Science  18 Feb 2011:
Vol. 331, Issue 6019, pp. 830

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  1. Lymph Node Surgery Unnecessary for Early Breast Cancer

    The century-old surgical practice of removing lymph nodes from breast cancer patients is likely unnecessary, says a new study in the 9 February issue of The Journal of the American Medical Association. Conventional wisdom has been that after a biopsy from a sentinel lymph node finds cancer, removal of all the armpit lymph nodes before they can spread the disease throughout the body would increase survival. But researchers at John Wayne Cancer Institute in Santa Monica, California, and other institutions found no difference in survival or clinical outcomes in a randomized trial of 891 women with early-stage breast cancer who were undergoing chemotherapy or radiation. Half of the women had only the sentinel node removed, whereas the others had all their lymph nodes removed.

    The authors credit the results to aggressive therapy that wiped out the cancer before it could spread from the lymph nodes. They recommend that physicians reconsider the need for the painful surgery, which can have complications such as swelling and infection—although persuading the field to change could be tough because the practice is so ingrained. Even so, several cancer clinics such as Memorial Sloan-Kettering, where some of the trials took place, have already started to implement the new standard.

  2. Fetal Surgery Success


    Fetal surgery can help unborn babies with spina bifida—but at a price. Although most fetal surgeries focus on fatal malformations, spina bifida is an exception: Children with it often have trouble walking and controlling bladder and bowel functions, but they rarely die. Because of the risks to mother and baby, surgeons felt it was especially important to test spina bifida fetal surgery in a big clinical trial.

    Last week, a team led by N. Scott Adzick of Children's Hospital of Philadelphia reported online in The New England Journal of Medicine that among 158 mothers and their babies, those who were operated on before birth fared better than those who got surgery immediately after. Forty percent of the fetal surgery group received shunts to drain fluid from the brain, and 42% could walk without help from devices. That compared with 82% in the control group who got shunts, and 21% who could walk without assistance.

    But nearly half of the babies who experienced fetal surgery were born quite prematurely, and there were other risks to mom and baby, too. Some say it may take years, tracking the children as they grow, to really understand when and whether the surgery is worth it.

  3. Probing the Secrets of Prostate Tumors

    A group of researchers has unveiled the first whole genome sequences of prostate tumors. Their results, published online last week in Nature, may lead to the development of more efficient, less invasive ways to diagnose and treat this cancer.

    Sequencing the whole genome of a prostate tumor, says co-author Levi Garraway of Harvard Medical School in Boston, allowed the researchers to see “biology that would have been invisible with any other method.” Most genetic analyses of tumors have focused on figuring out which mutations turn normal cells cancerous and how these “spelling errors” foster tumor growth.

    But by sequencing the entire genomes of seven prostate tumors and comparing them with genomes from the patients' normal cells, the researchers discovered an unexpected phenomenon. Rather than single spelling errors, the tumors had long “paragraphs” of DNA that seem to have broken off and moved to another part of the genome. The chunks of DNA that broke off all contained genes that help drive cancer progression, and they moved to prime locations in the genome where they would be most active. The authors note that they need to sequence more prostate tumors to learn how frequently different mutations occur and which of the rearranged genes drive cancer.

    Once researchers learn which genes may be markers for cancer, says co-author Mark Rubin, a pathologist at Weill Cornell Medical College in New York City, sequencing technology might be able to detect them in a blood or urine test, replacing an invasive prostate exam or biopsy.

  4. Outcast Planets Could Support Life

    Many astronomers assume a planet that harbors life would have to be warm and wet like Earth. Now, in a paper submitted to The Astrophysical Journal Letters, Dorian Abbot and Eric Switzer of the University of Chicago in Illinois suggest that a planet that has been slingshotted into the cold of outer space could also support life—in a hidden ocean under a blanket of ice, kept warm by geothermal activity.

    Abbot and Switzer simulated a lone planet between 1/10 and 10 times the size of Earth. They calculated that a planet with Earth's composition of rock and water but three times as big would, in spite of losing heat through its icy shell, generate enough warmth to maintain a hidden ocean. A planet with much more water, they say, would only need to be one-third Earth's size.

    David Ehrenreich, a planetary scientist at the Joseph Fourier University in Grenoble, France, calls the study interesting but notes that life buried under an ice sheet would be hard to detect. So would the planet itself, admits Switzer: Rogue planets are currently visible only within about 100 billion miles of Earth, where the probability of one existing is just one in a billion.