Seven patients with progressive localized or metastatic chemo-resistant osteosarcoma were treated by gemcitabine.The protocol included gemcitabine 1000 mg/m2/w for 7 consecutive weeks, followed by 1 week rest. If no progression was observed,maintenance by gemcitabine 1000 mg/m2/w for 3 weeks every 28 days was given until failure was clinically or radiologically evident.Results. The true objective response rate was 0%. However, disease stabilization and clinical benefit response were observed in five patients (70%) for 13-96 weeks.Discussion. Postponing the inevitable death with a relatively non-toxic treatment, is, in our opinion, an important issue especially in young patients.Thus it may be justified and warranted to investigate the activity of gemcitabine in a larger group of patients with bone sarcomas.
To study the impact of time factors on local and distant metastases in stomach cancer.67 patients with gastric cancer who received adjuvant treatment were reviewed for the time to initiation of radiotherapy, overall duration of RT and the events of first local recurrence or distant metastasis.The risk probability of local recurrence is increased by 10% (HR=1.1, p=0.0009) in association with each additional day of radiotherapy and by 3.8% (HR=1.038, p=0.13) per increased day of waiting time before the initiation of RT. The risk probability of distant recurrence was associated with an increase of 7.4% (HR=1.074 p=0.0031) with each additional day of RT time and by 2.3% (HR=1.023, p=0.0598) following the increase of a day of waiting time. Each day of prolongation of RT beyond 36 days was associated with an increased risk of local recurrence by 10% (OR=1.1, p=0.015). Prolongation of waiting time prior to initiation of irradiation retained significance in multivariate analysis.There is an association between total treatment time and, to some extent, the time between the surgery and the initiation of radiation on local control and distant metastases.
Sexuality is a basic need for every human being as long as he or she is alive, irrespective of age or health status. Approximately 23,500 individuals are diagnosed with cancer each year in Israel and join the 120,000 cancer patients currently living in Israel. The results of cancer treatments are traditionally assessed and based on the outcome regarding mortality versus survival. An equally important aspect to be addressed in this assessment must relate to quality of life. One of the more painful insults to the quality of life of cancer patients relates to the deleterious effects on sexuality. This article aims to present physicians with the spectrum of sexuality-related issues which are encountered by cancer patients and their partners, starting from the moment of diagnosis, throughout the various stages of treatment and to provide basic knowledge. Many individuals contracting cancer have difficulty dealing with the issue of sexuality. They are typically embarrassed and feel uneasy when asking health care providers about such a non-life threatening issue. Partners similarly feel both shame and guilt. In many cases sexuality, intimacy and emotional attachment are important aspects and may be essential for survival. Addressing these issues during treatment can provide patients with a sense of security, avoiding embarrassment and further exacerbation of such problems. Unfortunately, little has been done to develop an optimal interventional program, although standard sexual treatments have often been applied. Prospective clinical research and outcomes are missing. The physician can use the well-known PLISSIT model (1978): to provide sexuality involvement on different levels. The very new BETTER model (2004) can help emphasize that cancer treatment and the disease have an influence on intimacy and sexuality.
To evaluate cytoplasmic and nuclear ErbB-4 expression in prostate cancer specimens and its association with outcome.Specimens of 50 prostate cancer patients were investigated for ErbB-4 overexpression using Immunohistochemistry staining. Cytoplasmic and nuclear staining was graded as 0-3 according to its intensity. The prognostic parameters were tumor stage, PSA level, Gleason score, probability of positive lymph nodes (Partin's tables and Roach equation), and 5-year disease free survival (Kattan nomogram).Overexpression of ErbB-4 (> or = 1) was detected in 30 (60%) patients and overexpression using cytoplasmic and nuclear staining was > or = 2 in 19 (38%) and 17 (34%) patients, respectively. In only one third of the specimens was there any similarity between the 2 types of staining. Advanced tumor stage, high pretreatment PSA levels and high Gleason scores were evenly distributed among the patients with low (< or = 1) and intermediate/high (> or = 2) ErbB-4 expression. The probability of lymph node involvement and 5-year disease free survival were similar in both types of staining.ErbB-4 was overexpressed (cytoplasmic and nuclear staining) in approximately one third of prostate cancer patients. The rate of similarity between the 2 staining types was only 33%: overexpression was evenly distributed among intermediate/high and low risk prostate cancer patients with both staining methods.
The Radiation Therapy Oncology Group (RTOG) is part of the cooperative group network that is overseen by the National Cancer Institute (NCI). Although the NCI is a US-based group, it has empowered the cooperative groups to recruit foreign institutions to participate in collaborative clinical trials. The RTOG undertook the challenge of globalizing its efforts in 2004. This article describes the rationale for this decision and the tactics adopted by the first hospital outside of North America to enroll patients onto RTOG trials. The challenges confronted by foreign institutions seeking admission to the RTOG and the mechanism by which Tel Aviv Medical Center (TAMC) met these challenges are described. Shortly after its acceptance, TAMC emerged as one of the leading accruers of patients to RTOG studies. The public health implications of this accomplishment are discussed.
