Current opinion in oncology
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With an estimated 170,000 new cases and 149,000 deaths in the United States during 1993, lung cancer is now the leading cause of cancer deaths in both men and women. Tobacco smoking is an important risk factor, and a large fraction of the risk can be attributed to it. ⋯ Prevention of lung cancer through early detection and identification of individuals at risk is the goal of many recent studies. This review summarizes the current status of epidemiologic and biomarker research in understanding both the etiology and prognostic utility of environmental and host factors.
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Results of clinical trials in bone marrow transplantation (BMT) patients have shown that morbidity associated with myelosuppressive chemo- or radiotherapy is reduced in patients receiving hematopoietic growth factors such as recombinant human granulocyte colony-stimulating factor or recombinant human granulocyte-macrophage colony-stimulating factor. Recombinant human granulocyte-macrophage colony-stimulating factor has been approved by the Food and Drug Administration to speed neutrophil recovery, to reduce the severity and duration of infection, and to shorten hospital stays of patients with lymphoid malignancy who undergo autologous BMT. ⋯ Other hematopoietic growth factors, such as recombinant Human macrophage colony-stimulating factor, recombinant human interleukin (rhIL)-3, rhIL-3-GM-CSF (rh-PIXY 321), rhIL-6, rhIL-1, rhc-kit ligand (rh-KL), and erythropoietin (rh-EPO), are also being studied singly or in combination in patients undergoing BMT. The use of hematopoietic growth factors in marrow transplantation is reviewed.
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Review Comparative Study
High-dose rate brachytherapy for carcinoma of the cervix.
Increasingly popular in Europe and Asia as the intracavitary component for cervical cancer radiotherapy, high-dose rate brachytherapy demonstrates certain advantages over historical low-dose rate treatments. High-dose rate intracavitary treatment improves radiation safety, lessens treatment times, allows for outpatient treatment regimens, and has improved packing and retraction techniques, which can decrease rectal and bladder doses. ⋯ Recent data showing decreased local control in advanced cervical cancer with the prolonged overall treatment time of low-dose rate treatment suggest the practical advantage of outpatient high-dose rate intracavitary brachytherapy, which uses fractionated regimens and shortens overall treatment times. Although high-dose rate treatment has not been shown to improve survival compared with low-dose rate treatment, its practical advantages may account for its increasing use.
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Some biologic agents have proven effective in the treatment of lymphoproliferative diseases by stimulating host antitumor immunity or by applying active antitumor properties that specifically or nonspecifically effect tumor growth or tumor survival. These agents include interferons, which regulate cell gene expression, structure, and function; interleukin-2, which has several functions related to lymphoproliferation and mediation of lymphoid cell transport; anti-idiotype antibodies, which appear to cause a specific antiproliferative response against the patient's tumor; anti-idiotype vaccines, which produce cyclic complementary binding sites and idiotypes to induce specific immunity to tumors with resultant antitumor activity; radioisotope labeled monoclonal antibodies, which directly deliver tumoricidal doses of radiation to tumors, sparing normal tissue toxicity; and monoclonal antibody-immunotoxin conjugates, which directly deliver tumoricidal doses of radiation to tumors, sparing normal tissue toxicity. Encouraging results have been seen in clinical studies with these agents and much knowledge has been gained regarding the mechanisms involved. These findings dictate ongoing therapy modifications to produce continuing progress in the therapeutic applications of biologic agents in lymphoproliferative disease processes.
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Despite major progress in the treatment of chemotherapy-induced emesis, nearly one third of patients undergoing cisplatin-based regimens still experience emesis within the first 24 hours of chemotherapy. An adequate treatment of delayed and anticipatory emesis remains to be determined. For highly emetogenic chemotherapy, the combination of ondansetron and dexamethasone is superior to dexamethasone alone and protects most patients. ⋯ This would suggest that, to reduce the cost of antiemetic therapy, ondansetron can be limited in case of failure of standard therapy. Delayed emesis remains poorly controlled with no difference between metoclopramide, dexamethasone, ondansetron, and placebo. Although some data suggest an improved efficacy when combining ondansetron with dexamethasone, convincing confirmatory studies are needed.