremity soft‐tissue sarcoma treated at our institution over a 10‐year period (1968–1978) were reviewed. Data were subjected to both univariate and multivariate analysis, with independent variables in the multivariate analysis appearing in capital letters. Factors associated with an increased risk of local recurrence included the following: AGE > 53; PRESENTATION WITH RECURRENT DISEASE; HIGH TUMOR GRADE; positive regional nodes; TREATMENT BY LIMB‐SPARING SURGERY (LSS); invasion of vital structures (LSS only); INADEQUATE MARGINS; and biopsy with delayed definitive resection. Survival was adversely affected by the following: AGE > 53; PAINFUL MASS; PROXIMAL SITE; SIZE > 10 cm; HIGH TUMOR GRADE; POSITIVE NODES; invasion of vital structures; TREATMENT BY AMPUTATION; INADEQUATE MARGINS; and local recurrence after treatment at our institution. Significant variations in both local recurrence and survival according to histopathology were also observed, with EMBRYONAL RHABDOMYOSARCOMA, ANGIOSARCOMA, and MALIGNANT PERIPHERAL NERVE TUMORS emerging as independent predictors of local recurrence. Using the Cox models for local recurrence and survival, patients were stratified into high‐, intermediate‐, and low‐risk categories based on the presence or absence of each variable. Risk factor analysis should be part of the overall evaluation of each patient with extremity sarcoma.
Review of the clinical trials activity of the soft tissue and bone sarcoma group of the european organization for research and treatment of cancer
Authors: Bramwell Vivien H. C. , Santoro A. , Rouesse J. , Mouridsen H. , Steward W. , Van Oosterom A. , Somers R. , Buesa J. , Mulder J. , Schutte J. , Pinedo H. , Blackledge G. , Wagener T. , Dombernowky P.
Published: February 2007

Despite the low incidence of sarcomas, the Soft Tissue and Bone Sarcoma Group has established itself as one of the more active cooperative groups of the European Organization for Research and Treatment of Cancer. Performing over a 10 yr period three phase III protocols (total entry 750 patients), three randomized phase II studies (464 patients), a pilot combination study (185 patients), and 12 phase II studies (406 patients). The new randomized phase III protocol for advanced soft‐tissue sarcoma will provide an interesting test of the validity of the current membership policy, which has not discouraged the participation of enthusiastic new members. For extremity sarcomas, improved surgical techniques have increased the number of patients retaining functional limbs but have maintained excellent rates of local control. However, systemic metastasis remains a significant problem and presents a challenge for future adjuvant studies.
Intraarterial chemotherapy of soft‐tissue sarcomas
Authors: Bramwell Vivien H. C.
Published: February 2007

This review compares the results of preoperative intraarterial chemotherapy delivered by various methods, such as intraarterial injection/infusion, tourniquet infusion, and isolation perfusion, with the results achieved by pre‐ and postoperative radiotherapy. The histological heterogeneity of soft tissue sarcomas adds to the inherent difficulties of comparing results across studies. There is a clear need for randomized studies to directly compare these treatment modalities in similar patient populations. Patients with these rare tumors would benefit from the expertise of multidisciplin‐ary teams available at the larger centers. Metastatic spread, which even with the highest rates of local control, occurs in approximately 30% of high grade soft tissue sarcomas, represents a continuing challenge, and innovative approaches are needed to control systemic disease.
Prognostic factors of adult metastatic renal carcinoma: A multivariate analysis
Authors: De Forges Anne , Rey Annie , Klink May , Ghosn Marwane , Kramar Andrew , Droz Jean‐Pierre
Published: February 2007

In order to define the prognostic factors for metastatic renal carcinoma, we reviewed 134 patients who were treated from 1971 through 1986. Survival rates were 72,45, and 25% at 6, 12, and 18 months, respectively. Seventeen variables were tested using the logrank test. Improved survival was correlated with normal performance status, and an absence of fever, weight loss, hepatic metastasis, and lung metastasis (or, if lung metastasis was present, < 2 cm in diameter and limited to one site), a disease‐free interval, sedimentation rate < 100, and renal surgery. Four variables retained significant value in the multivariate analysis: hepatic metastasis, lung metastasis, disease‐free interval, and a variable combining the sedimentation rate and the weight loss (SWRL). Predictive survival rates based on these variables were calculated from the Cox model. Six subgroups of patients were identified. The estimation of survival is clinically of value for future phase II trials of chemotherapy in patients with adult metastatic renal carcinoma.
Principles of biotherapy and its application to the treatment of disseminated renal cancer
Authors: O'Connor T. E. , West W. H. , Marshall G. D. , Orr D. W. , Lewis M. , Oldham R. K.
Published: February 2007

