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Tumor involvement of the bone marrow in patients with Hodgkin's disease may be suspected in the presence of other manifestations of advanced disease such as fever, lymphopenia, hypoalbuminemia, mixed cellular histologic type, or Stage III or IV disease by other clinical parameters. It occurs more frequently in the older age groups. When anemia, leucopenia, and/or thrombocytopenia are present and are unrelated to recent bone marrow suppressant chemotherapy, marrow involvement is likely to be present. Bone marrow examination, done by multiple trephine biopsies, provides an adequate sampling of tissue and results in a high incidence of detection of involvement by Hodgkin's disease. This manifestation of Hodgkin's disease is associated with a relatively short survival. Aggressive combination chemotherapy is necessary to produce a significant remission.

BACKGROUND A patient with diffuse large cell lymphoma who had a complete response lasting 35 years following a 3-day course of uracil mustard stimulated a recall review of patients treated with this oral alkylating agent. METHODS Records of patients treated with uracil mustard between 1958 and 1970 were reviewed. A current histologic review according to the International Formulation was performed when possible. Total doses of uracil mustard were similar to those of mechlorethamine, although there were variations in the dose schedule. RESULTS Employing criteria used over 25 years ago to evaluate patients' responses, the overall regression rate for 94 non-Hodgkin lymphoma patients was 69.2% (complete response [CR] 23.4%). Of 62 patients with Hodgkin disease, 69.4% responded (CR 9.7%). For 39 patients with chronic lymphatic leukemia, the combined complete and partial response rate was 74% (CR 7.7%). Thrombocytopenia was the primary toxicity. CONCLUSIONS Uracil mustard is an unmarketed, inexpensive oral alkylating agent that has been effective in the treatment of patients with lymphoma, chronic lymphatic leukemia, and thrombocythemia. Perhaps it should be reevaluated. Cancer 1999;85:2265–72. © 1999 American Cancer Society.

BACKGROUND. Over the last 26 years, the subspecialty of medical oncology has been evolving, and in the process bringing to the community improved oncologic management. During this evolution, guidelines for training new members of the subspecialty have been developed, and these have been heralded as important strides forward in medical education. Continual adjustment to new technology and changing population needs represent challenges for the future. METHODS. The steps in the development of this subspecialty, which are documented in educational publications, are reviewed in this article. RESULTS. Medical oncology evolved because of the introduction of multiple new cancer therapies and an awareness of the need of patients with cancer for continual care, from diagnosis to the end-of-life phase. Together, certified medical oncologists represent the third largest of the current subspecialties of internal medicine. Training guidelines and the needs of the work force are being continually assessed in an effort to maintain an important future for these specialists. CONCLUSIONS. Medical oncologists are cancer specialists who are not in competition with primary care physicians, but are instead supportive. By serving as principal caregivers (those subspecialists who provide most of a patient's health care needs), and by paying increasing attention to older patients with cancer, medical oncologists will remain in demand.

BACKGROUND A national survey of the management of Hodgkin's disease patients based on cases in the National Cancer Data Base (NCDB) provides a basis for evaluating the results of educational and therapeutic programs. These patients are believed to have been drawn from all nationalities, native and migrant, and were reported by hospital cancer registries throughout the United States, including large and small community hospitals, university and other teaching hospitals, military and Veterans Administration (VA) hospitals, and National Cancer Institute (NCI)-Designated Centers. METHODS Data submitted voluntarily to the NCDB were used to determine trends in patterns of patient care across time. For the period 1985-1994, data from 35,033 patients with newly diagnosed Hodgkin's disease were analyzed and separated into two time periods, 1985-1989 and 1990-1994. RESULTS Data were analyzed with respect to age, race, histology, stage, treatment, and survival. The majority of patients (83.6%) were white, the age group with the highest incidence was 20-29 years, and nodular sclerosis was the most common histologic type. Staging was reported as a combination of clinical and pathologic stage ("combined stage"). The number of cases of reported stage increased from 51.7% for the years 1985-1989 to 75.7% for the years 1990-1994. Radiation therapy was used primarily to treat patients in Stages I and II, although the overall use of radiotherapy declined by 10% in the later period. The overall observed 5-year survival rate was 83.2%, and the disease specific observed survival rate was 84.9%. Stage for stage, survival was better for younger patients and poorer for older patients. CONCLUSIONS The survey reflects the actual management of Hodgkin's patients disease. The reported cases for 1994 represent 60.6% of the estimated occurrences for that year in the U.S. There has been a significant improvement in the frequency of use of the staging system. A continuing increase in survival for patients with Hodgkin's disease is occurring. This method of studying disease management provides a measure of educational efforts and guides to developmental research. Cancer 1998;83:1041-1047. © 1998 American Cancer Society.

