Radiotherapy is eye, sight, and life saving Even after chemotherapy has failed to cure retinoblastoma, doctors at the Eye Department of St Bartholomew’s and The Royal London Hospital, London, UK, have reported that external-beam radiotherapy can destroy the cancer and save patients’ vision. Michelle Chan, a resident in ophthalmology at the Royal Free Hospital, London, UK, who worked at St Bartholomew’s during the study, said that almost a third of patients who had salvage treatment retained enough vision to allow them to have normal activities of daily living— including the ability to drive a vehicle. “In these patients we were able to save 14 eyes out of 26 eyes”, Chan said at the annual meeting of the Association for Research in Vision and Ophthalmology (ARVO), Fort Lauderdale, FL, USA (April 30–May 5,
2006). Eight of those eyes had vision that was suﬃcient to pass a driver’s license examination; the others had lesser vision, but most patients were still able to function independently. Overall, 22 patients were studied. Six of 36 eyes needed enucleation, 11 of the remaining 30 eyes needed further treatments, and 19 eyes remained quiescent, Chan says. “These results are encouraging [in] that there is a treatment that we can oﬀer patients after chemotherapy fails”, Chan says. The rate of eye preservation was more than 83% at 40 months, she notes. In another study presented at the ARVO meeting, Italian doctors said they were able to save 92% of the eyes of patients who presented with uveal melanoma by use of stereotatic gamma knife radiation technology. Giulio Modorati, a staﬀ physician at San Raﬀaelle Scientiﬁc Institute,
Milan, Italy, said he has been able to save the eyes of 55 of 60 patients between 1994 and 2004. “More and more people are now looking at the gamma knife, to focus radiation energy on the tumour to eradicate it”, Modorati said. “We are reporting a 5-year survival of better than 80% in these patients.” Five eyes were removed because of inﬁltrating growth of the tumour. Ten patients died during the decade-long study period, including six who had cancer metastases. “The gamma knife procedure for tumours in the eye appears to be a better alternative than other methods of treating these diseases”, John Stokes, a fellow in ophthalmology at the University of Illinois-Chicago, IL, USA, comments.
Lobular carcinoma in situ linked to breast-cancer risk
Steve Gschmeissner/Science Photo Library
Women with lobular carcinoma in situ (LCIS) have a higher risk of invasive breast cancer than do those with ductal carcinoma in situ (DCIS), say researchers in Cancer (2006; 106: 2104–12). “Our ﬁndings challenge the notion that LCIS is a non-surgical disease and suggest that deﬁnitive local treatment for LCIS may be warranted”, explains
Assessing the risk of LCIS in breast cancer
Christopher Li (Fred Hutchinson Cancer Research Centre, Seattle, WA, USA). The researchers used the US National Cancer Institute Surveillance, Epidemiology and End Results (SEER) database to look at types of invasive breast cancer in women diagnosed with unilateral DCIS and LCIS between 1988 and 2002. In women with DCIS, rates of ipsilateral and contralateral invasive breast cancers were 5·4 and 4·5 per 1000 person-years, respectively. In those with LCIS, the rates were 7·3 and 5·2 per 1000 person-years, respectively. Women aged 20–49 years and African-American and Hispanic women with DCIS had a higher risk of stage III or IV breast cancer than did those aged 50–59 years or those who were non-Hispanic whites. This ﬁnding, Kimberly Van Zee (Memorial SloanKettering Cancer Centre, New York, NY, USA) notes, lends support to those of others which suggest that surveillance methods in these groups should be reassessed.
“The conclusion that LCIS may be a precursor rather than just a risk factor for invasive breast cancer is a valuable observation hypothesised by others. These ﬁndings should be used to initiate prospective studies on the subsequent risks for women with LCIS and methods of reducing risk”, she says. Van Zee thinks that the results of the study should be considered hypothesisgenerating because SEER lacked data for important determinants of breastcancer risk, such as use of hormonereplacement therapy, use of tamoxifen, and family history. Van Zee concludes that: “the credence of the current study’s results regarding the risk of subsequent invasive breast cancer after DCIS is called into question, as their reported risk (5·4 per 1000 patient-years) is lower than that seen in most of the prospective studies (6·9–14·2 per 1000 patient-years)”.
Khabir Ahmad http://oncology.thelancet.com Vol 7 June 2006