Preventing Pain on Injection of Propofol: A Comparison between Peripheral Ketamine Pre-Treatment and Ketamine Added to Propofol

The purpose of this study was to examine possible peripheral mechanisms for the reduction of propofol injection pain by the addition of ketamine. We hypothesised that pH changes associated with the addition of ketamine to propofol decrease propofol-induced pain on injection. We compared the efficacy of intravenous ketamine pretreatment under tourniquet with ketamine added to the propofol In the pre-treatment group, patients received ketamine 10 mg in a total volume of 1.0 ml with 0.9% saline (n=94; Group P) under tourniquet for 30 seconds before administration of propofol afler release of the tourniquet. In the mixture group, propofol 9 ml was mixed with ketamine 10 mg in 0.9% NaCl 1.0 ml (n=94, Group M). Pain was assessed with a four-point scale: 0=no pain, 1 =mild pain, 2=moderate pain, 3=severe pain at the time of propofol injection. The pH of propofol, ketamine and a range of propofol-ketamine mixtures were also measured. Forty-eight patients (51%) in Group P complained of pain on injection compared with 28 patients (30%) in Group M (P=0.005). The pH of the 1% propofol-ketamine mixture was 5.84 while 1% propofol had a pH of 7.86. Our results support pH changes as a more important cause for the decrease in propofol injection pain with the addition of ketamine to propofol than a peripheral effect of ketamine.

Phase II study of irinotecan, 5-fluorouracil (5-FU) and leucovorin combination chemotherapy in taxane and cisplatin-based chemotherapy-refractory metastatic gastric cancer

e15599

Background: The role of the second line chemotherapy in advanced gastric cancer was not clear, but possibility of prolongation of survival is open question. Irinotecan is promising agents in gastric cancer and this phase II study evaluated the efficacy and safety of combination chemotherapy with irinotecan, high dose of 5-fluorouracil (5-FU) and leucovorin in taxane and cisplatin based chemotherapy refractory metastatic gastric cancer. Methods: Eligible criteria were as followed; histologic confirmed adenocarcinoma of stomach, previously treated with taxane and cisplatin, age≥18, Eastern Clinical Oncology Group (ECOG) performance status of 1 or less, adequate organ function. Irinotecan (150 mg/m2) as a 30-min infusion and leucovorin (200 mg/m2) as a 15-min infusion were given on day 1, followed by 5-FU 400 mg/m2bolus infusion then 5-FU 2,400 mg/m2 as a 48-hour continuous infusion. This cycle was repeated every 2 weeks until disease progression or unacceptable toxicities. Results: Thirty-four patients were enrolled. The median age was 57 years (range 27–73 years), and the ECOG performance status of all patients was 1. All patients were evaluable for safety and survival and twenty seven patients (79.4%) were evaluable for tumor response. The overall response rate was 18.5% (95% CI: 3.9–33.1). The median progression free survival and overall survival were 4.6 (95% CI: 2.4–6.9) and 9.3 months (95% CI: 5.2–13.4), respectively. Greater than grade 3 haematological toxicities were neutropenia in nine (26.5%), febrile neutropenia in one (2.9%) and thrombocytopenia in one patient (2.9%). The major non-haematological toxicity was asthenia, but most of patients showed grade 1 or 2. Greater than grade 3 non- haematological toxicities were elevated AST/ALT in four (11.8%), hyperbilirubinemia in two (5.9%), nausea in two patients (5.9%). Conclusions: This results showed that the combination chemotherapy with irinotecan, 5-FU and leucovorin was well tolerated and active in taxane and cisplatin refractory patients.

No significant financial relationships to disclose.

