Monophosphoric acid diesters of 7 beta-hydroxycholesterol and of pyrimidine nucleosides as potential antitumor agents: synthesis and preliminary evaluation of antitumor activity

7 beta-Hydroxycholesterol, which has been shown to be selectively cytotoxic toward tumor cells cultured in vitro, was converted into the corresponding water-soluble phosphoric acid ester and linked to a pyrimidine nucleoside such as 5-fluoro-2'-deoxyuridine or 2'-deoxyuridine. 2-Chlorophenyl phosphorodichloridate (3), without activation, was used directly to phosphorylate the protected oxygenated sterol. The intermediate phosphorylated the 5'-OH group of nucleoside selectively, leading to compounds 1a and 1b after deprotection. These compounds were screened for their antiproliferative activity toward EL-4 murine leukemia cells in vitro and for their antitumor activity against the mice bearing Krebs II ascitic carcinoma in vivo.

Polyoxygenated sterols and triterpenes: chemical structures and biological activities

Cholesterol and other sterols are precursors of many hormones of vertebrates (pregnane, androstane, estrane derivatives), invertebrates (ecdysteroids) and even of plants (brassinoids). The normal biosynthetic processes which begin by a series of oxidations lead to a family of compounds, some of which exhibit a wide variety of biological activities. Among the latter, those well-established are their inhibitory effect on the biosynthesis of cholesterol in mammalian cells, their toxic effect on tumor cells and their ability to modify some immunological responses. None of the members of this family has all of the activities just mentioned. The intensity of the effect depends markedly upon the specific structure of each compound.

Review of the clinical results of fast neutron therapy

The clinical results reported from the different neutron therapy centres are reviewed. Fast neutrons were shown to be useful in the treatment of locally extended inoperable salivary gland tumours (average local control rates 67% for neutrons compared to 28% for photons). For paranasal sinuses and some tumours of the head and neck area, especially extended tumours with large fixed lymph nodes, neutrons could also be of interest. By contrast, the results obtained for brain tumours were, in general, disappointing. Neutrons were shown to be beneficial in the treatment of well differentiated soft tissue sarcomas, as well as to bone- and chondrosarcomas. For locally extended prostatic adenocarcinoma, a RTOG randomized trial gave local control rates of 77% for mixed schedule compared to 31% for photons. Neutrons could be useful also for palliative treatment of melanomas. Further studies are needed in order to evaluate the benefit of fast neutrons for other localizations such as uterine cervix, bladder and rectum. It can be concluded that fast neutrons could be of interest for about 10% of the radiotherapy patients, but it is likely that the new high-energy hospital-based cyclotrons will further extend the indications of neutron therapy. However, patient selection remains one of the main problems and there is a need for development of individual predictive tests.

Long term results of neutron- and neutron-boost irradiation of soft tissue sarcomas

The five-year follow-up results of 221 patients treated with neutrons or a neutron-boost at the West German Tumour Centre, Essen, are presented. 94 patients with gross tumour were treated with neutrons alone. 127 patients without gross tumour left behind post surgery were irradiated using a "mixed beam" schedule. The disease-free survival rate at five years is 62.6% for T1-, 71.5% for T2- and 28.7% for T3-tumours (p = 0.016). Significant differences were also found for various grades, i.e. 73.3% for G1-, 47.7% for G2- (p = 0.035) and 22.4% for G3-tumours (p = 0.024). Patients without microscopic tumour residue fared best with a survival rate of 86.6%, followed by patients with microscopic tumour (65.5%; p = 0.042) and patients with gross tumour (25.5%; p = 0.003) left behind. A functional limb was preserved in 86% of the patients with extremity lesions. The local control rate of patients with gross tumour was 76.5% compared with 53% in previous photon series. This finding underlines the potential biological advantage of neutrons in these tumours. Serious side effects ranged from 28% in the patients treated with neutrons for large volumes to 7% in patients treated with a neutron boost.

