Childhood melanoma in Europe since 1978: a population-based survival study.

The existence of the EUROCARE database now makes it possible to compare population-based survival for childhood melanoma in different European populations. The database contains verified information, including histological data, from cancer registries in 17 European countries, and as such it represents a particularly important source of survival information on a very rare cancer like childhood melanoma. The aim of the present paper was to describe survival in children with melanoma (MM), by sex, age and subsite, diagnosed during the period 1978--1989, using analysis of the data of the European pool of cases. Five year-survival for childhood MM diagnosed in 1978--1989 in Europe, is relatively good (80%; 95% confidence interval (CI) 47--95 for boys and 78%; 95% CI 58--91 for girls). Analysis by subsite, revealed the survival for MM on the head and neck, legs and arms was generally higher than survival for MM on other cutaneous sites (trunk, neck and scalp). For skin melanomas outcome for girls was better than boys, adjusting for age and sub-site. We suggest that the good survival observed in childhood MM seems to be related to early diagnosis.

Dietary profiles and anti-oxidants in a rural population of central Italy with a low frequency of cancer.

This descriptive, cross-sectional study reports the anti-oxidant activities of a population sample of 736 individuals, randomly selected from residents of two small towns of the Latina province of Italy (an area at low frequency of cancer). The circulating levels of vitamins A, C and E, ceruloplasmin, carotenoids (lutein + zeaxanthin, lycopene, alpha- and beta-carotene, cryptoxanthin), cholesterol, high-density lipoprotein cholesterol and triglycerides, as well as anthropometric measurements (skin-folds, height, weight) were evaluated. A dietary interview was also performed by means of a semi-quantitative questionnaire. All the anti-oxidants were above the cut-off points for normality, whereas body mass index, % fat and serum lipids were not clearly suggestive of a protected population. The data obtained could be useful to estimate the baseline values of protective microelements and to assess dietary profiles in populations following a Mediterranean diet.

[Survival for tumors of the colon and the rectum in Italy]. / Sopravvivenza per tumori del colon e del retto in Italia.

In population based from four Italian cancer registries (Varese, Modena, Latina, Ragusa), five-years relative survival was 34% for colon cancer patients (no. = 1864) and 28% from rectum cancer patients (no. = 1117). However, rectum cancer patients showed higher survival rates in the first year of follow-up, which is possibly due to earlier diagnosis for sites more accessible to clinical examination. For colorectal cancer, age was an important prognostic factor, both in univariate and in multivariate analysis, adjusting for competitive mortality, sex, geographical area and year of diagnosis. In the same multivariate analysis, the prognosis was better for women, significantly for colon cancer and the excess death risk was reduced by 25-30% from 1978-79 to 1984-85. No significant differences were found among different geographical areas, possibly because of the low number of patients from some of the participating cancer registries.

Cancer risk related to uncommon migration within Italy.

AIMS AND BACKGROUND: Given the industrialization in Italy over this past century much migration has occurred within the country especially from southern to northern regions. Following repeated drainings of the pre-existing marsh area (Pontina plain) during the 1930s the Latina province received an unusual north-south immigration from the regions of Veneto, Friuli and Emilia Romagna. This consisted principally of manual workers, farmers and their families. Four new towns developed after a few years (Littoria, later renamed Latina, Sabaudia, Pontinia and Aprilia), and the whole province quickly reached a population of 60,000. The availability of a population-based Cancer Registry in the Latina province allowed us to assess the cancer risk in this migrant population. METHODS: Standardized Incidence ratios (SIRs) according to cancer site and sex were computed for residents over the age of 55 years, born in northern Italy. Population data, by sex, age and region of birth were based on the 1981 census. The age-sex-site specific incidence rates for the 1983-1987 period for the entire population of the Latina province over 55 years of age were used as standard. RESULTS: A significant excess of cancer risk for subjects of both sexes born in northern Italy was found. In addition, a statistically significant higher risk was observed for the cancers of the lung, skin (non-melanomas) and prostate in males, and of the mouthpharynx, lung and skin (non-melanomas) in females. CONCLUSIONS: SIRs for all sites confirm the findings from other studies on migrants in Italy and strongly support the hypothesis that the place of birth has an important influence on the frequency of cancer. Some possible etiological factors are suggested for cancer sites with higher frequencies in northern-born subjects.

Basophil-bound and serum immunoglobulin E directed against Helicobacter pylori in patients with chronic gastritis.