Background. Chemotherapy is most effective when applied during the biologically active stage of tumor cells. According to the authors' previous tumor marker kinetic study, methotrexate plus 5-fluorouracil (MF) was found to yield either a cytolytic effect in an MF-sensitive tumor cell population or a cytostatic effect in an MF-resistant population. In the latter, the suppressive effect was transient and the biologic activity resumed in one week after MF administration. Methods. Based on this marker kinetic study, an alternating chemotherapy program was designed to study its antitumor and side effects. Methotrexate (M) (200 mg/ m 2 ) and 5-fluorouracil (F) (500 mg/m 2 ) were administered intravenously on day 1 followed 24 hours later by leucovorin (L) (10 mg/m 2 orally every 6 hours for 6 doses). Cyclophosphamide (C) 300 (mg/m 2 ), doxorubicin (A) (50 mg/ m 2 ), and vincristine (V) (1 mg/m 2 ) were given on day 8. The MFL/CAV was given every 4 weeks. Results. Forty-nine patients with metastatic breast cancer were enrolled; 41 were eligible. There were 5 complete and 23 partial remissions, producing a total response rate of 68%. In 15 patients with liver metastases, the response rate was 73% and the median survival 13.7 months, results superior to those previously reported for this subgroup of patients. Side effects were manageable. Conclusions. This regimen, which can be given safely in an outpatient setting, yielded encouraging response and survival rates in patients with visceral-dominant disease with poor prognoses

BACKGROUND The success of chemotherapy for Stage III testicular carcinoma warranted its use as an adjuvant therapy for Stage II cancer. The current report reflects the adjuvant program begun at the University of Minnesota using four courses of vinblastine, bleomycin, and cisplatin (VBP) before the onset of the Testicular Cancer Intergroup Study using two courses of chemotherapies. METHODS A review of 78 patients with Stage II nonseminomatous germ cell tumors treated between 1972 and 1986 defined three groups: 19 patients treated between 1972 and 1979 with various adjuvant chemotherapies (termed "other"), 37 patients treated from 1975 to 1986 with VBP adjuvant chemotherapy, and 21 patients who received no therapy during the same era of VBP. The latter group was not offered adjuvant chemotherapy at other institutions or declined therapy. RESULTS Nineteen patients received adjuvant chemotherapy before the cisplatin era. Their survival rate was 42%, including two patients treated with cisplatin-based chemotherapy for recurrence. In the group of 21 patients who did not receive adjuvant therapy, 14 (66.7%) survived. Of these, five had no recurrence and nine were treated for recurrence. In a third group, adjuvant VBP therapy was given to 37 patients, 32 of whom received four full courses. There have been no recurrences, and 36 (97.3%) remain alive; one obese patient with hypertension died of a ruptured aortic aneurysm 12.9 years after the retroperitoneal lymph node dissection. Nodal involvement was more extensive in the VBP group. CONCLUSION Four courses of VBP adjuvant chemotherapy for pathologic Stage II testicular cancer resulted in a 100% cure rate, all patients having been followed up for more than 6 years. Whether two courses are as adequate remains to be determined when long-term follow-up is reported.

