Early transplants are no better than chemotherapy followed by transplant for non-Hodgkin lymphoma patients, study finds

ScienceDaily (June 3, 2011) — Patients with a very aggressive form of non-Hodgkin lymphoma who receive a stem cell transplant after standard chemotherapy during their first remission have comparable survival rates to those who receive the same standard therapy alone and, if needed, a transplant when they relapse.

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These findings from a U.S. and Canadian clinical trial of 370 patients conducted at 40 clinical institutions were presented by Patrick Stiff, MD, lead investigator and director, Loyola Cardinal Bernardin Cancer Center, at the annual meeting for the American Society of Clinical Oncology (ASCO).

"The trial was based on several preliminary studies that indicated a survival benefit to early stem cell transplants," Dr. Stiff said. "These findings may save some patients from undergoing a stem cell transplant unnecessarily."

However, a subset with all of the possible poor risk factors with this form of non-Hodgkin lymphoma did seem to have a higher chance of survival in a sub- analysis.

"Additional research is necessary to determine the best plan of care for the highest-risk patients," Dr. Stiff said. "In the meantime, these patients will have to consult with their physician to carefully determine their treatment plan."

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Simple test could hold key to early diagnosis of cancers

ScienceDaily (June 10, 2011) — Cancers of the gut, stomach and pancreas could be detected much sooner with a simple urine test, research suggests. Researchers at the University of Edinburgh have identified key proteins in the urine of patients with advanced cancers.

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The findings could help the detection of these cancers in people who have not yet started to show symptoms of the disease.

This would enable patients to be diagnosed much earlier, leading to improved survival rates.

Only around 10 per cent of patients with these cancers -- known as cancers of the upper gastrointestinal tract -- are still alive five years after diagnosis.

This is because such cancers, which tend to be aggressive, are often diagnosed at an advanced stage.

Dr Holger Husi, of the University of Edinburgh's Tissue Injury and Repair Group, said: "The aim of this work is to enable these cancers to be diagnosed much earlier. This would help us to treat the cancer before it has a chance to spread. The majority of these cancers are currently diagnosed late where no surgery is possible due to its advanced stage. Earlier diagnosis would mean that curative surgery or chemotherapy would be possible for more patients."

The research, published in the journal Proteomics-Clinical Applications, compared urine samples from patients with upper gastrointestinal cancers with urine samples from people who were cancer-free.

Scientists analysed the samples to identify thousands of proteins. They then identified six particular proteins, which were present in 98 per cent of the cancer cases but absent in almost 90 per cent of samples from patients without cancer.

The researchers then narrowed molecules down to the two proteins -- S100A6 and S1009 -- most likely to appear in samples from patients with cancer but be absent from the other samples.

The scientists now intend to see whether people with early stage cancers, which have not yet been diagnosed, have the same levels of proteins present.

This would involve analysing samples from at least 1,000 volunteers and tracking the participants over a number of years to identify those who are then later diagnosed with upper gastrointestinal cancers.

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Emerging trends in radiation therapy for women over 70 with early stage breast cancer

ScienceDaily (June 2, 2011) — Patterns of radiation usage in breast conserving therapy for women 70 years and older with stage I breast cancer are changing: more women are opting for radioactive implants and those with estrogen positive tumors are opting out of radiation therapy, according to an abstract being presented at the American Society of Clinical Oncology annual meeting in Chicago by Thomas Jefferson University Hospital researchers.

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In another abstract, the researchers report that women with estrogen negative tumors were 91 percent more likely to die from breast cancer if they did not receive radiation therapy after a lumpectomy.

Given the relatively recent developments in radiation therapy (i.e., an increased use of brachytherapy and external beams) and data supporting the idea that radiation isn't necessary for women with estrogen positive tumors, researchers wanted to see how actual practice patterns were impacted.

Researchers found that there was a modest increase in the percentage of women with estrogen receptor positive cancers who did not get radiation therapy starting around 2004, and increasing use of radioactive implants, such the MammoSite, Contura, Savi or similar devices, since 2002.

There was also a corresponding drop in women who received external beam radiation, according to Xinglei Shen, M.D., a resident in the Department of Radiation Oncology at Thomas Jefferson University Hospital. "Among women with estrogen receptor negative cancers, there was not the same increase in frequency of women who did not get radiation, but there was an increased use of radioactive implants," he said.

The consequence of those findings was determining what impact omitting radiation has on survival. While there is data that the omission of radiation therapy in women with estrogen receptor positive tumors who receive endocrine therapy, such as Tamoxifen, is not associated with a survival difference, limited data exists for estrogen receptor negative tumors in older women who undergo breast conservation.

