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Voice box preservation and laryngeal cancer
Newsdesk Voice box preservation and laryngeal cancer know that cisplatin can enhance the effectiveness of radiation and, given simultaneously, destroy more tumour cells”, says Forastiere.
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Something to shout about.
Although the toxicity of the two treatment types was similar, patients receiving concurrent cisplatin and radiotherapy had almost twice as much mucosal toxicity during radiotherapy compared with patients receiving induction treatment or radiotherapy alone. 23% of patients who underwent concurrent treatment reported swallowing problems 1 year after completing treatment compared with just 9% of patients who received cisplatin
© Robert Harding Picture Library
In 1991, a landmark study established induction chemotherapy followed by radiotherapy as the standard alternative to total laryngectomy for treating laryngeal cancer (N Engl J Med 1991: 324: 1685–90). Now, a national US-based trial has found that cisplatin chemotherapy given simultaneously with radiation successfully preserves the voice box of more patients with advanced laryngeal cancer than induction chemotherapy followed by radiotherapy or radiotherapy alone. Overall survival at 2 and 5 years for both types of treatment was equivalent but patients who received concurrent therapy showed an absolute reduction in the need for laryngectomy (43%), and had better locoregional control; setting a new treatment standard for patients with previously untreated stage III or IV carcinoma of the larynx (N Engl J Med 2003; 349: 2091–98). In the new study, Arlene Forastiere (Johns Hopkins University, MD, USA) and colleagues assessed the contribution of chemotherapy to the overall efficacy of nonsurgical treatment, as well as examining the sequencing of chemotherapy and radiotherapy. “We
followed by radiotherapy. These differences, however, stabilised after 2 years with both groups experiencing similar long-term side-effects. The authors conclude that because toxicity resulting from sequential therapy was substantially more debilitating than from radiotherapy alone and did not improve laryngeal preservation, locoregional control, or locoregional survival, patients wishing to preserve their larynx who cannot undergo concurrent treatment should opt for radiotherapy alone. Everett Vokes (University of Chicago, IL, USA) points out that while the concurrent therapy group had better local and systemic control, the survival was equivalent to the other groups, and adds: “Prevention of second cancers and preventive cardiovascular care will be important for improving survival. This study consolidates the evidence that surgery should no longer be the first treatment option for most patients with laryngeal cancer and confirms concomitant chemoradiotherapy as the most successful model of combined-modality therapy”. Kathleen Nelson
Unique B cells cause multiple myeloma Researchers have identified cells that may be responsible for the origin and maintenance of multiple myeloma (Blood, published online Nov 20, 2003; DOI: 10.1182/blood-2003-093064). The majority of cancer cells in multiple myeloma are similar to normal plasma cells. Plasma cells are terminally differentiated, ie, they are so mature that they have lost the ability to divide. Therefore, until now, it has been unclear whether neoplastic plasma cells actually have an ability to divide and proliferate. “Our research demonstrates that these cells are similar to their normal counterparts in that they have a limited capacity to divide”, explains lead author William Matsui (Johns Hopkins University, MD, USA). The researchers found that highly
THE LANCET Oncology Vol 5 January 2004
clonogenic multiple myeloma cells express CD20 and surface immunoglobulin but lack CD138 expression— a characterisitc feature of normal plasma cells. Plasma cells are normally made from a less mature type of cell, such as the B cell. However, the researchers found that there are types of B cells in patients with multiple myeloma that have the ability to divide, and that these cells are the most likely source of new tumour-cell production. “If we want to design therapies that can stop the production of new myeloma cells, we should focus our attention on these [types of] B cells rather than the plasma cells”, comments Matsui. They also found that the antiCD20 monoclonal antibody, rituximab, inhibited the growth of
clonogenic multiple myeloma cells in vitro. Matsui said that the work of his team adds to a growing body of literature that suggests all cancers may be made up of different cell types, just like B cells and plasma cells in mutliple myeloma. Their research also suggests that there may be “tumour stem-cells”, which appear less mature and rarer in number than the cells that make up the majority of the tumour but are responsible for the production of all other tumour cells. Matsui’s group are now in the process of studying these stem cells to find ways in which their ability to divide could be stopped. “We are also trying to find out whether these cells display specific properties that will help find tumour stem-cells in other types of cancer”, Matsui concludes. Khabir Ahmad
http://oncology.thelancet.com
For personal use. Only reproduce with permission from The Lancet.
