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  • 1. ISSN 1751-4975 Oncology News Volume 3 Issue 2 :August/September 2008 www.oncologynews.biz Subscr ibe In this issue FREE www.o ncolog ynews .biz What is UCAN? Management of Primary Lung Cancer The Current Treatment of GIST With Reference to Laparoscopic Resection and Neoadjuvant Treatment Prostate Cancer reviewed: Part 2 - Treatment Options
  • 2. Comprehensive workflow and information management. ARIA™. The complete Oncology Information System. Providing quality cancer care to patients requires a team effort by all staff in the cancer o gy col On center. The ARIA Oncology Information System supports oncology practitioners with n o the tools needed to effectively manage clinical, financial and administrative data in their Radiati Medica l On departments, eliminating the need for films and paper charts. co ARIA streamlines the workflow of advanced techniques such as RapidArc™,IMRT, IGRT, log y gy adaptive and concomitant therapies. It features a complete chemotherapy manage- ical Oncolo ment system with the most sophisticated clinical trials administration and outcomes assessment tools that help to increase efficiency and reduce clinical risk. rg Su ARIA offers powerful and flexible communication tools based on DICOM and HL7, which pass treatment strategy relevant information to the right place in ARIA and connected partner systems. ARIA provides Record & Verify functionality for all Linac brands. Varian Medical Systems International AG, Zug, Switzerland Phone +41 - 41 - 749 88 44 www.varian.com/aria info.europe@varian.com
  • 3. Meet the Editorial Team Professor Denys Wheatley is Editor of Oncology News, and is Director of BioMedES. He has strong research ties in Albany, Davis, Auckland, Valencia, Detroit, Budapest, St Petersburg, Heidelberg, Zürich and Hong Kong. He is eager to establish strong interaction with cancer and cell biology teams worldwide, and initiate programmes in the areas in which his expertise lies. His work in cancer research, other scientific fields, with IFCB, and in publishing and scientific communication has led to his receiving awards in recent years. Professor Patrick J Bradley is Associate Editor of Oncology News, and, a Head and BioMedES Neck Oncologic Surgeon at the University Hospital, Nottingham. He is a member of numerous journals’ UK Editorial Boards; Journal of Laryngology and Otology, Oral Oncology, and International Journals: Laryngoscope, Head and Neck, Acta Otolaryngologica Scandinavia, as well as Section Editor of Head and Neck Oncology, and Current Opinions ORL-HNS. Producing the very best definitive versions of your biomedical reports and papers Dr Tom Lynch is Assistant Editor – Imaging, and is a Radiologist and Lead Nuclear Medicine Physician in the Northern Ireland Cancer Centre based at the Belfast City Hospital. Tom specialises in PET/CT scanning and nuclear medicine with a special interest in paediatric nuclear medicine. Never heard of us? Not surprising, since our operations are mostly ‘behind the scenes’. Dr Heidi Sowter is Assistant Editor – Web Review, and is a Lecturer in Forensic Science and Biology, at the Faculty of Education, Health and Science, University of Derby. Heidi But we may be able to help you with your continues to pursue her research interests in gynaecological and breast cancer. publication problems, from technical notes to e-books! What does BioMedES do? • BioMedES reworks sound scientific Ms Kathleen Mais is Assistant Editor – Nursing, and is a Nurse Clinician in Head & Neck papers, technical reports, and other Oncology at Christie Hospital, Manchester. Kathleen qualified as a nurse in Newcastle-upon- Tyne. Kathleen is a nurse-prescriber and runs a nurse-led chemotherapy clinic as well as (biomedical) documents, putting them continuing her work in clinical research. into the most idiomatic English that passes the most stringent peer review and quality control assessments • It copy edits for a number of big Marilena Loizidou is Assistant Editor – Colorectal, and is a Non-Clinical Senior Lecturer biomedical publishing houses in the Department of Surgery, UCL. Her research program focuses on aspects of colorectal cancer and liver metastases, from the basic underlying biology to new potential treatments. • Four journals in the life sciences are The current focus of research is the contribution of the peptide endothelin-1 to tumour growth run from, or with the aid of, the and progression in the bowel. Additional research areas include breast and bladder cancer. company • It helps administer an international organisation for cell biology Alan Cooper is Assistant Editor – Urology, and is Lead Scientist with the urology research (www.ifcbiol.org) group in Southampton University Hospitals and senior lecturer (albeit with virtually no lecturing burden) in the Department of Biomedical Sciences at Portsmouth University. • It prepares and publishes e-books in biomedicine • It designs logos for biomedical and many other organisations • It collates and prepares abstracts for Michael Douek is Assistant Editor – Breast, and is a Senior Lecturer and Consultant Surgeon scientific and other meetings at University College London Hospitals focusing on breast cancer surgery with a particular interest • The company is involved in arranging in pre-operative surgical planning using breast MRI. In 2003, he was awarded a prestigious Health Foundation Clinician Scientist grant by the UK Academy of Medical Sciences, fully funding both national and international his joint academic and clinical post in breast surgery. conferences. • It also runs courses on scientific and medical writing, and on electronic Dr S Gokul is Assistant Editor - Journal Reviews, and is a Consultant Medical Oncologist publishing at The James Cook University Hospital, Middlesbrough. His areas of interest are lung and gynaecological cancers. Why not contact us at: BioMedES, Leggat House, Keithhall, Inverurie, AB51 0LX, UK Tel: +44-1467-670280; Fax: +44-1467-629123 • Helen Evans is a Journal Reviewer for Oncology News. Helen recently worked as a Senior Lecturer in Cancer Nursing at the Institute of Nursing and Midwifery, University of Brighton but Email: wheatley@abdn.ac.uk; following the birth of her son has returned to clinical practice as a Clinical Nurse Specialist at St. info@biomedes.co.uk Wilfrid's Hospice in Chichester. Volume 3 Issue 2 • August/September 2008 3
  • 4. Editorial Lung Cancer Continues to Occupy the Frame here is little doubt that some of the cancer patient needs this more than almost T most serious cases of cancer are those that attack the lungs. If this is truly the main killer amongst the cancers in the UK, is any other cancer patient, especially when bones and brain become affected by metastases. We discussed in a recent not there a need for a great deal more editorial the topic of permutations and research into this particular organ and its combinations in the treatment of cancer, tumours? The provoking factors have been and this seems to be particularly pertinent fairly obvious for years, and in one guise or in the case of lung cancer patients. another are largely attributable to pollution, Denys Wheatley, Combinations of treatments that follow one Editor/ being self-administered by those of us who another rather than necessarily being given continue to smoke tobacco. The lungs have at about the same time seem to be prevalent an enormous area that is in immediate contact with because much depends on which type of lung cancer the environment, an area which is far greater than that it is, how large it is, whether it is in the local lymph of the skin that covers the body. Lung tissue, in nodes or more widespread, how much co-morbidity is contrast to skin, is moist and extremely thin, with involved, among other mitigating factors. On the last blood vessels intimately associated with the fine walls issue, smokers often have a high alcohol consumption, of the alveoli. many have a poor diet, and most of them get little How will the situation look in twenty to thirty years exercise - little wonder that their general health is from now? If we assume that the effects of smoking considerably below average. It is also no wonder that will then be affecting only the more aged members of patients have to be examined by a whole gamut of society who had smoked in the past, and far fewer different techniques to assess their general state of young people will be progressing in the same way, are health prior to surgery, chemotherapy and we going to see it become one of the least common radiotherapy. Resection of lobes of the lung becomes forms of cancer. [With asbestos the same story should less advisable when the sufferer has a poor cardiac unfold as crocidolite is “phased out” and HSE make condition. If done in the more robust patient, the loss sure stringent measures are taken to avoid its of lung tissue puts an immediate stress on the patient, inhalation by workers in future. We read earlier in ON who may thereafter have to use oxygen as a support, (Oncology News 2008;4(2):9-11) that mesothelioma or take on a much more sedentary life. will wane in the same way.] The worrying sector at the The outlook for all lung cancer patients seems present time is young women, who continue to smoke bleaker than for most other types of tumour. One and will be at risk of lung cancer for perhaps at least would hope that, despite the improvement in the two more generations. Since on average people are application of established techniques (better delivery living considerably longer these days than 30 or 40 of radiation, more specific chemotherapeutic agents, years ago, there is a high probability that sufficient etc.) some new avenues would open in terms of lung time will elapse for the incidence of lung cancer to rise cancer treatment. Are there any real grounds for in this sub-population of women smokers. The believing that there might be some breakthrough problem is that lung cancer can sometime be which will provide an effective means of controlling asymptomatic, or sufferers are too reluctant to seek lung cancer? Or do we stick to refining the ways in help that they do not present for so long that patients which the current modalities are administered, to do not present with tumours until they are optimise them and combine them using the most considerably advanced. If we screen for bowel and carefully devised strategies? If these are the issues cervical cancer, the question of whether we can do so before us, then what should be the focus of effort? for lung cancer has already been addressed in the The latter has to be done whether or not more basic pages of ON. research can find new methods of treatment, such as The treatments for lung cancer do not make for good immunotherapy. Perhaps before basic research could reading - that is, for the sufferer. Life expectancy is low add significantly in this way, it is probable that the and there seems to be little that can be done to raise tide of lung cancer we have seen through the 20th the expectation of life by even a short period of time. century and persisting into the first part of the 21st But in this issue, Espeed Khoshbin and Alan JB Kirk century will have receded, and less pressure will (p10), delve deeply into many of the approaches that come to bear on getting a better understanding of the can be taken, and emphasise a number of useful fundamental causes and cellular misbehaviour that points. One is that, given the circumstances, palliative leads to lung cancer. That leaves screening as the care has to be a priority so that good QOL is achieved only option needing to be considered, (see John Field in the short respite sufferers may have in their last K and Duffy SW, Oncology News 2008;3(1):6-8), in months. And the delivery of good medicine centres which there seems to be little advance even for the these days on the MultiDisciplinary Team (MDT) that most high risk groups. And yet lung cancer remains should meet regularly to review all such patients, the most common cause of death amongst cancers in making for the best possible management. The lung the UK. n 4 Volume 3 Issue 2 • August/September 2008
  • 5. Campto now in CytoSafe ® ® 40mg 100mg 300mg Vials shown not actual size Cytosafe® Tough, polypropylene vial developed to reduce the risk of breakage and leakage Plan for living New 300mg vial Designed with the typical FOLFIRI regimen* in mind (based on average patient dose)1,2 Indicated for the treatment of patients with advanced colorectal cancer. See prescribing information for full indication. CAMPTO® (irinotecan hydrochloride trihydrate): PRESCRIBING INFORMATION – UK Please refer to the Summary of Product Characteristics (SmPC) before prescribing Campto 20mg/ml. Presentations: modification. Adverse Reactions: Delayed diarrhoea (requires immediate treatment with loperamide). Nausea and Vials of concentrate for infusion containing either 40mg, 100mg or 300mg irinotecan hydrochloride trihydrate. vomiting, dehydration, neutropenia, fever, acute cholinergic syndrome, dyspnoea, asthenia, reversible alopecia. Indications: Treatment of adult patients with advanced colorectal cancer: in combination with 5-fluorouracil, folinic Infrequently dehydration-related renal insufficiency, hypotension or circulatory failure. Other system disorders acid in patients without prior chemotherapy and as monotherapy in patients who have failed a 5-fluorouracil, folinic include gastrointestinal, blood, infection and infestation, general disorders and infusion site reactions, cardiac, acid based therapy. Campto may be used in combination with cetuximab for the treatment of Epidermal Growth respiratory, skin and subcutaneous tissue, immune system, musculoskeletal, and nervous system. Refer to the Factor Receptor-expressing metastatic colorectal cancer after failure of Campto-including cytotoxic therapy. Campto relevant product information for details on adverse reactions that may occur when used in combination with may be used in combination with 5-fluorouracil, folinic acid and bevacizumab for the treatment of metastatic cetuximab or bevacizumab. Pharmaceutical Precautions: Solution must be prepared aseptically. Do not mix with carcinoma of the colon and rectum. Dosage & Administration: Campto should be administered as an intravenous other medications. The solution should be used immediately after reconstitution, as it contains no antibacterial infusion over 30 to 90 minutes. In first line: combination therapy of 180mg/m2 every 2 weeks followed by folinic preservative. Dilute with infusion solution (0.9% sodium chloride or 5% glucose solution). Protect from light. acid and 5-fluorouracil. In second line: monotherapy 350mg/m2 every 3 weeks. In combination with cetuximab: Comply with prevailing cytotoxic handling guidelines when preparing or handling Campto. Legal category: POM. Administer cetuximab first, do not administer Campto earlier than 1 hour after the end of cetuximab infusion. Refer Basic NHS Price: Vials: Campto 40mg; £53.00; Campto 100mg; £130.00; Campto 300mg; £390.00. Marketing to cetuximab product information for dosage. In combination with bevacizumab, refer to the bevacizumab product Authorisation Number: 40mg: PL 00057/0626, 100mg & 300mg PL 00057/0627. Marketing Authorisation information for dosage. Prophylactic antiemetics are recommended. Dosage Adjustments: Subsequent cycles Holder: Pfizer Limited, Sandwich, Kent, CT13 9NJ, United Kingdom. Date of Revision: February 2008 (REF: CF 5_0). should follow appropriate recovery of all adverse events to grade 0 or 1 NCI-CTC and resolution of diarrhoea. Dose reduction of 15-20% recommended if patients experience significant haematological toxicity, thrombocytopenia Adverse events should be reported to Pfizer Medical Information on 01304 616161. and leucopenia (grade 4), and non-haematological toxicity (grade 3-4). Impaired hepatic function: Monitor liver function regularly. In monotherapy blood bilirubin levels (up to 3 times ULN) in patients with performance status Information about adverse event reporting can also be found at www.yellowcard.gov.uk ≤2, should determine the starting dose of Campto. No data are available in patients with hepatic impairment treated by Campto in combination. Impaired renal function: Not recommended. Elderly: Care due to the greater References: frequency of decreased biological functions. Contraindications: Chronic inflammatory bowel disease and/or bowel 1. Mosteller RD. N Engl J Med 1987;371:1098. obstruction; severe hypersensitivity reactions to Campto; pregnancy; breastfeeding; bilirubin >3 ULN; severe bone 2. Campto® Summary of Product Characteristics, February 2008. marrow failure; WHO performance status >2, concomitant use of St John’s Wort. Refer to cetuximab or 3. Tournigand C et al. J Clin Oncol 2004;22:229-237. bevacizumab product information for contraindications. Warnings and Precautions: Use in units specialised in the administration of cytotoxic chemotherapy. Patients should be aware of the risk of delayed diarrhoea (occurring >24 *FOLFIRI – irinotecan 180mg/m2 given as a 90-minute infusion and leucovorin 200mg/m2 as a 2-hour infusion, hours after the infusion). Loperamide is the recommended treatment, but should not be given prophylactically. followed by bolus FU 400mg/m2 and a 46-hour infusion FU 2,400mg/m2 for two cycles, increased to 3,000mg/m2 Weekly monitoring of full blood counts recommended. Regular liver function tests should be performed. from cycle 3 in case of no toxicity greater than grade 1 during the two first cycles. Repeated every 2 weeks.3 Prophylactic treatment with antiemetics is recommended. Cases of acute cholinergic syndrome should be treated with atropine. Risk factors for the development of pulmonary infiltrates should be considered. Patients should not CAM08/019a drive if dizziness or visual disturbances occur. Women of childbearing age receiving Campto should be advised to avoid becoming pregnant. Interactions: Avoid concomitant use with CYP34A inducers or inhibitors. Care in patients Further information is available on request from: receiving neuromuscular blocking agents. St John’s Wort should not be administered with Campto. SN38 (the Medical Information at Pfizer Limited, active metabolite of Campto) concentrations were increased by 33% when combined with bevacizumab. Patients Walton Oaks, Dorking Road, Tadworth, Surrey, developing severe diarrhoea, leucopenia or neutropenia in combination with bevacizumab should have Campto dose KT20 7NS, UK. Tel: +44 (0) 1304 616161
  • 6. Contents Volume 3 Number 2 August/September 2008 3 Editorial Board 8 What is UCAN? 4 Editorial take responsibility for their own health to U CAN is a charitable company set up to improve the quality of life for people the same degree as women. We are and families living with urological working with employers to help get our cancers in the North of Scotland. messages across in the workplace. Early Urological cancers, (kidney, prostate, diagnosis of cancer would not only help 8 What is UCAN? bladder, testicular and penile) are among the most common types of cancers. They account for one in three of all cancers in men and one • the patient but also the employer through reduced time off work. Building effective support structures in five of all cancers in men and women. 1) There is a desperate need to provide Catherine Paterson, Sam McClinton, Aberdeen, UK. Catherine Paterson, UCAN Research Nurse, Academic Urology, UCAN was launched in January 2006 by Mr Sam McClinton and Professor James N’Dow, two consultant urological surgeons based at patients and families with new avenues of support to help them adjust to, and live with, the changes a cancer diagnosis University of Aberdeen, Health Sciences Building, the Aberdeen Royal Infirmary. They created might bring to their lives. On occasions, Aberdeen. UCAN as a direct result of cancer sufferers, the need will be for human contact; on 10 Management of Primary Lung Cancer families and health professionals identifying a other occasions the need might be for need to provide additional and improved relative anonymity through online contact. services which are not, and cannot be, 2) We recognised the need for a central hub provided under the statutory duties of the NHS. close to the clinical services. A new There exists a stigma associated with Urological Cancer Care Centre was opened Espeed Khoshbin, Alan JB Kirk, Clydebank, UK. urological cancers. Quite often patients seek medical advice from their doctor at a point when it is too late to offer curative treatment. in January 2008, in the department of urology and is already fully operational providing practical support to cancer Those who have been diagnosed with a sufferers. Sam McClinton, urological cancer often suffer long-term 3) An important element of building effective 14 Upper GI Oncology Section - Consultant Urological Surgeon, Aberdeen Royal Infirmary social, emotional and psychological support structures will be the Plain problems. Sufferers frequently struggle to English Guides which will convert a vast Correspondence to: come to terms with the trauma of urological amount of unregulated information into Catherine Paterson, UCAN/Total Research Nurse, cancer and the potentially life-changing short, easily understood documents, with The Current Treatment of GIST With Reference to Laparoscopic OTIS Study Co-ordinator, effects of treatment, such as urostomy and the facts a cancer patient needs to know. UCAN/Academic Urology, 1st Floor Health Sciences Building, Foresterhill, Resection and Neoadjuvant Treatment Aberdeen, AB25 2ZD, UK. A Urological CANcer is diagnosed every 10 minutes Siobhan Gill, Paras Jethwa, Surrey, UK. erectile dysfunction. Long-term psychological problems can affect sufferers’ partners and • Acquired knowledge and research 1) By researching the knowledge and families as much as the patient themselves, experience of urology cancer patients, significantly increasing the number of lives their families and clinicians worldwide, we blighted by urological cancer. UCAN will be able to determine what information 18 Urological Cancer Section – recognises that a significantly higher level of support is required for those diagnosed with urological cancer than is currently available. cancer sufferers need at different stages of treatment. The family unit also needs information as they are affected just as much as the cancer sufferers. This Prostate Cancer Reviewed: Part 2 Treatment Options What does UCAN plan to achieve? Our plans are split into three main areas: information is vital when deciding which treatment to choose if the cancer sufferer is not to regret that decision at a later date. Simon Mackie and Bhavan Rai, Aberdeen, UK. • Improving early diagnosis and knowledge It is also very important to discover the 1) Our awareness campaign has been best ways of managing the often running for two years. We need to raise the unpleasant effects of treatments. profile of urological cancers to the level of breast and bowel cancer, and educate What makes UCAN unique? individuals on the early signs of urological Our activities are distinctive in the following 20 Book Reviews cancers, in a bid to reduce the mortality rates. We also want to take the stigma out of these illnesses which by their nature can cause embarrassment. ways: • Projects are developed in partnership with the beneficiaries; allowing us the best chance of being relevant to urological 2) One of our key challenges is to get men to cancer sufferers and their families. 