"From the randomized trial data, we know that women with estrogen receptor positive stage I breast cancer have no detriment to survival by avoiding radiation, as long as they took Tamoxifen," Dr. Shen said. "However, it is unknown if this would be the case in women with estrogen receptor negative cancer."

Dr. Shen worked with Jefferson Medical College student Andrzej Wojcieszynski to examine survival in these women, and found that they were 91 percent more likely to die from breast cancer if they did not receive radiation therapy after a lumpectomy. (Abstract #1037).

"We have to be cautious when interpreting survival data from the SEER because of potential confounding variables, such as the health of the patients and use of chemotherapy," Dr. Shen said. "However, these data do raise hypotheses for future study."

"Our conclusion is that adjuvant radiation therapy after lumpectomy reduces breast cancer mortality in women over 70 with stage I, estrogen receptor negative breast cancers, and that radiation is currently underutilized in these women," said Wojcieszynski.

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Important step towards early detection of breast cancer

ScienceDaily (May 18, 2011) — European researchers have developed a clinical PET system with the highest resolution and sensitivity in the market, specifically dedicated to breast cancer detection in early stages. The MAMMI (MAMmography with Molecular Imaging) device will allow doctors to start treatments one or even two years earlier than usual and also evaluate the patient's response to chemotherapy.

See Also:Health & MedicineBreast CancerCancerMedical ImagingColon CancerLung CancerWomen's HealthReferenceMammographyBreast cancerMetastasisNuclear medicine

Coordinated by José María Benlloch, researcher of the Spanish National Research Council (CSIC) and co-director of the Institute for Molecular Imaging Instrumentation (I3M), the MAMMI Project was created by a multidisciplinary team of eight European research institutions and companies, ranging from medical oncology and pharmacokinetics research to molecular imaging instrumentation, advanced image processing software and integrated electronics circuit design.

The device is currently installed in the National Cancer Institute in Amsterdam (Netherlands) and was previously set up at the clinic of the Technical University of Munich (Germany), where they have completed the clinical research and examined over fifty patients. The new system will shortly be installed in the Provincial Hospital of Castellón (Spain) and other international hospitals have shown their interest in purchasing it.

The most striking novelty of the mammogram is the way it captures the image. The patient lies face down on a special table, and enters a breast in one of the openings. Beside the stretcher, the specialist positions a trolley that incorporates the detection system based on a gamma ray sensor.

The picture is taken without compressing the breast thanks to the ring shape of the detector that surrounds the pendant breast. According to Dr Benlloch: "This significantly improves the visualisation and diagnosis because sometimes there are tumours that are very close to the base of the pectoral muscle."

This new mammogram also provides greater patient comfort. In this sense, the Biomechanics Institute of Valencia (IBV) assessed the company ONCOVISION in the design, manufacturing, and mechanical tests of the stretcher, and applied user-friendly design methodologies and ergonomic criteria. For example, lifting columns were added to the table to facilitate its use by the elderly and disabled.

The PET system

The other major innovation is the technique used. The traditional mammogram is an x-ray of mammary glands. MAMMI, however, is based on the PET technique (Positron Emission Tomography) for the diagnosis of breast cancer, which offers numerous advantages.

In the first stages of a cancer, the malignant cells replicate in an uncontrolled way and, after one to two years, cause a lesion that is visible with the current techniques. After that, the lesion extends and takes about another year until it can be felt.

While current diagnostic equipment is based on morphological images and does not recognize the cancer until there is a lesion, the MAMMI PET measures the metabolic activity of the tumour by locating the high glucose uptake of the cancer cells. This allows the specialist to detect the disease much earlier and numerous studies have confirmed that early detection reduces mortality by 29%.

Until now, whole-body PET scans were indicated for breast cancer patients or for people with a high risk of suffering the disease. However, the result is a low resolution image and therefore does not detect small tumours. "Our device, however, is devoted exclusively to breasts so the detectors are very close to this part of the body and show tumours in early stages," explains Luis Caballero, head of the project in ONCOVISION.

In comparison, MAMMI can see lesions as little as 1.5 mm, while the best of the systems that currently exist offers a resolution of 5 mm. The system generally improves the diagnosis of all patients, but it is especially effective for women with breast implants or young women whose breast density has always made obtaining a clear image difficult.

Assessment in later stages

The mammography device marketed by the Valencian company can also monitor whether the treatment the patient with breast cancer is following actually works. According to Dr Caballero: "By showing the uptake of glucose, the PET technique is the only one able to reveal whether there are still cancer tissues after an operation, since with the other techniques it is impossible to distinguish tumour tissue from the scar left by the operation."

Also, the PET reveals whether the therapies of radiation and chemotherapy are effective or need to be modified. As MAMMI is a more precise PET instrument, it ensures a better assessment of tumour activity and its response to therapy.

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