A phase I study of misonidazole and pelvic irradiation in patients with carcinoma of cervix

A Phase I study of oral daily misonidazole (MISO) with conventional pelvic irradiation, has been conducted in patients with carcinoma of the cervix Stages IB, IIB, IIIB and IVA. MISO was administered in daily dosages to sequential groups of patients at doses of 0.15 g/m2, 0.30 g/m2 or 0.45 g/m2 for 22 days over 5 weeks. Sixteen patients were assigned to each dose level. Using a double-blind randomization, they received either placebo (3/16) or MISO (13/16). The major dose-limiting toxicity was peripheral neuropathy (PN). None of the 13 patients receiving 0.15 g/m2 or the 13 receiving 0.3 g/m2 developed PN. However, 6/13 at the 0.45 g/m2 level (total dose less than or equal to 9.9 g/m2) developed PN. Additional patients were entered at this level and a total of 13/26 developed PN, which was considered of clinically significant severity in 9. Symptoms of PN have persisted from 1 week to 10 months, and have been completely reversed in 9/13 patients. Pharmacological parameters were examined for correlation with clinically evident toxicities. Although peak plasma MISO levels and half-lives did not correlate significantly with PN, there was a significant correlation between the calculated "area under the curve" (AUC) and PN. No correlation exists between PN and total urinary excretion of MISO or the O-demethylation product. A daily dose of 0.45 g/m2; MISO (total dose less than or equal to 9.9 g/m2) is considered to produce an acceptable level of toxicity for this patient population.

Benefits of accelerated hyperfractionation for head and neck cancer

Accelerated hyperfractionation is a strategy intended to improve the likelihood of cancer control by delivery of a higher total dose of radiation without an offsetting increase in severe late normal tissue complications. The early results of a recently completed randomized trial of a 4-week hyperfractionated radiation schedule, and of two other regimens of accelerated hyperfractionation, confirm to some degree the biological hypotheses on which this strategy is based. The clinical benefits seen so far are limited, but are sufficient to support further refinement of the strategy and additional clinical trials.

Cumulative Impacts and COVID-19: Implications for Low-Income, Minoritized, and Health-Compromised Communities in King County, WA

Few studies have assessed how the intersection of social determinants of health and environmental hazards contributes to racial disparities in COVID-19. The aim of our study was to compare COVID-19 disparities in testing and positivity to cumulative environmental health impacts, and to assess how unique social and environmental determinants of health relate to COVID-19 positivity in Seattle, King County, WA, at the census tract level. Publicly available data (n = 397 census tracts) were obtained from Public Health–Seattle & King County, 2018 ACS 5-year estimates, and the Washington Tracking Network. COVID-19 testing and positive case rates as of July 12, 2020, were mapped and compared to Washington State Environmental Health Disparities (EHD) Map cumulative impact rankings. We calculated odds ratios from a series of univariable and multivariable logistic regression analyses using cumulative impact rankings, and community-level socioeconomic, health, and environmental factors as predictors and having ≥ 10% or < 10% census tract positivity as the binary outcome variable. We found a remarkable overlap between Washington EHD cumulative impact rankings and COVID-19 positivity in King County. Census tracts with ≥ 10 % COVID-19 positivity had significantly lower COVID-19 testing rates and higher proportions of people of color and faced a combination of low socioeconomic status–related outcomes, poor community health outcomes, and significantly higher concentrations of fine particulate matter (PM_2.5). King County communities experiencing high rates of COVID-19 face a disproportionate cumulative burden of environmental and social inequities. Cumulative environmental health impacts should therefore systematically be considered when assessing for risk of exposure to and health complications resulting from COVID-19.

Anal carcinoma

Although epidermoid cancer of the anus is an uncommon tumor, it has served well as a model for several disciplines within oncology. Advances in understanding the epidemiology and the definitive therapeutic role of combined radiation therapy and chemotherapy for anal tumors have encouraged many investigators to study similar applications in the more common epithelial malignancies. In this monograph, the anatomy of the anal area is reviewed emphasizing the differences in natural history and prognosis between anal margin and anal canal cancers. Treatment does not depend on the specific histologic variant of the epidermoid tumors which arise in this region. The roles of viruses, of immunodeficiency syndromes, and of a history of benign anal disease and trauma in the etiology and epidemiology of this tumor are discussed. Current staging will be critically reviewed stressing that invasive (pathologic) staging by surgery is not indicated, but noninvasive staging has definite limitations. Small superficial tumors may be definitively treated with either limited surgery or radiation. While regional treatments such as surgery and radiation offer cure to between 45% and 60% of nonselected patients, initial treatment with combination radiation and chemotherapy produces cure rates between 65% and 85% for similar groups of patients. The rationale for combined modality therapy is presented and recommendations for therapy by stage of the cancer are made. Finally, we present questions that remain for future research in the clinic and laboratory regarding epidermoid tumors of the anus.