21 Conference News 8 Volume 3 Issue 2 • August/September 2008 Previews and reports from the conference scene. 10 26 Imaging Section – Management of Primary Lung Cancer team (MDT) [3]. The workings and L ung cancer is one of the most common Introduction to the use of MRI in Staging of Rectal Cancer cancers in the Western world, with around 38,000 patients being diagnosed each year in the UK. Rarely diagnosed in the membership of the MDT vary from region to region. MDT meetings should ideally be held weekly and attended by all the major players K Lowry, A Armstrong, T Lynch, E Napier, Belfast, UK. under 40s, lung cancer is a disease of the late (Table 1). All patients with lung cancer middle-aged and elderly. Peak incidence is in should be reviewed, the object being to the 75-84 age-group, with 85% of patients deliver the best possible treatment to each being over the age of 60 (Figure 1). In the patient depending on their tumour stage and 1950s, the sex ratio was M:F 6:1; with state of health. reducing incidence in males and increasing 28 Diary Espeed Khoshbin Registrar in Cardiothoracic rates in females, wth the current sex ratio SCLC treatment Surgery. being nearly 7:5. Cigarette smoking is linked Patients with SCLC are categorised as either to lung cancer in well over 90% of cases, with limited disease (LD), where the disease although other environmental causes such as is confined to the thorax, or extensive disease Listing of meetings, courses and conferences, both UK and international. asbestos and radon gas exposure have been implicated. Lung cancer is the leading cause of death from cancer in the UK, 22% of all (ED), where there is evidence of distant metastases [4]. Patients with ED are generally given cancer deaths being attributable to lung chemotherapy, designed to produce palliation cancer. The current 5-year survival for lung and shrinkage of the tumour burden. About cancer in the UK is 7% [1]. 50% of patients with SCLC that are in the ED 29 Courses & Conferences Alan JB Kirk, Consultant Thoracic & Types of lung cancer There are two broad groups of lung cancer category will have clinical or subclinical cerebral metastases. For this reason, prophylactic cranial irradiation (PCI) is often Cardiac Surgeon. defined by their histological appearance [2]. administered [5]. These are Small Cell Lung Cancer (SCLC) and SCL cases categorised as LD also get Correspondence to: Non-Small Cell Lung Cancer (NSCLC). SCLC chemotherapy. Where there is a complete or 32 Web Review Department of Thoracic Surgery, and NSCLC differ in a number of ways; their good response, mediastinal radiotherapy +/- West of Scotland Regional Heart & Lung Centre, cell origin is different, SCLC being PCI is considered for survival advantage and Golden Jubilee National neuroendocrine, whereas NSCLC is epithelial. improved quality of life [6]. Hospital, SCLC is very chemosensitive, but NSCLC is There will be a small group of patients who Heidi Sowter, Derby, UK. Clydebank, UK. Email: khoshbinuk@ less so. SCLC is generally metastatic at present with early disease. Under these yahoo.co.uk presentation, whereas NSCLC may initially be circumstances, if properly staged, surgery locoregional. SCLC is generally not a surgical may have a role. disease, while NSCLC may be resectable. Examples of individual types of NSCLC are NSCLC treatment 33 Society News squamous, adenocarcinoma and large cell Key to the management of patients with carcinoma. NSCLC is TNM staging of the tumour, which The key to current treatment of patients is based on tumour characteristics (T), nodal with lung cancer is the multidisciplinary involvement (N), and the presence or absence of metastases (M). A summary of ECCO-ESMO Collaboration lung cancer TNM is given in Table 2. However this classification is being reassessed and updated; the update will be published later in 2008 [7]. 12 & 34 News Update Table 1: Key members of the MDT Chest physician Lung Cancer Nurse Specialist Details of the latest developments and news from the industry and Thoracic Surgeon Oncologist (Clinical +/- Medical) Palliative Care Physician and/or nurse charities. Chest radiologist Lung Pathologist Secretarial support and/or MDT coordinator Lung cancer audit staff Primary Care representative Source: Cancer Research UK 10 Volume 3 Issue 2 • August/September 2008 Oncology News is published by McDonnell Mackie, 84 Camderry Road, 14 Dromore, Co Tyrone, BT78 3AT, N Ireland. Upper GI Oncology Publisher: Patricia McDonnell • Web: www.oncologynews.biz The Current Treatment of GIST With Advertising and Editorial Manager: Patricia McDonnell Reference to Laparoscopic Resection and Tel/Fax: +44 (0)288 289 7023 • Email: Patricia@oncologynews.biz Neoadjuvant Treatment Advertising and Press Releases: Grant Mackie remains the treatment of choice when cure is G astrointestinal stromal tumours (GIST) are the most common mesenchymal sought. There is, however, still debate Miss Siobhan Gill, tumours of the alimentary tract; they regarding the most appropriate operative Email: Grant@oncologynews.biz MRCS, Senior House Officer in account for <1% of all GI malignancies with approach and the extent of resection required. Copyright: All rights reserved; no part of this publica- Surgery. approximately 900 new cases per year in UK [1]; primary GISTs tend to arise as solitary While metastatic spread is common at first diagnosis, spread to lymph nodes is rarely seen tion may be reproduced, stored in aEmail:system Design & Production retrieval design.dept@sky.com lesions most commonly affecting the stomach (60-70%), followed by the small bowel (20- thus, more extensive resection other than the primary site is questionable and has no bearing 25%) and less commonly the rectum, on survival or recurrence. Recently the or Printed in anyWarners Midlandselec- Tel: 01778 391000 transmitted by: form or by any means, PLC oesophagus and colon [2]. National Comprehensive Cancer Network Genetic analysis has revised the definition of (NCCN) task force reported that “laparoscopic tronic, mechanical, photocopying, recording or other- GIST to be that of “highly cellular mesenchymal tumours of the gastrointestinal or laparoscopic-assisted resection may be useful for small (<2cm) GISTs when the risk of wise without either the prior written permission of the tract containing spindle, epitheloid cells or a combination of both and displaying CD117/c- intraoperative tumour rupture is low. However, the use of laparoscopic resection is generally publisher or a All rightspermitting restricted photo- publication may be reproduced, Copyright: license reserved; no part of this ISSN 1751-4975 Mr Paras Jethwa, BSc kit positivity”. GISTs have been proposed to discouraged for GIST” [4]; despite this, Oncology (Hons), MD, originate from the interstitial cells of Cajal, laparoscopic resection of primary GIST has copying issued retrieval system or transmitted in any form or by any means, electron- stored in a in the UK by the Copyright Licensing FRCS(Gen), considered to be regulators of gastrointestinal become the treatment of choice in many Consultant General & Upper GI Surgeon. motility but, as they can arise from tissue centres in the UK and Europe. This article Authority. Disclaimer: The publisher, the authors and ic, mechanical, photocopying, recording or otherwise without either the prior writ- News Correspondence: P Jethwa, depleted of Cajal cells, the possibility that they arise from a pluripotent stem cell has been summarises the current role of surgery and targeted chemotherapy in the management of Surrey & Sussex NHS Trust, suggested [3]. GISTs. editors permissionresponsibility for loss incurred by permitting restricted photocopying ten accept no of the publisher or a license Volume 3 Issue 2 :August/September 2008 www.oncologynews.biz Dept of Surgery, Canada Avenue, The management of GISTs has evolved REDHILL, rapidly with our understanding of the Minimally invasive surgery for GIST any personin the UKrefraining from action as a result issued acting or by the Copyright Licensing Authority. Disclaimer: The publisher, Surrey, RH1 5RH, UK. molecular pathophysiology of this lesion Laparoscopic surgery for gastrointestinal cancer allowing for the rational development of and, more recently gastric cancer has been of material in or omitted from accept no responsibility for loss incurred by any person the authors and editors this magazine. Any new antitumour agents that target signalling aberrations in these cells. Imatinib mesylate widely adopted in Japan, Korea, China, Italy, USA and the UK, but not without some debate. methods and techniques described involving drug (Gleevac, Glivec), a tyrosine kinase and Unlike adenocarcinoma, lymphadenectomy is acting or refraining from action as a result of material in or omitted from this mag- platelet derived growth factor receptor (PDGR) unnecessary with the aim of GIST surgery being usage should be followed only in conjunction with antagonist, have shown excellent results in the complete removal (R0) of the tumour with azine. Any new methods and techniques described involving drug usage should patients with unresectable or metastatic GIST, negative resection margins and without drug manufacturers' own published literature. This is but surgical resection of the primary tumour capsule rupture or intra-abdominal spillage of an be followed only in conjunction of those con- independent publication - none with drug manufacturers' own published litera- tributing Thisinisany way supported or remuneratednone of those contributing are in any ture. are an independent publication - by any of the companies advertising in it, unlessof the companies advertising in it, unless way supported or remunerated by any other- otherwise clearly stated. Comments expressed in editorial are those of the wise clearly stated. Comments expressed in editorial In this issue Cover picture: areauthor(s) and author(s)necessarily endorsed by the editor, editorial board or pub- those of the are not and are not necessarily What is UCAN? Management of Primary Lung Cancer Stockholm endorsed Thethe editor,decision is final or publisher. lisher. by editor's editorial board and no correspondence will be entered into. The Current Treatment of GIST With Reference to Laparoscopic Resection and Neoadjuvant Treatment Clock Tower by The editor's decision is final and no correspondence Prostate Cancer reviewed: Part 2 - Treatment Options will be entered into. Andrew Conn. 14 Volume 3 Issue 2 • August/September 2008 6 Volume 3 Issue 2 • August/September 2008
  • 7. Prescribing Information for Innohep® 20,000 IU/ml and Innohep® Syringe 20,000 IU/ml Presentations: Innohep® 20,000 IU/ml contains tinzaparin sodium 40,000 anti-Factor Xa IU in a 2ml vial with preservative. Innohep® Syringe 20,000 IU/ml contains tinzaparin sodium 20,000 anti- Factor Xa IU/ml without preservative. The syringes contain 10,000 anti-Factor Xa IU in 0.5ml, 14,000 anti-Factor Xa IU in 0.7ml or 18,000 anti-Factor Xa innohep®- long term IU in 0.9ml. Indications: Treatment of deep vein thrombosis and of pulmonary embolus. Dosage efficacy in treatment and Administration: Subcutaneous injection only. Adults: 175 anti-Factor Xa IU/kg bodyweight once daily for at least 6 days and until adequate oral of PE and DVT in anti-coagulation is established. There is no need to monitor the anticoagulant activity of Innohep®. Use cancer patients1 in Children: No experience. Contra-Indications: Known hypersensitivity to constituents. Generalised haemorrhagic tendency, uncontrolled severe hypertension, active peptic ulcer, septic endocarditis. Thrombocytopenia in patients with a positive in vitro aggregation test in the presence of tinzaparin. Locoregional anaesthesia in elective surgical procedures. Precautions: Care in patients with severe liver or kidney insufficiency, a dose reduction should be considered. Do not give by intramuscular injection (risk of haematoma). Caution in patients with a history of asthma (presence of sodium bisulphite). Care in patients who have recently suffered from cerebral haemorrhage, trauma and/or had recent surgery to the central nervous system. Caution in patients with hypersensitivity to heparin or to other low molecular weight heparins. For some patients with pulmonary embolism (e.g. those with severe haemodynamic instability) alternative treatment, such as surgery or thrombolysis may be indicated. Heparin can lead to hyperkalaemia, particularly in patients with diabetes mellitus, chronic renal failure, pre-existing metabolic acidosis, a raised plasma potassium or taking potassium-sparing drugs. The risk appears to increase with duration of therapy but it is usually reversible. Measure plasma potassium in patients at risk before starting therapy and monitor regularly. In patients undergoing spinal/peridural anaesthesia or spinal puncture, the prophylactic use of heparin may be very rarely associated with epidural/spinal haematoma resulting in prolonged or permanent paralysis. Risk is increased by use of peridural/spinal catheter, drugs affecting haemostasis and traumatic/repeated puncture. Extreme vigilance and frequent monitoring are required. Platelet counts should be measured in patients receiving heparin for longer than 5 days (risk of thrombocytopenia). Stop treatment immediately in those who develop LEO® © LEO, LEO Pharma, UK, December 2007, ALL LEO TRADEMARKS MENTIONED BELONG TO THE LEO GROUP thrombocytopenia. Not recommended for use in patients with prosthetic heart valves. Drug Interactions: Any drug which affects platelet function or aggregation or blood coagulation should be used with caution. Pregnancy and Lactation: Do not use in pregnancy unless no safer alternative is available. Not recommended for use in pregnant women with prosthetic heart valves. It is not known whether Innohep® is excreted in breast milk. Stop breast-feeding while receiving Innohep®. Side Effects: Skin rashes and minor bruising at site of injection. Systemic allergic reactions have been You’re fighting cancer - reported extremely rarely. Innohep®, like heparin, has been shown to increase the risk of haemorrhage. However, at the recommended dose this risk is low. Thrombocytopenia may occur rarely. As for heparin, Don’t be beaten by a PE a transient rise in aminotransferase levels is frequently seen. Rarely, clinically significant hyperkalaemia may occur with heparin products particularly in patients with chronic renal failure and diabetes mellitus. Very rare cases of epidural/spinal haematoma have been reported in patients undergoing spinal or epidural anaesthesia or spinal puncture while receiving heparin prophylaxis. Skin necrosis has been reported. If this occurs withdraw treatment immediately. Priapism has been reported rarely. Valve thrombosis in patients with prosthetic heart valves have been reported rarely. Legal Category: POM Product Licence Numbers and Holder: Innohep® 20,000 IU/ml – PL 0043/0192, Innohep® Syringe 20,000 tinzaparin sodium IU/ml – PL 0043/0197. LEO Laboratories Limited, Longwick Road, Princes Risborough, Bucks. Basic NHS Price: Innohep® 20,000 IU/ml (40,000 anti- *innohep® - giving more life to patients with pulmonary embolism Factor Xa IU vial, 2ml) x 1, £34.20. Innohep® Syringe 20,000 IU/ml, 0.5ml x 2, £17.95. 0.5ml x 6, £53.85. 0.7ml x 2, £25.14. 0.7ml x 6, £75.40. 0.9ml x 2, £32.31. 0.9ml x 6, £96.93. Last revised: January 2006. Further information can be found in the Summary of Product Characteristics or from: LEO Pharma, Longwick Road, Princes Risborough, Buckinghamshire, HP27 9RR. If you wish to report an adverse event, this can be done either by contacting Drug Safety at LEO Pharma (01844 347333) or by logging on to www.yellowcard.gov.uk. ® Registered Trademark e-mail: Innohep.UKenquiries@leo-pharma.com 1. Hull RD et al. Am J Med 2006; 119:1062-1072 Date of Preparation: December 2007 1030/10216
  • 8. What is UCAN? CAN is a charitable company set up to take responsibility for their own health to U improve the quality of life for people and families living with urological cancers in the North of Scotland. the same degree as women. We are working with employers to help get our messages across in the workplace. Early Urological cancers, (kidney, prostate, diagnosis of cancer would not only help bladder, testicular and penile) are among the the patient but also the employer through most common types of cancers. They account reduced time off work. for one in three of all cancers in men and one • Building effective support structures in five of all cancers in men and women. 1) There is a desperate need to provide UCAN was launched in January 2006 by Mr patients and families with new avenues of Catherine Paterson, UCAN Research Nurse, Sam McClinton and Professor James N’Dow, support to help them adjust to, and live Academic Urology, two consultant urological surgeons based at with, the changes a cancer diagnosis University of Aberdeen, Health Sciences Building, the Aberdeen Royal Infirmary. They created might bring to their lives. On occasions, Aberdeen. UCAN as a direct result of cancer sufferers, the need will be for human contact; on families and health professionals identifying a other occasions the need might be for need to provide additional and improved relative anonymity through online contact. services which are not, and cannot be, 2) We recognised the need for a central hub provided under the statutory duties of the NHS. close to the clinical services. A new There exists a stigma associated with Urological Cancer Care Centre was opened urological cancers. Quite often patients seek in January 2008, in the department of medical advice from their doctor at a point urology and is already fully operational when it is too late to offer curative treatment. providing practical support to cancer Those who have been diagnosed with a sufferers. Sam McClinton, urological cancer often suffer long-term 3) An important element of building effective Consultant Urological Surgeon, Aberdeen Royal Infirmary social, emotional and psychological support structures will be the Plain problems. Sufferers frequently struggle to English Guides which will convert a vast Correspondence to: come to terms with the trauma of urological amount of unregulated information into Catherine Paterson, UCAN/Total Research Nurse, cancer and the potentially life-changing short, easily understood documents, with OTIS Study Co-ordinator, effects of treatment, such as urostomy and the facts a cancer patient needs to know. UCAN/Academic Urology, 1st Floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK. A Urological CANcer is diagnosed every 10 minutes erectile dysfunction. Long-term psychological • Acquired knowledge and research problems can affect sufferers’ partners and 1) By researching the knowledge and families as much as the patient themselves, experience of urology cancer patients, significantly increasing the number of lives their families and clinicians worldwide, we blighted by urological cancer. UCAN will be able to determine what information recognises that a significantly higher level of cancer sufferers need at different stages of support is required for those diagnosed with treatment. The family unit also needs urological cancer than is currently available. information as they are affected just as much as the cancer sufferers. This What does UCAN plan to achieve? information is vital when deciding which Our plans are split into three main areas: treatment to choose if the cancer sufferer is not to regret that decision at a later date. • Improving early diagnosis and knowledge It is also very important to discover the 1) Our awareness campaign has been best ways of managing the often running for two years. We need to raise the unpleasant effects of treatments. profile of urological cancers to the level of breast and bowel cancer, and educate What makes UCAN unique? individuals on the early signs of urological Our activities are distinctive in the following cancers, in a bid to reduce the mortality ways: rates. We also want to take the stigma out • Projects are developed in partnership with of these illnesses which by their nature the beneficiaries; allowing us the best can cause embarrassment. chance of being relevant to urological 2) One of our key challenges is to get men to cancer sufferers and their families. 8 Volume 3 Issue 2 • August/September 2008
  • 9. • The development of a comprehensive peer support this online support service is not only valuable for emotional framework is novel. It entails one-to-one mentoring by support, but is an area where practical information, questions other urological sufferers, web based forum support by and experiences can be shared by patients anonymously. other sufferers and a world class cancer care centre, These support services can be accessed in our Urological supported by skilled personnel, experts in the field of Care Centre, as shown in the following picture. urology. The centre will also be backed by international collaboration, with the experience and expertise necessary for studying the information needs of urological cancer sufferers. • We are proposing not only support for urological cancer sufferers, but the family unit as a whole because we recognise that the impact of a cancer diagnosis and treatment is more far-reaching than just the person with the cancer. The project has the potential to benefit cancer sufferers and their families nationally and internationally. Health Education • In addition, specific groups in society will be targeted, such TOTAL E&P UK Limited has generously sponsored the UCAN as young men who are traditionally reluctant to address Research Nurse, Catherine Paterson for three years. The North their medical needs. A key emphasis is on prevention and East of Scotland is the oil capital of Europe, with the oil early diagnosis that will limit the effects of these cancers industry being largely a male dominated work force. and promote a speedy and full recovery. It is hoped that Consequently, our UCAN nurse has taken the health wider knowledge about these cancers will reduce the social educational programme to the offshore oil rigs to target mens’ stigma often associated with these illnesses. knowledge and attitudes towards the early signs of urological cancers. Since UCAN had endeavoured into this new venture, How our make-up and direction differs from other feedback has proved that this is a success and certainly helps charities to empower men to take ownership for their health. Our work is overseen by an independent UCAN Steering Committee that advises the UCAN Board of Directors. The UCAN Research Nurse Offshore. committee chair, and half of the members, are urological cancer sufferers. Through the UCAN Steering committee, patients will continue to be at the centre of decisions about the activities of the charity. We also have a UCAN Patient Advisory Group (individuals who have had a urological cancer) who independently advises the clinical urology team and the direction of the support services for patients and their families. UCAN in Progress Buddy Network UCAN has recently launched its Buddy Network in partnership with NHS Grampian. In line with the health educational programme part our aim The Buddy Network allows cancer patients to seek to try to combat the stigma attached to these cancers. First additional support from other patients as their advisors, who of Group have helped UCAN to achieve this by a risqué, yet very course have been through a similar treatment experience. This effective, way of capturing the attention of the general public support network allows patients to seek out further emotional in the north east of Scotland. n support and practical advice from other individuals who have had a similar treatment journey. This is a very distinct support network from the NHS, and unique for patients as it allows an opportunity for newly diagnosed cancer patients to verbalise their concerns and ask questions without the worry about how their loved ones are feeling. We currently have a cohort of patient advisors waiting to be a buddy for a newly diagnosed cancer patient. Progress so far is positive and certainly a valued aspect of patients’ treatment packages. Forum UCAN is working hard to get a handle on urological The UCAN online forum was launched in April 2007; this cancers, for more information please contact; support service is moderated by the patients with an UCAN office, Polwarth Building, Foresterhill, overview from the medical team. Within the forum, we have Aberdeen AB25 2ZD, UK. a general area and cancer restricted areas (individual Website: www.ucanhelp.org.uk urological cancers to which only those who have had this Email: ucan@abdn.ac.uk cancer can gain access). From our pilot work, we found that Telephone: 01224 559312. Volume 3 Issue 2 • August/September 2008 9
