A prospective randomized placebo-controlled double-blinded pilot study of misoprostol rectal suppositories in the prevention of acute and chronic radiation proctitis symptoms in prostate cancer patients

OBJECTIVE

Radiation proctitis is a known complication of radiation therapy for prostate cancer. Available medical treatment is usually ineffective and has focused on relieving symptoms after damage has occurred. Our study aimed at evaluating the use of misoprostol rectal suppositories in the prevention of acute as well as chronic radiation proctitis symptoms.

METHODS

A prospective, randomized, placebo-controlled, double-blinded trial was conducted in patients with recently diagnosed stages B and C prostate cancer who underwent external beam irradiation. Patients received either a misoprostol or a placebo suppository 1 h before each radiation session. Misoprostol suppositories were made from two 200-microg tablets (Cytotec, Searle Pharmaceuticals, Skokie, IL), whereas the placebo was made from cocoa butter. A 12-point radiation proctitis symptom score was obtained from each patient at 4, 8, 12, and 36 wk after radiation therapy.

RESULTS

A total of 16 patients were enrolled. Seven patients received placebo, and nine patients received misoprostol. Mean radiation proctitis symptom scores in the placebo group were 4.86, 5.86, 5.71, and 3.83 at 4, 8, 12, and 36 wk, respectively. The mean scores in the misoprostol group were 0.78, 0.67, 0.33, and 0.37 at 4, 8, 12, and 36 wk, respectively. The difference between the two groups was statistically significant (p < 0.05) at 4, 8, 12, and 36 wk.

CONCLUSION

Misoprostol rectal suppositories significantly reduce acute and chronic radiation proctitis symptoms in patients receiving radiation therapy for prostate cancer.

Assaults by patients on psychiatric residents: a survey and training recommendations

OBJECTIVE

A survey was conducted to determine the frequency and severity of assaults on psychiatric residents and the level of training they receive in the management of violent patients.

METHODS

In early 1997 a survey was randomly distributed to 2,553 psychiatric residents, who represented half of all psychiatric residents in the United States. The survey asked about experiences of assaults and training received in management of violent patients.

RESULTS

Completed surveys were received from 517 residents, for a 20 percent response rate. Seventy-three percent reported being threatened, and 36 percent had been physically assaulted. A third received no training in managing violent patients, and a third described their training as inadequate.

CONCLUSIONS

Two-thirds of psychiatric residents are either undertrained or feel undertrained in dealing with violent patients. The authors propose a training curriculum based on recommendations of an American Psychiatric Association task force report on clinician safety.

Sociodemographic factors in Health Psychology research: 12 years in review

The article provides a 12-year review of health psychology research through a content analysis of the journal Health Psychology. Empirical studies of adults (n = 490) and children (n = 103) published between 1985-1996 were assessed with respect to information reported on race, income, education level, gender, and age characteristics of study participants. Although gender and age were usually reported, several studies did not provide race, income, or education information. However, time-trend analyses revealed significant improvements over the past few years in reporting of race, education, and age in articles on adults and in race reporting in articles on children.

Sociodemographic factors in Health Psychology research: 12 years in review

The article provides a 12-year review of health psychology research through a content analysis of the journal Health Psychology. Empirical studies of adults (n = 490) and children (n = 103) published between 1985-1996 were assessed with respect to information reported on race, income, education level, gender, and age characteristics of study participants. Although gender and age were usually reported, several studies did not provide race, income, or education information. However, time-trend analyses revealed significant improvements over the past few years in reporting of race, education, and age in articles on adults and in race reporting in articles on children.

Impaired permeability in radiation-induced lung injury detected by technetium-99m-DTPA lung clearance

This study evaluates the use of the 99mTc-DTPA aerosol lung clearance method to investigate radiation-induced lung changes in eight patients undergoing radiotherapy for lung or breast carcinoma. The sensitivity of the method was compared with chest radiography for detecting radiation-induced changes in the lung, regional alterations within (irradiated region) and outside (shielded region) the treatment ports, effect of irradiated lung volume, and dependence on time after radiotherapy.

