FIBERS: A group of vegetarian subjects have been shown to have a lower risk of cancer of the prostate than a control group. But the exact role of food fiber remains to be determined because plant foods also have an antioxidant effect on their own. PLANT PRODUCTS AND EXTRACTS: A compound called PD SPEC has been showed to have antitumor effects both in vitro and in vivo. Evaluated in patients with a cancer escaping hormone control, the clinical response was a lower level of prostate specific antigen (PSA). SOYBEANS: Several studies have demonstrated the interesting properties of soybeans. No study has however been able to demonstrate the optimal dose per day. A prospective study is currently under way using a 40 g/day dose. OVERALL NUTRITIONAL APPROACH: Several studies are being conducted using a proposed diet where 15% of the total energy intake comes from fat (associated with a low saturated/unsaturated ratio), high fiber content (18 g/100 kcal) and 40 g daily soybean protein. Although large-scale studies with rigorous methodology are lacking, an overall nutritional approach could be an interesting strategy for the management of cancer of the prostate.

Digestive complications are frequent dose-limiting side-effects of chemotherapy. The incidence and the severity of these toxicities have to be systematically evaluated in order to provide specific curative and preventive treatments. Quick resolution of these complications is important to improve quality of life, and also to prevent hospitalization. Nausea, vomiting, mucositis, and diarrhea are the main digestive toxicities of chemotherapy. This review emphasizes the recent therapeutic approaches which could lead to a decrease of the incidence or the severity of these toxicities. Although marked progress has been accomplished these last years, a substantial degree of further improvement is needed to improve the effectiveness of specific treatments. Furthermore, research might focus on new strategies which may prevent the development of overall toxicity, by increasing the selectivity of chemotherapy on tumor cells.

To increase the therapeutic index of second line hormonal treatment of breast cancer, new aromatase inhibitors have been synthetized; they belong to two groups: type I (formestane and exemestane) are steroidal irreversible and specific inhibitors, type II (anastrozole, letrozole and vorozole) are non steroidal reversible inhibitors, interfering with the aromatase heme. Several phase II and III trials demonstrated that these drugs are, at least, as active as aminoglutethimid or progestins in second line treatment, and are less toxic. Recently, an identical activity have been observed for anastrozole and tamoxifen in first line. In metastatic and adjuvant settings, large trials are ongoing to clarify the exact value of these drugs.

Selective new aromatase inhibitors are a new class of agents that are of considerable interest in the treatment of hormone-dependent breast cancer in postmenopausal women. Aromatase is an enzymic complex that catalyses the conversion of the adrenal androgens androstenedione and testosterone to estrone. In postmenopausal women, the process of peripheral aromatisation accounts for the majority of circulating estrogens. The selective inhibition of estrogen production by aromatase inhibitors is an efficient strategy for breast cancer treatment. These compounds are classified as irreversible inhibitors of aromatase (type I), and comprise steroidal compounds. Reversible inhibitors of aromatase, which comprises non-steroidal compounds are type II aromatase inhibitors. Second and third generation aromatase inhibitors are considerably more potent and more specific in their ability to inhibit aromatase, as compared with first generation compounds (aminoglutethimide).

In order to evaluate occurrence and risk factors for wound infection (WI) in breast cancer surgery, we carried out a prospective study.

Multifocal osteonecrosis has a wide variety of etiologies, but in the cancer patient several risk factors could have a synergic effect (chemotherapy, radiotherapy, corticosteroid, metabolism disorder).

The pregnancy-associated breast cancer seems to have become increasingly common with a high frequency of advanced breast cancer with axillary node metastases and so associated with poor prognosis.

We investigated the frequency of ADRs occurring during one year (1995) in a French regional cancer institute. Patients with at least one ADR leading to or occurring during hospitalization in the institute were identified by searching diagnosis codes potentially related to an adverse drug reaction in the hospital medical database of the PMSI (Programme de médicalisation des Systèmes d'Information). We found 435 hospitalizations relative to 285 patients (6.2 per cent of the whole population of inpatients in 1995 and 3.1 per cent of stays in 1995). The total cost to treat ADRs was 1.7 per cent of the total budget of the hospital with a median cost of 8517 francs (mean cost: 13,271 +/- 15,330 francs). The highest cost was due to medical staff, blood transfusions, and anti-infectious drugs, despite the use of prophylactic agents. These results emphasize the high incidence and excess costs of ADRs related to anticancer chemotherapy.

Recent improvement in the understanding of the mechanisms involved in the response to ionizing radiation have made it possible to identify new therapeutic targets to increase the anti-tumor efficacy or, alternatively, to decrease the effect on normal tissues. These approaches included targeting genes involved in the regulation of radio-induced DNA-repair and cell death as well as genes involved in the regulation of radio-induced apoptosis. Many other molecular targets have been recently identified to potentially interfere with the response to ionizing radiation, such as some cell membrane growth factor receptors (EGFr, TGFb) or molecules involved in intra-cellular signal transduction pathways, cell cycle regulation, etc. In addition, other promising ways to modulate radiation-induced response concern extracellular or tissue factors such as hypoxia and angiogenesis.