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Background: Gemcitabine is a potent radiosensitizer of pancreatic cancer cells. Concomitant full dose Gemcitabine and three dimensional conformal radiation to a small field is a novel approach to unresectable locally advanced pancreatic cancer. The aim of this study is to report the outcome, tolerability and toxicity of this combined therapy., Methods: A retrospective chart review, with survival data confirmed by the population registry and statistic analysis was performed with SPSS. Radiotherapy was planned using computerized tomography, treated only the gross tumor without regional lymph nodes and was delivered in 15 fractions of 2.4 Gy to a dose of 36 Gy. Gemcitabine was administered weekly during radiation at a dose of 1000 mg/m2. Gastrointestinal toxicity was scored according to the NCI Common Toxicity Criteria. Local control was assessed by RECIST criteria, a partial response defined as a decrease of at least 30% in the longest diameter of the tumor., Results: Eighteen of the 19 patients completed treatment as planned without the need for treatment break. Four patients subsequently developed severe grade III-IV gastrointestinal toxicity; 37% of patients achieved a partial response and 52% experienced significant clinical benefit. The median survival was 11.7 months., Discussion: Full dose gemcitabine with conformal 3-D radiotherapy to a small field was well tolerated and was associated with a low incidence of severe gastrointestinal toxicity compared with previous studies of combination therapy using standard large radiation portals which encompass both the tumor and the regional lymph nodes. A partial response was observed in over one third of patients, non-progression of the irradiated tumor in the rest with pain relief and clinical benefit in more than half the patients., Conclusion: This treatment approach was well tolerated with little morbidity and achieves outcomes equal to or better than other contemporary combination modality approaches.

Background: Gastrointestinal stromal tumor (GIST) is a rare gastrointestinal tumor. It is known to be resistant to radiotherapy and chemotherapy. The administration of imatinib mesylate, a tyrosine kinase inhibitor, resulted in a dramatic response and improved survival in patients with GIST. This study examined the long term response and side effects of imatinib treatment in Israeli patients with GIST., Patients and Methods: The study followed-up on 25 patients from various hospitals in Israel treated between the years 2001 and 2006. The mean follow-up time was 36.3 months (17-63 months)., Results: One patient achieved complete response, 13 patients (52%) achieved partial response, 9 patients (35%) achieved stable disease, and 2 patients did not have measurable disease. The median survival was not yet reached. Twelve patients (48%) had a decrease in the attenuation of the tumor into a cystic appearance. Eleven patients (44%) developed late resistance to the treatment (after 7-54 months). The median time to progression was not yet reached. The adverse events were mostly mild. Severe adverse events (grade 3-4 Common Toxicity Criteria (CTC)) occurred in 24% of the patients. There was no advantage regarding survival or time to progression for the patients who had partial response compared to those patients who had stable disease (P=0.39 and P=0.71 respectively)., Conclusions: Imatinib results in a dramatic response in patients with GIST, and is well tolerated. The introduction of new drugs such as sunitinib which is now in an advanced phase of clinical study, may provide additional solutions in the treatment of GIST.

Numerous studies have examined the association between body weight, nutritional factors, physical activity and the risk for primary breast cancer. Relatively few studies, however, have examined the associations between these issues and the recurrence of the disease and cure of the primary tumor. Today, three areas of focus are actively being researched for breast cancer survivors: body weight, diet composition and physical activity with specific emphasis on the risk for recurrence, survival and quality of life. Increased body weight or BMI (Body Mass Index) at diagnosis was found to be a significant risk factor for recurrent disease, decreased survival, or both. Overall obesity has been shown to adversely affect prognosis. Appropriate weight control may be particularly beneficial for breast cancer survivors. Breast cancer survivors should be encouraged to achieve and maintain a healthy weight. Limiting fat intake can reduce the risk of breast cancer recurrence. Increasing consumption of vegetables and fruits seems to have possible beneficial effects during and after treatments. To date physical activity after breast cancer diagnosis has been found to reduce the risk of death. The greatest benefit occurred in women who performed the equivalent of walking 3-5 hours per week at an average pace. Safe weight loss via increased physical activity and healthful food choices should be encouraged for normal, overweight or obese breast cancer survivors in order to improve survival and life quality.

Common gastrointestinal malignancies, including esophageal, gastric, pancreatic and colorectal cancer are among the leading causes of cancer morbidity and mortality worldwide. Modern surgical techniques, increasing use of endoscopic procedures, the use of new chemotherapy regimens and the development of novel biological therapies are among the major advances in the treatment of these malignancies that were achieved during the last years. In this review we provide an update of the current treatment of common gastrointestinal malignancies and focus on these recent advances.

Somatostatin is a short-acting natural peptide secreted by specialized cells in the GI tract, the central and peripheral nervous systems, and a variety of other tissues. Its many actions include suppression of the secretion of GH, TSH, GI hormones, and inhibition of GI exocrine secretion. A long-acting analogue developed by Sandoz (Sandostatin, SMS 201-995) has been used to treat acromegaly and neuroendocrine tumors. We report our experience with it in carcinoid tumors (4 cases), glucagonomas (2), gastrinoma (1), VIPoma (1) and nonfunctioning islet cell tumor (1). It was given by continuous subcutaneous infusion, using a small portable pump, in doses ranging from 300 to 1500 mcg/day, without significant side-effects. 7 of the 9 patients had complete relief of symptoms, and tumoral hormone secretion decreased in 4 of the 5 in whom it was measurable, but there was no evidence of tumor regression. SMS 201-995 is useful for the symptomatic treatment of patients with neuroendocrine gut tumors.