Most hepatocellular carcinomas are diagnosed at intermediate or advanced stages, and only a minority of patients with tumors larger than 3 cm benefit from curative treatments. Radiofrequency thermal ablation (RFA) has been used effectively to treat small tumors, and some studies suggest that transarterial chemoembolization (TACE) improves survival in patients with hepatocellular carcinoma. To assess whether treating patients with TACE and RFA may offer a survival benefit, Cheng and colleagues Article randomly assigned 291 patients with hepatocellular carcinomas larger than 3 cm to treatment with TACE-RFA, TACE alone, or RFA alone. During a median 28.5 months of follow-up, median survival times were 37 months in the TACE-RFA group, 24 months in the TACE-alone group, and 22 months in the RFA-alone group. In an editorial, Zhu and Abou-Alfa Article discuss expanding treatment options for hepatocellular carcinoma.
Persons with type 2 diabetes have an increased risk of cardiovascular disease (CVD), and some data have suggested that setting low-density lipoprotein cholesterol (LDL-C) and blood pressure targets below those currently recommended might slow or reverse CVD progression. In the Stop Atherosclerosis in Native Diabetics Study (SANDS), Native American patients with type 2 diabetes were randomly assigned to aggressive treatment targets (LDL-C ≤ 70 mg/dL and systolic blood pressure [SBP] ≤115 mm Hg) or standard treatment targets (LDL-C ≤ 100 mg/dL and SBP ≤ 130 mm Hg), and the progression of subclinical atherosclerosis was assessed. Howard and colleagues Article report that compared with standard treatment targets, aggressive treatment targets were associated with regression of carotid intimal media thickness and greater decrease in left ventricular mass during the 3-year study. In an editorial, Peterson and Wang Article discuss the evidence regarding intensive risk factor lowering and primary prevention of CVD.
An effective, safe, and inexpensive therapy to maintain remission of Crohn disease is needed. Some evidence suggests that omega-3 free fatty acids are effective in treatment of some inflammatory disorders, although evidence for a beneficial effect in patients with Crohn disease is inconsistent. Feagan and colleagues report results of 2 multicenter randomized placebo-controlled studies, EPIC-1 (Epanova Program in Crohn’s) and EPIC-2, in which patients with quiescent Crohn disease were randomly assigned to receive either 4 g of omega-3 free fatty acids or placebo for up to 58 weeks. In an analysis of data from 738 patients, the investigators found that treatment with high-dose omega-3 free fatty acids was no more effective than placebo in preventing relapse of Crohn disease over 1 year of follow-up.
In a systematic review of data from randomized controlled trials, Zimmermann and colleagues examined the evidence for the effectiveness of specialized palliative care to improve patients' quality of life, increase patient and family satisfaction with care, and reduce economic cost.
“[H]ere was a 50-year-old woman with a wound that seemed so harsh and raw, cruelly robbing her of a vital piece of her external femininity.” From “Wound Healing.”
A new online tool aims to help primary care physicians in a variety of settings better assess fracture risk in patients with low bone mass.
Sharing interim clinical trial results
Iraqi refugee crisis
Join Laura P. Svetkey, MD, MHS, April 16, 2008, from 2 to 3 PM eastern time to discuss strategies for sustaining weight loss. To register, go to http://www.ihi.org/AuthorintheRoom.
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl
How would you manage a 50-year-old man with chronic low back pain? Go to www.jama.com to read the case and submit your response. Your response may be selected for online publication. Submission deadline is April 30.
For your patients: Information about Crohn disease.
This Week in JAMA . JAMA. 2008;299(14):1639. doi:10.1001/jama.299.14.1639