Health care disparity: An analysis of breast, colon, and lung cancer

6579

Background: Lung cancer patients are associated with feeling of guilt about their disease (Schmidt ASCO 2006) and less likely to be referred to specialists (Wassenaar ASCO 2006). They are also commonly affected by smoking related comorbidities. A study was undertaken to evaluate whether treatment differences between lung and other cancers exist. Methods: Public access data for the year 2005 from the National Cancer Data Base (NCDB) was analyzed. Treatment data were categorized by institution (teaching/research [TR] versus community cancer center [CC]) and tumor type (non-small cell lung cancer-NSCLC, breast, colon cancer). Descriptive analysis was performed with student T tests for proportions. Results: The analysis included 18,960 NSCLC patients from a CC and 33,924 from a TR. More patients at TR than CC had surgery: Stage I 65% vs 52% (p < 0.001), Stage II 35% vs 22% (p < 0.001), respectively. The frequency of chemoradiation for stage I and II was higher in CC than TR: stage I 6% vs 3% (p = 0.10), stage II 19% vs 9% (p = 0.004). The frequency of no first course treatment at initial presentation at CC and TR were the following: stage I 15% vs 6%, stage II 18% vs 8%, stage III 21% vs 19%, stage IV 30% vs 24%. For breast and colon cancer, no major differences in no first course treatments were seen between TR and CC in a stage based analysis. More patients with NSCLC (21.2%) did not receive first course treatment in comparison to breast (3.4%, p < 0.001) or colon cancer (7.8%, p < 0.001). These differences were maintained in stage based analysis of the three tumor types. Conclusions: NSCLC patients are at higher risk of not receiving treatment as opposed to those with breast and colon cancer. While medical comorbidities in lung cancer patients may affect these treatment decisions, we noted a higher incidence of no first course treatment in CC than TR centers. For stage I and II, the frequency of no first course treatment in a CC was twice that of a TR. Such institution based differences were not noted in breast and colon cancer.

No significant financial relationships to disclose.

Phase II study of S-1 monotherapy in taxane, cisplatin refractory gastric cancer

4551

Background: S-1 is a fourth-generation oral fluoropyrimidine that was developed to mimic protracted continuous infusion of 5-fluorouracil (5-FU). In previous study, S-1 demonstrated promising activity which is comparable to combination chemotherapy in advanced gastric cancer. This phase II study evaluated the efficacy and safety of S-1 salvage chemotherapy, in patients with taxane and cisplatin refractory gastric cancer. The primary end point was progression free survival and secondary end points were overall survival, safety and clinical benefit. Methods: Patients were eligible if they had histologically documented gastric adenocarcinoma previously treated with taxane (docetaxel or paclitaxel) and cisplatin; age≥18; Eastern Clinical Oncology Group (ECOG) performance status of 2 or less; adequate organ function; no evidence of gastrointestinal obstruction or passage disturbance. S-1 treatment was performed according to BSA as followed; < BSA 1.25, 80 mg/day, 1.25 ≤ BSA < 1.5, 100 mg/day; BSA ≥ 1.5, 120 mg/day. Every dosage was delivered divided two times and administered for 4 weeks followed by 2 weeks of resting period. Treatment continued until progression of disease or life-threatening adverse events were occurred. Results: Fifty-four patients were enrolled in this study and of the patients, forty-eight patients were evaluable. A total 194 chemotherapy cycles were administered and median number of cycles was three. Four (8.3%) patients had a partial response and 18 (37.5%) patients had stable disease. The median progression free survival and overall survival were 3.8 and 10.2 months, respectively. Grade III/IV hematologic toxicities included neutropenia in 6 patients (12.5%) and there was no febrile neutropenia. Most of nonhematologic toxicities were diarrhea, asthenia, and mucositis, and there was no grade 3 or grade 4 except two patients, who developed grade 3 anorexia and diarrhea, respectively. The clinical benefit response was observed in 16 patients (33.3%). Conclusions: This results showed that S-1 monotherapy was active and safe salvage chemotherapy in patients with advanced gastric cancer previously treated with taxane and cisplatin.

No significant financial relationships to disclose.

Exchange boson dynamics in cuprates: optical conductivity of HgBa_2CuO_4+delta

The electron-boson spectral density function I;{2}chi(Omega) responsible for carrier scattering of the high temperature superconductor HgBa_{2}CuO_{4+delta} (T_{c}=90 K) is calculated from new data on the optical scattering rate. A maximum entropy technique is used. Published data on HgBa_{2}Ca_{2}Cu_{3}O_{8+delta} (T_{c}=130 K) are also inverted and these new results are put in the context of other known cases. All spectra (with two notable exceptions) show a peak at an energy (Omega_{r}) proportional to the superconducting transition temperature Omega_{r} approximately 6.3k_{B}T_{c}. This charge channel relationship follows closely the magnetic resonance seen by polarized neutron scattering, Omega_{r};{neutron} approximately 5.4k_{B}T_{c}. The amplitudes of both peaks decrease strongly with increasing temperature. In some cases, the peak at Omega_{r} is weak and the spectrum can have additional maxima and a background extending up to several hundred meV.

