Objective To explore the treatment preferences of clinical oncologists for managing early prostate cancer and to compare the results with the preferences of urologists. Methods A postal questionnaire survey was conducted of consultant clinical oncologists in the UK. Results Consultant clinical oncologists favour radical radiotherapy in most men aged < 70 years, whereas a previous study showed that consultant urologists had a greater preference for radical surgery.Conclusion There is little consensus about which treatment should be used for managing early prostate cancer. There is an urgent need for results from randomized clinical trials to determine the optimum treatment. Keywords prostate cancer, radical radiotherapy, radical prostatectomy, brachytherapy, watchful waiting. IntroductionThere is no information from randomized trials to guide the decision among the treatment options in early prostate cancer of radical prostatectomy, radical radiotherapy and conservative management or watchful waiting [1]. Previous attempts to conduct randomized trials have failed because of poor recruitment. A recent questionnaire survey showed that consultant urologists favoured radical treatments for all patients with localized disease aged < 70 years, with radiotherapy and conservative management reserved for older men [2]. This approach is not based on high-quality evidence, but is an attempt by urological surgeons to balance the risk of cancer progression with the risk of dying from other causes and the morbidity of the treatment, based on their knowledge and experience. In the present study we aimed to explore the attitudes and treatment preferences of oncologists, the other major professional group managing men with early prostate cancer. MethodsA postal questionnaire survey was conducted of consultant clinical oncologists, asking their treatment preferences for five clinical cases. Doctors were asked about their first choice of treatment plus any others they would discuss with the patients. The cases were identical to those presented previously to urologists [2], to enable a direct comparison. In all, 169 doctors were identified, by enquiring of all oncology departments in the UK which of their doctors treated urological malignancy. ResultsIn all, 119 questionnaires (70%) were returned, of which 103 doctors confirmed that they were consultant clinical oncologists treating prostate cancer. These oncologists see an estimated 8663 new patients with prostate cancer each year (median 60, range 10-450); 87% of patients are seen by consultants with a site-specialized interest in prostate cancer. Site specialists see a median of 110 new patients each year (others see 25/year); 36% of patients are assessed in multidisciplinary clinics and 65% of oncologists have treatment guidelines agreed with urologists. All treatments are widely available except brachytherapy, available to only 28% of oncologists.Results from the clinical vignettes showed that clinical oncologists discuss a range of options with patients. For their first choice...
Snuunary We have conducted a retrospective study of high-dose folimc acid and 5-fluorouracil in % patients with advanced colorectal cancer. Patients received 200mg m -(maximum 300-350 mg) folinic acid by infusion over 2 h followed by an i.v. bolus of 5-fluorouracil 400mg m -then an infusion of 5-fluorouracil 600 mg m -' over 22 h. This was repeated over the next 24 h. The schedule was given every 2 weeks for four cycles; thereafter patients with objective response continued to a maximum of eight cycles. The overall response rate was 10.6% in 85 evaluable patients. The median duration of response was 11 months. The median survival was 6 months. Toxicity was low, only one patient experiencing toxicity greater than WHO grade II (grade IV platelet toxicity). Diarrhoea, nausea, vomiting and mucositis also occurred but were mild and infrequent. Our low response rate may be related to factors such as patient characteristics or duration of treatment.
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