Phase II trial of preoperative chemoradiotherapy with oxaliplatin, cisplatin, and 5-FU in locally advanced esophageal and gastric cancer

BACKGROUND

Based on a phase I study showing the feasibility of combining of oxaliplatin, cisplatin, and 5-fluorouracil (5-FU) (OCF) with radiation therapy (RT) in esophageal cancer, the efficacy of this regimen in esophageal, gastroesophageal (GE), and gastric (G) cancer was assessed in this phase II multicenter study.

PATIENTS AND METHODS

Patients with resectable tumors were eligible. Treatment included two cycles of oxaliplatin 85 mg/m(2), cisplatin 55 mg/m(2), and continuously infused 5-FU 3 g/m(2) in 96 h and concurrent RT (45 Gy), followed by surgery after 6-8 weeks. Primary end point was complete pathologic response (pCR).

RESULTS

Forty-one patients were enrolled. Tumor location was esophagus 39% (squamous 10/adenocarcinoma 6), GE junction 32%, and stomach 29%. G3-G4 adverse events included asthenia (27%) and neutropenia (14%). One toxic death occurred. Thirty-one patients (75.6%) underwent surgery (R0 in 94%). Pathologic response was achieved in 58% of patients, with pCR in 50% and 16% of esophageal and GE/G cancer, respectively. pCR was achieved in 67% of squamous cell carcinoma. Survival: median follow-up, 50.4 months; median progression-free survival and overall survival were 23.2 and 28.4 months, respectively.

CONCLUSION

Preoperative OCF plus RT showed an acceptable toxicity and promising activity especially in squamous cell esophageal cancer.

Usefulness of PET/CT in the diagnosis of distant metastases of potentially operable gastric adenocarcinoma

e15598

Background: 1) To evaluate the usefulness of Positron Emission Tomography with combined 18F-Fluorodeoxyglucose with Computed Tomography (PET/CT) in the diagnosis of distant metastases in patients with gastric adenocarcinoma (GAC) compared to spiral double contrast thoracoabdominal Computed Tomography (CT); 2) To establish the utility of PET/CT in the detection of peritoneal carcinomatosis compared to laparoscopy. Methods: Thirty prospective patients (22 men, 8 women; mean age 67±11) who underwent endoscopic ultrasound and were classified as T2–3N1 or T3Nx GAC were included in this study. Whole body images were obtained 1 hour after injection of 370 MBq of 18F-Fluorodeoxyglucose. CT was performed within 2 weeks of PET/CT. Laparoscopy was performed without remarkable incidences. All findings were confirmed by histopathology examination and/or by at least 6 months follow- up. Results: Distant metastases were found in 9/30 cases: carcinomatosis (3), retroperitoneal (3) or mediastinal (2) pathological lymph nodes and one case of bone metastases (1). PET/CT diagnosed unsuspected distant metastases by CT in 4/9 patients (retroperitoneal (1) or mediastinal (2) pathological lymph nodes and 1 case of bone metastasis in the spine). In 1/3 patients with histopathological confirmed diagnosis of peritoneal carcinomatosis by laparoscopic findings was negative by PET/CT, and considered as a false negative case. On the other hand, 3 patients with initially positive peritoneal carcinomatosis by invasive laparoscopy were finally diagnosed as benign lesions. These lesions did not show significant uptake in PET/CT and were considered as true negative cases. Conclusions: 1) PET/CT is useful in the diagnosis of distant metastases in patients with GAC 2) Further studies are needed to establish the role of PET/CT to detect peritoneal carcinomatosis.

No significant financial relationships to disclose.

Phase II study with preoperative oxaliplatin (O), cisplatin (P), 5-fluorouracil (F) (OPF) and radiation (XRT) in patients with esophageal (ES), gastroesophageal (GE), and gastric (G) cancer

e15612

Background: A phase I study showed the feasibility of the triplet combination (OPF) with XRT in ES and GE cancer (Maurel et al, IJRBOP, 2005). We conducted a phase II study to evaluate the efficacy of the regimen. Methods: Enrolled pts had resectable, high-risk (HR) based on endoscopic ultrasonography (EUS) (uT3, uN1 or uT4 if deemed resectable) ES, GE and G cancer. The primary objective was to determine the pathologic complete response (pCR). If 2 or more pCR were reported in the first 18 pts treated, enrollment continues with 23 additional pts. Eligibility criteria: squamous cell or adenocarcinoma of the ES, GE or G cancer and ECOG Performance status (PS) 0–1. Staging was done with EUS and computed spiral tomography. Laparoscopic staging was mandatory for pts with ES, GE and G adenocarcinoma. Pts received 2 cycles of O 85 mg/m2, P 55 mg/m2, F (3 g/m2 in 96h CI) q4w, with concomitant 45 Gy XRT in 25 fractions; surgery was planned 5–8 weeks after XRT. All pathological specimens were reviewed by a unique pathologist and regression analysis was recorded using Cologne (C) and M.D.Anderson (MDA) classification for ES and European Journal of Surgical Oncology (EJSO) for GE and G. Results: Between 5/04 to 12/07, 41 pts were enrolled in 5 Spanish Institutions. Median age 62 yrs (39–75 yrs); Male/female 83%/17%; PS 0/1 27%/73%; ES/GE/G 39%/32%/29%; EUS stageT3N0 (20%), T2–3N1 (65%) and T4 (10%). G3/4 adverse events included asthenia (27%), infection (7%), diarrhea (7%) and stomatitis (5%). There were 2 toxic deaths. Of the 31 pts who underwent surgery, there were R0=94%/R1=3%/R2= 3%. 7/41 pts (17%) achieved pCR. Using C and MDA classification, 9/14 (61%) and 12/14 (85%) ES achieved grade IV/III and P0/P1 regression, respectively. With EJSO classification 3/17 (18%) GE and G tumors achieved pCR. Median time to progression or death (PFS) was 16.2 (CI:12.2-NR) months (mo). Median overall survival (OS) was 28.9 mo. (CI: 22.5-NR). Conclusions: Although in the whole group pCR, PFS and OS does not appear superior to results achieved in other trials with preoperative P/F/XRT in HR pts, the OPF regimen seems specially active in ES cancer.

