NCI Cancer Bulletin: A Trusted Source for Cancer Research NewsNCI Cancer Bulletin: A Trusted Source for Cancer Research News
June 14, 2005 • Volume 2 / Number 24 E-Mail This Document  |  Download PDF  |  Bulletin Archive/Search  |  Subscribe

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Prostate Surgery Outcomes Found To Be Better Than Watchful Waiting

Overall, long-term survival rates for men who underwent radical prostatectomy for prostate cancer were superior to survival rates among prostate cancer patients who engaged in "watchful waiting," according to a study published in the May 12 New England Journal of Medicine.

After a median of 8.2 years follow-up of 695 men, 10-year estimates show the surgery to be superior in all endpoints investigated, according to researchers led by Dr. Anna Bill-Axelson of Sweden's Uppsala University Hospital. Within the two study arms, the difference in overall survival was significant: 106 of the 348 men in the watchful waiting arm died of all causes, compared with 83 of the 347 men in the surgery arm, the researchers report.

In addition, among the surgery group, death due to prostate cancer was reduced by 44 percent compared with the watchful waiting group. Similarly, in the surgery group, the risk of distant metastasis decreased by 40 percent and the risk of local progression decreased by 67 percent. Preliminary data reported in 2002 indicated advantages for the surgical group. The authors predict "that the benefits of this surgery will increase during longer periods of follow-up."

The men in the study were newly diagnosed with prostate cancer between 1989 and 1999. Their tumors were generally more advanced than would be found in men newly diagnosed in the United States, where watchful waiting is more often recommended.

Bone Pain and Radiation: 1 Dose Equals 10

A single dose of radiation alleviates bone pain as well as 10 multiple doses over 2 weeks, with fewer adverse effects, concludes a study in the June 1 Journal of the National Cancer Institute.

Many patients with breast, prostate, lung, and other solid tumors develop metastases in the bones of the pelvis, spine, or extremities, which can cause excruciating pain. For decades, many of these patients have received a standard radiation regimen: a 3-gray dose of radiation is delivered to the painful bones in 10 treatment sessions over 2 weeks. Some 50 to 80 percent of patients report significant pain reduction with this regimen.

To help resolve a long-running debate over the time- and cost-effectiveness of this regimen, Dr. William Hartsell and colleagues at the Lutheran General Cancer Care Center in Park Ridge, Ill., recruited 900 patients with breast or prostate cancer and 1 to 3 sites of painful bone metastases. Half received the standard 10-day regimen while the other half received a single 8-gray dose.

Three months after treatment, two-thirds of patients in each group reported significant pain relief, including 15 percent in the single-dose group and 18 percent in the 10-dose group that reported complete pain relief. A third of the patients in each group no longer required narcotics. While the single-dose group returned for retreatment more often, they reported fewer adverse side effects such as nausea.

The work of Dr. Hartsell and colleagues parallels findings from two recent large trials, the Dutch Bone Metastasis Study and the Bone Pain Trial Working Party Study.

While the 10-session schedule is most common in the United States, radiologists in Great Britain are inclined to use the single 8-gray regimen, write Drs. Lisa Kachnic and Lawrence Berk in an accompanying editorial. They encouraged U.S. radiologists to adopt the single-session regimen.

Working Groups Discuss Graft-Versus-Host Disease

Researchers studying chronic graft-versus-host disease (GvHD) met on June 6 in Bethesda, Md., to share information and recommendations related to developing future clinical trials for the disease.

The meeting, co-chaired by Dr. Steven Pavletic of NCI's Center for Cancer Research and Dr. Georgia Vogelsang of the Johns Hopkins School of Medicine, marked the first anniversary of the NIH Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-Versus-Host Disease. The project aims to develop definitions and tools for conducting clinical trials, outline standards of clinical care, and guide future research.

At the meeting, six working groups reported findings from investigations into the design of clinical trials, diagnosis and staging, biomarkers, histopathology, response criteria, and ancillary therapy and supportive care. One of the main topics of discussion was the critical need to establish a common language for communicating about chronic GvHD and to develop standards for diagnosing and evaluating the disease in patients.

GvHD is a devastating disease that can occur following bone marrow transplantation if the donor's immune cells in the transplanted marrow mount an attack against the patient's tissues and vital organs. About 6,000 cancer patients in the United States are treated by allogeneic hematopoietic stem cells each year, and chronic GvHD is reported in about half of them.

The project is scheduled to publish the final findings and recommendation of the working groups starting in the fall. "In just 1 year we have laid the foundation for a new cycle of research in chronic GvHD," said Dr. Pavletic at the meeting.

Pooled Data Suggest that Alcohol Reduces Risk of non-Hodgkins Lymphoma

By pooling the original results of 9 studies involving more than 15,000 people, researchers found that participants who drank alcohol had a lower risk of developing non-Hodgkins lymphoma (NHL) compared with nondrinkers.

The overall reduction in risk was modest - about 25 percent - for current drinkers, and the source of the reduced risk is not yet clear, the researchers say. It might be due to drinking alcohol or it might be due to other lifestyle factors that distinguish drinkers from nondrinkers.

"We found a slight and consistent lower risk in current drinkers and in people who recently quit, regardless of the type of alcohol or the amount they consumed," says Dr. Lindsay Morton, a research follow in NCI's Division of Cancer Epidemiology and Genetics (DCEG) and first author of the paper.

For unknown reasons, the greatest reduction in risk was associated with Burkitt's lymphoma, one of the many NHL subtypes that involve lymph cells.

The study, published online in the June 7 Lancet Oncology, is the second in a planned series by the International Lymphoma Epidemiology Consortium (InterLymph), which includes researchers in the United States, Europe, Canada, Australia, and Asia. Future studies will follow drinkers and nondrinkers prospectively to determine whether the result is actually a biological effect of consuming ethanol. They may also focus on genetic variants associated with the metabolism of alcohol.

"We would have an important clue about the biology of the disease if we can show that drinking alcohol is found to lower the risk of NHL," says Dr. Patricia Hartge of DCEG, the study's senior author. "The current results have no implications for people's drinking habits."

eHealth Conference Discusses Research and Evaluation Issues

At last week's "Critical Issues in eHealth Research" conference in Bethesda, Md., more than 400 participants discussed the latest behavioral research concerning the use and impact of the Internet and other new communication technologies. The 2-day conference convened government scientists, academic researchers from a variety of disciplines, survey research scientists and practitioners from the private and public sectors, and students to discuss the state of the science of eHealth research theory, design, methodology, ethics, and evaluation.

Organizers of the meeting hope to jump-start a move toward scientific coherence, said Dr. Robert Croyle, director of NCI's Division of Cancer Control and Population Sciences. "Research on the basic methods and processes that underlie communication and information processing - cognition, decision making, how to utilize the technology - is scattered across 400-odd different journals, fields, and departments, where excellent science has been done. But we think it's time to assemble the theory and methodology underlying the field." Looking for efficiencies and synergy, the National Institutes of Health (NIH) wants to help organize the field to "build on the strength of the foundational, empirical research on strategies and methodology to inform our applications and interventions," Dr. Croyle said.

The conference was sponsored by NCI, the National Institute of Mental Health, the National Institute on Drug Abuse, the National Library of Medicine, the Office of Behavioral and Social Sciences Research of the Department of Health and Human Services, the Office of Disease Prevention of NIH, and the Health e-Technologies Initiative of the Robert Wood Johnson Foundation.