Memorial Cancer Center Research Articles

Martin Memorial Cancer Center

Martin Memorial Cancer Center

Provision of cancer care in Eastern Europe

During a visit to Poland and Croatia in February, I heard from oncologists about the effect that the political developments in this region have had on cancer incidence, detection, and treatment. Poland and Croatia ended the 1980s in a similar position. Both countries had relatively liberal communist governments and were open to Western influences. Their experiences since then have been dramatically different. Poland now stands on the brink of EU membership, possibly as early as 2004, whereas Croatia, after suffering a damaging war of independence in the early 1990s, is barely on the starting blocks. Cancer treatment was given high priority in east-central Europe throughout the twentieth century, even during periods of financial crisis and rapid change. Services set up during the relatively prosperous 1970s were maintained during the financial crisis of the eighties and subsequent upheavals. Marie Curie herself opened the Radium Institute in Warsaw in 1932 (figure 1), with a gift of a gram of radium from the USA. The original institute was burned down during the Second World War but rebuilt a few years later, and still functions as the Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology (figure 2). This institute now serves all of Greater Warsaw, an area covering a population of about five million people. About a fifth of new cancer cases in Poland are referred there, and it offers a full range of modern treatment modalities including combination therapies. “Over 60% of radiotherapy and 70% of chemotherapy is now delivered on an outpatient basis, or in a day hospital, which is less expensive and which the patients prefer,” says its director, Marek Nowacki. In addition, because the Polish currency, the zloty, is now fully convertible to other currencies, it is possible to import expensive equipment and drugs from the West. Oncologists in the institute are currently involved in close to 200 different clinical trials, involving drugs, radiotherapy, mixed modalities, and novel biological treatment methods. Many are conducted in According to the World Health Organization, in 1990, a 15-year-old boy from the former Soviet bloc was less likely to reach his sixtieth birthday than his counterparts in many less developed countries, including China and India. But disease patterns in Eastern Europe were already similar to those in the established market economies. This immense burden of disease was almost entirely due to an “epidemic” of cancer and other noncommunicable diseases. Since then, some of these transitional countries have made substantial progress in cancer control. However, it is still predicted that at least one in every five citizens of Eastern Europe will die from cancer. Reportage

Evaluation of the National Cancer Program and Proposed Reforms

A statement by 68 prominent national experts in cancer prevention, carcinogenesis, epidemiology, and public health, released at a February 4, 1992, press conference in Washington, D.C., charged that the National Cancer Institute (NCI) has misled and confused the public by repeated claims of winning the war against cancer. In fact, age-standardized incidence rates have escalated to epidemic proportions over recent decades, while the ability to treat and cure most cancers has not materially improved. Furthermore, the NCI has minimized evidence for increasing cancer rates, which are largely attributed to smoking, trivializing the importance of occupational carcinogens as non-smoking attributable causes of lung and other cancers, and to diet perse, in spite of tenuous and inconsistent evidence and ignoring the important role of carcinogenic dietary contaminants. Reflecting this near exclusionary blame-the-victim theory of cancer causation, with lockstep support from the American Cancer Society and industry, the NCI discounts the role of avoidable involuntary exposures to industrial carcinogens in air, water, food, the home, and the workplace. The NCI has also failed to provide any scientific guidance to Congress and regulatory agencies on fundamental principles of carcinogenesis and epidemiology, and on the critical needs to reduce avoidable exposures to environmental and occupational carcinogens. Analysis of the $2 billion NCI budget, in spite of fiscal and semantic manipulation, reveals minimal allocations for research on primary cancer prevention, and for occupational cancer, which receives only $19 million annually, 1 percent of NCI's total budget. Problems of professional mindsets in the NCI leadership, fixation on diagnosis, treatment, and basic research, much of questionable relevance, and the neglect of cancer prevention, are exemplified by the composition of the National Cancer Advisory Board. Contrary to the explicit mandate of the National Cancer Act, the Board is devoid of members authoritative in occupational and environmental carcinogenesis. These problems arc further compounded by institutionalized conflicts of interest reflected in the composition of past executive President's Cancer Panels,and of the current Board of Overseers of the Sloan-Kettering Memorial Cancer Center, the NCI's prototype comprehensive cancer center,with their closely interlocking financial interests with the cancer drug and other industries. Drastic reforms of NCI policies and priorities are long overdue. Implementation of such reforms is, however, unlikely in the absence of further support from industrial medicine professionals, besides action by Congress and concerned citizen groups.