  • 10. Management of Primary Lung Cancer ung cancer is one of the most common team (MDT) [3]. The workings and L cancers in the Western world, with around 38,000 patients being diagnosed each year in the UK. Rarely diagnosed in the membership of the MDT vary from region to region. MDT meetings should ideally be held weekly and attended by all the major players under 40s, lung cancer is a disease of the late (Table 1). All patients with lung cancer middle-aged and elderly. Peak incidence is in should be reviewed, the object being to the 75-84 age-group, with 85% of patients deliver the best possible treatment to each being over the age of 60 (Figure 1). In the patient depending on their tumour stage and 1950s, the sex ratio was M:F 6:1; with state of health. reducing incidence in males and increasing Espeed Khoshbin Registrar in Cardiothoracic rates in females, wth the current sex ratio SCLC treatment Surgery. being nearly 7:5. Cigarette smoking is linked Patients with SCLC are categorised as either to lung cancer in well over 90% of cases, with limited disease (LD), where the disease although other environmental causes such as is confined to the thorax, or extensive disease asbestos and radon gas exposure have been (ED), where there is evidence of distant implicated. Lung cancer is the leading cause metastases [4]. of death from cancer in the UK, 22% of all Patients with ED are generally given cancer deaths being attributable to lung chemotherapy, designed to produce palliation cancer. The current 5-year survival for lung and shrinkage of the tumour burden. About cancer in the UK is 7% [1]. 50% of patients with SCLC that are in the ED category will have clinical or subclinical Types of lung cancer cerebral metastases. For this reason, Alan JB Kirk, prophylactic cranial irradiation (PCI) is often There are two broad groups of lung cancer Consultant Thoracic & Cardiac Surgeon. defined by their histological appearance [2]. administered [5]. These are Small Cell Lung Cancer (SCLC) and SCL cases categorised as LD also get Correspondence to: Department of Thoracic Non-Small Cell Lung Cancer (NSCLC). SCLC chemotherapy. Where there is a complete or Surgery, and NSCLC differ in a number of ways; their good response, mediastinal radiotherapy +/- West of Scotland Regional Heart & Lung Centre, cell origin is different, SCLC being PCI is considered for survival advantage and Golden Jubilee National neuroendocrine, whereas NSCLC is epithelial. improved quality of life [6]. Hospital, SCLC is very chemosensitive, but NSCLC is There will be a small group of patients who Clydebank, UK. Email: khoshbinuk@ less so. SCLC is generally metastatic at present with early disease. Under these yahoo.co.uk presentation, whereas NSCLC may initially be circumstances, if properly staged, surgery locoregional. SCLC is generally not a surgical may have a role. disease, while NSCLC may be resectable. Examples of individual types of NSCLC are NSCLC treatment squamous, adenocarcinoma and large cell Key to the management of patients with carcinoma. NSCLC is TNM staging of the tumour, which The key to current treatment of patients is based on tumour characteristics (T), nodal with lung cancer is the multidisciplinary involvement (N), and the presence or absence of metastases (M). A summary of lung cancer TNM is given in Table 2. However this classification is being reassessed and updated; the update will be published later in 2008 [7]. Table 1: Key members of the MDT Chest physician Lung Cancer Nurse Specialist Thoracic Surgeon Oncologist (Clinical +/- Medical) Palliative Care Physician and/or nurse Chest radiologist Lung Pathologist Secretarial support and/or MDT coordinator Lung cancer audit staff Primary Care representative Source: Cancer Research UK 10 Volume 3 Issue 2 • August/September 2008
  • 11. Table 2: Lung Cancer TNM (summary) T1 Tumour less than or equal to 3cm in its greatest diameter T2 Tumour >3cm T3 Tumour invading local adjacent structure that can be easily resected eg chest wall diaphragm T4 Tumour invading adjacent structure that cannot be resected eg oesophagus, vertebra, aorta N0 No nodal spread N1 Involvement of local ipsilateral nodes within the envelope of the visceral pleura N2 Involvement of ipsilateral mediastinal nodes N3 Involvement of contralateral mediastinal nodes and/or isilateral/contralateral supraclavicular or scalene nodes M0 No evidence of distant metastases M1 Evidence of distant metastases Treatment strategies Medical considerations: Bearing in mind that these Management of patients with NSCLC can be considered as patients are generally elderly and have probably been either radical (ie with curative intent) or palliative. cigarette smokers, many of them will have significant co- morbidities. Cardiac disease and COPD are often fellow- Radical treatment options travellers, making careful clinical examination essential. These would include surgery, radical radiotherapy and Supportive laboratory tests are often required. Cardiac multimodality options. investigations should at a minimum be good clinical history and examination, with ECG. Further tests such as Surgery echocardiography, exercise ECG and cardiac catheterisation It is fair to say that surgical resection of primary lung cancer may be required. Respiratory assessment is clinical, lung is the mode of therapy most often and consistently associated function tests being essential. with cure [8]. The key question at an MDT meeting should be “is this patient suitable for surgery?” If not, the reasons Surgical points should be documented. Indications for surgery can be If the PET scan shows evidence of FDG uptake in the subdivided into oncological and medical indications. mediastinum, mediastinoscopy is required for tissue Oncological considerations: All patients being considered diagnosis. However if the PET scan is negative in the for lung resection have the following investigations mediastinum, no mediastinoscopy is necessary. performed to stage the disease: chest X-ray, bronchoscopy, CT Once the decision to operate has been made, the principles thorax, and PET/CT scan [9]. In certain circumstances other of surgery are to resect the tumour widely, leaving as much imaging may be required, eg CT or MR brain scan, isotope non-diseased functional lung as possible. In practice, bone scan, liver ultrasound. lobectomy is the treatment of choice. This is certainly Patients suitable for tumour resection will generally be those preferable to wedge resection or segmentectomy. Sometimes, in whom the primary tumour is small, where it has not eroded however, lobectomy alone is insufficient to resect the cancer into adjacent structures that would deem it irresectable, and and bi-lobectomy or pneumonectomy is required. where there is no (or minimal) lymph node spread and distant Operative mortality is 2-3% for lobectomy and ~7% for metastatic spread. Suitable tumour stages would be T1 and pneumonectomy. Long-term survival is dictated by the post- T2. Certain T3 tumours may be suitable for resection, such as resection histology report. A 1cm T1 lesion with no nodal local overlying rib invasion, where the tumour can be resected spread may have a 5-year survival in excess of 80%. A 5cm by lobectomy and en bloc chest wall resection. T4 tumours (eg T2 tumour with resected N2 disease may have a 5 year where the tumour has infiltrated oesophagus, vertebral survival of only 20%. For those patients who undergo a lung column or great vessels) are generally unresectable. resection, their case should be discussed at a MDT meeting. Patients who are staged as N0 or N1 are generally suitable In certain circumstances, adjuvant chemotherapy may be for lung resection provided everything else is favourable. If a associated with survival advantage. patient is staged preoperatively as N2 (ipsilateral mediastinal nodes), surgery is not usually the best treatment. Pre- Radical radiotherapy operatively staged N3 nodal disease would generally be a In certain circumstances with small tumours showing no contraindication to surgery, outside a clinical trial. evidence of nodal spread, the patient may not be suitable for The presence of metastases would also be a surgery. Recent stroke, myocardial infarction or significant contraindication to surgery. For example, a patient with COPD may deem surgery inappropriate. In addition, small hepatic, bony or adrenal metastases would certainly not be a tumours that are thought to be inoperable may be better suitable candidate for surgery. However, a small highly treated by radical radiotherapy [11]. With limited disease selected group of patients with solitary cerebral metastases under these circumstances, radical radiotherapy may be and otherwise operable lung cancer might be treated by associated with cure or extended survival. High dose cerebral metastasectomy and lung resection, with survival radiotherapy (e.g. 60 Gy over four weeks on a daily basis) can benefit [10]. be given. An improved form of radiotherapy called CHART Volume 3 Issue 2 • August/September 2008 11
  • 12. Key points • Lung cancer is a common disease with generally a poor outcome; good results can be achieved in appropriately selected individuals • All patients with lung cancer should be reviewed by the Lung Cancer MDT and optimum treatment established • All patients in whom a radical option is being contemplated should have a CT scan of thorax and abdomen • All patients who might have radical treatment should have a PET scan Figure 2: Malignant pleural effusion secondary to lung cancer. References 1. Office of National Statistics. Cancer Statistics Registration: Registrations of (Continuous Hyperfractionated Accelerated Radiotherapy) is cancer diagnosed in 2004, England, Series MBI no 33, 2005 a 3-times daily treatment over about 12 days with no 2. WHO histological typing of lung cancers. In: International classification of tumours 2nd edition 1981, Geneva weekend breaks, giving improved survival (12). In certain 3. Spira A, Ettinger DS. Multidisciplinary management of lung cancer. New circumstances chemotherapy can be administered in England Journal of Medicine 2004;350:379-92. combination with radiotherapy to attempt to improve the 4. Jackman DM, Johnson BE. Small-cell lung cancer. Lancet 2005;306:1385-96. 5. Prophylactic cranial irradiation in small-cell lung cancer: is it still controversial results. or is it a no-brainer? The Oncologist 2000;5:299-301. 6. Elias AD, Ayash L, Frei E et al. Intensive combined modality therapy for limited- Palliative therapy stage small cell lung cancer. J Natl Cancer Inst 1993;85:559-66. In advanced disease, it is accepted that cure is improbable. 7. Goldstraw P, Crowley J, Chansky K et al. The IASCLC lung cancer staging project. Journal of Thoracic Oncology 2007;8:706-14. The management plan would be to reduce tumour bulk and 8. Jablons D. Neoplasms of the lung. In: LW Way, GM Docherty (eds). Current provide the patient with as good a quality of life as possible. Surgical Diagnosis & Treatment 11th ed: 395-407. Radiotherapy is an excellent palliative therapy, and can 9. Shim SS, Lee KS, Byung-Tae K et al. Non-small cell lung cancer: prospective comparison of integrated FDG PET/CT and CT alone for pre-operative staging. provide relief from bony pain, irritating cough, haemoptysis Radiology 2005;236:1011-9. and cerebral metastases [13]. Chemotherapy can also provide 10. Granone P, Margaritora S, D’Andrilli A, Cesario A, Kawamukai K, Meacci E. Non-small cell lung cancer with single brain metastasis: the role of surgical excellent palliation of symptoms and generally promote well- treatment. Eur J Cardiothorac Surg 2001;20:361-6. being, improve appetite and slow down weight loss [14]. 11. Tyldesley S, Boyd C, Schulze K, Walker H, Mackillop WJ. Estimating the need Surgical procedures can provide palliation, such as for radiotherapy for lung cancer: an evidence-based, epidemiologic approach. Int J Radiat Oncol Biol Phys 2001;49:973-85. pleurodesis of recalcitrant pleural effusions (Figure 2), 12. Saunders MI. A randomised multicentre trial of CHART vs conventional disobliteration of airways with laser and stenting of radiotherapy in non-small cell lung cancer. Lung Cancer 1997;18:28-9. oesophageal strictures secondary to mediastinal nodal 13. Lester JF, Macbeth FR, Toy E, Coles B. Palliative radiotherapy regimens for non- small cell lung cancer. The Cochrane Database of Systematic Reviews 2006; involvement. issue3: Art no: CD 002143. These specific interventional measures are undertaken in 14. Tassivari D, Sartori S, Papi M et al. Outcomes of palliative care in stage IV non- addition to the general and specialist palliative care input that small cell lung cancer. Have we found what we are looking for? Lung Cancer 2004;43:373-4. is provided at all stages of the progression of the disease in 15. Kvale PA, Selecky PA, Prakash, UBS. Palliative care in lung cancer. CHEST the patient, as is appropriate to their needs [15]. n 2007;132:368-403. Top Oncologist on Jury Panel Reel Lives: The Cancer Chronicles Film Festival is executive director of UICC, the leading the first ever international documentary film international non-governmental organization competition focused on cancer. It aims to raise dedicated exclusively to the global control of awareness of the impact of cancer while also cancer. “We believe the festival will help honouring people who have been touched by demystify cancer and deepen awareness of the disease. cancer as a pressing global health issue, while Reel Lives is produced by the International also highlighting progress in the fight against Union Against Cancer (UICC) and will be held in the disease.” Geneva, Switzerland, on 28-30 August. The The festival will take place during the 2008 festival is supported by a grant from GlaxoSmithKline Oncology. World Cancer Congress in Geneva. The grand prize winner will In its inaugural year, the festival has already received more than receive $10,000. Other monetary prizes will also be awarded. 100 film entries from around the world, and has just added noted For further information - www.reellives.org Contact: oncologist Dr. Larry Norton to its team of expert judges. Claudia Durgnat, UICC/Reel Lives Film Festival Switzerland, “We are thrilled with the positive response,” says Isabel Mortara, Tel: +41 79 507 2324. 12 Volume 3 Issue 2 • August/September 2008
  • 13. A lifeline in relapsed NSCLC Prescribing Information Tarceva® (erlotinib) 25, 100 and 150 mg tablets Full prescribing information should be viewed prior to prescription. Indication: Treatment of patients with locally advanced or metastatic non-small cell lung cancer after failure of at least one prior chemotherapy regimen. When prescribing, factors associated with prolonged survival should be taken into account. No survival benefit or other clinically relevant effects of the treatment have been demonstrated in patients with EGFR-negative tumours. Dosage and administration: The daily dose is 150 mg taken orally at least one hour before or two hours after the ingestion of food. When dose adjustment is necessary, reduce in 50 mg steps. Safety and efficacy of Tarceva in children has not been established. Contra-indications: Known hypersensitivity to erlotinib or any of the excipients. Precautions: Smokers should be advised to stop smoking as a clinically significant reduction in plasma concentration is likely. Interstitial lung disease (ILD), including fatalities, has been reported (incidence 0.6%). In patients who develop acute onset of new and/or progressive unexplained pulmonary symptoms such as dyspnoea, cough and fever, interrupt therapy pending diagnostic evaluation. If ILD is diagnosed, discontinue therapy and initiate appropriate treatment. Diarrhoea should be treated with loperamide. Tarceva dose reduction or interruption may be necessary in patients with severe or persistent diarrhoea. It may be necessary to intensively rehydrate the patient intravenously, monitor renal function and serum electrolytes including potassium. In patients with pre-existing liver disease or on concomitant hepatotoxic medications, periodic liver function testing should be considered. Tarceva dosing should be interrupted if changes in liver function are severe. As tablets contain lactose they should not be administered to patients with galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption. Avoid concomitant administration with PPIs (Proton Pump Inhibitors), H2 antagonists and antacids (see Drug Interactions below). Drug Interactions: Plasma concentrations increase when combined with potent CYP3A4 inhibitors e.g. ketoconazole. It may therefore be necessary to reduce the dose of erlotinib. Potent CYP3A4 inducers e.g. rifampicin will decrease erlotinib plasma concentrations. Concomitant treatment should be avoided. If the combination cannot be avoided an increase in Tarceva dose to 300 mg can be considered, provided safety is closely monitored (renal/liver function and serum electrolytes). If well tolerated, after 2 weeks a further increase to 450 mg could be considered with continued monitoring. Caution should be observed in concomitant treatment with other CYP3A4 inducers. Significant interactions with the clearance of CYP3A4 substrates e.g. midazolam, erythromycin and paclitaxel, is unlikely. Potential interactions may occur with active substances which are metabolised by, or are inhibitors or inducers of CYP1A2, CYP1A1 and CYP1B1. Caution should be observed when ciprofloxacin or potent CYP1A2 inhibitors (e.g. fluvoxamine) are combined with erlotinib. Dose reduction may be required if an adverse event occurs. Monitor patients taking warfarin or other coumarin-derivative anticoagulants for changes in prothrombin time or international normalised ratio (INR). Concomitant administration of inhibitors of the P-glycoprotein active substance transporter e.g. cyclosporin and verapamil may lead to altered distribution and/or elimination of erlotinib. Solubility of erlotinib decreases at pH above 5. Drugs that alter the pH of the upper GI tract e.g. omeprazole (PPI) may alter the solubility of erlotinib and hence its bioavailability. Use with antacids and H2 antagonists should be avoided. If use of antacids is necessary take at least 4 hours before or 2 hours after erlotinib. Erlotinib increases platinum concentrations, though this is not considered to be clinically relevant. A study showed that carboplatin and paclitaxel did not affect erlotinib pharmacokinetics. Capecitabine may increase erlotinib concentrations but a clinical study showed there were no significant effects of erlotinib on the pharmacokinetics of capecitabine. Erlotinib and gemcitabine can be combined without significant effects on the pharmacokinetics. The inhibition of glucuronidation may cause interactions with medicinal products which are substrates of UGT1 A1 and exclusively cleared by this pathway. Pregnancy and lactation: There is no adequate experience in human pregnancy and lactation therefore Tarceva should only be used if the potential benefit justifies the potential risks. Women of childbearing potential must be advised to avoid pregnancy while on erlotinib and adequate contraceptive methods should be used during therapy, and for at least 2 weeks after completing therapy. Side effects and adverse reactions: See SmPC for full listing. Serious adverse reactions: Gastrointestinal: Cases of gastrointestinal bleeds have been commonly reported. Hepato-biliary disorders: Rare cases of hepatic failure (including fatalities) have been reported. Respiratory, thoracic and mediastinal disorders: Uncommon reports of serious interstitial lung disease (ILD), including fatalities. Infections and infestations: Severe infections, with or without neutropenia, have included pneumonia, sepsis and cellulitis. Common adverse reactions: Rash (75%), diarrhoea (54%), fatigue (52%) and anorexia (52%) were the most commonly reported adverse events in the BR.21 study. Most were grade 1/2 in severity and manageable without intervention. Diarrhoea can rarely lead to dehydration, hypokalemia and renal failure. Other adverse events reported, which occurred at a frequency ≥3% over placebo included pruritus, dry skin, nausea, vomiting, stomatitis, abdominal pain, dyspnoea, cough, infection, conjunctivitis and keratoconjunctivitis sicca. In the primary safety population the following was observed: Skin and subcutaneous disorders: Alopecia, paronychia, hirsutism, eyelash/eyebrow changes and brittle and loose nails. Hepato-biliary disorders: Liver function test abnormalities have been commonly observed. Most cases were mild or moderate in severity, transient in nature or associated with liver metastases. Eye disorders: Keratitis and corneal ulcerations. Respiratory, thoracic and mediastinal disorders: Epistaxis. Legal category: POM Presentations, Basic NHS Costs, and Marketing authorisation numbers: Tarceva (erlotinib) tablets 25 mg x 30: pack £378.33. EU/1/05/311/001. Tarceva (erlotinib) tablets 100 mg x 30: pack £1,324.14. EU/1/05/311/002. Tarceva (erlotinib) tablets 150 mg x 30: pack £1,631.53. EU/1/05/311/003. Marketing authorisation holder: Roche Registration Ltd, 6 Falcon Way, Shire Park, Welwyn Garden City, AL7 1TW, United Kingdom. Tarceva is a registered trade mark. Date of preparation: January 2008. Adverse events should be reported. Reporting J340678/JUL08 forms and information can be found at www.yellowcard.gov.uk. Adverse events should also be reported to Roche Products Limited. Please contact UK Drug Safety Centre on 01707 367554.