Monoclonal antibody technology permits the preparation of tumor‐specific immunoglobulin reagents that can be used directly in tumor therapy or that can be coupled to various chemotherapeutic drugs or toxins to aid in their delivery to the tumor site and thus enhance their therapeutic effectiveness. Additionally, recombinant DNA technology has facilitated the economic production of rare lymphokines (e.g., interleukin 2, interferon and interferon γ) or cytokines (tumor necrosis factor, lymphotoxin) that can either modulate the host immune response or kill tumor cells, respectively. These developments collectively have led to the development of a fourth modality for treatment of human cancers—biotherapy—as an addition to surgery, radiation, and chemotherapy modalities. This paper presents the rationale and emerging practice of the biotherapy of cancer and documents early clinical results, including the treatment of metastatic renal carcinoma at the Biological Therapy Institute.
Hormone receptors in renal cancer: An overview
Authors: Jakse Gerhard , Müller‐Holzner Elisabeth
Published: February 2007

The current literature concerning hormone receptors in renal cell cancer is reviewed. Our own results of histochemical determination of estrogen receptors by means of monoclonal antibodies are presented. Based on the studies that have been reviewed and the differing results of the receptor assays, we conclude that there is a very limited basis to apply hormone therapy in renal cell cancer. However, the new immunohisto‐chemical methods should be used to resolve the question about the hormone dependency of renal carcinoma.
Deoxyribonucleic acid content in metastatic renal cell carcinoma: Clinical implications
Authors: Ljungberg Börje , Roos Göran , Stenling Roger
Published: February 2007

Tumor DNA content was analysed in 26 patients with metastatic renal cell carcinoma. The primary tumors were homogenously diploid in ten patients (38%). In 16 patients (62%) an aneuploid DNA content was found in at least one of eight tumor samples analyzed. Patients with diploid tumors survived significantly longer (P < 0.001) than patients with aneuploid primary tumors (median 32.5 and 6 months, respectively). The DNA content of the metastases seems to give additional prognostic information. The results indicate that DNA content is a useful prognostic predictor in renal cell carcinoma. Patients with homogenously diploid tumors might be treated aggressively with nephrectomy and excision of apparent metastases, particularly solitary, since these patients seem to have a chance for prolonged survival time. Aneuploidy in metastases, solitary and multiple, indicates that nephrectomy is not meaningful.
Immunotherapy of metastatic renal cancer
Authors: Rauschmeier H. A.
Published: February 2007

Various reports in the literature suggested active specific immunotherapy to be highly efficient in metastatic renal cell cancer (RCC). Thirty five patients with tumor stage III or IV, according to Robson, were treated with autologous or homologous cell vaccine after radical nephrectomy had been performed. In stage III tumors immunotherapy was administered as prophylaxis or after an interval, when metastases occurred. Clinical results during a 3‐year follow‐up period revealed no statistically significant differences in comparison to an age‐matched control group. There was no advantage in employing autologous instead of homologous therapy. Three‐year survival rate in stage IV tumors with autologous vaccination was 11% vs. 6% in tumors with homologous therapy. Two complete and two partial tumor remissions occurred.
Interferon therapy for metastatic renal cell carcinoma
Authors: Swanson David A. , Quesada Jorge R.
Published: February 2007

We have used multiple interferon protocols to treat 274 patients who had metastatic renal cell carcinoma. Leukocyte (alpha) interferon in 50 patients produced 3 complete responses (CR) and 10 partial responses (PR), a 26% response rate that was nearly matched among the next 89 patients treated with recombinant alpha interferon (2 CR, 17 PR, 21%). Other types and combinations of interferon, even when coupled with cytotoxic chemotherapy or other biologic agents, did not produce better results. Interferon has definite activity against renal cell carcinoma, but clinical experience has not yet defined the optimal type dose, and treatment schedule.
Laser treatment of urologic cancers
Authors: Smith Joseph A.
Published: February 2007