No significant financial relationships to disclose.

Prognostic value of tyrosinase reverse transcriptase PCR analysis in melanoma sentinel lymph nodes: long-term follow-up analysis

OBJECTIVE

To determine the prognostic value of detecting tyrosinase transcripts in melanoma sentinel lymph nodes (SLNs).

METHODS

Reverse transcription (RT) PCR for tyrosinase mRNA was performed on negative SLNs of 76 patients with melanoma.

RESULTS

Tyrosinase mRNA was found in 39 patients (51.3%). After a median follow-up period of 51 months, significant differences were found in overall survival (OS) but not in disease-free survival (DFS). The 5-year OS and DFS rates were 97.2% and 80%, respectively, for RT-PCR tyrosinase-negative (TN) patients vs. 78.67% and 66.24% for RT-PCR tyrosinase-positive (TP) patients (P = 0.019 and P = 0.38, respectively). Of four progressing patients in the TN group, three relapsed with subcutaneous, soft-tissue or lymph-node metastases, while seven out of nine progressing patients in the TP group relapsed at visceral sites.

CONCLUSIONS

No significant differences in DFS were found by RT-PCR tyrosinase expression analysis at melanoma SLNs. Significant differences in OS could be related to a different pattern of relapse and must be confirmed after a longer follow-up time.

Pathological femur fracture secondary to radiation therapy for soft tissue sarcoma

Bone fracture is a well known possible late complication of radiation treatment. Little has been written about fractures of long bones after irradiation. We present a case of femur bone necrosis secondary to postoperative radiation for a soft tissue sarcoma of the thigh 20 years earlier. Fixation of the diaphyseal fracture and radiological evolution are described.

Phase I trial of neoadjuvant chemoradiotherapy with capecitabine and weekly irinotecan followed by laparoscopic mesorectal excision

14556

Background: To establish the feasibility and efficacy of capecitabine with weekly irinotecan (CAPIRI) and concurrent radiotherapy (RT) in patients with locally advanced and resectable metastatic rectal cancer, followed by LAME. Methods: Eligible criteria included adenocarcinoma of the rectum staged by endoscopic ultrasonography (us), spiral abdominal and pelvic CT and chest X-ray. Patients received weekly irinotecan 50 mg/m2 (days 1,8,15,22,29) and two doses of capecitabine (days 1 through 5 for 5 weeks); dose level; (DL) I 250 mg/m2 bid; DL II 375 mg/m2 bid; DL III 500 mg/m2 bid, according to phase I methodology. Conformal radiotherapy was administered up to a total dose of 45 Gy/1.8 Gy per fraction. LAME was planned 5–7 weeks after CRT. Results: From January 2003 to March 2006, 22 patients (three with potentially resectable metastatic disease) were included. Median age was 62 (range 48 to 78). 6 pts were usT3N0 and 16 pts usT3–4N1. Seven patients were treated at DL I, six at DL II and nine at DL III. Grade 3 or 4 adverse events were observed in all levels; DL I asthenia (1p); DL II diarrhea (2p) and DL III asthenia and neutropenia (1p), diarrhea (1p) and hyperbilirrubinaemia (1p). All patients except one who refused treatment after 1 week therapy (DL I), completed CRT and underwent surgical resection (R0 81%, R2 19%). Abdominoperineal resection was done in two cases (9%). Conversion rate to open surgery was 5%. Median hospital stay was 7.9 days. The overall postoperative morbidity was 4.7%. Median excised nodes were 11 (range 4–21). Pathological complete response was observed in two patients (9%), both of them in DL III. With a median follow-up of 25 months (range 9–46), disease free survival and overall survival was 67% and 95% respectively. Conclusions: Preoperative CRT with CAPIRI is feasible, but severe adverse events were found in all levels despite the use of lower dose of capecitabine than previously published. LAME after CAPIRI had short oncologic outcomes comparable with open mesorectal excision.

No significant financial relationships to disclose.

Clinical outcome in patients with intramedullary spinal cord metastases from lung cancer

Intramedullary spinal cord metastases (ISCM) are uncommon and present with rapidly progressing neurological deficits. The objective of this study was to determine the rate, duration of neurological response and survival after radiation therapy. We have retrospectively reviewed the clinical outcome of six cases with a diagnosis of ISCM from primary lung cancer, non-small cell (NSCLC) (n=3) and small cell (SCLC) (n=3). Total radiation dose ranged from 27 Gy/5 fr to 40 Gy/20 fr. Ambulation was preserved in 3 patients and partially recovered in one. Five out of the six patients (83%) showed improvement in neurological signs/symptoms with a mean duration of 17.2 days (max: 40 days; min: 6 days). Median survival time was 5 months (confidence interval (CI) 95%: 0-12) for NSCLC and 5 months (CI 95%: 4-6) for SCLC. Although radiation response rate is high, the interval free of neurological progression is very short. A therapeutic approach should be considered for each individual.