  • 14. Upper GI Oncology The Current Treatment of GIST With Reference to Laparoscopic Resection and Neoadjuvant Treatment astrointestinal stromal tumours (GIST) remains the treatment of choice when cure is Miss Siobhan Gill, MRCS, Senior House Officer in G are the most common mesenchymal tumours of the alimentary tract; they account for <1% of all GI malignancies with sought. There is, however, still debate regarding the most appropriate operative approach and the extent of resection required. Surgery. approximately 900 new cases per year in UK While metastatic spread is common at first [1]; primary GISTs tend to arise as solitary diagnosis, spread to lymph nodes is rarely seen lesions most commonly affecting the stomach thus, more extensive resection other than the (60-70%), followed by the small bowel (20- primary site is questionable and has no bearing 25%) and less commonly the rectum, on survival or recurrence. Recently the oesophagus and colon [2]. National Comprehensive Cancer Network Genetic analysis has revised the definition of (NCCN) task force reported that “laparoscopic GIST to be that of “highly cellular or laparoscopic-assisted resection may be mesenchymal tumours of the gastrointestinal useful for small (<2cm) GISTs when the risk of tract containing spindle, epitheloid cells or a intraoperative tumour rupture is low. However, combination of both and displaying CD117/c- the use of laparoscopic resection is generally Mr Paras Jethwa, BSc kit positivity”. GISTs have been proposed to discouraged for GIST” [4]; despite this, (Hons), MD, originate from the interstitial cells of Cajal, laparoscopic resection of primary GIST has FRCS(Gen), considered to be regulators of gastrointestinal become the treatment of choice in many Consultant General & Upper GI Surgeon. motility but, as they can arise from tissue centres in the UK and Europe. This article depleted of Cajal cells, the possibility that they summarises the current role of surgery and Correspondence: P Jethwa, arise from a pluripotent stem cell has been targeted chemotherapy in the management of Surrey & Sussex NHS Trust, suggested [3]. GISTs. Dept of Surgery, Canada Avenue, The management of GISTs has evolved REDHILL, rapidly with our understanding of the Minimally invasive surgery for GIST Surrey, molecular pathophysiology of this lesion Laparoscopic surgery for gastrointestinal cancer RH1 5RH, UK. allowing for the rational development of and, more recently gastric cancer has been antitumour agents that target signalling widely adopted in Japan, Korea, China, Italy, aberrations in these cells. Imatinib mesylate USA and the UK, but not without some debate. (Gleevac, Glivec), a tyrosine kinase and Unlike adenocarcinoma, lymphadenectomy is platelet derived growth factor receptor (PDGR) unnecessary with the aim of GIST surgery being antagonist, have shown excellent results in the complete removal (R0) of the tumour with patients with unresectable or metastatic GIST, negative resection margins and without but surgical resection of the primary tumour capsule rupture or intra-abdominal spillage of 14 Volume 3 Issue 2 • August/September 2008
  • 15. tumour cells. Evidence has shown that survival is dependant easily. This latter group requires particular attention to on tumour size (<5cms), mitotic activity (<5/50 mitoses per ensure no tumour spillage at time of resection. Current high powered field), angiogenic upregulation and evidence of consensus suggests that if these tumours are encountered mutation rather than the extent of resection [2,5]. Many during laparoscopic surgery, the procedure should be GISTs can be treated without major anatomical resection and switched to laparoscopically assisted or conventional open therefore are suitable for minimally invasive surgery, with surgery. wedge resection of gastric GISTs widely reported to be both As with the majority of GI neoplasms in western countries, successful and most commonly performed [6]. With the most GIST patients present late, with complaints of vague growth in laparoscopic surgical experience subtotal and total abdominal discomfort or anaemia due to large bulky disease, gastrectomies are now both practical and suitable for more and are not suitable for primary surgery at first presentation. proximal lesions however, larger GISTs in difficult anatomical Before 2001, surgery was the only effective treatment for positions (oesophagus/oesophagogastric junction/proximal GISTs however, the introduction of tyrosine kinase inhibitors stomach) present a more technically demanding challenge as neoadjuvant chemotherapeutic agents has revolutionised and have a greater propensity for open surgery or the approach to these tumours with, previously irresectible intraoperative conversion. The role of laparoscopic surgery in lesions downstaged to the point of curative resection. This is the resection of small bowel GISTs remains unclear at present further discussed below. though laparoscopic excision of large bowel and rectal GISTs have been reported to be technically feasible and have Neoadjuvant treatment successful outcomes [7,8]. Combined modality strategy has shown significant benefit The majority of reported series have supported the role of from imatinib mesylate (Gleevac) in downstaging GISTs, laparoscopic treatment of gastric and gastro-oesophageal thus rendering previously inoperable tumours resectable GISTs, demonstrating it to be associated with lower with tumour regression of up to 80% of patients. With as morbidity, mortality, length of stay and rates of long term many as 90% of patients developing recurrent disease survival comparable to, if not better, than that of during their lifetime there has been a considerable rise in conventional surgery [9]. Wherever possible anatomical our familiarity of the use of imatinib mesylate in the pre- function should be preserved but this should not be at the operative setting and, for those patients that develop cost of an R0 resection with enucleation of the tumour best symptomatic or functional recurrent disease. This has been avoided. In order to facilitate this a combined endoscopic demonstrated in a variety of settings with reports of laparoscopic local resection of tumours has proven to be successful R0 resection in previously advanced tumours or beneficial in patients with upper GI GISTs, known as an marginally resectable tumours, including locally advanced endoscopic rendezvous procedure [10]. This technique lesions of the stomach, metastatic hepatic GISTs and in facilitates preservation of anatomical function during the small bowel disease [13,14]. resection by ensuring lumen patency at all time. Despite Despite an initial response to imatinib secondary or Laparoscopic resection of primary GISTs has become the the treatment of choice... with lower morbidity, mortality, length of stay and [improved] rates of longterm survival initial concerns there have been favourable results reported acquired resistance tends to develop after a median of two from the resection of larger GISTs (up to 15cm in size), with years with this most commonly due to KIT mutation in no local or peritoneal recurrence after four years [11]. clonally expanded cells. Mutational analysis has helped to In order to successfully remove GISTs it is imperative to characterise the behaviour of these tumours with proximal gently handle the tumour and, if at all possible, direct deletions of exon 11 and duplication of exon 9 associated with handling should be minimised. We have found that once the high risk lesions whereas, PDGF α exon 18 mutated GISTs stomach has been mobilised, normally requiring the have a lower malignant potential. In light of this drug division of the gastrocolic omentum for tumours on the resistance the use of a newer agent, sunitinib malate (Sutent, greater curve or the gastohepatic ligament for those on the SU11248), has been trialed in patients with advanced disease, lesser curve, placing stay sutures either side of the tumour with GISTs resistance to imatinib. Two phase II trials and one mass greatly enhances operative control and reduces the phase III trial have reported a significant clinical benefit with risk of tumour cell spillage. After adequate mobilisation an increase in time to tumour progression and death, leading gastric resection is performed by elevating the stomach wall to suntinib being licensed for all patients in the US with and transecting the normal stomach with a linear imatinib resistant disease [15]; however tumour shrinkage endoscopic GI anastomosis stapler (Figures 1 & 2, tumour compared to placebo was not common and its role as a arising from lesser curve). For the resection of larger lesions neoadjuvant downstaging agent needs further clarification (>5cm),careful tactile handling and adequate traction of and investigation [16]. In addition, mutational analysis of the the tumour can be more problematic, with the use of hand primary tumour may also help to target drug therapy, with assisted laparoscopic surgery (HALS) advocated by some exon 9 mutation GISTs especially sensitive to sunitnib authors [12]. While most GISTs are hard, elastic and coated treatment whilst at best having an intermediate response to with a thin pseudo-capsule some are very fragile and bleed imatinib. It is clear, at present, that a randomised clinical trial Volume 3 Issue 2 • August/September 2008 15
  • 16. 4. Demetri GD, Benjamin RS, Blanke CD, Blay JY et al. NCCN Task Force report: of these agents as neoadjuvant treatments in advanced GISTs management of patients with gastrointestinal stromal tumor (GIST) - update of is needed to establish any relative superiority. the NCCN clinical practice guidelines. J Natl Compr Canc Netw. 2007;Jul;5 Suppl 2:S1-29. It is our experience that in advanced and recurrent disease, 5. Imamura M, Yamamoto H, Nakamura N, Oda Y, Yao T, Kakeji Y, Baba H, increasing the dose of imatinib mesylate (up to 800mg/day) Maehara Y, Tsuneyoshi M. Prognostic significance of angiogenesis in gastrointestinal stromal tumors. Mod Pathol 2007:20(5):529-37. in patients that initially have a poor response or are refractory 6. Nowain A, Bhakta H, Pais S, Kanel G, Verma S. Gastrointestinal stromal to therapy proves to be both efficacious and therapeutic. This tumours: clinical profile, pathogenesis, treatment strategies and prognosis. J Gastroenterol Hepatol. 2005;Jun;20(6):818-24. increase leads, in a sizeable proportion, to a decrease in 7. Nguyen SQ, Divino CM, Wang JL, Dikman SH. Laparoscopic management of tumour volume and is associated with complete surgical gastrointestinal stromal tumors. Surg Endosc 2006;20(5):713-6. resection in those with locally advanced primary GISTs [17]. 8. Nakamura T, Ihara A, Mitomi H, Kokuba Y, Sato T, Ozawa H, Hatade K, Onozato W, Watanabe M. Gastrointestinal stromal tumor of the rectum resected Early surgical intervention should be considered for imatinib by laparoscopic surgery: report of a case. Surg Today. 2007;37(11):1004-8. responsive disease and in these patients multiple 9. Novitsky YW, Kercher KW, Sing RF, Heniford BT. Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg reoperation(s) are associated with prolongation of life. 2006;Jun;243(6):738-45; discussion 745-7. 10. Ludwig K, Wilhelm L, Scharlau U, Amtsberg G, Bernhardt J. Laparoscopic- endoscopic rendezvous resection of gastric tumors. Surg Endosc. 2002 Conclusion Nov;16(11):1561-5. The current management of GISTs continues to rapidly 11. Otani Y, Kitajima M. Laparoscopic surgery for GIST: too soon to decide Gastric Cancer. 2005;8(3):135-6. progress with the combination of new surgical techniques 12. Yano H, Kimura Y, Iwazawa T, Takemoto H, Imasato M, Monden T, et al. Hand- and targeted chemotherapy delivering real benefits in keeping assisted laparoscopic surgery for a large gastrointestinal tumor of the stomach. with their promised potential expectations seen at the cellular Gastric Cancer. 2005;8:186-92. 13. Gomez D, Al-Mukthar A, Menon KV, Toogood GJ, Lodge JP, Prasad KR. level. The treatment of GISTs continues to evolve with Aggressive surgical resection for the management of hepatic metastases from dramatic reductions seen in mortality and associated surgery gastrointestinal stromal tumours: a single centre experience. HPB (Oxford). 2007;9(1):64-70. from this disease. n 14. Chiang KC, Chen TW, Yeh CN, Liu FY, Lee HL, Jan YY. Advanced gastrointestinal stromal tumor patients with complete response after treatment with imatinib mesylate. World J Gastroenterol. 2006 Apr 7;12(13):2060-4. 15. Hopkins TG, Marples M, Stark D. Sunitinib in the management of gastrointestinal stromal tumours (GISTs). Eur J Surg Oncol. 2008 Aug;34(8):844- 50. References 16. Demetri GD, van Oosterom AT, Garrett CR, Blackstein ME, Shah MH, Verweij J, 1. Pidhorecky I, Cheney RT, Kraybill WG, Gibbs JF. Gastrointestinal stromal McArthur G, Judson IR, Heinrich MC, Morgan JA, Desai J, Fletcher CD, George tumors: current diagnosis, biologic behavior, and management. Ann Surg Oncol. S, Bello CL, Huang X, Baum CM, Casali PG. Efficacy and safety of sunitinib in 2000;7(9):705-12. patients with advanced gastrointestinal stromal tumour after failure of imatinib: 2. DeMatteo RP, Lewis JJ, Leung D, Jeung D, Mudan SS, Woodruff JM, Brennan a randomised controlled trial. Lancet. 2006 Oct 14;368(9544):1329-38. MF. Two hundred gastrointestinal stromal tumour: recurrence patterns and 17. Andtbacka RH, Ng CS, Scaife CL, Cormier JN, Hunt KK, Pisters PW, Pollock RE, prognostic factors for survival. Ann Surg 2000 Jan;231:51-8. Benjamin RS, Burgess MA, Chen LL, Trent J, Patel SR, Raymond K, Feig BW. 3. Connolly EM, Gaffney E, Reynolds JV. Gastrointestinal stromal tumours. Br J Surgical resection of gastrointestinal stromal tumors after treatment with Surg 2003;90(10):1178-86. imatinib. Ann Surg Oncol. 2007 Jan;14(1):14-24. ibe Subscr FREE ISSN 1751-4975 www.o ncolog ynews .biz Oncology News Volume 3 Issue 2 :August/September 2008 www.oncologynews.biz Subscription Information International readers can read each issue FREE online at: www.oncologynews.biz Or for a paper copy there is a charge: Europe £30.00 (GBP) Rest of World £50.00 (GBP) In this issue What is UCAN? Management of Primary Lung Cancer Please send a cheque in pounds sterling made payable to: The Current Treatment of GIST With Reference to Laparoscopic Resection and Neoadjuvant Treatment Prostate Cancer reviewed: Part 2 - Treatment Options ‘McDonnell Mackie’ and send to: Oncology News 84 Camderry Road, Dromore, Co Tyrone, BT78 3AT, UK ISSN 1751-4975 ISSN 1751-4975 ISSN 1751-4975 ISSN 1751-4975 ISSN 1751-4975 ISSN 1751-4975 Oncology News Oncology News Oncology News Oncology News Oncology News Oncology News Volume 2 Issue 5 : February/March 2008 www.oncologynews.biz Volume 2 Issue 6 : April/May 2008 www.oncologynews.biz Volume 3 Issue 1 : June/July 2008 www.oncologynews.biz Volume 2 Issue 2 : August/September 2007 www.oncologynews.biz Volume 2 Issue 3 : October/November 2007 www.oncologynews.biz Volume 2 Issue 4 : December/January 2008 www.oncologynews.biz In this issue In this issue In this issue In this issue In this issue In this issue Arginine Deprivation Addresses the Achilles Heel of Cancer: Urea Cycle Photodynamic Therapy Role in the Premalignancy / Malignancy of the Paediatric Oncology: Clinical Practice and Clinical Trials Lung Cancer Screening: Stratification of High Risk Populations Chinese Medicine and Cancer Sentinel Lymph Node Biopsy: Role in Melanoma Deficiencies in Melanoma, HCC and other Cancers Head and Neck A Potential New Drug that Kills Malignant Cells Without Affecting Healthy Multiple Myeloma High Impact Trials in Screening and Treatment of Colorectal Cancer Stem Cell Therapy for Paediatric Malignant Brain Tumours: Future Directions in the Medical Management of Malignant Mesothelioma Nutrition in Upper GI Cancer The Silver Bullet? Normal Cells Optimising Transurethral Resection for Non-Muscle Invasive Bladder Advances in Management of Renal Cell Carcinoma Role of the Endothelin Axis in Colorectal Cancer Urinary Tissue Factor in Bladder Cancer The Genetics of Prostate Cancer and the Potential for Targeted Screening: Cancer; A Recurrent Problem Chemotherapy Resistance, Apoptosis and Future Directions in Therapy Colorectal Cancer – A Sticky Problem CNS/Brain Tumour 2-Week Referral Guidelines: A Review of their Utility Screening For Colorectal Cancer The IMPACT Study An Introduction to MR Imaging of the Spine in Oncology in Neurological Practice Prostate Cancer Reviewed: Part 1 – Epidemiology, Aetiology and Pathology Diagnosing Lung Cancer on the Chest Radiograph – Pitfalls and Pearls 16 Volume 3 Issue 2 • August/September 2008
  • 17. Uftoral offers people with mCRC an effective oral chemotherapy with very rare incidence of HFS.1 Allow your patients to continue with the everyday activities that are essential for their lifestyle. E ed IC d Uftoral: a lifestyle choice for your patients en m N m co re Merck Serono Oncology Uftoral Prescribing Information (UK) Presentation: Capsules containing 100 mg tegafur and 224 mg uracil. elderly. Monitor patients on coumarin anticoagulant treatment (such as modification. Please refer to Uftoral SPC for full details of side effects. Therapeutic Indications: First-line chemotherapy treatment of metastatic warfarin) and phenytoin treatment. Drug Interactions: Warfarin, phenytoin, Legal Category: POM. Basic NHS cost: pack of 36 capsules - £96.12; pack colorectal cancer in combination with calcium folinate. Dosage and substrates or inhibitors of the CYP2A6 enzyme such as coumarin, of 120 capsules - £320.40. Marketing Authorisation Holder: Merck administration: The dose of Uftoral is 300 mg/m2/day tegafur and 672 methoxypsoralen, clotrimazole, ketoconazole, miconazole. Must not be Pharmaceuticals (A Division of Merck Ltd), Harrier House, High Street, West mg/m2/day uracil combined with 90 mg/day oral calcium folinate, given in co-administered with inhibitors of dihydropyrimidine dehydrogenase eg Drayton, Middlesex, UB7 7QG, UK. MA Number: PL11648/0065. Date of three divided doses, at least one hour before or after meals. Calcium brivudine (allow interval of 4 weeks before Uftoral treatment). Pregnancy Preparation: August 2007. Further information, including a summary folinate should be taken at the same time as Uftoral. The treatment cycle and Lactation: Should not be administered to patients who are pregnant of product characteristics is available from: Merck Serono, Bedfont is 35 days. Uftoral/calcium folinate is taken for 28 consecutive days or attempting to become pregnant or breast feeding. Undesirable Effects: Cross, Stanwell Road, Feltham, Middlesex, TW14 8NX, UK Tel: 020 8818 followed by 7 days without Uftoral/calcium folinate. Only suitable for Very common: GI disorders such as diarrhoea, nausea/vomiting, abdominal 7373. (Uftoral is a trademark of Taiho Pharmaceutical Co., Ltd, used under adults. Monitor patients with renal or hepatic impairment carefully. pain, asthenia, stomatitis and anorexia; blood disorders such as license by Merck KGaA, Darmstadt, Germany) Exercise caution in patients with renal impairment. In the elderly, monitor myelosuppression, anaemia, thrombocytopenia, leucopoenia and renal, hepatic and cardiac function. Contraindications: Hypersensitivity neutropenia; increased alkaline phosphatase, ALT, AST and total bilirubin. References : to the constituents or 5-FU; pregnancy or breast feeding; adolescents, Common: other GI disorders including intestinal obstruction; fever, 1. Uftoral SmPC November 2006 children and infants; severe hepatic impairment; deficiency of hepatic headache, malaise, chills, dehydration, cachexia; CNS disorders including Adverse reactions should be reported to Merck Serono CYP2A6; bone marrow suppression from previous radiotherapy or taste disturbance, dizziness, depression and confusion; eye disorders, cardiac (please see contact details within PI). antineoplastic agents; known or suspected dihydropyrimidine and vascular disorders including DVT; respiratory disorders; skin and Alternatively, adverse reactions may be reported using the dehydrogenase deficiency; current or recent treatment with musculoskeletal disorders. Uncommon: Other GI disorders, hepatitis, Yellow Card Scheme (www.yellowcard.gov.uk) dihydropyrimidine dehydrogenase inhibitors such as brivudine. Special jaundice, liver failure, chest pain, sepsis, coagulation disorders, febrile Warnings and Precautions: Patients with: renal or hepatic impairment, neutropenia, arrhythmia, congestive heart failure, myocardial infarction, signs and symptoms of bowel obstruction, signs and symptoms of liver or heart arrest, shock, pulmonary embolism, abnormal kidney function, urinary renal disease, diarrhoea, a history of significant cardiac disease and the retention, haematuria, impotence. Side effects may require dose Date of preparation: March 2008 UFT08-0007
