Curative intended radiation therapy for young patients with invasive uterine cervical carcinoma: Clinical outcomes in 105 patients in a Japanese multi-institutional study

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Background: Recently, the number of young patients with invasive uterine cervical carcinoma is increasing in Japan because of earlier sexual activity and low rate of receiving screening test of uterine cervical carcinoma in Japan. However, no large studies have been performed so far to evaluate the clinical outcomes of curative intended radiation therapy for young patients with invasive uterine cervical carcinoma in Japan. Then, the current study was designed. Methods: One hundred and five patients under 40 years old were registered in the mulitiinstitutional study. The median age was 34.5 years old (range: 24–39 years old). According to FIGO, clinical stage was as follows. Stage Ib/IIa/IIb/IIIa/IIIb/IVa were 10/4/38/2/47/3, respectively. The median maximal tumor diameter was 5.5 cm (range: 2–9.2 cm). Curative intended radiation therapy was the combination of high-dose rate intracavitary brachytherapy (HDR-ICBT) combined with external beam radiation therapy (ERT). The total dose of ERT ranged from 44 Gy to 68 Gy. The total dose of HDR-ICBT to point A ranged from 12 Gy to 48 Gy. Eighty five patients received chemotherapy. Results: The 5-year overall survival rate and local control rate of all patients was 58.4 % and 59.3 %, respectively. The 5-year overall survival rates of stage Ib/IIa/IIb/IIIa/IIIb/IVa were 90.0 %/not available (NA)/73.8%/100%/37.4%/0%, respectively. The 5-year local control rates of Stage Ib/IIa/IIb/IIIa/IIIb/IVa were 80.0 %/50.0 %/73.8 %/100 %/54.6 %/NA, respectively. Sixteen patients experienced grade 3 or greater late radiation morbidity. Conclusions: Clinical outcomes of stage I-II in the young were equivalent to the Japanese standard treatment results of all ages. However, clinical outcomes of stage IIIb and IVa in the young were worse than those of all ages (5-year OS of all ages in Japan: IIIb: 50 %, IVa: 25 %).

No significant financial relationships to disclose.

Carotid artery stenting for calcified lesions

BACKGROUND AND PURPOSE

Our aim was to assess the feasibility of carotid artery stent placement (CAS) for calcified lesions.

MATERIALS AND METHODS

Using embolic protection devices (EPDs), we performed 51 CAS procedures in 43 patients with severe carotid artery stenosis accompanied by plaque calcification. Before intervention, all lesions were subjected to multidetector-row CT. The arc of the circumferential plaque calcification was measured on axial source images at the site of maximal luminal stenosis, and the total volume of the plaque calcification was determined. The angiographic outcome immediately after CAS, and intra- and postoperative complications were recorded.

RESULTS

The mean arc of calcification was 201.1 +/- 72.3 degrees (range, 76-352 degrees ), and the mean of the total calcification volume was 154.9 +/- 35.4 mm(3) (range, 92-2680 mm(3)). Balloon rupture occurred in 1 procedure (2.0%) at predilation angioplasty; all 51 CAS procedures were successful without clinical adverse effects. Although there was a correlation between the arc of plaque calcification and residual stenosis (r = 0.6, P < .001), excellent dilation with residual stenosis < or =30% was achieved in all lesions. There was no correlation between the total volume of calcification and residual stenosis. None of the patients developed stroke or death within 30 days of the CAS procedure.

CONCLUSION

CAS by using EPDs to treat lesions with plaque calcification is feasible even in patients with near-total circumferential plaque calcification.

[Pulmonary benign metastasizing leiomyoma from uterine myoma; report of a case]

A 46-year-old female with benign metastasizing leiomyoma was reported. The patient had undergone a lobectomy of thyroid for adenomatous goiter at the age of 30, and a myomectomy for uterine myoma and a modified radical masmectomy for breast cancer at the age of 32. The chest X-ray on health screening revealed multiple nodules in the bilateral lung. Computed tomography (CT) revealed 6 nodules in the right side and 3 nodules in the left side of the lung. The tumors of the right lung were resected under thoracoscopic surgery. Pathologically these lesions were diagnosed as benign metastasizing leiomyoma. Left lung nodules have been followed-up.