Low dose rate brachytherapy in lip carcinoma

BACKGROUND

Lip cancer is frequently treated with surgery although radiation therapy offers comparable results. The aim of the study was to evaluate the local cure rate in patients with lip carcinoma treated with 192-Ir low dose rate interstitial brachytherapy.

METHODS

Fifty-four patients with a mean age of 70 years (range, 40-90 years) were retrospectively evaluated. The tumour location was the superior lip in 4 (7.4%) and the inferior lip in 50 (92.6%). Tumour stage was T1N0 in 33 patients and T2N0 in 21 patients. The radioactive sources with hypodermic needles in 49 patients (90.7%) and plastic tubes in 5 (9.3%) were placed parallel and equidistant from one another across the tumour volume according to the Paris system rules.

RESULTS

The median dose was 61.5 Gy (range, 60-65 Gy). All patients experienced acute brisk skin and mucositis RTOG grade III around the implanted volume, subsiding within 4-6 weeks after the implant. Local control was achieved in 98% of patients. The mean follow-up was 7 years.

CONCLUSIONS

Low dose rate interstitial brachytherapy with 192-Iridium is a well established and efficacious way to achieve local control of the tumour in lip cancer. It offers the advantage of avoiding surgery in an elderly population.

Melanoma inhibiting activity protein (MIA), beta-2 microglobulin and lactate dehydrogenase (LDH) in metastatic melanoma

BACKGROUND

Serum levels of melanoma markers may have a role in monitoring disease evolution in metastatic melanoma.

PATIENTS AND METHODS

Serial measurements of melanoma inhibiting activity protein (MIA), lactate dehydrogenase (LDH), S-100 and beta2-microglubulin were obtained from 42 metastatic melanoma patients during their biochemotherapy treatment.

RESULTS

High pre-treatment serum levels of S-100, LDH, MIA and P2-microglobulin were detected in 50%, 57%, 50% and 24% of the patients, respectively. Only S-100 had prognostic significance for both disease-free (p=0.011) and overall survival (p=0.021). In patients who responded to treatment, S-100 levels decreased significantly from pre-treatment to the time of response (p = 0.050). When patients progressed, levels of MIA and P2-microglobulin increased significantly (p =0.028 and p =0.030, respectively).

CONCLUSION

Correlation with disease evolution was found for S-100, MIA and P2-microglobulin levels. Despite the small sample size of the study, S-100 was a significant prognostic marker for overall survival and disease-free survival.

Phase I trial of gefitinib with concurrent radiotherapy and fixed dose-rate gemcitabine infusion, in locally advanced pancreatic cancer

4105

Background: Pancreatic cancers are resistant to radiotherapy (RT) and current chemotherapy agents. Epidermal growth factor receptor (EGFR) is over-expressed in pancreatic cancer and in vitro studies have shown that EGFR inhibitors can overcome radio- and chemo-resistance. The aim of the study was to determine the maximally tolerated dose of gefitinib, in combination with RT and gemcitabine for patients with locally advanced pancreatic carcinoma (LAPC). Methods: Eighteen patients with pathological proven LAPC, due to major vascular invasion based on helical computed tomography and endoscopic ultrasound, were entered. The targeted irradiated volume included the tumor and 2 cm-margin. Prophylactic irradiation of regional nodes was not allowed. Patients with >500 cc of planned tumor volume (PTV) were excluded. An initial cohort of 6 patients was treated with RT (45 Gy/25 fractions/5 weeks) plus concomitant gefitinib (250 mg/day). Successive cohorts of patients received 100, 150 and 200 mg/m2/day of gemcitabine in a 2 hour infusion over weeks 1,2,3,4, and 5 with gefitinib (250 mg/day) and RT. Gefitinib was continued after RT until progression. A pharmacodynamic study of angiogenic markers (VEGF and IL-8) was also performed. Results: Mean PTV was 293cc (range 137–462 cc). There were no dose-limiting toxicities on study. Common toxicities were mild neutropenia, asthenia, diarrhea, cutaneous rash and nausea/vomiting. One patient showed a partial response of 13 months in duration, and 7 patients showed disease stabilization. Median progression free survival (PFS) was 3.7 months and median overall survival (OS) was 7.5 months. No patients have a reduction in VEGF levels >50%. Reduction in VEGF serum levels >25% and IL-8 levels >50% had no impact on PFS and OS. Conclusion: Our results support thatthe combination of gefitinib, RT and gemcitabine showed an acceptable toxicity but with modest activity in LAPC.

[Table: see text]

[Radiation therapy in simultaneous choroidal and brain metastases]

Choroidal metastases from lung cancer can be the initial clinical manifestation of metastasic disease, although they generally coexist with at least two more metastasic sites. The most common symptom is decreased vision, however 20% of brain metastases can present with visual alterations. A differential diagnosis within brain metastases and/or choroidal is necessary. We present the case of a patient with lung cancer and decreased vision who was diagnosed as simultaneous choroidal and brain metastases. Radiation therapy (20Gy/5fractions) significantly improves decreased vision. This case shows that, although life expectancy of patients with metastasic lung cancer is short, an adequate diagnosis and treatment, can improve the quality of life of those patients.

