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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.

WASHINGTON--At its first public meeting, the new National Cancer Policy Board (NCPB) heard from a number of groups about the topics they believe should shape its early agenda. Not surprisingly, access to care proved a recurring theme, in one form or another.

NEW YORK--The development of guidelines for the management of psychological distress in cancer patients has lagged far behind that of treatment guidelines for specific cancers, said Jimmie Holland, MD, chair, Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center.

MIAMI BEACH, Fla--Few women who undergo voluntary bilateral mastec-tomy as a prophylactic measure have regrets about having the surgery performed, according to a survey of 322 women who had the procedure. Patrick Borgen, MD, chief of the Breast Service at Memorial Sloan-Kettering Cancer Center, presented the data at the 14th Annual International Breast Cancer Conference.

THOUSAND OAKS, Calif--A new formulation of Neupogen (filgrastim or G-CSF) that contains sorbitol instead of mannitol is now available from Amgen.

NEW YORK--Children's fears about needles and their physical pain during medical procedures are not being adequately managed, according to a Gallop telephone survey of 500 children (aged 6 to 14), 1,000 parents of children under 14 (not parents of the children surveyed), and 300 pediatricians.

Mayo Clinic study of patient-physician communication found that patients frequently do not remember what their doctor tells them.

Data presented at the Fourth Conference on Retroviruses and Opportunistic Infections showed that the blood-brain barrier permeability of nevirapine (Viramune) is superior to that of other antiretrovirals in both in vitro and in vivo animal models.

NEW YORK--Researchers are accumulating more evidence that diets rich in tomato products may prevent several types of cancer. Although the chemical components of tomatoes that have anticancer properties remain to be identified, investigators are hopeful that lycopene, a little-known carotenoid responsible for the tomato's red color, will prove an effective tool in cancer prevention.

WASHINGTON--In today's evolving health care system, on-cologists and oncology centers must reach out to primary care physicians as never before. And unaccustomed as oncology is to such marketing efforts, the ways to a primary care practitioner's trust and allegiance provoke more than a little puzzlement within the specialty, according to Sara Sprague, RN, EdD, director of cancer services, Phoenix Memorial Hospital. She summed up the important issues of oncologist/primary care physician relationships at a roundtable discussion during the Association of Community Cancer Centers meeting.

WASHINGTON--A consortium of 11 cancer centers is in the midst of a phase I dose-escalation study of carmus-tine in brain cancer patients, using Guilford Pharmaceutical's Gliadel Wafer as the drug delivery vehicle.

This paper offers a very good overview of a large topic that encompasses a multitude of tumors, each with its own set of controversial issues in terms of diagnosis and management. The authors discuss the various diagnostic and therapeutic options available for these tumors in a general sense, rather than concentrating on the specifics of each pathology. Although this approach certainly provides a satisfactory overview, it does not delineate the many diagnostic and therapeutic dilemmas that may confront the practicing head and neck surgeon. However, given the space limitations for such a paper, a more detailed discussion probably was infeasible.

FRANKLIN, Tenn--National Cancer Survivors Day 1997, the world's largest cancer survivor event, is set for Sunday, June 1. This 10th anniversary Celebration of Life will recognize America's 7.4 million cancer survivors and those who support them.

The Position Statement on the Use of Placebos for Pain Management in Patients with Cancer, developed recently by the Oncology Nursing Society (ONS), has been endorsed by 24 nursing and other healthcare organizations.

BUFFALO, NY--The Medicaid Managed Care Act of 1996 and the pending 1115B waiver in New York State would mandate that all Medicaid recipients be transferred to managed health care plans. (Such transfers are currently voluntary.) In New York State, more than 65% of persons with HIV are either in Medicaid or are Medicaid-pending.

CHICAGO--Cellular tumor bio-markers may be able to identify patients with N1 non-small-cell lung adenocarcin-oma who could achieve better survival and control of metastasis through aggressive adjuvant therapy, Ritsuko Komaki, MD, said at the Radiological Society of North America meeting.

NEW YORK--Good communication about the dying process can reduce fear and promote decision-making, but accurate information about resuscitation and artificial hydration and feeding is often not communicated, Judith C. Ahronheim, MD, said during a teleconference on communication of end-of-life issues organized by Cancer Care, Inc.

A test measuring the status of DNA multiplication in tumor cells (ploidy), along with other known predictors of treatment response, could provide guidance in selecting chemotherapy for infants with neuroblastoma, the most common childhood

PARIS--Detection rates of ductal carcinoma in situ (DCIS) have soared thanks to mammography but, to date, only one randomized trial has attempted to quell the resulting therapeutic turmoil. Now, eight-year follow-up results from that NSABP trial indicate that the advantages of breast irradiation following local excision continue to be maintained over the long term. "All patients benefit from radiation," Bernard Fisher, MD, scientific director of the NSABP, said at the Seventh International Congress on Anti-Cancer Treatment (ICACT). "The most optimal prevention of second ipsilateral breast tumors is free specimen margins and post-lumpectomy radiation."

CHICAGO--Investigators at the John Wayne Cancer Center, Santa Mon-ica, Calif, have discovered a lipid that appears to be unique to multidrug-resistant (MDR) cancers.

The first 15 years of the AIDS pandemic can be summarized simply by the oxymoron "constant change." The syndrome unfailingly has presented new challenges and demanded nearly continual refinement of our patterns of management. In the future, progressively more effective antiretroviral therapy paradoxically may permit infected patients to live longer and fall victim to more HIV-related and HIV-independent malignancies. Swift's review of the role of radiation therapy in the setting of HIV infection therefore provides a useful "snapshot" of current standards and a necessary warning of likely changes to come. Several points warrant emphasis.