The role of neutrons in the treatment of soft tissue sarcomas

Two-hundred twenty-one patients with soft tissue sarcoma were treated from 1978 to 1983. Treatment was nonrandomized and consisted of neutron irradiation in 94 cases with gross tumor. Treatment was nonrandomized and consisted of neutron boost irradiation after photon-irradiation or electron-irradiation in 127 cases with no gross tumor after surgery. Patient distribution according to UICC (1978) criteria was 15, 100, and 106 of T1, T2, and T3 respectively. Distribution by pathologic grade was 54, 107, and 60 for Grade 1, Grade 2, and Grade 3 tumors. Distribution by tumor residuum after surgery was 23 cases without microscopic disease (R0), 104 with microscopic disease (R1), and 94 with gross residuum (R2) or nonoperative disease. Five-year follow-up reveals a significant difference (P = 0.024) in disease-free survival (DFS) for T1 (60%), T2 (71%), and T3 (29%, P = 0.016) tumors. Similarly, there are significant DFS differences among G 1 (74%), G 2 (48%, P = 0.035), and G 3 lesions (22%, P = 0.024). The impact of tumor bulk or residuum on DFS after operation is significant when comparing R0 (87%) and R1 (65%) disease (P = 0.042). The 5-year survival of patients who had gross residuum (R2) after surgery was significantly worse (26%, P = 0.003). Ninety percent of patients failed treatment locally and distally within 2 years. The late morbidity rate was 27% for neutron and 7% for neutron-boost irradiation. In our series and reported photon data, local control rates for tumors 5 to 10 cm with neutrons were 76% and 53%, respectively. Low energy (d(14) + Be) neutrons are considered beneficial in the postoperative treatment of well-differentiated soft tissue sarcomas where gross tumor remains. Neutron-boost irradiation is of potential benefit in the treatment after operation of T2-3, and G 1-2 tumors if there is microscopic residual tumor.

[Combined radiotherapy with cis- or carboplatin in advanced head and neck tumors]

This report reviews the treatment results of 111 patients with stage T3-4, N0-3, M0, biopsy proven squamous cell carcinoma of the oropharynx and oral cavity. All patients were treated by primary irradiation with 1.8 to 2 Gy per day for five days a week up to a target volume dose of 39.6 or 40 Gy. Simultaneously 20 mg/m2 cisplatin was given under hyperhydration and mannitol diuresis on days 1 to 5. In case of partial tumour regression radiotherapy was continued up to 70 Gy with another course of cisplatin. In case of minor response surgery was interposed followed by subsequent irradiation with 30 Gy and a second course of cisplatin. 67% of the patients showed an initial complete tumour involution and 27% a partial response. The five year actuarial survival rate with a minimum follow-up of two years is 47.6%. More than 96% of the long term survivors showed a complete response after the end of treatment. The results demonstrate that concomitant radiation and chemotherapy with cisplatin is a highly effective treatment in advanced head and neck carcinoma with tolerable toxicity. Carboplatin (CBDCA) is a second generation platinum analog and has shown comparable antitumour activity but less nephro- and neurotoxicity than cisplatin in head and neck cancer. In order to determine the feasibility and efficacy of simultaneous application of CBDCA and radiotherapy a phase I-II study is going on. Between September 1987 and March 1988 30 patients with advanced squamous carcinoma of the head and neck (T3-4, N0-3) have entered this trial. Patients were separated into three groups which received 60 mg/m2. 70 mg/m2 and 80 mg/m2 CBDCA from days 1 to 5 and 28 to 32. Radiotherapy was administered up to a target absorbed dose of 70 Gy. 5 X 2 Gy/week in shrinking field technique. The group which received 80 mg/m2 CBDCA reached the myelotoxicity limit so that subsequent patients were treated with 70 mg/m2. Among 30 patients who completed the treatment, 22 showed a complete (CR) and eight a partial remission (PR). Despite the short follow-up period the preliminary results appear to be comparable with those achieved after combined radiotherapy and cis-DDP application without any limitations for patients with renal or cardiovascular disorders.

Effect of the 21-aminosteroid U-74006F on cerebral vasospasm following subarachnoid hemorrhage

