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NEW YORK--Pain is highly prevalent in patients with HIV disease. Yet clinicians are often afraid to prescribe opioids when the patient is a former substance abuser, William Breitbart, MD, said at a conference on chemical dependency and pain management.

WASHINGTON--Cancer advocacy groups, institutions, publishers, and professional organizations are rapidly making the World Wide Web a major source of cancer and other health-related information.

NEW YORK--About 60% of the US population dies in the hospital, and many have questioned whether hospitals are the best place to care for the dying. However, the hospital setting offers many advantages, Myra Glajchen, DSW, said during a teleconference sponsored by Cancer Care Inc.

Mycobacterial cell wall therapy may be an alternative to BCG in the treatment of carcinoma in situ (CIS) of the bladder, Dr. Alvaro Morales, of Queen's University, Kingston, Ontario, reported at the AUA meeting.

ROCKVILLE, Md--Last year, the National Cancer Institute established the Office of Cancer Survivorship, and NCI director Richard D. Klausner, MD, named Anna T. Meadows, MD, to head its efforts to explore issues of the physical, psychological, and economic well being of cancer patients.

NEW YORK--A hospice is not a place but, rather, a point of view, Paul Brenner, MDiv, said during a teleconference sponsored by Cancer Care Inc. "Hospice care can take place in different settings: home, hospital, or hospice," he said. It is hospice's fundamental assumption--that the end of life is a normal and valued part of human development--that sets it apart from other health care services.

SAN DIEGO--Genetically engineered bacteria have the potential to deliver anticancer genes directly to a tumor site, according to four presentations of preclinical data at the American Association for Cancer Research (AACR) annual meeting.

CHICAGO--Despite an overall trend toward breast conservation, many breast cancer authorities believe that ductal carcinoma in situ (DCIS) too often is treated by mastectomy, and that axillary dissection and irradiation frequently are performed unnecessarily.

WASHINGTON--The American Cancer Society (ACS) has initiated a new, long-term advocacy program aimed at enhancing its influence on federal and state government actions that affect efforts to eliminate cancer.

SAN DIEGO--So little is known about cell cycling that a new study on a possible mechanism for why cells fail to exit the cell cycle was termed the "most exciting presentation" of the American Association for Cancer Research's 88th annual meeting. Stephen H. Friend, MD, of the Fred Hutchinson Cancer Research Center, made the comment at a press briefing held at the meeting.

KANSAS CITY, Mo--Hoechst Marion Roussel is offering research grants totaling nearly $500,000 to fund health economics and outcomes studies through its 1997 ACCORD (A Company-wide Commitment to Outcomes Research and Development) program.

ASCO--As the country awaits a Supreme Court decision on the constitutionality of state laws forbidding physician-assisted suicide, two physicians presented both sides of the debate at an ASCO session on end-of-life issues.

Studies presented at the annual meeting of the American Urological Association (AUA) in New Orleans show positive results for the treatment of early-stage prostate cancer using brachytherapy or "seeding." The studies, conducted by Nelson

WASHINGTON-- The federal government should revise its system for funding the training of physicians, to help cut costs and adapt to ongoing changes in health care delivery, says a report from the Institute of Medicine (IOM) at the National Academy of Sciences.

Drs. Buatti and Marcus concisely review the clinical presentation, diagnosis, and current management of pituitary adenomas. It would be difficult, if not impossible, for a brief review article to cover in depth all of the areas of controversy for such a broad subject. Consequently, several supplementary comments are in order.

Johnson and Goldberg provide a comprehensive review of the management of the Pancoast tumor, a bronchogenic carcinoma located in the superior pulmonary sulcus. Due to this specific location, Pancoast tumors can invade nerves, blood vessels, and musculoskeletal structures located at the level of the thoracic inlet. Such invasion can produce a wide range of clinical signs and symptoms, recognized as the Pancoast syndrome.

The Agency for Health Care Policy and Research established a forum for quality and effectiveness in health care under which practice guidelines were to be evaluated. The groups involved in this forum turned to the Institute of Medicine to evaluate the

In a well-written and focused article, Drs. Buatti and Marcus review the diagnosis and treatment of pituitary adenomas.

The US blood system is a vast network comprised of approximately 190 regional blood centers, which collect 90% of the nation's blood, and 621 hospital blood centers, which collect the remaining 10%.[1] Many of the regional blood centers are operated by the American Red Cross, which collects approximately 45% of the blood in the United States.[2]

Dr. Paulino provides a concise yet complete review of the radiotherapeutic management of patients with medulloblastoma. Radiotherapy treatment planning for medulloblastoma is complex, requires considerable attention to detail, and remains the subject of debate and clinical research. Clearly, this is an area of neuro-oncology in which multidisciplinary research has played a significant role in improving survival for children and young adults with this disease.