Use of ear tags and injectable transponders for the identification and traceability of pigs from birth to the end of the slaughter line1,2

A total of 557 newborn piglets were used to compare eight identification devices, including one plastic ear tag as a control (C, n = 348) and two types of electronic ear tags (E1, n = 106; and E2, n = 103), and five types of injectable transponders (n = 557): small 12-mm (D12, n = 116; and S12, n = 110), medium 23-mm (T23, n = 108), and large (32-mm, T32, n = 115; and 34-mm, S34, n = 108). Injections were made s.c. in the auricle base (n = 248) and intraperitoneally (n = 309) using a new technique. All piglets were identified with two devices, but using electronic ear tags in conjunction with injection in the auricle was avoided on the same pig. Readability of devices was checked during fattening (until 110 kg BW) and slaughtering. On-farm losses were lower for control than for electronic ear tags (C = 1.1%; E1 = 8.8%; and E2 = 44.9%; P < 0.01); the latter also suffered electronic failures (E1 = 5.5%; and E2 = 55.1%; P < 0.001). On-farm losses of transponders injected in the auricle base were greater in large (S34 = 72.5%; and T32 = 46.3%; P < 0.05) than in small transponders (S12 = 19.4%; and D12 = 17.1%), but T23 (29.8%) only differed from S34. Transponder size did not affect on-farm losses for intraperitoneal injections in which only one loss was recorded (0.4%). All ear tags had similar losses during transportation to the slaughterhouse (1.2%), but no losses were observed in injectables. Slaughtering losses did not differ between ear tags (C = 11.2%; and E1 = 6.4%), but apart from losses, 12.8% of E1 failed electronically. Injection site affected losses and breakages during slaughtering (auricle base = 6.4%; and intraperitoneal = 0%), but recovery time did not significantly differ (auricle base = 28.6 s; and intraperitoneal = 18.9 s). Transponders in the auricle base were recovered by sight (30.2%), palpation (27.4%), or by cutting (42.5%). Intraperitoneal transponders were mainly recovered loose in the abdominal cavity (81.4%), whereas 18.6% fell on the floor. As a result, traceability varied significantly (P < 0.05) between control (86.7%) and electronic ear tags (0 to 68.1%) and injectable transponders, with the auricle base (17.8 to 75.0%) having lower values than intraperitoneal (98 to 100%). Intraperitoneal injection was a very effective tool for piglet identification and traceability, ensuring the transfer of information from farm to slaughterhouse. To warrant the use of this technique in practice, transponder recovery requires further investigation.

Serum Protein S-100 Predicts Clinical Outcome in Patients with Melanoma Treated with Adjuvant Interferon – Comparison with Tyrosinase RT-PCR

OBJECTIVE

To study the clinical value of the determination of serum S-100 protein as a single tumor marker or in combination with tyrosinase RT-PCR in patients with melanoma receiving adjuvant interferon.

PATIENTS AND METHODS

Patients were tested for serum S-100 protein luminoimmunometric assay and for blood tyrosinase mRNA (RT-PCR), before starting interferon and every 2-3 months thereafter.

RESULTS

One hundred and six patients (stage IIA, 27; IIB, 19; III, 49; and IV, 11) were included in the study. Median follow-up was 51 months (range 2-76). In the univariate analysis, under treatment S-100 > or =0.15 microg/l and a positive RT-PCR correlated with a lower disease-free survival and overall survival (OS). In the multivariate analysis, clinical stage, under therapy positive RT-PCR and S-100 levels > or =0.15 mug/ml, were independent prognostic factors for OS. The hazard ratio for OS was 3.9 (95% CI, 1.67-9.15; p = 0.004) and 2.2 (95% CI, 1.05-4.6; p = 0.016) for S-100 > or =0.15 microg/l and positive RT-PCR, respectively. When both techniques where combined, a positive RT-PCR indicated a poorer clinical outcome only in patients with S-100 <0.15 microg/l.

CONCLUSIONS

S-100 > or =0.15 microg/l and a positive RT-PCR during adjuvant interferon therapy indicate a high risk of death in resected melanoma patients. S-100 determination has a higher positive predictive value than RT-PCR, while tyrosinase RT-PCR adds prognostic information in patients with S-100 <0.15 microg/l.

Angiolymphoid hyperplasia with eosinophilia of the nail bed and bone: successful treatment with radiation therapy

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare entity characterized by the presence of one or several papules or nodules in the skin. Histopathology of ALHE shows a marked proliferation of blood vessels with distinctive large endothelial cells and variable inflammatory infiltrates with eosinophils. We report a 32-year-old Caucasian woman with multiple nodules involving the skin, subcutaneous tissue and bone of the distal phalanx of the fingers that were treated successfully with orthovoltage radiation therapy (40 Gy/20 fractions) and without any side-effects after 9 years of follow-up.

Radiotherapy for in situ extramammary Paget disease of the vulva

BACKGROUND

Radiotherapy as a first-choice treatment for in situ extramammary Paget disease has been successfully used.

OBJECTIVES

To review the most relevant aspects of radiotherapy as first-choice treatment in selected cases of in situ extramammary Paget disease of the vulva.

