Role of radiotherapy in combined modality treatment of locally advanced non-small-cell lung cancer

PURPOSE

For patients with locally advanced (stage III) non-small-cell lung cancer (NSCLC), radiotherapy (RT) has been used conventionally for many years. Few prospective trials have determined the role of RT. Recently, chemotherapy (CT) has been shown to produce excellent responses in regionally advanced disease. We therefore conducted a randomized trial using cisplatin (P)-based CT regimens with or without thoracic irradiation.

PATIENTS AND METHODS

We randomly assigned 92 patients with locally advanced NSCLC to receive one of three arms of P-based combination chemotherapy: vindesine (V) plus P, mitomycin (M) plus V plus P, or etoposide (E) plus P alternating with V plus M. After two cycles of CT, patients were reevaluated and those with stage III were again randomized to receive RT or not. RT consisted of 50 to 60 Gy in 5 to 6 weeks; 2 Gy was delivered once daily in conventional fractions.

RESULTS

Sixty-three patients were included in the second randomization. The patients in the CT/RT group (n = 32) and CT-alone group (n = 31) were comparable in terms of age, sex, performance status, histologic features, stage of disease, and induction CT regimen. The median durations of survival were similar for the two groups (461 days in CT/RT group and 447 days in CT-alone group). The survival rate in the CT/RT group was 58% at 1 year, 36% at 2 years, and 29% at 3 years, as compared with 66%, 9%, and 3% at 1, 2, and 3 years, respectively, in the CT-alone group. One patient in the CT/RT group died of pneumonitis, but there were no CT-related deaths.

CONCLUSION

In locally advanced NSCLC, P-based combination CT followed by chest irradiation significantly increases the number of long-term survivors as compared with CT alone. RT to bulky disease in the thorax is thus an important part of combined modality therapy, and a necessary part of further studies in locally advanced disease.

[Development of a new delayed healing model of an open skin wound and effects of M-1011G (ointment gauze containing 5% lysozyme hydrochloride) on the model]

We tried to develop a new delayed healing model of an open wound made on the dorsal skin of a rat by inducing malnutrition with restriction of food intake. We determined the effects of a newly introduced ointment gauze containing 5% lysozyme hydrochloride (M-1011G) on this model. Malnutrition characterized by a decrease in body weight and serum protein was produced by restricting the daily intake of commercially available food to 6 g for 2 weeks without liver disturbance and thereafter maintained with food intake of 12 g/day. Under these conditions, healing of the open wound made on the dorsal skin was prolonged, as compared with that of the wound made on a well-nourished animal. In this model, statistical studies showed that M-1011G was the most effective in accelerating the reduction of the wound area and shortening of the time required for the complete healing, among the following treatments: sterilized gauze alone, ointment gauze alone and 5% lysozyme hydrochloride-containing emulsified ointment. Histological findings showed that M-1011G greatly accelerated the granulation of this tissue which is essential for wound healing, probably due to stimulation of epidermization and regenerated granulation in the wound.

[Ventricular premature contraction observed after anti-cancer chemotherapy with ifosfamide]

We encountered 3 cases of ventricule premature contraction (VPC) after anti-cancer chemotherapy with ifosfamide (IFM). These cases were administered IFM of more than 2 g/body/day for 3 days, and they were more than 70 years old. They had no cardiovascular disorder before the chemotherapy. Among them, 1 case who received a total dose of 15.0 g of IFM showed severe VPC. She had also received a total dose of 155 mg of doxorubicin (ADM) in earlier treatment. There was also 1 case, whose VPC was aggravated after anti-cancer chemotherapy with IFM. He had dilated cardiomyopathy and had already showed frequent VPC before the chemotherapy. His VPC became more frequent after the chemotherapy. IFM was a common agent among the anti-cancer agents used in these cases. We must be careful for the occurrence of VPC when more than 2 g/body/day of IFM is administered to patients more than 70 years old. An increase in the total dose of IFM or former ADM may cause severe VPC. When IFM is given a patient with VPC, the existing VPC may be aggravated.

