MHL Medical.com Information for doctors, healthcare
practitoners, scientists news and media
|
Latest and Archieved Research References
Centre Hospitalier Universitaire de Liège Currently Under Construction |
|
|
|
|
Research at
the University Hospital New concept at the intersection of basic research and clinical research, translational research aimed at accelerating the translation for the benefit of patients discoveries of basic research driven by clinical questions. In this regard, CHU of Liège enjoys an extremely favorable environment close to being integrated research centers such as GIGA (Interdisciplinary Group genoproteomics applied) or the Centre de Recherche du Cyclotron (CRC), University of Liège ( ULg). Carrying the dual membership and university hospital, many doctors of the University Hospital of Liège conduct translational research in their various disciplines. An inventory was recently completed which indicates that over 200 projects of which 58% are achieved in partnership with the GIGA, 12% in partnership with CRC and 30% with other laboratories ULg or other Universities. Thirty-eight hospital units have as a collaboration with GIGA. The research themes of distributed as listed below: * Inflammatory
bowel disease (Crohn's disease: genetics, pathophysiology, biomarkers,
new treatments) Cardiovascular system * Relodelage
heart (biomarkers) Cancers * Biomarkers
Oncology: liver metastases, prostate cancer, DNA methylation,
colon cancer Neuroscience * Parkinson's
disease (biomarkers) Endocrinology and urogenital system * Diabetes
type 1 (lymphoid tyrosine phosphatase) Genetics * Genetic
diseases (cystic fibrosis, pituitary adenoma) New concept
at the intersection of basic research and clinical research, translational
research aimed at accelerating the translation for the benefit
of patients harvested discoveries in basic research. In this regard,
CHU of Liège enjoys particular the proximity of a research
center at the highest level, the GIGA interdisciplinary group
of genoproteomics Applied University of Liege. Wearing two hats
and university hospital, many doctors of the University Hospital
of Liege also undertake translational research within their various
disciplines.
|
|||
| Matadine,
a cytotoxic alkaloid from Strychnos gossweileri Quetin-Leclercq, Joëlle; Coucke, Philippe ULg; Delaude, Clément et al in Phytochemistry (1991), 30(5), 1697-1700 Matadine, a new alkaloid, has been isolated from the root bark of Strychnos gossweileri. Elucidation of its structure is mainly based on 1H and 1D NMR studies. Its cytotoxic activity has been tested on ... [more ] Matadine, a new alkaloid, has been isolated from the root bark of Strychnos gossweileri. Elucidation of its structure is mainly based on 1H and 1D NMR studies. Its cytotoxic activity has been tested on cancer cells and normal cells. Matadine is an anhydronium base as serpentine, that exerts also a selective inhibiting activity on B16 melanoma cells while it is less toxic in human 2002 non-cancer cells. This selective activity might be well due , as it seems to be the case for serpentine and alstonine, to a higher affinity of matadine for destabilized single-stranded DNA as mainly present in cancer cells. [less ?] The
future of radiation oncology: technology, ethical considerations
and economical aspects in Revue Médicale de Liège (2010), 65(4), 186-90 We are facing a real technical revolution in radiation oncology. The radiation oncologist is pushed by the industry to implement rapidly new and "high-tech" therapeutic modalities. All of the technical ... [more ] We are facing
a real technical revolution in radiation oncology. The radiation
oncologist is pushed by the industry to implement rapidly new
and "high-tech" therapeutic modalities. All of the technical
improvements are obviously aiming at an increase in the therapeutic
index. However, one should be cautious before implementing on
a large scale those technical innovations as no one really knows
neither what the possible impact is on medical outcome (efficacy,
toxicity and risk), nor what the economical consequences will
be. It is our duty as radiation oncologists to make a comprehensive
estimation of the impacts in order to be able to set up guidelines
for use that are both ethical and in respectful of human dignity.
