Intensity-modulated arc therapy with cisplatin as neo-adjuvant treatment for primary irresectable cervical cancer. Toxicity, tumour response and outcome

PURPOSE

The goal of this work was to evaluate the feasibility and outcome of intensity-modulated arc therapy ± cisplatin (IMAT ± C) followed by hysterectomy for locally advanced cervical cancer.

PATIENTS AND METHODS

A total of 30 patients were included in the study. The primary tumour and PET-positive lymph node(s) received a simultaneous integrated boost. Four weeks after IMAT ± C treatment, response was evaluated. Resection consisted of hysterectomy with or without lymphadenectomy. Tumour response, acute and late radiation toxicity, postoperative morbidity and outcome were evaluated.

RESULTS

All hysterectomy specimens were macroscopically tumour-free with negative resection margins; pathological complete response was 40%. In 2 patients, one resected lymph node was positive. There was no excess in postoperative morbidity. Apart from two grade 3 hematologic toxicities, no grade 3 or 4 acute radiation toxicity was observed. No grade 3, 1 grade 4 (4%) intestinal, and 4 grade 3 (14%) urinary late toxicities were observed. The 2-year local and regional control rates were 96% and 100%, respectively. The 2-year distant control rate was 92%. Actuarial 2-year progression free survival rate was 89%. Actuarial 1- and 2-year overall survival rates were 96% and 91%, while 3-year overall survival was 84%.

CONCLUSION

Surgery after IMAT ± C is feasible with low postoperative morbidity and radiation toxicity. Local, regional, distant control and survival rates are promising.

A high-fat diet impairs cardiac high-energy phosphate metabolism and cognitive function in healthy human subjects

BACKGROUND

High-fat, low-carbohydrate diets are widely used for weight reduction, but they may also have detrimental effects via increased circulating free fatty acid concentrations.

OBJECTIVE

We tested whether raising plasma free fatty acids by using a high-fat, low-carbohydrate diet results in alterations in heart and brain in healthy subjects.

DESIGN

Men (n = 16) aged 22 ± 1 y (mean ± SE) were randomly assigned to 5 d of a high-fat, low-carbohydrate diet containing 75 ± 1% of calorie intake through fat consumption or to an isocaloric standard diet providing 23 ± 1% of calorie intake as fat. In a crossover design, subjects undertook the alternate diet after a 2-wk washout period, with results compared after the diet periods. Cardiac (31)P magnetic resonance (MR) spectroscopy and MR imaging, echocardiography, and computerized cognitive tests were used to assess cardiac phosphocreatine (PCr)/ATP, cardiac function, and cognitive function, respectively.

RESULTS

Compared with the standard diet, subjects who consumed the high-fat, low-carbohydrate diet had 44% higher plasma free fatty acids (P < 0.05), 9% lower cardiac PCr/ATP (P < 0.01), and no change in cardiac function. Cognitive tests showed impaired attention (P < 0.01), speed (P < 0.001), and mood (P < 0.01) after the high-fat, low-carbohydrate diet.

CONCLUSION

Raising plasma free fatty acids decreased myocardial PCr/ATP and reduced cognition, which suggests that a high-fat diet is detrimental to heart and brain in healthy subjects.

Radionuclide therapy for hepatocellular carcinoma

AIM

Several techniques for radionuclide therapy of hepatocellular carcinoma (HCC) have been developed. In this overview the available radionuclide treatment modalities for HCC are presented, with an emphasis on Yttrium-90 (90Y) microspheres.

METHODS

We comment on the commercially available products and describe the practical aspects of these treatment modalities. Medical literature was screened for clinical data on these therapies in patients suffering from HCC. The most relevant studies are summarized, focusing on patient selection, safety and outcome.

DISCUSSION

Randomized trials are still ongoing or recently initialized. These trials will elucidate the role of 90Y-microspheres in relation to biotherapy and chemoembolization for palliative use in patients not amenable to surgery.

