The lancet oncology
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The lancet oncology · Apr 2008
ReviewTherapeutic stem-cells for cancer treatment: hopes and hurdles in tactical warfare.
As our understanding of stem-cell behaviour rapidly increases, more and more reports suggest that use of stem-cell therapy will extend well beyond regenerative medicine in the near future. Due to their inherent tumoritropic migratory properties, stem cells can serve as vehicles for the delivery of effective, targeted treatment to isolated tumours and to metastatic disease. In vitro, stem cells can readily be engineered by inserting specifically tailored transgenes with antitumour effects to create tumour-seeking therapeutic vehicles. ⋯ Many of these strategies have been validated in a wide range of studies assessing treatment feasibility or efficacy and establishing methods for real-time monitoring of stem-cell migration and fate in vivo. New insights into avenues for stem-cell sourcing have shortened the probable time to realisation of such treatments for patients. In this Review, we provide an outline of the rationale and status of stem-cell-based treatments for tumours, and we discuss prospects for clinical implementation and the factors crucial for maintaining momentum towards this goal.
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The lancet oncology · Feb 2008
ReviewCancer registration in developing countries: luxury or necessity?
Differences in culture and resources between low-income and high-income countries have resulted in unequal rights to health. In the past few decades, developing countries have had an increase in chronic-disease burden, including cancer. ⋯ To fight this burden, the extent of the cancer must be known so that programmes for cancer control can be planned efficiently, not only to implement standards of care but also to define prevention strategies. In this Review, we advocate the need for availability of cancer data and discuss potential opportunities for hospital-based and population-based cancer registries to collaborate in providing these data in low-income countries.
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Gastroenteropancreatic (GEP) neuroendocrine tumours (NETs) are fairly rare neoplasms that present many clinical challenges. They secrete peptides and neuroamines that cause distinct clinical syndromes, including carcinoid syndrome. However, many are clinically silent until late presentation with mass effects. ⋯ More-reliable serum markers, better tumour localisation and identification of small lesions, and histological grading systems and classifications with prognostic application are needed. Comparison between treatments is currently very difficult. Progress is unlikely to occur without development of centers of excellence, with dedicated combined clinical teams to coordinate multicentre studies, maintain clinical and tissue databases, and refine molecularly targeted therapeutics.
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The lancet oncology · Nov 2007
ReviewGastrointestinal symptoms after pelvic radiotherapy: a new understanding to improve management of symptomatic patients.
Gastrointestinal symptoms after pelvic radiotherapy, which affect quality of life, are substantially more common than generally recognised and are frequently poorly managed. These symptoms develop because radiation can induce change in one or more specific physiological functions in widely separated parts of the gastrointestinal tract that lie in the path of the radiotherapy beam. Radiation-induced changes are not confined by normal anatomical boundaries. ⋯ Simple diagnostic tests that are used in other contexts, if applied appropriately to patients with new gastrointestinal symptoms after radiotherapy, can identify the underlying causes of new-onset symptoms. Starting treatment without knowing the cause of the symptom is commonly ineffective because prediction of the combination of treatments needed is difficult. Evidence suggests that many patients have unusual but highly treatable malfunctions of gastrointestinal physiology, which if correctly diagnosed may enable a patient with difficult symptoms to be helped.
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The lancet oncology · Oct 2007
ReviewAndrogen-response elements in hormone-refractory prostate cancer: implications for treatment development.
Many attempts have been made to derive genetic signatures for progressive prostate cancer for both prognostic and therapeutic purposes. These investigations have resulted in the discovery of many pathways, but the signatures exhibit heterogeneity and restricted reproducibility. A thorough and disciplined analysis of genes with androgen-response elements that are expressed in progressive, castration-resistant prostate cancer is an integral step towards the development of new therapeutic or diagnostic targets. We discuss the effects of bona-fide downstream targets of the androgen receptor on cellular proliferation, evasion of apoptosis, and angiogenesis, and consider the clinical potential of these targets.