Initial report of RTOG 9601, a phase III trial in prostate cancer: Effect of anti-androgen therapy (AAT) with bicalutamide during and after radiation therapy (RT) on freedom from progression and incidence of metastatic disease in patients following radical prostatectomy (RP) with pT2-3,N0 disease and elevated PSA levels

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Background: To test if long term AAT when combined with RT in these patients (pts) with prostate cancer (PC) will improve cancer control outcomes as well as overall survival (OS).

Methods: Post-RP pts with pT3,N0 or with pT2,N0 (and positive margins) who have an elevated PSA were entered on a phase III, double-blinded, placebo-controlled trial of RT alone (64.8 Gy in 1.8 Gy fractions) vs RT + AAT (24 months of bicalutamide, 150mg daily) during and after RT. The primary end point is OS.

Results: From 3/98 to 3/03, 771 eligible pts (median age 65) were randomized to RT + AAT (387) or RT alone (383). Pretreatment characteristics were balanced. 672 (87%) had a PSA nadir after RP of < 0.5 ng/mL. 655 (85%) had an entry PSA value of <1.6, 115 (15%) had an entry PSA of 1.6-3.9. Median follow-up was 7.1 years. Actuarial OS at 7 years was 91% for RT + AAT and 86% for RT alone. Too few primary end-point events have occurred to allow a statistical comparison between groups. Freedom from PSA progression (FFP) at 7 years was 57% for RT + AAT and 40% for RT alone (P < 0.0001); for 226 pts with GS < 7 were 63% and 50% (P<0.02), for 411 GS 7 these were 55% and 39% (P<0.0006), and for 134 GS 8-10 were 56% and 26% (P < 0.0008). The 7-yr cumulative incidence of metastatic PC was less in the RT and AAT arm, 7% vs 13% in the RT arm (p<0.041). Late grade 3-4 toxicities were similar in both arms. By category the combined grade 3-4 toxicities for RT + AAT and RT alone were: bladder 6% vs 5% bowel 2% vs 1%, cardiac 3% vs 2%. Gynecomastia (mostly grades 1-2) differed significantly, 89% vs15%. In the RT + AAT arm grade 3 was the highest liver toxicity, which occurred in 3 pts.

Conclusions: The addition of 24 months of bicalutamide 150 mg daily during and after RT significantly improved FFP and reduced the incidence of metastatic PC without adding significantly to RT toxicity. The significance of benefit in OS, as well analysis of risk-stratified subsets, wait longer follow-up.

No significant financial relationships to disclose.

Neoadjuvant stereotactic body radiation therapy (SBRT) for borderline resectable pancreas cancer: Moffitt Cancer Center initial experience

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Background: Our institution has reported a strategy of using neoadjuvant GTX (gemcitabine, docetaxel, and capecitabine) chemotherapy followed by 5FU-based intensity-modulated radiation therapy (IMRT) for borderline resectable pancreas cancer. We now report our early experience with induction chemotherapy followed by stereotactic body radiation therapy (SBRT).

Methods: This retrospective review evaluates our initial 5 fraction SBRT experience in 15 patients following induction chemotherapy for borderline resectable pancreatic cancer. Staging included pancreatic protocol CT, endoscopic ultrasound, and PET/CT scan. Induction regimens consisted of GTX for 3 cycles in 12 patients and gemcitabine alone in 3. Daily SBRT was delivered to the pancreas at least 1 week after completing systemic chemotherapy. Endoscopically implanted fiducial markers and daily cone beam CT were used for image guidance. Treatment was delivered on a Varian Trilogy unit using 6-15 MV photons. Doses were selected based on dose painting the portion of tumor adjacent to the vasculature to a higher dose while meeting normal tissue constraints. The entire gross tumor received a dose of 5-6 Gy per fraction while the portion of the tumor adjacent to the vasculature resulting in the borderline designation received up to 8 Gy per fraction. Patients were re-imaged 3-4 weeks after SBRT for consideration of surgery.