Computer-aided 2D and 3D quantification of human stem cell fate from in vitro samples using Volocity high performance image analysis software

Accurate automated cell fate analysis of immunostained human stem cells from 2- and 3-dimensional (2D-3D) images would improve efficiency in the field of stem cell research. Development of an accurate and precise tool that reduces variability and the time needed for human stem cell fate analysis will improve productivity and interpretability of the data across research groups. In this study, we have created protocols for high performance image analysis software Volocity® to classify and quantify cytoplasmic and nuclear cell fate markers from 2D-3D images of human neural stem cells after in vitro differentiation. To enhance 3D image capture efficiency, we optimized the image acquisition settings of an Olympus FV10i® confocal laser scanning microscope to match our quantification protocols and improve cell fate classification. The methods developed in this study will allow for a more time efficient and accurate software based, operator validated, stem cell fate classification and quantification from 2D and 3D images, and yield the highest ≥94.4% correspondence with human recognized objects.

Radiation treatment for rectal cancer

Radiation treatment is widely used in the management of adenocarcinomas of the rectum, either alone or more frequently as part of multimodality treatment protocols. External beam radiation is capable of eradicating about one-third of bulky but mobile primary rectal cancers and is an alternative to be considered when standard surgery is not possible. Endorectal irradiation, either alone or combined with external beam treatment, has proved highly effective for selected superficial cancers of the distal rectum. Irradiation alone or in conjunction with cytotoxic chemotherapy appears to reduce the risk of tumor progression at the primary site or in regional lymph nodes when combined with local surgical excisions that preserve anorectal function. The treatment of recurrent and metastatic cancer frequently provides palliation, although cure by irradiation is rare.

Radiation therapy for colorectal cancer

The role of radiation therapy in the management of colorectal cancer has become more clearly defined as the number of clinical studies has grown. It is now evident that radiation is capable of sterilizing subclinical deposits of cancer at doses tolerable by adjacent normal tissues, and to a lesser extent, these doses can control more bulky cancers. The integration of radiation and chemotherapy has already led to some improvement in survival rates in the adjuvant treatment of rectal cancer. The further development of such combinations seems likely to improve tumor control and survival rates in many stages of cancer. In the next decade, it is also likely that there will be refinement of the use of radiation through better understanding of the biology of colorectal cancer, perhaps supplemented by the development of predictive assays that can guide both the selection of patients for treatment and the choice of the most effective radiation schedule.

A phase I study of combined radiation therapy with 5-fluorouracil and low dose folinic acid in patients with locally advanced pancreatic or biliary carcinoma

PURPOSE

To evaluate the toxicities of a Phase I study of radiation therapy with concurrent 5-fluorouracil (5FU) and low dose folinic acid in patients with locally advanced pancreatic or biliary carcinoma.

METHODS AND MATERIALS

Twenty-seven patients with locally advanced carcinoma of the pancreas (n = 19), bile duct (n = 7), and gall bladder (n = 1) were entered into a Phase I study of combined radiation therapy, 5FU, and folinic acid. Radiation was given as a split course of 40 Gy in 20 daily fractions with a gap of 2 weeks after 20 Gy. 5-Fluorouracil, 300 to 375 mg/m2/day and folinic acid, 20 mg/m2/day were given as an i.v. bolus daily for 5 days beginning on day 1 and again on day 29.

RESULTS

Eight patients developed Grade 3 or 4 toxicities (National Cancer Institute common toxicity criteria) including nausea and vomiting (n = 4), oral mucositis (n = 4), myelosuppression (n = 2), infection (n = 2), and diarrhea (n = 1). Four patients did not complete the planned protocol due to treatment toxicities. There were two treatment deaths secondary to septic neutropenia. Treatment toxicity appeared to be related to age (> 70), performance status (ECOG = 2), and 5FU dose (> 350 mg/m2/day).

CONCLUSION

This protocol is poorly tolerated by elderly patients or those with poor performance status, and 350 mg/m2/day is our recommended dose for 5FU as given in this protocol.

Observer variation in the assessment of patients with rectal cancer

To examine the reliability of clinical features as possible components of a clinical method of prognostic staging for patients with rectal cancer, the results obtained when two pairs of physicians interviewed and examined a consecutive series of 60 patients with unresected rectal cancer were compared. High levels of agreement between physicians were found for most items of the patient's history, on whether the lesion was palpable, on the distance of the tumor from the anus, on the location and circumferential extent of the tumor, and on whether the tumor was fixed or mobile. Although physicians elicited similar physical signs, their use of terms to describe the rectal lesions varied widely unless agreed-upon criteria were used. There was 63 per cent agreement on the use of descriptive terms among physicians using criteria and only 13 per cent agreement among physicians not using criteria. These results show that prognostically important clinical features in patients with rectal cancer can be reliably identified and are thus suitable for inclusion in methods of clinical prognostic staging for this disease.

