Adjuvant chemoradiotherapy of advanced resectable rectal cancer: results of a randomised trial comparing modulation of 5-fluorouracil with folinic acid or with interferon-α

Background:

Standard adjuvant chemoradiotherapy of rectal cancer still consists of 5-fluorouracil (5-FU) only. Its cytotoxicity is enhanced by folinic acid (FA) and interferon-α (INFα). In this trial, the effects of FA and IFNα on adjuvant 5-FU chemoradiotherapy in locally advanced rectal cancer were investigated.

Methods:

Patients with R₀-resected rectal cancer (UICC stage II and III) were stratified and randomised to a 12-month adjuvant chemoradiotherapy with 5-FU, 5-FU+FA, or 5-FU+IFNα. All patients received levamisol and local irradiation with 50.4 Gy.

Results:

Median follow-up was 4.9 years (n=796). Toxicities (WHO III+IV) were observed in 32, 28, and 58% of patients receiving 5-FU, 5-FU+FA, and 5-FU+IFNα, respectively. No differences between the groups were observed for local or distant recurrence. Five-year overall survival (OS) rates were 60.3% (95% confidence interval (CI): 54.3–65.8), 60.4% (54.4–65.8), and 59.9% (53.0–66.1) for 5-FU, 5-FU+FA, and 5-FU+IFNα, respectively. A subgroup analysis in stage II (pT3/4pN0) disease (n=271) revealed that the addition of FA tended to reduce the 5-year local recurrence (LR) rate by 55% and increase recurrence-free survival and OS rates by 12 and 13%, respectively, relative to 5-FU alone.

Conclusions:

Interferon-α cannot be recommended for adjuvant chemoradiotherapy of rectal cancer. In UICC stage II disease, the addition of FA tended to lower LR and increased survival. The addition of FA to 5-FU may be an effective option for adjuvant chemoradiotherapy of UICC stage II rectal cancer.

[Memorandum registry for health services research]

On August 30, 2010, the German Network for Health Services Research [Deutsches Netzwerk Versorgungsforschung e. V. (DNVF e. V.)] approved the Memorandum III "Methods for Health Services Research", supported by their member societies mentioned as authors and published in this Journal [Gesundheitswesen 2010; 72: 739-748]. Registries in Health Services Research vary in their aims and research questions as well as in their designs, methods of data collection, and statistical analyses. This paper aims to provide both a methodological guideline for developers to ensure a high quality of a planned registry and, to provide an instrument for users of data from registries to assess their overall quality. First, the paper provides a definition of registries and presents an overview of objectives in Health Services Research where registries can be useful. Second, several areas of methodological importance for the development of registries are presented. This includes the different phases of a registry (i. e., conceptual and preliminary design, implementation), technical organisation of a registry, statistical analysis, reporting of results, data protection, and ethical/legal aspects. From these areas, several criteria are deduced to allow the assessment of the quality of a registry. Finally, a checklist to assess a registry's quality is presented.

Determination of depth gradients of grain interaction and stress in Cu thin films

Grain-interaction and residual stress depth gradients in a sputter-deposited Cu thin film (thickness 4 µm) were determined by employing X-ray diffraction stress measurements at constant information depths in the range between 200 and about 1500 nm. A novel procedure, which allows the determination of an effective grain-interaction parameter on the basis of thef(ψ,hkl) method and the Voigt and Reuss models of elastic grain interaction, was used. The range of accessible penetration depths was maximized by employing different photon energies using a laboratory diffractometer with Cu Kα radiation and a diffractometer at a synchrotron beamline. The variation of grain interaction with depth could be successfully related to the microstructure of the specimen. The tensile residual stress in the film parallel to its surface decreases with decreasing depth. By measuring the lattice spacing for several reflections at one penetration depth with two different photon energies (i.e.using small and large incident beam angles) it was found that the surface roughness of the specimen counteracts the effect of beam refraction to some degree. As a consequence, irrespective of whether a refraction correction is applied or neglected for the low-incidence angle measurement, erroneous results are obtained for lattice spacings derived from reflections at small incidence angles; reliable grain-interaction and stress analysis requires measurements at high incidence angle.

Prognostic factors influencing the survival of patients with colon cancer receiving adjuvant 5-FU treatment

AIM

Adjuvant chemotherapy is recommended for stage III colon cancer. The aim of this study was to identify important prognostic factors among patients with colon cancer receiving adjuvant 5-FU-based treatment.

METHODS

Data sets of 855 colon cancer patients treated between 1992 and 1999 within a multicenter adjuvant trial comparing 5-FU modulation with folinic acid or interfereron-alpha were examined. Backward elimination in a proportional hazards model was used to identify prognostically relevant clinical and pathological factors.

