Reviews & Analysis

Survival rates for patients with gastric cancer in Japan are considerably higher than reported for US patients. Surgery for gastric cancer is the mainstay of treatment, but the extent of regional lymphadenectomy is under considerable debate. Roukos and Kappas provide insights explaining the reasons for differences in treatment decisions between the US and Japan. The latest data from recent trials are discussed together with neoadjuvant treatment options, which could improve clinical outcomes.

Hodgkin's lymphoma has become a curable disease successfully treated using dose-escalated BEACOPP chemotherapy regimens pioneered by the German Hodgkin's Lymphoma Study Group. However, the unacceptable side effects of chemotherapy have propagated new therapeutic concepts based on biological characteristics of the disease to be explored. This viewpoint discusses the promises and pitfalls of targeted therapy.

The combination of transurethral resection of the bladder tumor (TURBT), chemotherapy, and radiotherapy in selected patients with bladder cancer may result in survival rates comparable to the best cystectomy series, while preserving bladder function. This Viewpoint article discusses the role radiotherapy plays in this approach.

The use of prognostic and predictive factors for the treatment of breast cancer patients has both advantages and limitations when applied to the interpretation of microarray data in the clinical setting. This review focuses on the critical aspects of genomic parameters and how the information gleaned from microarray analysis can be used to enhance clinical therapy.

Radical surgical treatment for breast cancer has become superseded by breast conserving surgery with protracted whole breast irradiation. The last decade has seen the emergence of a new treatment paradigm for early breast cancer in the form of partial breast treatment with conservative surgery and accelerated partial breast irradiation. Survival, cosmetic, and cost implications are comprehensively discussed.

Intensity-modulated radiation therapy (IMRT) is a new technical advance in radiotherapy that delivers high dose of radiation to the tumor, while reducing the dose to adjacent non-target tissue, thereby sparing critical organs. This technique is especially attractive for treating head and neck cancers, and this review critically discusses the advantages of this targeted therapy.

Treating cancer patients who have type II diabetes is a challenge, especially as cardiac, renal, and neurologic complications need to be considered. This review discusses the evidence from population-based studies and clinical trials, and suggests how improvements in cancer outcomes can be achieved by improved diabetes control.

In the treatment of rectal cancer, the additional use of radiotherapy has changed treatment policy dramatically. Compelling data showed that preoperative radiotherapy, in addition to surgery for resectable rectal cancer, is superior to postoperative treatment. Considering evidence-based data, it is hard to understand why preoperative radiotherapy has not been accepted in the US.

In 1990, an NIH Consensus Conference recommended postoperative chemoradiotherapy as standard treatment for stage II and III rectal cancer. Many European centers and even some countries have adopted the US recommendations as standard care. In other parts of Europe, however, the jury is still out, as discussed in this Viewpoint.

Advances in imaging and computing technology have improved the targeting of tumor tissue using conventional X-ray therapy, especially for the treatment of childhood brain tumors. Proton radiotherapy allows better sparing of normal tissues than the most conformal photon radiation. The characteristics of this technology and examples of who would benefit most from this treatment are discussed.

Untangling the complex pathways underlying the major cancer phenotypes remains a significant challenge, but deregulated expression of a single multi-component enzyme, telomerase, is implicated as a causative factor for immortalization in the vast majority of human tumors. This review highlights the potential of telomerase as a target for novel cancer gene therapies.

High-throughput technologies have been developed in hopes of increasing the pace of biomedical research, accelerating the rate of translation from bench to bedside. Using such technology in target discovery has necessitated validation of the targets in an equally rapid manner. This review looks at the role of tissue microarrays in validating potential tumor biomarkers, now and in the future.

Among the most intensely studied new agents are the epidermal growth factor receptor (EGFR) inhibitors. This review focuses on how radiosensitization of tumors by EGFR inhibitors may be mediated, with reference to cell proliferation, survival, angiogenesis, and DNA repair. Defining the signals involved in radiosensitization could potentially predicting response and guide approaches to combine further novel regimens.

Gene-expression profiles are now being used as classifiers of patients' prognosis and response to therapy but the development of classifiers is subject to many pitfalls. This Viewpoint discusses ways to improve development, stressing the importance of internal and external validation.

A 48-year-old man presented to his GP with an indolent swelling in his left axillary region. He had also increasingly suffered from night-time sweating and fever. Physical examination and an ultrasound revealed an enlarged lymph node in the left axillary region. The patient was diagnosed with Hodgkin's lymphoma and treated with chemotherapy and involved-field radiotherapy.

Non-small-cell lung cancer is the leading cause of cancer death in the US despite advances in therapy. The epidermal-growth-factor receptor has been investigated as a target for therapy using EGFR-specific tyrosine kinase inhibitors. This Viewpoint discusses the implications of the correlation of positive responses seen in patients harboringEGFRmutations.

The molecular revolution has paved the way for the development of diagnostic technologies and predictors of response to treatment. This review describes how gene expression profiling using DNA microarrays are emerging as diagnostic tool, and advances in the application of gene expression profiling can help predict response to chemotherapy in breast cancer.

Survivors of childhood cancers are at an increased risk of adverse heath outcomes. Large-scale studies of mortality of cancer survivors beyond 5 years demonstrate that the majority of deaths are caused by recurrent tumors, second malignant neoplasms, cardiac and pulmonary deaths. This comprehensive review quantifies progress achieved in childhood cancer as well as the long term-side-effects of therapies.

Vascular endothelial growth factor (VEFG) stimulates tumor-associated angiogenesis, thereby making it a prime target for the development of anti-VEGF compounds. One such anti-VEGF drug, bevacizumab, has improved survival rates in some cancer trials. The key clinical trial data and reasons for some of the contrasting results seen in different patient studies are discussed.