METHODS

Serial DTPA lung clearance studies were performed before the first radiation treatment (baseline), then weekly during a 5- to 7-wk course, and up to 12 times post-therapy over periods of 56-574 days. The total activity deposited in the lungs for each study was approximately 150 microCi (approximately 5.6 MBq). DTPA clearance, expressed in terms of the biological half-time, t 1/2, was computed from the slopes of the least-squares fit regression lines of the time-activity curves for the first 10 min for irradiated and shielded lung regions.

RESULTS

Major findings include: (a) significant and early DTPA t 1/2 changes were observed in all patients during and after radiotherapy; (b) changes in DTPA t 1/2 values were observed in both irradiated and shielded lung regions in all patients suggesting a radiation-induced systemic reaction; (c) changes in DTPA t 1/2 values were correlated (p < 0.05) with the irradiated lung volumes; (d) significantly reduced DTPA t 1/2 values were observed in three patients who subsequently presented with clinical symptoms and/or radiographic changes consistent with radiation pneumonitis (t1/2 felt to 19% +/- 6% of baseline values, compared with 64% +/- 17% in the remaining patients [p < 0.01]); (e) the onset of decreased DTPA t 1/2 values in these three patients occurred 35-84 days before clinical symptoms and/or radiographic changes; and (f) DTPA t 1/2 tended to approach baseline values with time after radiotherapy, suggesting a long-term recovery in lung injury.

CONCLUSION

These observations show significant and early alterations in DTPA lung clearance during and after radiotherapy that may provide a sensitive assay to monitor changes in radiation-induced lung injury and may facilitate early therapeutic intervention.

Effect of delayed radiation therapy on local control in breast conservation therapy

PURPOSE

To assess local control when radiation therapy is delayed to complete chemotherapy in breast conservation therapy.

MATERIALS AND METHODS

Breast conservation therapy was performed in 310 cases in 297 patients (aged 24-85 years) with stage 0-II breast cancer. Adjuvant chemotherapy was used in 76 cases. The authors analyzed the time between diagnosis and radiation therapy and correlated these findings with local control of disease.

RESULTS

The time between diagnosis and radiation therapy in the 247 cases treated without chemotherapy-related delay was 2-59 weeks (mean, 8 weeks). The interval in the 63 cases with chemotherapy-related delay was 12-63 weeks (mean, 31 weeks; P < .001). Ten of the 11 cases with an in breast relapse were in the group treated without a delay (P = .57).

CONCLUSION

Delaying radiation therapy for chemotherapy does not compromise local control.

Glucose metabolic changes in nontumoral brain tissue of patients with brain tumor following radiotherapy: a preliminary study

PURPOSE

Our goal was to measure the effect of radiotherapy on the brain glucose metabolism of tumoral and nontumoral tissue of patients with brain malignancies.

METHOD

Fifteen patients with primary or metastatic brain tumors were studied with 2-deoxy-2-[18F]fluoro-D-glucose and PET prior to radiotherapy, and nine of them were rescanned 1 week after completing radiotherapy.

RESULTS

Brain metabolism in patients (all brain regions except for tumoral and edematous tissue) was lower than that of matched controls (34.0 +/- 8.3 vs. 46.5 +/- 6.4 mumol/100 g/min; p < or = 0.0001). Five of the nine patients retested after radiotherapy showed decrements in tumor metabolism (47 +/- 10%; p < or = 0.05) and increases in brain metabolism (10 +/- 4%; p < or = 0.004), and the other four showed no changes in tumor or in brain metabolism. Radiotherapy-induced changes in tumor metabolism were negatively correlated with changes in brain metabolism (r = 0.85, p < or = 0.004), but not with changes in tumor volume (assessed with MR images).

CONCLUSION

The study indicates that radiotherapy-induced increases in metabolism of nontumoral tissue are secondary to decreased tumor metabolic activity and not just due to volume reduction.

