ONCOLOGY Vol 9 No 7

Payment for bone marrow transplant (BMT) therapy for breast cancer from a managed care perspective will be influenced by clinical arguments put forth by research and clinical communities, outcomes measures over time, and the subscription

Increasing numbers of Americans are using smokeless tobacco, because they think it is a safe alternative to cigarettes. Upcoming federal guidelines on smoking prevention and cessation should include information about the health risks

adiation therapy before surgery increases survival without increasing long-term complications for patients with rectal cancer, according to a 10-year study at Tufts University presented at the recent meeting of the American Radium Society. Resection

New statistics from the Centers for Disease Control and Prevention (CDC) show Utah and Nevada (so close in proximity, so distant in life-style) at the top and bottom, respectively, of a ranking of states by smoking-related mortality (see table). The

Radioimmunotherapy with an iodine 131-labeled monoclonal antibody shows promise in two applications in patients with myeloid leukemias: as cytoreductive therapy prior to bone marrow transplantation and for reduction of minimal residual

In a preliminary analysis of a study of more than 800 patients with early-stage cancer, researchers found that those who gave a negative self-appraisal of their situation and their ability to cope were more likely to develop affective disorders during the

Scientists have developed a technique for evaluating the potency of an AIDS patient's T4 lymphocytes. Preliminary findings indicate the new test may provide HIV-positive patients with a more accurate prognosis than current

A dose-intensive outpatient regimen of doxorubicin and CMF (cyclophosphamide, methotrexate, and fluorouracil) with growth factor support proved to be effective and well tolerated in women with advanced breast cancer, Mark L. Graham,

Surviving Childhood Cancer, A Guide for Families" meets a tremendous need for easy-to-read, simple-to-understand information about the childhood cancer experience. All too often health-care professionals myopically focus attention and

The venerable recommended dietary allowances (RDAs) for vitamins and other nutrients could soon have a strikingly different look based on a new--and more activist--concept of what they are supposed to accomplish.

Within the next 2 years, peripheral blood will replace bone marrow as the medium for autologous transplants, predicted Malcolm A.S. Moore, DPhil, at a press briefing co-sponsored by the Cancer Research Institute and Immunex Corporation.

In this issue, Harrison et al give the rationale for intraoperative high-dose-rate brachytherapy (IOHDR) and provide an excellent summary of the Memorial Sloan-Kettering Cancer Center (MSKCC) experience with this treatment. Intraoperative high-dose-rate brachytherapy is used in very few centers [1-4], and its worldwide use has been recently summarized [5,6]. Although our experience with IOHDR at Ohio State University parallels that of Harrison et al in some respects, it differs in others. I will highlight these differences to give readers a more balanced view of IOHDR.

Since 1995 represents the 20th anniversary of Kohler and Milstein's description of the hybridoma/monoclonal antibody technology, it is an appropriate time to take stock of progress in this area. The article by Harrison and Tempero provides a useful review and update of the field of monoclonal antibody imaging in this anniversary year.

Intraoperative radiation therapy (IORT) has the obvious advantage of maximally irradiating the tumor bed while eliminating surrounding normal organs from the field of radiation. This approach has been especially useful when the required radiation dose exceeds the tolerance dose of the surrounding normal tissues. However, the application of IORT has been significantly limited by cost, logistic issues, and technical problems related to delivering treatment to difficult anatomic areas. We have developed a new approach to IORT that obviates the need for patient transport: In a dedicated, shielded operating room, the surgery is performed and IORT is delivered via HDR remote afterloading. We have found this approach to be cost effective, logistically sound, and suitable for a wide range of anatomic sites. The technical aspects of the procedure, as well our preliminary results in colorectal cancer, will be presented. Lastly, the authors present the technical aspects of delivering HDR intraoperative brachytherapy, their dosimetry atlas, and their results using HDR-IORT in the treatment of patients with colorectal cancer[ONCOLOGY 9(7):679-683, 1995]

This new topic, practice guidelines in oncology, has emerged for one primary reason-managed care. Now that insurance companies have developed the software to measure wide variations in practice behavior, they have quickly realized that

The excellent review by Drs. Takimoto and Allegra summarizes the current status of the new antifolates in clinical development. Based on knowledge of why methotrexate is ineffective in the treatment of many tumors (ie, either intrinsic or acquired resistance), and on the identification of new targets for folate inhibitors (eg, thymidylate synthase [TS] and glycinamide ribonucleotide [GAR] transformylase), new antifolate development has recently received a great deal of attention from both industry and academic centers.

It is somewhat bittersweet that an article about the need for cancer guidelines is being written in 1995. On the one hand, it is heartening that Dr. Winn has patiently organized a coherent framework for creating and implementing guidelines. On the other hand, it is quite bitter medicine to realize, as Dr. Winn points out, that even today, "follow-up studies.... have not been able to

Antibodies against a variety of tumor-associated antigens have been studied, as well as a number of modifications to the antibodies themselves, including Fab' fragments and chimeric, humanized, and human

Drs. Takimoto and Allegra present a comprehensive overview of the development of antifolates over the past decade and a half. The antifolates are antimetabolite antineoplastic agents that are structurally and chemically similar to naturally occurring folates required for the synthesis of purines and pyrimidines. These drugs interfere with DNA synthesis by inhibiting key enzymes. They are transported across the plasma membrane and converted intracellularly to cytotoxic species, which must compete with endogenous substrates for target enzyme binding.

Numerous new antifolate drugs have been developed in an attempt to overcome the potential mechanisms of tumor cell resistance to methotrexate, which can include decreased drug transport into cells; decreased

In this comprehensive review of a pilot study, Dr. Harrison and colleagues at Memorial Sloan-Kettering Cancer Center (MSKCC) describe a new intraoperative radiation treatment, its technical details, early results, and complications. This new treatment, high-dose-rate intraoperative radiotherapy using a remote afterloading technique (HDR-IORT), is being explored in a number of major centers in the United States and abroad. My comments below will focus on Dr. Harrison's technique. In addition, data from the MSKCC pilot study as well as information from other centers are summarized in Tables 1 and 2.

A large number of organizations are currently developing practice guidelines in oncology. These include federal agencies; medical societies and groups, including both oncologic and nononcologic specialty societies; and

The development of cancer imaging with radiolabeled antibodies, or radioimmunodetection (RAID), has spanned at least 2 decades, if we begin dating this from the use of antibodies made against human tumor-associated antigens, such as oncofetal