In urologic surgery, laser energy has been used to treat various cancers of the genitourinary system. Excellent functional and cosmetic results have been obtained with squamous cell carcinoma of the penis. In selected patients, the need for partial penectomy may be avoided. Demonstrated practical advantages and decreased patient morbidity form the basis for laser treatment of superficial bladder cancer. Therapeutic advantages over electrocautery resection are theoretical. Nd:YAG laser treatment can provide reasonable local control rates for tumors that invade the bladder muscle, but this treatment should be reserved for patients who are poor candidates for radical surgery. For kidney cancer, lasers may facilitate tumor removal in solitary kidneys and extend the margin of resection.
Management of endobronchial tumors: A comparative study
Authors: McCaughan James S. , Hawley Philip C. , Walker John
Published: February 2007

Between September 1982 and July 1987 we treated 102 patients with endobronchial or endotracheal disease with one or a combination of the following modalities: CO2 laser, Nd:YAG laser, and photodynamic therapy (PDT). Many patients had multiple treatments and treatment sites. In all, 259 Nd:YAG treatments were performed on 154 sites in 80 patients, 118 PDT treatments were performed on 87 sites in 45 patients, and nine CO2 treatments were performed on nine sites in nine patients. Of the 71 patients who died, 19 lived longer than 6 months, and seven lived longer than 1 year. A total of 11 patients have survived for more than 1 year, including four who are still alive 18, 22, 33, and 54 months after treatment. Five patients achieved a status of “no evidence of disease,” and at autopsy. Two others had no evidence of disease to the treated site. All seven of these patients wcrc treated with PDT only. There were no intraoperative deaths or cases of intraoperative bleeding or smoke with PDT. Eight patients died from pulmonary hemorrhage 2 to 9 weeks after treatment. Four had been treated with Nd:YAG therapy alone and four with PDT alone. Evaluation of the survival rate in this study must consider that this therapy involves severely ill paticnts with a high potential for intraoperative or perioperative fatality. Some patients who were near death before treatment have enjoyed quality survival for over 1 year.
Lasers in cutaneous disease
Authors: Aronoff B. L.
Published: February 2007

One of the first clinical uses of the laser was in dermatology. It was used to help in diagnosing not only the presence of disease but the extent. It was used in various large naevi and very soon in port wine stains and other vascular anomalies. Skin cancer soon was treated with the laser, and soon tumors in patients with various platelet defects could be resected successfully with a minimal risk. The advent of photodynamic therapy now allows successful treatment of many lesions.
Imaging techniques in breast cancer
Authors: Dershaw D. David , Osborne Michael
Published: February 2007

In the diagnosis of clinically inapparent breast cancer, mammography remains the most effective imaging modality, which is due in large part to its ability to detect microcalcifications. Of the ancillary modalities, sonography is the most useful because it readily differentiates cysts from other breast lesions. Internal mammary and axillary node imaging have been tried with varying levels of success, but false‐positive and false‐negative rates remain high with available techniques. Pulmonary metastases are best evaluated by chest X‐ray with specificity increased by other imaging techniques. Liver and bone metastases may be screened for with isotope scans with computerized tomography, sonography, and magnetic resonance imaging, increasing the specificity of abnormal scans. CT and MRI are the most effective tools for evaluating CNS disease.
The present state of screening for breast cancer
Authors: Tabár László , Dean Peter B.
Published: February 2007

The results to date are convincing enough to justify recommending large scale mammography screening. The International Union Against Cancer (UICC) Workshop on screening for breast cancer in 1986 concluded that “In countries where breast cancer is common and where the necessary resources are available, screening using mammography alone or mammography plus physical examination is applicable as public health policy.” The Swedish government has recommended screening with mammography for all women aged 40–74. This recommendation repeatedly emphasizes the necessity of high‐quality examinations interpreted by well‐trained radiologists. Screening with mammography is bringing breast cancer patients to therapy at a far earlier stage in the development of the disease. This calls for a re‐evaluation of therapeutic methods.
Breast conservation versus mastectomy: Psychological considerations
Authors: Maguire Peter
Published: February 2007