Coexistence of paraneoplastic sensory neuronopathy and Lambert-Eaton myasthenic syndrome in a small cell lung cancer patient

The present report is on a 72-year-old male patient with combined paraneoplastic sensory neuronopathy (PSN) and Lambert-Eaton myasthenic syndrome (LEMS) with small cell lung cancer. He noticed a painful paresthesia of the legs which advanced over seven days, and both hands became numb and painful. Three months later, he was found to have small cell lung cancer by mediastinoscopic examination. PSN was diagnosed by clinical symptoms and anti-Hu antibody, and LEMS was diagnosed by the waxing phenomenon on an electromyogram (incremental in compound muscle action potential up to 120%) and autoantibody against the presynaptic voltage-gated calcium channel. High titers of anti-Hu antibody were detected in the serum (1:12800) and cerebrospinal fluid (1:320). Although a partial response to chemoradiotherapy was obtained, the neurologic symptoms of PSN did not improve. The anti-Hu antibody titers obtained on five different occasions during the patient's clinical course did not change. The patient died from respiratory arrest six months after the initiation of therapy. To the best of the authors' knowledge, this combined form of disease, confirmed by both clinical and laboratory tests, is the rarest case ever to be reported.

Inhibition of carbon tetrachloride-induced hepatotoxicity by neopterins

We investigated the inhibitory effects of neopterin (NP) and its reduced form, 5,6,7,8-tetrahydroneopterin (NPH4), on carbon tetrachloride (CCl4)-induced hepatotoxicity. In in vivo experiments, intraperitoneal administration of NP or NPH4 significantly inhibited the elevation of plasma alanine aminotransferase activity induced by CCl4 in mice. In in vitro experiments using cultured rat hepatocytes, CCl4 induced in a manner which was both time- and dose-dependent lactate dehydrogenase release, and the addition of NP or NPH4 to the culture-medium significantly inhibited its release from cells. NPH4, but not NP, reacted directly with a stable radical, 1,1-diphenyl-2-picrylhydrazyl. These results suggest that NP and NPH4 inhibit CCl4-induced hepatotoxicity through different mechanisms.

[A case of resected gastric cancer in which cancer had apparently disappeared by preoperative administration of tegafur]

This paper reports a case of gastric carcinoma in which cancerous tissue was not found in the resected specimen, apparently due to preoperative tegafur administration. The patient was a 56-year-old woman who was diagnosed by initial endoscopic examination including endoscopic biopsy as having an advanced gastric cancer of Borrmann type 2. During the waiting period for operation, she was placed on oral administration of tegafur (Futrafur capsule) 600 mg 3 times a day for 31 days. The second endoscopic examination 14 days later showed reduction of both marginal elevation and central excavation of the lesion, and biopsy at this time was negative for carcinoma. Because of the initial definite diagnosis of cancer, a gastric resection was performed 31 days later, but no cancerous tissue was found in the resected specimen. This case was considered to be a carcinoma especially sensitive to tegafur.

Terminology in prescription-event monitoring

The terminology used in prescription-event monitoring for postmarketing surveillance is described. It has been developed by the Drug Safety Research Unit while processing records of 500,000 events associated with the use of new chemical entities by 460,000 patients in England since 1981. Currently, the events are arranged in 24 classes which include 108 high-level terms and 1197 low-level terms. Low-level terms are used to code individual events reported by general practitioners, usually without an opinion about any possible causal relationship with a particular drug. Some low-level terms are lumped together as one high-level term when the event rates are estimated.