  • 18. Urological Cancer Prostate Cancer reviewed: Part 2 - Treatment Options ollowing estimation of pathological waiting, with regular PSA and DRE, offering F staging using the criteria outlined in part 1 of this review, there are three important categories into which tumours are hormone therapy if there is evidence of significant disease progression. A more proactive form of watchful waiting termed placed in order to determine the appropriate active surveillance is available for younger Simon Mackie, treatment options. These include organ men with low volume, low to moderate grade SpR in Urology, Aberdeen Royal Infirmary, UK. confined T1 and T2 lesions, locally advanced disease. With more intensive follow-up using T3 and T4 (N0 M0) tumours and metastatic PSA, DRE and interval repeat TRUS biopsy disease. There are a number of treatment radical treatment can be deferred until there is options available for each category and evidence of disease progression. Up to 50% of patients’ care needs to be carefully men are progression free at 10 years and determined taking into account quality of life, deferred radical treatment remains effective competing co-morbidities, life expectancy and [2]. For some men this is a viable alternative patient preference. The Multi-Disciplinary to early radical treatment and its consequent Team (MDT) approach to patient management side effects. However, it should be carefully is key to this process, involving surgeons, explained to patients that there is a risk that Bhavan Rai, oncologists, radiologists, pathologists and potentially treatable disease may progress Urology Research Fellow, specialist nursing staff. during the monitoring period with an University of Aberdeen, UK. increased risk of local progression, metastatic Treatment of Organ Confined Prostate spread and death from prostate cancer [3]. Correspondence to: Dept Urology, Cancer Aberdeen Royal Infirmary, Organ confined disease now represents the Radical Surgery Foresterhill, majority of tumours at diagnosis and is Radical surgery is considered the gold standard Aberdeen, AB252ZN, UK. potentially curable. However, due to the long treatment for prostate cancer in appropriately natural history of prostate cancer and the selected patients. Such patients should have a evolution of different interventions it has been greater than 10 year life expectancy, with organ difficult to effectively measure and compare confined disease which is biologically the outcomes of different treatment strategies. resectable and they should be fit enough to Therefore there is a significant degree of undergo major surgery. To date there is limited controversy surrounding the optimum data comparing surgery directly with radical treatment of this category of disease. Again, radiotherapy, although surgery is considered treatment needs to be carefully planned in the the optimum treatment option due to the MDT setting taking into account patient reduced risk of local recurrence. However, preference, age and co-morbidity. The three there is good evidence that disease progression main treatment options include watchful and disease specific survival is better with Factors Indirectly waiting or active surveillance, radical surgery surgery compared to watchful waiting [3]. Affecting and radical radiotherapy. These options have There are a number of surgical approaches Treatment similar long term outcomes but different side including open retropubic, open perineal and Quality of Life effects and complications and therefore each laparoscopic. Acute complications include Co-morbidity option should be carefully explained to the haemorrhage, infection, and complications Life expectancy patient who can then make an informed related to anaesthesia. Significant late Patient preference decision. complications include erectile dysfunction in around 50% of patients, incontinence in 10% Results Pending Watchful Waiting and Active surveillance and bladder neck stenosis in 5%. Ten year Definitive data on Low risk, low Gleason grade disease carries progression free survival is in the region of optimum treatment only a 4-7% risk of death at 15 years and 85% for organ confined disease, but this falls strategy for organ confined disease is Gleason 7 disease carries a 42 – 70% risk at 15 to 55-65% with evidence of extracapsular some way off. years [1]. Thus men over the age of 75 years extension, 25% with seminal vesical disease The results of a number with organ confined disease and a life and 10% if there is nodal disease [4]. Several of studies investigating expectancy of less than 10 years are unlikely series of laparoscopic and robotic radical the role of cancer to gain benefit from radical treatment. In such prostatectomy have recently been reported and screening are awaited cases it is generally considered appropriate to while some reports suggest shorter recovery monitor disease status, termed watchful time, less blood loss and improved 18 Volume 3 Issue 2 • August/September 2008
  • 19. incontinence and impotence rates [5] other reports show more was noted over 60 years ago that prostate cancer responded mixed results [6] However, oncological outcomes between to surgical castration or oestrogen therapy that reduced open and minimally invasive techniques are similar and circulating testosterone levels by negative feedback on the therefore with continued advances in technology minimally hypothalamic-pituitary axis [13]. Since then a number of invasive surgery for prostate cancer is likely to become the alternative agents have been produced including leutenising standard in the future. hormone releasing hormone (LHRH) analogues which reduce testosterone production by negative feedback and steroidal Radiotherapy and non-steroidal anti-androgens which block testosterone External beam radiotherapy (EBR) has seen significant action in the prostate. Both normal prostatic epithelial cells advances in technology in recent years with the development and cancer cells are dependent on androgens for normal of 3-dimensional conformal radiotherapy (3D-CRT). This growth and around 70% of tumours will respond to androgen targets the radiation more accurately to the shape of the deprivation. However, tumours rapidly develop androgen prostate gland avoiding damage to adjacent tissues and independence with a mean time to progression of 14 months. allowing higher doses of 70–80 Gy to be administered. When disease progresses, changing the type of androgen Further improvements in accuracy have been made with deprivation therapy or combining treatments, which is intensity modulated radiotherapy (IMRT) which utilises termed 2nd or 3rd line hormonal therapy, offers some computer technology to allow precise targeting. improvement but response times are limited and treatment Brachytherapy is the implantation of radioactive seeds into should be aimed at palliation of the symptoms of metastatic the prostate. Computer models are used to guide precise complications. In selected patients with androgen placement of the seeds allowing high radiation doses of up to independent disease chemotherapy with docetaxol may be 145 Gy to be given. Adjuvant hormone therapy is indicated with response rates of 20 – 40%, but again median recommended for 2-3 years in high risk disease and six survival rates are low at 24 – 44 weeks [14]. months in low and intermediate risk disease due to improved Thus prostate cancer is a serious disease with significant local control and survival [7,8]. Cancer specific outcomes are morbidity and mortality and although there are effective equivalent to surgery but there are problems making direct interventions available for organ confined disease treatment comparisons as many of the end points used in the study of options for more advanced disease are limited. However, work the different treatment modalities have not been comparable continues in an attempt to define the molecular genetics and [9]. The five year progression free survival rates for natural history of the disease as well as to optimise both radical radiotherapy are in the range 70-85% [10]. However, local and palliative treatment. Moreover, the results of a number of recurrence has been noted in up to two thirds of patients on studies investigating the role of cancer screening are awaited, long term follow up [11]. Long term complications include the outcomes of which will have a significant impact on men’s chronic cystitis and proctitis and erectile dysfunction in health in the primary and secondary care setting. n around 50% of patients at one year. A number of other treatment options are currently References 1. Albertsen PC, Hanley JA, Gleason DF, Barry MJ. Competing risk analysis of men undergoing evaluation including cryotherapy, radio-frequency aged 55 to 74 years at diagnosis managed conservatively for clinically localized ablation and high intensity focussed ultrasound (HIFU). prostate cancer. JAMA 1998:280:975-80. Comparison of radical treatment options have shown broadly 2. Patel MI, DeConcini DT, Lopez-Corona E, Ohori M, Wheeler T, Scardino PT. An analysis of men with clinically localized prostate cancer who deferred definitive similar outcomes but different end points have been used and therapy. J Urol 2004:171:1520-4. there are no randomised controlled studies available [12]. 3. Bill-Axelson A, Holmberg L, Ruutu M, Haggman M, Andersson SO, Bratell S et al. Radical prostatectomy versus watchful waiting in early prostate cancer. N However, an ongoing multi-centre research project in the UK Engl J Med 2005:352:1977-84. comparing radical surgery, radiotherapy and active 4. Catalona WJ, Ramos CG, Carvalhal GF. Contemporary results of anatomic radical prostatectomy. CA Cancer J Clin 1999:49:282-96. surveillance is underway. The Prostate testing for cancer and 5. Stolzenburg JU, Rabenalt R, Do M, Truss MC, Burchardt M, Herrmann TR et al. Treatment (ProecT) trial was started in 2001, has been Endoscopic extraperitoneal radical prostatectomy: the University of Leipzig experience of 1,300 cases. World J Urol 2007:25:45-51. randomising patients to the different treatment groups and 6. Touijer K, Eastham JA, Secin FP, Romero OJ, Serio A, Stasi J et al. aims to report in 2015. Therefore, definitive data on the Comprehensive prospective comparative analysis of outcomes between open and laparoscopic radical prostatectomy conducted in 2003 to 2005. J Urol optimum treatment strategy for organ confined disease is still 2008:179:1811-7. some way off and the management of prostate cancer will 7. Bolla M, Collette L, Blank L, Warde P, Dubois JB, Mirimanoff RO et al. Long- continue to centre around a careful and thorough discussion term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III of all the available options with the patient. randomised trial. Lancet 2002: 360:103-6. 8. D'Amico AV, Manola J, Loffredo M, Renshaw AA, DellaCroce A, Kantoff PW. 6- month androgen suppression plus radiation therapy vs radiation therapy alone Treatment of Locally Advanced and Metastatic Prostate for patients with clinically localized prostate cancer: a randomized controlled Cancer trial. JAMA 2004:292:821-7. 9. Gretzer MB, Trock BJ, Han M, Walsh PC. A critical analysis of the interpretation In the UK locally advanced disease is most frequently of biochemical failure in surgically treated patients using the American Society managed with radiotherapy combined with adjuvant for Therapeutic Radiation and Oncology criteria. J Urol 2002:168:1419-22. 10. Bolla M, Gonzalez D, Warde P, Dubois JB, Mirimanoff RO, Storme G et al. hormonal therapy. This approach has been shown to offer Improved survival in patients with locally advanced prostate cancer treated with improved disease free and overall survival compared to radiotherapy and goserelin. N Engl J Med 1997:337:295-300. 11. Swanson GP, Riggs MW, Earle JD. Long-term follow-up of radiotherapy for radiotherapy alone with five year survival rates in the region prostate cancer. Int J Radiat Oncol Biol Phys 2004: 59:406-11. of 80% [10]. For elderly patients with limited life expectancy 12. Nilsson S, Norlen BJ, Widmark A. A systematic overview of radiation therapy or those patients wishing to avoid the complications and effects in prostate cancer. Acta Oncol 2004:43:316-81. 13. Huggins C, Hodges CV. Studies on prostatic cancer: I. The effect of castration, of impact on quality of life of radiotherapy, hormone therapy estrogen and of androgen injection on serum phosphatases in metastatic alone or watchful waiting may be appropriate alternatives. carcinoma of the prostate. 1941. J Urol 2002: 168:9-12. 14 Tannock IF, de Wit R, Berry WR, Horti J, Pluzanska A, Chi KN et al. Docetaxel Hormone therapy in the form of androgen deprivation plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. forms the mainstay of management for metastatic disease. It N Engl J Med 2004:351:1502-12. Volume 3 Issue 2 • August/September 2008 19
  • 20. Book Reviews Neuro-oncology. The essentials (2nd edition) Bernstein M, Berger MS (eds.). Publisher: Thieme, 2008. ISBN: 9781588904973 / 9783131163325. Price €149.95. euro-oncology is a broad discipline encompassing the only chemotherapy and radiotherapy but also antiepileptic drugs N work of oncologists, radiotherapists, neurosurgeons, and even an occasional neurologist (although I am only aware of two such dedicated neurologists in the UK), in both and anticoagulation; quality of life, with a particular focus on neuropsychological consequences of brain tumours and their treatment; and ethics, especially with respect to clinical trials. adult and paediatric practice, not to mention basic scientists. To Production qualities are high, with excellent illustrations, produce a text which pleases all in this diverse constituency is although a few figure legends are incongruous (e.g. 5.12A, difficult, but in my view the current text, with a largely North 37.1). A key point according to the editors’ preface, retained American authorship based around centres of excellence in San from the first edition of 2000, is the supplementation of the text Francisco and Toronto, has largely succeeded. with special boxed features (“Pearls”, “Controversies”, “Special The book is divided into eight sections: Biology, Evaluation, Considerations”, and “Pitfalls”). There is some repetition of Surgery, Radiation, Chemotherapy, Biological Therapy, Specific material between chapters, perhaps inevitable in a multi-author Tumours, and Related Issues. Biology addresses epidemiology work, but this is not intrusive. Typographical errors and editori- and the basic sciences of tumour molecular pathology and al oversights are few: the two references to chromosomal tumorigenesis, including the possible role of cancer stem cells. abnormalities in meningiomas do not exactly correspond (308, This section might profitably be read in conjunction with that on 321-2; loss of 18p or 18q?) and it seems unlikely that cabergo- Biological Therapy, which reviews innovative treatments stem- line has become first-line therapy for prolactinoma “due to its ming from increasing understanding of tumour biology such as higher side-effect profile and lower efficacy” (337). These are tumour vaccines, gene therapy, and small-molecule-based thera- minor quibbles, though. pies, including use of convection-enhanced delivery mechanisms. “Everything you need to know about neuro-oncology” claims The latter also crops up in the section on Chemotherapy, a pro- the blurb, and although this may be overstatement it is difficult pos intratumoral chemotherapy; this section also covers photody- to think of any serious omissions. Something on the WHO clas- namic therapy as well as more conventional systemic chemother- sification of tumours would have been appropriate, as may apy. Evaluation revolves around the diverse imaging modalities some commentary on the use of “guidelines” for tumour iden- now available (anatomic, metabolic, physiological and function- tification such as those inspired (imposed?) by the UK al), although there was no mention of longitudinal volumetric MR Department of Health. As a neurologist, I would have liked a imaging for assessing change in tumour size. The core of the chapter on paraneoplastic syndromes. Nevertheless, one has no book, around 40% of the text, is devoted to Specific Tumours, hesitation in recommending this book, perhaps for the person- addressing clinical presentation, investigation and diagnosis, and al library and definitely for the departmental library. n treatment of individual tumour types. Generally these chapters are excellent summaries, although one or two have a tendency to Andrew J Larner, read like manuals of surgical procedure. The book’s final section, Walton Centre for Neurology and Neurosurgery, Related Issues, addresses complications of medical therapy, not Liverpool, UK. Special Reader Offer! Problem Solving in Oncology D O’Donnell, M Leahy, M Marples, A Protheroe, P Selby • Comprehensive range of 54 case studies • Practical approach including pictorial overviews • Valuable training and CPD resource Detailed studies covering: breast, ovarian, urological, gastrointestinal, lung, melanoma and more uncommon cancers ( e.g. endocrine/neuro-endocrine tumours, GISTs, chorionic malignancy and head/neck tumours). General aspects of oncology therapy are also covered including work ups, assessment of chemotherapy response, toxicity and psychological aspects of management. Each case begins with practical questions followed by the clinical presentation and a logical work-up to reach a diagnosis. An algorithm accompanies most cases to provide a rapid pictorial overview of the clinical steps. Essential references are provided throughout. 256pp 240 x 170 mm Paperback Illustrations: Tables, algorithms & diagrams. RRP £35-00 978 1 904392 84 2 To order at the special offer price of £30 (incl’ p&p)* CLINICAL PUBLISHING Please call 01235 465500 (quoting ref ONC 1) www.clinicalpublishing.co.uk * UK & Eire only 20 Volume 3 Issue 2 • August/September 2008
  • 21. Conference News Are you organising an annual meeting or conference which you would like to tell our readers about? Or would you like to write a report on a meeting or conference of particular interest? If so, contact Patricia McDonnell at Oncology News on Tel/Fax: +44 (0)288 289 7023, Email: patricia@oncologynews.biz 1st Wales Cancer Conference Venue: Cardiff, Wales. Date: 30 April-1 May, 2008. ointly organised by the Wales Cancer therapies can be chosen to fit the J Institute and the Wales Cancer Alliance we welcomed 300 delegates including patient’s needs in the clinic.. Away from the science Cancer patients, research nurses, laboratory Research UK organised a very lively researchers, policy makers, clinicians and question and answer session with cross Welsh Assembly Members to the varied party representation of Welsh Assembly two day programme. members chaired by the BBC’s Health Upcoming researchers were given the Correspondent Hywel Griffiths. This opportunity to showcase their work on session covered a range of topics from the second day in a Young Investigators the need for a cancer plan in Wales and session where the prize winning talk on the roll out of the bowel screening “Using an in-vitro MTOR kinase assay to programme to views on co-payments for further characterise the MTOR pathway” cancer treatment. by Elaine Dunlop give the name set the An Oxford Union style debate on “All high standard of the science in Wales. effective treatment should be free” saw This described a way to understand a key the case for being argued for the motion pathway that is often affected in the Dennis Slamon by Prof Richard Sullivan of the London cancer cell, making the cancer more School of Economics and Political Science likely to respond to one treatment rather and Prof Gordan McVie, Managing Editor than another. major changes (translaocations and of ecancermedicalscience, Cancer The conference began with a talk from rearrangements) in the genetic code of Intelligence, Bristol. The case against was Prof Paul Workman of the Institute of cancer which will help to identify new argued by Dr Fergus McBeth, Director of Cancer Research, Sutton, on “Drugging ways to target treatment. Dennis the National Collaborating Centre for the cancer genome: Developments in Slamon, the discoverer of Herceptin from Cancer and Sir Michael Rawlins, novel therapies” which highlighted two UCLA in California, gave an excellent talk Chairman of the National Institute for other new approaches to cancer about the discovery of herceptin and the Health and Clinical Excellence. The vote treatment which have been developed in underlying abnormalities in breast from the chamber was for the motion his laboratory and are now in early cancer that makes it work so effectively but Sir Rawlins went on to give a plenary clinical studies (that is inhibition of the in the 20-25% of women whose breast lecture on “NICE and its role in cancer activity of PI3 kinase, a key signalling cancer is driven by an amplification of care” highlighting to the audience that pathway, and HSP-90, a nuclear that gene, and how this could further providing the correct individualised chaperone molecule). This linked with Dr affect decisions about treatment. These treatment for patients is what would also Andy Futreal who is one of the leaders in talks all pointed out the fundamental be the most cost-effective and this the Human Genome Project from the importance of genetic changes in the should be the drive of research. Wellcome Trust Sanger Institute in cancer cell and that these are a key basis Professor Lesley Fallowfield from the Cambridge. He showed the way in which for identifying new targets for therapy Sussex Psychosocial Oncology Group at the new technology is able to identify and in turn begin to influence how University of Sussex spoke on Volume 3 Issue 2 • August/September 2008 21