From the available evidence it is clear that mastectomy is associated with a substantial psychological and psychiatric morbidity. To date there is no convincing evidence that counseling can prevent this morbidity, but monitoring of women's psychological adjustment can lead to early detection and effective treatment of their problem. The use of immediate or delayed implantation or reconstruction appears to reduce the psychiatric morbidity in those women who are particularly concerned about their appearance at the time of surgery. Psychiatric morbidity is further increased when adjuvant chemotherapy is used and when treatment results in persistent arm pain and swelling. A shorter course of adjuvant chemotherapy and reduction of surgery within the axilla could reduce psychiatric morbidity. The role of radiotherapy is still unclear, but in some studies a link has been found between the amount of radiotherapy given, adverse effects, and psychiatric morbidity. In women undergoing breast conservation the reduction in body image problems is offset by greater anxiety about recurrence and depression caused by radiotherapy. Exploring and allowing choice when a patient has a strong preference for breast conservation or mastectomy appears to reduce morbidity. But attention still needs to be paid to the early recognition and treatment of psychological problems in patients with breast cancer, and guidelines are provided.
The role of tumor markers in the early detection of cancer
Authors: Humphrey Peter A.
Published: February 2007

Tumor markers include a broad range of substances expressed at different levels and in different biochemical forms. Bence‐Jones protein, carcino‐embryonic antigen and alpha‐fetoprotein are recognized as some of the earlier utilized markers.

Recent technologic advances have led to the development of a variety of serum tumor markers, tumor markers in body fluids, tissue tumor markers, and genetic tumor markers, such as protooncogenes.
Early detection of prostate cancer
Authors: Huben Robert P.
Published: February 2007

Prostate cancer is the second most common malignancy in American males and the third leading cause of cancer deaths in this population. There are no symptoms that are unique to early prostate cancer, and nearly one‐half of patients will have metastatic disease at diagnosis. Because of its tremendous impact upon the health and well‐being of the American male population, and the importance of early diagnosis in curability, there is keen interest in the development of effective screening procedures that are highly sensitive, specific, and cost‐effective. Rectal examination serves as the historical control. The serum tumor markers of prostate cancer, prostatic acid phosphatase (PAP), and prostate‐specific antigen (PSA), are sensitive but relatively nonspecific in the diagnosis of prostate cancer. The use of transrectal ultrasound as a screening tool is highly controversial but suffers from a similar lack of specificity. As yet, no diagnostic tests, alone or in combination, have proven to be of practical value in screening for prostate cancer. Fundamental but unanswered questions about the natural history and the high incidence of “latent” disease also obscure the issue of early diagnosis of prostate cancer and its impact on survival.
Testicular cancer
Authors: Garnick Marc B.
Published: February 2007

The management of testis cancer is continually changing. Since the introduction of curative chemotherapy for metastatic disease, the entire approach to early disease (stage I and stage II) is undergoing reevaluation. Individuals with favorable prognostic features can be offered, under detailed clinical protocols, orchiectomy followed by meticulous surveillance. Likewise, individuals with retroperitoneal disease may be offered retroperitoneal lymph node dissection initially or, alternatively, chemotherapy initially. The prognosis for individuals with metastatic disease is extremely favorable, with the majority of patients being cured with 9–12 weeks of combination chemotherapy. Major efforts are still underway to identify appropriate second‐line or “salvage” regimens for individuals who are not cured with first‐line chemotherapy. Likewise, the use of new modalities, such as bone marrow transplantation, and new drugs must be evaluated in appropriately designed, prospective studies. Such studies will continue to increase the cure rate of individuals with metastatic disease and enhance the prognosis for such high‐risk populations of patients. This paper reviews basic aspects relating to histology, clinical staging, and approach to management for all stages of germ cell cancer of the testis.
The value of regional lymph node dissection in genitourinary cancer
Authors: Skinner Donald G.
Published: February 2007

Regional lymph node dissection in the management of genitourinary (GU) neoplasms is controversial but is based on a 17 year clinical experience and the achievement of survival figures as good or better than those achieved by any other modality of therapy. Lymphadenectomy has proved to be effective in curing patients with metastatic testicular cancer, renal cell carcinoma and transitional cell carcinoma. Its efficacy in prostate cancer is much less certain and remains largely a staging procedure.
Treatment of localized prostatic cancer
Authors: Smith Joseph A.
Published: February 2007