[Magnetic resonance imaging and cerebrospinal fluid examinations in a case of central nervous involvement of systemic lupus erythematosus]

A 69-year-old woman was admitted to our hospital with a 7-month history of sensory disturbance of the bilateral lower extremities. Since she developed paraplegia of the extremities, urinary incontinence and left hemiplegia several days after admission, neurologic involvement both in the lumbar cord, and in the cervical cord or the brain was suspected. While no abnormalities were noted by computerized tomography of the brain. T2-weighted magnetic resonance imaging (MRI) clearly demonstrated foci in the periventricular and the basal ganglia regions bilaterally. Furthermore, the levels of immunoglobulin G and interleukin 6 were increased in the cerebrospinal fluid (CSF). From physical and other laboratory findings in addition to the MRI and CSF findings, she was diagnosed as having systemic lupus erythematosus with central nervous involvement. The administration of prednisolone resulted in marked improvement in her neurologic symptoms in two months. Thus, it is considered that the MRI and CSF examinations are useful for the diagnosis and treatment of central nervous involvement of systemic lupus erythematosus.

Active and passive mechanisms of [fluorine-18] fluorodeoxyglucose uptake by proliferating and prenecrotic cancer cells in vivo: a microautoradiographic study

In this study, [18F]FDG uptake mechanisms were investigated in neoplastic cells during cell proliferation and cell death.

METHODS

Detailed analysis was performed on mouse tumor models of different growth rates using [18F]FDG, [6-13H]thymidine [3H]Thd (a precursor of DNA synthesis) and [125I]bovine serum albumin ([125I]BSA) (a marker of diffusion) with autoradiographic and histopathologic techniques and electron microscopy.

RESULTS

The three compounds, [18F]FDG, [3H]Thd and [125I]BSA, showed different heterogeneous patterns of distribution within tumor tissue sections in neoplastic and non-neoplastic cellular elements. The uptake of [18F]FDG by prenecrotic (or necrobiotic) tumor cells surrounding focal necrotic cell debris was 1.5 to 2.3 times higher than that of viable tumor cells. Prenecrotic cells did not retain trapped [18F]FDG; therefore, the uptake was considered to be nonmetabolic. Inconspicuous cell membrane, vesicular cytoplasmic organelles and condensed nuclear chromatin were remarkable findings in the prenecrotic cells. A comparison of viable tumor cells in tumors undergoing different growth rates showed that the ratio of [18F]FDG uptake was similar to that of [3H]Thd uptake in each S-phase cell. Fluorine-18-FDG showed a cell cycle dependency, with a higher uptake observed in cells in G0/G1 and G2 phases of the cell cycle compared with the S and M phases.

CONCLUSION

A passive mechanism of [18F]FDG uptake may exist in the necrobiotic/prenecrotic or hypoxic/anoxic cells in tumors. However, the discordance of [18F]FDG and [3H]Thd uptake may be the result of the different cell cycle dependency of tracer uptake in the same tumor.

Molecular study of eight Japanese cases of glucose-6-phosphate dehydrogenase deficiency by nonradioisotopic single-strand conformation polymorphism analysis

Using a newly developed nonradioisotopic method of polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP) analysis combined with the direct sequencing using the fluorescence-labeled terminator, we identified seven missense mutations, 527 A-->G, 1003 G-->A, 1159 C-->T, 1160 G-->A, 1229 G-->A, 1246 G-->A, and 1361 G-->A, in eight Japanese patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Except for the 527 A-->G, each mutation has been reported to cause variants G6PD Chatham, G6PD Guadalajara, G6PD Beverly Hills, G6PD "Japan", G6PD Tokyo, and G6PD Andalus, respectively. In addition, a single base deletion in intron 5 was found in the patients with G6PD Guadalajara or G6PD Andalus. The variant with unique 527 A-->G was characterized and designated as G6PD Shinshu. We also characterized G6PD "Japan" and found that the variant had the striking resemblance with G6PD Riverside, bearing a missense mutation in the same codon, but causing a different amino acid substitution. Our modified PCR-SSCP analysis using minigel and ethidium bromide staining could detect six of the eight diverse mutations in the G6PD gene. Because it is easy and requires no special apparatus, this modified method will be useful for screening mutations in the G6PD gene.

