European journal of cancer : official journal for European Organization for Research and Treatment of Cancer (EORTC) [and] European Association for Cancer Research (EACR)
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Multicenter Study Clinical Trial
Clinical activity and benefit of irinotecan (CPT-11) in patients with colorectal cancer truly resistant to 5-fluorouracil (5-FU).
The aim of this prospective study was to assess the efficacy, clinical benefit and safety of CPT-11 (irinotecan) in patients with stringently-defined 5-fluorouracil-resistant metastatic colorectal cancer (CRC). 107 patients with documented progression of metastatic CRC during 5-FU were treated with CPT-11 350 mg/m2 once every 3 weeks in a multicentre phase II study. Tumour response and toxicity were assessed using WHO criteria. Changes in performance status (PS), weight and pain were also measured. ⋯ Diarrhoea grade > or = 3 occurred in 7% of cycles and 28/107 (26%) of patients. CPT-11 350 mg/m2 once every 3 weeks has an encouraging degree of activity in progressive metastatic CRC truly resistant to 5-FU with a relatively high rate of tumour growth control translated into clinical benefit. The toxicity profile of CPT-11 is becoming better understood and has been considerably improved.
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The aim of this prospective study was to identify the psychiatric morbidity associated with the diagnosis and treatment of early breast cancer. At each of five time points, 269 women were interviewed using a shortened version of the Present State Examination (PSE) and 266 completed self-assessment questionnaires, the Hospital and Anxiety Depression Scale (HADS) and the Rotterdam Symptom Checklist (RSCL). This paper compares the ability of the questionnaires to detect psychiatric morbidity with that of the PSE. ⋯ Lowering the threshold values raised the sensitivity of both the instruments but decreased their specificity: the lower the threshold, the greater the number of women who were identified as false positives which would increase the work load for clinic staff if used as a screening tool. Given that the HADS was inadequate in discriminating for depressive illness, it was not surprising that its use as a unitary scale with a threshold value as low as 12 resulted in a sensitivity of only 42.7%. In the light of these findings, we question the use of both the HADS and the RSCL as suitable research or screening instruments for detection of psychological morbidity in early breast cancer.
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The membrane-bound complement inhibitors CD46 (membrane cofactor protein), CD55 (decay-accelerating factor) and CD59 (protectin) protect tumour cells against lysis by activated complement. In this study, a total of 14 (3 gastric, 3 colonic and 8 pancreatic) gastrointestinal tumour cell lines were examined for the expression of CD46, CD55 and CD59 with respect to the regulatory efficacy of interferon-gamma (IFN-gamma). The effects of IFN-gamma on mRNA and protein expression levels of CD46, CD55 and CD59 were evaluated by Northern blot hybridisation, RT-PCR, flow cytometry and immunostaining. ⋯ Upregulation of protein expression was only observed in HT29 cells for CD55 and CD59 and was accompanied by a marked increase of the corresponding transcripts. We conclude that membrane-bound complement inhibitors are broadly expressed in gastrointestinal tumour cells and vary in their susceptibility to IFN-gamma. Thus, they may be involved in tumour escape mechanisms in gastric, pancreatic and colorectal cancer.
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This introduction provides a general overview of the aims, methods and procedures used in the EUROCARE II study and the types of analyses presented in each article of this Special Issue of the European Journal of Cancer. The main aims of the EUROCARE II project are the updating of the survival database of the European Cancer Registries, the study of recent trends in relative survival rates and the interpretation of the survival differences observed both in time and across populations. Once having completed the preliminary stage of data checking, a total of 3,473,659 individual records from patients of all cancer sites, diagnosed between 1978 and 1989 and provided by 45 cancer registries in 17 European countries were accepted to build up the EUROCARE database. ⋯ Statistical analysis was based on age-specific relative survival rates, computed for each cancer sites as the ratio of observed survival to the expected survival of the general population of the same area, gender and age, according to the Hakulinen method. An estimate of the European survival was computed as a weighted mean of the corresponding survival of the different countries, using as weights the expected yearly number of incident cases in each country. For comparison purposes, age-standardised survival was also calculated for Europe and for each country involved in the study.
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Data on 73,070 patients for seven major haematological malignancies diagnosed in Europe between 1985 and 1989 from 39 population-based cancer registries in 17 countries are included in the EUROCARE database. Relative survival was analysed by country and age between 1985 and 1989 and time trends were analysed from 1978-1989 for 13 countries which collaborated in EUROCARE for this entire period. The European weighted age-standardised 5-year relative survival rate was 72% for patients with Hodgkin's disease (HD, ranging from 45 to 76% in 13 countries), 63% for chronic lymphocytic leukaemia (CLL, range 51-79%, 14 countries), 46% for patients with non-Hodgkin's lymphoma (NHL, range 25-63%, 17 countries), 31% for patients with chronic myelocytic leukaemia (CML, range 8-40%, 13 countries), 28% for patients with multiple myeloma (MM, range 18-36%, 14 countries), 25% for patients with acute lymphoblastic leukaemia (ALL, range 19-33%, 7 countries) and 10% for patients with acute myeloblastic leukaemia (AML, range 4-15%, 11 countries). ⋯ Compared with 1978-1979, relative 5-year survival improved in 1987-1989 for most haematological malignancies (relative risk (RR) of death for CLL 0.65, AML 0.75, HD 0.76, ALL 0.79, NHL 0.82), with only CML (RR 0.95) and MM (RR 1.00) showing little or no change. These results suggest that generally and particularly in Eastern Europe there is room for improvement in the diagnosis and treatment of haematological malignancies. The intercountry differences also highlight the importance of socio-economic conditions to health status.