European Journal of Cancer: Highlights of Issue 39:14

Cutting the risk of death in rectal cancer patients

Better management of rectal cancer in the Netherlands

Patients with rectal cancer aged less than 75 years showed significant improvements in survival over the last 2 decades, a study reports in this issue. Martijn and colleagues examined data from 3635 patients diagnosed in South-east Netherlands from 1980 to 2000. They observed a shift in treatment from surgery alone to a combination of surgery and radiotherapy and also a shift from postoperative to preoperative radiotherapy. Older patients (aged 75 years and over) were less likely to receive radiotherapy and no survival benefit was observed in this group. The authors speculate that the improving survival observed in those aged less than 75 years could be due to the shift from postoperative to pre-operative radiotherapy, the development of total mesorectal excision and the specialisation of surgeons in this field.

Imatinib mesylate in GISTs and soft tissue sarcomas

Verweij and colleagues report in this issue that imatinib mesylate is active in KIT-positive gastrointestinal stromal tumours (GIST), but not in 'other soft tissue sarcomas' (STS) that are unselected for a molecular target. They examined the response rate and time to progression (TTP) of 27 GIST patients and 24 patients with 'other STS', both groups having advanced or metastatic disease, who were given imatinib mesylate (400mg twice daily). In the GIST patients, 4% experienced complete remission and 67% partial remission whilst there were no objective responses in the 'other STS' patient group. 73% of the GIST patients were progression-free at one year. The median TTP in the 'other STS' group was 58 days. Toxicity was mild to moderate and no patient was taken off the study due to toxicity. The authors conclude that this dose of imatinib mesylate is active in KIT-positive GIST patients, but is unlikely to benefit patients with 'other STS' that are unselected for a molecular target. In a related paper, Stroobants and colleagues have compared and contrasted the response of patients to imatinib mesylate treatment as determined by [18F]-fluorodeoxyglucose-positron emission tomography (FDG-PET) or computerised tomography (CT) scan in 21 patients with soft tissue sarcomas (17 gastrointestinal stromal tumours). They found that "FDG-PET was an early and sensitive method to evaluate an early response to imatinib mesylate treatment". Dr. Demetri discusses these 2 papers in an accompanying Editorial.

Cancer of an unknown primary- a review

Pavlidis and colleagues review in this issue the diagnostic and therapeutic management of cancers of an unknown primary. They examine the clinicopathological features of this group of heterogeneous cancers that represent approximately 3% of all malignancies. The epidemiology, pathology, imaging, molecular diagnostics and treatment strategies of these cancers are also discussed. Favourable subsets of patients have been identified that respond to treatment and the authors propose that "the identification and treatment of these patients is of paramount importance".

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