Experimental demonstration of a soft x-ray self-seeded free-electron laser.

The Linac Coherent Light Source has added a self-seeding capability to the soft x-ray range using a grating monochromator system. We report the demonstration of soft x-ray self-seeding with a measured resolving power of 2000-5000, wavelength stability of 10(-4), and an increase in peak brightness by a factor of 2-5 across the photon energy range of 500-1000 eV. By avoiding the need for a monochromator at the experimental station, the self-seeded beam can deliver as much as 50-fold higher brightness to users.

Phase I clinical trial of an MAF-containing lymphoblastoid cell line supernatant.

A preliminary Phase I evaluation of macrophage activating factor (MAF) derived from the partially purified supernatant of human RPMI-1788 lymphoblastoid cell line was performed in 4 parts in 39 patients with advanced cancer. The first two parts used subcutaneous routes of administration and the second two parts used a 4-h intravenous infusion method. Individual doses ranged from 0.1 ml (1.7 mg protein) to 100 ml (1,700 mg protein). Subcutaneous dose was limited by the volume of administered material, and an attempt to use a concentrate of the supernatant resulted in severe local skin reactions. Larger doses given intravenously were well tolerated. Resultant toxicity was mild and consisted of transient fever and chills. One patient with malignant melanoma had a complete response of a 3-cm skin metastasis; one patient with breast cancer had disappearance of a skin nodule while visceral disease progressed; and one patient with histiocytic lymphoma had resolution of a conjunctival lesion. Treatment in many patients was associated with an increase in absolute peripheral lymphocytes. In the high-dose intravenous group, a statistically significant increase in the phagocytic index of peripheral blood leukocytes was noted. Lymphoblastoid MAF appears to be relatively safe to administer and has promise both as an antitumor agent and in the treatment of other altered immune conditions.

The impact of breast cancer screening on survival. A 5- to 10-year follow-up study.

The Missouri Breast Cancer Detection Demonstration Project (BCDDP) at the Cancer Research Center in Columbia, Missouri, detected 136 malignant lesions among 10,187 asymptomatic participants between 1974 and 1980. Mammography was the sole detection modality in 76 or 56% of cases (Group 1). Mammography combined with physical examination revealed 41 (30%) additional cases (Group 2). Physical examination alone detected 19 (14%) cases (Group 3). Follow-up was complete in all cases. There were 26 (19%) noninvasive and 110 (81%) invasive lesions. Positive axillary nodes were found in 34 (25%) cases, and 102 (75%) patients had negative nodes. The overall 5-year survival was 84.5%. After a minimum follow-up of 5 years and a median follow-up of 8.5 years, 108 patients are alive, 5 of whom have recurrences. Among 28 deceased patients, 9 died of causes unrelated to breast cancer. The 5-year survival of Group 1 was 95% (72/76). Among this group of patients, 84% (64/76) had negative lymph nodes. At 5 to 10 years follow-up, there have been no breast cancer-related deaths among this group, and only one patient has recurrent disease 91 months after mastectomy. Furthermore, 85% (22/26) of all noninvasive lesions were found in this group. Of the remaining 12 patients diagnosed by mammography alone but who had positive nodes, the 5-year survival was 75% (9/12). By contrast, patients diagnosed by mammography plus physical examination (Group 2) experienced a survival of 71% (29/41) at 5 years. Sixty-three percent of patients diagnosed by physical examination had negative lymph nodes. Their 5-year survival was 84%, which contrasts with a 50% 5-year survival for patients with positive nodes. In Group 3, 79% (15/19) had negative nodes. The 5-year survival rate of this group was 74% (14/19), and the 5-year survival rate of the node-negative patients with invasive disease in this group was 29% and 21% lower than that of the node-negative patients with invasive disease of Groups 1 and 2, respectively (P less than 0.01). This study suggests that improved survival in breast cancer screening program is in large measure dependent on the ability to detect lesions before they become palpable. The authors conclude that mammography is a determining factor in early diagnosis, and at 5 to 10 years contributes significantly to improved 5- and 10-year survival rates.

Cancer of the breast. Screening.

Screening is a more complicated issue than has been indicated in this chapter. Long-term followup is essential to exclude misleading initial impressions, and survival predictions must stand this test. The problem of interval cancers must be acknowledged, and methods of developing more cost-effective systems that might provide even broader coverage of the population at risk have to be considered. Suffice it to say that mass screening for breast cancer can be accomplished. Large numbers of American women are sufficiently concerned about this disease to participate, as evidenced by the success of the National Cancer Institute/American Cancer Society Breast Cancer Detection Demonstration Projects. It has been demonstrated that breast cancers so small that they would previously be considered a pathological curiosity are detected with surprising frequency. The ultimate effect on survival time by this screening can of course only be determined after passage of time, but there is every reason to believe that it represents one of the really great advances in detection-diagnosis in recent history. The chief detection modality is mammography, and it is to be expected that technological advances in this area will permit images of even greater reliability and resolution at a level of radiation exposure that will be acceptable to everyone. The definitive role of thermography in detection of breast disease has yet to be fully determined. The maximal scientific benefit and the true impact of the screening demonstration projects will be realized only after long-term followup of the 280,000 participants.