Discovery of a localized prostatic cancer frequently creates a therapeutic dilemma. A significant number of patients do well for an extended period of time without treatment, while others suffer rapid tumor progression and death from prostatic cancer. Without treatment nearly one third of patients with stage B prostatic cancer can be expected to develop distant metastatic disease or death from prostatic cancer within 10 years. In patients who otherwise have a reasonable life expectancy of 10 years or more, aggressive therapy is justified. Long‐term disease‐free survival has been reported after both radical prostatectomy and external irradiation. The fact that nearly 50% of patients treated with external irradiation for stage B prostatic cancer have positive postirradiation biopsies is of concern, but the impact of this finding on overall survival is yet to be determined. The only randomized prospective study comparing radical prostatectomy with external irradiation showed a statistically significant decrease in the time to evidence of disease progression in the radical prostatectomy group. Nevertheless, as evidenced by the National Institutes of Health Consensus Development Panel, further randomized prospective trials are needed to determine the relative value of radical prostatectomy versus external irradiation for localized prostatic cancer. For the forseeable future, definitive scientific data on which to base treatment recommendations will not be available. Therefore, patients should be well informed of the various treatment options available, and the wishes of the patient are paramount. The clinician's roles are to interpret the data, present it in a meaningful manner to patients, be guided in discussions by patient preferences, and make recommendations. In this manner, the most appropriate form of therapy can be selected that provides the greatest chance of prolonged disease‐free survival with morbidity that is acceptable for an individual patient.
Diagnosis and management of superficial bladder cancer
Authors: Soloway Mark S.
Published: February 2007

Superficial transitional cell carcinoma is defined as a transitional cell urothelial tumor that is confined to the mucosa, stages Ta or CIS, or with invasion of the lamina propria, T1. The initial treatment is transurethral resection with an attempt to remove all tumor. This should provide an accurate histologie grade and stage, and from this information a prognosis can be determined. The important predictive factors that correlate with a new occurrence or true recurrence and the development of a subsequent tumor with muscle invasion are a high tumor grade, lamina propria invasion, a positive cytology following resection, multifocal tumors, dysplasia or carcinoma in situ from mucosal biopsies of normal appearing urothelium, and a prior history of bladder cancer. Based on these factors, the recurrence rate varies from 30 to 80% and progression with a muscle invasive tumor up to 30%. Intravesical chemotherapy or “immunotherapy” following tumor resection has been shown to diminish the likelihood of a recurrence. Thiotepa has been used for the longest period of time. It is relatively inexpensive, safe if myelosuppression is closely monitored, and effective. Mitomycin C was more effective than Thiotepa in randomized trials, but is significantly more expensive. This has retarded its use as a first‐line agent. It has been shown to eradicate persistent tumor in 30 to 40% of patients who have failed Thiotepa. Mitomycin C is also highly effective when used for prophylaxis. Intravesical bacillus Calmette‐Guerin (BCG) has recetly been demonstrated to be an effective intravesical therapeutic agent. It is effective both for treatment and prophylaxis. BCG is relatively safe and inexpensive. The most important factor in the treatment and monitoring of patients with superficial bladder cancer is rigorous follow‐up after the initial transurethral resection. This consists of regular endoscopy and cytology. The urologist must be ready to intervene with cystectomy once it is apparent that the tumor is no longer remaining superficial or has become resistant to intravesical therapeutic agents, particularly with a high‐grade tumor.
Neoadjuvant chemotherapy for invasive bladder cancer
Authors: Herr Harry W.
Published: February 2007

Neoadjuvant chemotherapy is being integrated increasingly into the primary therapy for locally advanced bladder cancer. The rationale is due to the favorable responses observed in patients with metastatic bladder cancer, the high systemic relapse rate after apparent local control with either surgery or radiotherapy, the potential for using the bladder lesion as a indicator for selecting patients responsive to chemotherapy, and the ultimate possibility of bladder preservation. While neoadjuvant chemotherapy can induce significant clinical and pathologic tumor regression, such experiences have exposed multiple variables involving bladder tumor heterogeneity, patient selection, and investigator evaluation that raise serious questions regarding the overall efficacy of neoadjuvant therapy.
Treatment alternatives for invasive bladder cancer
Authors: Wajsman Zev , Klimberg Ira W.
Published: February 2007

Radical cystectomy remains the gold standard in the treatment of patients with muscle invasive bladder cancer. However, the specter of high failure rates coupled with morbid treatment methods has caused urologists, oncologists, and radiotherapists to explore modifications in, and alternatives to, the traditional treatments for invasive bladder cancer.

