The experience of pain and anxiety in rectal cancer patients during high-dose-rate brachytherapy

BACKGROUND

Pain and anxiety have been reported as primary concerns for patients with head-and-neck, gynecologic, and prostate cancers undergoing high dose rate (hdr) brachytherapy. However, almost no research has been published on the degree to which these symptoms are experienced by rectal cancer patients undergoing hdr brachytherapy. We conducted a pilot study examining the experiences of rectal cancer patients during hdr brachytherapy, specifically the intensity and trajectory of their anxiety and pain.

METHODS

Rectal cancer patients (n = 25) who received hdr brachytherapy treatment at a hospital in Montreal, Quebec, completed verbal analog scales for pain and anxiety at 4 time points over 4 treatment days.

RESULTS

On all 4 days, a subset of patients reported moderate-to-severe anxiety before applicator insertion. Pain increased significantly from the time patients were lying on the table to immediately after insertion of the applicator (p < 0.001). Insertion of the applicator appears to be the most painful part of the procedure, and although anxiety declined to below baseline after applicator removal, pain remained somewhat elevated. Some patients required conscious sedation; however, reports of moderate-to-severe pain were more frequent from patients who received pain medications than from patients who did not receive such medication (p < 0.05).

CONCLUSIONS

Most patients with rectal cancer tolerated hdr rectal brachytherapy well, although the procedure is stressful and painful for some. Insertion of the applicator was found to be the point of maximal pain, and medication was not always completely successful at alleviating the pain, suggesting that additional psychosocial interventions might be needed, with particular emphasis on the time of applicator insertion.

Cerebellopontine angle oligodendroglioma in a child: first case report

The reported incidence of oligodendrogliomas in the paediatric population is less than 1 %. The posterior fossa is a rare location, with the vast majority arising in the cerebral hemispheres. We report the first paediatric case of a WHO grade II oligodendroglioma arising in the cerebellopontine angle (CPA). CPA oligodendrogliomas in children appear to behave aggressively and adjuvant therapy must be considered early; especially when complete resection cannot be achieved.

Transformation products and reaction pathways of carbamazepine during photocatalytic and sonophotocatalytic treatment

This study examines the degradation of the antiepileptic carbamazepine (CBZ) by sonolysis, TiO2-based heterogeneous photocatalysis under UV-A and simulated solar irradiation, and by the combined use of UV-A and ultrasound irradiation (i.e. sonophotocatalysis) in demineralized water, ground water and effluent wastewater. The processes were compared with respect to substrate conversion rate and the extent of DOC reduction as a measure of mineralization. CBZ was degraded following a pseudo-first order kinetics. Sonophotocatalysis provided the highest rate of CBZ transformation over the time-course of the experiment while the degree of DOC removal in pure water was similar for all the studied treatments (around 40%), and always lower than CBZ conversion. This indicated that a considerable organic load remained in the treated solutions that could also be attributed to the presence of persistent oxidation products. UPLC-(+ESI)-QToF-MS was employed to determine major CBZ-related transformation products. Several recalcitrant hydroxy- and keto-derivatives of CBZ were tentatively identified. A Daphnia magna bioassay was used to evaluate the potential toxicity of the samples collected at different time points showing that the mixtures were highly toxic to D. magna.

Light-induced catalytic transformation of ofloxacin by solar Fenton in various water matrices at a pilot plant: mineralization and characterization of major intermediate products

This work investigated the application of a solar driven advanced oxidation process (solar Fenton), for the degradation of the antibiotic ofloxacin (OFX) in various environmental matrices at a pilot-scale. All experiments were carried out in a compound parabolic collector pilot plant in the presence of doses of H2O2 (2.5 mg L(-1)) and at an initial Fe(2+) concentration of 2 mg L(-1). The water matrices used for the solar Fenton experiments were: demineralized water (DW), simulated natural freshwater (SW), simulated effluent from municipal wastewater treatment plant (SWW) and pre-treated real effluent from municipal wastewater treatment plant (RE) to which OFX had been spiked at 10 mg L(-1). Dissolved organic carbon removal was found to be dependent on the chemical composition of the water matrix. OFX mineralization was higher in DW (78.1%) than in SW (58.3%) at 12 mg L(-1) of H2O2 consumption, implying the complexation of iron or the scavenging of hydroxyl radicals by the inorganic ions present in SW. On the other hand, the presence of dissolved organic matter (DOM) in SWW and RE, led to lower mineralization per dose of H2O2 compared to DW and SW. The major transformation products (TPs) formed during the solar Fenton treatment of OFX, were elucidated using liquid chromatography-time of flight-mass spectrometry (LC-ToF-MS). The transformation of OFX proceeded through a defluorination reaction, accompanied by some degree of piperazine and quinolone substituent transformation while a hydroxylation mechanism occurred by attack of the hydroxyl radicals generated during the process leading to the formation of TPs in all the water matrices, seven of which were tentatively identified. The results obtained from the toxicity bioassays indicated that the toxicity originates from the DOM present in RE and its oxidation products formed during the photocatalytic treatment and not from the TPs resulted from the oxidation of OFX.