RESULTS

Tumor recurrence (p<0.001), duration of adjuvant treatment (p<0.001), tumor substage (p=0.004), age (p=0.005), grading (p=0.016), treatment-related toxicity (p=0.021), and treatment (p=0.031) were identified in descending order of importance as prognostic factors for overall survival.

CONCLUSIONS

Adjuvant 5-FU-based treatment should be performed for at least 6months with a stepwise adjustment of 5-FU doses until toxicity >WHO II. Substages should be reported separately and used for stratification in future trials due to their broad variation in outcome. In the future, this may result in adjuvant treatment of stage III colon cancer adjusted for the risk of substages.

UV/Vis spectra and solubility of some naphthoquinones, and the extraction behavior of plumbagin from Plumbago scandens roots in supercritical CO2

The solubility of 1,4-naphthoquinone, plumbagin, lawsone, and juglone in supercritical carbon dioxide was determined spectroscopically at 40 degrees C, and in the pressure range 8-18 MPa. Their solubilities at 12 MPa were between 0.3 and 10 g L(-1). Plumbagin from Plumbago scandens L. roots was extracted at 40 degrees C and 20 MPa. The extracted plumbagin mass fraction was up to 0.2% in fresh roots but down to about 0.006% in aged roots. n-Hexane and chloroform extraction of such aged roots indicates that the older and dryer the roots are, the stronger they bind plumbagin. Reversed-phase HPLC indicated a relatively pure plumbagin extract with supercritical carbon dioxide.

Evaluation of the concept of heterology in a monoclonal antibody-based ELISA utilizing direct hapten linkage to polystyrene microtiter plates

A series of new heterologous haptens has been synthesized and used as coating haptens in an antigen-immobilized immunoassay with a monoclonal antibody against atrazine. Coating was achieved by covalently linking the different haptens to a glutaraldehyde network directly bound to the polystyrene surface of a standard 96-well microtiter plate. With the assay designed in the antigen-immobilized format with direct chemical linkage of the hapten to the solid polystyrene surface well-defined hapten densities were achieved in all experiments. The results of different experiments with different coating haptens were comparable. Using different heterologous haptens it appears that the concept of heterology is applicable in this case and can be used to enhance the sensitivity of an immunoassay in the coating-hapten format.

Formation of nanoparticles in flames; measurement by particle mass spectrometry and numerical simulation

The size distributions of nanoparticles in flames are measured using a novel particle mass spectrometer (PMS), which is developed for the size range between 0.3 and 50 nm and for number concentrations between 10(9) and 10(13). Using this instrument the particles are sampled without prior dilution from the flame into a molecular beam. The charged nanoparticles are then deflected by an electric field, to determine the mass according to the time-of-flight principle. The PMS is installed in a low pressure combustion chamber operated at 30 mbar. Measurements are made on primary soot particles and iron oxide particles in a laminar, premixed acetylene/oxygen flame. The soot particles increase in size as a function of the height above the burner and the C/O ratio from 2 up to 10 nm. Iron oxide particles of 3-5 nm are detected as a function of burner height. The soot particles form more rapidly than the iron oxide particles. A model calculation for the formation of silica and iron oxide in hydrogen/oxygen flames is developed, based on previously published reaction mechanisms. On adding a mono-disperse particle coagulation scheme, the time history of the particle number concentration and the particle size is calculated. In agreement with experimental data, the calculations show that iron oxide particles are formed more slowly than silica particles.

Dipole Moments of 4?-Aminoflavonol Fluorescent Probes in Different Solvents

Electrooptical absorption measurements (EOAM) were used to measure the dipole moments of the normal form of 4'-(dimethylamino)-3-hydroxyflavone (FME), and 4' N-(15-azacrown-5)-3-hydroxyflavone (FCR) in 1,4-dioxane, toluene, and cyclohexane. With these probes excited-state intramolecular proton transfer (ESIPT) takes place. For comparison, the dipole moments of 4'-(dimethylamino)-3-metoxyflavone (FME3ME), for which ESIPT is lacking, were measured, too. For all three probes the ground (micro(g)) and excited Franck-Condon state (micro(e)FC) electrical dipole moments are parallel to each other and also parallel to the transition dipole moment. The electrical dipole moments of FCR, FME, and FME3ME in their ground state have values within the range (12.0-17.7) x 10(-30) C m. Upon optical excitation, the dipole moments increase by (41.9-52.9) x 10(-30) C m. The value of the change of the dipole moment vector delta(a)micro with excitation to the Franck-Condon state and the value of the vector micro(e)FC for FCR and FME are practically independent on the solvent polarity. From this point of view and due to large values of the dipole moments FCR and FME are very promising probes for the investigation of the distribution of the local polarity in biological systems using site-selective excitation of the different sites. Our steady-state fluorescence studies on FME and FCR have demonstrated a high spectral sensitivity of the normal form to such solvent characteristics as polarity.