Background. The Minnesota Cancer Surveillance System (MCSS) provides information on the occurrence of newly diagnosed cancers among Minnesota residents. Cancer is a major cause of death and morbidity in older persons. Population cancer risk (PCR) was assessed as a measure of the number of cancers that will occur in the lifetime of 1000 persons. Methods. Approximately 98.6% of all cancers diagnosed in residents of Minnesota are reported by pathologists to the MCSS. By statistical methodology an estimate was made of the total number of cancers that will occur in the lifetime of 1000 people (PCR). The calculation assumes people born today will have the 1988–1990 Minnesota cancer incidence and life expectancy rates. Results. Incidence rates for all cancers in Minnesota have been increasing. Life expectancy in Minnesota is greater than in most areas of the United States. Approximately 50% of all cancers occurred in Minnesotans older than 70 years. The overall PCR is 459 cancers per 1000 lifetimes. It is estimated that by the year 2020 more than 100,000 living Minnesotans will have had cancer diagnosed during their lifetime. Conclusion. During the next 20 years, as the Baby Boomer generation in Minnesota moves into the high-risk years for cancer, the number of newly diagnosed cancers will increase disproportionately more than the increase in size of the older population. In view of the projected number of patients with cancer by the year 2020, cancer care will be different from what it is today. Geriatric cancer care will become a significant medical, public health, economic, bioethical, and social issue.

Patterns of care for Hodgkin's disease in the United States were surveyed through voluntary audits of hospitals with cancer programs nonapproved and approved by the Cancer Commission of the American College of Surgeons. Four hundred and seventy-three hospitals reported 6,345 patients diagnosed immediately preceding December 31, 1975. The survival rates varied with age, being better at younger ages and worse in the elderly. By pathologic stage, the younger patients faired better than the elderly in each stage grouping. Histologic type was not a factor in this poor prognosis. Hodgkin's disease in elderly patients has a different biologic behavior than in younger patients.

OBJECTIVE: Prior reports on Hodgkin's disease have suggested a biologic behavior difference between young and old patients. A study of 35,033 patients could confirm that older patients do not do as well as young patients regardless of age. METHODS: The National Cancer Data Base provided data from U.S. tumor registries on 35,033 patients newly diagnosed with Hodgkin's disease from 1985 through 1994. For analysis the patients were divided into two time periods, 1985-1989 and 1990-1994. The earlier period provided survival data to assess the impact of age and stage. RESULTS: The overall disease-specific, 5-year survival rate for the 1985-1989 period was 84.9%. For stages I and II, it reached almost 90%. For both observed survival based on all deaths and disease-specific survival, the duration of survival decreased with increasing age. This decrease with age occurred for all stages of the disease. CONCLUSIONS: The data reflect the actual status of management of Hodgkin's disease in the United States rather than the best attainable results. The decreasing survival with increasing age and in all stages further supports the concept of a difference in biologic behavior of Hodgkin's disease associated with age.

Controversy exists in using carcinoembryonic antigen (CEA) for monitoring the clinical course of breast cancer. In this study, the kinetics of two plasma tumor markers, CEA and CA15-3, immediately after the initiation of chemotherapy were assessed in 30 patients with advanced breast cancer. Four distinct kinetic patterns were seen. Two patterns fitted the expected relationship where the plasma marker increased during tumor progression (nine patients), and declined in tumor regression (five patients). The third pattern was paradoxical in that objective tumor regression in eight patients was associated with an acute surge of these markers followed by a steady decline. The doubling times for both CEA and CA15-3 were immediately shortened four-fold after therapy suggesting tumor cytolysis in treatment responders. Equally paradoxical was the fourth pattern where tumor progression in eight patients was associated with a rapid and transient decline of markers followed by rebounds. Such a rapid decline may be due to a suppression of marker release, as demonstrated in an in vitro study. Adequate knowledge of these putative paradoxical patterns will permit their effective use in monitoring the disease course and perhaps in the early prediction of the therapeutic response.

