Bisphosphonate-related osteonecrosis of the jaws: how to manage cancer patients.

Bisphosphonate related osteonecrosis of the jaw (BRONJ) is defined as exposed necrotic bone appearing in the jaws of patients treated by systemic IV or oral BPs never irradiated in the head and neck area and that has persisted for more than 8 weeks. More than 90% of cases of osteonecrosis of the jaw have been in patients with cancer who received IV-BPs. The estimate of cumulative incidence of BRONJ in cancer patients with IV-BPs ranges from 0.8% to 18.6%. The pathogenesis of BRONJ appeared related to the potent osteoblast-inhibiting properties of BPs which act by blocking osteoclast recruitment, decreasing osteoclast activity and promoting osteoclast apoptosis. Dental extractions are the most potent local risk factor. Cancer patients wearing a denture could also be at increased risk of BRONJ. Non-healing mucosal breaches caused by dentures could be a portal for the oral flora to access bone, while the oral mucosa of patients on IV-BPs could also be defective. Whether periodontal disease is a risk factor for BRONJ remains controversial. Preventive measures are fundamental. Nevertheless, some teams have questioned its cost-effectiveness. The perceived limitations of surgical therapy of BRONJ led to the restriction of aggressive surgery to symptomatic patients with stage 3 BRONJ. The evidence-based literature on BRONJ is growing but there are still many controversial aspects.

Regional Advisory Committee on Cancer - Guidance for the Management of Haematological Cancer (September 2004) (PDF 163 KB)

Haematological cancers in adults include a range of diseases including leukaemias, lymphomas and myeloma, all of which differ in diagnosis and management. Collectively they account for about 1 in 14 cancers. This guidance provides a profile of the major haematological malignancies with brief reference to relevant epidemiological factors and management implications. It emphasises the collaborative and specialised nature of the clinical haematology service currently being delivered in the Cancer Centre and Cancer Units on a hub and spoke basis. The guidance sets out recommendations aimed at strengthening the current clinical service, which should continue to operate as a network, facilitating rapid referrals and the use of shared protocols. Specifically, it recommends that patients should be managed by a multi-disciplinary approach and that the provision of diagnostic facilities including radiological and cytogenetic analysis must be sufficient to provide high quality and timely information. åÊ

ALK rearrangement in a selected population of advanced non small cell lung cancer patients. FISH and inmunohistochemistry diagnostic methods, prevalence and clinical outcomes

Anaplastic lymphoma kinase (ALK) rearrangements represents a new driver oncogenic event in non-small cell lung cancer (NSCLC). ALK positive patients account for a 1-7% of NSCLC patients. The objective of this study is to know the prevalence and clinical characteristics of ALK positive patients in a cohort of NSCLC patients and to compare inmunohistochemistry with D5F3 monoclonal antibody with gold standard method fluorescence in situ hybridation

Directory of Colon and Rectal Cancer Specialist Teams

The Directory of Colon and Rectal Cancer Specialist Teams has been produced under the auspices of the Northern Ireland Regional Advisory Committee on Cancer. It contains details of the full membership of the clinical teams providing care for colon and rectal cancer in each of Health and Social Services Board Area. Lead Clinicians For Colon and Rectal Cancer Services (PDF 74 KB) EHSSB (PDF 198 KB) NHSSB (PDF 107 KB) SHSSB (PDF 130 KB) WHSSB (PDF 131 KB)

Directory of Lung Cancer Specialist Teams

The Directory of Lung Cancer Specialist Teams has been produced under the auspices of the Northern Ireland Regional Advisory Committee on Cancer. It contains details of the full membership of the clinical teams providing care in each of Health and Social Services Board Area. Lead Clinicians for Lung Cancer Services (PDF 74 KB) EHSSB (PDF 140 KB) NHSSB (PDF 106 KB) SHSSB (PDF 115 KB) WHSSB (PDF 126 KB)

Directory of Familial Cancer Genetics Specialist Teams

The Directory of Familial Cancer Genetics Specialist Teams has been produced under the auspices of the Northern Ireland Regional Advisory Committee on Cancer. It contains details of the full membership of the clinical teams providing care in each of Health and Social Services Board Area. Lead Clinicians for Familial Cancer Genetics Service (PDF 58 KB) Eastern (PDF 68 KB) Northern (PDF 61 KB) Southern (PDF 62 KB) Western (PDF 11 KB) The Directory will be updated on an annual basis. Please e-mail amendments to:- irene.wilkinson@dhsspsni.gov.uk

