p53 protein expression and radiation-induced apoptosis in human tumors transplanted to nude mice

Relationships between p53 protein expression and radiation-induced apoptosis in five human tumors transplanted to nude mice were studied immunohistochemically. They were irradiated with 200 kV X-rays. Six hours after 2, 5, 10, or 20 Gy irradiation, tumors were excised and fixed. Tumors were also examined 1-48 hours after 10 Gy. Immunohistochemical studies were performed for analysis of p53 protein expression. TUNEL and electron microscopic studies were performed to identify apoptosis. In non-irradiated control groups, the incidence of apoptosis was very low in all of the five tumors. Most tumor cells of the ependymoblastoma were p53 protein negative, but the other four tumors were p53 positive. Following irradiation, most tumor cells of the ependymoblastoma became p53 positive, and the incidence of apoptosis increased. However, we could not find significant changes in the percentage of p53 positive cells in the other tumors, and radiation-induced apoptosis in them was low or negligible. These results suggest that radiation-induced apoptosis in a radiosensitive human tumor is related to wild-type p53 protein expression. In contrast, the p53 protein expression of the other four human tumors should be mutant type, and it does not lead to radiation-induced apoptosis.

The effect of overall treatment time of radiation therapy on local control of T1-stage squamous cell carcinoma of the glottis

From 1975 to 1990, 72 patients with T1 glottic cancer, excluding a verrucous type of carcinoma, were treated with radiation therapy (RT). All treatments were given with a standard fractionation of 2 Gy per day. The total dose to the tumor ranged from 60 to 70 Gy. Six patients received a split-course RT. The overall local control rate was 87% at 5 years. Forty-one patients who completed RT in 45 days or less had a 5-year local control rate of 95%. Sixteen patients who completed a treatment course in 46 to 49 days had a local control rate of 81%. Fifteen patients with a treatment course of more than 50 days had a local control rate of 73%. There was a statistically significant difference in local control rates among the three groups (P<.05). The split-course RT group had a 5-year local control rate of 50%; that rate was statistically significantly inferior to that of the continuous course group (P<.001). Multivariate analysis also showed that an interruption of the treatment course was an important parameter in relation to the local control. The prolongation of standard RT schedules adversely affected local control of T1 glottic carcinoma and, therefore, should be avoided whenever possible.

A radioresistant variant cell line, NMT-1R, isolated from a radiosensitive rat yolk sac tumour cell line, NMT-1: differences of early radiation-induced morphological changes, especially apoptosis

A radioresistant variant cell line, NMT-1R, was isolated by repeated radiation exposure of a radiosensitive rat yolk sac tumour cell line, NMT-1, producing alpha-fetoprotein, with the potential for lymphatic metastasis in the inbred Wistar rat. Cultured NMT-1R cells showed more cobblestone-like appearances, although the morphological features were almost the same as radiosensitive NMT-1 cells reported previously. The doubling time of NMT-1R cells was 13.6 h, being shorter than that of NMT-1 cells (16.0 h). For NMT-1R cells, D0 for radiation sensitivity was 165 +/- 3 cGy, 1.7 times as large as for NMT-1 cells. The extrapolation number, n, was 1.48 +/- 0.17 for NMT-1R cells although that for NMT-1 cells was 1.08 +/- 0.15. The surviving fractions at 2 Gy (SF2) were 0.42 for NMT-1R cells and 0.28 for NMT-1 cells. The population of G2-M phase for NMT-1R cells was larger than for NMT-1 cells (32.5 versus 26.8%) in exponentially growing cells. Although a clear G2 delay was observed after irradiation with a dose of 182 cGy for both cell lines, NMT-1R cells had a shorter recovery time from G2 block than NMT-1 cells, G1 arrest was observed in NMT-1 cells. NMT-1 cells showed much higher incidence of early morphological changes, especially apoptosis, after irradiation with a dose > 500 cGy compared with NMT-1R cells.