Anal Canal Cancer and Chemoradiation Treatment in Two Patients with Systemic Lupus Erythematosus treated by Chronic Therapeutic Immunosuppression

Two case reports of anal cancer developing during chronic therapeutic immunosuppression for systemic lupus erythematosus (SLE) and their cancer management are presented. The complex issues of delivery of curative chemoradiation treatment for anal cancer in the context of co-existing autoimmune connective tissue disease (AICD) are discussed. These two cases show that combined chemotherapy and radiation regimens are possible in patients with SLE. However, frequent, careful assessment with judicious and prompt management of haematological and other complications during treatment is important.

Role of a DT-diaphorase mutation in the response of anal canal carcinoma to radiation, 5-fluorouracil, and mitomycin C

PURPOSE

To determine, retrospectively, the status of the bp 609 mutation in the DT-diaphorase gene in anal canal carcinoma patients who have undergone radical radiotherapy with concurrent 5-fluorouracil (5-FU) and mitomycin C (MMC), to determine the relationship of the mutant form of the gene to treatment outcomes.

METHODS AND MATERIALS

Paraffin blocks of pretreatment tumor biopsies were obtained on 49 patients who underwent treatment with curative intent using radiation, infusional 5-FU and bolus MMC from January 1991 to December 1993. DNA was extracted and subjected to polymerase chain reaction (PCR) analysis using primers that encompassed the bp 609 C to T mutation. Restriction endonuclease cleavage with Hinf 1 and gel electrophoresis were used to determine the polymorphism status of each patient.

RESULTS

DNA of 46 patients was successfully amplified. The 46 patients were distributed as follows: 26 (56.5%) C/C-homozygous wildtype, 18 (39%) T/C-heterozygous, and 2 (4.5%) T/T-homozygous mutant. Eleven of 46 patients had suffered treatment failure. The status of the bp 609 polymorphism in this group was 5 (45.5%) C/C, 5 (45.5%) C/T, and 1 (9%) T/T.

CONCLUSION

In this series, there was not an overrepresentation of the mutant allele in patients with treatment failure, suggesting that the bp 609 alteration is not a strong determinant of treatment outcome.

Indoor Air Quality Intervention in Schools: Effectiveness of a Portable HEPA Filter Deployment in Five Schools Impacted by Roadway and Aircraft Pollution Sources

The Healthy Air, Healthy Schools Study was established to better understand the impact of ultrafine particles (UFPs) on indoor air quality in communities surrounding Seattle-Tacoma (Sea-Tac) International Airport. The study team took multipollutant measurements of indoor and outdoor air pollution at five participating school locations to estimate infiltration indoors. The schools participating in this project were located within a 7-mile radius of Sea-Tac International Airport and within 0.5 mile of an active flight path. Based on experimental measures in an unoccupied classroom, infiltration rates of (a) UFPs of aircraft origin, (b) UFPs of traffic origin, and (c) wildfire smoke or other outdoor pollutants were characterized before and after the introduction of a portable high-efficiency particulate air (HEPA) filter intervention. The portable HEPA cleaners were an effective short-term intervention to improve the air quality in classroom environments, reducing the UFP count concentration from one-half to approximately one-tenth of that measured outside. This study is unique in focusing on UFPs in schools and demonstrating that UFPs measured in classroom spaces are primarily of outdoor origin. Although existing research suggests that reducing particulate matter in homes can significantly improve asthma outcomes, further investigation is necessary to establish the benefits to student health and academic performance of reducing UFP exposures in schools.

Is there a limit to dose escalation for rectal cancer?

The radiation tolerance of the rectum is not fully understood. Published studies on the radiation treatment of cancers of the prostate, cervix and rectum have been reviewed to determine currently recommended dose-volume guidelines. The need for further studies directed specifically at the treatment of primary rectal cancer and perirectal node metastases is discussed. There seems to be room for escalation of the external beam doses currently given.

Neurotoxic radiosensitizers and head and neck cancer patients--how many will benefit?

The causes for the exclusion of patients from a Phase I dose tolerance study of metronidazole as a hypoxic cell sensitizing agent in patients receiving radiation therapy for head and neck cancer have been reviewed. One hundred and fifty nine consecutive patients were assessed between October 1979 and December 1980 according to eligibility criteria decided upon prior to the study. Only 26 (23%) of 111 patients treated with radical radiation therapy entered the Phase I study. The major reasons for exclusion were a history of prior nervous system abnormality, age over 70, and refusal by some patients to participate in the study. The criteria used for patient selection for studies of hypoxic cell sensitizers (and other investigational agents) must be known so that data from each study can be assessed appropriately before being extrapolated to the general patient population. Clinical trials should be designed to take into account factors that might influence patient entry.