PATIENTS AND METHODS

Two Caucasian females aged 76 and 92 years with in situ extramammary Paget disease localized in the genital region were treated by means of ortovoltage X-rays: 100 kV, 8 mA, 1.7 mm Al filter, field size of 12-cm cone, and source skin distance of 30 cm. Both patients received 40 Gy, 200 cGy per fraction, five fractions per week.

RESULTS

Complete regression of in situ extramammary Paget disease was observed in both patients after radical radiation therapy and neither local recurrences nor internal malignancies were detected.

CONCLUSIONS

Radiotherapy is a curative treatment in selected cases of in situ extramammary Paget disease affecting the vulva.

[Evaluation of the efficacy and efficiency of a multidisciplinary unit for the treatment of patients with colorectal cancer]

INTRODUCTION

Because of the increased complexity of the diagnostic-therapeutic approach to colorectal cancer (CRC), these patients should be managed in specialized multidisciplinary units. The aim of this study was to evaluate the efficacy and efficiency of a CRC unit (CRCU) in the diagnostic-therapeutic management of these patients.

PATIENTS AND METHODS

Two groups of 50 patients with colon cancer treated in our center before and after the implementation of the CRCU were selected. Fulfillment with the protocol in terms of tumoral staging, surgical and adjuvant treatment, follow-up, interval until treatment, hospital stay, morbidity and early mortality, and the overall duration of the diagnostic-therapeutic process was analyzed. In addition, clinical workload was evaluated and a cost-minimization analysis was performed.

RESULTS

The CRCU reduced the interval until surgery (20.3 12.0 vs 28.0 20.4 days; p = 0.05), hospital stay (9.8 7.7 vs 14.5 9.3 days: p = 0.01), the time to the start of adjuvant treatment (29.4 10.2 vs 39.7 19.8 days; p = 0.03) and the overall duration of the process (60.4 23,8 vs 82.1 46.1 days; p = 0.05), representing a saving of 978.85 E per patient. This improvement took place despite an increase in clinical workload (24% in 5 years in relation to the number of admissions) and had no effect on morbidity (26 vs 24%; NS) or immediate mortality (6 vs 4%; NS).

CONCLUSION

Specialized multidisciplinary units increase the efficacy and efficiency of the management of patients with CRC.

The use of passive injectable transponders in fattening lambs from birth to slaughter: effects of injection position, age, and breed

A total of 1,159 Tiris half-duplex passive injectable transponders (PIT) of 32-mm length were used to study the electronic identification of 618 fattening lambs of two breeds used for different production purposes (Ripollesa, meat breed, n = 271, and Manchega, dairy breed, n = 347). The lambs were s.c. injected in the armpit and the retro-auricular positions at 2, 15, and 30 d of age. All lambs were also tagged with a small plastic ear tag after birth. A group of 76 lambs were injected only in the right armpit and were kept for breeding. The PIT losses, breakages, and electronic failures were evaluated at weekly weight recordings throughout the fattening period using two types of hand-held transceivers. Fattened lambs were harvested in a commercial abattoir between 3 and 4 mo of age when they reached market weight (11 to 12 kg hot carcass weight). The total number of PIT that fell or broke in the slaughtering line, the location method, and the recovery time were recorded. On the farm PIT losses were not affected (P > 0.05) by age at injection, injection position, or breed. Mean losses of PIT and ear tags during the same period were 5% and 6.3%, respectively (P > 0.05). No PIT breakages or failures were observed during the fattening period. Mean recovery of PIT in the abattoir (85.6%) was affected (P < 0.05) by breed and injection position. Losses of PIT in the abattoir were greater (P < 0.05) in the Ripollesa breed (18.4%) than in Manchega (10.0%), and for both breeds losses were greater (P < 0.05) in the retro-auricular than in the armpit positions (18.6 vs 10.8%, respectively). The percentage of PIT broken during slaughtering was low (0.3%). The mean recovery times (18 +/- 2 s) were not affected (P > 0.05) by breed, injection position, or age, thus allowing a harvesting speed of 200 lambs/h on average. In conclusion, the injection of 32-mm PIT into the armpit or the retro-auricular region is not recommended as a practice for the electronic identification of fattening lambs, even though they perform similarly to small plastic ear tags. This is partly a consequence of the PIT losses observed on the farm but mainly because of the difficulties with recovering the PIT in the abattoir. More research will determine whether the use of smaller transponders or injection in other positions could improve their performance in fattening lambs.

Radiotherapy for genital extramammary Paget's disease in situ

BACKGROUND

Radiotherapy as a first-choice treatment for extramammary Paget's (EMP) disease in situ has been seldom used.

OBJECTIVE

To review the most relevant aspects of radiotherapy as first-choice treatment in selected cases of anogenital EMP disease in situ.

METHODS

Two men with an age range of 71-79 years (mean age 75 +/- 5.6 years) with EMP disease in situ localized in the genital region were treated by means of X-rays of 100 kV, 440 cGy/day, 3 days a week over 3 weeks until a total dose of 3960 cGy was completed.

RESULTS

Complete regression of EMP disease in situ was observed in both patients after radical radiation therapy and neither local recurrences nor internal malignancies have been documented.

CONCLUSION

Radiotherapy is a curative treatment in selected cases of EMP disease in situ affecting large areas of the anogenital region.