The immunoglobulin (Ig) E immune response in patients with Helicobacter pylori-associated chronic gastritis has been evaluated. Of 26 patients with H. pylori infection, 22 (84%) tested positive for basophil-bound specific IgE (determined by the histamine release test) and 18 (69%) for serum specific IgE (determined by an enzyme-linked immunosorbent assay). In contrast, only 1 of 17 persons in whom the bacterium was not detected presented cell-bound and serum specific IgE. In the 4 histamine release test--positive but enzyme-linked immunosorbent assay--negative patients, removal of antibody from the basophil surface by acid elution showed that histamine release occurred through an IgE-dependent mechanism. When normal basophils, passively sensitized with serum from IgE-positive patients, were exposed to the H. pylori antigen, a significant release was observed, confirming the class specificity of the response. Inhibition experiments with bacteria other than H. pylori showed that the IgE antibody was specifically directed against this organism. The percentage of antigen-induced histamine release did not correlate with serum specific IgE level. However, the response of basophils to antigenic challenge was proportional to IgE-dependent cellular releasability. This finding suggests that target cell sensitivity may be the most important factor in determining the entity of biological response to the antigenic challenge. The ability of H. pylori to induce a specific IgE immune response could answer key questions regarding the mechanisms inducing gastric inflammation.

Combination chemotherapy with oral idarubicin and cyclophosphamide for metastatic breast cancer.

A group of 40 women with objectively measurable metastatic breast cancer was treated with idarubicin, 35 mg/m2 on day 1, and cyclophosphamide, 200 mg/m2 on days 2-5, both drugs being administered orally every 3 weeks. Of 37 evaluable patients, 4 (10.8%) achieved a complete response and 14 (37.8%) a partial response, for an overall response rate of 48.6% (95% confidence interval, 37.45%-59.75%). In previously untreated patients the response rate was 58.3%, whereas it was 44% in patients previously exposed to cytotoxic drugs. The median duration of response was 6.5 months, and the median survival of all patients was 10.5 months. Moderate nausea and vomiting were common. Diarrhoea, which occurred in 37% of the patients, was usually short-lived. Alopecia was generally mild, myelosuppression was the dose-limiting toxicity. Grade 3-4 leukopenia occurred only in pretreated patients. In previously untreated patients it was generally of grade 1-2. Laboratory evidence of cardiotoxicity (greater than or equal to 20% decrease in the left-ventricular ejection fraction from the baseline value) was observed in 3 out of 26 patients, who had at least two determinations of the left-ventricular ejection fraction, and was transient in nature. No cases of congestive heart failure were observed. These results indicate that the combination of idarubicin + cyclophosphamide represents a practical and effective regimen to be used in selected patients with advanced breast cancer.

Epirubicin and DTIC (EDIC) for advanced soft-tissue sarcomas.

Fifty-six patients with measurable advanced soft-tissue sarcomas were treated with epirubicin, 90 mg/m2 intravenously on day 1, and DTIC, 250 mg/m2 intravenously on days 1-5, with the entire regimen repeated every 3 weeks. The overall response rate in 52 evaluable patients was 48% with 9 complete remissions. Noncardiac toxicity was limited predominantly to vomiting, alopecia and myelosuppression. Laboratory evidence of cardiotoxicity [greater than or equal to 20% decrease in left-ventricular ejection fraction (LVEF) from the baseline value] was observed in 4 out of 39 patients who had at least two determinations of LVEF, at a median dose of 1,305 mg/m2. Two patients had clinical congestive heart failure at cumulative dose of 1,440 and 1,620 mg/m2. These findings suggest that the combination of epirubicin and DTIC is an active regimen in soft-tissue sarcomas, and provide further evidence that epirubicin is a doxorubicin analogue with reduced cardiac toxicity, but preserved efficacy in this disease.

5-Fluorouracil, epirubicin, and BCNU (FEB) in advanced measurable gastric cancer.

Forty-eight patients with advanced measurable gastric cancer were treated with the three-drug combination of 5-fluorouracil, epirubicin, and BCNU (FEB). The response rate was 42% in 45 evaluable patients. There were five complete responders (11%). The median duration of response was 13 months, and the median survival of all patients was 9.2 months. Toxicity was generally mild to moderate. No instances of congestive heart failure were recorded. These results indicate that patients with metastatic gastric cancer can be effectively palliated with FEB chemotherapy.

5-Fluorouracil, adriamycin, cyclophosphamide (FAC) vs. 5-fluorouracil, epirubicin, cyclophosphamide (FEC) in metastatic breast cancer.

94 evaluable patients with metastatic breast cancer were randomly assigned to 5-fluorouracil, adriamycin, and cyclophosphamide (FAC) or 5-fluorouracil, epirubicin, and cyclophosphamide (FEC), with cycles repeated every 3 weeks. The objective response rate to FAC was 46% versus 44% to FEC. There was no significant difference in the median duration of response and median survival for the two regimens. Toxicity was more frequent and more pronounced in patients receiving FAC. Results indicate therapeutic equivalence of the two regimens and reduced toxicity of the epirubicin arm.

[The role of family planning units in the prevention of female tumors]. / Le donne, i consultori e la prevenzione dei tumori femminili.