Results: There were no acute or late grade 3 toxicities. At the time of this analysis, not all treated patients have reached the restaging time point, but 9 of 15 (60%) were candidates for resection. Six patients have gone to resection with negative margins and without any increased complications. Two patients were found to have disease surrounding the vasculature preventing resection. One patient had cardiac issues at surgery and resection was aborted. One patient was explored and found to have liver metastases.

Conclusions: Integration of SBRT in conjunction with systemic therapy is well-tolerated and appears to facilitate margin-negative resection in borderline resectable pancreatic cancer.

No significant financial relationships to disclose.

An isolated cardiac metastasis from colorectal adenocarcinoma

Epidemiological information relating to cardiac metastases is predominantly based on autopsy studies. The reported incidence ranges from 2.3-18.3%. It is usually found in the presence of widely disseminated disease. Here, a case of an isolated, asymptomatic cardiac metastasis from colonic adenocarcinoma is reported. The metastasis was detected later, following bowel resection and was not amenable to surgical resection. The patient is receiving ongoing care from the oncology team.

Foam posturography: standing on foam is not equivalent to standing with decreased rapidly adapting mechanoreceptive sensation

Standing on a foam surface is believed to exaggerate balance deficits by decreasing the reliability of somatosensory information from cutaneous mechanoreceptors on the plantar soles (i.e. base of feet) and by altering the effectiveness of ankle torque. The aim was to further document the nature of foam posturography testing by comparing between standing on foam and standing with decreased Rapidly Adapting Mechanoreceptive Sensation (RAMS). Sixteen healthy adults (mean age 20.8 years) were tested with posturography, standing with eyes open and closed on a solid surface and on foam, with and without decreased plantar RAMS. Standing balance was measured as torque variance and further analyzed by being divided into three spectral categories. Plantar cutaneous hypothermic anesthesia by ice-cooling was used to decrease RAMS. Plantar mechanoreceptive sensation was precisely determined with tactile sensitivity and vibration perception tests. Vibration perception was significantly decreased by hypothermic anesthesia, but tactile sensitivity was not. The anterior-posterior torque variance was significantly larger for frequencies less than 0.1 Hz under eyes closed conditions when standing on a solid surface with decreased RAMS compared to normal sensation. No effect of decreased RAMS was seen with eyes open on a solid surface, nor on foam with eyes open or closed. Decreased RAMS produced body sway responses on a solid surface that were different in spectral composition, amplitude, direction and that responded differently to vision compared with standing on foam. Hence, this study showed that RAMS contributes to postural control but reduction in RAMS does not produce a similar challenge as standing on foam.

Solid-state characterization and in vitro dissolution behavior of lorazepam: Hydroxypropyl-β-cyclodextrin inclusion complex

The objectives of this research were to prepare and characterize inclusion complexes of lorazepam with hydroxypropyl-β-cyclodextrin and to study the effect of complexation on the dissolution rate of lorazepam, a water-insoluble drug. The phase solubility profile of lorazepam with hydroxypropyl-β-cyclodextrin was an AP-type, indicating the　formation of 2:1 stoichiometric inclusion complexes. Gibbs free energy values were all negative, indicating the spontaneous nature of lorazepam solubilization, and they decreased with an increase in the cyclodextrin concentration, demonstrating that the reaction conditions became more favorable as the concentration of cyclodextrins increased. Complexes of lorazepam were prepared with cyclodextrin using various methods such as physical mixing, kneading, spray-drying, and lyophilization. The complexes were characterized by differential scanning calorimetry, Fourier-transform infrared, scanning electron microscopy, and powder X-ray diffraction studies. These studies indicated that a complex prepared by lyophilization had successful inclusion of the lorazepam molecule into the cyclodextrin cavity. Complexation resulted in a marked improvement in the solubility and wettability of lorazepam. Among all the samples, a complex prepared with hydroxypropyl-β-cyclodextrin by lyophilization had the greatest improvement in the in vitro rate of lorazepam dissolution. The mean dissolution time for lorazepam decreased significantly after preparing complexes and physical mixtures of lorazepam with cyclodextrin. The similarity factor indicated a significant difference between the release profiles of lorazepam from complexes and physical mixtures and from plain lorazepam. Tablets containing complexes prepared with cyclodextrins had significant improvement in the release profile of lorazepam as compared to tablets containing lorazepam without cyclodextrin.