Dose-escalation in non-small cell lung cancer using 3-dimensional radiation treatment planning : Mark B. Hazuka, M.D., Andrew T. Turrisi III, M.D., Mary K. Martel, Ph.D. and Randall K. Ten Haken, Ph.D. Memorial Cancer Center, Colorado Springs, CO 80909 and University of Michigan Medical Center, Ann Arbor, MI, USA, 48109

Dose-escalation in non-small cell lung cancer using 3-dimensional radiation treatment planning : Mark B. Hazuka, M.D., Andrew T. Turrisi III, M.D., Mary K. Martel, Ph.D. and Randall K. Ten Haken, Ph.D. Memorial Cancer Center, Colorado Springs, CO 80909 and University of Michigan Medical Center, Ann Arbor, MI, USA, 48109

Evaluation of the national cancer program and proposed reforms.

A statement by 68 prominent national experts in cancer prevention, carcinogenesis, epidemiology, and public health, released at a February 4, 1992, press conference in Washington, D.C., charged that the National Cancer Institute (NCI) has misled and confused the public by repeated claims of winning the war against cancer. In fact, age-standardized incidence rates have escalated to epidemic proportions over recent decades, while the ability to treat and cure most cancers has not materially improved. Furthermore, the NCI has minimized evidence for increasing cancer rates, which are largely attributed to smoking, trivializing the importance of occupational carcinogens as non-smoking attributable causes of lung and other cancers, and to diet per se, in spite of tenuous and inconsistent evidence and ignoring the important role of carcinogenic dietary contaminants. Reflecting this near exclusionary blame-the-victim theory of cancer causation, with lockstep support from the American Cancer Society and industry, the NCI discounts the role of avoidable involuntary exposures to industrial carcinogens in air, water, food, the home, and the workplace. The NCI has also failed to provide any scientific guidance to Congress and regulatory agencies on fundament principles of carcinogenesis and epidemiology, and on the critical needs to reduce avoidable exposures to environmental and occupational carcinogens. Analysis of the +2 billion NCI budget, in spite of fiscal and semantic manipulation, reveals minimal allocations for research on primary cancer prevention, and for occupational cancer, which receives only +19 million annually, 1 percent of NCI's total budget. Problems of professional mindsets in the NCI leadership, fixation on diagnosis, treatment, and basic research, much of questionable relevance, and the neglect of cancer prevention, are exemplified by the composition of the National Cancer Advisory Board. Contrary to the explicit mandate of the National Cancer Act, the Board is devoid of members authoritative in occupational and environmental carcinogenesis. These problems are further compounded by institutionalized conflicts of interest reflected in the composition of past executive President's Cancer Panels, and of the current Board of Overseers of the Sloan-Kettering Memorial Cancer Center, the NCI's prototype comprehensive cancer center, with their closely interlocking financial interests with the cancer drug and other industries. Drastic reforms of NCI policies and priorities are long overdue. Implementation of such reforms is, however, unlikely in the absence of further support from industrial medicine professionals, besides action by Congress and concerned citizen groups.

Obituary — Robert S. Laufer: 1942–1989

Robert S. Laufer died on July 25, 1989 in Sloan-Kettering Memorial Cancer Center in New York City following a valiant and courageous battle with cancer. Throughout several experimental treatment protocols for his leukemia, Bob was supported by his wife, fellow scholar and co-author, Ellen FreyWouters, who shared in his struggle to live fully and productively in the face of his terminal illness. Dr. Laufer was born in Holland in 1942 during the Nazi Holocaust. During infancy he was hidden by the Dutch underground to protect his religious identity as a Jew while his family was interned at Auschwitz concentration camp; only his mother survived. The Protestant women who hid him were a strong influence on his later commitment to contribute to the understanding and help of those who were victimized. He emigrated to the United States when he was 8 years old, and spent most of his childhood in Detroit, Michigan. Dr. Laufer attended Monteith College, an innovative liberal arts college in Detroit, Michigan, where he obtained his bachelor of arts degree in sociology and psychology in 1964. He continued his studies in sociology at Wayne State University and Brandeis University where he received his doctorate in 1972. During his professional career, he taught at Beloit College (1968-1969), the University of Wisconsin (1969-1970), and the State University of New York at Albany (1970-1972)o After receiving his Ph.D., he moved to New York City, joined the graduate faculty of the City University of New York, and taught at Brooklyn College, where he was a full professor at the time of his death. His doctoral dissertation was entitled, Education in Post-Industrial Society: Innovation and Conflict in American Higher Education, a theme which reflected his research publications early in his career. In particular, his inter~t in generational conflict, radical youth identity, and the relationship of the individual to complex social systems were eventually to lay the cornerstone for his later theoretical conceptualizations of the fundamental impact of traumatic events on personal identity and intrapsychic structure.

