One hundred forty-one patients with advanced breast cancer who had not received prior chemotherapy were randomly assigned to receive doxorubicin 60 mg/m2 or epirubicin 90 mg/m2 every 3 weeks. These doses were selected to produce equivalent toxicities. All patients were assessed for toxicity, and 138 patients were assessable for response. After a median of five treatment cycles, 47% (32 of 68) of doxorubicin-treated patients achieved a partial or complete response. Response duration and survival were 10 and 12 months for doxorubicin and 8 and 10 months for epirubicin, respectively. Noncardiac toxicities were similar for both drugs. Of 41 patients receiving doxorubicin who had serial left ventricular ejection fraction assessments, seven sustained a fall of 10% or more, and one patient developed congestive cardiac failure at a cumulative doxorubicin dose of 489 mg/m2. Of 39 patients receiving epirubicin who had serial cardiac assessments, five sustained left ventricular ejection fraction falls of 10% or more and two patients developed congestive cardiac failure at cumulative doses of 178 mg/m2 and 833 mg/m2. These data indicate that an epirubicin dose of 90 mg/m2 produces toxicity equivalent to doxorubicin 60 mg/m2 but does not improve response rates, response duration, or survival in advanced breast cancer.

The literature concerning the subcellular location of Y-box binding protein 1 (YB-1), its abundance in normal and cancer tissues, and its prognostic significance is replete with inconsistencies. An explanation for this could be due in part to the use of different antibodies in immunohistochemical and immunofluorescent labeling of cells and tissues. The inconsistencies could also be due to poor resolution of immunohistochemical data. We analyzed two cohorts of breast tumours for both abundance and subcellular location of YB-1 using three different antibodies; two targeting N-terminal epitopes (AB- a and AB- b) and another (AB- c) targeting a C-terminal epitope. We also investigated stress-induced nuclear translocation of YB-1 in cell culture. We report that both AB- a and AB- c detected increased YB-1 in the cytoplasm of high-grade breast cancers, and in those lacking estrogen and progesterone receptors; however the amount of YB-1 detected by AB- a in these cancers is significantly greater than that detected by AB- c. We confirm our previously published findings that AB- b is also detecting hnRNP A1, and cannot therefore be used to reliably detect YB-1 by immunohistochemistry. We also report that AB- a detected nuclear YB-1 in some tumour tissues and stress treated cells, whereas AB- c did not. To understand this, cancer cell lines were analyzed using native gel electrophoresis, which revealed that the antibodies detect different complexes in which YB-1 is a component. Our data suggest that different YB-1 antibodies show different staining patterns that are determined by the accessibility of epitopes, and this depends on the nature of the YB-1 complexes. It is important therefore to standardize the protocols if YB-1 is to be used reproducibly as a prognostic guide for different cancers.

A large amount of quality of life (QoL) information has been and is being collected in the oncology setting but it is unclear how such data influence decisions about the management of individual patients. A questionnaire designed specifically for the study was mailed to 260 senior oncologists to investigate how QoL data are being used outside the context of cancer clinical trials; replies were received from 154 (59%). Approximately 80% believed QoL information should be collected prior to the commencement of treatment, but less than 50% actually did so. Similarly, less than 50% assessed QoL as a method of monitoring the responses to treatment even when the treatment goal was palliation. The barriers to collecting such data were time and resource constraints, perceived lack of an appropriate instrument and a belief that QoL assessments were unnecessary. Other than making a subjective assessment based on examination and history, 73 (47%) used either standardized questionnaires or a system derived in their unit to assess the QoL of their patients. Given an appropriate instrument the majority believed that QoL data could be collected on a routine basis. The main barriers to collecting QoL data are logistic and the challenge remains to develop a method of collecting and analysing QoL information in a manner which enhances decision making.

Objective To re-evaluate a national prospective study in for relapse in this series. Only one relapse occurred >28 months after orchidectomy. Despite poor comNew Zealand after 17 years to define whether orchidectomy alone and surveillance for nonseminoma pliance in some patients (12%) their survival was not prejudiced. Three patients died from disease despite germ cell testicular tumour (NSGCTT) is a sound policy and matches the results achieved by other chemotherapy at relapse. At 17 years and a median follow-up of 53 months, 242 of the 248 men are treatment protocols. Patients and methods Between 1980 and 1997, 248 disease-free and the disease-specific survival rate is 98%. men with stage I NSGCTT, from six New Zealand centres, were managed by orchidectomy alone and Conclusions This study shows that orchidectomy alone and treatment of relapses produces excellent longsurveillance, with treatment of relapses using combination chemotherapy.term results without the adverse eCects associated with retroperitoneal node dissection or elective chemoResults Seventy of the 248 patients (28%) relapsed; 42 of 92 (46%) with vascular and/or lymphatic invasion therapy for high-risk cases. Keywords Stage I nonseminoma, testicular cancer, (VLI) in the primary tumour relapsed, whereas only 26 of 151 (17%) without this feature relapsed surveillance, long-term follow-up, orchidectomy (P<0.001). VLI was the only identifiable risk factor ommend that high-risk patients should be oCered adju-

Depression is highly prevalent in patients with advanced cancer, commonly affecting quality of life. Considering the response delay with conventional antidepressants and the short life expectancy for these patients, treatments for Major Depressive Disorder (MDD) with faster onset of action are desirable. In this case report, a female patient with metastatic ovarian cancer presented rapid and sustained response to intramuscular (IM) injections of ketamine (1mg/kg). Over a course of six treatments, her mood response was identical on each occasion and provided remission of her depressive symptoms. Pain was also improved, although for a shorter duration. These findings support the use of IM ketamine as a possible antidepressant option for this population.