[less ?] Triple
negative breast cancer in Revue Médicale de Liège (2010), 65(3), 120-126 Le cancer du sein touche une femme sur huit dans les pays occidentaux. Son incidence a considérablement augmenté au cours de ces deux dernières décennies mais, en même temps, le niveau de mortalité ... [more] Le cancer
du sein touche une femme sur huit dans les pays occidentaux. Son
incidence a considérablement augmenté au cours de
ces deux dernières décennies mais, en même
temps, le niveau de mortalité spécifique est resté
stable et a même diminué en Europe et aux Etats-Unis,
notamment, grâce à l’apport de nouvelles armes
thérapeutiques, aux changements dans l’utilisation
du traitement hormonal substitutif à la ménopause
et à un diagnostic plus précoce. Malgré cela,
le cancer du sein reste la première cause de décès
par cancer chez la femme de moins de 65 ans. Le cancer du sein
«triple négatif», un sous-type représentant
environ 10 % des cancers du sein, est caractérisé
par l’absence de récepteurs hormonaux aux oestrogènes
et à la progestérone et l’absence d’expression
du facteur de croissance HER-2 en étude d’immunohistochimie.
Ce type de cancer du sein est associé à un profil
clinique défavorable avec un haut risque de rechute métastatique
précoce. De plus, le cancer du sein «triple négatif»
ne présente aucune cible thérapeutique propre et
son pronostic est donc particulièrement mauvais. La définition
de facteurs prédictifs de la réponse tumorale aux
différents traitements et l’apport des thérapies
ciblées sont deux pistes susceptibles d’améliorer
la prise en charge et la survie des patients atteints par ce type
de cancer extrêmement agressif. [less ?] Vascular
perfusion as the origin of neoplasm resistance to radio- and chemotherapy in Revue Médicale de Liège (2010), 65(3), 133-139 Angiogenesis is a hallmark of tumours. The newly formed tumour vessels are structurally and functionally abnormal leading to tumour perfusion heterogeneities and subsequently to the development of hypoxic ... [more] Angiogenesis
is a hallmark of tumours. The newly formed tumour vessels are
structurally and functionally abnormal leading to tumour perfusion
heterogeneities and subsequently to the development of hypoxic
areas. Generally, tumour hypoxia refers to an increasing distance
between vasculature and tumour cells (i.e. chronic hypoxia). Chronic
hypoxia promotes tumour resistance to treatments and metastasis.
The temporal aspect of hypoxia is completely neglected in chronic
hypoxia. Intermittent hypoxia (HI) takes the transient and temporal
aspect of hypoxia into account. HI is defined as pO2 fluctuations
in tumour vessels secondary to transient arrest of tumour blood
flow. IH extends the concept of tumour hypoxia to tumour vessels
and vascular cells. Transient arrest of tumour blood flow promotes
tumour resistance to radio- and chemotherapy treatments and favours
metastasis. Moreover, IH protects tumour vessels and endothelial
cells against pro-apoptotic stresses and promotes angiogenesis.
A comprehensive dissection of the mechanisms leading to IH allows
the development and establishment of new therapeutic approaches.
[less ?] Pourquoi
les traitements de radiothérapie adjuvante pour cancer
du sein ne comptent-ils plus autant de séances ? in Revue Médicale de Liège (2010), 65(1), 10-14 La radiothérapie adjuvante postopératoire pour cancer du sein compte habituellement vingt-cinq séances de radiothérapie auxquelles on ajoute une surimpression centrée sur le lit tumoral. Dans le contexte ... [more] La radiothérapie
adjuvante postopératoire pour cancer du sein compte habituellement
vingt-cinq séances de radiothérapie auxquelles on
ajoute une surimpression centrée sur le lit tumoral. Dans
le contexte d’une augmentation progressive et continue de
la charge de travail et afin de réduire les contraintes
humaines et techniques, une radiothérapie plus courte est
aujourd’hui utilisée. Ces schémas hypo-fractionnés
sont validés par des essais randomisés et publiés.
