Cancer
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Chordomas are rare neoplasms that show a proclivity for the spheno-occiput and sacral regions. A "chondroid" variant involving the spheno-occiput has been associated with improved survival. "Classic" or nonchondroid chordomas are uniformly immunoreactive for keratins. Chondroid chordomas are said to be immunonegative for epithelial markers, a feature used to support the concept that they represent chondrosarcomas. ⋯ Regardless of tumor subtype, age is the single most important variable in determining survival; patients younger than 40 years of age do better than older patients. There are no significant survival differences between patients with cartilage-containing tumors that are keratin immunopositive ("true" chondroid chordoma) or negative (chondrosarcoma). Immunostaining for keratins is of no prognostic value in assessing chondroid lesions of the spheno-occiput.
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Clinical trials are a major commitment for a university-based comprehensive cancer center. In 1992, The Johns Hopkins Hospital registered 3508 new patients with cancer and, from this large population, 2880 patients were entered in clinical trials (many patients participated in more than one protocol). The Oncology Center, one of many departments at Johns Hopkins that conducts clinical research, participates in phase I and II new drug trials, phase III comparative studies, and, increasingly, in epidemiologic and prevention research. ⋯ The clinical trial must meet rigorous criteria of design, conduct, and analysis. The patient must understand the issues and be a volunteer. We must make every effort to help patients and physicians get information about clinical trials and to participate if they choose.
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As the federal government struggles to meet ever-growing budgetary constraints, the need for research into the causes of and potential therapies for treating cancer demands the urgent attention of Congressional leaders. This will require innovative, cost-effective approaches to address the unique needs of cancer researchers, physicians, and patients. As a new member of the Senate Appropriations Committee and a member of the Labor, Health and Human Services, and Education Subcommittee, I will be in the forefront of this important debate; as a cancer survivor, I will approach this new assignment with a deep personal conviction. Key issues in the fight against cancer will focus on the way to make cancer screening available to all Americans, the National Cancer Institute Bypass Budget, and the process by which the Food and Drug Administration approves new therapies.