Solar photocatalytic treatment of trimethoprim in four environmental matrices at a pilot scale: transformation products and ecotoxicity evaluation

The pilot-scale solar degradation of trimethoprim (TMP) in different water matrices (demineralized water: DW, simulated natural freshwater: SW; simulated wastewater: SWW; and real effluent: RE) was investigated in this study. DOC removal was lower in the case of SW compared to DW, which can be attributed to the presence of inorganic anions which may act as scavengers of the HO·. Furthermore, the presence of organic carbon and higher salt content in SWW and RE led to lower mineralization per dose of hydrogen peroxide compared to DW and SW. Toxicity assays in SWW and RE were also performed indicating that toxicity is attributed to the compounds present in RE and their by-products formed during solar Fenton treatment and not to the intermediates formed by the oxidation of TMP. A large number of compounds generated by the photocatalytic transformation of TMP were identified by UPLC-QToF/MS. The degradation pathway revealed differences among the four matrices; however hydroxylation, demethylation and cleavage reactions were observed in all matrices. To the best of our knowledge this is the first time that TMP degradation products have been identified by adopting a solar Fenton process at a pilot-scale set-up, using four different aqueous matrices.

P2-12-10: Low TCR Diversity (Divpenia) Is a Prognosis Factor of Overall Survival in Metastatic Breast Cancer

Background: We already showed that lymphopenia (&lt;1000 lymphocytes/μl) or CD4+ T cell lymphopenia (&lt;450/μl) detected before initiation of chemotherapy are prognostic factors for toxicity and death for metastatic breast cancer (MBC) patients. The goal of the present study was to identify the characteristics of the T cells in these lymphopenic patients. TCR diversity was investigated and tested as a prognostic factor for overall survival (OS).

Patients and methods: The ImmunTraCkeR® assay (ImmunID, Grenoble, France), which analyzes through semi quantitative multiplex-PCR the V-D-J combinatorial diversity of TCR-beta chain (TRB), was used to investigate diversity of T cell repertoire on cryopreserved blood samples from a retrospective cohort of MBC patients before chemotherapy administration (n=66). Univariate and multivariate analysis were performed. We then validated our score on a prospective cohort (n=67) using the same eligibility criteria (MBC patients before first line chemotherapy administration).

Results: Using a 33% cutoff for divpenia in our retrospective cohort (T cell diversity below 33%) (average diversity for healthy people is 70%), divpenia was associated with a median OS of 10 months vs 22 months for patients with diversity &gt;33% (logrank p value=0.04). The NDL® score (Numeration Diversity Lymphocytes representation) that combines lymphocyte numeration with TRB diversity, demonstrated that lympho-divpenia (T cell diversity below 33% and lymphopenia below lGiga/L) was associated with a poor OS compared to patients with either lymphocyte &lt;1000/μL & diversity &gt;33% or lymphocyte &gt;1000/μL & diversity &lt;33% or both lymphocyte &gt;1000/μL and diversity &gt;33% (p=0.015). In multivariate analysis, including performance status (PS), hemoglobin level, polynuclear neutrophil count (PNN), age, and liver metastasis, NDL® score was identified as an independent prognostic factor for OS. In our prospective validation cohort, NDL® score was also identified as a prognostic factors for OS (p=0,007), as well as lymphopenia (&lt;1000/μL) (p=0,0003), CD4+ lymphopenia (&lt;450/μL) (p=0,04), menopausal status (p=0,02), hormonal receptor status (estrogen receptor p=0.02; progesterone receptor p=0.002) and lung metastasis (p=0,009). In multivariate analysis, hemoglobin level was the only independent prognostic factor in this cohort.

Conclusion: We showed that Divpenia and NDL® score are prognostic factors for OS in MBC patients. In order to confirm these results, a prospective clinical trial is ongoing on a larger cohort of MBC and lung cancer patients.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-12-10.

Calcium oscillations induced by gambierol in cerebellar granule cells

Gambierol is a marine polyether ladder toxin derived from the dinoflagellate Gambierdiscus toxicus. To date, gambierol has been reported to act either as a partial agonist or as an antagonist of sodium channels or as a blocker of voltage-dependent potassium channels. In this work, we examined the cellular effect of gambierol on cytosolic calcium concentration, membrane potential and sodium and potassium membrane currents in primary cultures of cerebellar granule cells. We found that at concentrations ranging from 0.1 to 30 microM, gambierol-evoked [Ca(2+)]c oscillations that were dependent on the presence of extracellular calcium, irreversible and highly synchronous. Gambierol-evoked [Ca(2+)]c oscillations were completely eliminated by the NMDA receptor antagonist APV and by riluzole and delayed by CNQX. In addition, the K(+) channel blocker 4-aminopyridine (4-AP)-evoked cytosolic calcium oscillations in this neuronal system that were blocked by APV and delayed in the presence of CNQX. Electrophysiological recordings indicated that gambierol caused membrane potential oscillations, decreased inward sodium current amplitude and decreased also outward IA and IK current amplitude. The results presented here point to a common mechanism of action for gambierol and 4-AP and indicate that gambierol-induced oscillations in cerebellar neurons are most likely secondary to a blocking action of the toxin on voltage-dependent potassium channels and hyperpolarization of sodium current activation.

