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This Week in JAMA: Apr 18, 2012

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In JAMA this week, researchers at the Dana-Farber Cancer Institute report on the efficacy of adding bevacizumab to carboplatin and paclitaxel to improve survival in older patients with non-small-cell lung cancer. The team retrospectively studied 4,168 patients aged 65 or older with stage IIIB or stage IV non-squamous cell non-small-cell lung cancer. They treated the patients with either a carboplatin-paclitaxel combination, or all three drugs in combination, and found that adding bevacizumab did not significantly increase survival times. "Neither multivariable nor propensity score-adjusted Cox models demonstrated a survival advantage for bevacizumab-carboplatin-paclitaxel compared with carboplatin-paclitaxel cohorts," the authors write. "The propensity score-weighted model and propensity score-matching model similarly failed to demonstrate a statistically significant superiority for bevacizumab-carboplatin-paclitaxel. Subgroup and sensitivity analyses for key variables did not change these findings."

Also in JAMA this week, a team led by researchers at the University of Michigan report on differences in the long-term survival of older kidney cancer patients following partial or radical nephrectomy. The team retrospectively studied 7,138 early-stage kidney cancer patients, 27 percent of whom were treated with partial nephrectomy and 73 percent of whom were treated with radical nephrectomy. At a median follow up of 62 months, 25.3 percent of the patients who had undergone partial nephrectomy died, compared to 41.5 percent of the patients who had undergone radical nephrectomy, the team found. "Patients treated with partial nephrectomy had a significantly lower risk of death," the researchers add. "This corresponded with a predicted survival increase with partial nephrectomy. … No difference was noted in kidney cancer-specific survival."

Finally in JAMA this week, researchers at the University of North Carolina at Chapel Hill report on the efficacy of various radiation therapies for the treatment of localized prostate cancer. The team analyzed data from patients with non-metastatic prostate cancer who had been treated with either intensity-modulated radiation therapy, proton therapy, or conformal radiation therapy, and found that men who had received intensity-modulated radiation therapy were less likely to have gastrointestinal morbidities and hip fractures than men treated with conformal radiation therapy. However, the researchers add, intensity-modulated radiation therapy was associated with more diagnoses of erectile dysfunction than conformal radiation therapy. "Intensity-modulated radiation therapy patients were less likely to receive additional cancer therapy," the authors write. Further, intensity-modulated radiation therapy was also associated with less gastrointestinal morbidity when compared to proton therapy.

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