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New Treatment for Pancreatic Cancer Shows Promise
When someone is diagnosed with pancreatic cancer, surgery
to remove the tumor offers the greatest potential for survival.
But in the vast majority of cases, surgery is not an option,
forcing patients and their doctors to look to other, less-effective
treatments often involving radiation together with
chemotherapy, or chemotherapy alone.
Even with these therapies, nearly all pancreatic cancer patients
show evidence that the cancer has spread throughout the body
within months of diagnosis, making it one of the most deadly
and difficult cancers to treat. In 1996, the Food and Drug
Administration approved a more effective chemotherapy drug
called gemcitabine for use, and several leading medical centers
have investigated techniques to combine this drug with radiation.
But many of these studies have found the combination causes
unacceptable side effects.
U-M study of combined therapy
Now, a new University of Michigan Cancer Center study has
shown that the drug can be delivered safely in combination
with accurately targeted radiation. In fact, the combination
could actually be more beneficial than currently available
therapy, without an increased risk of severe side effects.
In a paper published in the Journal
of Clinical Oncology (please note this link will
open in a second browser window), a team of U-M pancreatic
cancer specialists reports that gemcitabine can be delivered
at the recommended standard dose together with carefully aimed
radiation without substantial side effects. This clinical
study results from years of laboratory research at the U-M
to understand the mechanism of interaction between gemcitabine
and radiation, and technical advances in the delivery of radiation.
Side effects of combination therapy
Previous research on this combination has focused on broadly
targeted radiation therapy techniques with the addition of
relatively low doses of gemcitabine. Although promising, the
combination proved to result in unacceptable nausea, vomiting
and excessive weight loss.
The U-M technique, co-developed by Cornelius McGinn, M.D.,
assistant professor of radiation oncology, and Mark
Zalupski, M.D., clinical associate professor in medical
oncology, produced relatively modest side effects and allowed
the chemotherapy to be kept at a standard dose, rather than
a reduced dose.
Conformal radiation with standard-dose chemotherapy
Since pancreatic cancer spreads very easily, it is important
to attack it throughout the body with effective chemotherapy.
But treatment must also target the tumor in the pancreas itself,
and thats where focused radiation comes in, says
Dr. McGinn. By investigating the appropriate radiation
dose using a conformal radiation technique that spares non-cancerous
tissue, we have effectively targeted the primary cancer while
still delivering systemic therapy for potential spread, something
no other study has attempted.
Encouraged by the initial results, the team of researchers
is opening a new trial to further test the approach at the
U-M and other medical centers throughout the country. The
development of a specific clinic for patients with pancreatic
cancer within the U-M Comprehensive Cancer Center is under
way as well, as a means to provide coordinated multidisciplinary
care for this special patient population and develop further
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Study finds melanoma web sites give incomplete or wrong information
Popular Internet sites devoted to melanoma may seem trustworthy,
but the information they provide is often only skin-deep,
a new Univer-sity of Michigan Cancer Center study finds. In
fact, the majority of sites studied had incomplete facts about
the increasingly common and potentially deadly form of skin
cancer, and about one in eight had an inaccuracy.
The results from the first study of its kind, published in
of Clinical Oncology (please note
this link will open in a second browser window),
suggest that Web users should beware when searching for information
on melanoma, and that their physicians should guide them toward
sites that give full and correct details on the disease.
With more people turning to the web for health information,
especially after diagnosis, the researchers warn that incomplete
sites could raise anxiety for those diagnosed with melanoma,
mislead those at risk, and even undermine the relationship
between doctors and patients.
No one expects every web site on a given topic to include
every bit of information available, but the lack of even basic
preventive, diagnostic, treatment and risk factor data on
so many sites amazed us, says lead author
Christopher Bichakjian, M.D., a lecturer in dermatology
at the U-M Health System. The fact that melanoma so
often strikes young adults, who might be most likely to turn
to the Internet for medical information, gives web-site quality
even more importance.
Search engine results for melanoma
The studys authors most of them dermatologists
in the Cancer
Centers melanoma clinic often encounter skin
cancer patients who come to appointments with printouts from
web sites, some of them misleading or inaccurate. So, the
researchers conducted their study by putting themselves in
their patients shoes. They typed the word melanoma
into six of the most popular commercial search engine services,
as well as two well-known medical search engines.
After discarding more than 160 dead links, duplicates and
pages with many links but no facts, they found 74 web sites
that could be assessed against a gold standard
checklist of 35 factors, from basic definitions and incidence
rates to specific risk factors and treatment options.
Only eight of the factors were included on at least half the
sites, and no one piece of information appeared on more than
62 percent of the sites. Fourteen percent of sites had erroneous
information. Most inaccuracies were relatively minor, but
some were considerably more dangerous. Some sites recommended
unnecessary tests and more invasive, unnecessary surgery,
says co-author Timothy
M. Johnson, M.D., director of the U-M Comprehensive Cancer
Centers melanoma clinic and the William B. Taylor professor
According to researchers:
Only 62 percent of sites defined melanoma, while
59 percent correctly stated that the prognosis for someone
diagnosed with it can range from death to disease-free survival,
depending on what stage its in when treated.
Just 47 percent of sites included statistics on melanoma
Less than a third included images of melanomas, which
could be powerful tools for those wondering if a spot on
their skin might be dangerous.
Just over half the sites listed signs and symptoms
Only 38 percent mentioned the importance of screening
by oneself or a physician.
Prevention techniques such as sunscreen, hats or
clothing, and avoidance of the midday sun were only mentioned
on a third of sites.
The increased risks of melanoma that come with a
history of sunburn, fair skin or hair, moles on the skin,
or a personal or family history of the disease, were raised
on less than half of the sites.
About half of the sites mentioned surgery as the
treatment to remove lesions, but less than a quarter mentioned
diagnostic workups or sentinel lymph node biopsies, which
can tell whether the cancer has begun to spread beyond the
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