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PHILADELPHIA--When practice guidelines or pathways take financial considerations into account, they may be termed clinical financial pathways (CFPs). This technique was developed by Kent Giles, MPPM, vice president of development at PhyMatrix, a physician management company headquartered in West Palm Beach, Fla, and is currently being utilized by PhyMatrix to reduce unnecessary medical costs.

NEW YORK--All physicians, regardless of their specialty, must be prepared to treat HIV-infected patients, according to an expert from the Centers for Disease Control and Prevention. Although fears of nosocomial transmission of the virus are not unwarranted, much can be done to avoid it.

his excellent review analyzes ophthalmologic complications following high-dose irradiation of the orbit and surrounding structures as a necessary adjunct to the treatment of patients with carcinomas of the head and neck region. It confirms the critical importance of dose-fraction size in the production of radiation complications, especially in nerve tissue.

The failure to contain health-care costs and curtail growth is a growing national economic concern and public policy issue. The marketplace is rapidly changing how health care is paid for by moving from fee-for-service mechanisms to prospective payment, diagnosis-related groups, and increasing exclusion of some treatment(s).

Parsons and colleagues present an excellent summary of their clinical experience with ocular complications of radiotherapy for primary periocular malignancies, together with a retrospective review of the literature on this subject. The authors emphasize the roles of both total dose and dose-per-fraction in radiation-associated eye complications.

pplication of the techniques of flow cytometry and image analysis to quantitation of DNA and estimation of events in the cell cycle in human tumors has achieved considerable popularity as a laboratory procedure but so far has failed to be of practical clinical value. As brilliantly summarized by Dr. Ross, retrospective studies have repeatedly shown abnormal DNA values to be of prognostic significance in several organ systems, among them, tumors of the urothelium [1] and prostate [2] and, perhaps to a lesser extent, mammary carcinomas [3].

This comprehensive report summarizes the current management of primary liver cancer and of metastatic colorectal cancer in the liver. Numerous tests to help define the location and stage of disease have been evaluated. It now appears that spiral CT with arterial portography is superior to other nonoperative methods in evaluating liver tumors. Immunoscintography using monoclonal antibodies is currently under development and appears to be of potential great value. Subclinical, micrometastatic disease is the bane of all efforts at surgical control of cancer. An ability to detect this would have far-reaching consequences. Complete evaluation of patients with these diseases must include a medical evaluation, including liver function tests and a chest CT. Particular attention must also be paid to cardiac, pulmonary, and renal function.

That nucleic acids can be measured spectrophotometrically in intact, fixed, or viable single cells was demonstrated in a series of publications by Caspersson in the 1930s and '40s, culminating in his now classic monograph [1]. In that paper, Caspersson demonstrated an increase in nucleic acid content in proliferating vs resting cells and malignant vs benign cells. However, although his measurements of ultraviolet absorption were specific for nucleic acids, the absorption maximums for DNA and RNA were too close to be distinguished. Probably, he was measuring differences in RNA, which are more striking than differences in DNA.

The article by Dr. Ross provides an overview of the current status of the medical literature regarding the role of DNA ploidy and cell cycle analysis in cancer diagnosis and patient prognosis. The scope of the article is quite broad, covering virtually every organ system and, as such, provides only a brief summary of the data in each diagnostic category. From these data, there is general agreement about the value of detection of aneuploidy in tumor specimens but a lack of consensus about the importance of cell proliferation analyses, such as S-phase fraction (SPF) measurements. This conclusion reflects the inherent variability in the two determinations. Detection of aneuploidy by analytic cytometry is reliable; it is accurate and depends upon the specimen (frozen vs formaldehyde- fixed, presence of necrosis, cellularity) as well as the quality of specimen preparation. Thus, DNA ploidy analysis can easily be standardized, minimizing intralaboratory variation. Cell cycle analysis, however, is more complex and as yet is not standardized.

Dr. Sardi and colleagues lay out, in a clear and concise fashion, current alternatives for the management of primary and metastatic liver tumors. Their emphasis on "high-value" treatments is crucial. In this group of patients, unnecessary treatments not only are costly in terms of dollars but also reduce the quality of the short life remaining in patients with unresectable disease.

Primary and metastatic liver tumors continue to be a significant health problem in the United States. Hepatic resection or, in selected cases, transplantation are the only curative therapies for patients with resectable

Historically, new therapeutic strategies for cancer have been evaluated on the basis of safety and clinical efficacy. However, the current national emphasis on efficiency of resource allocation has led to the inclusion of economic assessments in oncology studies. Economic assessments measure patients' health status and resource consumption associated with a therapeutic strategy, and combine these in a cost-effectiveness analysis. Study design can include prospective analysis of clinical trials, retrospective analysis of a clinical trial or administrative databases, or a decision analytic model. Economic analysis is being used increasingly in oncology and will continue to provide meaningful data to assist clinicians in determining the optimal treatment strategies for cancer patients and to help inform health policy decision-makers about the importance of specific cancer therapeutic strategies. [ONCOLOGY 9(6):523-538, 1995]