Obituary ? Robert S. Laufer: 1942?1989

Robert S. Laufer died on July 25, 1989 in Sloan-Kettering Memorial Cancer Center in New York City following a valiant and courageous battle with cancer. Throughout several experimental treatment protocols for his leukemia, Bob was supported by his wife, fellow scholar and co-author, Ellen FreyWouters, who shared in his struggle to live fully and productively in the face of his terminal illness. Dr. Laufer was born in Holland in 1942 during the Nazi Holocaust. During infancy he was hidden by the Dutch underground to protect his religious identity as a Jew while his family was interned at Auschwitz concentration camp; only his mother survived. The Protestant women who hid him were a strong influence on his later commitment to contribute to the understanding and help of those who were victimized. He emigrated to the United States when he was 8 years old, and spent most of his childhood in Detroit, Michigan. Dr. Laufer attended Monteith College, an innovative liberal arts college in Detroit, Michigan, where he obtained his bachelor of arts degree in sociology and psychology in 1964. He continued his studies in sociology at Wayne State University and Brandeis University where he received his doctorate in 1972. During his professional career, he taught at Beloit College (1968-1969), the University of Wisconsin (1969-1970), and the State University of New York at Albany (1970-1972)o After receiving his Ph.D., he moved to New York City, joined the graduate faculty of the City University of New York, and taught at Brooklyn College, where he was a full professor at the time of his death. His doctoral dissertation was entitled, "Higher Education in Post-Industrial Society: Innovation and Conflict in American Higher Education," a theme which reflected his research publications early in his career. In particular, his inter~t in generational conflict, radical youth identity, and the relationship of the individual to complex social systems were eventually to lay the cornerstone for his later theoretical conceptualizations of the fundamental impact of traumatic events on personal identity and intrapsychic structure.

4666892 Method and composition for hepatitis treatment with pyrimidine nucleoside compounds: Jack J Fox, Kyoichi Watanabe, Carlos Lopez, Christian Trepo assigned to Sloan-Kettering Memorial Cancer Center

4666892 Method and composition for hepatitis treatment with pyrimidine nucleoside compounds: Jack J Fox, Kyoichi Watanabe, Carlos Lopez, Christian Trepo assigned to Sloan-Kettering Memorial Cancer Center

The inverse relationship between cost and survival in the critically ill cancer patient.

The enormous cost of intensive multiple organ system support is apparent from patient or third party charges of $1500--$2000 per day exclusive of physician fees sampled during a retrospective review of 700 consecutive recent admissions to the Critical Care Facility of Memorial Cancer Center. Mortality rates of 49% for general medical, 54% for lymphoma or leukemia, and 20% for surgery patients suggest the need for a selective admission and discharge policy which concentrates financial and personnel resources on those for whom there remains a reasonable chance of worthwhile palliation, if not cure, of their malignancy. An informal policy of this kind may have contributed to a 10% increase in hospital discharges and a reduction of in-unit mortality from 22--18% when compared to 1035 earlier unselected admissions. A modified version of the classification suggested by the Critical Care Committee of the Massachusetts General Hospital has been adopted for use at this institution. A similar approach by other cancer centers is urged so that predictive indices based on prognosis of the underlying disease as well as physiological status may be developed. Otherwise, cost-benefit analysis by third party payers or government will become an unavoidable, and less satisfactory, alternative.

The role of an intensive care unit in a cancer center. An analysis of 1035 critically ill patients treated for life-threatening complications editorial.

