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HACKENSACK, NJ-- Tough economic times can be blamed for the current game of roulette played by health-care insurers when it comes to coverage of experimental or off-label treatments, said Grace Powers Monaco, JD, director of the Medical Care Ombudsman Program, Medical Care Management Corp. Bethesda, Md. But overeager physicians, patients, and patient advocacy groups must also share some of the blame for the current tug of war, she said.

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

LONG BEACH, Calif--Using five key indicators of the severity of illness to determine the cost effectiveness of growth factor use, researchers from Blue Cross of Western Pennsylvania found an average cost ratio of about 1:7 for the use of G-CSF (filgrastim, Neupogen) in stage IV breast cancer patients undergoing high-dose chemotherapy/autologous bone marrow transplantation.

NEW YORK--How much scientific research is enough? In the best of all possible worlds, an appropriate response might be, "one can never have too much of a good thing." But in the real world, the question must be rephrased: "How much research is possible with the resources available?"

LONG BEACH, Calif--Neoplasms account for more than 5% of the $675 billion in direct annual US health-care expenditures, Thomas C. Tucker, MPH, said at the 1995 Quality of Life Symposium, sponsored by St. Mary Medical Hospital. This figure, derived from a 1990 National Center for Health Statistics Survey, does not include indirect costs, such as loss of wages, associated with morbidity and mortality.

BETHESDA, Md--An Advisory Committee on Research on Women's Health has been chartered to advise the NIH Office of Research on Women's Health. The committee is mandated to offer advice on how to enhance women's health research, ensure that women are included in NIH-supported studies, and improve opportunities for women in biomedical careers.

LONG BEACH, Calif--Of the different types of economic analyses used in cost studies of medical therapies, only the cost utility analysis takes into account quality of life as an outcome, Jane Weeks, MD, said at the 1995 Quality of Life Symposium, sponsored by St. Mary Medical Center. To understand how this type of analysis works, physicians must add two new measurement units to their vocabulary: "utilities" and "quality-adjusted life years (QALYs)," she said.

CAMBRIDGE, Mass--In a phase II study, Genetics Institute's recombinant human interleukin-11 (rhIL-11) restored platelets in throm-bocytopenic patients undergoing cancer chemotherapy to the extent that significantly fewer rhIL-11 treated patients required platelet transfusions, compared to placebo.

SAN FRANCISCO--For physicians who treat cervical lesions, abandonment of traditional colposcopy for one-step loop excision procedures could lead to excessive treatment and excessive expense, Philip Roland, MD, said at the Society of Gynecologic Oncologists meeting.

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

BETHESDA, Md--In an anxiously awaited report, the National Cancer Advisory Board (NCAB) Ad Hoc Working Group on the NCI Intramural Research Program (IRP) made dozens of recommendations for change in the way intramural research is administered and conducted at the Institute (see below).

ROCKVILLE, Md--The Food and Drug Administration has announced that the National Cancer Information Center toll-free hotline, 1-800-4-CANCER, will now provide the names of all US radiology centers that are equipped to perform high-quality mammography.

CAMBRIDGE, Mass--Repligen Corporation and Medco Research, Inc. (Research Triangle Park, NC) have agreed to merge their two companies. The resulting company's product portfolio will serve three primary markets: cardiovascular disease, oncology, and immunology.

LONG BEACH, Calif--There is no controversy in medical oncology that G-CSF decreases the risk of infection associated with neutropenia in patients receiving cytotoxic chemotherapy. But does it save money? To answer that question, John Glaspy, MD, MPH, and his colleagues at UCLA School of Medicine used a decision analysis model to determine the economic impact of G-CSF given as supportive care.

PARIS, France--Ultrasound-guided fine-needle aspiration (FNA) cytology has emerged as a highly accurate approach to diagnosing occult breast malignancies in women with suspicious mammograms, said Thomas Frazier, MD, of the Medical College of Pennsylvania. What's more, he said, the ultrasound method costs less than a tenth as much as needle-localized open biopsy.

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.

BALTIMORE, Md--Both thallium-201 and technetium-99m are under study as agents for use in examining breast lesions for malignancy, Alan Waxman, MD, of Cedars-Sinai Medical Center, Los Angeles, said at a meeting on nuclear medicine sponsored by Johns Hopkins University.

Counseling and testing are important components of state and local HIV prevention programs [1]. Analysis of national data sources indicates that HIV antibody tests are obtained from a variety of

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.

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]

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.

NEW YORK--Society throws up numerous barriers to effective management of cancer pain: Physicians who don't ask questions about pain because they weren't trained to do so or don't see it as their responsibility; patients who don't mention pain because they want their doctor to focus on their cancer; a regulatory system that places legal restrictions on opioid prescribing; and a health-care system that leaves many people uninsured or underinsured.

SAN DIEGO, Calif--IDEC Pharmaceuticals Corporation has begun a phase III trial of its anti-lymphoma antibody IDEC-C2B8 in patients with relapsed low-grade and follicular non-Hodgkin's lymphomas. The company is developing the agent in collaboration with Genentech, Inc.

DETROIT--William P. Peters, MD, PhD, noted for pioneering outpatient ABMT for breast cancer at Duke University (see story on page 9), has been named president and CEO of the Michigan Cancer Foundation and director of the Meyer L. Prentis Comprehensive Cancer Center of Metropolitan Detroit, effective July 1. He will also serve as associate dean for cancer programs at Wayne State University School of Medicine.

MENLO PARK, Calif--Matrix Pharmaceutical, Inc. has initiated two phase III trials of its AccuSite injectable gel for patients with basal cell cancer. The company has completed phase III testing of the gel for the treatment of genital warts and expects to submit a new drug application to the FDA for that indication later this year.

NEW ORLEANS--Since Duke University moved part of its autologous bone marrow transplantation (ABMT) service to an outpatient setting, "the hospital has saved bundles, and the patients couldn't be happier," William Peters, MD, director of bone marrow transplantation and professor of medicine, told reporters at the American Cancer Society Science Writers Seminar.

LOS ANGELES--In a Canadian study of women with node-positive adenocarcinoma of the breast, a chemotherapy regimen (CEF) including epidoxorubicin (Epirubicin), an anthracycline available in Canada and Europe, produced better results than standard CMF (cyclophosphamide, methotrexate, and fluorouracil), Dr. Mark Levine reported at the ASCO annual meeting.

TORONTO, Canada--Understanding why normal cells grow old and die while cancer cells do not could be a boon to cancer research (see drawing on page 1). US and Canadian scientists have discovered that a protein called telo-merase may be the cause of the "eternal youth" of cancer cells, and they are seeking to develop drugs to block its effects.

WASHINGTON--The shift in health-care delivery methods from fee-for-service to managed care may bring with it troubling shifts in medical ethics.