Radiation therapy of tumors near the eye or optic nerves often requires incidental irradiation of these structures, even when they are not clinically involved by tumor. Depending on the radiation treatment volume and dose required, radiation injury to the lens, lacrimal apparatus, retina, or optic nerve may result. The time to expression and severity of injury are dose-dependent. This paper reviews the results of 157 patients who were followed for a minimum of 3 years after radiotherapy for primary extracranial tumors at the University of Florida, in which the lacrimal gland, lens, retina, and/or optic nerve(s) received irradiation. This review shows that, after treatment at approximately 1.8 to 2.0 Gy per fraction, the incidence of severe dry-eye syndrome, retinopathy, and optic neuropathy appears to increase steeply after doses of 40, 50, and 60 Gy, respectively. [ONCOLOGY 10(6):837-852, 1996]

WASHINGTON--Put GAR in your patients' records. It can prove extremely useful should you find yourself being sued for medical malpractice, Marvin A. Dewar, MD, JD, said at the National Conference on Prevention and Early Detection, sponsored by the American Cancer Society.

This review focuses on the clinical utility and potential value of cell cycle analysis and DNA ploidy interpretation in the diagnosis of human tumors, the application of these techniques to cytologic diagnosis, and their capability

CARDIFF, Wales--Breast imaging studies can proceed immediately after fine-needle aspiration (FNA) cytology without concern that the biopsy procedure will distort tissue architecture and compromise diagnostic accuracy, said Neil Fenn, MD, a breast disease specialist at the University of Wales.

Pediatric Cancer Guidelines Are a National Effort

WASHINGTON--The Environmental Protection Agency (EPA) is proposing that scientists rely less on animal testing and more on microbiological studies in calculating the cancer risk of chemicals and pollutants. The new regulations would place more emphasis on how chemicals actually affect human cells.

BOTHELL, Wash--A High Definition Imaging (HDI) digital ultrasound system from Advanced Technology Laboratories (ATL) has been granted FDA approval for a new indication--adjuvant use with mammog-raphy and physical examination to help physicians determine if a biopsy is necessary after discovery of a suspicious breast lesion.

Radiation therapy targeted at the cellular level can halt the advance of lymphoma while avoiding the major drawbacks of chemotherapy, according to a Stanford University study in the March 1996 issue of Clinical Cancer Research.

BETHESDA, Md--Although only 10 mg/day of vitamin C is enough to prevent deficiency, the optimal daily intake is probably 200 mg, according to results of a new NIH-sponsored study. The current Recommended Dietary Allowance (RDA) is 60 mg.

NEW YORK--The more that is learned about the natural history of the human immunodeficiency virus (HIV), the stronger the case for early intervention. Recent research confirms "the notion that HIV infection is a dynamic process throughout the course of infection," said H. Clifford Lane, MD, clinical director, National Institute of Allergy and Infectious Diseases (NIAID).

Meriden, Conn--A 5-year study at Walter Reed Army Institute of Research found no significant clinical benefit for patients receiving MicroGenesys, Inc's therapeutic AIDS vaccine,VaxSyn rpg 160,compared with placebo, the company has announced.

WASHINGTON--Representative John Edward Porter of Illinois has received an American Academy of Otolaryngology--Head and Neck Surgery, Inc. award for "superb legislative leadership for medical research."

WASHINGTON--Caring for patients and conducting research in the age of managed care raises tough problems for all involved, said Peter Quesenberry, MD, director, University of Massachusetts Cancer Center, Worcester. "How can we assure access to treatment, support research, and still be cost effective?"

On May 26, 1995, Philip Morris USA* announced a voluntary recall of 36 cigarette product lines (approximately 8 billion cigarettes) because, during production, the company detected unusual tastes and peculiar odors and identified methyl

PRINCETON, NJ--Blenoxane (bleomycin), Bristol-Myers Squibb Co.'s anticancer agent, has received FDA clearance for a new indication as intrapleural therapy for the relief of symptoms resulting from malignant pleural effusion (MPE) and prevention of recurrent pleural effusions.

MARINA DEL REY, Calif--The changing reimbursement system in California provides a "real challenge" for academic institution to compete on cost with other area hospitals, said Robert B. Smith, MD, professor of surgery/urology, UCLA School of Medicine, at a conference cosponsored by the Clark Urological Cancer Center and the UCLA School of Medicine.

DUMONT, NJ--The Berlex On-cology Foundation is seeking applicants for two workshops: Epidemiology and Clinical Trial Design, to be held August 23-29, 1996, in Brewster, Mass, and The Clinical Pharmacology of Anticancer Drugs, which will take place October 4-8, 1996, in Leesburg, Va.

WASHINGTON--Community hospitals gain immensely in enhanced patient care when they form partnerships with universities, Allen S. Lichter, MD, said at the annual national meeting of the Association of Community Cancer Centers (ACCC). The benefits of such a joint venture, however, flow both ways, said Dr. Lichter, chairman of the Department of Radiation Oncology, University of Michigan.