General Palliative Care Guidance for Control of Pain in Patients with Cancer (PDF 56 KB)

This document is intended to be a practical clinical guideline for the control of pain in patients with cancer. Its target group is hospital staff, primary care team members and nursing home staff. It attempts to apply the clinical principles outlined in the document 'Control of Pain in Patients with Cancer' published by "Scottish Intercollegiate Guidelines Network" (SIGN). This document has been adapted with the permission of SIGN. Rigour of Development A full evidence based reference list is available with the SIGN document. This can be accessed at www.sign.ac.uk. Contents not based on the SIGN document are referenced separately. This document has been developed as one part of the recommendations identified in the Regional Review of Palliative Care Services, 'Partnerships in Caring'. The development of these Pain Guidelines was led by the Northern Ireland Group of the National Council for Hospice and Specialist Palliative Care, whose membership is detailed in Appendix 4. They will be reviewed and updated in two years. A wide consultation process with potential users was undertaken. åÊ åÊ

Application de la modélisation moléculaire à de nouvelles approches thérapeutiques du cancer [Application of molecular modeling to new therapeutic cancer approaches].

Recent progress in the experimental determination of protein structures allow to understand, at a very detailed level, the molecular recognition mechanisms that are at the basis of the living matter. This level of understanding makes it possible to design rational therapeutic approaches, in which effectors molecules are adapted or created de novo to perform a given function. An example of such an approach is drug design, were small inhibitory molecules are designed using in silico simulations and tested in vitro. In this article, we present a similar approach to rationally optimize the sequence of killer T lymphocytes receptors to make them more efficient against melanoma cells. The architecture of this translational research project is presented together with its implications both at the level of basic research as well as in the clinics.

An Evaluation of Cancer Services in Ireland: A National Strategy 1996

An Evaluation of “Cancer Services in Ireland: A National Strategy 1996″ This report presents the outcome of a comprehensive study that evaluated the extent to which the objectives and actions of the 1996 National Cancer Strategy were achieved. The evaluation was commissioned by the Department of Health and Children on behalf of the National Cancer Forum. The field work was carried out by Deloitte and Touche Management Consultants between October 2002 and February 2003. Click here to download PDF 360kb

Descriptive epidemiology of skin cancer in the Swiss Canton of Vaud.

Incidence registration and survival data for non-melanocytic skin neoplasms and cutaneous melanoma have been abstracted from the population-based system of the Cancer Registry of the Swiss Canton of Vaud, which has been operating in a particularly favourable environment, since the large majority of cutaneous lesions resected in the area are examined by a pathologist. Among the 5,712 cases registered, 66.7% were basal-cell carcinomas, 20.6% squamous-cell cancers, 9.3% cutaneous melanomas and 3.4% other miscellaneous histological types. The distribution by histological type did not differ appreciably in the 2 sexes, but there were marked inter-sex differences as regards anatomical site. In both sexes, head and neck was by far the commonest localization for non-melanomatous neoplasms (69 to 81% of all incident cases), followed by trunk for basal-cell cancers (18% in males, 15% in females) and upper limb for squamous-cell (10% in males, 17% in females). The distribution of skin melanomas differed considerably between the 2 sexes, by far the commonest site being the trunk for males (45% of cases) and lower limbs for females (40%), followed by head and neck (22% in both sexes). Incidence rates for both basal- and squamous-cell cancers increased with age, and rates were higher in males for each localization except the lower limb. In contrast, incidence for melanoma was higher in females, and incidence rates did not increase with age above 55 years for all sites except head and neck. This can be interpreted in terms of cohort effect, since mortality from melanoma has substantially increased in Switzerland across subsequent birth cohorts. Although this study is essentially descriptive, accurate inspection of these data provides some support for the major aetiological hypotheses of skin carcinogenesis, i.e., the observation that the large majority of basal- and squamous-cell cancers arise on the head and neck confirms the importance of long-term ultraviolet exposure; the relative excess of squamous-cell as compared to basal-cell neoplasms on the upper limb may suggest the role of exposure to other (chemical) carcinogens; and the proportional excess of melanomas on the trunk in males and lower limb in females further indicates that intermittent exposure to sunlight is probably the relevant aetiologic factor for melanocytic skin neoplasms.