CONCLUSION

Large retrospective or cohort studies proof the safety of 90Y-microspheres for palliative use in HCC patients suffering Child-Pugh A or B7 cirrhosis. Future research will yield more information on its efficacy when compared to chemoembolization or sorafenib. Several groups have reported on the use of selective internal radiation therapy (SIRT) for downstaging patients to surgical curative treatment.

18-Fluorodeoxyglucose positron emission tomography as a tool for response prediction in solid tumours

Current response guidelines for the treatment of solid tumours are based on CT criteria. Over the last decades new techniques have emerged to evaluate cancer therapy. FDG-PET scanning is a more functional imaging technique, which can measure differences in metabolic activity. Although it has a low specificity, studies show that it can outperform classical CT scanning criteria. Especially in lung, breast and oesophageal cancer it can predict response earlier in the neo-adjuvant setting. This could reduce the use of ineffective cancer therapies, reducing costs and patient toxicity, and direct patients sooner towards effective therapy. The main problem with FDG-PET remains the difficulty in defining thresholds for response, as there is clearly a lack in large prospective randomized studies validating the use of FDG-PET in response guidelines.We give an overview of data on response prediction in solid tumours by the application of PET.

Fast-growing, aerobic, heterotrophic bacteria from the rhizosphere of young sugar beet plants

Fast-growing, aerobic, heterotrophic bacteria from the root surface of young sugar beet plants were inventoried. Isolation of the most abundant bacteria from the root surface of each of 1,100 plants between the second and tenth leaf stage yielded 5,600 isolates. These plants originated from different fields in Belgium and Spain. All isolates were characterized by sodium dodecyl sulfate-polyacrylamide gel electrophoresis of total cellular proteins. Comparison of protein fingerprints allowed us to inventory the bacteria of individual plants of different fields or leaf stages and to analyze the composition and variability of the rhizobacterial population of young sugar beet plants. Each field harbored a specific population of bacteria which showed a highly hierarchic structure. A small number of bacteria occurring frequently at high densities dominated in each field. The major bacteria were identified as Pseudomonas fluorescens, Xanthomonas maltophilia, Pseudomonas paucimobilis, and Phyllobacterium sp. The former three species showed a high genetic variability as they were represented by different protein fingerprint types on the same or different fields or leaf stages. Twinspan analysis and relative abundance plots showed that the structure and composition of the bacterial populations varied strongly over time. Pseudomonads were typically early colonizers which were later replaced by X. maltophilia or Phyllobacterium sp.

Rhizobacteria of maize and their antifungal activities

During the growing season of 1984, the rhizobacteria (including organisms from the rhizosphere soil, the rhizoplane, and internal root zones) of 47 maize plants (two varieties) sampled from different locations in France and at different growth stages were inventoried. Isolates were characterized by sodium dodecyl sulfate-polyacrylamide gel electrophoresis of their total cell proteins and were found to represent 352 different protein electrotypes. Maize seedlings were initially colonized by a small number of different strains. Densities reached up to 10 CFU/g of root. Later in the season, the population density decreased but the heterogeneity of the rhizobacterial populations increased. Fluorescent pseudomonads represented up to 35% of the total rhizobacterial population and comprised 43 different electrotypes. Other bacteria regularly present were Xanthomonas maltophilia, Serratia liquefaciens, Pseudomonas paucimobilis, and Bacillus spp. There was a very low similarity between rhizobacterial populations of plants of the same cultivar (LG5) within one field at different growth stages and also between rhizobacterial populations of the cultivars LG5 and BRIO42 on the same field. Most electrotypes (76%) were found on a single occasion. None of the 352 electrotypes was present on all plants. In the 1985 analysis the rhizobacteria of maize seedlings (one variety) sampled from one field were characterized. They represented 236 different protein electrotypes. Thirty-three isolates showed antifungal activity against major maize pathogens; they comprised four Pseudomonas cepacia strains, producing pyrrolnitrin as well as another unknown antifungal compound.