Role of P-selectin in radiation-induced intestinal inflammatory damage

The aims of our study were to characterize the dose- and time-dependent changes in endothelial P-selectin expression and the role of this adhesion molecule as a mediator of radiation-induced inflammation. For that purpose, endothelial P-selectin expression was measured by the radiolabeled antibody technique in control and irradiated mice at 2, 6, and 24 hr following abdominal irradiation with 4 or 10 Gy; leukocyte endothelial cell interactions were assessed using intravital microscopy in intestinal venules following irradiation at the aforementioned doses and times in C57BL/6 and P-selectin-deficient mice. In wild-type mice, radiation induced a time- and dose-dependent up-regulation of P-selectin and a significant increase in the flux of rolling leukocytes 2 hr after irradiation. Irradiation induced a significant increase in leukocyte adhesion that was dose-dependent. Following irradiation, P-selectin-deficient mice did not show any increase in leukocyte rolling but did demonstrate a response in leukocyte adhesion similar to that of the wild-type mice. Radiation-induced dose-dependent histological inflammatory damage that did not differ between P-selectin-deficient and wild-type mice. We conclude that P-selectin is up-regulated following irradiation and is a key molecular determinant of leukocyte rolling but not leukocyte adhesion in this inflammatory condition. Therefore, isolated neutralization of this adhesion molecule is not an effective means for preventing radiation-induced inflammation.

[Influence of highly active antiretroviral therapy on the evolution of AIDS-associated Kaposi's sarcoma]

BACKGROUND

To evaluate the highly active antiretroviral therapy (HAART) in the Kaposi's sarcoma evolution.

PATIENTS AND METHOD

Retrospective analysis of a cohort of 126 HIV infected patients suffering from Kaposi's sarcoma with or without HAART. Clinical evolution, immunological status (CD4+ cell count) and response to therapy (HIV-RNA plasma viral load and human herpes-8 virus determination).

RESULTS

All patients without HAART died and the cumulate probability survival (SD) among those who received HAART was 2.078 (74) days. The CD4+ count at baseline in the HAART group was 130 (125) * 106/l and the HIV-RNA viral load was 196,818 (244,195) copies/ml while at the moment of the clinical response was 235 (209) * 106/l CD4 + and 2,629 (6.444) copies/ml, respectively.

CONCLUSION

HAART prolongs survival in HIV patients suffering from Kaposi's sarcoma. There is a clear relationship among clinical response, HAART and immunological recovery.

Effects of injection position and transponder size on the performances of passive injectable transponders used for the electronic identification of cattle

A total of 686 Tiris half-duplex passive injectable transponders (PIT) of two sizes (23 and 32 mm) were randomly injected s.c. in three positions, armpit, ear scutulum, and upper lip, in 343 fattening calves (1 to 3 mo old). Injections were performed by two trained and two untrained operators. Losses and breakages on the farm were recorded at wk 1, 3, 7, 11, and 15 in restrained animals using two types of hand-held transceivers with a stick antenna. Dynamic reading efficiency (DRE) in animals running through a raceway was also evaluated at wk 1 and 3 and monthly until slaughter, using a stationary transceiver working at 137 dB x microV x m(-1) at 3 m. The total number of PIT that fell or broke in the slaughtering line, the location method, and the recovery time were also recorded. Results on the farm showed low breakages on average (0.4%) and differences (P < 0.05) in losses according to position (armpit, 1.7%; ear, 5.2%; and lip, 14.0%). An interaction (P < 0.05) between position x size was observed, and losses were greatest using a 32-mm PIT in the lip. The DRE was affected (P < 0.05) by PIT position and size, and values were greater for the 32-mm PIT in all positions (armpit: 99.9 +/- 0.1 vs 95.8 +/- 4.9%; ear: 93.8 +/- 2.2 vs 81.9 +/- 4.6%; lip: 66.8 +/- 4.9 vs 53.4 +/- 4.7%, respectively, for 32 vs 23 mm). Recovery of PIT in the abattoir was on average 96.7, 96.7, and 99.2% for armpit, ear, and lip, respectively (P > 0.05). Most of the PIT injected in the armpit were recovered by sight or palpation, but 31.9% were recovered after cutting the muscles around the area and 10.7% were recovered on the internal side of the hide, which jeopardized carcass identification. Recovery of PIT injected in the ear was 23.4% in the hide and 76.6% in the auricular muscles of the head. The easiest recovery was in the lip, 8.9% of PIT were located in the hide and 91.1% in the head. Recovery time was affected (P < 0.05) by position: the quickest was lip (27 +/- 2 s), followed by ear (52 +/- 5 s) and armpit (78 +/- 7 s). In conclusion, taking into account retention and reading performances, injection of a 32-mm PIT into the armpit showed the best results on the farm, but a careful and longer recovery was needed in the abattoir. Improvement of recovery methodology and time would be necessary in order to recommend injection of PIT in the armpit instead of in the ear for cattle tracking or monitoring.

