Cancer imaging informatics workshop report from the Biomedical Imaging Program of the National Cancer Institute.

A group of experts on very large databases, quantitative imaging, data format standards development, image management and communications, and related technologies for cancer imaging met at a recent workshop sponsored by the BIP and discussed the key issues confronting this field. The BIP received recommendations regarding steps that can be taken to advance the technology and take advantage of the opportunities to improve collaboration and utility in cancer imaging. There are tremendous opportunities to change radically the way we use image information. These opportunities are most obvious in clinical research, in which we seek to advance the dissemination and use of cancer image data in research and practice. Important opportunities and new modes of information use are provided by supporting the entire "information cycle" of creation, dissemination, and collaboration in addition to image organization, access, presentation, and preservation. To learn more, visit the BIP Web site at www3 .cancer.gov/bip/steer_iasc.htm and join the image archive listserver at the NIH (ARCHIVE-COMM-L, available online at list.nihgov). These resources are open and available to all.

Phase II study of fludarabine combined with interferon-alpha-2a followed by maintenance therapy with interferon-alpha-2a in patients with low-grade non-hodgkin's lymphoma.

Randomized trials suggest improved disease-free survival in low-grade non-Hodgkin's lymphoma (LGNHL) when interferon is combined with multiagent chemotherapy. This phase II trial was conducted to investigate the feasibility of combining fludarabine monophosphate (fludarabine) and IFN in a regimen for treatment of LGNHL. Twenty-one patients were evaluable. Median age was 55 years, and patients had been treated with an average of 1.7 chemotherapy regimens before enrollment. Patients received 25 mg/m2 of fludarabine intravenously on days 1 through 5 followed by 2 x 10(6) U/m2 of interferon-alpha-2a subcutaneously on days 22 through 26. Cycles were repeated every 4 weeks with delays and dose modifications for significant cytopenias. Patients were restaged after cycles 4 and 8, and those with at least a partial response to therapy were given maintenance therapy consisting of 2 x 10(6) U/m2 interferon-alpha-2a subcutaneously three times per week for 6 months. The overall response rate was 76% with a 25% complete response (CR) rate. Overall response rates were 75% (3/4 with 2 CR's) for chemotherapy-naive patients and 76% (13/17 with 3 CR's) for previously treated patients. Median time to progression was 12 months, and currently two patients are without evidence of progression at a median follow-up of 55 months. Grade III or greater toxicities included neutropenia (39%), anemia (17%), thrombocytopenia (5%), fevers/chills (5%), and fatigue (5%). Fludarabine and interferon can be effectively and safely combined in a regimen with significant activity against LGNHL. A modification of this regimen may be suitable for further study.

Factors affecting patient enrollment in radiology clinical trials: a case study of the American College of Radiology Imaging Network.

RATIONALE AND OBJECTIVES: This study was designed to identify factors that affect the enrollment of patients into American College of Radiology Imaging Network clinical trials. MATERIALS AND METHODS: A quality improvement study was performed. Brainstorming produced an exhaustive list of factors that could affect the interest of sites in participating in American College of Radiology Imaging Network trials, as well as factors that could influence patient recruitment. Surveys, structured interviews, and benchmarking were used to validate and rank the importance of these factors. RESULTS: Site participation was influenced mainly by the support of the department chair and the interest of the investigator. Patient recruitment was affected primarily by the ease of identifying candidates and the perceived experience level and skill of the support staff. CONCLUSION: Because radiologists do not control patient referrals for imaging tests, a premium must be placed on developing systems to maximize the identification and enrollment of candidates for clinical trials. Other factors considered critical to success in patient enrollment include the supportiveness of the departmental leadership, the experience and skill level of study personnel, and the availability of site-specific infrastructure to support the study.