Combustion characteristics of simulated gas fuel in a 30 kg/h scale pyrolysis-melting incinerator

Combustion characteristics of gas fuel in a pyrolysis-melting incinerator having a 30 kg/h capacity were investigated. Pyrolyzed gas from waste was simulated by propane that was injected in the combustion chamber, and burnt through multi-staged combustion by distributing the combustion air to primary, secondary, and tertiary air nozzles. Temperatures and the concentrations of gas components in the combustion chamber were measured. Combustion performance was evaluated with respect to the temperature distribution and combustion gas concentrations of O2, CO and NOx. Using secondary air and/or tertiary air, the combustion performance was improved, and, in particular, NOx concentration decreased significantly following the tertiary air injection.

Exploring the limits of single emitter detection in fluorescence and extinction

We present an experimental comparison and a theoretical analysis of the signal-to-noise ratios in fluorescence and extinction spectroscopy of a single emitter. We show that because of its homodyne nature the extinction measurements can be advantageous if the emitter is weakly excited. Furthermore, we discuss the potential of this method for the detection and spectroscopy of weakly emitting systems such as rare earth ions.

Evidence for a pseudogap in underdoped Bi{2}Sr_{2}CaCu{2}O{8+delta} and YBa2Cu3O6.50 from in-plane optical conductivity measurements

The real part of the in-plane optical self-energy data in underdoped Bi_{2}Sr_{2}CaCu_{2}O_{8+delta} (Bi-2212) and ortho II YBa2Cu3O6.5 contains new and important information on the pseudogap. Using a theoretical model approach, a major new finding is that states lost below the pseudogap Delta_{pg} are accompanied by a pileup of states just above this energy. The pileup along with a sharp mode in the bosonic spectral function leads to an unusually rapid increase in the optical scattering rate as a function of frequency and a characteristically sloped peak in the real part of the optical self-energy. These features are not found in optimally doped and overdoped samples and represent the clearest signature so far in the in-plane optical conductivity of the opening of a pseudogap.

Bosonic spectral density of epitaxial thin-film La1.83Sr0.17CuO4 superconductors from infrared conductivity measurements

We use optical spectroscopy to investigate the excitations responsible for the structure in the optical self-energy of thin epitaxial films of La(1.83)Sr(0.17)CuO(4). Using Eliashberg's formalism to invert the optical spectra we extract the electron-boson spectral function and find that at low temperature it has a two component structure closely matching the spin excitation spectrum recently measured by magnetic neutron scattering. We contrast the temperature evolution of the spectral density and the two-peak behavior in La(2-Sr(x)CuO(4) with another high temperature superconductor Bi(2)Sr(2)CaCu(2)O(8+delta). The bosonic spectral functions of the two materials account for the low T(c) of LSCO as compared to Bi-2212.

Phytophthora Blight and Dieback in North Carolina Nurseries During a 2003 Survey

A survey of 14 nurseries growing hybrid rhododendron, Pieris spp., or Viburnum spp. was conducted as part of the 2003 Sudden Oak Death Pilot National Survey to determine if Phytophthora ramorum, the causal agent of sudden oak death, had been introduced to nurseries in North Carolina. Over 220,000 hybrid rhododendrons, 1,700 plants of Pieris spp., and 2,800 plants of Viburnum spp. were surveyed. Across nurseries, blight and dieback incidence averaged 2.4% for Pieris spp. and 10% for rhododendron. P. ramorum was not recovered by isolation or detected by polymerase chain reaction in the 347 plant samples collected. Three species of Phytophthora were isolated from hybrid rhododendron and Pieris spp., but no Phytophthora isolates were recovered from Viburnum spp. P. citricola and P. cambivora were isolated most frequently (61 and 39 isolates, respectively), while 2 isolates of P. cactorum were recovered. Occasionally, two Phytophthora spp. were found in the same block of rhododendrons within a nursery, but only one species was recovered from an individual plant. Most cultivars of rhododendron surveyed, including 'English Roseum,' 'Nova Zembla,' and 'Roseum Elegans,' had less than 0.5% incidence of Phytophthora blight and dieback, whereas 'Lee's Dark Purple' had 3.8% disease incidence across all nurseries surveyed.