General and illness-specific adjustment to cancer: relationship to marital status and marital quality

This study examined the relationship between psychological adjustment of adults with cancer and two marital variables: married versus unmarried and high versus low marital quality. Eighty-six married and 46 unmarried adults with cancer completed general and illness-specific measures of psychological adjustment. In general, men and subjects with low marital quality reported more depression and anxiety, a less positive health care orientation, and more illness-induced family difficulties than did women and subjects with high marital quality; unmarried subjects reported more dysphoric thoughts and feelings related to the their illness than did married subjects; and unmarried men reported more disruption in work activities and extended family relationships than did unmarried females or married subjects. Moreover, a greater percentage of unmarried subjects and subjects with low marital quality reported clinically elevated levels of symptomatology compared to those with high marital quality. The clinical implications of these findings are discussed.

A new isocenter shift method for ideal geometric matching of two adjacent fields

The most commonly used technique for matching two adjoining parallel opposed fields has been geometric matching with a skin gap calculation. Many modifications have been suggested in order to minimize the shortcomings of this technique. Most of these, however, are more complex and time consuming in clinical practice, with little dosimetric improvement. We propose a simple new method for adjacent field abutment that eliminates hot and cold spots due to different beam divergences. This method is based upon the use of a single match plane for both the cephalad and caudad parallel opposed beams. The divergence angle of these opposed beams is forced to be equal at the junction through the use of the same field length and the same target axis distance (TAD). For the isocentric treatment case, the procedure is summarized as follows. After setting up the cephalad AP/PA fields to midplane in the conventional manner, the patient support couch is shifted longitudinally in the cephalad direction by a precise distance equal to the cephalad field length. The superior collimator of the caudad field is kept the same as for the cephalad field to ensure equal divergence angles. The actual irradiated volume of the caudad field is adjusted as needed by a large block or an asymmetric jaw. An analogous procedure is described for the nonisocentric case. This new isocenter shift method culminates in several distinct advantages over the other geometric methods.(ABSTRACT TRUNCATED AT 250 WORDS)

A prospective study of prostate specific antigen levels in patients receiving radiotherapy for localized carcinoma of the prostate

Prostate Specific Antigen (PSA) is becoming the preferred tumor marker in the management of prostate cancer. Prostate Specific Antigen levels fall exponentially after radical prostatectomy with a half-life of between 2 and 3 days. Persistently elevated Prostate Specific Antigen levels beyond 7 half-lives suggest occult residual disease and may serve as an indication for post operative adjunctive therapy. The change in Prostate Specific Antigen levels during a course of radical external beam radiotherapy for prostate cancer has not been described. In this study of 81 patients receiving radiotherapy for primary prostate cancer, 47 had elevated Prostate Specific Antigen levels prior to therapy and 35 had serial measurement of Prostate Specific Antigen during their course of treatment. Working on an assumption that in patients with radioresponsive localized prostate cancer Prostate Specific Antigen levels will fall exponentially during the radiotherapy, a half-life of 43 +/- 11 days was derived. Prostate Specific Antigen half-life appears independent of stage, grade, or pretreatment Prostate Specific Antigen level and may be an independent prognostic indicator. A prolonged Prostate Specific Antigen half-life may suggest untreated or resistant disease and serve as an indication for adjuvant hormonal treatment in patients receiving radiotherapy for primary prostate cancer.

Clinical use of a wing field with transmission block for the treatment of the pelvis including the inguinal node

Treatment planning of photon and electron beams to include the pelvis and the groin poses a technical difficulty of positioning beams, and a dosimetric problem of abutting fields at the groin. We have analyzed a simpler AP/PA method using a central transmission block. The posterior portal is smaller and opposes only the pelvic portion of the anterior portal under the transmission block, while the anterior extended portion (hence the wing) is unattenuated to treat the inguinal region. By calculating the attenuation thickness according to the patient's separation and the beam quality, the dose distribution is tailored to yield the proper dose to the pelvic mid-plane and the inguinal nodes while minimizing the dose to the femora. Measured dose distribution (6MV) using film dosimetry in a tissue-equivalent phantom indicates that a 30% hot spot is created by the posterior portal diverging into the wings of the anterior field. Therefore, the pelvic attenuator is tapered at its lateral edges, thereby significantly reduced the dose inhomogeneity (5%) at the groin. Clinical methods are outlined for the verification of the patient portal films against possible mismatch in beam divergence.