â–º United Kingdom Rapid Versus Standard Induction Chemotherapy for Children With Stage 4 Neuroblastoma
Chemotherapeutic treatment for high-risk neuroblastoma generally consists of induction treatments separated by 21-day intervals. Physicians from the U.K. Children’s Cancer and Leukaemia Group sought to determine whether the use of more aggressive protocol would result in better event-free survival in patients older than 12 months.
Twenty-nine centers enrolled 262 children (median age, 2.95 yr) with stage 4 tumors over 10 years. Once enrolled, the patients were randomized to receive higher-dose treatment every 10 days (utilizing cisplatin, vincristine, carboplatin, etoposide, and cyclophosphamide or standard treatment with vincristine, carboplatin, etoposide, and cyclophosphamide. The intended total doses of each drug, except vincristine, were the same. Rapid treatment had a dose intensity that was 1.8-fold higher than that of standard treatment.
Surgical tumor resection was attempted in patients who responded to therapy, followed by myeloablation and hemopoietic stem-cell rescue.
Although chemotherapeutic doses were not recorded in all patients, 67% of those in the study group whose doses were recorded received at least 90% of the scheduled dose, compared with 79% in the standard therapy group (but with a relative dose intensity of 94% higher than in the standard therapy group). In terms of event-free survival, the Figure illustrates the differences between the groups. The greatest advantage for the rapid-dosing group came at the 5-year mark, with a 66% difference in survivals. The difference at 10 years was still 49% higher in the rapid-dosing group, but this did not reach statistical significance.
There was no difference in overall survival, according to the investigators. Importantly, myeloablation was provided a median 55 days earlier in the rapid-dosing group compared with the standard care group, which might contribute to an improved outcome.
Pearson AD, Pinkerton CR, Lewis IJ, et al:High-dose rapid and standard induction chemotherapy for patients aged over 1 year with stage 4 neuroblastoma: A randomized trial. Lancet Oncol 2008;9:247-256.
Does HPV Remain in Situ After Treatment of Precancerous Lesions?
Human papillomavirus (HPV) is recognized as the primary cause of cervical cancer. With the availability of the HPV vaccine, many experts believe that the incidence of cervical cancer will decrease. However, if patients who did not have the vaccine develop precancerous lesions that are actively treated, do HPV remain after treatment, thus threatening a new cycle of lesion development?
Researchers from the International Center for Reproductive Health, Ghent University, Belgium, attempted to answer this question by studying 122 women who had tested positive for HPV and had cervical intraepithelial neoplasia (CIN)-1 or -2/-3 lesions. Of those with CIN-1 lesions, 55 were treated with cryotherapy and electrosurgical excision. Sixty-seven women with CIN-2/3 lesions were treated similarly. During the follow-up, the women underwent DNA testing, biopsy, and cytology, if needed.
The researchers found that HPV levels dropped considerably just after either type of treatment, although those receiving surgical excision attained a lower HPV concentration. As time passed, any differences in HPV levels diminished. After two years, 17.7% of women in the cryotherapy group were found to have any HPV DNA present compared with 8.4% in the electrosurgical excision group.
The investigators concluded that either cryotherapy or electrosurgical excision resulted in high clearance of HPV at least two years after the procedures.
Aerssens A, Claeys P, Garcia A, et al: Natural history and clearance of HPV after treatment of precancerous cervical lesions. Histopathology 2008; 52:381-386.
â–º France / Japan
Turning Up the Heat on Lung Tumors
The use of temperature extremes seems like a fertile area of cancer therapy. Cryotherapy, or freezing prostate tumors, has received a good deal of press in the national media. This procedure has also shown promising results in kidney cancer. On the other side of the spectrum, perhaps less is known about the utility of using thermal energy to kill tumors. A new study from France was presented at the meeting of the Society of Interventional Radiology in March, that explored the possibility of using radiofrequency ablation to treat advanced lung cancers that are not resectable.
Two hundred forty-four patients (60% men, 40% women) with either lung metastases or with non–small cell lung cancer enrolled in the study. Using radiofrequency ablation guided by computed tomography, 88% of those undergoing the procedure were alive after 12 months and 70% after 24 months of follow-up, yielding survivals similar to those who are able to undergo surgery.