Combined-modality therapy for rectal carcinoma - the time has come

Article Abstract:

After decades of very little progress in the treatment of colorectal cancer, dramatic improvements in diagnosis and treatment are finally occurring. A series of well-designed trials of adjuvant treatment with a combination of radiation and chemotherapy, one of which is described in the March 14, 1991 issue of The New England Journal of Medicine by James E. Krook and his colleagues, have helped immensely to translate research findings into clinical applications. Unlike colon cancer, which spreads (metastasizes) to other parts of the body, rectal cancer more often recurs locally or regionally. In the study by Krook and his colleagues, as well as in that by the Gastrointestinal Tumor Study Group (GITSG), the reduction in recurrence was doubled by using combined therapy. Radiation still caused small-bowel complications in six to seven percent of patients who underwent radiation therapy, and other side effects were noted. There were differences in dosage and timing between the two studies, but the outcomes were comparable. The addition of semustine to fluorouracil (methyl-CCNU) is being studied because it is highly toxic and evidence indicates that it has either no benefit, or causes a slight increase in the rate of recurrence. The conclusion from these trials is that patients with Stage II or Stage III rectal cancer should receive fluorouracil and external-beam radiation as given in the trial by Krook and others, which should lower mortality by one third. Currently only 3 percent of patients with high-risk colon and rectal cancer receive postoperative adjuvant treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Radiotherapy, Chemotherapy, Fluorouracil, Adjuvant chemotherapy, editorial

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The DCC protein and prognosis in colorectal cancer

Article Abstract:

The absence of the DCC protein indicates a poor prognosis in patients with colorectal cancer. DCC is a gene on chromosome 18q21.2 whose absence is believed to be linked to a worse outcome. Researchers used monoclonal antibodies against the DCC protein to test 132 tumor samples from patients with stage II or III colorectal cancer. In stage II patients whose samples expressed the DCC protein, the 5-year survival rate was 94.3% compared to a 61.6% survival rate in those whose tumors did not express the protein. Five-year survival rates in those in stage III were 59.3% and 33.2%, respectively.

Prognosis

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A vaccine consisting of recombinant Borrelia burgdorferi outer-surface protein A to prevent Lyme disease

Article Abstract:

A vaccine against Lyme disease appears to be effective in people who have a high risk of contracting the illness. Researchers gave a placebo or a vaccine made from the outer-surface protein A of the organism that causes Lyme disease to 10,305 people who live in parts of the US where Lyme disease is endemic. After two doses, the vaccine reduced the risk of infection by 68%. It was 92% effective in a smaller group of participants who received three doses.

Prevention, Lyme disease, Bacterial vaccines

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