Sur la base de ces publications, un nouvel arbre décisionnel
a été établi qui permet d’obtenir des
résultats équivalents en contrôle local tout
en gardant un taux de complications comparable, voire même
inférieur au schéma classique [less ?] la
vascularisation tumorale en tant que source de rtésistance
aux traitements de radiothérapie et chimiothérapie in Revue Médicale de Liège (2010), 65(3), 143-149 L'angiogenèse tumorale est une caractéristique commune à toutes les tumeurs. Ce nouveau réseau vasculaire tumoral présente des anomalies structurelles et fonctionnelles conduisant inévitablement à une ... [more] L'angiogenèse
tumorale est une caractéristique commune à toutes
les tumeurs. Ce nouveau réseau vasculaire tumoral présente
des anomalies structurelles et fonctionnelles conduisant inévitablement
à une perfusion tumorale hétérogène
et à l'apparition de zones hypoxiques. Classiquement, l'hypoxie
tumorale réfère à une inadéquation
spatiale entre les vaisseaux et les cellules tumorales (i.e. hypoxie
chronique). Elle confère aux cellules tumorales une résistance
aux traitements et favorise les métastases. L'aspect temporel
du phénomène est complètement négligé
dans l'hypoxie chronique. L'hypoxie intermittente (HI), permet
de tenir compte de l'aspect transitoire et temporel du phénomène.
L'HI se définit comme une fluctuation de la p02 due à
des arrêts transitoires du flux sanguin dans les vaisseaux
tumoraux. Le compartiment tumoral et le compartiment vasculaire
souffrent tous deux de l'hypoxie. L'HI étend donc le concept
d'hypoxie tumorale au réseau vasculaire et aux cellules
qui composent les vaisseaux. Les conséquences sont une
plus grande résistance de la tumeur aux traitements de
radio- et de chimiothérapie, une augmentation des métastases,
mais également une résistance vasculaire accrue
avec une diminution de l'apoptose des cellules endothéliales
et une potentialisation de l'angiogenèse. L'identification
et la compréhension des causes et des origines de l'HI
permettent l'édification de nouvelles approches thérapeutiques.
[less ?] L'OBSERVANCE
AU TRAITEMENT DE LONGUE DURÉE: le cas particulier de l'hormonothérapie
adjuvante du cancer du sein in Revue Médicale de Liège (2010), 65(5-6), 405-408 L'objectif de l'hormonothérapie adjuvante dans le cancer du sein est d'atteindre en pratique quotidiennee, une efficacité comparable à celle obtenue au cours des études cliniques. Malgré l'efficacité ... [more ?] L'objectif
de l'hormonothérapie adjuvante dans le cancer du sein est
d'atteindre en pratique quotidiennee, une efficacité comparable
à celle obtenue au cours des études cliniques. Malgré
l'efficacité démontrée de l'hormonothérapie,
la compliance constitue un défi majeur et un problème
multidimensionnel. Une meilleure compréhension des raisons
de cette non-compliance aiderait à mieux identifier les
patientes à risque et à développer des interventions
capables d'améliorer l'adhésion à l'hormonothérapie
adjuvante.C'est dans ce but que nous avons entrepris une revue
de la littérature des six dernières années
(Pub Med 2003-2006). [less ?] Does
radiation treatment delay affect survival in glioblastoma in Surgical
Neurology (2009), 72(5), 519 ANTICORPS
MONOCLONAUX ET CANCER DU SEIN: Actualités thérapeutiques in Revue Médicale de Liège (2009), 64(5-6), 120 About 9,500 new breast cancers are diagnosed in Belgium every year. Improvement of our knowledge of altered molecular events leading to the proliferation of tumor cells has resulted in the development of ... [more] About 9,500 new breast cancers are diagnosed in Belgium every year. Improvement of our knowledge of altered molecular events leading to the proliferation of tumor cells has resulted in the development of targeted therapies in subgroups of cancers. One of the first validation of targeted therapy is the anti-HER-2 monoclonal antibody trastuzumab (Herceptin) in patients with overexpression of human epidermal growth factor receptor type 2 (HER2) occurring in 20 to 25% of invasive breast carcinoma. Trastuzumab binds the extracellular juxtamembrane domain and is only active in tumor with HER2 gene amplification detected by fluorescence in situ hybridization (FISH). The results from randomized trials have rapidly lead to the approvement of the drug in the metastatic and then in the adjuvant setting. Another targeted therapy, also approved in the treatment of breast cancer, is the monoclonal antibody bevacizumab with an anti-VEGF (Vascular Endothelial Growth Factor) activity. We will review the benefit of these targeted therapies in breast cancer and their role in the treatment of breast cancer.