An increased incidence of malignancies has occurred in recipients of organ transplantation who are immunosuppressed. Although testicular cancers have been uncommon, seminomas are extremely rare. Two patients with long-standing diabetes mellitus and renal transplants developed clinical stage I seminoma of the testis. These patients posed a therapeutic problem with respect to the use of radiation therapy. In one, none was given because of a combination of kidney rejection and antibiotic-induced renal damage. The second patient received radiation therapy with shielding of the transplanted kidney. The surgical distortion of lymph node architecture increases the problems in the use of radiation therapy. Individual factors need to be considered in the use of postorchiectomy radiation therapy for seminoma in transplant patients.

Fifteen patients with biopsy-proven mediastinal germ cell tumors treated with platinum-based chemotherapy were reviewed. They had a period of 4 to 6 weeks between the onset of symptoms and diagnosis. Four patients had sarcomatous elements in their tumor in association with common germ cell histologies. The sarcomatous components consisted of one angiosarcoma, one rhabdomyosarcoma, and two cases with mixed angiosarcoma and rhabdomyosarcoma. All patients with sarcomatous elements died; the median survival for these patients was 9 months. In contrast, six (54%) of the patients who did not have sarcomatous elements in their tumor are long-term disease-free survivors 5 to 8 years after diagnosis. The occurrence of sarcomatous elements in a mediastinal germ cell tumor is a poor prognostic sign, and therapy should be oriented to include drugs and regimens that may be effective against sarcoma.

What follows are the perceptions of two individuals-a patient and a highly respected medical oncologist who did not participate in the care of this patient but read the patient's essay. We encourage readers to share their thoughts about these essays in correspondence. Barrie E. Cassileth, Ph.D. Department of Integrative Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York A. Bernard Ackerman, M.D. Ackerman Academy of Dermatopathology, New York, New York Copyright 2000 American Cancer Society.

The electrocatalytic behaviour of carbon-supported ruthenium oxide electrodes for oxygen evolution and methanol oxidation in acid solutions is reported. Physical characterization of the electrodes by X-ray diffraction, X-ray photoelectron and 99Ru Mossbauer spectroscopies indicated the ruthenium to be present as a mixture of RuIV oxides including the stable rutile phase. Electrochemical studies show that a RuVI species promotes the catalytic oxidation of methanol, whilst surface-bound RuO4 is involved in the oxygen evolution reaction.

We report the first organic light emitting diode with a highly efficient electron transport and Ohmic cathode contact layer using nanostructured carbon fullerene (nanOLED). Fullerene or nanobuckyball (NBB) has high mobility for electron transport and forms an Ohmic contact to LiF/Al cathode (nanoCathode). It lowers driving voltage by ∼2V and improves power efficiency by 30∼50%. Due to its robust interface structure, NBB devices show longer lifetime and higher stability. It also provides better tunability for full colour displays compared with devices using Alq as electron transport materials.

In 1965 we reported mithramycin (plicamycin) to produce objective regression in 7 of 12 patients with advanced testicular carcinoma. Between 1963 and 1975 mithramycin was administered to 62 patients with advanced testicular carcinoma as the initial chemotherapy and to 30 patients who failed to respond to prior chemotherapies. There were 13 complete regressions (23%) in 56 patients who as initial chemotherapy received more than one course of mithramycin. The median follow-up is 23 years with 10 patients still alive. A partial regression occurred in 11 (18%), all of whom are dead. Of 30 patients receiving mithramycin after prior chemotherapies, none had a complete regression, 5 had a partial regression, and all are dead. Of 13 patients undergoing complete regression, 85% never had a recurrence of testicular carcinoma. The median follow-up of 23 years implies that these patients are cured.

The factors important in predicting survival in the non-Hodgkin's malignant lymphomas have not previously been clearly identified. This study evaluates the prognostic usefulness, in predicting survival, of a modified Rappaport pathologic classification, the Ann Arbor clinical staging classification, initial bone marrow involvement, symptoms, extranodal involvement, age, and sex in 128 consecutive adult patients with malignant lymphoma. Conventional life table analysis indicates that symptoms, pathology, and clinical stage are the most important factors in predicting survival. However, multiple regression analysis identifies pathology, symptoms, and bone marrow involvement as the three most important variables. Clinical stage when considered with other risk factors (in the multiple regression analysis) adds little prognostic information. Age, sex, and extranodal involvement do not significantly influence survival in either analysis. Pathology, symptoms, and bone marrow involvement appear most important in designing adequate clinical treatment trials in patients with non-Hodgkin's lymphoma.