Combined thermophilic aerobic process and conventional anaerobic digestion: effect on sludge biodegradation and methane production

The efficiency of hyper-thermophilic (65 degrees Celsius) aerobic process coupled with a mesophilic (35 degrees Celsius) digester was evaluated for the activated sludge degradation and was compared to a conventional mesophilic digester. For two Sludge Retention Time (SRT), 21 and 42 days, the Chemical Oxygen Demand (COD) solubilisation and biodegradation processes, the methanisation yield and the aerobic oxidation were investigated during 180 days. The best results were obtained at SRT of 44 days; the COD removal yield was 30% higher with the Mesophilic Anaerobic Digestion/Thermophilic Aerobic Reactor (MAD-TAR) co-treatment. An increase of the sludge intrinsic biodegradability is also observed (20-40%), showing that the unbiodegradable COD in mesophilic conditions becomes bioavailable. However, the methanisation yield was quite similar for both processes at a same SRT. Finally, such a process enables to divide by two the volume of digester with an equivalent efficiency.

Interim Analysis of a Randomized Phase II Study of the Novel Ii-Key Hybrid HER2/Neu Peptide (AE37) Vaccine To Prevent Breast Cancer Recurrence: United States Military Cancer Institute Clinical Trials Group Study I-05

BACKGROUND: CD4+ T helper peptides from HER2/neu have been evaluated in vaccine trials. The Ii-Key addition, a 4-amino-acid (LRMK) modification, increases vaccine potency when compared to unmodified class II epitopes. We present results of a prospective, randomized, single-blinded phase II clinical trial of the Ii-Key hybrid HER2/neu peptide (AE37) + GM-CSF immunoadjuvant vaccine versus GM-CSF alone in the adjuvant setting in disease-free, high risk breast cancer (BCa) patients to prevent recurrence.METHODS: Disease-free, high risk BCa patients who have completed standard adjuvant therapy were enrolled and randomized to receive six monthly inoculations of either 500 mcg of AE37 with 62.5 or 125 mcg of GM-CSF (Peptide group; PG) or 62.5 or 125 mcg of GM-CSF alone (adjuvant group; AG). Toxicity was assessed after each inoculation using National Cancer Institute Common Terminology Criteria for Adverse Events v3.0 (CTCAE). Immunologic response was monitored using delayed type hypersensitivity reactions (DTH) and 3H-thymidine proliferative assays for both hybrid AE37 (LRMK+HER2/neu:776-790) and AE36 (unmodified HER2/neu:776-790) peptides. Patients were clinically, radiographically, and pathologically monitored for recurrence of BCa.RESULTS: Thus far, 120 (49 PG, 71 AG) of the planned 200 patients have completed the primary series. The PG and AG have similar demographic/prognostic characteristics (Table 1). Toxicity profiles in the PG and AG were almost identical with no grade 4-5 local toxicities and no grade 3-5 systemic toxicities in either arm. Median DTH reaction to AE36 and AE37 increased significantly from baseline at 1 month after completion of the primary series in the PG group (AE36: 0.0±0.8 cm to 15.3 ±2.1 cm; AE37: 0.0±0.7 cm to 24.5±2.6 cm; p&lt;0.0001) and did not change in the AG group (AE36: 0.0±0.5 cm to 0.0±1.4 cm; AE37: 0.0±0.7 cm to 0.0±1.6 cm; p&gt;0.05). Median proliferation response to AE36 and AE37 increased significantly from baseline at 3, 6, and 12 months after the start of the vaccine series in the PG (p&lt;0.015) and did not change significantly in the AG. At a median follow up of 13 months, there have been no (0.0%) recurrences in the PG (0/49) compared to 7.0% (5/71) in the AG (p=0.08).CONCLUSIONS: The modified peptide AE37 is safe with mild toxicities observed primarily due to the GM-CSF immunoadjuvant. AE37 elicits a strong HER2/neu-specific in-vivo and ex-vivo immune response to the modified and unmodified peptides. Importantly, the AE37 peptide vaccine may protect against BCa recurrences. peptideadjuvantp valueN=4971 Age (median)49520.06Node Positive75.5%62.1%0,16Grade 348.9%57.8%0.44Tumor ≥2 cm55.1%56.1%1ER/PR negative38.8%40.9%0.84HER2 over-expressor59.2%60.6%1 

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3183.

NOTE: This abstract was accepted for presentation at the Symposium after the Abstract Book went to press.