A study of dose escalation of teniposide (VM-26) plus cisplatin (CDDP) with recombinant human granulocyte colony-stimulating factor (rhG-CSF) in patients with advanced small cell lung cancer

A dose escalation study of teniposide (VM-26) plus cisplatin (CDDP) was carried out using recombinant human granulocyte colony-stimulating factor (rhG-CSF) in 46 previously untreated patients with advanced small cell lung cancer (SCLC). The dose of CDDP was 80 mg/m2/day intravenously (i.v.) (day 1) and VM-26 was escalated from 60 mg/m2/day to 80, 100 and 120 mg/m2/day i.v. x 5 days for four cycles. The dose of rhG-CSF was 90 micrograms/m2/day subcutaneously for 13 days. The feasibility of the regimen at the starting dose level of VM-26 with or without rhG-CSF was initially examined in 10 patients chosen through random allocation. WHO grade 4 neutropenia was observed in 17% (three out of 18 courses) of patients in the rhG-CSF group and in 63% (12 out of 19 courses) of the control group (P < 0.01). The number of patients with febrile episodes (> 38 degrees C) over the four courses of chemotherapy was 1 in the rhG-CSF group and 4 in the control group. According to these results, all 36 patients received rhG-CSF in the dose escalation stage. The incidence of WHO grade 4 neutropenia at the dose levels of 60, 80, 100 and 120 mg/m2/day of VM-26 was 66, 57, 76 and 85%, respectively (P > 0.1). The incidence of grade 4 thrombocytopenia was 19, 31, 18 and 46%, respectively (P > 0.1). The overall response rate was 100% in patients with limited stage SCLC and 83% in patients with extensive stage SCLC. The actual administered VM-26 dose per week at the dose level of 100 mg/m2/day was 1.6-fold higher than the planned starting dose (60 mg/m2/day) per week. At the dose level of 120 mg/m2/day, 50% of patients developed WHO grade 4 leucopenia, which lasted longer than 1 week and 67% of the patients had WHO grade 3 or 4 diarrhoea. At this same dose, all patients had at least one febrile episode (> 38 degrees C), and 1 patient died of cerebral bleeding with severe thrombocytopenia. The median survival time of all patients was 451 days (411 days, extensive disease; 497 days, limited disease). VM-26 plus CDDP with rhG-CSF was active in previously untreated patients with SCLC. The recommended dose of VM-26 in combination with CDDP for a phase II study is 100 mg/m2/day for 5 days with rhG-CSF support.

Charting of daily weight pattern reinforces maintenance of weight reduction in moderately obese patients

To maintain reduced body weight by behavioral therapy in moderately obese patients, body weight was measured four times daily and charted in a weekly graph. Seventy-two female patients with simple obesity were divided into two groups: 55 patients with appliance of charting of weight pattern (group-I), and 17 patients without the charting (group-II). The percentage of patients followed for 2 years was different between group-I (87%) and group-II (65%) during 2 years after completion of weight reduction therapy interviews (p less than 0.05). Forty-eight of group-I patients succeeded in decreasing their weight by 15.2 +/- 1.5 (mean +/- SEM) kg during the 6.5 +/- 0.8 months of the therapy interviews. They were followed up for 3.8 years with no rebound weight gain. Eleven patients in group-II also succeeded in decreasing their weight by 16.8 +/- 1.9 kg during 7.8 +/- 1.3 months but their body weight rebounded by 9.0 kg during the 2-year followup period. Twelve of 15 male patients with weight charting maintained reduced weight during 4.3 years. It was easier and more effective for obese patients to maintain weight graphs for the longer period than to record no weight graphs. Obese patients could themselves monitor irregular weight patterns produced by overeating and correct the irregularities in food intake and daily lifestyles. This seems to explain why the illustration of daily fluctuations of weight measurements was useful for long-term maintenance of weight reduction.