Properties of a new mouthrinse for patients receiving radiation therapy

INTRODUCTION

Patients receiving radiation therapy due to oral cancer develop complications such as hyposalivation, mucositis, oral infections, dental hypersensitivity and caries. Mouthrinses can alleviate some of these problems.

AIMS AND OBJECTIVES

To investigate the in vitro antimicrobial properties and cytotoxicity of an experimental mouthrinse.

METHODS

The mouthrinse contained 30% hexylene glycol (glycerine), 7% potassium nitrate and 0.025% sodium fluoride. The minimal inhibitory concentration (MIC) of these ingredients and the mixture was determined for C. albicans, S. aureus and S. mutans over 24 hours at different concentrations. The MICs of two commercial mouthrinses, Corsodyl and Plax, were also determined using the same organisms. All mouthrinses were then tested to determine the percentage kill over 1, 2, and 3 minutes.

RESULTS

The MICs for hexylene glycol were 10%, 30% and 10% for C. albicans, S. aureus and S. mutons respectively. Potassium nitrate and sodium fluoride had no antimicrobial effects. The MIC of Corsodyl was 0.016 mg/ml for all the test organisms. The MIC for Plax varied from 0.0002 mg/ml to 0.001 mg/ml. The kill rates for all mouthrinses were acceptable, with no statistical differences between them. The experimental mouthrinse was not toxic to human oesophageal SCC cells after 1 minute exposure. At the time of the experiment, the costs of a similar quantity of the experimental mouthrinse, Corsodyl and Plax were R5.24, R30.00 and R10.00 respectively.

CONCLUSIONS

The experimental mouthrinse was cost-effective and proved to have an antimicrobial effect and could be used safely to alleviate oral infections, desensitize teeth, improve oral hygiene and control dental caries in cancer patients after radiation therapy.

Symbiotic role of Glomus mosseae in phytoextraction of lead in vetiver grass [Chrysopogon zizanioides (L.)]

Lead (Pb) has limited solubility in the soil environment owing to complexation with various soil components. Although total soil Pb concentrations may be high at a given site, the fraction of soluble Pb that plants can extract is very small, which is the major limiting factor for Pb phytoremediation. The symbiotic effect of arbuscular mycorrhizal (AM) fungus, Glomus mosseae was examined on growth and phytoextraction of lead (Pb) by vetiver grass [Chrysopogon zizanioides (L.)]. A hydroponic study, Phase I (0, 1, 2, and 4mM Pb) was conducted followed by an incubation pot study, Phase II (0, 400, 800, and 1200 mg kg(-1) Pb) where vetiver plants were colonized with G. mosseae. The results obtained indicate that plants colonized by the AM fungi not only exhibit better growth (increase in plant biomass), but also significantly increase Pb uptake in root and higher translocation to the shoot at all given treatments. Moreover, plants colonized with AM fungi had higher chlorophyll content and reduced levels of low molecular weight thiols, indicating the ability to better tolerate metal-induced stress. Results from this study indicate that vetiver plants in association with AM fungi can be used for improved phytoextraction of Pb from contaminated soil.

Effects of dyslexia on postural control in adults

Dyslexia has been shown to affect postural control. The aim of the present study was to investigate the difference in postural stability measured as torque variance in an adult dyslexic group (n=14, determined using the Adult Dyslexia Checklist (ADCL) and nonsense word repetition test) and an adult non-dyslexic group (n=39) on a firm surface and on a foam block and with eyes open and eyes closed. Another aim was to investigate the correlation between ADCL scores and postural stability. Findings showed that ADCL scores correlated with torque variance in the anteroposterior direction on foam with eyes closed (p=0.001) and in the lateral direction on the foam surface with eyes closed (p=0.040) and open (p=0.010). General Linear Model analysis showed that high dyslexia scores were associated with increased torque variance (p<0.001). However, we found no significant difference between dyslexics and non-dyslexics, though there were indications of larger torque variance in the dyslexics. The findings suggest that adults with high dyslexic ADCL scores may experience sub-clinical balance deficits. Hence, assessing motor ability and postural control in those with high ADCL scores is motivated.