Three-dimensional measurement study of the maximum protuberance and cervical line of the upper molars

The maximum protuberance and the cervical line of 48 upper first molars and 56 second molars were observed using a three-dimensional measuring device. On the basis of the results, the relationship between the maximum protuberance and the cervical line was investigated on the respective contour line and lateral aspect waveform. The contour of the cervical line was positioned at the center of the maximum protuberance in both first and second molars. The distance of the lateral aspect between the measurement points of the maximum protuberance and the cervical line were wider in the mesiodistal direction than in the buccolingual direction. In the second molar, the distance between the maximum protuberance and the cervical line was narrower, and the stricture from the tooth crown to the cervical line on the second molar was decreased. The lateral aspect waveform of the cervical line and maximum protuberance tended to be similar, but the top-to-bottom distance of undulation on the maximum protuberance was longer than that of the cervical line. The buccolingual direction of the lateral aspect waveform showed much more marked fluctuations than that of the mesiodistal direction.

Elderly onset of adult Still's disease: report of a case

Adult Still's disease is a variant of juvenile rheumatoid arthritis occurring most frequently in women 16-35 years of age, but rarely in elderly people. We describe a 75-year-old woman who was considered as having adult Still's disease.

Unique properties of a cytotoxic CD4+CD8+ intraepithelial T-cell line established from the mouse intestinal epithelium

Growth factor-dependent gut intraepithelial lymphocyte (IEL) cell lines were established from a long-term in vitro culture of BALB/c IEL with syngeneic irradiated spleen cells in the presence of concanavalin A-stimulated spleen supernatant fluids. The cell lines were preferentially consisted of very limited thymoindependent subsets of IEL; i.e., Thy-1+CD5-TCR alpha beta+CD4+CD8 alpha+beta- (double-positive; DP) IEL and Thy-1+CD5-TCR alpha beta+CD4-CD8 alpha+beta- (CD8 single-positive; CD8 SP) IEL. The CD8 SP IEL cell line had cytotoxic activities and was triggered to proliferate by T-cell receptor (TCR)-directed stimuli. The DP IEL cell line expressed high levels of the CD3-TCR alpha beta, exhibited cytotoxic activity in redirected lysis assays, and had perforin in the cytoplasm, indicating the functional maturity of this cell line. However, the DP IEL cell line did not proliferate in response to TCR alpha beta-directed stimuli, which indicated that TCR alpha beta-mediated signalling was able to initiate cytotoxic function but not to induce proliferation of the DP IEL cell line. Although both cell lines were shown to have functional competence, they expressed J11d antigen which marks immaturity in thymocyte differentiation pathways. These results indicate that the established thymoindependent DP and CD8 SP IEL cell lines have unique properties distinct from DP thymocytes and CD8 SP peripheral T cells. Together with a recent report on freshly isolated DP IEL (10), the unique properties of the DP IEL cell line seems to support the notion that DP IEL may undergo a unique maturation process in the gut microenvironment.

Visual response properties of single neurons in the temporal pole of behaving monkeys

1. The responses of single neurons in the anterior part of the temporal cortex in monkeys, mainly the temporopolar cortex, area 36, and the most anterior part of area TE of von Bonin and Bailey (1947) (these areas were designated here as the temporal pole), were examined during the performance of a visual recognition memory task. The visual stimulus (sample stimulus) was presented when the monkey pressed a lever. The same sample stimulus was presented one to four times and, thereafter, a new stimulus was presented. The monkeys were trained to discriminate the new stimulus from the sample stimulus and to release the lever in response to the new stimulus. We used colored photographs of natural objects (human faces, monkeys, foods, and non-food objects) as complex visual stimuli or computer-generated two-dimensional shapes (a red square, a green circle, etc.) as simple visual stimuli. 2. In total, the activity of 311 neurons was recorded, and 225 of these responded to at least one visual stimulus. All visually responsive neurons were located in the ventral part of the temporal pole including the banks of the superior temporal sulcus. 3. The relationship between the monkey's eye movements and visual responses was investigated. Visual response properties, such as the number of spikes, onset latency, and response duration, were stable regardless of the monkey's eye positions and movements if the eyes were directed to the display. We also examined the receptive field property of neurons (n = 3). The neurons tested in the temporal pole tended to have a large receptive field (24 x 24 degrees). 4. The neurons tended to respond to different stimuli in different magnitudes. In each case, the maximal responses were elicited by complex, colored photographs, whereas simple, two-dimensional colored shapes elicited little or no responses. In 21% of the cases (47/225), the magnitude of the maximal response was significantly larger than for any of the other responses. 5. An achromatic version of the stimulus that induced the maximal response was tested in 53 neurons. About 80% of the neurons (41/53) responded to the achromatic stimulus at a magnitude that was not significantly different from the response to the original stimulus. In 12 neurons, the removal of color did significantly decrease the magnitude of the response. When other colors were tested, 3 of 9 neurons were found to code for color. 6. In 21 of these 53 neurons, a portion (the left-, right-, upper-, or lower-half) of the stimulus was also tested.(ABSTRACT TRUNCATED AT 400 WORDS)