Life-threatening complications of cancer therapy often involve multiple organ systems and offer a therapeutic challenge which can be met with efficiency and success by concentrating personnel and equipment in a facility devoted to these problems. Three years ago, an Intensive Care Unit was created at Memorial Cancer Center to offer such patients the benefit of highly skilled nursing, advanced monitoring and supportive techniques, and full-time attendance by physicians and surgeons with a particular interest in Critical Care Medicine. Since then, 1035 patients have been admitted to the eight-bed unit with a mortality rate of 22.3%, which compares favorably with those reported from other institutions. Analysis of this experience has revealed that an average of 16% of those who survived their acute problems after considerable effort and expense, subsequently died of their underlying disease within 2 months. This experience has suggested the need for prognostic criteria to facilitate recognition of those patients for whom intensive supportive measures offer a reasonable chance of worthwhile palliation.

Soft part sarcomas of the head and neck

During the twenty year period from 1949 to 1969, 235 patients with sarcoma of the head and neck region were seen and treated at Memorial Cancer Center. Two hundred and seven cases were determinate, and none was lost to follow-up study. The determinate and absolute five year cure rate was 30 per cent. More than 50 per cent of the cases were seen in children (six cases were congenital) and were almost universally anaplastic and prone to generalized metastasis with fatal outcome. Soft part sarcomas are an unusual group of tumors with a common fibrosarcomatous background. The qualified pathologist can identify quite accurately the different histologic entities and their varying grade, a point of great significance as to clinical course and treatment.

Salmonellosis in patients with neoplastic disease. A review of 100 episodes at Memorial Cancer Center over a 13-year period.

One hundred Salmonella isolations from 95 patients at Memorial Cancer Center over a 13-year period were reviewed. Salmonella typhimurium and Salmonella derby made up 61% of the isolations. Practically all patients had serious underlying disease, and most were under or had undergone recent adrenocorticosteroid treatment, chemotherapy, radiotherapy, or surgery. The predisposition of patients with recent surgery to salmonellosis was reaffirmed. A striking relationship was found between patients with leukemia and lymphoma and S typhimurium septicemia. It is suggested that the hemolytic component in these diseases may predispose to S typhimurium septicemia, and these diseases should perhaps be included with sickle-cell disease, bartonellosis, and malaria in having a specific predisposition to associated salmonellosis. A number of unusual Salmonella infections were noted.

Salmonellosis in Patients With Neoplastic Disease

One hundred<i>Salmonella</i>isolations from 95 patients at Memorial Cancer Center over a 13-year period were reviewed.<i>Salmonella typhimurium and Salmonella derby</i>made up 61% of the isolations. Practically all patients had serious underlying disease, and most were under or had undergone recent adrenocorticosteroid treatment, chemotherapy, radiotherapy, or surgery. The predisposition of patients with recent surgery to salmonellosis was reaffirmed. A striking relationship was found between patients with leukemia and lymphoma and<i>S typhimurium</i>septicemia. It is suggested that the hemolytic component in these diseases may predispose to<i>S typhimurium</i>septicemia, and these diseases should perhaps be included with sickle-cell disease, bartonellosis, and malaria in having a specific predisposition to associated salmonellosis. A number of unusual<i>Salmonella</i>infections were noted.

Malignant vascular tumors of the head and neck

Summary During a forty year period (1930 through 1969) twenty-seven patients with malignant vascular tumors of the head and neck region were seen at Memorial Cancer Center and twenty-one are now available to determine five and ten year end results. All cases are determinate, having received treatment, and none was lost to follow-up study. The classification of these tumors can be unduly complicated and therefore for the benefit of the clinician is simplified in this presentation: ten angiosarcomas and eleven hemangiopericytomas. The absolute and net five year cure rate was 25 per cent and was achieved by radical surgery alone. Among those having had previous treatment (more than half of our cases) there were no five year cures. The five year survival rate of 67 per cent was surprisingly high and can be explained by the prolonged clinical course of hemangiopericytoma as compared with angiosarcoma, for they represent two separate clinical and pathologic entities.

Bone metastases in cancer of the esophagus.

