Despite being the subject of clinical research for more than 20 years, the role of anthracyclines in the treatment of ovarian cancer is still undefined. This review summarizes and re-evaluates the published data with the anthracylines doxorubicin, epirubicin (4'-epi-doxorubicin), daunorubicin (idarubicin), aclarubicin, and pirarubicin. The studies were identified by MEDLINE-search and analysis of the references cited in the identified articles and reviews covering this subject. First-line therapy: Studies from the 70ies could demonstrate that doxorubicin was as effective as alkylating agents. The combination of anthracylines and alkylating agents provided superior results compared with alkylating agents alone. Further improvements were gained by the introduction of platinum-anthracyline combination regimens. Doxorubicin and epirubicin showed comparable activity when combined with platinum. The comparison between platinum-anthracyline containing combination regimens with platinum based regimens without anthracylines did not provide definitive answers. The majority of studies (with relatively small patient numbers) did not reveal any significant benefit for the anthracyline containing regimens. In contrast, four meta-analyses combining several studies showed a significant improvement when anthracylines were added to platinum based regimens. This question came up again when standard treatment for ovarian cancer was modified by the introduction of paclitaxel in the mid 90ies. Currently, two randomized large intergroup trials evaluate the role of anthracyclines in combination with platinum and paclitaxel. Results from these studies will be available in 1-2 years and might help to describe the role for anthracyclines in ovarian cancer treatment more precisely. Until then, the use of anthracyclines in upfront chemotherapy of ovarian cancer outside of clinical trials cannot be recommended. 2n-line therapy: The anthracyclines doxorubicin and epirubicin are among the most active single agents for the treatment of platinum refractory ovarian cancer. Both agents achieved tumor responses in up to 25%. Preliminary data suggest, that the combination with paclitaxel could increase efficacy. No such effect was reported for any other combination. In contrast, single agent anthracyclines cannot be recommended for treatment of platinum sensitive tumors. However, combining anthracyclines with platinum resulted in remarkable response rates of more than 50% of patients with platinum sensitive tumors. Only few studies report the use of anthracylines after platinum and paclitaxel containing first-line chemotherapy. Preliminary data from small studies (40 patients) suggest that anthracyclines showed activity in this particular population. No final conclusions can be drawn. There is a need for developing effective 2nd-line therapies for patients failing platinum and paclitaxel combination regimens. Among others, anthracyclines should be evaluated in this clinical setting.

Treatment of cancer with chemotherapy is becoming increasingly more effective but is associated with short and long-term side effects. Oral side effects remain a major source of illness despite the use of a variety of agents to prevent them.

To compare luteinizing hormone-releasing hormone (LHRH) agonists with orchiectomy or diethylstilbestrol, and to compare antiandrogens with any of these three alternatives.

The effects of acupuncture on health are generally hard to assess. Stimulation of the P6 acupuncture point is used to obtain an antiemetic effect and this provides an excellent model to study the efficacy of acupuncture. Thirty-three controlled trials have been published worldwide in which the P6 acupuncture point was stimulated for treatment of nausea and/or vomiting associated with chemotherapy, pregnancy, or surgery. P6 acupuncture was equal or inferior to control in all four trials in which it was administered under anaesthesia; in 27 of the remaining 29 trials acupuncture was statistically superior. A second analysis was restricted to 12 high-quality randomized placebo-controlled trials in which P6 acupuncture point stimulation was not administered under anaesthesia. Eleven of these trials, involving nearly 2000 patients, showed an effect of P6. The reviewed papers showed consistent results across different investigators, different groups of patients, and different forms of acupuncture point stimulation. Except when administered under anaesthesia, P6 acupuncture point stimulation seems to be an effective antiemetic technique. Researchers are faced with a choice between deciding that acupuncture does have specific effects, and changing from 'Does acupuncture work?' to a set of more practical questions; or deciding that the evidence on P6 antiemesis does not provide sufficient proof, and specifying what would constitute acceptable evidence.

Agents commonly used in the treatment of neoplastic diseases may impair pulmonary function, and a wide spectrum of agents are currently implicated as toxic to the pulmonary system. Agents most commonly implicated are bleomycin, carmustine, busulfan, methotrexate, and thoracic radiotherapy. Less commonly implicated agents include mitomycin, procarbazine, melphalan, chlorambucil, and cyclophosphamide. Therapeutic interactions at time of operation and postoperatively may exacerbate existing pulmonary damage. It is imperative for the physicians treating patients receiving antineoplastic therapy to recognize potentially dangerous therapeutic interactions, and adjust the therapeutic regimen accordingly. Concentrations of inspired oxygen must be maintained as low as is safely possible. Intraoperative monitoring of arterial and mixed venous oxygen tensions will enable the clinician to adjust inspired oxygen concentrations to the lowest possible level while maintaining adequate oxygen tensions to the tissues. A systematic review of antineoplastic agents currently implicated, drug-oxygen interactions, and a review of the pathophysiology are presented.