Investigation of tumor invasion with [111In]antimyosin

Accumulation of [111In]antimyosin in various types of tumors has been reported. In order to test the possibility that the destruction of muscle tissue by tumor invasion could induce high uptake of [111In]antimyosin, we investigated the distribution of [111In]antimyosin in tumor and muscle using autoradiography (ARG). High uptake of [111In]antimyosin was observed both in rabbit papilloma VX2 and rat hepatoma AH109A by scintigraphy and tissue distribution studies, and its concentration was found to be highest at the periphery and outer surface of the tumors using whole-body ARG. However, in micro- and macro-ARG, high grain density was observed in granulation tissue with macrophage infiltration between the tumor and muscle, not in the muscle tissue invaded by tumor cell. Significant non-specific accumulation of [111In]antimyosin in inflammatory tissue surrounding the tumor was suggested.

Neuronal responses to photographs in the superior temporal sulcus of the rhesus monkey

The activity of a total of 174 visual neurons in the superior temporal sulcus (mostly area TE) of rhesus monkeys was examined quantitatively using complex visual stimuli. Colored photographs of human faces (n = 411), monkeys (n = 308), and non-face objects (n = 35), as well as computer-generated graphics were presented as visual stimuli during a performance of a visual discrimination task. All neurons responded to a limited number of photographs. We quantified these stimulus-selective responses, using two kinds of selectivity indices. With the first index (SI1), we attempted to estimate how many stimuli produced a significant response. The mean value of SI1 was 0.63. About 31% of neurons had values of SI1 greater than 0.8. With the second index (SI2), we attempted to estimate how many stimuli could be distinguished from the stimulus that elicited the strongest activity. The mean value of the SI2 was 0.71. About 51% of neurons had values of SI2 greater than 0.8. About 66% of neurons had values of either SI1 or SI2 that were greater than 0.8, a value that corresponds to a selectivity of one out of five stimuli. We designated these neurons as stimulus-selective (SS) neurons. Of these SS neurons, 45% showed the best response to human faces. Similarly, 28.8% showed the best response to a photograph of monkeys. 7.5% to food, 8.8% to non-food and 10% to simple graphics, such as, a colored square or a circle.(ABSTRACT TRUNCATED AT 250 WORDS)

Metabolism and degradation of betamethasone 17-valerate in homogenized living skin equivalent

The metabolism of betamethasone 17-valerate was estimated using an artificial living skin equivalent (LSE). Betamethasone 17-valerate, betamethasone 21-valerate and betamethasone were measured by a normal-phase high-performance liquid chromatographic (HPLC) method. Betamethasone 17-valerate was added to the culture medium with or without LSE homogenate. Degradation profiles (%) of betamethasone 17-valerate remaining in the culture medium with skin homogenate did not differ from those without homogenate. However, the conversion of betamethasone 21-valerate to betamethasone was accelerated by skin homogenate, indicating that LSE has a sufficient level of esterase.