Estrogen receptor contents (ER), determined by a sucrose gradient method in 250 primary or metastatic breast cancers, were analyzed with respect to the influence of the patient's menopausal status, chemotherapy, and tissue sampling. The incidence of the presence of estrogen receptors (ER+) increased in the order of para-, pre- and postmenopausal status of the patient, suggesting that a tumor occurring at the paramenopausal phase tends to be a hormone-independent type. Chemotherapy did not alter the incidence of ER(+), nor the quantity of ER in metastatic lesions. Multiple biopsies done simultaneously or sequentially in the same patient are consistent in their qualities and quantities of ER, provided histological confirmation and examination of the amount of cellularity are included in the process of interpretation.

Between 1950 and 1981, 31 patients with mesothelioma were treated at the University of Minnesota. An average of 0.2 to 0.6 patients were seen per year between 1950 and 1970, and since 1970 there has been an average of 1.4 to 2.4 patients per year. Twenty-seven of the 28 patients with malignant mesothelioma are known or presumed dead. Mesotheliomas occurred in all areas of Minnesota, and 28.6% of the patients had a definite history of asbestos exposure. This was also a probable cause of the disease in an additional 25% of patients. The clinical findings and course of the disease were similar to other series. The median survival of all patients was eight months. Doxorubicin-treated patients survived a median of 16 months (range, 2-36 months). Malignant mesothelioma is being increasingly recognized in Minnesota and has a grim prognosis in spite of doxorubicin therapy.

The epipodophyllotoxin derivative VP 16--213 (NSC 141540) was studied by the Cancer and Leukemia Group B in a broad phase II trial at three dose levels: 60 mg/m2, 90 mg/m2, and 135 mg/m2 I.V. twice weekly. No correlation between dose of VP 16--213 and response frequency in a particular disease category could be demonstrated. Of the 382 patients, 8% obtained a complete (CR) or partial remission (PR), 8% showed improvement, and 14% had stable disease. By tumor type the best responses were obtained in lymphomas (8/31 CR + PR), uterus (2/9), prostate (1/5), rhabdomyosarcoma (2/6), neuroblastoma (2/4), colon/rectum (5/81), other gastrointestinal (4/32). In lung tumors, 4/80 patients obtained CR or PR. VP 16--213 has definite antineoplastic activity but the response frequency with the twice weekly schedule may be lower than that reported with other schedules.

Thirty-eight patients with advanced Hodgkin's disease were treated with a combination of cyclophosphamide, vinblastine, procarbazine, and prednisone (CVPP). Complete remissions were obtained in 74% of patients. Response rates were similar for previously untreated and previously extensively irradiated patients. Fifty-six percent of patients older than 50 and 50% of patients with bone marrow involvement responded. All patients with mixed cellularity Hodgkin's disease responded compared with 74% of patients with nodular sclerosis. At the present time the median duration of complete remission is 27+ months. However, of the responders, 75% (21 of 28) remain in continous complete remission for 14+ to 49+ months. Only five patients have relapsed but two have died from apparent sepsis without evidence of recurrent disease. The complete remission rate for CVPP is comparable of that for MOPP, CVPP is an easily administered, well-tolerated alternative to MOPP chemotherapy for patients with advanced Hodgkin's disease.

Continuous flow centrifuge leucapheresis (CFCL) provides a simple, mechanical technique for removing large numbers of circulating lymphocytes without cytotoxicity. Seven sequences of CFCL were performed on six patients with chronic lymphocytic leukaemia (CLL). In six, the median course consisted of six procedures in 10 days. A median total of 27.7 X 10(11) leucocytes were removed and a 70% drop in leucocyte counts (from 433 X 10(9)/l. to 130 X 10(9)/l.) was observed with little fall in haemoglobin and platelet counts. Tissue massess decreased in two patients. A similar effect was seen in one patient managed less intensively with 21 procedures being performed over 73 days, removing a total of 87.6 X 10(11) leucocytes. The peripheral leucocyte count decreased from 760 X 10(9)/l. to 114 X 10(9)/l. and hepatomegaly diminished markedly. One patient has survived for over 9 months since CFCL but stayed in control only briefly after each of two courses. Short courses of daily CFCL can produce short-term benefit in the management of advanced CLL but at present its main value is as an investigational form of therapy which provides a unique opportunity to study the cytokinetics of advanced CLL without the complications of superimposed cytotoxic therapy.

