Annals of oncology : official journal of the European Society for Medical Oncology
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The article describes the history and organization of the European Society for Medical Oncology. The society, founded in 1975, aims at advancing medical oncology on a pan-European basis. Postgraduate training and education constitute a major part of ESMO's activities through a current CME programme of courses and other activities. ⋯ A task force (CEE TF) with members from 16 Central Eastern European countries meets twice a year to discuss key areas. An e-mail communication system has been launched, courses are planned for 1998-1999, exchange programmes are in progress, and support in setting up national guidelines will follow. A Central Eastern European Oncology Group (CEE OG), which performs clinical trials on a cooperative basis, has been established with ESMO guidance.
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Lung cancer represents the leading cause of cancer mortality. Non-small cell lung cancer (NSCLC) accounts for about 75% to 80% of lung cancer cases and carries a 5-year survival of about 10% to 15% for all stages. Approximately one third of NSCLC patients present with stage III disease, which is defined as locally advanced tumour confined to the chest without distant metastasis. ⋯ These recent reports of randomised clinical trials of combined modality therapy for stage III NSCLC form the basis for this report. Several new agents, like the taxanes, CPT-II and gemcitabine show promising activity in NSCLC treatment. Ongoing studies are evaluating the potential role of these new agents in combined modality treatment but since the phase III trials have not been reported yet these studies will not be discussed.
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Quality of life is receiving increasing attention as a criterion for the assessment of treatment, not least for surgery, in pancreatic cancer. In exocrine pancreatic cancer there are three main symptoms that must be dealt with: pain, loss of weight and jaundice. All of them seriously impair quality of life, but most often pain is the most feared by the patients. ⋯ With this approach the sympathetic fibers lead by the symphathetic chain and further by the nervus splanchnicus major, minor and minors are divided. The denervation is easily done and can be performed bilateraly in one seance. This method will probably be used more often as the technique is now well described.
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Clinical Trial
Cardiac effects of high-dose epirubicin and cyclophosphamide in women with poor prognosis breast cancer.
To prospectively evaluate the long term cardiac effects of high-dose epirubicin and cyclophosphamide given to women with early stage, poor prognosis breast cancer. ⋯ During follow-up after high-dose epirubicin and cyclophosphamide as delivered in this study, the LVEF fell to below normal in approximately one third of patients. However, in over half of these patients the LVEF subsequently recovered to the normal range, and the incidence of clinically evident chronic cardiac failure was low. Further follow-up is required to assess the long-term safety. A randomized comparison with standard-dose anthracycline-based chemotherapy is needed to determine whether this regimen is associated with an increased risk of clinical cardiac toxicity.
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There is a potential for neo-adjuvant chemotherapy to provide significant benefit in outcome for patients with locally advanced non-small-cell lung cancer (NSCLC). Patients with N2/T3 NSCLC have a poor prognosis when treated by surgery alone since micrometastases result in relapse in the majority of cases. The same is true of patients with N3/T4 disease treated only with radiotherapy. Systemic therapy is therefore required, and cisplatin-based induction chemotherapy prior to surgery or radiotherapy has been shown to improve survival when compared with surgery or radiotherapy alone. Docetaxel has been shown to have significant activity in stage IV NSCLC and ongoing phase III trials are comparing single agent docetaxel or doceatxel in combination with cisplatin or VP16 before local treatment to local treatment alone. ⋯ The details of time-to-progression and survival in this study will eventually confirm the results from recent small trials of neo-adjuvant chemotherapy in locally-advanced NSCLC.