The identification of the active methotrexate‐platinum‐based combination chemotherapy regimens heralds a new era in our ability to treat advanced disease effectively. Patients with less extensive muscle invasive tumors may be efficiaciously treated using conservative surgical excision, either alone or in combination with adjunctive treatments. In addition, definitive radiation therapy, given via the interstitial route or in combination with radiosensitizers, may result in long‐term survival and preservation of bladder function.

Progress has been made on multiple fronts in our ability to improve overall survival rates while allowing for the preservation of bladder function. The ability of these new mixed multimodality treatment initiatives to produce viable statistics equal to that of radical exenteration is an important landmark on the route towards an ideal treatment for invasive bladder cancer.
Salvage surgery for renal cell carcinoma
Authors: Pontes J. Edson , Huben R. , Novick A. , Montie J.
Published: February 2007

Complete surgical excision of solitary metastatic lesions in renal cell carcinoma has been reported to be associated with improved survival.

An analysis of 65 outpatients undergoing excision of metastatic renal cell carcinoma is reviewed. In our series there was no significant difference among patients with solitary versus those with multiple metastasis. The overall 5‐year survival was considerably lower than previously reported. We recommend that only patients with good performance status, who are participating in protocols with biological response modifiers, could potentially benefit from surgical removal of metastatic lesions.
Autotransfusion and blood conservation in urologic oncology
Authors: Klimberg Ira W.
Published: February 2007

Autotransfusion is the reinfusion of the patient's own blood. Currently utilized forms include preoperative donation, perioperative hemodilution, and intraoperative salvage. The principal benefit of autotransfusion is a reduction in the complications associated with receipt of homologous blood products. Principal among these are febrile reactions, allergic and hemolytic reactions, alloimmunization, and the transmission of hepatitis and acquired immune deficiency syndrome. An additional benefit in the management of cancer patients is the avoidance of transfusion induced immunosuppression. Redeposit autologous transfusion is a simple and safe method to reduce patient's requirements for exogenous blood. Although well suited for cancer patients, predeposit programs remain underutilized with only 5% participation. Perioperative hemodilution can be a valuable adjunct in selected patients.

Although the presence of malignancy has been regarded as a contraindication to the use of intraoperative autotransfusion, preliminary reports suggest that intraoperative autotransfusion can be safely used in patients undergoing surgery for urologic malignancies.
Diagnostic and therapeutic utility of monoclonal antibodies in urologic oncology
Authors: McCarley Dean L. , Weiner Roy S.
Published: February 2007

Remarkable advances in the treatment of urologic malignancies have recently been made. Monoclonal antibodies selective for a variety of normal and malignant urologic tissues have been useful in defining normal antigens and tumor‐associated antigens and have potential as diagnostic and immunotherapeutic agents. In renal cancer, monoclonal antibodies can define serum markers, radiolabel tumor xenografts, and assist in specific tissue diagnosis. Additionally, there is potential for these antibodies either alone or as conjugates to localize and kill tumors. Monoclonal antibodies to bladder cancer associated antigens are able to demonstrate differential antigen expression on superficial versus invasive tumors, to refine urinary cytologic diagnosis of bladder cancer, and to predict invasive recurrence of superficial cancer. Monoclonal antibodies have localized bladder tumor xenografts and can inhibit tumor growth when conjugated to radioisotopes or toxins. In prostate cancer monoclonal antibodies to prostate antigens are not usually tumor specific. Monoclonal antibodies to prostate antigen (PA) and prostatic acid phosphatase (PAP) are able to localize prostate cancer metastases. Chemotherapy‐conjugated anti‐PAP monoclonal antibodies have demonstrable inhibition on human prostate cancer xe‐nografted tumor growth. Monoclonal antibodies have defined normal and tumor‐associated antigens in urologic cancers and are expected to be useful in immunodiagnosis and cancer therapy in the near future.
Surgical pathology of squamous carcinoma of the oral cavity: Its impact on management
Authors: Borges A. M. , Shrikhande S. S. , Ganesh B.
Published: February 2007

Squamous carcinoma of the oral cavity is relatively common in India. The anterior tongue and buccal mucosa are the two common sites. A retrospective analysis of various histological parameters in surgically treated patients with carcinoma of the anterior tongue (57 cases) and buccal mucosa (71 cases) was undertaken to evaluate their role in prognosis and management.