  • 22. “Communicating effectively with patients” and she will be from people’s perception of cancer to targeting cancer working with the Wales Cancer Trials Network across Wales to tumours; from stem cells to evaluating the HPV vaccine to help integrate the “teams talking trials” programme into discussions on do we need a cancer plan for Wales? The multidisciplinary teams. breadth of delegates gave a real sense of everyone pulling Prof Jane Maher the National Clinical Lead NHS Improvement together. and Chief Medical Officer from MacMillan Cancer Support The conference highlighted the issues of payment for cancer talked about “Life after cancer treatment: a spectrum of chronic treatment, the need for an updated cancer policy in Wales and survivorship conditions” on issues of survivorship and living that research should be driven by the focus on predictive with cancer. This picked up from Prof Jessica Corner’s talk genetic markers and trial programmes incorporating molecular highlighting the problems of long terms toxicities of cancer selection and individualisation of therapy. therapy. The Wales Cancer Alliance and the Wales Cancer Institute In addition to the plenary lectures, sessions were held on would like to thank all speakers, chairs, poster judges and many research aspects including basic science, from bench to delegates and we look forward to welcoming you to the next bedside, on new therapies for cancer and their evaluation in conference in 2010. n clinical trials, a translational science focus, a clinical trials symposium, cancer immunology, palliative care and also cancer More information available at: and the primary care setting. www.walescancerinstitute.co.uk The conference attracted a huge breadth of topics in cancer 44th American Society of Clinical Oncology (ASCO) meeting Venue: Chicago, USA. Date: 31 May - 3 June, 2008. SCO’s main meeting, the premier event in the world endothelial growth factor and platelet derived growth factor A medical oncology calendar, once again featured numerous advances in several cancers with many arising from European receptors - both implicated in tumour progression. Dr Robert Figlin of City of Hope Hospital, Duarte, California said median research. The Medical Research Council’s testicular cancer trial OS for patients remaining on allotted therapies from is a prime example. Latest findings of the trial, TE19/EORTC randomisation and receiving no post-study treatment were 28 30982, which began in 1996, confirmed a single dose of months for sunitinib and 14 months for IFN alpha (p=0.0033). carboplatin following orchiectomy is as effective as adjuvant However, patients failing IFN alpha at pre-specified interim radiotherapy in preventing disease recurrence among men with analyses were crossed over to sunitinib. Overall, patients stage 1 seminoma. Tim Oliver, MD, Emeritus Professor of randomised to sunitinib had a median survival of 26.4 months Medical Oncology at St. Bartholomew's Hospital, London, compared to 21.8 months for those randomised to IFN alpha presented results of the trial which randomised 573 patients to giving a hazard ratio of 0.82 (p<0.05). Updated efficacy data carboplatin, administered over one hour, and 904 patients to show the median progression free survival (PFS) was 11 months daily radiotherapy for 2-3 weeks. After five years, cancer for sunitinib and 5 months for IFN alpha and objective response recurrence rates for the two study arms were comparable (5 per rates, according to investigators were 47 and 12 per cent cent for carboplatin vs 4 per cent for radiotherapy). Patients respectively (p<0.000001). The data confirm sunitinib as the who received the full dose of carboplatin had a relapse-free rate reference standard for first-line therapy for advanced renal of 96.1 per cent, which was identical to that of radiotherapy. cancer, Dr Figlin concluded. Within five years, carboplatin-treated patients were also 82 per In lung cancer the big news was the FLEX study. Late- cent less likely to develop a cancer in the contralateral testicle. breaking data reported for the phase III FLEX (First-line in Lung “The rate was better than tamoxifen achieves in breast cancer cancer with ErbituX) trial showed a significant overall survival and opens up the possibility of testis conservation for these benefit for non-small cell lung cancer (NSCLC) patients when patients,” he commented. Future studies will investigate the epidermal growth factor receptor (EGFR) inhibitor lumpectomy and single-dose carboplatin as an option for men cetuximab (Erbitux) was added to platinum-based with small tumours presenting early enough who wish to avoid chemotherapy. Benefit was seen across all histological losing the diseased testicle. But 20 years of follow-up are subtypes, and irrespective of age, gender, smoking status and needed to examine death rates from non-germ cell cancer and tumour size. The trial included 1125 previously-untreated heart disease and to establish the final incidence of patients with advanced (stage IIIB/IV) NSCLC and EGFR-positive contralateral tumours, he stressed. tumours. All NSCLC histological types were included; In metastatic renal cell cancer (mRCC), there was good news adenocarcinomas represented 47 per cent and squamous cell on survival. Overall survival (OS) data from a randomised phase carcinomas 34 per cent. Almost all patients (94 per cent) had III study comparing first-line sunitinib (Sutent) with standard stage IV metastatic disease and 17 per cent had an ECOG interferon (IFN) alpha therapy in 750 previously untreated performance status (PS) of 2. Overall, patients randomised to a patients with mRCC show sunitinib extends median survival to cetuximab / cisplatin / vinorelbine regimen survived 1.2 months more than two years. Around 80 per cent had metastases at longer than patients randomised to chemotherapy alone (11.3 two or more sites. This finding breaks new ground and more vs 10.1 months HR 0.87, p=0.04). One-year survival rates than doubles survival time typically observed with IFN alpha were 47 and 42 per cent respectively. Lead investigator treatment, say oncologists. Sunitininb is a multi-targeting Professor Robert Pirker of Medical University of Vienna, tyrosine kinase inhibitor whose targets include vascular Austria, said: “The data set a new standard for treating newly- 22 Volume 3 Issue 2 • August/September 2008
  • 23. diagnosed patients with advanced NSCLC. This is the first trial randomised in further clinical trials of EGFR inhibitors in mCRC. of a front-line targeted therapy to include patients with In early-stage breast cancer, a 1803-patient study showed squamous cell carcinomas, and patients who have a the bisphosponate zoledronic acid (Zometa) significantly particularly poor prognosis,” he pointed out. reduced risk of recurrence when added to hormone therapy In metastatic colorectal cancer (mCRC) there was news that with tamoxifen or anastrazole. After median follow-up of 60 patients whose tumours express KRAS normal or wild-type months it was found adding zoledronic acid reduced risk of genes have a significantly greater chance of responding to first- relapse by 35 per cent. Lead investigator Michael Gnant, line targeted EGFR-inhibitor treatment as has been Professor of Surgery at Vienna University said future research demonstrated previously for second/third line therapy. On would now focus on optimising the dosing schedule and average, the ratio of wild-type to mutant KRAS in mCRC identifying patients who benefit most. tumours is 2:1. Tumours with mutant KRAS derive no benefit A British-led international trial in locally advanced or from EGFR inhibition, said researchers. Data from the 1198- metastatic breast cancer showed adding the anti-angiogenic patient CRYSTAL trial on 540 archived tumour tissue samples therapy bevacizumab (Avastin) to taxane chemotherapy with evaluable for KRAS, found response rates for first-line docetaxel (Taxotere) slows disease progression in patients with cetuximab and FOLFIRI were much higher in the presence of no prior chemotherapy exposure. In the AVADO trial 736 wild-type KRAS (59 per cent vs 43 per cent for FOLFIRI alone) patients receiving docetaxel were randomised to either placebo and PFS was increased by 32 per cent in the cetuximab/FOLFIRI or one of two doses of bevacizumab (7.5 or 15mg/kg). Lead arm (HR 0.68 p=0.017). KRAS mutant tumours showed no investigator David Miles, Professor of Medical Oncology at enhanced response from adding cetuximab to FOLFIRI; Mount Vernon Cancer Centre, London, said after median response rates were 36 per cent for cetuximab/FOLFIRI and 40 follow-up of 11 months patients in the lower dose per cent for FOLFIRI alone and PFS was actually shorter HR1.07 bevacizumab group were 21 per cent, and those in the higher p=0.75. Professor Eric Van Cutsem of University Hospital dose group were 28 per cent, less likely to have their disease Gasthuisberg, Leuven, Belgium, who presented the data hailed progress compared to those receiving docetaxel only. Response the findings as “a real advance”. It showed patients with wild- rates were 55.2, 63.1 and 44.4 per cent respectively. type KRAS had twice the chance of surviving one year without Bevacizumab added limited incremental toxicity, mostly tumour growth if they received EGFR-targeted therapy treatable hypertension, commented Professor Miles. n alongside irinotecan-containing therapy, he said. KRAS status of tumours is now likely to be determined ahead of patients being Olwen Glynn Owen, Medical Journalist. BACR/RSM Oncology Section/Academy of Pharmaceutical Sciences Joint Meeting “Preclinical models; biomarkers and targeted therapy” Venue: London, UK. Date: 27 November, 2008. PREVIEW he British Association of Cancer Research session. Following lunch there will be a poster T (BACR), Royal Society of Medicine (RSM) Oncology section and the Academy of session in which selected posters will be chosen for discussion. In the afternoon there will be Pharmaceutical Sciences of Great Britain (APSGB) presentations discussing more specific examples of are holding the second in a series of inter- the development of preclinical models to validate disciplinary meetings on Thursday 27th the use of biomarkers. November 2008. This one-day meeting will be Confirmed speakers: Johann de Bono (Royal held in the Royal Society of Medicine. Marsden Hospital, UK), Sally Burtles (Cancer The aim of these meetings is to provide an Research UK), Steve Wedge (AstraZeneca, UK), opportunity to discuss issues relating to Chand Khanna (National Cancer Institute, US), Bob translational preclinical research and the Brown (Imperial College London, UK), Val Brunton challenges for transfer of agents into the clinic. (University of Edinburgh, UK) and Gill Tozer This meeting is to be on the role of model (University of Sheffield, UK). systems in informing the clinical and pre-clinical Paul Workman (The Institute of Cancer Research, development of cancer drugs and drug/gene UK) and Sue Burchill (Leeds Institute of Molecular delivery systems, working through the challenges Medicine) will lead panel and poster discussion in taking targeted therapies forward to the clinic. sessions. We hope you will agree this is an Specifically we want to address the requirement important area and will support this exciting for robust biomarkers in the development of initiative by putting the date in your diary and targeted therapies and explore how informative coming along to the meeting. n current preclinical models are in taking these forward to the clinical setting. The day will begin For further information contact: with three introductory lectures exploring these Barbara Cavilla, BACR, c/o The Institute of issues from a clinical, academic and industrial Cancer Research, Email: bacr@icr.ac.uk perspective, followed by a panel discussion Volume 3 Issue 2 • August/September 2008 23
  • 24. ORBS 2008 - The first Scientific Meeting in Oncoplastic and Reconstructive Breast Surgery Venue: Nottingham, UK. Date: 22-24 September, 2008. PREVIEW he ORBS meetings are aimed to give both a scientific and Broaden your horizons in breast cancer surgery at ORBS T teaching platform for this rapidly expanding specialty. As the surgical approaches to breast cancer surgery expand the 2008: • IMPORTANT TOPICS & TECHNICAL DEMONSTRATIONS requirements for knowledge of these new techniques expand as FROM WORLD EXPERTS - Breast reshaping, Implant, LD and does the need for evidence based practice. The meetings will DIEP reconstruction plan to span the breadth of modern oncoplastic breast cancer • HOT TOPICS - Fat Injection techniques, Advanced techniques surgical management and is aimed at all members of the in breast conservation, New Implants medical and nursing breast cancer surgical teams from both • DIFFICULT TOPICS - Radiotherapy strategies, Assessing breast and plastic surgery. Teaching and presentations will be in outcomes, Neoadjuvant therapy the full spectrum of techniques from the role of adjuvant • NEW DATA - Hear and discuss the latest studies therapy, improved breast conservation techniques through to • FUN TOPICS - Wine tasting at social evening!! n microsurgical reconstruction. This spectrum emphasises the expanding options available and the need for broader For further information contact: understanding and integration of teams delivering surgical Stephen McCulley and Douglas Macmillan (Course Convenors), www.orbs2008.com breast cancer care. Advances in all aspects of the use and delivery of radiotherapy have improved cancer care for millions of people across Europe, and ESTRO 27 provides the opportunity for specialists to publish their results and debate critically how best to improve care still further through: • Teaching sessions in clinical radiotherapy, brachytherapy, radiobiology, physics, • Joint sessions to maximise the use of multi-disciplinary cancer management, • Presentation of research results and major break- throughs, • Proffered papers, poster presentations and discus- sions, • 10.000 m2 exhibition of brand new materials, which makes ESTRO 27 the largest European industrial exhibi- tion in Radiotherapy. Late registration deadline is 22 August 2008. European Society for Therapeutic Details about the congress including programme, reg- Radiology and Oncology Annual Congress istrations, exhibition and hotel accommodation will More than 4,500 cancer specialists from all over the world will be available on the website attend a challenging, state-of-the-art programme in Göteborg this www.estro27.org. September. Over 500 presentations will highlight advances in radiotherapy and multidisciplinary approaches to the For more information: ESTRO – +32 2 775 93 40 – treatment of cancer. muriel.hallet@estro.be 24 Volume 3 Issue 2 • August/September 2008
  • 25. what are you waiting for? VISIT ESMO B O O T H 16 MOSAIQ combines a complete image enabled oncology medical chart, capable of streamlining advanced therapies regardless of equipment, with fundamental patient administration, workflow management and flexible reporting features. The result is a system that actually increases staff productivity yet still promotes quality patient care. Patients no longer have to wait, why should you? MOSAIQ TM management information system www.elekta.com managing the spectrum of cancer care
  • 26. Imaging Introduction to the use of MRI in Staging of Rectal Cancer mesorectal fascia extends down from the peritoneal reflection to Lowry K1, Armstrong A2, Lynch T1, Dr Tom Lynch the level of the anorectal junction. Denonvilliers fascia is a Napier E1. fibrous band that separates the rectum from the prostate gland 1. Department of Radiology and Nuclear Medicine, Northern Ireland Cancer Centre, and seminal vesicles; it is fused with the anterior aspect of the Belfast Trust. mesorectal fascia. Denonvilliers fascia is removed during total 2. Department of Surgery, Northern Ireland Cancer Centre, Belfast Trust. mesorectal excision. The inferior hypogastric nerves are important for genitourinary function and care must be taken when dissecting Denonvilliers fascia as the nerves lie very close to the mesorectum at this level. Posteriorly the mesorectal fascia meets the presacral fascia. maging of the rectum with magnetic resonance imaging I (MRI) is frequently used for both malignant and non- malignant conditions, such as fistulae and abscesses. It remains the only part of the bowel that is regularly imaged Table 1 MRI Technique WFOV T2 5mm sag with MRI. In patients with rectal cancer prior to the WFOV T1 5mm axial introduction of MRI surgeons relied upon rectal examination SFOV T2 3mm sagittal, coronal and axial in deciding whether tumours where fixed or tethered within (WFOV; Wide Field of View. SFOV; Small field of View) the pelvis. MRI has been shown to be accurate in both staging of rectal tumours and in defining there relationship to the Ideally MRI for rectal cancer should be undertaken by mesorectal fascia. It has been shown to be an accurate tool in experienced radiographers with knowledge of the pelvic deciding pre-operative management and in predicting anatomy and correct imaging planes so that the sequences outcome. MRI is often the first investigation ordered obtained allow accurate staging. Intravenous buscopan can be following histological confirmation of the tumour and given to decrease artefact from peristalsing adjacent bowel. In patients normally have their MRI prior to being discussed in our centre the sequences listed in Table 1 are undertaken. The the multidisciplinary meeting to decide upon treatment. images are normally checked by the supervising consultant In this article we discuss the use of body coil MRI in imaging radiologist and further sequences can be done as necessary. rectal cancer, as this is the most commonly used technique. Initial wide field of view sagittal imaging delineates the length After discussing the important anatomical landmarks within the of the tumour and allows planning of the small field of view pelvis we will look at the MRI techniques involved in acquiring images. The axial small field of view images are performed the correct sequences in the appropriate planes. We will then perpendicular to the long axis of the rectum. These images are focus on the role of MRI in determining the stages of rectal the most useful when looking at the relationship of the tumour cancer and look at treatment options. to the mesorectal fascia. Coronal imaging is frequently used in The most significant advance in the management of rectal looking at low rectal tumours and in determining their cancer has come with the development of total mesorectal relationship with the anus. The axial T1 images of the whole excision surgery, in which the rectum is removed along with its pelvis are helpful in identifying involved lymph nodes and surrounding mesorectum and the nodes within it. The metastatic bone involvement. circumferential margin in this procedure is the mesorectal Body coil MRI has been shown to be accurate in T staging of fascia. This technique has been shown to lower the rates of rectal cancers. It is difficult to usefully delineate early T1 and T2 local recurrence and improve long term survival. It is widely stage tumours but it is an accurate technique for assessment of accepted as best practice. MRI has been shown to complement the more advanced tumours in the T3 and T4 categories of TME well, providing important anatomical and tumour disease. CT is routinely used to look for more distant morphological information prior to surgery. metastases within the chest or abdomen (typically liver). T1 tumours are limited to the sub-mucosa and account for Anatomy approximately 10% of all rectal cancers. Body coil imaging as The rectum is classically divided into upper, middle and lower described here is not the optimal imaging to discern T1 from T2 thirds, each section being on average 5cm long, with the border disease, if local excision rather than TME is being considered. of the lowest section being the anal verge. The peritoneal In this case endoluminal imaging either with ultrasound or reflection extends posteriorly from the bladder to meet the endoanal coil MRI is more appropriate. Until relatively recently anterior border of the rectum. In males this occurs between the it was felt that curative treatment of low risk, that is without lower and middle two thirds of the rectum but can be lower in evidence of neurovascular invasion or poorly differentiated females. It is important to identify this structure as invasion will tumours, could be achieved with local excision but more recent change both staging and the type of operation required. papers have shown that there remains a significant risk of local The mesorectal fascia completely surrounds the mesorectum, recurrence and that perhaps more radical surgery should be which contains fatty tissue, lymphatics and lymph nodes. The undertake despite the apparent low stage of the tumour. 26 Volume 3 Issue 2 • August/September 2008