The prognosis for patients with newly diagnosed medulloblastoma has improved dramatically over the past several decades. In contrast to the dismal results of treatment during the first half of the 20th century, current 5-year survival rates of better than 50% are now being reported, and certain subsets of patients have more than a 70% chance of long-term disease-free survival.[1,2] Although neurosurgeons and radiation oncologists have proposed that this improvement is due to advances in their respective specialties, probably multiple factors are involved.

Although craniospinal irradiation has been employed in children with medulloblastoma for the past 40 years, many issues concerning its use have been raised and examined, and some continue to be debated. Careful radiation technique includes adequate irradiation of the neuraxis with special attention to the cribriform plate region and termination of the thecal sac. Conventional-dose craniospinal radiation therapy, in combination with chemotherapy, is currently recommended for patients with high-risk medulloblastoma. The appropriate dose of radiation to the craniospinal axis when this modality is combined with chemotherapy for low-risk medulloblastoma remains to be defined. Long-term results of hyperfractionated radiation therapy are likewise awaited. In an effort to decrease late toxicity to the immature central nervous system, radiation therapy can be delayed in a proportion of infants by administering chemotherapy after maximal tumor debulking. [ONCOLOGY 11(6):813-823, 1997]

Pituitary adenomas are benign neoplasms that can be effectively managed by a variety of therapeutic options. The clinician's goal in managing patients with these tumors should be to minimize the morbidity of each intervention used in diagnosis and treatment. Standard diagnostic interventions include MRI, hormonal assessment, and tissue diagnosis. Therapies include transsphenoidal surgery, external-beam radiotherapy, newer stereotactic irradiation techniques, and medical management. Appropriate treatment selection requires detailed knowledge of the expected outcomes and side effects of each option. Newer and perhaps less toxic treatment techniques are evolving and require further evaluation. [ONCOLOGY 11(6):791-796, 1997]

The relatively recent introduction of a new class of chemotherapeutic agents--the taxoids--has raised hope of improved survival for patients with advanced or metastatic cancer. Following encouraging preclinical results of taxoid combinations, this phase I, nonrandomized trial was designed to evaluate a 1-hour intravenous infusion of docetaxel (Taxotere) on day 1 combined with fluorouracil (5-FU) as a daily intravenous bolus for 5 consecutive days.

Tumors of the superior pulmonary sulcus (Pancoast tumors) are bronchogenic carcinomas that occur at the thoracic inlet and typically involve, by direct extension, the lower trunks of the brachial plexus, the intercostal nerves, the stellate ganglion, and adjacent ribs and vertebrae. These tumors are rare, comprising 5% of all lung cancers. Treatment of Pancoast tumors has traditionally consisted of preoperative radiation to a dose of 3,000 to 4,500 cGy followed by surgical resection. Overall 5-year survival rates range from 30% to 50%. Even if treatment achieves local disease control, distant failure (brain or bone) is common. Recent treatment efforts have focused on the use of induction chemoradiation followed by surgery and further chemotherapy. This combined-modality approach may become the new treatment paradigm for Pancoast tumors. [ONCOLOGY 11(6):781-785, 1997]

BETHESDA, Md--A new analysis of data from five large studies of smoking and health, which involved a total of nearly 2.75 million participants, reveals that mortality risks associated with cigarette smoking have surged over the last four decades, particularly for women.

BOSTON--Advances in three fields--imaging, medical physics, and computer technology--have led to the development of a radiation therapy modality that may represent a significant breakthrough in cancer treatment.

COLUMBUS, Ohio--Standardized descriptions of mammographic findings and standardized reporting of final assessments continue to play an important role in improving the predictive value of mammography, Lawrence W. Bassett, MD, said at the Ohio State University James Cancer Hospital and Research Institute's Third Oncology Update.

WASHINGTON--With regional hospital partnerships on the rise, cancer program administrators often find themselves charged with managing multi-institutional programs melded together within a system. Three middle managers who have been through such transformations offered their insider views at the Association of Community Cancer Centers (ACCC) meeting.

PARIS--Low-dose therapy with the differentiation-inducing agent azaciti-dine is transforming the formerly bleak prognosis for preleukemic myelodys-plastic syndrome (MDS), reported James Holland, MD, of Mount Sinai Medical Center, NY, at the Seventh International Congress on Anti-Cancer Treatment.