Concomitant cisplatin and hyperfractionated radiotherapy in locally advanced head and neck cancer: 10-year follow-up of a randomized phase III trial (SAKK 10/94).

Purpose: To compare the long-term outcome of treatment with concomitant cisplatin and hyperfractionated radiotherapy versus treatment with hyperfractionated radiotherapy alone in patients with locally advanced head and neck cancer.Methods and Materials: From July 1994 to July 2000, a total of 224 patients with squamous cell carcinoma of the head and neck were randomized to receive either hyperfractionated radiotherapy alone (median total dose, 74.4 Gy; 1.2 Gy twice daily; 5 days per week) or the same radiotherapy combined with two cycles of cisplatin (20 mg/m(2) for 5 consecutive days during weeks 1 and 5). The primary endpoint was the time to any treatment failure; secondary endpoints were locoregional failure, metastatic failure, overall survival, and late toxicity assessed according to Radiation Therapy Oncology Group criteria.Results: Median follow-up was 9.5 years (range, 0.1-15.4 years). Median time to any treatment failure was not significantly different between treatment arms (hazard ratio [HR], 1.2 [95% confidence interval [CM 0.9-1.7; p = 0.17]). Rates of locoregional failure-free survival (HR, 1.5 [95% CI, 1.1-2.1;p = 0.021), distant metastasis-free survival (HR, 1.6 [95% CI, 1.1-2.5; p = 0.021), and cancer-specific survival (HR, 1.6 [95% CI, 1.0-2.5;p = 0.03]) were significantly improved in the combined-treatment arm, with no difference in major late toxicity between treatment arms. However, overall survival was not significantly different (HR, 1.3 [95% CI, 0.9-1.8; p = 0.11]).Conclusions: After long-term follow-up, combined-treatment with cisplatin and hyperfractionated radiotherapy maintained improved rates of locoregional control, distant metastasis-free survival, and cancer-specific survival compared to that of hyperfractionated radiotherapy alone, with no difference in major late toxicity. (C) 2012 Elsevier Inc.

Instruction of haematopoietic lineage choices, evolution of transcriptional landscapes and cancer stem cell hierarchies derived from an AML1-ETO mouse model.

The t(8;21) chromosomal translocation activates aberrant expression of the AML1-ETO (AE) fusion protein and is commonly associated with core binding factor acute myeloid leukaemia (CBF AML). Combining a conditional mouse model that closely resembles the slow evolution and the mosaic AE expression pattern of human t(8;21) CBF AML with global transcriptome sequencing, we find that disease progression was characterized by two principal pathogenic mechanisms. Initially, AE expression modified the lineage potential of haematopoietic stem cells (HSCs), resulting in the selective expansion of the myeloid compartment at the expense of normal erythro- and lymphopoiesis. This lineage skewing was followed by a second substantial rewiring of transcriptional networks occurring in the trajectory to manifest leukaemia. We also find that both HSC and lineage-restricted granulocyte macrophage progenitors (GMPs) acquired leukaemic stem cell (LSC) potential being capable of initiating and maintaining the disease. Finally, our data demonstrate that long-term expression of AE induces an indolent myeloproliferative disease (MPD)-like myeloid leukaemia phenotype with complete penetrance and that acute inactivation of AE function is a potential novel therapeutic option.

An Evaluation of Cancer Services in Ireland: A National Strategy

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Guidelines for the safe administration of cytotoxic medical preparations in the treatment of patients with cancer

The Minister for Health’s Strategy for effective health care in the 1990s has emphasised quality of service as one of its key principles.  Within the medical sphere, almost no other field has developed and continues to expand as rapidly as that of cancer biology and treatment.  Cytotoxic therapies are a major part of these developments. The Cancer Strategy has highlighted the importance of these drugs in the treatment of cancers. Download the Report here

Development of Services For Symptomatic Breast Disease: Report of the Sub-Group to The National Cancer Forum

In April 1999, the Minister of Health and Children asked the National Cancer Forum to report and make recommendations on the development of breast services for symptomatic women. The Forum established a subgroup to undertake this exercise, under the Chairmanship of Prof J. Fennelly. Download the Report here