  • 27. T2 tumours extend to the muscularis Figure 1 (arrowheads). Seminal vesicles are seen propria, but not beyond it. T3 tumours can anteriorly (arrow). go as far as the mesorectal fascia, but do Figure 2 is an axial T2 image showing a T3 not invade other organs or the pelvic tumour with disruption of the muscularis sidewall. T2/T3 tumours are the most propria indicating extension into mesorectal common and it is in these patients that fat as indicated by loss of dark line (arrow). radical surgery, based on total mesorectal There is an enlarged lymph node in the excision is undertaken. Involvement of the mesorectal fat (arrowhead). Neither the circumferential resection margin, or tumour tumour material or node is close to the within 1mm of it. has a high predictive mesorectal fascial line and hence anticipated value for local recurrence and long term circumferential resection margins are clear. survival. The mesorectal fascia forms the Figure 3 is an axial T2 image showing a T3 circumferential margin in total mesorectal tumour with a tongue of tumour extending out Figure 2 excision and as this can be clearly seen on through mesorectal fat to contact the MRI, this technique is ideal in pre- mesorectal fascial line and hence threaten the operatively staging these patients. Some circumferential resection margin (arrow). studies now advocate the use of pre- Figure 4 is a sagittal T2 image operative radiotherapy or chemotherapy in demonstrating a tumour of the upper third of patients with known involvement of the the rectum which extends out of the mesorectal fascia prior to surgery, with mesorectum to involve peritoneal reflection findings showing that this can both down- and hence represent T4 disease (arrows). stage the tumour and reduce the incidence Enlarged nodes are also seen (arrowheads). of local recurrence. MRI can be used to Multiplanar examinations allow better restage tumours following treatment with appreciation of anatomical extent of local chemo/radiotherapy, but this is not as Figure 3 disease. accurate as staging without treatment. MRI overestimates the stage in these patients, Conclusion having difficulty differentiating between All patients with rectal cancer in whom tumour and changes related to tumour surgery is being considered should have an treatment. MRI unless contraindicated, i.e. permanent T4 tumours invade adjacent organs or the pacemaker in situ. Body-coil imaging can be pelvic sidewall. More radical multivisceral done well in different centres if standard resection may be considered for these sequences and planes are used. It has been patients, although again pre-operative shown to be well tolerated by patients and treatments with radio/chemotherapy Figure 4 accurate in assessment of relevant T and N should be given. staging and of tumour proximity to routine Lymph nodes down to approximately circumferential resection margins. Once these 3mm can be detected using body-coil MRI. are established the multidisciplinary team Nodes smaller than this, although not seen can decide whether to undertake pre- on MRI, are virtually never infiltrated with operative treatment and then proceed to tumour. Lymph node staging using MRI has surgery if appropriate. The MRI will allow the traditionally used size as the main factor in operating surgeon to plan the approach to the determining nodal involvement, however tumour and alert them to where the tumour different centres use between 5 and 10mm may come close to their resection margin. n as there cut-off point for normal. The evidence suggests that most lymph nodes over 8mm are likely Suggested reading MERCURY Study Group. Diagnostic accuracy of magnetic resonance imaging in to be involved. It is important to consider that enlarged nodes predicting surgical resection margin status: prospective observational study. BMJ that border close to the mesorectal fascia likely threaten the 2006;333: doi:10.1136/bmj.38937.646400.55 Madbouly KM, Remzi FH, Erkek BA, Senagore AJ, Baeslach CM, Khandwala F, Fazio CRM. The absence of detectable lymphadenopathy on MRI has VW, Lavery IC. Recurrence after transanal excision of T1 rectal cancer: should we be a strong predictive value that no positive nodes will be seen in concerned? Dis Colon Rectum 2005; 48: 711-9. Brown G, Richards CJ, Bourne MW, Newcombe RG, Radcliffe AG, Dallimore NS, et al. the histological specimen. This has led other authors to look at Morphologic predictors of lymph node status in rectal cancer with use of high-spatial other features of the lymph nodes. The presence of an irregular resolution MR imaging with histopathologic comparison. Radiology 2003;227:371–7. Kim JH, Beets GL, Kim MJ, Kessels AG, Beets-Tan RG. High resolution MR imaging for border and/or signal heterogeneity increases the probability nodal staging in rectal cancer: are there any criteria in addition to the size? Eur J Radiol that the node is involved. MRI scanning following injection of 2004;52:78–83. iron oxide particles has been shown to increase the detection of Hermanek P, Heald RJ. (2004) Pre-operative radiotherapy for rectal carcinoma? Has the case really been made for short course pre-operative radiotherapy if surgical standards involved lymph nodes, although this is not as yet used in for rectal carcinoma are optimal? Colorectal Disease 2004;6(1):10–4. doi:10.1111/j.1463-1318.2004.00569.x routine practice. Sebag-Montefiore D, Steele R, Quirke P, et al. Routine short course pre-op radiotherapy Figure 1 is an axial T2 image demonstrating a T2 tumour. or selective post-op chemoradiotherapy for resectable rectal cancer? Preliminary results of Tumour material is contained within the muscularis propria the MRC CR07 randomized trial. Proc Am Soc Clin Oncol. J Clin Oncol 2005;24(Suppl):148s abstract 3511. which is appreciated as a smooth darker line surrounding the Lahaye MJ, et al. USPIO-enhanced MR imaging for nodal staging in patients with rectum (asterisk). The mesorectal fat surrounding the rectum is primary rectal cancer: predictive criteria. Radiology. 2008 Mar;246(3):804-11. Epub 2008 Jan 14. normal and contains a few tiny nodes. The mesorectal fascial Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery: the clue to line is shown as a thin dark line surrounding the fat pelvic recurrence? Br J Surg. 1982;69:613-6. Volume 3 Issue 2 • August/September 2008 27
  • 28. Diary of Events If you would like an event listed in the Oncology News diary please send the relevant information to email Patricia@oncologynews.biz by September 5th, 2008. 2008 33rd ESMO Congress NCRI Cancer Conference 2008 Female Cancers study day 12-16 September, 2008; Stockholm, 5-8 October, 2008; Birmingham, UK 22 October, 2008; Middlesex, UK Sweden Sharon Vanloo Anni Hall August European Society for Medical Tel : +44 (0)20 7269 3420 Tel: 01923 844177 Oncology Email: ncriconference@ncri.org.uk Fax: 01923 844172 International Conference on Head Tel: + 41 (0) 91 973 19 19 Email: anni.hall@mvh-ljmc.org and Neck Cancer American Society for Therapeutic Email: congress@esmo.org 9-13 August, 2008; San Francisco, USA Radiology and Oncology, Annual Web: www.esmo.org NEW American Head & Neck Society Meeting Drug Therapy in Palliative Care for Tel: +1 (310) 437-0559 NEW 5-9 October, 2008; Baltimore, USA Healthcare Professionals Web: www.headandneckcancer.org Palliative Care for Non-Malignant ASTRO 23 October, 2008; Caterham, UK International Union Against Cancer Conditions for Healthcare Tel: +1 (800) 962-7876, Barbara Hirons World Cancer Congress Professionals (703) 502-1550 Tel: 01883 832664 27-31 August, 2008; Geneva, 16 September, 2008; Stevenage, UK Web: www.astro.org Email:barbara.hirons@ Switzerland Barbara Hirons mariecurie.org.uk Tel: 01883 832664 End of Life Issues in Cancer Care World Cancer Congress 2008 Email:barbara.hirons@ Study Day Frenchay Breast Ultrasound Course Tel: +41 22 809 1811 mariecurie.org.uk 9 October, 2008; Clatterbridge, UK for Surgeons Fax: +41 22 809 1810 Email: teresa.mealor@ccotrust.nhs.uk 30-31 October, 2008, Bristol, UK Web: www.uicccongress08.org Gynaecological Cancer Study Day 17 September, 2008; London, UK Royal Marsden Palliative Care Tel: 0117 9753753 Breast Cancer Current Therapeutics Email: mike.shere@nbt.nhs.uk 28 August, 2008; London, UK Tel: 020 7808 2921 Update Day Web: www.mahealthcareevents.co.uk Email: conferencecentre@rmh.nhs.uk 10 October, 2008; London, UK Managing Oedema due to Advanced Web: www.royalmarsden.nhs.uk Tel: 020 7808 2921 Disease Email: conferencecentre@rmh.nhs.uk September NEW Web: www.royalmarsden.nhs.uk 30-31 October, 2008; Glasgow, UK Essentials in Palliative Care for Karen Hegyi or Margaret Sneddon, Foundations in Cancer Oncology Tel: 0141 330 2072/2071 Healthcare Professionals Annual Meeting of the American Module (Level 2 or 3) Email: k.hegyi@clinmed.gla.ac.uk 17-18 September, 2008; College of Surgeons 1 September, 2008; Clatterbridge, UK Web: www.gla.ac.uk/schools/nursing/ Southampton, UK 12-17 October, 2008; San Francisco, Email: teresa.mealor@ccotrust.nhs.uk lymphoedema Barbara Hirons USA Influences on Cancer Care Tel: 01883 832664 Convention and Meeting Division, Oncology Module (Level 2 or 3) Email:barbara.hirons@ American College of Surgeons November 1 September, 2008; Clatterbridge, UK mariecurie.org.uk Tel: +1 (312) 202-5244 Email: teresa.mealor@ccotrust.nhs.uk Web: www.facs.org Lung Cancer Awareness Month NEW 1-30 November, 2008. Care of the Patient Requiring Palliative Care in Action for Advanced Chemotherapy Study Day Web: www.lungcanceralliance.org Chemotherapy (Leve1 2 or 3) Healthcare Professionals 15 October, 2008; London, UK 1 September, 2008; Clatterbridge, UK 23 September, 2008; Tiverton, UK Tel: 020 7808 2921 Joint ABS at BASO & BASO ~ ACS Email: teresa.mealor@ccotrust.nhs.uk Barbara Hirons Email: conferencecentre@rmh.nhs.uk Scientific Conference Tel: 01883 832664 Web: www.royalmarsden.nhs.uk 3-4 November, 2008; London, UK Oncology Course for Allied Health Email:barbara.hirons@ Professionals Email: jackiespencer@baso.org.uk mariecurie.org.uk NEW Tel: 020 7405 5612 Module 1: An Introduction to Local Training Seminar - Rare sce- Oncology for AHPs RADT 500 Oncoplastic & Reconstructive Web: www.baso.org.uk narios within breast cancer 1 September, 2008; Clatterbridge, UK Breast Surgery Meeting 16 October, 2008; Southampton, UK Influencing policy, changing prac- Email: teresa.mealor@ccotrust.nhs.uk 23-24 September, 2008; Nottingham, Kylie Vilcins Tel: 0845 092 0802 tice: Improving the care of people UK NEW with metastatic breast cancer Email: joanna.cooper@nuh.nhs.uk 11th Annual BOPA Symposium Symptom Management in Palliative 4 November, 2008; London, UK Web: www.orbs2008.com 17-19 October, 2008; Liverpool, UK Care for Healthcare Professionals Jan Hannell Web: succinctcomms.com 5 September, 2008; Tamworth, UK Living with cancer study day Tel: 0845 092 0802 Barbara Hirons 24 September, 2008; Middlesex, UK 8th International Conference of Email: nursetraining@ Tel: 01883 832664 Anni Hall Anticancer Research breastcancercare.org.uk Email:barbara.hirons@ Tel: 01923 844177 17-22 October 2008; Kos, Greece Web: www.breastcancercare.org.uk/stfc mariecurie.org.uk Fax: 01923 844172 www.iiar-anticancer.org/ Email: anni.hall@mvh-ljmc.org Chemotherapy Foundation 11th European Worksop on Lymphoedema: Diagnosis, Symposium Cytogenetics and Molecular BTOG Small Cell Lung Cancer Assessment & Prevention of 5-8 November, 2008; New York City, Genetics of Solid Tumours (SCLC) Study Day 2008 Complications USA 6-9 September, 2008; Bilbao, Spain 25 September, 2008; Manchester, UK 21-24 October, 2008; Glasgow, UK The Mount Sinai Medical Center Web: www.cicbiogune.es/congreso/ Web: www.btog.org Karen Hegyi or Margaret Sneddon, Tel: +1 (212) 241-6772 congreso1_CMGST/index.php Tel: 0141 330 2072/2071 Web: www.mssm.edu/tcf 14th European Society of Surgical October Email: k.hegyi@clinmed.gla.ac.uk Web: www.gla.ac.uk/schools/nursing/ Staff Nurse Study Day Oncologists Breast Cancer Awareness Month lymphoedema 7 November, 2008; London, UK 10-13 September, 2008; The Hague, 1-31 October, 2008. Tel: 020 7808 2921 the Netherlands www.breakthrough.org.uk 20th EORTC-NCI-AACR Email: conferencecentre@rmh.nhs.uk ESSO 2008 Conference secretariat, MAGIC for Nurses Education Day Symposium on “Molecular Targets Web: www.royalmarsden.nhs.uk Federation of European Cancer 3 October, 2008; London, UK and Cancer Therapeutics” Societies 21-24 October, 2008; Geneva, NEW Tel: +32 (0)2 775 02 05 Tel: 0131 557 3332 Switzerland Palliative Care in Action for Fax: +32 (0)2 775 02 00 Web: www.myeloma.org.uk 20th EORTC – NCI- AACR Healthcare Professionals Email: ESSO2008@fecs.be British Lymphology Society Annual Symposium Secretariat, Federation of 10 November, 2008; Worcester, UK Improve Your Communications Conference – Lymphoedema: European Cancer Societies, Barbara Hirons Skills Alternative Pathways Tel: +32 (0)2 775 02 01, Tel: 01883 832664 11-12 September, 2008; Glasgow, UK 5-7 October, 2008; Belfast, UK Fax: +32 (0)2 775 02 00, Email:barbara.hirons@ Email: K.Hegyi@clinmed.gla.ac.uk Web: www.thebls.com Email: ENA2008@fecs.be mariecurie.org.uk 28 Volume 3 Issue 2 • August/September 2008
  • 29. Management of the Cancer Patient: Haemato-Oncology Study Day December 2009 An Overview for Physiotherapists 14 November, 2008; London, UK 10 November, 2008; London, UK Tel: 020 7808 2921 50th ASH Annual Meeting and Tel: 020 7808 2921 Email: conferencecentre@rmh.nhs.uk Exposition January Email: conferencecentre@rmh.nhs.uk Web: www.royalmarsden.nhs.uk 6-9 December, 2008; San Francisco, PREVENT (Prediction, Web: www.royalmarsden.nhs.uk USA NEW Recognition, Evaluation and Breast Cancer Study Day American Society of Hematology Eradication of Normal Tissue Nature of Cancer Course 18 November, 2008; Newmarket, UK Tel: +1 (202) 776-0544 effects of radiotherapy) 10-17 November, 2008; Bev Johnson Email: ash@hematology.org 11-12 January, 2009; Brussels, Tel: 01223 596627 Web: www.hematology.org Clatterbridge, UK Belgium Email: teresa.mealor@ccotrust.nhs.uk Email: beverley.johnson@ Bowel Cancer Study Day Web: www.estro.be/estro/index.cfm addenbrookes.nhs.uk 10 December, 2008; Clatterbridge, UK Clatterbridge Centre for Oncology Management & Use of NEW Email: teresa.mealor@ccotrust.nhs.uk NHS Foundation Trust and the PICC/Hickman & Port Lines Cancer: Nature; Treatment and Royal College of Nursing Annual 11 November, 2008; Middlesex, UK Impact for All Lymphoedema: Assessment and National Conference Anni Hall 21 November, 2008; Stevenage, UK Management 23-24 January, 2009; Chester, UK Tel: 01923 844177 Barbara Hirons 10-12 December, 2008; Glasgow, UK Contact mirka.ferdosian@rcn.org.uk Fax: 01923 844172 Tel: 01883 832664 Karen Hegyi or Margaret Sneddon, Web: www.rcn.org.uk/events Email: anni.hall@mvh-ljmc.org Email:barbara.hirons@ Tel: 0141 330 2072/2071 mariecurie.org.uk Email: k.hegyi@clinmed.gla.ac.uk NEW British Gynaecological Cancer International Conference Learning Web: www.gla.ac.uk/schools/nursing/ Lymphoedema: Diagnosis, Society Scientific Meeting 2008 From The Past, Influencing The lymphoedema Assessment & Prevention of 12-14 November, 2008; Liverpool, Future San Antonio Breast Cancer Complications UK 24-25 November, 2008; Liverpool, Symposium 27-30 January, 2009; Newcastle, UK Email: j.a.green@liv.ac.uk UK 11-14 December, 2008; - San Karen Hegyi or Margaret Sneddon, Email: teresa.mealor@ccotrust.nhs.uk Antonio, TX Tel: 0141 330 2072/2071 NEW Rich Markow, Symposia Director, Email: k.hegyi@clinmed.gla.ac.uk Lymphoedema In Breast Cancer Pain Management in Palliative Care CTRC/Breast Cancer Symposium Web: www.gla.ac.uk/schools/nursing/ Patients for Healthcare Professionals 27 November, 2008; London, UK Tel: +1 (210) 616-5912 lymphoedema 13 November, 2008; London, UK Tel: 020 7830 2323 Web: www.sabcs.org NEW Barbara Hirons Fax: 020 7830 2324 NEW Palliative Care for Non-Malignant Tel: 01883 832664 Email: j.hafezi@medsch.ucl.ac.uk Cancer: Nature; Treatment and Conditions for Healthcare Email:barbara.hirons@ RCN Breast Cancer Care Nursing Impact for All Professionals mariecurie.org.uk Society Conference and Exhibition, 18 December, 2008; Stevenage, UK 28 January, 2009; Caterham, UK One size doesn’t fit all Barbara Hirons Barbara Hirons 14th Annual CTOS Meeting 28 November, 2008; London, UK Tel: 01883 832664 Tel: 01883 832664 13-15 November, 2008; London, UK Email: laura.benfield@rcn.org.uk Email:barbara.hirons@ Email:barbara.hirons@ www.ctos.org/ Web: www.rcn.org.uk/events mariecurie.org.uk mariecurie.org.uk Organised by Current Therapeutics Series The Royal Marsden NHS Foundation Trust 2. Breast 29-30 September 2008 International Federation of Head and Neck Oncologic Cancer Society (IFHNOS) World Tour: London Conference 2008 £300 (participants) • £250 ( Trainees) The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE A series of one day meetings aimed 03 October 2008 at general medical practitioners and The 1st Annual Royal Marsden Breast Cancer Meeting: postgraduate medical trainees Neoadjuvant Therapy £100 (Full delegates) • £75 (CNSs/Trainees) Institute of Physics, London, W1 The Royal College of Physicians, 11 St. Andrew's Place, Regent's Park, London NW1 Thursday 28th August 2008 14 November 2008 Update on Aspects of Diagnosis and Management in For full programme details and Malignant Haematology to book your place at this event £75 please visit our website The Royal Marsden Education and Conference Centre, Fulham Road, London SW3 6JJ www.mahealthcareevents.co.uk 29 January 2009 Alternatively call our booking hotline A state of the art Multidisciplinary Approach to: on 020 7501 6762 Cholangiocarcinoma £100 (Full delegates) • £75 (CNSs/Trainees) MA Healthcare Ltd, St. Jude’s Church, The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE Dulwich Road, London SE24 0PB For further information on the Royal Marsden conference events, CONFERENCE FEE INCLUDES ENTRANCE TO THE CONFERENCE, LUNCH AND REFRESHMENTS, FULL CONFERENCE CPD please visit http://www.royalmarsden.nhs.uk/studydays DOCUMENTATION AND CERTIFICATE OF ACCREDITATION APPROVED or contact The Royal Marsden Education and Conference Centre: Tel: 020 7808 2921 Fax: 020 7808 2334 40 YEARS OF MEDICAL EDUCATION Email: conferencecentre@rmh.nhs.uk Volume 3 Issue 2 • August/September 2008 29
  • 30. Courses & Conferences Sunday 5 October – Wednesday 8 October 2008 The International Convention Centre, Birmingham, UK www.ncri.org.uk/ncriconference Registration open Dates to remember please register online at Monday 2 June: Registration opens www.ncri.org.uk/ncriconference Monday 7 July: Late-breaking abstract The NCRI Cancer Conference is the major forum in the UK for showcasing the submission opens best British and international cancer research. It offers unique opportunities Thursday 31 July: for networking and sharing knowledge by bringing together the leading Earlybird registration deadline experts from all cancer research disciplines. Monday 4 August: Late-breaking abstract submission deadline Confirmed speakers include: Monday 1 September: Mariano Barbacid (Spain) Rebecca Fitzgerald (UK) Paul Nurse (USA) Online registration deadline Valerie Beral (UK) Joe Gray (USA) Martine Piccart (Belgium) Sunday 5 October: Harvey Chochinov (Canada) Rakesh Jain (USA) Howard Scher (USA) Lisa Coussens (USA) Tony Kouzarides (UK) NCRI Cancer Conference commences NCRI Cancer Conference Secretariat | t: +44 (0)20 7438 5453 | e: ncriconference@ncri.org.uk SECOND WORLD CONGRESS OF THE INTERNATIONAL ACADEMY OF ORAL ONCOLOGY (IAOO) ORAL ONCOLOGY IMAGINE THE FUTURE Toronto, Canada July 8–11, 2009 Following the success of its inaugural congress the International Academy of Oral Oncology is pleased to announce a Second CALL FOR PAPERS World Congress. The program will include keynote addresses, Contributions are invited by December 1, panel discussions, debates, instructional courses, oral papers 2008 on the following topics for oral and poster presentation at the Congress. and posters supported by a commercial exhibition, delegate Epidemiology and Health Economics receptions and a gala dinner. A half day workshop ‘Supportive Molecular Biology and Genetics Care: Prevention and Management of Complications of Cancer Diagnosis, Staging and Prognosis Therapy’ will follow the congress. Pathology Surgery KEYNOTE PRESENTERS Radiotherapy and Combined Treatments James S. Brown, UK Jens Overgaard, Denmark Chemotherapy, Immunotherapy, Alternative and Maura Gillison, USA Poul Erik Petersen, Switzerland Future Treatments David Jaffray, Canada Richard Reznick, Canada Reconstruction Merrill Kies, USA Dental Rehabilitation and Quality of Life Recurrences, Metastasis, Nursing and Terminal Care. Enquiries: Janet Seabrook. Tel: +44 1865 843691 Email jm.seabrook@elsevier.com For further information and to submit abstracts visit www.iaoo2009.com 30 Volume 3 Issue 2 • August/September 2008