The main findings of this study are the strong correlation between high tumour grade, infiltrative tumour margins, perineural invasion, and tumour size >2 cm and lymph node metastasis at presentation, for both groups of patients. Tumour thickness >5 mm was an additional variable associated with both overt and occult nodal metastases for anterior tongue lesions. All tumours thicker than 5 mm recurred in the untreated N0 neck.

Clinically palpable nodes (N1) were falsely positive in 63% of patients with T4 buccal mucosa carcinoma. Grade I histology on biopsy can be used to predict which patients will have negative lymph nodes. Patients with pathologically proven nodal metastases have a poor prognosis. However, the mode of invasion and the presence of perineural invasion in the resected specimen determines the subsequent recurrence of histologically staged N0 cases, most of whom will relapse at the primary site. The low incidence of neck node metastases even in large, buccal mucosa tumours and the virtual absence of “skip” metastases to low nodal sites has made a supraomohyoid lymph node dissection after intraoperative staging a logical alternative to a conventional neck dissection for T3 and T4 buccal mucosa tumours.

Finally, carcinoma of the oral cavity in India can be said to be at least two diseases. Cancer of the buccal mucosa and alveolus differs widely in its biological behaviour from carcinoma of the anterior tongue and floor of the mouth.
Radiotherapy of carcinoma of the buccal mucosa
Authors: Chaudhary A. J. , Sharma V. , Shrivastava S. K. , Gonsalves M. A. , Hingorani C. B. , Dinshaw K. A.
Published: February 2007

A retrospective study of 399 cases of buccal cancer, presenting to the Tata Memorial Hospital, Bombay, during January to December 1984 was undertaken to define the efficacy of various treatment modalities in different clinical stages. Analysis of treatment technique and response was carried out in 185 cases that completed adequate therapy. Sixty percent of patients with stage I and II disease (21/35) received radiation therapy alone as the primary modality of treatment. Patients (150) with stage III or IV disease received palliative irradiation (57 cases), radical surgery (54 cases), or a combination of both (39 cases).

The 2‐year disease‐free survival (DFS) rates were 48% for radiotherapy and 46% for surgery in the early stages and 5% and 33%, respectively, for advanced stages. Radiotherapy with a modifed technique is recommended for the early‐stage cancers and preoperative irradiation with adjuvant chemotherapy or hyperthermia for the advanced stages.
Epidemiology of esophageal cancer
Authors: Rao D. N. , Sanghvi L. D. , Desai P. B.
Published: February 2007

The incidence of cancer of the oesophagus is high in India but not as high as the rates reported from the Caspian Littoral of Iran. Incidence data available for three places in India—Bombay, Madras, and Bangalore—show regional variations. In Bombay, the rates for males are high compared to Madras and Bangalore.

A case control study of 503 oesophageal cancer cases in males and 634 controls registered at the Tata Memorial Hospital during the period 1980–84 was carried out to determine the association of oesophageal cancer with two types of dietary practices, viz., vegetarian and non‐vegetarian, in addition to tobacco and alcohol habits. In the presence of an alcohol habit, the relative risk for tobacco chewing and smoking was observed to be high in the non‐vegetarian group compared to the vegetarian group. A vegetarian diet was protective. Further studies are suggested to confirm this finding.
Current status of surgical treatment of cancer of the esophagus
Authors: Desai P. B. , Vyas J. J. , Sharma S. , Deshpande R. K. , Badwe R. A.
Published: February 2007

Treatment modalities for cancer of the esophagus continue to encourage a healthy debate amongst surgeons, radiotherapists, and chemotherapists. This is because overall results by current treatment methods are generally unsatisfactory, though an all‐round steady gain is now being reported by many authors. With increasing sophistication in radiotherapy techniques (external and intracavitary) and more effective combination chemotherapy, it is likely that surgical treatment of this cancer may be reexamined. There is little doubt, however, that despite the advent of radiotherapy and chemotherapy, surgery is still the most important treatment method in providing lasting relief of dysphagia and maximum survival. While increasingly low surgical mortality and a high cure rate are now being reported, the type and extent of surgery are still contentious issues. Alternatives ranging from a very radical excision (monobloc total esophagectomy with mediastinal dissection) to a blunt transhiatal esophagectomy are now being advocated. Radiotherapists and chemotherapists are now investigating the feasibility of a nonsurgical treatment for cancer of the esophagus.
Combined treatment modalities in esophageal cancer
Authors: Desai P. B. , Vyas J. J. , Sharma S. , Deshpande R. K. , Badwe R. A. , Advani S. H. , Saikia T. , Dinshaw K. A. , Swaroop V. Santhi
Published: February 2007

