The oncologist
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Clinical trials, particularly large cooperative group trials, establish the standards that we use to treat many of our cancer patients. The process by which multi-institutional clinical trials are developed, performed and peer-reviewed in the United States is equaled by few other countries around the world. Our clinical cooperative groups should be considered an important national resource. ⋯ Assuming the ACoSOG initiative is funded by the NCI, the administrative and educational efforts required to establish a successful cooperative group encompassing all surgical disciplines are daunting. Many years will be necessary to bring such efforts to maturity in a smoothly functioning organization. However, the ACoSOG has the opportunity to provide a new force, energy and vision in clinical trials which could radically change our approach to patient care and could greatly strengthen the activities of the current cooperative groups.
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As a physician specializing in the treatment of cancer, I have had to watch hundreds of patients die from cancer because current treatments have limited benefit. I know of no disease that can strike a patient more tragically than cancer. However, I can say with absolute certainty that the medical and scientific communities are on the verge of major breakthroughs in our ability to control this dreadful disease. ⋯ We no longer wonder if we will find a cure for cancer but when. America has an incredible opportunity to conquer this deadly disease. Increasing funds for cancer research could now accelerate by years the development of new and more effective treatments for cancer, literally saving tens of thousands of American lives.
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Breathtaking insights into carcinogenesis and tumor biology have been gained mainly by recent technical advances in molecular-biological and genetic techniques. Thus, dimensions of earlier diagnosis and the development of new concepts in therapy arise, which were previously unavailable. There is no doubt that through these techniques the future role and tasks of surgical oncology will change. ⋯ Technology should be used according to the situation, not to adapt the patient to a technocratic environment, but to emphasize human treatment of the individual patient. From the opinion of the telephone being a futile technical invention to the other extreme of computed technology as a substitute for the physician (Dr. Cyber), the future role of telemedical techniques and their potential for medical advantage or support, especially in the field of oncology, should be critically viewed and evaluated.
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To the Editors: We have read with interest and some concern the recently published editorial, "We've Got a Treatment, but What's the Disease," by Rosenthal and Glatstein. This editorial enunciates these common anxieties (? "mid-life") about radiosurgery: A) that thedure as currently practiced worldwide, even in the United States, does not in all cases rely on the talents of radiation oncologists; B) that the technique disregards fundamental (? proven) principles about radiobiology, and C) that the authors of the editorial have chosen to ignore a tremendous body of historical and clinical literature relative to outcomes. In fact, long-term clinical data have been published in a wide variety of reports during the last ten years. ⋯ Instead, fractionation evolved which permitted us to exploit repopulation, redistribution, reoxygenation and repair. The use of these large single doses remains, at least in our minds, investigational in the treatment of especially malignant tumors. This is the way this subject is presented to patients here.
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The current standard treatments for childhood cancers are highly successful. The five-year survival rates for all children diagnosed with cancer in the late 1980s approaches 70%, and the outlook continues to improve. For some types of localized embryonal tumors, such as retinoblastoma and Wilms' tumor, the cure rates approach or exceed 90%. ⋯ It may be more feasible to initially test these new treatment approaches in those cancers in which current standard therapy is less successful. Once they have been demonstrated to have antitumor activity in poor prognosis tumors, they can be applied to the treatment of cancers that respond well to current standard multimodality treatments. With these changes in the patient population entering investigational drug studies and the development of new non-cytotoxic treatment approaches, the design and end-points of conventional phase I and II trials must be adapted to ensure that new therapies are efficiently developed in the pediatric population.