Surgical removal of bulky metastases of non-seminomatous germ-cell testicular cancer has been advocated as an adjuvant to chemotherapy in patients whose disease probably is too extensive to be cured by chemotherapy or surgery alone. However, in 8 of our patients, cytoreductive surgery was followed by a sudden and dramatic exacerbation of the disease. In some cases, a marked rise in the serum levels of alpha-fetoprotein and human chorionic gonadotropin was the only evidence. The cause and prevalence of such exacerbations are unknown. Cytoreductive surgery in patients with advanced testicular tumor is accepted treatment and should be advocated, but it appears that in some cases such surgery may adversely alter the course of the malignancy. This must be considered in planning treatment for patients with advanced disease.

The influence of local tumor spread (T-classification) and of tumor size on the occurrence of metastases was studied in 241 patients with testicular germ-cell neoplasms. All patients underwent thorough clinical or pathologic staging, or both, and were treated at the University of Minnesota Hospitals. Spread of tumor through the tunica vaginalis (T2) was associated with abdominal lymph node or distant metastases in eight of nine patients. Local tumor extension to the spermatic cord (T4a) was associated with metastatic spread in 29 of 31 men. Tumor size did not appear to correlate with metastatic rate. These findings are an important aid in designing adjuvant therapy trials and in establishing a "no treatment" approach after orchiectomy.

Thirty men with metastatic germ cell cancer were treated with cisplatin (20 mg/m2 administered intravenously, days 1-5), vinblastine, and bleomycin at 3- to 4-week intervals for four to six courses. There was a sequential fall in serum magnesium (P less than 0.001) with each course of therapy: 26 of the 30 patients (87%) became hypomagnesemic, and the median magnesium nadir was 1.1 meq/l. No acute clinical effects of the hypomagnesemia were observed. The mean creatinine clearance declined from 115 ml/minute before therapy to 65 ml/minute, and the mean serum creatinine rose from 0.9 mg/dl to 1.6 mg/dl after six courses of therapy. With a minimum follow-up of 36 months, 13 of the patients (43%) have clinical evidence of Raynaud's phenomenon. Severity of prior hypomagnesemia predicted an increased risk of Raynaud's phenomenon. Renal dysfunction, hypomagnesemia, and Raynaud's phenomenon are common chronic toxicities of vinblastine, bleomycin, and cisplatin therapy.

Tumor estrogen receptor status in women with advanced breast cancer was correlated with clinical response to cytotoxic chemotherapy in a retrospective study. Following an extramural review of the clinical data of 40 patients, 26 responded to chemotherapy (65%). The response rate in 19 receptor-rich tumors was 89% and in 21 receptor-poor tumors, 43% (P < 0.01). The lowest response rate (14%) was observed in seven postmenopausal patients with receptor-poor tumors. Clinical characteristics of patients and variants in chemotherapy programs failed to explain the favorable response of receptor-rich tumors to cytotoxic chemotherapy.

The marginal neutrophil leukocyte pool and the bone marrow neutrophil reserves were assessed in 43 patients with lymphoreticular malignancies, using epinephrine and steroid stimulation. Thirty-three patients were studied before staging, following splenectomy, before and after nodal irradiation and during remission induction chemotherapy. Ten patients in partial remission were studied after 12 months or more of chemotherapy. A neutrophil count of 1,500–2,500 cells/mm3 is not a sufficient guide for modifying the chemotherapy. The response to steroid stimulation may be a more dependable guide to evaluate the patient's potential risk for infection.