The purpose of this study was to use a new 21-aminosteroid (U-74006F) with in vitro antioxidant and antilipolytic properties as a pharmacological probe to assess the role of lipid hydrolysis and peroxidation in a rabbit model of subarachnoid hemorrhage (SAH)-induced vasospasm. Cerebral angiograms were performed on 15 rabbits. Eighteen hours later, 1 cc/kg of autologous blood was infused into the cisterna magna of all 15 animals. Six rabbits received no treatment, six received U-74006F starting 30 minutes after SAH, and three rabbits received the vehicle for U-74006F starting 30 minutes after SAH. At 72 hours post-SAH, a second angiogram was obtained. Digital subtraction angiographic techniques were used to measure the diameter of and contrast material flow through the basilar artery. At 72 hours post-SAH, vasospasm was evident in all untreated and vehicle-treated rabbits. The diameter of and the flow through the basilar artery were significantly reduced 42.3% +/- 6.6% and 46.8% +/- 5.8%, respectively, below pre-SAH levels (means +/- standard error of the means). Treatment with U-74006F eliminated the SAH-induced vasospasm; in treated animals, both the flow through and the diameter of the basilar arteries were at pre-SAH levels. These findings indicate that: 1) membrane lipid changes (that is, hydrolysis with eicosanoid production and/or peroxidation) contribute to the chronic vasospasm resulting from SAH, and 2) U-74006F prevents the SAH-induced chronic vasospasm in this model by limiting these pathological membrane events.

Risk factor adapted treatment of Hodgkin's lymphoma: strategies and perspectives

In a national multicenter trial in the Federal Republic of Germany, patients with Hodgkin's lymphoma in stages I, II and IIIA presenting with large mediastinal tumor (MT), extranodal (E), or massive spleen (S) involvement received a combined modality treatment with 2x (COPP + ABVD) followed by 20 or 40 Gy EF radiation (HD1 protocol). By October 1987, 89 patients aged 15-60 years had finished therapy and were evaluable for response. Of these 74 (83%) achieved complete remission (CR). After 3 years freedom from treatment failure (FFTF) is 80% (+/- 8%, 95% confidence interval) and survival (SV) 92% (+/- 6%, 95% confidence interval). In a univariate and multivariate analysis using FFTF as endpoint we could not identify any particularly prominent prognostic risk factor among the following examined: stage, constitutional symptoms, MT, E stage, S involvement, age, sex, histology, laparotomy, erythrocyte sedimentation rate (ESR), leukocytes, lymphocytes, and alkaline phosphatase (AP). These data suggest that the inclusion criteria have selected a fairly homogeneous group of patients with respect to prognosis. In a separate trial (HD3 protocol) patients in stages IIIB/IV received induction chemotherapy with 3x (COPP + ABVD). Patients in complete remission (CR) received consolidation therapy by either radiotherapy (20 Gy IF) or further chemotherapy (COPP + ABVD). Patients not in CR received salvage therapy (40Gy in the case of persisting nodal disease, or else 4x CEVD chemotherapy). By October 1987, 137 patients had finished therapy and were evaluable for response. Of these 86 (63%) achieved CR after induction chemotherapy. Including salvage therapy a total of 104 patients (76%) achieved CR. After 3 years FFTF is 56% (+/- 10%, 95% confidence interval) and SV 84% (+/- 8%, 95% confidence interval). Univariate and multivariate prognostic risk factor analyses were performed using FFTF as endpoint. Sex, age, stage, splenectomy, bone marrow, and liver and bone involvement had no prognostic impact. In contrast, a pretreatment erythrocyte sedimentation rate (ESR) above 80 mm/h and a serum alkaline phosphatase (AP) above 230 IU/ml each appeared as significant prognostic factors (P less than 0.01; relative risk, 2.3). The two parameters can be combined to separate two groups (A: ESR and AP both low; B: ESR and/or AP high) which differ significantly for FFTF (P less than 0.001) and survival (P less than 0.04). The decision for risk-adapted treatment requires identification of groups of patients in the frame of specified diagnostic and therapeutic strategies.(ABSTRACT TRUNCATED AT 400 WORDS)

[Results of whole lung irradiation and chemotherapy in comparison with partial lung irradiation in metastasizing, undifferentiated soft tissue sarcomas]