Conference
(2009, March 21) Does
Radiation treatment delay affect survival in glioblastoma ? Conference
(2009, March) Tumor
Margin after conservative breast cancer surgery for early disease:
an issue or not ? in Belgian Journal of Medical Oncology [=BJMO] (2009), 3(3), 93-100 Summary is standard of care. However, the question is Conservative breast surgery (CBS), i.e. tumorec- whether this approach is able to consolidate local tomy (TUM), has replaced more radical surgical ... [more] Summary is
standard of care. However, the question is Conservative breast
surgery (CBS), i.e. tumorec- whether this approach is able to
consolidate local tomy (TUM), has replaced more radical surgical
control irrespective of the extent of the surgical approaches
such as mastectomy (MAST) and margin. No consensus exists in the
literature con-quadrantectomy (QUAD). The aim of surgeons is cerning
what should be considered as a minimal to avoid recurrence and
still obtain a good cos-and hence a safe margin. This review will
summetic result. After CBS for early disease, adjuvant marize
the published data in order to try to define radiation consisting
of whole breast irradiation a pragmatic treatment approach. followed
by a boost dose on the surgical bed is standard of care. However,
the question is whether this approach is able to consolidate local
control irrespective of the extent of the surgical margin. No
consensus exists in the literature concerning what should be considered
as a minimal and hence a safe margin. This review will summarize
the published data in order to try to define a pragmatic treatment
approach. [less ?] in Belgian
Journal of Medical Oncology [=BJMO] (2009), 3(3), 117 in Belgian
Journal of Medical Oncology [=BJMO] (2009), 3(3), 121 in Belgian
Journal of Medical Oncology [=BJMO] (2009), 3(3), 117 in Onco :
Revue Multidisciplinaire d'Oncologie (2009), 3(6), 206-207 in Strahlentherapie und Onkologie (2009), 185(11), 736-742 Background and Purpose: Dose escalation in order to improve the biochemical control in prostate cancer requires the application of irradiation techniques with high conformality. The dosimetric selectivity ... [more ?] Background
and Purpose: Dose escalation in order to improve the biochemical
control in prostate cancer requires the application of irradiation
techniques with high conformality. The dosimetric selectivity
of three radiation modalities is compared: high-dose-rate brachytherapy
(HDR-BT), intensity-modulated radiation radiotherapy (IMRT), and
helical tomotherapy (HT). Patients and Methods: Ten patients with
prostate adenocarcinoma treated by a 10-Gy HDR-BT boost after
external-beam radiotherapy were investigated. For each patient,
HDR-BT, IMRT and HT theoretical treatment plans were realized
using common contour sets. A 10-Gy dose was prescribed to the
planning target volume (PTV). The PTVs and critical organs’
dose-volume histograms obtained were compared using Student’s
t-test. Results: HDR-BT delivers spontaneously higher mean doses
to the PTV with smaller cold spots compared to IMRT and HT. 33%
of the rectal volume received a mean HDR-BT dose of 3.86 ±
0.3 Gy in comparison with a mean IMRT dose of 6.57 ± 0.68
Gy and a mean HT dose of 5.58 ± 0.71 Gy (p < 0.0001).
HDR-BT also enables to better spare the bladder. The hot spots
inside the urethra are greater with HDR-BT. The volume of healthy
tissue receiving 10% of the prescribed dose is reduced at least
by a factor of 8 with HDR-BT (p < 0.0001). Conclusion: HDR-BT
offers better conformality in comparison with HT and IMRT and
reduces the volume of healthy tissue receiving a low dose. [less
?] in Onco :
Revue Multidisciplinaire d'Oncologie (2009), 3(3), 79-81 in Revue Médicale de Liège (2008), 63(2), 7581 Dans le cadre de la prise en charge multidisciplinaire du carcinome intracanalaire du sein (carcinome intra-canalaire in situ = DCIS = Ductal Carcinoma In Situ), on évoque souvent la possibilité de ... [more ?] Dans le cadre
de la prise en charge multidisciplinaire du carcinome intracanalaire
du sein (carcinome intra-canalaire in situ = DCIS = Ductal Carcinoma
In Situ), on évoque souvent la possibilité de renoncer
à la radiothérapie complémentaire après
un geste de chirurgie conservatrice. S’il est vrai que la
radiothérapie, dans ce contexte, n’apporte pas de