Lab-scale test of a ventilation system including a dielectric barrier discharger and UV-photocatalyst filters for simultaneous removal of gaseous and particulate contaminants

A ventilation system including a dielectric barrier discharger (DBD) and UV-photocatalyst (UVP) filters was designed and tested for simultaneous removal of gaseous and particulate contaminants in a test chamber. The DBD was used in the first stage of electrostatic precipitator (ESP) for particle charging and gas decomposition. An applied DC electric field was used in the second stage of ESP to collect the charged particles. UVP filters were then used to decompose gaseous species, such as formaldehyde (HCHO) and benzene, toluene, and xylene (BTX) including O3, which was inherently produced by the DBD. %Reductions in mass concentration of PM2.5 and number concentration of submicron particles were approximately 79.5% and 76.3%, respectively, after the ventilation with air cleaning system was operated for 5 h. Both HCHO and BTX were completely removed when the initial concentration of each gas was 1 ppm.

PRACTICAL IMPLICATIONS

Indoor air quality (IAQ) problems, such as sick building syndrome (SBS), are caused by limited ventilation in high-rise buildings. To overcome these problems, DBD and UVP filters were applied into a lab-scale ventilation system for simultaneous removal of pollutant particles and gases. The data supplied in this study will be useful for designing any actual ventilation system after further research, including scale-up experiments.

Bond cutting in Cs-doped tris(8-hydroxyquinoline) aluminium

A series of Cs 4d and Al 2p spectra associated with valence-band and cut-off spectra have been used to characterize the interaction between caesium and tris(8-hydroxyquinoline) aluminium (Alq(3)) molecules in a Cs-doped Alq(3) layer. The Cs 4d and Al 2p spectra were tuned to be very surface sensitive by selecting a photon energy of 120 eV at the National Synchrotron Radiation Research Center, Taiwan. A critical Cs concentration exists, above which a new Al 2p signal appears next to the Al 2p peak of Alq(3) in the lower binding-energy side. The Al 2p signal was analyzed and assigned as being contributed from a mixture of Alq(2), Alq and Al. Experimental data supported the observation that bond cutting of Alq(3) by the doped Cs atoms occurred at high Cs doping concentration.

Structural studies of the final enzyme in the alpha-aminoadipate pathway-saccharopine dehydrogenase from Saccharomyces cerevisiae

The 1.64 A structure of the apoenzyme form of saccharopine dehydrogenase (SDH) from Saccharomyces cerevisiae shows the enzyme to be composed of two domains with similar dinucleotide binding folds with a deep cleft at the interface. The structure reveals homology to alanine dehydrogenase, despite low primary sequence similarity. A model of the ternary complex of SDH, NAD, and saccharopine identifies residues Lys77 and Glu122 as potentially important for substrate binding and/or catalysis, consistent with a proton shuttle mechanism. Furthermore, the model suggests that a conformational change is required for catalysis and that residues Lys99 and Asp281 may be instrumental in mediating this change. Analysis of the crystal structure in the context of other homologous enzymes from pathogenic fungi and human sources sheds light into the suitability of SDH as a target for antimicrobial drug development.

First-in-human phase I trial of a cyclodextrin-containing polymer-camptothecin nanoparticle in patients with solid tumors

14078

Background: IT-101 is a de novo designed experimental therapeutic comprised of linear, cyclodextrin(CD)-containing polymer conjugates of camptothecin(CPT) that assemble into ca. 40 nm diameter nanoparticles via polymer-polymer interactions that involve inclusion complex formation between the CPT and the CD. Particle size, near neutral surface charge and CPT release rate were specifically designed into IT-101. Published pre-clinical animal studies show extended circulation times (t1/2 of ca. 20 h in rodents), tumor accumulation, slow release of the CPT and anti-tumor efficacy that directly correlate to the properties of the nanoparticle. Release of CPT can disassemble the nanoparticle into individual polymer chains that have size ca. 10 nm that are capable of renal clearance (t1/2 of several minutes in rodents). Methods: Patients with relapsed or refractory cancer were evaluated every two cycles of therapy (90 minute IV infusions of IT- 101 in D5W on days 1, 8 and 15 of a 28 day cycle). Three dose levels of 6, 12 and 18 mg CPT eq./m2 have been tested. Results: At the time of this interim analysis, eight patients have been enrolled and five evaluated. In general, IT-101 is well tolerated and pancytopenia is the DLT. The expected MTD is 12 mg/ m2.Three out of five patients demonstrated stable disease on CT scan evaluation. One pancreatic cancer patient remains stable for 6 months. PK data are available from the first 5 patients. Total and free CPT display biphasic elimination from plasma with mean terminal elimination half lives of 38±3.7 and 61±43 hours, respectively. The mean Vd and CLsys of total CPT are 6.1±1.4 L and 0.1±0.03 L/h and are unrelated to dose over the range tested, with a mean total-to-free AUC ratio of 10.7±3.7. Conclusions: These first in human PK data for IT-101 confirm that 40 nm particles with near neutral surface charge provide favorable PK properties. The stable disease rate, although not yet conclusive, is consistent with promising efficacy. The preliminary results of this phase I study warrant continued enrollment that is ongoing.