Prognostic factors for loco-regional control and outcome of re-irradiation for patients with poorly-differentiated squamous cell carcinoma of the nasopharynx

Retrospective analysis was performed to evaluate the prognostic factors for loco-regional control and the results of re-irradiation for 28 patients with recurrent, poorly-differentiated squamous cell carcinoma (PDSCC) of the nasopharynx. Twenty-four of them received re-irradiation. Local, local plus regional and regional recurrences were observed in 19, five and four patients, respectively. Except for three patients, all had Stage IV disease at the initial diagnosis. The only parameters influencing loco-regional recurrence were T and N stage categories. The median latent period from initial treatment to recurrence was 18.5 (range, 2-100) months. There was no difference in latent period by first recurrence site, although recurrent tumors confined to the nasopharynx or those only regionally developed had a longer latent period. Only four patients developed secondary distant bone metastases with a median latency of three months from loco-regional relapse. The patients with local recurrent tumors confined to the nasopharynx, and those with regional recurrences only, could be salvaged by re-irradiation, with five-year survival rates of 44 and 100%, respectively. Five of 28 patients (18%) developed severe chronic radiation sequelae: cerebrospinal complications in four patients, bilateral neck fibrosis in one. We conclude that recurrent PDSCC of the nasopharynx can be controlled by re-irradiation with some success. Radiation therapy techniques must, however, be carefully planned in order to avoid the severe late post re-irradiation sequelae. For patients with advanced non-curable local recurrences, palliative care should be recommended instead of agressive re-irradiation.

Results of postoperative radiation therapy for patients with carcinoma of the uterine cervix: evaluation of intravaginal cone boost with an electron beam

Retrospective analysis was carried out from the records of 108 patients with carcinoma of the uterine cervix treated with postoperative external whole pelvic irradiation (EWPI) followed by intravaginal cone boost with an electron beam to the vaginal cuff (IVCB) to evaluate the efficacy of this method. The 5-year cause-specific survival rates were 89% for 89 patients undergoing prophylactic radiation therapy and 56% for 19 patients undergoing salvage radiation therapy (P < 0.001). The 5-year survival rates were 62% for 11 patients with macroscopic residual tumors and 41% for 8 patients with microscopic residual tumors. Of the patients with pelvic lymph node (PLN) involvement, incidences of intrapelvic recurrence, extrapelvic recurrence, and distant metastases were 12, 9, and 3%, respectively. The prognosis for patients without PLN metastasis was significantly better than that for patients with PLN metastasis in the prophylactic radiation therapy group (P < 0.001). Recurrent tumors at the vaginal cuff were observed in only 2 patients in the prophylactic radiation therapy group. Vesicovaginal fistula was observed in 4 patients. Only 1 patient developed Grade 2 rectal complications. No other severe complications were observed. IVCB following EWPI is a safe and effective postoperative radiation therapy technique for patients with cervical cancer.

Squamous cell carcinoma of the uterine cervix: radiation therapy for patients aged 70 years and older

PURPOSE

To evaluate the usefulness of radiation therapy for elderly patients with squamous cell carcinoma of the uterine cervix.

MATERIALS AND METHODS

Two hundred ninety-three patients with squamous cell carcinoma of the uterine cervix underwent external pelvic irradiation and three sessions of low-dose-rate intracavitary irradiation. One hundred twenty-six patients were aged 70 years or older (elderly group), and 167 patients were aged 69 years or younger (younger group). Survival rates, pattern of failure, local control rates, and complications for the two groups were compared.

RESULTS

The 5-year, cause-specific survival rates for the elderly group with stage I, II, III, or IV disease were 100%, 81%, 73%, and 54%, respectively. Corresponding rates for the younger group were 100%, 92%, 74%, and 32%. Differences in survival curves, patterns of failure, recurrence rates, and incidences of radiation complications for the two groups were not statistically significant.

CONCLUSION

Age did not influence the effectiveness of radiation therapy for the elderly patients.