bénéfice en survie, il n’en reste pas moins
qu’on observe à long terme un effet bénéfique
en contrôle local. Il existe un effet significativement
marqué sur le taux de rechute de type DCIS et de type invasif
dans les différentes études randomisées destinées
à éclaircir la problématique du rôle
de la radiothérapie. La question est de savoir si on peut
distinguer un sous-groupe de patientes pour qui le contrôle
local n’est pas modifié par l’adjonction d’une
radiothérapie adjuvante. Pour l’instant, nous ne sommes
pas à même de définir ce sous-groupe, car
les critères de sélection n’ont pas été
mis à l’épreuve dans le cadre d’un essai
randomisé. Faute de ces données, il nous semble
plus adéquat de proposer jusqu’à preuve du
contraire, une radiothérapie aux patientes opérées,
même si l’intervention est a priori radicale, mais
conservatrice, et même si les facteurs pronostiques semblent
plutôt favorables. Cependant, la radiothérapie n’est
pas indiquée après une mastectomie. [less ?] in Belgian Journal of Medical Oncology [=BJMO] (2008), 2 Treatment-related late complications on non-target normal tissues and appearance of secondary malignancies are well known side-effects induced by effective treatment regimens currently used in the ... [more ?] Treatment-related
late complications on non-target normal tissues and appearance
of secondary malignancies are well known side-effects induced
by effective treatment regimens currently used in the curative
approach of early and advances Hodgkin's lymphoma. Radiotherapy
(RT) and chemotherapy (CT) can lead to these late complications.
Efforts have been conducted to reduce the morbidity and mortality
related to these treatments. In particular there has been a progressive
shift from radiotherapy used as sole modality to chemotherapy
as first line followed by consolidation radiotherapy. As the side-effects
of radiotherapy are linked to dose, volume and interaction with
chemotherapy, trials have been launched to assess the impact of
modifying the characteristics of the radiation treatment. For
early-stage Hodgkin's lymphoma radiotherapy cannot be avoided
but dose and volume can be reduced. In advances Hodgkin's lymphoma
omitting radiotherapy seems reasonable only in cas of complete
response (CR). The clinical trials allowing such a paradigm shift
are highlighted in this review. [less ?] in Belgian Journal of Medical Oncology [=BJMO] (2008), volume 2(6), 326-333 Summary Non-small cell lung cancer (NSCLC) is a heterogeneous tumour. A wide variety of treatment options is currently available. Surgery remains the mainstay of curative treatment and an operative ... [more ?] Prognostic
Factors in Urothelial Renal Pelvis and Ureter Tumours: a Multicentre
Rare Cancer Network Study in European Journal of Cancer & Clinical Oncology (1999), 35/5 To assess the prognostic factors in patients with transitional-cell carcinoma of the renal pelvis and/or ureter, a series of 138 patients with transitional-cell carcinoma of the renal pelvis and/or ureter ... [more ?] To assess
the prognostic factors in patients with transitional-cell carcinoma
of the renal pelvis and/or ureter, a series of 138 patients with
transitional-cell carcinoma of the renal pelvis and/or ureter
was collected in a retrospective multicentre study. 12 patients
with distant metastases were excluded from the statistical evaluation.
All but 3 patients underwent radical surgery: nephroureterectomy
(n = 71), nephroureterectomy and lymphadenectomy (n = 20), nephroureterectomy
and partial bladder resection or transurethral resection (n =20),
nephrectomy (n =10), and ureterectomy (n = 5). Sixty-one per cent
(n = 77) of the tumours were located in the renal pelvis, and
21% (n = 27) in the ureter (both in 22 [17%]). Following surgery,
residual tumour was still present in 33 patients (16 microscopic
and 17 macroscopic). Postoperative radiotherapy was given to 45
(36%) patients. The median follow-up period was 39 months. In
a median period of 9months, 66% of the patients relapsed (34 local,
7 locoregional, 16 regional, and 24 distant). The 5- and 10-year
survival were 29% and 19%, respectively, in all patients. In univariate
analyses, statistically signi®cant factors in¯uencing
the outcome were Karnofsky index, pT-classi®cation, pN-classi®cation,
tumour localisation, grade, and residual tumour after surgery.
