Article Abstract:
The response of a cancer patient to therapy is usually based on clinical signs and symptoms. A complete response is suggested by the disappearance of clinical signs and symptoms of disease, although microscopic evidence and subclinical signs may exist. It would be advantageous to have a noninvasive method of monitoring the response of patients to therapy, as well as a method of detecting tumor recurrence as early as possible. Modern imaging techniques have contributed greatly in this regard. In the case of neuroblastoma, the measurement of urinary catecholamines may be helpful as well, but these tests are not always sensitive enough. One method that may be highly sensitive is the identification of individual neuroblastoma cells floating in the blood, as the shedding of such cells may be one of the first and most sensitive indicators of tumor recurrence. Conversely, the disappearance of such cells may be an excellent indicator of response to treatment, particularly when suspicious masses remain visible by imaging techniques such as magnetic resonance imaging. Until recently, the examination of blood for neuroblastoma cells has been impractical. Culturing the cells is too elaborate and time-consuming, and visually identifying the cells under the microscope is fraught with opportunities for error. The advent of monoclonal antibody technology may make the detection of these cells in the blood feasible. Using antibodies that are highly specific for neuroblastoma cells it is possible to confidently identify a small number of neuroblastoma cells among an overwhelming number of normal blood cells. This method was used to monitor two children with neuroblastoma. In one case, the examination of the blood using the monoclonal antibodies documented the persistence of neuroblastoma cells; in the other, the technique documented the disappearance of these cells. In both cases, the indications of the blood test were confirmed upon autopsy. The authors suggest that for patients with disseminated neuroblastoma, immunocytological monitoring of the blood should become a standard technique to be performed along with the more conventional methods of patient monitoring. (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
Cancer of the glottis, the vocal apparatus of the larynx (voicebox), is variously treated by surgery, radiotherapy, or a combination of the two. Each approach has its proponents. Except in the case of advanced cancer, when surgery is the only responsible approach, it seems that there is little survival difference between surgery and radiotherapy. However, since surgery invariably results in the loss of the larynx (and speech), there is a compelling reason to lean towards radiotherapy, as long as survival is not compromised. The authors reviewed the cases 478 patients who were treated for cancer of the glottis by irradiation; of these, 320 were receiving initial treatment while the remainder were suffering a recurrence of previously treated cancer of the glottis. Follow-up revealed that 10 percent of the previously untreated patients developed primary recurrences. Patients suffering a recurrence were treated surgically, with removal of the larynx. The 5-year survival after suffering a primary recurrence was 39 percent, while the 5-year survival rate among the patients suffering a recurrence in lymph nodes was 16 percent. Among the various risk factors for survival after relapse, the importance of lymph node recurrence was so great that other risk factors were of little significance. Of the patients for whom 5-year follow-up was possible, 49 percent were alive and still retained their larynx, 5 percent were alive without a larynx, 13 percent had died of glottic cancer, and 33 percent had died of other causes. The results suggest that the application of radiotherapy as the primary treatment for glottic cancer, keeping surgery in reserve as treatment for recurrence, results in a majority of patients surviving 5 years and over 90 percent retaining their larynx (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
The frequency of laryngeal cancer varies within Italy, with northern areas having a higher rate compared with the southern areas and the island of Sardinia. The difference has been attributed to alcohol consumption and tobacco use. The characteristics of laryngeal cancer in patients on the island of Sardinia, an area of low-risk, were analyzed by reviewing 378 surgically treated cases. The five-year survival rate was 61 percent. Since the 10-year survival was 51 percent, it appears that at five years a plateau of survival has been reached. Normally, the stage at which a tumor is diagnosed is a significant prognostic factor, with patients in earlier stages having better survival rates. However, among patients who delayed seeking medical treatment after noticing symptoms, there was no statistically significant influence on survival. The stage of cancer was not as important a prognostic indicator as was the ulceration of the cancer; the survival of patients with ulcerated tumors was roughly 40 percent, in contrast to a better than 70 percent survival rate achieved by those without ulceration. The precise location of the cancer and the type of surgery performed were not important factors in predicting patient outcome. (Consumer Summary produced by Reliance Medical Information, Inc.)
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