Monday, June 27, 2011

Treatment of cancer pain

In the Lancet:

A reasonable review of the management of cancer related pain:


[Series] Treatment of cancer pain: "SummaryIn patients with active cancer, the management of chronic pain is an essential element in a comprehensive strategy for palliative care. This strategy emphasises multidimensional assessment and the coordinated use of treatments that together mitigate suffering and provide support to the patient and family. This review describes this framework, an approach to pain assessment, and widely accepted techniques to optimise the safety and effectiveness of opioid drugs and other treatments. The advances of recent decades suggest a future that includes increased evidence-based targeting of specific analgesic interventions within an individualised plan of care that is appropriate throughout the course of illness."

Meta analysis: Neoadjuvant treatment for Esophageal Cancer

In the Lancet Oncology:

A meta-analysis is updated, again suggesting that neoadjuvant treatment results in superior results over surgery alone for esophageal cancer. The comparison between chemoradiotherapy and chemotherapy was not quite significant, but there was a strong trend towards better results with chemoradiation.


[Articles] Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis: "SummaryBackgroundIn a previous meta-analysis, we identified a survival benefit from neoadjuvant chemotherapy or chemoradiotherapy before surgery in patients with resectable oesophageal carcinoma. We updated this meta-analysis with results from new or updated randomised trials presented in the past 3 years. We also compared the benefits of preoperative neoadjuvant chemotherapy compared with neoadjuvant chemoradiotherapy.MethodsTo identify additional studies and published abstracts from major scientific meetings, we searched Medline, Embase, and Central (Cochrane clinical trials database) for studies published since January, 2006, and also manually searched for abstracts from major conferences from the same period."

Friday, June 17, 2011

secondary breast cancer after RT for HL

In the JCO this week:

An interesting article looking at the prognosis of patients developing a secondary breast cancer after RT for Hodgkin's Lymphoma, compared to sporadic disease. Perhaps not surprisingly, the cancers were detected earlier (due to more intensive screening), and was more likely to be bilateral. Additionally, there was increased risk to the other breast later in the woman's life. There was an increased risk of all cause mortality, and a non-significant increase in breast cancer specific mortality.

What this trial doesn't answer however is how patients with HL who did not recieve RT do with respect to breast cancer outcomes; therefor making it a little more difficulty to tease out the true effect of radiotherapy. That said, the finding are very consistent with the known increased risk of breast cancer induction from RT, and appropriately recommends close surveillance of these patients.

Abstract and Link:

Characteristics and Outcomes of Breast Cancer in Women With and Without a History of Radiation for Hodgkin's Lymphoma: A Multi-Institutional, Matched Cohort Study [Breast Cancer]: "Purpose

To compare characteristics and outcomes of breast cancer in women with and without a history of radiation therapy (RT) for Hodgkin's lymphoma (HL).

Patients and Methods

Women with breast cancer diagnosed from 1980 to 2006 after RT for HL were identified from eight North American hospitals and were matched three-to-one with patients with sporadic breast cancer by age, race, and year of breast cancer diagnosis. Information on patient, tumor and treatment characteristics, and clinical outcomes was abstracted from medical records.


A total of 253 patients with breast cancer with a history of RT for HL were matched with 741 patients with sporadic breast cancer. Median time from HL to breast cancer diagnosis was 18 years. Median age at breast cancer diagnosis was 42 years. Breast cancer after RT for HL was more likely to be detected by screening, was more likely to be diagnosed at an earlier stage, and was more likely to be bilateral at diagnosis. HL survivors had an increased risk of metachronous contralateral breast cancer (adjusted hazard ratio [HR], 4.3; 95% CI, 1.7 to 11.0) and death as a result of any cause (adjusted HR, 1.9; 95% CI, 1.1 to 3.3). Breast cancer–specific mortality was also elevated, but this difference was not statistically significant (adjusted HR, 1.6; 95% CI, 0.7 to 3.4).


In women with a history of RT for HL, breast cancer is diagnosed at an earlier stage, but these women are at greater risk for bilateral disease and are more likely to die as a result of causes other than breast cancer. Our findings support close follow-up for contralateral tumors in these patients and ongoing primary care to manage comorbid conditions.