Multivariate analysis revealed that independent prognostic factors
in¯uencing outcome were pTclassi ®cation, the existence
of residual tumour, and tumour localisation. In patients with
urothelial renal pelvis and/or ureter tumours, a radical surgical
attitude is mandatory; and the presence of tumour in the ureter
is associated with a poorer prognosis. # 1999 Elsevier Science
Ltd. All rights reserved. [less ?] in Analytical Biochemistry (1999), 270 Simultaneous determination of ribonucleoside and deoxyribonucleoside triphosphates in cells by HPLC is an analytical challenge since the concentration of dNTP present in mammalian cells is several orders ... [more ?] Simultaneous
determination of ribonucleoside and deoxyribonucleoside triphosphates
in cells by HPLC is an analytical challenge since the concentration
of dNTP present in mammalian cells is several orders of magnitude
lower than the corresponding NTP. Hence, the quantitation of dNTP
in cells is generally performed after selective oxidation or removal
of the major NTP. The procedures reported so far are lengthy and
cumbersome and do not enable the simultaneous determination of
NTP. We report the development of a simple, direct HPLC method
for the simultaneous determination of dNTP and NTP in colon carcinoma
WiDr cell extracts using a stepwise gradient elution ion-pairingHPLCwith
uv detection at 260 nm and with a minimal chemical manipulation
of cells. Exponentially growing WiDr cells were harvested by centrifugation,
rinsed with phosphate- buffered saline, and carefully counted.
The pellets were suspended in a known volume of ice-cold water
and deproteinized with an equal volume of 6% trichloroacetic acid.
The acid cell extracts (corresponding to 2.53 106 cells/100 ml)
were centrifuged at 13,000g for 10 min at 4°C. The resulting
supernatants were stored at 280°C prior to analysis. Aliquots
(100 ml) were neutralized with 4.3 ml saturated Na2CO3 solution
prior the injection of 40 ml onto the HPLC column (injection speed
250 ml/min). Chromatographic separations were performed using
two Symmetry C18 3.5-mm (2 3 3.9 3 150 mm) columns (Waters), connected
in series equipped with a Sentry guard column (3.9 3 20 mm i.d.)
filled with the same packing material. The HPLC columns were kept
at 30°C. The mobile phase was delivered at a flow rate of
0.5 ml/min, with the following stepwise gradient elution program:
% solvent A/solvent B, 100/0 at 0 min 3 100/0 at 1 min 3 36/64
at 5 min 3 31/69 at 90 min 3 31/69 at 105 min 3 0/100 at 106 min
3 0/100 at 120 min; 50/50 MeOH/solvent B from 121 to 130 min;
100% solvent A from 131 to 160 min. Solvent A contained 0.01 M
KH2PO4, 0.01 M tetrabutylammonium chloride, and 0.25% MeOH and
was adjusted to pH 7.0 (550 ml 10 N NaOH for 1 liter solvent A).
Solvent B consisted of 0.1 MKH2PO4, 0.028Mtetrabutylammonium chloride,
and 30% MeOH and was neutralized to pH 7.0 (1.4 ml 10 N NaOH for
1 liter solvent B). Even though dNTPs are minor components of
cell extracts, satisfactory regression coefficients were obtained
for their calibration curves (r2 > 0.99) established with the
addition–calibration methods up to 120 pmol/40-ml injection.
The applicability of the method was demonstrated by in vitro studies
of the modulation of NTP and dNTP pools in WiDr colon carcinoma
cell lines exposed to various pharmacological concentrations of
cytostatic drugs (i.e., FMdC, IUdR, gemcitabine). In conclusion,
this optimized, simplified, analytical method enables the simultaneous
quantitation of NTP and dNTP and may represent a valuable tool
for the detection of minute alterations of cellular dNTP/NTP pools
induced by anticancer/ antiviral drugs and diseases. © 1999
Academic Press [less ?] in Schweizerische Medizinische Wochenschrift (1999), 129(9), 370-376 External radiotherapy or non-steroid antiinflammatory drugs for prevention of heterotopic ossification following total hip replacement Heterotopic ossification (HO) is defined as the development of ... [more ?] External radiotherapy
or non-steroid antiinflammatory drugs for prevention of heterotopic
ossification following total hip replacement Heterotopic ossification
(HO) is defined as the development of abnormal ossification in
soft tissues. HO is a common disease after total hip replacement.