Direct comparison of sensitivity encoding (SENSE) accelerated and conventional 3D contrast enhanced magnetic resonance angiography (CE-MRA) of renal arteries: effect of increasing spatial resolution

PURPOSE

To assess the effect of attaining higher spatial resolution in contrast-enhanced magnetic resonance angiography (MRA) of renal arteries using parallel imaging, sensitivity encoding (SENSE), by comparing the SENSE contrast-enhanced (CE) MRA against a conventional CE-MRA protocol with identical scan times, injection protocol, and other acquisition parameters.

MATERIALS AND METHODS

Numerical simulations and a direct comparison of SENSE-accelerated versus conventional acquisitions were performed. A total of 41 patients (18 male) were imaged using both protocols for a direct comparison. Both protocols used fluoroscopic triggering, centric encoding, breath-holding, equivalent injection protocol, and lasted approximately 30 seconds.

RESULTS

Simulated point-spread functions were narrower for the SENSE protocol compared to the conventional protocol. In the patient study, although the SENSE protocol produced images with lower signal-to-noise ratio (SNR), image quality was better for all segments of the renal arteries. In addition, ringing of kidney parenchyma and renal artery blurring were significantly reduced in the SENSE protocol. Finally, reader confidence improved with the SENSE protocol.

CONCLUSION

Despite a reduction in SNR, the higher-resolution SENSE CE-MRA provided improved image quality, reduced artifacts, and increased reader confidence compared to the conventional protocol.

Immobilization of actinide ions in thin layers of polypyrrole/polyacrylamidoglycolic acid (PPy/PAGA) composite. Application to the preparation of alpha spectrometry sources

We propose a new fully aqueous electrochemical method for the preparation of high resolution alpha sources. Thin films of polypyrrole (PPy) are prepared by anodic electropolymerization, starting from aqueous solutions of the pyrrole monomer and an anionic polyelectrolyte which is able to complex actinide and play the role of PPy doping agent: polyacrylamidoglycolic acid (PAGA). These thin films can be prepared on various electrodes: stainless steel, platinum, glassy carbon and polyethylene doped by carbon-black. Peeling tests revealed their strong adhesion on stainless steel electrode. Alpha sources were prepared by simple immersion in actinide containing solutions. This easy process results in alpha sources with outstanding energy resolution (FWHM: around 9 keV for various isotopes).

The utility of delayed-enhancement magnetic resonance imaging for identifying nonischemic myocardial fibrosis in asymptomatic patients with biopsy-proven systemic sarcoidosis

BACKGROUND

The pathophysiology of sarcoidosis includes infiltrative inflammatory injury, as well as interstitial fibrosis formation. Delayed-enhancement (DE) magnetic resonance imaging (MRI) techniques have been shown to identify fibrotic tissue as areas of hyperenhancement. To test the hypothesis that DE-MRI can be used to identify myocardial fibrosis resulting from cardiac sarcoidosis, we assessed this method in asymptomatic patients with biopsy-proven systemic sarcoidosis.

METHODS

Thirty-one patients with biopsy-confirmed systemic sarcoidosis and no known history of heart disease or sarcoid cardiac involvement underwent DE-MRI after gadolinium-chelate administration. The location and extent of DE were quantified by 2 radiologists experienced at evaluating cardiovascular MRI images.

RESULTS

According to DE-MRI, 8 (26%) of the 31 patients had nonischemic fibrosis, as evidenced by abnormal DE patterns. Unlike characteristic ischemic injuries, most of the fibrosis was mid-myocardial, extending to the adjacent endocardium, epicardium, or both. The most frequent site of fibrosis was the basal inferoseptum, followed by the basal inferolateral wall.

CONCLUSIONS

In asymptomatic patients with systemic sarcoidosis, DE-MRI may provide a novel, noninvasive method for the early identification of myocardial fibrosis.