The poor prognosis of patients with unresectable pulmonary metastases of soft tissue sarcoma is well known. In order to evaluate the beneficial effect of radiotherapy, we have treated 44 patients with pulmonary metastases of grade 3 soft tissue sarcoma from 1980 to 1986. In 36 patients the treatment volume was restricted to the single metastases up to a dose of 50 to 60 (9 to 10 Gy/week). The survival rate at one year was 18% and at two years 6%. Eight patients were treated with a combined regimen, consisting of cisplatin and ifosfamide with simultaneous whole lung irradiation. Irradiation was performed with 8 or 16 MV photons at a hyperfractionation of 2 x 0.8 Gy/day (8 Gy/week). After a dose of 12 Gy, the single metastases were boosted up to 50 to 60 Gy, with a second course of chemotherapy. In six of eight patients complete remissions were achieved, one patient showed a partial remission. The survival rate at 27 months was 50%. The patients with partial remission died from pulmonary progression at 23 months. One patient died after twelve months from a loco-regional recurrence in the tonsillar fossa without evidence of pulmonary disease. Side effects included alopecia and moderate bone marrow suppression approximately twelve days after each chemotherapy cycle. Pulmonary fibrosis was observed only at the high dose volume without impairment of respiratory function. From these observations the conclusion is drawn that whole lung irradiation simultaneously with cisplatin and ifosfamide chemotherapy provides good palliative results without relevant morbidity in patients with high grade unresectable pulmonary metastases of soft tissue sarcomas.

Primary gastric tuberculosis: a case report and literature review

Gastric tuberculosis is a rare entity; it usually occurs secondary to another lesion(s), mainly in the lungs. Only a few cases of primary gastric tuberculosis have been reported in the literature. Most commonly, gastric tuberculosis lesion(s) is located in the lesser curvature of the antrum and prepylorus, so the clinical picture is similar to that of peptic ulcer, in addition to the constitutional symptoms seen in tuberculosis in general. We report a case of a young man presented with abdominal pain acute gastric outlet obstruction due to a large mass in the lesser curvature of the antrum and the pylorus. The histological examination revealed caseating granuloma with the presence of acid-fast bacilli. Partial gastrectomy with Bilroth II reconstruction was performed and the patient was put on antituberculosis medications. There was no evidence of the tuberculous lesion anywhere else. Patient's follow-up observation in the clinic was uneventful.

Effect of long-term supplementation of folate on folate status in plasma and erythrocytes

Folate nutritional status was estimated by radioassay of folate levels in plasma and erythrocytes during and after a long-term supplementation of folic acid. A 1-mg dose of folic acid per day was administered orally to 6 healthy subjects for 17 weeks. After 4 weeks of supplementation the mean folate concentration in plasma reached 11 ng/ml and remained constant thereafter, but decreased exponentially after stopping the supplementation. However, the folate concentrations in reticulocytes and erythrocytes increased linearly in all subjects during the supplementation. These results suggest that folate-rich, young erythrocytes are mixed at a constant rate with circulating ripe ones, which have a lower folate content, during folate supplementation.

Neurotrophic effect of naturally occurring long-chain fatty alcohols on cultured CNS neurons

A long-chain fatty alcohol,n-hexacosanol, that we have isolated from the Far-Eastern traditional medicinal plant, Hygrophila erecta, Hochr., is shown to promote the maturation of central neurons. Added at 500 nM to fetal rat brain neurons in culture, it increased both neurite outgrowth by a factor of 4-6 and the number of collaterals, especially in multipolar neurons. The biochemical differentiation of cultured neurons was also strikingly enhanced by this compound: it increased the protein content and almost doubled the activities of two neuron-specific enzymes, phosphate-activated glutaminase and neuron-specific enolase, by 92 and 78%, respectively. Extensive studies with several synthetic long-chain fatty alcohols showed that the neurotrophic activity was maximal for n-hexacosanol. It is suggested that some long-chain fatty alcohols with an appropriate length of hydrocarbon chain might play an important role in central neuron development.

[A patient positioning system in head and neck irradiation]

A holding system is presented which allows a good, easy, and reproducible positioning of the patient in percutaneous head and neck radiotherapy. The patients are lying comfortably on a neck support and are fixed in such a way that they are not able to turn in a lateral or longitudinal direction. The distance chin-jugulum can be easily determined by an integrated measuring tape. Due to the use of UV ink and UV lamps, the field marking of the patient's skin cannot be seen in the spectrum of visible light.

[Value of radiotherapy in the interdisciplinary therapeutic treatment concept of rectal cancer]

Postoperative radiotherapy reduces the local recurrence rate of rectal carcinoma. However, the recurrence free interval and survival time are not influenced. Postoperative radio- and chemotherapy reduce the local recurrence rate as well and prolongs the recurrence free interval. The survival rate is not significantly improved. Combined pre- and postoperative radiotherapy are presently being evaluated in prospective randomised trials. The actual results demonstrate a reduced local recurrence rate, a prolongation of the recurrence free interval and an improved survival time. Because of the relatively small numbers of patients in the different treatment groups a final evaluation is not yet possible.