No significant financial relationships to disclose.

Phase II study of induction chemotherapy with fixed dose rate (FDR) gemcitabine and cisplatin followed by concurrent chemoradiation with capecitabine for locally advanced pancreatic cancer (LAPC)

15122

Background: Despite the use of 5-FU based chemoradiotherapy (CRT) over the past decades, prognosis of patients with LAPC remains dismal. To deliver more efficient systemic treatment earlier and reduce toxicity of CRT, we designed a treatment protocol consisting of induction (IND) chemotherapy with FDR gemcitabine (GEM) and cisplatin (CDDP), followed by CRT with capecitabine (CAP) in LAPC. Methods: Eligible patients had unresectable, histologically confirmed adenocarcinoma of pancreas, ECOG PS of 0–2, and no prior chemo- or radiotherapy for this phase II study. Patients received FDR GEM 1000 mg/m2 (D1,8) and CDDP 60 mg/m2 (D1) every 3 weeks for 3 cycles. Patients without disease progression subsequently received CRT of 55.8 Gy in 31 fractions concurrently with CAP, 650 mg/m2 given twice daily without drug holidays. Four weeks after CRT, FDR GEM 1000 mg/m2 was given on day 1, 8 every 3 weeks for 3 cycles. Time to progression was the primary endpoint. Results: Between Jan 2005 and Nov 2006, 21 patients were enrolled (median age 59, M/F: 13/8, ECOG PS 0/1: 3/18). Two patients withdrew consent after 1st and 2nd cycle and remaining 19 patients completed all three cycles of IND chemotherapy, with three (15.8%) out of 19 evaluable patients achieving partial response (0 CR, 3 PR, 14 SD, 2 PD). All 17 patients completed CRT with mean radiation dose of 55.4 Gy. Further four patients progressed during CRT, while one additional patient achieved partial response. As of Jan 2007, 5 patients died and 12 patients showed tumor progression. Median TTP was 12.5 mo (95% CI: 4.2–20.8) and median survival was not reached with median follow up duration of 9.7 months. Grade III/IV toxicities included neutropenia (38.1%/9.5%), thrombocytopenia (4.8%/0%), and anemia (14.3%/0%) during IND phase. Toxicites were generally mild during CRT phase with grade III neutropenia and diarrhea occurring in one and two patients, respectively. One patient died of neutropenic sepsis after 3rd cycle of IND chemotherapy. Conclusions: FDR GEM-CDDP induction chemotherapy followed by CAP-RT and maintenance FDR GEM is feasible and active with promising TTP of 12.5 months. Enrollment continues till reaching target accrual of 37 patients.

No significant financial relationships to disclose.

Pharmacokinetic (PK) and phase I study of sorafenib (S) for solid tumors and hematologic malignancies in patients with hepatic or renal dysfunction (HD or RD): CALGB 60301