[A case of mild obesity accompanied by epicardial fat deposition]

A 61-year-old woman with low grade obesity index complained of general fatigue. Cardiomegaly had been present since the age of 45. According to a roentgenogram on admission, her cardia-thoracic ratio was 61%. Pericardial effusion was strongly suspected because of extra echo spaces on both posterior and anterior walls, and unsynchronized echocardiograph waves of epicardium and pericardium. However, values of dynamic CT measured at areas equivalent to the extra echo spaces were -120. On admission, T1-emphasized MRI image showed a high signal density in those areas. After significant weight reduction, the abnormal values and signs of the clinical examinations, as well as the patient's complaints were attenuated or disappeared. Together with these results, cardiomegaly of the patient was diagnosed to be due to excessive fat deposit between the epicardium and cardiac muscle. Dissociation between mildness of obesity index and excessive deposition of fat in the pericardium was discussed from the point of view of body mass index and time course of fat deposition.

Characteristics of psychomotor performance and time cognition in moderately obese patients

To clarify adherence of obese subjects to external food-relevant stimuli, we examined time cognition and psychomotor functioning of the obese under noneating conditions in the present study. Matched on the basis of age, sex, height, intelligence quotient and education, 13 moderately, but adult-onset obese (mean obesity index +/- SEM, 53.9 +/- 5.0% by Matsuki's method) and 13 normal weight subjects (-6.3 +/- 2.3%) were tested. Obese females were slower than normal weight control subjects in alternate tapping of two metal plates (p less than 0.01) and in transfer of a dowel (p less than 0.05). Normal subjects were slightly but significantly (p less than 0.05) more efficient in a self-cued traverse movement test, whereas the obese subjects were very much less efficient in the self-cued than in the externally-cued test. These findings suggest that evaluation of deficits of the obese must consider other factors in addition to simple physical slowness due to fattening. In time cognition tests, cognitive levels of the obese were more accurate when initiated by time cues than when they were self-cued (p less than 0.01). The results indicate that obese (even after adult-onset) may exhibit impairment in internal time cognition when deprived of external modulating time cues.

Attenuation of anorexia induced by heat or surgery during sustained administration of ginsenoside Rg1 into rat third ventricle

Effects of ginsenoside Rg1 (Rg1), a major component of panax ginseng, on modulation of ingestive behavior were investigated. No direct effect was observed on food intake after 10 microliters infusion of 1.0, 2.0, 4.0 or 8.0 mM Rg1 into the rat third ventricle for 10 min. Continuous osmotic infusion of 4.0 mM Rg1 at a rate of 0.966 microliter/h into the third ventricle prevented feeding suppression caused by surgical procedure to implant an osmotic minipump. Continuous infusion of Rg1 attenuated anorexia, increased water intake, and decreased ambulation, that were produced by elevation of environmental temperature from 21 degrees C to 30 degrees C. Consequently, rats maintained body weight and rectal temperature unchanged. The results indicate that sustained central administration of Rg1 may relieve anorexia caused by implantation surgery or by a heated environment.

[Ginsenoside-Rb1 as a suppressor in central modulation of feeding in the rat]

Ginsenosides, the main component of Panax ginseng root, have been reported to show several pharmacological actions on the peripheral metabolism of glucose and lipid and on endocrine secretion. The present study aimed to clarify the effects of ginsenoside-Rb1 on feeding behavior and endogenous chemical substances. Rb1 infusion into the rat third cerebroventricle was started at 1930 hr, and ingestive behavior was recorded in a soundproof room illuminated daily from 0800 to 2000 hr. Rb1 at doses of 0.05, 0.10 and 0.20 mumol potently decreased food intake dose-dependently during the first dark period after infusion. Analysis of meal patterns revealed that the suppressive effect was due to decreasing meal size, but not to postprandial intermeal interval and eating speed. Drinking episodes decreased concomitantly with feeding suppression only at the highest dose of 0.20 mumol. Ambulatory activity was not affected in the doses tested. Infusion of Rb1 increased plasma glucose, leaving insulin unaffected. Microinjection of 0.01 mumol Rb1 into the hypothalamic ventromedial nucleus (VMH) decreased food intake, but injection into the lateral hypothalamic area did not. Taking these data together, Rb1 was found to have a suppressive effect on feeding partly through the VMH.

