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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.

BOSTON, Mass--Under a grant from the US Army Breast Cancer Program, Harvard researchers are attempting to create medullary carcinoma of the breast (MCB) cell lines as part of their immunologic studies. There is currently only one line in the world for this infrequent tumor. "We are especially interested in pleural effusions (or ascites)--the best source to make cell lines--but will also use fresh, unfixed tumor tissue, and will pay all shipping costs," said investigator Richard Junghans, PhD, MD.

WASHINGTON--The U.S. Patent and Trademark Office has awarded a broad patent on gene therapy to the National Institutes of Health. Six years after filing the application, NIH and its licensee, Genetic Therapy, Inc. of Gaithersburg, Maryland, can now use the patent for ex vivo human gene therapy.

WASHINGTON--The number of women over age 40 who have ever had a mammography has risen significantly in the past few decades, P. Ellen Parsons, MPH, PhD, said at the spring meeting of the National Mammography Quality Assurance Advisory Committee.

WASHINGTON--By the end of the century, cancer will surpass heart disease as the leading cause of death in the United States. According to a report to Congress from the National Cancer Advisory Board (NCAB) Subcommittee to Evaluate the National Cancer Program, if the nation fails to address six major issues (see table "the resulting health-care costs, lost productivity, and personal tragedy [will be] staggering."

A study of 166 women with suspicious mammograms who underwent ultrasound-guided fine-needle aspiration cytology (USFNAC) showed the technique to be 100% accurate in diagnosing cancers, reported Dr. Thomas G. Frazier at the annual

WASHINGTON--The FDA's Biological Response Modifiers Advisory Committee unanimously recommended approval of Hoffmann-La Roche Inc.'s Roferon-A (interferon alfa-2a, recombinant) for the treatment of adult patients with Philadelphia chromosome positive chronic myelogenous leukemia (CML). The interferon is currently approved for use in hairy cell leukemia and AIDS related Kaposi's sarcoma.

WASHINGTON--The US Public Health Service's 10-year plan for improving Americans' health, dubbed Healthy People 2000, will be a disappointment to antismoking forces. The goal--to decrease the number of smokers to only 15% of the population--will not be reached, and it is likely that 20% of Americans will still be smoking by the end of the century. "We're talking about a lot of people who are going to die," said Harold Freeman, MD, chairman of the President's Cancer Panel.

WASHINGTON--Managed care holds tremendous opportunities for oncologists who are able to restructure their practices to meet the challenge, Merrick Reese, MD, said at the Association of Community Cancer Centers (ACCC) meeting.

WASHINGTON--Physicians and hospitals have good reason to learn as much as possible about the expanded Stark self-referral law, which went into effect last January, and federal anti-kickback legislation. The penalties if convicted under these measures can be large, and the federal government is committed to their enforcement.

LOS ANGELES--An economic analysis has shown that use of filgrastim-primed peripheral blood progenitor cells (PBPCs) in relapsed lymphoma patients undergoing high-dose chemotherapy is significantly less expensive than autologous bone marrow transplantation (ABMT), Thomas J. Smith, MD, said at the American Society of Clinical Oncology (ASCO) annual meeting.

BETHESDA--Harold Varmus, MD, Director of the NIH, has removed the "reasonable pricing" clause from the Public Health Service's model Cooperative Research and Development Agreement (CRADA). Many believe that the clause has driven industry away from potentially beneficial collaboration with government scientists. "Eliminating [it] will promote research that can enhance the health of the American people," Dr. Varmus said.

A new blood substitute with broad life-saving potential is being tested at the University of Medicine and Dentistry of New Jersey (UMDNJ). The unique blood product is made with a patented chemical modification process developed by Enzon

BALTIMORE, Md--The results of a phase III double-blind trial of Guilford Pharmaceutical Inc.'s Gliadel have been published in Lancet (April 22, 1995). In patients with malignant brain tumors, 6-month median survival rates increased from 23 weeks with placebo to 31 weeks with Gliadel treatment, the company said. For patients with glioblastoma multiforme, the increase was from 20 weeks to 28 weeks, a 55% improvement.

PARIS, France--Cyclophosphamide with total body irradiation (TBI) provides better survival rates than cyclophosphamide plus busulfan when used as a pre-autologous bone marrow transplant (ABMT) conditioning regimen in patients with advanced acute myeloid leukemia (AML), a University of Minnesota study has found.

FORT LAUDERDALE, Fla--Cancer education and screening in the worksite need not be an expensive venture, several speakers said at a session on costs at the Industries' Coalition Against Cancer (ICAC) conference.

LOS ANGELES--Use of a radiolabeled monoclonal antibody in patients with relapsed B-cell lymphoma may allow higher doses of radiation to the tumor and less toxicity to normal organs, Oliver W. Press, MD, PhD, of the University of Washington Medical Center, Seattle, said in his ASCO presentation.

STANFORD, Calif--Researchers at Stanford University Medical Center have found profound shortages of naïve T cells among individuals infected with HIV. In contrast, previous studies have suggested that naïve T cells remain stable with the progression of HIV disease.

TORONTO, Canada--The benefits of annual mammography screening for women aged 50 and over are undisputed, but experts are still polarized over whether the screening procedure is worthwhile for women aged 40 to 49.

NEW YORK--Depression is more common in patients with advanced cancer and can have an adverse effect on cancer pain. For example, in patients with advanced breast cancers, a study showed that concomitant depression and interpretation of pain influenced pain more than site of disease or presence of metastases, Memorial Sloan-Kettering psychiatrist William S. Breitbart, MD, said at a conference sponsored by Cancer Care, Inc., a social work agency for cancer patients and their families.