Creating a research agenda with relevance to cancer nursing practice.

To be clinically relevant, a research program must seek to answer questions considered significant and meaningful by front-line clinicians. This article describes the process used by one Nursing Department to identify significant clinical questions in cancer nursing that could form the basis for a clinical research agenda. Priorities for cancer nursing research were identified in the literature and through interviews with all nursing staff.

Fostering the growth of research-based oncology nursing practice.

Purpose/objectives: To describe the initial stages involved in fostering a research-based oncology nursing practice in a comprehensive cancer program, including planning the initial implementation strategies to stimulate research awareness and create a program of research studies in clinical oncology nursing.

Data Sources: Literature searches; published articles, abstracts, and books; interviews with staff nurses; departmental, committee, and task force meetings; nursing grand rounds and workshops.

Data Synthesis: Review and use of the available information facilitated the design of implementation strategies that addressed issues identified in the literature and in clinical practice.

A 40-100 MHz B-scan ultrasound backscatter microscope for skin imaging.

There is a growing interest in high resolution, subsurface imaging of cutaneous tissues using higher frequency ultrasound, and several commercial systems have been developed recently which operate at 20 MHz. Some of the possible applications of higher frequency skin imaging include tumour staging, boundary definition, and studies of the response of tumours to therapy, investigations of inflammatory skin conditions such as psoriasis and eczema, and basic studies of skin aging, sun damage and the effects of irritants. Investigation of these areas is quite new, and the role of ultrasound skin imaging is continuing to evolve.

Radiotherapy in early ovarian cancer.

Radiation therapy is an effective curative treatment modality in early ovarian cancer. A combination of the independent prognostic factors of grade, stage, and residual disease defines an "intermediate" risk group whose probability of long-term disease-free survival from abdomino-pelvic radiation therapy (APRT) is between 62 and 91%. This group in which abdomino-pelvic radiotherapy is recommended as the sole postoperative treatment is mainly constituted from patients with Stage II disease of all grades with no residuum or less than 2 cm residuum in the pelvis and selected optimal Stage III patients with low grade tumors.

MR evaluation of cervical cancer in hysterectomy specimens: correlation of quantitative T2 measurement and histology.

Specimens from modified radical hysterectomies performed for invasive carcinoma of the cervix were analyzed with quantitative T2 magnetic resonance (MR) imaging and histologic study to determine to what degree there was a correlation between the findings of the two modalities. The mean T2 of cervical stroma was 48 msec, while the outer zone of the cervix had a mean T2 of 62 msec and the central canal region typically had T2 values of 115 msec +/- 20 (standard deviation). A total of nine cervical cancers were analyzed, and their mean T2 value was 79 msec.

Spinal cord tumors in children: long-term results of combined surgical and radiation treatment.

The authors report a series of 31 children under 17 years of age with primary spinal cord tumors who underwent radiation treatment following decompression laminectomy with or without tumor resection between 1959 and 1990. The tumors consisted of 15 astrocytomas, 11 ependymomas, one mixed glioma, one gangliolioma, and three of unknown histology. Ten- and 20-year survival rates and 10- and 20-year relapse-free survival rates for the 28 patients with known histology were 80% and 53%, and 73% and 67%, respectively.

Clinical cooperative trials of the National Cancer Institute of Canada Clinical Trials Group Breast Cancer Site Group.

For more than 10 years, the National Cancer Institute of Canada Clinical Trials Group (NCIC CTG) Breast Cancer Site Group has focused primarily on trials of adjuvant therapy and of investigational new drugs (IND). Four trials of adjuvant therapy in node-positive women have been completed, are active, or are about to begin. Investigational new drug (IND) studies have included Phase II trials of intravenous and oral menagaril, 10-EDAM (edatrexate), taxotere, and mifepristone (RU-486) as well as a Phase I/II trial of 5-fluorouracil (5-FU), doxorubicin, and vinorelbine (FAN); a Phase I/II trial of 5-FU, leucovorin, doxorubicin, and vinorelbine (super-FAN), all as first-line therapy for metastatic disease; and a Phase III study of vinorelbine plus doxorubicin versus doxorubicin alone as first- or second-line metastatic therapy.

Role of radiotherapy in the treatment of cancer of the ovary.

The initial management of carcinoma of the ovary is surgical. The need for further treatment is determined by a consideration of tumor stage, grade, and the presence of residual disease. Approximately one-third of patients are suitably managed by primary post-operative radiotherapy directed to the entire abdomen and pelvis with curative intent.

Clinical indications for the radiosurgical treatment of brain tumors.

Recently there has been an exponential growth in the use of radiosurgery in the treatment of brain tumors. Although a place for radiosurgery in the management of benign disorders, especially arteriovenous malformations (AVM) is established, its role in the treatment of brain tumors continues to be defined. This paper reviews the results of recently-published studies of the use of radiosurgery for brain metastases, acoustic neuromas, primary brain tumors and tumors at the base of skull.

Significance of a partial or slow response to front-line chemotherapy in the management of intermediate-grade or high-grade non-Hodgkin's lymphoma: a literature review.

Purpose: The purpose of this review was to assess the outcome of patients with non-Hodgkin's lymphoma (NHL) who achieve an incomplete or slow response to front-line chemotherapy and to determine whether salvage treatment with intensive combination chemotherapy with or without autologous bone marrow transplantation (ABMT) is successful in such patients.