PIP: 1000 women selected randomly in the Italian provinces of Roma and Latina were given a questionnaire seeking information on age, occupation, oral contraceptive (OC) use, self-examination of the breasts, frequency of visits to clinics and Pap test, parity, and family history of tumors. 98% of the women were familiar with the services offered by family planning (FP) units. 786 questionnaires were analyzed. 80% of the subjects were 35 years old: the 21-25 age group was most prevalent. 40% were employed, the rest were housewives or retired (according to official statistics in 1984 only 25.9% of women were employed). Visits to the gynecologist increased with advancing age but proved to be inadequate for prevention even in the age segment most at risk of acquiring malignant neoplasms (p .05). Women who stayed at home were most likely to have regular gynecological checkups and Pap tests. 24% of women answered in the affirmative about self-examination of the breasts, and the 26-30 age group was most interested in it. 31% of housewives also practiced it, compared to only 10% of those who worked (p .01). OC use was most prevalent in the 26-30 age group (over 30%), while those 35 and under 20 neglected its use. FP units play an important role in oncological prevention by observing cultural and social aspects of women's lives and by adapting preventive programs accordingly.^ieng

Randomized trial comparing two short courses of moderate-dose metoclopramide for moderate-dose cisplatin-induced emesis.

To better define the dose-response relationship of moderate-dose (MD) metoclopramide (MCP), 42 patients receiving their first course of cisplatin (50 mg/m2) were randomly allocated to receive a short-course regimen of MCP, either at 1 mg/kg X 1 dose, 30 min before cisplatin (regimen A) or 1 mg/kg X 2 doses, 30 min before and 1 h after cisplatin (regimen B). The antiemetic response was assessed only by objective means (duration and volume of emesis over a 6-hour period). The results obtained in the two groups show a significantly better antiemetic effect (p = 0.03) employing the higher dose of this short-course regimen, with as much as 76% of the patients experiencing no vomiting or only a low degree of emesis. Furthermore, the lower-dose MCP regimen seems to be inadequate for preventing emesis, especially in the subgroups at higher emetic risk (patients with prior chemotherapy exposure and those concurrently receiving adriamycin. No significant side effects were present with either treatment. Further studies are required to define the best short-course regimen of MCP for patients receiving MD cisplatin.

Cancer mortality in the Republic of San Marino.

San Marino is a small independent Republic encircled by Italy, with a population of approximately 20,000. It still maintains an ethnic profile favoured by a tendency to genetic segregation due to endogamy. Since 1908 detailed data have been kept on all deaths among residents also for those dying outside the country. In this study the mortality trends based on crude rates are reported for all neoplasms and for selected sites in the years 1908 to 1980, showing increased rates for all neoplasms and the highest rate for stomach cancer. Age-adjusted death rates were calculated for all neoplasms and for selected sites, by sex, in the years 1966 to 1980. Stomach cancer was the commonest cause of cancer death in San Marino and its age-adjusted death rate was the highest in the world. A sharp increase was also observed for respiratory tract and colorectal cancers in recent years.

Treatment of advanced measurable gastric carcinoma with 5-fluorouracil, adriamycin, and BCNU.

61 patients with advanced measurable gastric carcinoma were treated with 5-fluorouracil, adriamycin and BCNU (FAB). Of 50 evaluable patients, 48% achieved a response (3 complete and 21 partial responses), and 24% experienced disease stabilization. The median duration of response was 9 months, and median survival of all patients was 7 months. Responding patients survived significantly longer than nonresponders (p less than 0.001). Toxicity was generally mild to moderate, rarely requiring dose reduction or prolongation of treatment intervals. These results indicate that FAB regimen is an active combination in metastatic or locally advanced gastric cancer, and can be used as first-line treatment in patients with this disease.

Randomized open cross-over trial between metoclopramide (MCP) and dexamethazone (DXM) for the prevention of cisplatin-induced nausea and vomiting.

Thirty-five patients receiving chemotherapeutic regimens including cisplatin (CDDP) were entered into a randomized open cross-over trial. Sixteen patients had previously received chemotherapy. Metoclopramide (MCP) was given i.v. in 4 doses of 1 mg/kg over a period of 4 1/2 hr, dexamethazone (DXM) was administered i.m. in 4 doses of 8 mg over 24 hr and another 10 mg i.v. just prior to CDDP administration. Sixteen patients who expressed a positive opinion on both previous antiemetics were given placebo (PLC). No significant differences were found between MCP and DXM, considering the mean score of both emesis intensity and patient's opinion. The mean duration of the symptoms was significantly longer with MCP than with DXM (P less than 0.02). Both antiemetic agents were more effective than PLC. No significant side-effects were observed. The results of this study indicate that both MCP and DXM provide a similar protection against CDDP-induced nausea and vomiting.