  • 31. ANNOUNCEMENT The BTOG Small Cell 7th Annual BTOG Lung Cancer (SCLC) Meeting 2009 Study Day 2008 Date Dates Thursday 25th September Wednesday 28th January 2008 2009 to Venue Friday 30th January 2009 Education Centre, Christie Venue Hospital, Manchester Clontarf Castle Hotel, Clontarf, Dublin 3 • Multi-disciplinary • State of the art management of SCLC, • Wednesday BTOG Symposium SCLC clinical practice and research • Sponsored Satellite Meetings • Travel bursaries will be available Wednesday • CPD credits from the Royal College of • Sponsored Thursday & Friday Breakfast Physicians, London will be applied for Meetings • Sponsored by GSK Oncology • Thursday & Friday Annual Meeting • Further details and how to register are • Please visit the website, www.BTOG.org available on www.BTOG.org or from the for details secretariat British Thoracic Oncology Group (BTOG) is a lung cancer and mesothelioma research group. The principal aim of BTOG is to encourage the development of clinical and scientific research in all areas of Thoracic Oncology and the provision of a multi-disciplinary educational forum. All individuals involved in any aspect of lung cancer or mesothelioma research, treatment or care are eligible to become members of the Group. BTOG Secretariat Dawn Mckinley, Operational Manager, British Thoracic Oncology Group (BTOG) Hospital Management Offices, Glenfield Hospital, Leicester LE3 9QP England Tel: 00 44 116 2502811 • Fax: 00 44 116 2502810 Email: dawn.mckinley@uhl-tr.nhs.uk • www.BTOG.org
  • 32. Web Review Web Review is compiled by Heidi Sowter, who is a lecturer in Forensic and Biological Science at Derby University, where she continues to pursue her research interests in gynaecological and breast cancer. Heidi aims to Dr Heidi Sowter analyse, inform and encourage enhanced online activity and creativity Lecturer in Forensic Science and Biology within the oncology profession. Submit your comments, suggestions or Faculty of Education, Health and Science website details for review by email to: H.Sowter@oncologynews.biz University of Derby. http://www.ecancermedicalscience.com oday’s featured website is symposia and masterclasses run T ecancermedicalscience, founded by the European Institute of Oncology in in association with King's College London, and links to several Milan, the home of an independent speakers who discuss the online journal that (refreshingly) features currently available scientific open access cancer journals. Scientists evidence and expert clinical are able to submit articles online which opinion for the prevention, are then fully peer-reviewed before investigation and management being published immediately on of different cancers. acceptance. With Open Access The Key Advances educational publishing a reality and an urgent need programmes are webcast on for improved cancer communications, ecancermedicalscience and are ecancermedicalscience fits the 21st available to watch, free of century bill for a cancer journal. Their charge, at any time. Current vision is to create a free future; free to topics listed are Key Advances in publish, free to read and free to the Effective Management of comment. The articles section is easy to Thyroid and Head and Neck navigate, and papers are listed in various Cancer, and other educational ways (for example, research, conference initiatives will be forthcoming. reports, most viewed) to ease searching. You need to register to access Another way in which this website these services, although (being a stands out is by providing an ecancer.tv service, through which member myself), I can recommend the news email that keeps you can watch, amongst other things, live surgery, new imaging you up-to-date with latest developments. Thanks to online, techniques and interviews from their editorial board. An multimedia technology and a community poised to podcast and educational programme is also offered via a collaboration with blog, ecancermedicalscience offers a multimedia and the UK Key Advances in Clinical Practice Series. This is a series of multidisciplinary approach to cancer. ■ Read Oncology News free on-line You can read every issue free of charge by downloading from our Do you have an idea for an article? website: www.oncologynews.biz Are you organising an event, can we help with publicity? Simply register by sending an email to Would you like to review a book, perhaps you’re writing one? Register@oncologynews.biz or by visiting the website. Contact: Patricia McDonnell, Publisher We’ll notify you each time a new issue is uploaded to the website. Patricia@oncologynews.biz Come and see us... If you are planning to attend any of these meetings, please stop by and: 2008 • Meet the team ESMO September, Stockholm • Start your free subscription ESTRO September, Gothenburg • Give us feedback, comments and suggestions to improve the NCRI October, Birmingham magazine 2009 • Discuss a potential article or report • Learn how to advertise IAOO July, Toronto • Learn how to become a journal or book reviewer NCRI October, Birmingham We look forward to seeing you there! For further information contact Patricia on 0288 289 7023 or Patricia@oncologynews.biz 32 Volume 3 Issue 2 • August/September 2008
  • 33. Society News The ECCO-ESMO Collaboration: A Powerful Force in Combating Cancer ridging the bench to bedside gap and the widely B accepted approach of mulitdisciplinarity are pivotal in advancing research and improving patient treatment and care. The actual reality in the implementation and measurable outcomes of both ideals generally translates into palpable debate between professional specialties and communities. In the relentless battle to eliminate cancer much more can - and will - be done. The recently announced collaboration between ECCO – the European CanCer Organisation, and ESMO, the European Society for Medical Oncology, was happily received by the oncology community as a turning point in uniting forces, efforts and professionals across Europe. Alexander MM Eggermont and José Baselga. The win/win spin ECCO exists to both uphold the right of all European cancer patients to the best possible treatment and care and promote interaction between all organisations involved in cancer research, education, treatment and care. ESMO represents one of the most implicated specialties in such interaction since through all-encompassing comprehensive programmes of the medical oncology demands a scientific and academic base, a highest calibre. vision toward developing and evaluating novel treatment Setting the standard for congresses to come, the first ECCO- methodologies, and an involvement in total cancer care. ESMO Congress will take place in Berlin, Germany, 20-24 To deliver on multidisciplinarity and provide equal access to September 2009. quality care, neither ECCO nor ESMO can stand alone - a reality that has connected the two in unison. ESMO’s membership in An organised approach to oncopolicy ECCO represents a further step forward in shaping a united Efforts aimed at strengthening oncopolicy will only succeed by front – the convergence of specialty organisations that share standing united. Heterogeneity will fail. Cancer naturally poses the same determination to uphold a coherent, concise and a challenge in this respect since, unlike many other fields, it harmonised approach to tackling the second leading cause of incorporates a multiplicity of interrelated disciplines. The time death in Europe. to get organised is now. ESMO’s membership in ECCO will be crucial in road mapping A mass gathering of cancer science, treatment and the collective campaign to create awareness of patients’ needs technology and encourage progressive thinking in cancer policy, training One critical outcome of the ECCO-ESMO collaboration has been and education at the EU level. Never before has the oncology the paring of the two leading educational opportunities in community been better situated to improve care and research European oncology: ECCO and ESMO Congresses. By fusing interactivity across Europe. excellence and expertise, the joint ECCO and ESMO Multidisciplinary Congresses are set to draw record attendance Alexander MM Eggermont and José Baselga. We would like to publish information on other societies and associations in future issues of Oncology News. If you’d like your association considered for this feature please send details to Patricia@oncologynews.biz Volume 3 Issue 2 • August/September 2008 33
  • 34. News update Latest developments on products and services from the industry. To have your news included contact Grant Mackie on Grant@oncologynews.biz or Tel/Fax: +44 (0)288 289 7023. Elekta announce global launch of Virtual Clinic The Elekta Virtual Clinic was initially designed library which contains case-studies and as an Elekta internal training aid, however, treatment protocol papers. Elekta are now making this exciting platform Voice over commentary guides users available for general view. The clinic, available through various parts of the clinic and further via http://www.elekta.com/evc allows the user functionality and content, including a focus on to follow the course of treatment for a patient Elekta VMAT* are planned in the future. Elekta undergoing lung treatment, from initial are inviting all interested parties to visit consultation, treatment planning, radiation www.elekta.com where they can view or treatment all the way through to completion in download the entire clinic and leave feedback the MOSAIQ® patient management system. via 'Send a Comment'. Alternatively, it is possible to ‘fly over’ and treatment tools, such as Elekta Synergy®. Also For further information please contact zoom in to find out more about specific available is an auditorium to view movies and a Email: inquiries@elekta.com First Varian Trilogy in France unveiled by Health Minister Cancer patients in eastern France now have Bachelot praised the work of the Georges-François access to advanced image-guided radiotherapy Leclerc Cancer Center and reiterated radiotherapy's treatments with the arrival of the first Trilogy® status as a key weapon in the battle against cancer linear accelerator in the country. The treatment in France. machine has been unveiled by French health The Trilogy device is the hospital’s third Varian minister Roselyne Bachelot in a special linear accelerator. “The Trilogy enables us to carry inauguration ceremony. out very precise image-guided stereotactic Professor Philippe Maingon, head of radiation treatments in addition to our established program oncology at the Georges-François Leclerc Cancer of intensity-modulated radiotherapy (IMRT) Center in Dijon, said, “We were honoured that treatments,” said Professor Maingon. the health minister was able to attend our For further information contact: unveiling ceremony and acknowledge the vital Neil Madle, Varian Medical Systems, role of radiotherapy in treating cancer patients.” The health minister being given an overview of the Tel: +44 7786 526068, Carrying out the opening ceremony, Madame Trilogy by Professor Maingon. Email: neil.madle@varian.com BMI installs the UK’s First 128-slice adaptive CT scanner BMI, The London Independent Hospital, has standard, so a 128-slice adaptive scanner could installed the UK’s first SOMATOM Definition AS+ be considered platinum,” said Dr Charles CT scanner from Siemens. The system is one of the Blakeney, Consultant Radiologist at BMI London world’s first adaptive scanners that not only Independent Hospital. “With the SOMATOM provides exceptional image quality but is suited to Definition AS+ CT, we are able to offer the people any patient, from paediatric to bariatric, or any of East London access to one of the most clinical need. Without exclusions, the AS+ makes advanced CT scanners in the country. Patients can complex examinations routine. be assured that we are employing some of the The SOMATOM Definition AS+ is an expert in latest, fastest and safest CT technology to quickly cardiac imaging obtaining extremely fast coverage determine their best course of personalised with 128 slices per rotation. With a temporal treatment and care.” resolution of 150ms, images are free from For more information contact: Siemens, movement artefacts and show the finest Tel: +44 (0)1276 696000, Siemens’ SOMATOM Definition AS+ CT adapts to anatomical details. each patient to provide fast image acquisition, 4D Email: medmarketing.med.gb@siemens.com “Currently 64-slice CT scanners are the gold high quality scans and low radiation exposure. Web: http://www.siemens.co.uk/medical Varian products ordered by leading Danish cancer center One of Denmark’s leading cancer centers has placed an part of the Aarhus campus. order for three new treatment machines and nine Cai Grau, research professor at Aarhus University advanced RapidArc™ volumetric arc therapy systems from Hospital, says, “We are very much looking forward to the Varian Medical Systems, the world leader in radiotherapy. efficiency gains that RapidArc will bring, which will mean Aarhus University Hospital plans to have RapidArc installed we can treat more people with advanced techniques in less on all nine of its Clinac® linear accelerators. time. We have a roadmap for replacing all our older The order is the latest wave of a multi-year investment machines and introducing image-guided radiotherapy program by Aarhus University Hospital to consolidate all throughout the department, and this order means we are radiotherapy hardware and software in an integrated on course to achieve this goal.” system. Two of the additional treatment machines will be For further information contact: installed at a new radiotherapy center being constructed Neil Madle, Varian Medical Systems, alongside the general hospital in the town of Herning, Tel: +44 7786 526068, which is sixty miles from Aarhus but will effectively be a Email: neil.madle@varian.com 34 Volume 3 Issue 2 • August/September 2008
  • 35. Leksell Gamma Knife® Perfexion™ receives OIS adds skin cancer regulatory approval In Japan treatment system to The Japanese Ministry clinical documentation. portfolio for Health, Labour and Unlike other systems, Welfare, MHLW, has invoking compromises Oncology Imaging Systems Ltd. is introducing a given approval for in order to be able to new superficial radiotherapy system for the Leksell Gamma KnifeR treat the whole body, treatment of skin cancer this year, PerfexionT, which Leksell Gamma Knife is manufactured by TOPEX Inc. The TOPEX SRT Elelkta claim is the specifically designed to 100™ System has been specifically designed to world-leading clinical optimize treatment to meet the increasing number of skin cancer solution for non- the head and neck area - cases diagnosed each year, offering a superior invasive radiosurgical a fact appreciated by non-surgical treatment. treatments of tumors, neurosurgeons and The TOPEX SRT 100™ System is a compact, vascular malformations patients alike. mobile, productive and cost effective solution and other brain disorders. Elekta, the Launched by Elektain 2006 and now in clinical for the non-surgical treatment of skin cancer. international medical technology group and use in over 30 locations around the world, Elekta Created in consultation with the medical developer of Gamma KnifeR surgery, will now claim the Leksell Gamma Knife Perfexion community, this system has a footprint of just be able to deliver and install this advanced combines the proven precision of the 30” x 30” and a broad range of motion (both technology at new and existing customer sites in revolutionary Leksell Gamma Knife, with a horizontal and vertical) to allow the patient to Japan. dramatic increase in clinical reach to treat a be treated either sitting or lying down. The Gamma Knife surgery has become the world's wider range of targets faster and more efficiently reduction of set-up procedures, ease of use and most widely used radiosurgery treatment due to than ever before. reduced installation and operational costs, its extraordinary accuracy, reduction of excess For further information please contact provides maximum system up-time and greatly radiation dose to the body, extensive history and Email: inquiries@elekta.com improves a clinic’s productivity and scheduling, whilst providing all patients with a considerably better, broader and more efficient treatment method. Three Novalis Tx radiosurgery platforms ordered For more information on the TOPEX SRT 100™ System and all other patient by top Danish cancer hospital positioning and immobilisation devices, please Varian Medical Systems imaging system and the contact Oncology Imaging Systems Ltd, (NYSE: VAR) and BrainLAB Varian On-Board Imager® for Tel: 01825 744 063, Fax: 01825 749 557, AG are announcing that one precise patient positioning. Email: sales@oncologyimaging.com of Scandinavia’s leading Dr Svend Aage Engelholm, Web: www.oncologyimaging.com cancer centres has ordered chief radiation oncologist of three Novalis Tx™ the Department of Radiation radiosurgery platforms which Oncology at Copenhagen combine the most advanced University Hospital technologies from both (Rigshospitalet), stated that companies to offer superior Rigshospitalet has a long non-invasive radiosurgery for tradition of carrying out high- patients. precision radiotherapy Rigshospitalet in Copenhagen has ordered treatments and is one of the two leading two new Novalis Tx radiosurgery platforms and hospitals in Denmark for stereotactic the associated suite of accessories and will radiosurgery. The hospital was the first in upgrade an existing BrainLAB Novalis device to Scandinavia to introduce IMRT treatments and the more advanced new generation Novalis Tx. was also the region’s first hospital to offer All three machines will be equipped with Varian’s image-guided radiotherapy (IGRT) as a routine RapidArc™ radiotherapy technology for image- preferred treatment for a number of cancer guided, intensity-modulated radiotherapy (IMRT) indications. treatments, meaning seven treatment machines For further information contact: Neil Madle, at the hospital will have this new capability. They Varian Medical Systems, Tel: +44 7786 526068, will also include the BrainLAB ExacTrac® X-Ray 6D Email: neil.madle@varian.com Imran Khan opens Bradford’s new cancer research centre The University of Bradford’s Chancellor, Imran we’re in the business of anti-cancer drug Khan, recently opened its new Institute of discovery and we’re open for business.” Cancer Therapeutics (Thursday 17 July 2008). Research themes at the Institute include the To mark the event, Imran also announced a development of new molecules and describe new three-year student scholarship that will see a three broad stages of medicine development: researcher from his own Shaukat Khanum discovery, pre-clinical evaluation and clinical Memorial Hospital come to Bradford to do a PhD. application. Imran said: “This scholarship is vitally It costs over £3 million a year to fund the important. Pakistan has almost twice as many work of the Institute, supported mainly by people than here yet only one specialist cancer Yorkshire Cancer Research as well as grants hospital and research centre which is why such from research councils, Government and a partnership will be a great help to us.” industry. Director of the Institute of Cancer For more information about the Institute of Therapeutics, Professor Laurence Patterson, Chancellor, Imran Khan and Director of the Institute Cancer Therapeutics, visit: said: “This official opening will let people know of Cancer Therapeutics, Professor Laurence Patterson. Web: www.cancer.brad.ac.uk Volume 3 Issue 2 • August/September 2008 35
  • 36. ROCHE IN ONCOLOGY p p p ® trastuzumab p p Roche has been a world leader in Oncology Current products within the Roche Oncology for over 40 years, discovering, researching and portfolio include: MabThera® (rituximab), Xeloda® developing innovative treatments for cancer. Now (capecitabine), Herceptin® (trastuzumab), Bondronat® world number 1 in oncology, the Roche oncology (ibandronic acid), NeoRecormon® (epoetin beta), portfolio includes innovative targeted treatments for Avastin® (bevacizumab), Tarceva® (erlotinib). breast, colorectal, lung and haematological cancers, along with supportive care treatments for patients MabThera®, Xeloda®, Herceptin®, Bondronat®, NeoRecormon®, Avastin®, Tarceva® are registered trade marks. Legal Category: POM undergoing chemotherapy. Roche was the first company to introduce monoclonal antibodies in the treatment of cancer – novel drugs which, unlike chemotherapy target the cancer cells directly. Full prescribing information available on request. Information about adverse event reporting can be found at Roche Products Ltd, Hexagon Place, yellowcard.gov.uk. Adverse events shoud also be reported to 6 Falcon Way, Shire Park, Roche Products Limited. Please contact UK Drug Safety Centre Welwyn Garden City, Herts Al7 1TW on: 01707 367554 J999119A, August 07