Usefulness of strontium-89 for bone pain palliation in metastatic breast cancer patients

Most studies of prostate cancer have shown that strontium-89 chloride (89Sr) is effective in the palliation of metastatic bone pain, refractory to conventional analgesia. The aim of this study was to evaluate the usefulness of 89Sr for bone pain palliation in breast cancer patients. Forty women were treated with 148 MBq of 89Sr. Six patients were retreated, receiving two or more doses. The Karnofsky performance status was assessed and pain and analgesia were scored on scales of 9 and 5 points, respectively. The efficacy of 89Sr was evaluated at 3 months of treatment. The response was good in 60% of the patients and partial in 32%; there was no response in the remaining 8% (pre-treatment Karnofsky < or = 60). The duration of the response was 120+/-143 days. In the patients retreated, the response was good in 83% and partial in 17%, without significant differences compared with the first dose, but the pre-treatment Karnofsky and the duration of the efficacy were lower (P < 0.05). A transient and slight decrease of leukocyte and platelet counts after the first month of treatment with 59Sr was observed. In conclusion, breast cancer patients with metastatic bone pain can benefit from therapy with 89Sr. If necessary, the treatment may be repeated safely and with the same efficacy as is achieved after the first dose. A low functional performance status could be a cause of the lower effectiveness of 89Sr.

Tepoxalin inhibits inflammation and microvascular dysfunction induced by abdominal irradiation in rats

BACKGROUND

Inflammatory cells contribute to the acute and sub-acute sequelae of radiation therapy. Tepoxalin, an inhibitor of cyclooxygenase and 5-lipoxygenase that suppresses NF-kappaB activation, has potent anti-inflammatory activity.

AIMS

To assess the effects of tepoxalin on radiation-induced inflammatory damage, and determine its mechanisms of action.

METHODS

Leucocyte rolling, adhesion and emigration, and albumin leakage were determined by intra-vital microscopy in rat mesenteric venules. NF-kappaB activation was measured by electrophoretic mobility shift assays, and endothelial intercellular adhesion molecule-1 expression by the radiolabelled antibody technique. Groups of irradiated rats were treated with tepoxalin, N-acetyl-L-cysteine, zileuton (lipoxygenase inhibitor), or vehicle.

RESULTS

Irradiated animals had a marked increase in the number of rolling, adherent and emigrated leucocytes in mesenteric venules, and in microvascular permeability. Tepoxalin prevented leucocyte adhesion and the increase in permeability after radiation. Tepoxalin did not inhibit radiation-induced NF-kappaB activation or intercellular adhesion molecule-1 up-regulation, while N-acetyl-L-cysteine, which attenuated NF-kappaB activation, had no effect on leucocyte recruitment. In contrast, tepoxalin inhibited the increase in leukotriene B4 levels after radiation, and the anti-inflammatory effects of the drug were mimicked by zileuton.

CONCLUSIONS

Tepoxalin affords significant protection against radiation-induced inflammation and microvascular dysfunction in splanchnic organs through a mechanism dependent on leukotriene synthesis inhibition.

Influence of dose-rate on inflammatory damage and adhesion molecule expression after abdominal radiation in the rat

PURPOSE

The goal of this study was to assess the effects of two clinically relevant radiation dose-rates on endothelial adhesion molecule expression, inflammatory response, and microvascular dysfunction.

METHODS AND MATERIALS

Rats were irradiated with 10 Gy at low (0.9 Gy/min) or high (3 Gy/min) dose-rates. Control animals received sham irradiation. Leukocyte rolling, adhesion, emigration, and microvascular permeability were assessed in mesenteric venules by intravital microscopy 6 hours after irradiation. P-selectin and intercellular adhesion molecule-1 (ICAM-1) expression were measured using radiolabeled monoclonal antibodies.

RESULTS

Low dose-rate (LDR) abdominal irradiation increased leukocyte adhesion compared with sham-irradiated animals, whereas high dose-rate (HDR) irradiation resulted in enhanced leukocyte rolling, adhesion, and emigration, compared with the LDR or with sham-irradiated rats. Both dose-rates increased microvascular permeability, although this effect was significantly greater after radiation with the high (8-fold) than the low (5-fold) dose-rate. HDR radiation induced significantly larger increments in P-selectin expression in splanchnic organs than LDR, whereas in most organs ICAM-1 expression was only upregulated by the HDR. Blockade of ICAM-1, but not P-selectin, abrogated leukocyte adhesion at both dose-rates.

CONCLUSIONS

The magnitude of upregulation of endothelial adhesion molecules, leukocyte recruitment, and endothelial barrier dysfunction elicited by radiation therapy is dependent on the dose-rate at which the radiation is delivered.

Systemic xanthohistiocytoma: a variant of xanthoma disseminatum?

We present a 66-year-old man who had maculopapular pigmented lesions on the skin of the head, neck and trunk suggesting generalized eruptive histiocytoma (GEH). These lesions had a yellowish centre in a target-like pattern that has not been previously described. The patient suffered from diplopia and had a severe sensorimotor polyneuropathy causing progressive paresis of the limbs. The explorations performed disclosed the presence of specific xanthomatous infiltrates in the skin, lungs, respiratory tract, peripheral nerves and meninges, suggesting xanthoma disseminatum (XD) or juvenile xanthogranuloma. Multiple osteolytic lesions of large bones were also found. The infiltrate was CD68, MAC 387 and factor XIIIa positive and S-100 and CD1 negative. Some cells contained worm-like bodies visible by electron microscopy. Our patient presented clinical and immunohistochemical findings suggestive of GEH, juvenile xanthogranuloma or XD, supporting the idea of a wide spectrum of non-Langerhans cell histiocytosis. These specific target-like xanthomatous lesions seem to be unique for this new variant of XD.