Role of the glucopyranose ring in the elicitation of feeding

To relate the structural characteristics of the glucose pyranose ring to feeding elicitation, biochemically and structurally similar glucose analogues were investigated to determine if they could elicit short- or long-term effects on food intake in rats. Testing solutions were infused once into unrestrained and unanesthetised rats through a chronically indwelling cannula in the third ventricle. D-Glucose markedly decreased meal size in doses from 6 to 24 mumol, but it's epimers, D-mannose, D-allose and D-galactose, did not affect food intake. Among the glucose analogues modified at C-2, rats treated with 12 mumol D-glucosamine ate a much larger size of meal than those with 12 mumol halogenglucoses or 24 mumol 2-deoxy-D-glucose, while 2-fluoro-2-deoxy-D-glucose with 2-chloro-2-deoxy-D-glucose induced a more potent feeding than 2-deoxyglucose. Glucosamine also induced hyperglycaemia, but did not affect plasma insulin. Activity of glucose, sensitive neurons in the lateral hypothalamus was increased by electro-osmotic application of 2-deoxyglucose or glucosamine, and the reciprocity was observed on neurons of the ventromedial hypothalamus. One-aminoglucose (beta-D-glucopyranosylamine), which is an aminoglucose analogue modified on C-1, increased meal size and more potently prolonged the duration of the meal compared to 1-deoxyglucose (1,5-anhydroglucitol). Together with the behavioural and structural characteristics of glucose analogues, a hydroxyl group on C-1 or C-2 is involved in feeding elicitation. The magnitude of the effect can be partly explained by the chemical concept of 'inductive effect'.

Anorexia induced in rat by D-glucosamine deoxidized at C-1

The effects of D-glucosamine (2-amino-2-deoxy-D-glucose), an endogenous glucose analogue, and 1-deoxy-D-glucosamine on feeding behavior were clarified. Test solutions (24 mumol) were infused into the third cerebroventricle of the rat. Glucosamine induced a feeding episode within 30 min after infusion and then prolonged the ensuing postprandial intermeal interval for the first 4 h of the dark period, while glucose suppressed feeding by decreasing meal size. Ventricular injection of 1-deoxyglucosamine potently suppressed feeding in a dose-related manner by affecting all meal parameters, and oral administration of 2,400 mumol also induced anorexia. Changes in activity of glucose-sensitive neurons in the lateral hypothalamus and glucoreceptor neurons in the ventromedial hypothalamus after electrophoretic application of glucosamine and 1-deoxyglucosamine were compatible with behavior changes. The results indicate that replacement of a hydroxyl group by an amino group at C-2 of the glucose molecule affects feeding behavior and deoxidation of C-1 potently induces anorexia.

D-glucose suppression of eating after intra-third ventricle infusion in rat

To clarify the hypophagic action of D-glucose, meal size, postprandial intermeal interval and eating rate were analyzed after infusion of glucose into the third cerebroventricle. The effects of glucose structure modification on feeding modulation were examined by comparing the effects of glucose to those of its epimers, D-mannose, D-allose and D-galactose. Glucose, infused in doses of 6 to 24 mumol, dose relatedly reduced meal size, but did not change other meal parameters. The minimum dose of glucose to induce feeding suppression was between three and 6 mumol. The epimers, at doses of 24 mumol, did not affect food intake or body weight. Drinking patterns and ambulatory activity were not changed by glucose infusion. These findings were consistent with neuronal activity observed in the ventromedial hypothalamic nucleus.