Forty-eight patients with advanced bronchogenic carcinoma were treated with a combination of CCNU and Adriamycin. There was an overall objective response rate of 38%. This consisted of 1 of 12 (8%) patients with epidermoid carcinoma, 5 of 15 (33%) with adenocarcinoma, 2 of 5 (40%) with large cell undifferentiated carcinoma and 10 of 16 (63%) with small cell undifferentiated carcinoma. The overall median survival time (MST) from initiation of therapy was 28 weeks. The MST was 18 weeks for patients with epidermoid carcinoma, 30 weeks for those with adenocarcinoma, 39 weeks for those with large cell carcinoma, and 30+ weeks for those with small cell carcinoma. Objective tumor response was associated with prolonged survival. There were no drug related deaths and toxicity was minimal.

The effectiveness of combination therapy with diethylstilbestrol, cyclophosphamide, and 5-fluorouracil (DES + CTx + FU) was compared with DES alone or CTx + FU in 87 postmenopausal women with advanced breast cancer. Therapy was randomized according to the tumor estrogen-receptor (ER) status. In 30 patients with ER-rich tumors and 35 patients with ER-unknown tumors, combination therapy yielded a higher response rate than DES therapy (87% vs. 64% and 59% vs. 23%, respectively). The pooled data from these two groups of patients suggest that the improved response rate from DES + CTx + FU against DES becomes more apparent in patients with visceral involvement (89% vs. 47%) (P less than 0.025) and that patients treated initially with combination therapy (DES + CTx + FU) appeared to have a longer survival than those treated with sequential therapy (DES leads to CTx + FU) (P = 0.06). The survival data in 22 patients with receptor-poor tumors were significantly inferior to those with receptor-rich tumors (P = 0.001). The ER status and presence of visceral metastases are significant factors in the selection of treatment programs.

Summary. Six patients with chronic myelogenous leukaemia (CML) were treated by repeated continuous flow centrifuge (CFC) leucapheresis. In six of seven courses of leucapheresis there was no improvement in splenomegaly. In no instance was the leucocyte count reduced to the normal range. The immediate changes in peripheral leucocytosis produced by each CFC leucapheresis procedure were quite variable. There was no correlation between the intensity of a series of CFC leucapheresis procedures and the total clinical effectiveness of the therapy. Balancing potential benefits against definite costs to the patient, CFC leucapheresis seems justified in only a minority of CML patients. Untreated CML patients who have cyclic leucocytosis may be the best candidates for this therapy. Currently this form of therapy for CML remains experimental.

The serum levels of human chorionic gonadotropin (HCG), alphafetoprotein (AFP), lactic dehydrogenase (LDH), and carcinoembryonic antigen (CEA) were measured in 62 men with advanced nonseminomatous germ-cell testicular tumors. The HCG level was elevated in 64%, the AFP level in 67%, and the LDH level in 62%, including three of the six men with normal levels of the other two markers. At least one of these three markers was elevated in 91% of patients. Sustained or rising levels of HCG or AFP always were accompanied by persistent or recurrent tumor. Carcinoembryonic antigen was found not to be a useful marker in testicular cancer. Patients whose tumors contained yolk-sac elements always had elevated AFP levels, and patients with choriocarcinoma always had elevated levels of HCG. However, absence of these histologic types did not preclude elevations of the respective markers. Tumor markers are indispensable in the management of patients with testicular cancer, and several markers must be measured repeatedly if the greatest percentage of patients is to benefit.

The protection of human subjects in research is a shared responsibility. The informed consent procedure was introduced to implement protection of the subjects. The contents of consent forms have been in dispute, and the impact of the procedure on the human subject has caused concern. It was demonstrated that patients with cancer have poor recall of the contents of a signed consent form.

The evaluation of a medical school course in Medical Oncology assessed the experience in which medical students act as interns. The direct involvement of the student as a physician in managing patients with cancer furthered the students' knowledge of cancer, improved their competency in dealing with patients with cancer and their families, and developed the students' insight and attitudes toward the problems of cancer.