Esophageal cancer has been conventionally treated with surgery and radiotherapy for many years. The overall results for all cancers are poor because the majority of patients present late for therapy. The advent of increasingly effective chemotherapeutic drugs—used as single agents and in combination—for squamous cancer has added one more modality in the management of esophageal cancer. Previous publications from this institution and in the literature have indicated the palliative efficacy of such chemotherapy management along with surgery and radiotherapy, particularly for advanced disease. The selection of an individual patient likely to respond to chemotherapy, the number of cycles to be given, and their exact timing in relation to radiotherapy and/or surgery still remains a matter of debate.

With appropriate endoscopic and imaging techniques, chemotherapy responsive and non‐responsive lesions can be generally identified; even radiotherapy responses can be predicted with appropriate evaluation in a majority of cases. This assessment avoids delay in instituting the most appropriate type of treatment for a given patient with esophageal cancer.

Cisplatinum‐based front‐loading (anterior) chemotherapy was used in 75 patients of locally advanced esophageal cancer (>7.5 cm on esophagogram) with a 76% (57/75) overall response rate and 10% (8/75) showing complete responses as judged by esophagogram, endoscopy; and surgical resection in 7. Patients evaluable for 2‐ and 3‐year survivals show a control rate of 35% and 24%, respectively, which is better than hitherto reported for advanced esophageal cancer. Similar reports are now available in the literature, and further studies with combined therapy should be pursued to improve the salvage rates in the usual advanced case of esophageal cancer.
Nutrition and esophageal cancer
Authors: Swaroop V. Santhi , Damle S. R. , Advani S. H. , Desai P. B.
Published: February 2007

Several case control studies in esophageal cancer employing a food‐frequency dietary questionnaire suggested a fairly uniform dietary pattern which could be implicated in the causation of the disease. Although various micronutrients (vitamins and trace elements) have also been found to have either a positive or negative association, findings were more clear‐cut for the different food items contributing the micronutrients than for the specific micronutrients themselves. The difficulties encountered in dietary interviews in case control studies are discussed. Nutritional supplementation has a theoretical rationale, but clinical experience with randomized trials did not support the same.
Overview of interleukin‐2 as an immunotherapeutic agent
Authors: Chang Alfred E. , Rosenberg Steven A.
Published: February 2007

Interleukin‐2 (IL‐2) is a lymphokine which has a variety of in vivo immunomodulatory effects. The administration of IL‐2 can mediate enhancement of cellular immune responses, induction of lymphocyte proliferation, production of cytokines, and regression of established tumor in animal models. The availability of large quantities of recombinant IL‐2 has enabled investigators to examine its therapeutic potential in the treatment of human cancer. Several studies have documented the ability of IL‐2 administration to cause durable tumor regression in patients with advanced melanoma and renal cell cancer. Toxicity of therapy is dose related and is mediated by a vascular capillary leak syndrome, lymphocytic infiltration, and the release of cytokines secreted in response to IL‐2 administration. The side effects are completely reversible upon cessation of therapy. Future efforts are aimed at increasing the antitumor efficacy and decreasing the toxicity of IL‐2 administration.
Interferons: Biological and clinical effects
Authors: Nelson Beth E. , Borden Ernest C.
Published: February 2007

Interferons play a key role in the immune system as biological response modifiers. Interferons α, β, and γ have been characterized, their nucleotide sequences defined, and the proteins produced by recombinant DNA technology. The myriad actions of interferons include enhancement of natural killer cell activity and antigen expression, induction of varied proteins, activation of macrophages, and antiviral, antiproliferative and antitumor effects. Clinical trials have demonstrated efficacy of interferons in some malignancies and ongoing studies are investigating results of combinations with other biological response modifiers and cytotoxic agents.