The lancet oncology
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The lancet oncology · Dec 2006
ReviewImmunobiology of the sentinel lymph node and its potential role for antitumour immunity.
The sentinel lymph node (SLN) is thought to be an important lymphoid organ for protecting against metastasis and is thought to play a crucial part in provoking antitumour immunity. Because SLN biopsy is undertaken for various types of cancers, such as malignant melanoma and breast cancer, SLN mapping has become a standard procedure, thereby eliminating unnecessary lymph-node resection in patients who do not have affected nodes. ⋯ Furthermore, cell death after primary systemic chemotherapy for solid tumours can provoke an antigen-specific immunity in the tumour, which affects tumour response to treatment and, therefore, survival in patients. This review discusses the immunobiology of the SLN and potential strategies for activation of antitumour immunity by primary systemic chemotherapy and other modalities, in terms of tumour-size reduction and survival benefit.
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The lancet oncology · Nov 2006
ReviewMultidisciplinary teams in cancer care: are they effective in the UK?
Cancer care can be complex, and given the wide range and numbers of health-care professionals involved, an enormous potential for poor coordination and miscommunication exists. Multidisciplinary teams (MDTs) should improve coordination, communication, and decision making between health-care team members and patients, and hopefully produce more positive outcomes. This review describes the many practical barriers to the successful implementation of MDT working, and shows that despite an increase in the delivery of cancer services via this method, research showing the effectiveness of MDT working is scarce.
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The lancet oncology · Jul 2006
ReviewReassessment of the role of induction chemotherapy for head and neck cancer.
Head and neck cancers are a complex group of diseases defined by variations in histological features, anatomical location, and cause. Once the realm of surgeons and radiation oncologists, the treatment of locally advanced disease now involves medical oncologists. Major developments include primary chemoradiotherapy for unresectable disease and organ preservation, the addition of chemotherapy to adjuvant radiotherapy, improvement in surgical and radiation techniques, and biological therapies. ⋯ Given this shift in site of recurrence, therapeutic strategies to suppress distant metastases may be the next goal for further improvement of survival. One approach that merits reassessment is the use of induction chemotherapy in the setting of locally advanced disease--both resectable and unresectable. In this review we summarise data for the use of induction chemotherapy to define better which patients will likely benefit from this approach now and which questions are important in the design of future clinical trials.
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The lancet oncology · Mar 2006
ReviewDiffuse brainstem glioma in children: critical review of clinical trials.
Diffuse intrinsic brainstem gliomas constitute 15-20% of all CNS tumours in children, and are the main cause of death in children with brain tumours. Many clinical trials have been done over the past three decades, but survival has remained static. More than 90% of children die within 2 years of diagnosis, and conventional fractionated radiation remains the standard treatment. ⋯ We appraised the consistency between protocols in terms of eligibility criteria, definition and assessment of response and progression, statistical design, and endpoints. Study designs varied substantially, which could explain the differences in outcome, and no treatment has shown a benefit over conventional radiotherapy. However, consistency between protocols (eg, eligibility criteria and outcome measures) is important to measure the progress in management of diffuse pontine gliomas.
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A causal association has been established between alcohol consumption and cancers of the oral cavity, pharynx, larynx, oesophagus, liver, colon, rectum, and, in women, breast; an association is suspected for cancers of the pancreas and lung. Evidence suggests that the effect of alcohol is modulated by polymorphisms in genes encoding enzymes for ethanol metabolism (eg, alcohol dehydrogenases, aldehyde dehydrogenases, and cytochrome P450 2E1), folate metabolism, and DNA repair. The mechanisms by which alcohol consumption exerts its carcinogenic effect have not been defined fully, although plausible events include: a genotoxic effect of acetaldehyde, the main metabolite of ethanol; increased oestrogen concentration, which is important for breast carcinogenesis; a role as solvent for tobacco carcinogens; production of reactive oxygen species and nitrogen species; and changes in folate metabolism. Alcohol consumption is increasing in many countries and is an important cause of cancer worldwide.