3
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Something to shout about.
Although the toxicity of the two treatment types was similar, patients receiving concurrent cisplatin and radiotherapy had almost twice as much mucosal toxicity during radiotherapy compared with patients receiving induction treatment or radiotherapy alone. 23% of patients who underwent concurrent treatment reported swallowing problems 1 year after completing treatment compared with just 9% of patients who received cisplatin
© Robert Harding Picture Library
In 1991, a landmark study established induction chemotherapy followed by radiotherapy as the standard alternative to total laryngectomy for treating laryngeal cancer (N Engl J Med 1991: 324: 1685–90). Now, a national US-based trial has found that cisplatin chemotherapy given simultaneously with radiation successfully preserves the voice box of more patients with advanced laryngeal cancer than induction chemotherapy followed by radiotherapy or radiotherapy alone. Overall survival at 2 and 5 years for both types of treatment was equivalent but patients who received concurrent therapy showed an absolute reduction in the need for laryngectomy (43%), and had better locoregional control; setting a new treatment standard for patients with previously untreated stage III or IV carcinoma of the larynx (N Engl J Med 2003; 349: 2091–98). In the new study, Arlene Forastiere (Johns Hopkins University, MD, USA) and colleagues assessed the contribution of chemotherapy to the overall efficacy of nonsurgical treatment, as well as examining the sequencing of chemotherapy and radiotherapy. “We
followed by radiotherapy. These differences, however, stabilised after 2 years with both groups experiencing similar long-term side-effects. The authors conclude that because toxicity resulting from sequential therapy was substantially more debilitating than from radiotherapy alone and did not improve laryngeal preservation, locoregional control, or locoregional survival, patients wishing to preserve their larynx who cannot undergo concurrent treatment should opt for radiotherapy alone. Everett Vokes (University of Chicago, IL, USA) points out that while the concurrent therapy group had better local and systemic control, the survival was equivalent to the other groups, and adds: “Prevention of second cancers and preventive cardiovascular care will be important for improving survival. This study consolidates the evidence that surgery should no longer be the first treatment option for most patients with laryngeal cancer and confirms concomitant chemoradiotherapy as the most successful model of combined-modality therapy”. Kathleen Nelson
Unique B cells cause multiple myeloma Researchers have identified cells that may be responsible for the origin and maintenance of multiple myeloma (Blood, published online Nov 20, 2003; DOI: 10.1182/blood-2003-093064). The majority of cancer cells in multiple myeloma are similar to normal plasma cells. Plasma cells are terminally differentiated, ie, they are so mature that they have lost the ability to divide. Therefore, until now, it has been unclear whether neoplastic plasma cells actually have an ability to divide and proliferate. “Our research demonstrates that these cells are similar to their normal counterparts in that they have a limited capacity to divide”, explains lead author William Matsui (Johns Hopkins University, MD, USA). The researchers found that highly
THE LANCET Oncology Vol 5 January 2004
clonogenic multiple myeloma cells express CD20 and surface immunoglobulin but lack CD138 expression— a characterisitc feature of normal plasma cells. Plasma cells are normally made from a less mature type of cell, such as the B cell. However, the researchers found that there are types of B cells in patients with multiple myeloma that have the ability to divide, and that these cells are the most likely source of new tumour-cell production. “If we want to design therapies that can stop the production of new myeloma cells, we should focus our attention on these [types of] B cells rather than the plasma cells”, comments Matsui. They also found that the antiCD20 monoclonal antibody, rituximab, inhibited the growth of
clonogenic multiple myeloma cells in vitro. Matsui said that the work of his team adds to a growing body of literature that suggests all cancers may be made up of different cell types, just like B cells and plasma cells in mutliple myeloma. Their research also suggests that there may be “tumour stem-cells”, which appear less mature and rarer in number than the cells that make up the majority of the tumour but are responsible for the production of all other tumour cells. Matsui’s group are now in the process of studying these stem cells to find ways in which their ability to divide could be stopped. “We are also trying to find out whether these cells display specific properties that will help find tumour stem-cells in other types of cancer”, Matsui concludes. Khabir Ahmad
http://oncology.thelancet.com
For personal use. Only reproduce with permission from The Lancet.
3