Yttrium-90 labelled resin microspheres for treatment of primary and secondary malignant liver tumors

Neither regional nor systemic chemotherapy significantly improve survival in the majority of patients presenting with liver metastases and their median survival is short. While the incidence of hepatocellular (HCC) is increasingly worldwide, the various treatment approaches that hve been developed to treat non-resectable HCC have had minimal or moderate impact on overall survival. SIR-Spheres (SIRS) are commercially available (90)Y-labelled resin microspheres that when selectively injected via the hepatic artery will become trapped in the tumor caplliary bed and will selectively deliver radiation to the tumor whilst sparing normal tissue. In this manuscript, the available literature on the use of SIRS in the clinic is summarized. First, available, predominantly phase I and II studies, on SIRS treatment performed in patients suffering from liver metastases as well as in patients suffering from multinodular asymptomatic unresectable HCC with a well preserved liver function have consistently reported a favourable safety profile for SIRS therapy; only a limited number of patients develop gastrointestinal ulceration or bleeding. Second, most of the studies also reported a high reponse rate to SIRS treatment resulting in increased life expectancy; median survival rates proved consistently higher when compared to historical controls. Finally, in two randomized controlled phase III trials, benefits were demonstrated for SIRS combined with chemotherapy when compared to the chemo-arm alone in patients suffering from colorectal liver metastasis. However, since these reports, novel, potentially more effective chemotherapeutics have been introduced for treating colorectal liver metastasis and the clinical value of (90)Y-Sirspheres when compared to these novel chemotherapeutics warrants confirmation and validation.

Rhenium-188 based radiopharmaceuticals for treatment of liver tumours

Rhenium-188 (188Re) is a high energy beta-emitter with a physical half life of 17 hours. Various 188Re based radiopharmaceuticals were developed to treat liver malignancies. The vast majority of studies focus on patients suffering from hepatocellular carcinoma (HCC). Most radiopharmaceuticals are based on Lipiodol as a vehicle for the rhenium-188. The radiopharmaceutical that was tested clinically in detail is the 188Re-HDD/Lipiodol, developed by the Seoul University. Clinical data derived from several phase I and II studies using 188Re-HDD/Lipiodol suggest an excellent tolerance in patients with Child-Pugh A cirrhosis. A shortcoming in some trials was the occasional low labelling efficiency of 188Re-HDD/Lipiodol. Some newer 188Re based radiopharmaceuticals claim to have consistent high labelling efficiencies, however clinical data for these compounds are scarce or lacking at this moment. Hopefully, phase I clinical data will become available for promising radiopharmaceuticals such as 188Re-SSS-Lipiodol, developed by the group of Rennes, in the upcoming years. In Dresden a very different approach is used. They labelled human serum albumin microspheres with high activities of 188Re. In a small group of patients with liver metastasis and a few HCC patients, treatment proved safe. In the present clinical field, 188Re-based radiopharmaceuticals will have to proof firmly their strength and reliability in large patient groups if they want to compete with the commercially available yttrium-90 microspheres.

Correlations between unsatisfactory colposcopy, cytology, and biopsy in patients with cervical abnormalities

BACKGROUND

The main purpose of this study is to review the clinical features of negative loop electrosurgical procedure(LEEP)-cones, in order to lower their rate.

METHODS

Some 162 patients with LEEP-cones were reviewed. Control cytology,satisfactory-unsatisfactory colposcopy, biopsies and endocervical curettage (ECC) were compared to the presence or absence of cone pathology. Statistical analysis, t -tests and Pearson x2 tests were performed, with a significance level of p<0.05.

RESULTS

Negative cones are associated with unsatisfactory colposcopy in 47/60 cases (78.3%) compared to 13/60(21.8%) for satisfactory colposcopy (p=0.011). Unsatisfactory colposcopy is associated with a negative ECC in 53/74(71.6%) cases, compared to 21/74 (28.4%) for satisfactory colposcopy (p=0.024). Finally, negative ECC are associated with negative cones in 32/41 (78%) compared to 9/41 (22%) for positive ECC (p=0.002).

CONCLUSIONS

Low grade cytology, CIN1 biopsies and ECC should be followed for at least 1 year. This results in a lowering of cone negativity from 60/162(37%) to 32/162 (19.8%).