Neoadjuvant intra-arterial doxorubicin chemotherapy in combination with low dose radiotherapy for the treatment of locally advanced transitional cell carcinoma of the bladder

Between 1979 and 1990, 60 patients with locally advanced bladder cancer (stages T2 to 4NXM0) were treated with intra-arterial doxorubicin chemotherapy in combination with low dose radiotherapy and 36 (60%) achieved a complete remission. The tumor size (p < 0.01), tumor grade (p < 0.05) and clinical stage (p < 0.05) correlated significantly with the tumor response to the combined therapy. Of the 36 patients with complete remission and the 24 patients who did not achieve a complete remission 35 and 22, respectively, underwent a conservative bladder operation after treatment. Median followup was 71 months. The overall 5-year disease-free and cause-specific survival rates for the 60 patients were 49% and 72%, respectively. A significantly higher (p < 0.01) 5-year survival rate was observed in patients who achieved a complete remission (94%) than in those who did not (40%). The results suggest that intra-arterial chemotherapy plus radiotherapy is a useful regimen for patients with locally advanced bladder cancer, and bladder function may be preserved in those who achieve a complete remission.

[A case of erythropoietin-producing renal cell carcinoma with a skin metastasis]

An 83-year-old man came to our hospital complaining of asymptomatic gross hematuria. We found a subcutaneous tumor in his chest and an abdominal mass in his left upper quadrant. Laboratory data showed red blood cell count of 737 x 10(4)/mm3 and hemoglobin level of 17.9 g/dl. The serum erythropoietin level measured by radioimmunoassay was considerably high. He underwent left nephrectomy and tumor resection in the chest wall. Serum erythropoietin level became normal following surgery and erythrocytosis disappeared. Histological findings revealed renal cell carcinoma, alveolar type, clear cell subtype, grade 2. The erythropoietin levels of the extracts of the cancer tissue and the normal kidney tissue were 2430 mU/g and 59.5 mU/g, respectively. Lung, liver and bone metastases appeared four months after the operation and serum erythropoietin level increased again.

[Clinical study of squamous cell carcinoma of the bladder]

Clinical and statistical observations were made on 15 cases of squamous cell carcinoma of the bladder experienced at our department during the past 19 years. The patients were 10 men and 5 women ranging in age from 41 to 80 years (median: 65.1 years). Forty percent of the chief complaints was bladder irritability without macrohematuria. The prognosis was very poor. Three-year and five-year survival rates were 32.3% and 26.1% respectively.

Immunohistochemical detection of carcinoembryonic antigen in benign hyperplasia and adenocarcinoma of the prostate with monoclonal antibody

Immunoperoxidase localization of carcinoembryonic antigen was done on tissue sections of benign hyperplasia and adenocarcinoma of the prostate using murine monoclonal antibody against carcinoembryonic antigen. The study was done to determine whether carcinoembryonic antigen would be a tissue marker of prostatic malignancy. Of 30 benign lesions 25 (83 per cent) were negative and 5 had focally weak staining, while of 36 adenocarcinomas 31 (86 per cent) had diffusely positive staining and 5 were negative. Diffusely moderate or strong staining was noted in 5 of 10 grade I (50 per cent), 11 of 12 (92 per cent) grade II and 13 of 14 (93 per cent) grade III tumors, as well as 14 of 15 (93 per cent) tumors from patients with bone metastasis. These findings suggested that extensive immunostaining for carcinoembryonic antigen in prostatic glandular lesions might be a potentially important prognostic marker of malignancy. Further studies are warranted to extend and confirm these results.

Prostatic origin of metastases: immunoperoxidase localization of prostate-specific antigen

An immunoperoxidase technique for prostate-specific antigen was used to evaluate autopsy material from 8 patients with multiple prostatic metastases, 22 primary prostatic carcinomas and 12 nonprostatic tumors. All specimens of primary and metastatic prostatic carcinomas stained positively, irrespective of the Gleason grade. None of the nonprostatic tumors showed immunostaining. Thus, the method appeared to be highly specific and highly sensitive for the detection of the prostatic origin of metastases.