3538

Background: We sought to characterize the PK and determine a tolerable dose of S in patients with HD or RD. Methods: Patients with performance status 0–2 and pathologically proven solid tumors, multiple myeloma, or non-Hodgkin’s lymphoma, for whom standard therapy was exhausted, were assigned to one of 9 cohorts: [1] Bilirubin (B) =ULN and SGOT =ULN and creatinine clearance (CC) =60 ml/min; [2] B > ULN but = 1.5 x ULN and/or SGOT > ULN; [3] CC between 40 and 59 mL/min; [4] B > 1.5 x ULN to = 3 x ULN (any SGOT); [5] CC between 20 and 39 mL/min; [6] B > 3 x ULN to 10 x ULN (any SGOT); [7] CC < 20 mL/min; [8] albumin < 2.5 mg/dL (any B/ SGOT); and [9] hemodialysis. S was administered po as a 400 mg test dose on day 1 with blood sampled before and 1, 2, 3, 4, 6, 24, and 168 hrs afterwards for PK. Total S concentrations were fit to a 2-compartment model and population parameters from previous studies were utilized. On day 8, continuous daily po S started with dose escalation in groups of at least 3 evaluable patients. Dose-limiting toxicity (DLT) by day 29 was defined as: grade 4 neutrophils or platelets; B = 1.5 x baseline in HD and = 2.5 x ULN in RD; CC reduction by > 20 mL/min in RD and >10 mL/min in HD; grade = 3 nausea/vomiting/diarrhea despite optimal supportive care; or any other grade = 3 non-hematologic toxicity. Results: Between 1/05 and 12/06, 146 patients (target 150) were registered but 12 never started therapy. With the exception of cohorts 6 and 7, at least 12 patients per cohort were evaluable. The dose level in each cohort with DLT in less than one third of patients was: [1] 400 mg bid; [2] 400 mg bid; [3] 400 mg bid; [4] 200 mg bid; [5] 200 mg bid; [6] not even 200 mg every third day tolerable; [7] n/a; [8] 200 mg qd; and [9] 200 mg qd. All DLT was non-hematologic: 9 of 12 events in patients with HD were increase in B; other DLT included abdominal pain, rash, fatigue, nausea/vomiting, hand-foot syndrome, congestive heart failure, diarrhea, hemorrhage, and hypertension. PK data are available for 51 patients. Apparent S clearance was: highly variable, median 5.69 (range 1.27 - 19.98) L/hr; not related to age, body weight, or sex; and not different among cohorts. Conclusions: Apparent S clearance does not depend on cohort. We propose the above empiric starting doses by cohort.

No significant financial relationships to disclose.

A phase I trial of RX-0201 (AKT anti-sense) in patients with an advanced cancer

3564

Background: Akt-1, a proto-oncogene, plays a vital role in cancer progression by stimulating proliferation and inhibiting apoptosis of cancer cells. RX-0201, a 20-mer oligonucleotide with sequence complementary to Akt-1 mRNA, is designed to inhibit the expression of Akt-1 within cancer cells in cancer patients (pts). Non-clinical studies conducted on RX-0201 demonstrated that RX-0201 bears significant in vitro and in vivo anti-cancer activities with favorable safety. Purposes: The aims of the current phase I trial were to determine the maximum tolerated dose (MTD) and to establish pharmacokinetic (PK) and safety profiles of RX-0201 in pts with an advanced cancer. Methods: RX-0201 was administered to pts with an advanced cancer by up to 2 cycles of continuous infusion; each cycle of infusion lasted for 14 days which was followed by a 7-day rest. Rapid dose escalation had been used until at least a grade (G) 2 toxicity was observed, and then a traditional dose escalation followed. Entry criteria included Karnofsky Performance Status score =70, advanced cancer, tumor accessible for paired biopsy, and signed informed consent. 17 pts were enrolled and treated at a dose level ranging from 6 to 315 mg/m2/d on D1–14, repeated q 21 d. Results: G 3 fatigue was observed in two pts at the 315 mg/m2/d dose; three pts dosed at 250 mg/m2/d were not noted with any G 3 toxicity, which make this dose (250 mg/m2/d) the recommended phase II trial dose. No other significant, compound-related, adverse events were observed in those 17 pts participated. Pts PK profiles of RX-0201 and AKT-1 immunohistochemistry results on pts’ tumor biopsy samples will also be presented. Conclusion: MTD of RX-0201 is 315 mg/m2/d in pts with an advanced cancer when the compound is administered in the current continuous infusion regimen.

No significant financial relationships to disclose.

CyberKnife high-dose fractionated stereotactic radiosurgery with tumor tracking: An effective non-surgical treatment alternative for single small peripheral lung tumors