BONE METASTASES IN CANCER OF THE ESOPHAGUSJOHN T. GOODNER, M.D. and A. D. M. TURNBULL, M.D.Audio Available | Share

Primary malignant tumors of the liver

Over a span of 20 years, 137 patients with primary malignant tumors of the liver received treatment at the Memorial Cancer Center. Seventy-one percent of the patients had hepatocellular carcinoma. Various modalities of therapy were applied in the treatment of these patients. Early diagnosis is mandatory to increase the resectability rate. Thirty-two patients had some form of hepatic resection of whom 5 survived more than 5 years. Good palliation and prolongation of life occurred in 2 out of 6 patients who had hepatic artery infusion by chemotherapeutic agents. The role of hepatic transplantation and re-vascularization of segments of the liver in extending the scope of hepatic resection remains in the experimental phase.

Malignant vascular tumors of the head and neck

Summary During a forty year period (1930 through 1969) twenty-seven patients with malignant vascular tumors of the head and neck region were seen at Memorial Cancer Center and twenty-one are now available to determine five and ten year end results. All cases are determinate, having received treatment, and none was lost to follow-up study. The classification of these tumors can be unduly complicated and therefore for the benefit of the clinician is simplified in this presentation: ten angiosarcomas and eleven hemangiopericytomas. The absolute and net five year cure rate was 25 per cent and was achieved by radical surgery alone. Among those having had previous treatment (more than half of our cases) there were no five year cures. The five year survival rate of 67 per cent was surprisingly high and can be explained by the prolonged clinical course of hemangiopericytoma as compared with angiosarcoma, for they represent two separate clinical and pathologic entities.

URINARY DIVERSION AND PELVIC SURGERY FOR CANCER

Brunschwig and Barber (p 617) have made an important study of secondary and tertiary rediversion of the urinary tract in 72 patients, found among a group of 840 patients who had pelvic exenteration for advanced cancer performed in the last 20 years. They have shown that, if a five-year survival is achieved, the most frequent subsequent cause of death is deterioration of the diverted urinary tract. Also, at various shorter times following the initial exenteration, the diverted urinary tract may be the cause of major and indeed fatal complications, aside from any problem concerned with the cancer itself. This vigorous attack on female pelvic cancer made by Brunschwig at the Memorial Cancer Center represents a unique and brave effort. The specific emphasis on the importance of urinary tract diversion, the careful study of the complications, and the methods used to correct the morbidity deserve special commendation. The common immediate complications

Malignant Melanoma

<h3>To the Editor:</h3> —In the Oct 20 issue ofThe Journal(<b>182:</b>298), there appeared a paper entitled "Malignant Melanoma of the Stomach," by Reed, Raskin, and Graff. The patient involved had malignant melanoma in the mucosa of the stomach confirmed by gastroscopie biopsy, and malignant melanoma in an axillary node confirmed by biopsy. No primary melanoma was discernible. I wish to make the following comment concerning this case report: Malignant melanoma of the stomach is not infrequent, as mentioned in the authors' preliminary statement. In the course of treating many patients with malignant melanoma at the Memorial Cancer Center, ample opportunities have been afforded for analyzing the distribution of metastases as determined by postmortem examination. Forty-one per cent of patients dying of melanoma coming to necropsy<i>had</i>metastatic melanoma involving the stomach. At the postmortem examinations, 44% of patients had metastasis to the heart and 38% to the brain.

Clinical pharmacology of analgesics. 1. A method of assaying analgesic effect.

Animal screening tests and methods employing induced pain in human volunteers have failed to predict with any consistency the clinical performance of analgesic drugs. These drugs must be assayed in a clinical setting in which they might be used therapeutically. The lack of adequate objective standards for the measurement of pain or pain relief, the variability in responses among patients, and the influence of environmental factors on these responses, all make it essential that the study be adequately controlled and so designed as to provide some measure of the sensitivity of the method and of the statistical significance of the results.Such a method for evaluating analgesics in patients with chronic pain due to cancer has been employed at the Memorial Cancer Center for the past 8 years. Measurements of analgesia are derived from the patients' own estimates of pain intensity both before and at hourly intervals after a test medication Yielding data which allow comparison of drugs in terms of peak and total effects. Using these criteria, studies of the effects of morphine and a placebo were carried out and provide the basis for a method of assaying other analgesic drugs. A prototype of the latter is presented in the form of a study of aspirin, morphine, and a combination of these drugs.