Methods: A comprehensive literature search of studies using combination chemotherapy for the front-line therapy of advanced-stage intermediate- and high-grade NHL and for salvage therapy of patients with a partial response (PR) was reviewed.

Results: The median survival duration of patients with a PR ranged between 5 to 14 months, while the median survival duration of patients with a complete response (CR) was not reached in many studies.

Analysis of photon beam exit dose using photon point kernels.

The Monte Carlo method is used to analyse the dose fall-off at the exit surface of a megavoltage photon beam. The convolution/superposition method of dose calculation using Monte-Carlo-generated homogeneous photon kernels is shown to be in error for exit dose calculation. Instead, photon kernels that incorporate modelling of the exit surface were generated, also using Monte Carlo, to analyse the problem, and the calculated dose fall-off using these kernels agrees well with measured data.

Temporal trends in breast cancer surgery in Ontario: can one randomized trial make a difference?

Objective: To assess the effect of a single randomized clinical trial, the National Surgical Adjuvant Breast Project (NSABP) B-06, on the surgical management of breast cancer in women.

Design: Retrospective cohort study.

Setting: All hospitals in Ontario.

The use of radiochromic film in treatment verification of dynamic stereotactic radiosurgery.

Standard silver-based films are usually too sensitive to be used as direct indicators of dose in dynamic radiosurgery because of optical saturation. This paper describes the use of a new radiochromic film to measure 6-MV radiosurgery doses and dose distributions in a head phantom. Dose calibration of the radiochromic film was performed in the range of 2.

A model for holistic staff development.

In this article the authors describe a holistic staff development model to assist organizations meet their strategic goals. The principles of this conceptual model are generic and can be applied to both service- and business-oriented organizations. The advent of specialization has significantly affected all industries.

Variation in breast cancer surgery in Ontario.

Objectives: To analyse the extent of variation by county and hospital in the use of breast-conserving surgery in the initial management of breast cancer and to assess some factors that might explain the observed variation.

Design: Population-based retrospective cohort study.

Setting: Ontario.

Hypoxia and Carcinoma of the Cervix.

The article examines current laboratory and clinical information with respect to the relative importance of tumor hypoxia to the radiation control of carcinoma of the cervix. Its impact is difficult to quantify because of interrelated important parameters, which are also operational, including inherent radiosensitivity, reoxygenation, repair, and clonogenic cell proliferation. Strategies that have been investigated to modify the detrimental affects of hypoxia are reviewed including laboratory and clinical data examining modifications of oxygen delivery by the use of blood transfusion, erythropoietin and perfluorochemicals.

Nasopharyngeal carcinoma in the young.

This study was carried out to determine whether locoregional control of nasopharyngeal carcinoma in the young by irradiation has improved since 1975. Fifty-seven consecutive, previously untreated, patients, less than 30 years old, were diagnosed and treated at University of Toronto Hospitals between 1958 and 1990; 21 patients were treated before and 36 after 1975. Staging was as follows: M0, n = 54; M1, n = 3; T1 + T2, n = 26; T3 + T4, n = 31; N0, n = 10; N1 + N2a, n = 10; N2b + N2c, n = 24; N3, n = 13.

How much should I say to whom?

During the past several decades, attitudes in North America have shifted with regards to disclosing information to patients about their own diagnosis. There is still debate, however, about the extent of the information that should be shared regarding treatment and prognosis. Families have their own set of needs in the face of coping with life-threatening illness and supporting the patient.

A phase I/II study of salvage radiosurgery in the treatment of recurrent brain metastases.

Radiosurgery has been advocated as a salvage treatment for relapsed patients with brain metastases. This report describes a phase I/II study of salvage radiosurgery for patients previously treated with whole brain irradiation. The study was opened in March 1989 and the last patient was treated in July 1992.

Is there a role for consolidation or salvage radiotherapy after chemotherapy in advanced epithelial ovarian cancer?

Cure rates following surgery and platinum-containing chemotherapy in advanced epithelial ovarian cancer are only 20-30%. Relapse rates even after complete chemotherapy responses or those leaving only microscopic residual disease are disappointingly high at 30 to 80%. Strategies to improve outcome, consolidate the results of surgery and chemotherapy, or salvage those with residual disease include whole-abdominopelvic irradiation.

Long-term results of concurrent radiation and chemotherapy for carcinoma of the cervix recurrent after surgery.

Between 1981 and 1991, 41 patients with carcinoma of the cervix recurrent only in the pelvis, or pelvis and para-aortic nodes after initial surgery, were treated with concurrent chemo-radiation (CT-RT). The total dose of radiation was tailored to the disease extent. Radiation was delivered to the pelvis and/or pelvis plus para-aortic nodes.

Reactivation and dissemination of blastomycosis complicating Hodgkin's disease: a case report and review of the literature.

Patients presenting with Hodgkin's disease (HD) may show lung involvement characterized by contiguous spread from ipsilateral hilar lymph nodes. Lung consolidation or noncontiguous pulmonary involvement makes an alternative diagnosis more likely. This report describes a patient with HD in whom concurrent pulmonary blastomycosis was recognized only after chemotherapy had started and dissemination had occurred.

Integrating radiation therapy into the management of ovarian cancer.

Several studies during the last 15 years have elucidated the role of postoperative external beam radiation therapy as curative management of some subsets of patients with ovarian cancer. Despite this, the use of radiation therapy in patients with ovarian cancer has remained a controversial subject. Substantially improved cure rates have not been realized during the past decade despite the early promise of high response rates to cisplatin chemotherapy.