Serial effects on left ventricular load and contractility during hemodialysis in patients with concentric hypertrophy

To separate the effects of hemodialysis on loading conditions from those on contractile state, six patients with concentric left ventricular hypertrophy and normal left ventricular function were studied before, during, and after hemodialysis. Two-dimensional-directed M-mode ultrasound was used to measure left ventricular dimensions and wall thickness; a sphygmomanometer and carotid pulse recording were used to determine peak and end-systolic blood pressure. From these data, meridional stress at end systole was calculated and stress-dimension and stress-shortening relations were derived; measurements of metabolic parameters were made simultaneously. Heart rate and systolic blood pressure were stable throughout dialysis. Reductions in left ventricular dimensions and increased shortening were evident by 30 minutes of dialysis and were largely complete by mid-dialysis. These changes coincided with a decrease in potassium and an increase in ionized calcium but not in pH, which changed only in the latter half of dialysis. When stress-dimension and stress-shortening relations were examined, both individual and group data for all coordinates before, during, and after dialysis demonstrated an excellent linear fit consistent with a single contractile state. We conclude that in stable patients with left ventricular hypertrophy, the reduction in heart size and improvement in shortening are due primarily to reductions in preload and afterload.

[Combined therapy of tumors in adults]

A significant amelioration of treatment results is achieved by sequential chemotherapy and radiotherapy in patients with lymphogranulomatosis of stage IIb to IVb and in patients with non-Hodgkin's lymphomas in corresponding stages. Similar results will probably be obtained in patients with small cell bronchial carcinomas in a limited stage. Patients suffering from an initially inoperable ovarian cancer often reach an operable condition by sequential chemotherapy and radiotherapy. In the stages Dukes B2 and C of the rectum carcinoma, preoperative and/or postoperative irradiation significantly reduces the recurrence rates and increases the survival times. A considerable reduction of recurrence rates is obtained by postoperative radiotherapy in soft tissue sarcomas of the stages T1 to T3. Another improvement is anticipated by a neutron or neutron boost irradiation for stage T3 and by adjuvant chemotherapy for G3 tumors. In the osteosarcoma of adult persons, the results of the limb-sparing sequential therapy will not be worse than the results achieved by amputation. Retrospective analyses of the long-term results of radical mastectomy and conservative operation with postoperative irradiation in case of mammary carcinoma did not show any difference for the stages T1 to T3, N0 to N1.

Absence of inhibitory dopaminergic control of the rabbit pituitary gland intermediate lobe

No immunoreactive axons were detected with an antiserum against tyrosine hydroxylase in the rabbit intermediate lobe (IL), which thus appears to be devoid of dopaminergic (DA) innervation. Dopamine and its agonists, which classically inhibit alpha-MSH release have no inhibitory effects on rabbit IL superfused in vitro but, paradoxically, stimulate alpha-MSH release. D2 type DA receptors, known to mediate inhibitory control of dopamine on melanotropic cells, and detectable by their affinity for (3H)-spiroperidol, were as previously reported absent from the rabbit IL. The absence of (3H)-spiroperidol binding sites in the IL was further confirmed on rabbit pituitary sections by radioautography. The mechanism of DA stimulation is still not clear, but might be tentatively explained by interference with other receptors involved in the stimulation of the gland. The lack of DA inhibitory control over the rabbit IL is an exception among the species so far studied.

Results of curative pion therapy at SIN

The experiences of the treatment of bladder carcinoma indicated the direction in which the dose optimization program of intraabdominal tumours can be carried out. Small intraabdominal target volumes seem to tolerate doses from 31 to 33 Gy applied in 20 fractions. The best results with local tumour control and low complication rates have so far been reached in carcinoma of the cervix. It has not so far been organizationally possible at SIN to treat with pions on more than four days per week. This restricts changes to the fractionation scheme in the treatment of highly malignant gliomas. An improvement of results could be possible on the basis of experience to date. The significance of a postbiopsy preoperative radiotherapy, of the increase of target volume and the increase of the total dose will be tested in a study by the SAKK (Swiss Group for Clinical Cancer Research).