18125

Background: We report preliminary outcomes using CyberKnife radiosurgery with tumor tracking to treat small (<4 cm) peripheral inoperable stage I lung cancers and single pulmonary metastases. Methods: Enrollment of eligible pts began in July 2004. Prior conventional thoracic irradiation and the incorporation of systemic therapy were permitted. Fiducials (3–5) were placed near tumors under CT guidance. Pts received 45–60 Gy in 3 equal 1–2 hour fractions delivered over a 5–9 day period. Results: The median follow-up period of survivors was 12 months (range = 3–24 months). A total of 24 lesions were treated, 15 clinical stage I lung cancers and 9 single lung metastases. Four patients had prior conventional thoracic radiation (17%) and 6 patients received systemic therapy in conjunction with radiosurgery (25%). Two received systemic doses of platinum based doublet chemotherapy, 3 received gefitinib and 1 received sunitinib. Pneumothorax was a complication of fiducial placement in 7 pts, requiring tube thoracostomy in 4. All pts completed treatment with few acute side effects. No unexpected additional toxicities were noted with systemic therapy except for one pt who developed Grade III radiation pneumonitis while receiving gefitinib. A second pt with Grade III radiation pneumonitis had prior extensive conventional thoracic radiation. All tumors responded to treatment at 3 months as seen by a decrease in gross tumor volume. At 12 months 14 CT scans were evaluable. Four lesions responded completely (33%), 2 exhibited a partial response and the remaining 8 were obscured by radiation fibrosis corresponding to the high-dose irradiated volume (57%). Local progression was seen in only 2 single lung metastases at 10 and 12 months. There have been no regional lymph node failures. Four patients have died, 1 of progressive metastatic disease and 3 of comorbid illnesses. Conclusion: CyberKnife high-dose fractionated stereotactic radiosurgery with tumor tracking is an effective well-tolerated treatment option for small peripheral lung tumors, both primary and metastatic. The integration of systemic therapy appears feasible but needs to be further evaluated in clinical trials.

No significant financial relationships to disclose.

Phase II study of weekly docetaxel in combination with capecitabine (C) in advanced gastric (AGA) and gastro-esophageal adenocarcionma (AGEA)

15139

Background: Chemotherapy regimens for AGA and AGEA have shown considerable toxicity and most require continuous IV administration. Both D and C are active agents in AGA. D upregulates thymidine phosphorylase, the enzyme which catalyzes the conversion of C to 5-FU, with preclinical evidence of synergy for the combination. A phase I study of D and C showed acceptable tolerability and activity in patients (pts) with AGA (Ramanathan et al., 2005). This multi-institutional phase II trial evaluates the combination of D and C in 1st or 2nd line treatment of AGA and AGEA. Methods: Pts with AGA/AGEA who received ≤ 1 prior chemotherapy regimen were eligible. D 30 mg/m2 on d 1, 8 and C 825 mg/ m2 BID were administered on days 1–14 of a 21 day cycle. The one stage study design had an accrual goal of 40 pts. The primary endpoint was to detect a 50% improvement in median survival in previously untreated pts to 10 months (mo), by one-sided log-rank test at level a = 0.05. Results: Enrollment is complete with 40 pts, all are evaluable for response and toxicity. Pt characteristics: 79% male; 94% with ECOG performance status 0/1; median age 60 yrs (34–84), 32 pts (80%) were previously untreated. Overall response rate is 25% with 1CR and 9 PR. The projected median time to progression (TTP) and survival are 6.2 and 7.8 mo respectively. Dose modifications were required in 9%. Median cycles administered 4 (range 1–10). Grade 3/4 adverse events include: diarrhea (13%), hand-foot syndrome (13%), dehydration (6%), abd pain, anorexia, fatigue, febrile neutropenia, gastric ulcer, hyperglycemia, vertigo, and vomiting (3% each). Conclusion: The combination of D and C is well tolerated and active. The preliminary TTP (6.2 mo) and survival (7.8 mo) compare favorably with published regimens for 1st line therapy, but did not meet study endpoint. The combination of D and C is an easily administered outpatient regimen for AGA and AGEA and may be worthy of further investigation with a targeted agent. (Funded by Sanofi-Aventis and Roche Pharmaceuticals).

No significant financial relationships to disclose.

Design and development of virtual reality based perceptual-motor rehabilitation scenarios

Virtual reality technology may provide new options for conducting perceptual-motor assessment within simulated 3D environments for persons with a wide range of disabilities. This paper outlines our work developing a series of game-like VR scenarios to assess and rehabilitate eye-hand coordination, range of motion and other relevant perceptual-motor activities. Our efforts have focused on building engaging game-based stereoscopic graphic scenarios that allow clients to participate in perceptual-motor rehabilitation by interacting with 3D stimuli within a full 360-degree space using a head mounted display or by way of a "face-forward" format using 3D projection displays. Exploratory work using multiple video sensors to detect and track 3D body motion, identify body postures and quantify motor performance is also described.