European Journal of Cancer: Highlights of Issue 38:01

Carboplatin dosing

In this issue two papers related to carboplatin dosing are presented. Dooley and colleagues compared carboplatin doses calculated using the Calvert and Chatelut formulae and also compared this data with doses calculated using the Calvert formula modified with a non-isotopic estimation of the glomerular filtration rate (GFR) using either the Cockcroft and Gault or the Jelliffe formulae. These latter formulae underestimated the GFR and the authors also found a gender bias in the calculations of the Chatelut formula and state that 'further prospective evaluation for the Chatelut formula is required before it can be recommended for routine clinical application'. In another study, Leger and colleagues show that differences in the serum creatinine assay affects the carboplatin dosing. In an accompanying Editorial, Calvert and Egorin discuss how the field of dose calculation has developed since Stoller's study in 1977 on the 'Use of plasma pharmacokinetics to predict and prevent methotrexate toxicity' to the current day situation for carboplatin dosing.

Incidence and mortality in Europe in 1995

In this issue, Bray and colleagues present incidence and mortality estimates for 1995 in Europe for 25 cancer sites using World Health Organisation (WHO) mortality data and published estimates of incidence from national registries. Where national data were not available, high quality incidence and mortality data from the rapidly expanding population-based cancer registries were used. 2.6 million new cases were estimated and 1.6 million deaths. In men, lung (22%), colorectal (12%) and prostate (11%) were the most common cancers and in women the most common sites were breast (26%), colorectal (14%) and stomach (7%). Lung cancer was the most common cause of death (330,000). The authors also discuss potential reasons for the variance in the rates for specific sites in countries within four regions (Eastern, Northern, Southern and Western Europe) and between these regions. They hope that such studies will provide scope for prevention, but voice concerns that the introduction of informed consent to include patient details in registries may limit such studies in the future.

Substantial intertumoral variation limiting the usefulness of microvessel density analysis in hot-spots

The ability of tumours to induce the new formation of blood vessels in the tumour stroma, angiogenesis, is reported to be a prognostic factor in breast cancer. However, data reported in the literature have been conflicting. Ahlgren and colleagues suggest that variability in the intertumoral measurements of angiogenesis, in this case Microvessel density (MVD) in hot spots, may, at least in part, explain the conflicting results. They assessed angiogenesis by immunohistochemical staining of 21 invasive breast cancer tumours for the endothelial marker CD31. Two to 15 blocks were obtained from each tumour and 6 sections were cut. Their results showed that the variation between the sections contributed more to the total variance than variations between different tumours (45.0% vs. 37.3%). The concordance between 2 sections in paired comparisons using the median of all the highest values from each section as a cut-off point was also only 59.0%. The authors suggest that the use of MVD in hot spots to measure angiogenesis should thus be questioned.

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