Symptom prevalence in the last week of life

Palliative care is the management of patients with progressive, far-advanced disease for whom the prognosis is limited and the focus of care is quality of life. During the last days of life, it is important to redefine the goals, as previously present symptoms may increase and new symptoms may appear. To assess these symptoms, 176 patients were evaluated. A questionnaire evaluated symptoms during the last week of life and compared these prevalences with those at the first evaluation. The patients comprised 121 men and 55 women. The mean age was 67.7 years. Metastases were present in 66.5% and were multiple in 52%. The most frequent symptoms at the end of life (> 50%) were anorexia, asthenia, dry mouth, confusion, and constipation. The majority of patients died at home (64.2%). We observed good control of "reversible" symptoms, but many symptoms were difficult to control at the end of life. Symptom assessment is important in this population.

Strontium-89 for palliation of pain from bone metastases in patients with prostate and breast cancer

We have used strontium-89 chloride (89Sr) for the palliative treatment of metastatic bone pain. Seventy-six patients (50 males with prostate carcinoma and 26 females with breast cancer) were treated with 148 MBq of 89Sr. Sixteen patients were retreated, receiving two or three doses; the total number of injected doses was consequently 95. The Karnofsky performance status was assessed and pain and analgesia were scored on scales of 9 and 5 points, respectively. The efficacy of 89Sr was evaluated at 3 months of treatment. Three levels of response were considered: good - when there was an increase in the Karnofsky status and a decrease in the pain score (equal to or higher than 4) or analgesic score (equal to or higher than 1); partial - when there was an increase in the Karnofsky status and a decrease in the pain score (2 or 3 points) without significant changes in the analgesic score; no response - if no variation or deterioration in these parameters was observed. In prostate cancer patients, the response was good in 64% of cases and partial in 25%, and there was no response in the remaining 11%. In breast cancer patients, the response was good in 62% of cases and partial in 31%, and there was no response in the remaining 8%. Duration of the response ranged from 3 to 12 months (mean 6 months). In the patients who were retreated the effectiveness was as good as after the first dose of 89Sr. A decrease in the initial leucocyte and platelet counts was observed after the 1st month of treatment, with a gradual partial to complete recovery within 6 months. It is concluded that 89Sr is an effective agent in palliative therapy for metastatic bone pain in patients with prostate or breast carcinoma. If required, retreatment can be administered safely and with the same efficacy as is achieved by the first dose.

Radiation therapy in AIDS-related cutaneous Kaposi's sarcoma

BACKGROUND

Treatment of cutaneous Kaposi's sarcoma associated with AIDS depends on localization, extension, associated symptoms and the patient's general condition. The most frequent sites of involvement are the face and neck. The aim of this retrospective study was to evaluate the response rate as well as the cosmetic results comparing two different schedules of palliative radiation treatment.

METHODS

251 Skin lesions in 22 patients were treated with irradiation using 100 kV X-ray energy. Applied doses varied between 8 Gy/1 fraction and 30 Gy/10 fractions. The mean age of patients was 38 years (28-59 years). According to Mitsuyasu's staging, 2 patients had stage I, 8 stage II and 12 patients stage IV. The lesions were localized on the face (n = 190), lower extremities (n = 28), upper extremities (n = 24) and the thorax (n = 9). The total given dose was 30 Gy in 68 lesions (27%), 21 Gy in 11 lesions (4.4%), 20 Gy in 2 lesions (0.8%) and 8 Gy in 170 lesions (67.8%).

RESULTS

Complete response with or without residual pigmentation was achieved in 95.2% of lesions, while 4.4% had a partial response and 0.4% no response. Pain was completely relieved in all patients.

CONCLUSIONS

Radiotherapy can be recommended as palliative treatment to relieve physical discomfort (pain) and to improve the cosmetic results in patients with AIDS-related Kaposi's sarcoma. Doses ranging from 8 Gy/1 fraction to 30 Gy/10 fractions, tailored to the individual patient's need, permit to achieve an excellent local control with minimal toxicity.

Prognostic significance of metastases to mediastinal lymph node levels in resected non-small cell lung carcinoma

BACKGROUND

The prognosis of patients who have non-small cell lung carcinoma (NSCLC) with mediastinal lymph node metastases remains a controversial issue. This study was performed to evaluate survival by level of mediastinal lymph node metastasis and the number of mediastinal levels involved.

METHODS

The authors retrospectively reviewed the cases of 113 patients with NSCLC and pathologic mediastinal lymph node involvement who underwent a complete tumor resection and ipsilateral mediastinal lymphadenectomy.

RESULTS

Most patients presented with involvement of only one mediastinal lymph node level (68.2%). The overall survival rate was 17% at 3 years. No differences in survival were observed in relation to which lymph node level was involved (P = 0.667). Differences in survival based on the number of lymph node levels involved were statistically significant (P = 0.001).

CONCLUSIONS

Although there were no differences in survival when only one of any of the three defined levels was involved, metastasis to more than one level was associated with significantly poorer survival.

[Total abdominal irradiation. Choice of experimental dosage]

Radiation therapy induces morphological and functional changes in small intestine leading to nutrient malabsorption. The aim of this study was to determine the effect of total abdominal irradiation on body weight in rats. The study was performed in four groups of animals treated at increased levels of radiation: 400, 600, 800 and 1,000 cGy. The decrease in body weight observed was similar at the caloric and nitrogen intake and were more pronounced as the dose of radiation increased.