Many therapeutic modalities have been proposed to prevent HO.
The most commonly used modalities are nonsteroidal anti-inflammatory
drugs (NSAID) or ionizing radiation administered just before or
immediately after total hip replacement. As far as external radiation
therapy is concerned, there are several published randomized studies
aimed at investigating its efficacy and timing related to surgery,
and at comparing ionizing irradiation to NSAID. In this article
we review the published data in order to define guidelines which
could be used in daily practice for the choice of prophylactic
treatment against HO. [less ?] in Cancer Research (1999), 59 ABSTRACT (E)-2*-Deoxy-(fluoromethylene)cytidine (FMdC) is known as an inhibitor of ribonucleoside diphosphate reductase, a key enzyme in the de novo pathway of DNA synthesis. FMdC was tested as a modifier ... [more ?] ABSTRACT (E)-2*-Deoxy-(fluoromethylene)cytidine
(FMdC) is known as an inhibitor of ribonucleoside diphosphate
reductase, a key enzyme in the de novo pathway of DNA synthesis.
FMdC was tested as a modifier of radiation response in vitro on
a human colon carcinoma cell line (WiDr), and the observed radiosensitization
was confirmed on two human cervix cancer cell lines (C33-A and
SiHa). Using the clonogenic assay, the effect ratio (ER) at a
clinically relevant dose level of 2 Gy was 2.10 (50 nM FMdC),
1.70 (30 nM FMdC), and 1.71 (40 nM FMdC) for the three cell lines
WiDr, C33-A, and SiHa, respectively. A more detailed analysis
of the importance of timing and concentration of FMdC was done
on the WiDr cell line alone, yielding an increased ER(2Gy) with
increasing concentration and duration of exposure to the drug,
ranging from 1.0 (6 h) to 1.8 (72 h) at 30 nM FMdC and from 1.2
(6 h) to 3.5 (24 h) at 300 nM. We investigated the effect of FMdC
on the cellular deoxynucleotide triphosphate pool in WiDr cells
and demonstrated a marked depletion of dATP and a significant
rise of TTP levels. Cell cycle analysis showed early S-phase accumulation
induced by FMdC alone, G2-M block induced by irradiation alone,
and an increased accumulation of cells in G2-M if both modalities
are used. Our data suggest that FMdC is a radiation response modifier
in vitro on different cancer cell lines. The observed radiosensitization
may in part be explained by alteration of the deoxynucleotide
triphosphate pool, which is consistent with the effect of FMdC
on ribonucleoside diphosphate reductase. [less ?] in Radiotherapy & Oncology (1999), 51(3) Abstract Purpose: A comparative treatment planning study has been undertaken between standard photon delivery techniques,b intensity modulated photon methods and spot scanned protons in order to ... [more ?] Abstract Purpose:
A comparative treatment planning study has been undertaken between
standard photon delivery techniques,b intensity modulated photon
methods and spot scanned protons in order to investigate the merits
and limitations of each of these treatment approaches. Methods:
Plans for each modality were performed using CT scans and planning
information for nine patients with varying indications and lesion
sites and the results have been analysed using a variety of dose
and volume based parameters. Results: Over all cases, it is predicted
that the use of protons could lead to a reduction of the total
integral dose by a factor three compared to standard photon techniques
and a factor two compared to IM photon plans. In addition, in
all but one Organ at Risk (OAR) for one case, protons are predicted
to reduce both mean OAR dose and the irradiated volume at the
50% mean target dose level compared to both photon methods. However,
when considering the volume of an OAR irradiated to 70% or more
of the target dose, little difference could be shown between proton
and intensity modulated photon plans. On comparing the magnitude
of dose hot spots in OARs resulting from the proton and IM photon
plans, more variation was observed, and the ranking of the plans
was then found to be case and OAR dependent. Conclusions: The
use of protons has been found to reduce the medium to low dose
load (below about 70% of the target dose) to OARs and all non-target
tissues compared to both standard and inversely planned photons,
but that the use of intensity modulated photons can result in
similar levels of high dose conformation to that afforded by protons.
However, the introduction of inverse planning methods for protons
is necessary before general conclusions on the relative efficacy
of photons and protons can be drawn. [less ?] in Radiotherapy & Oncology (1998), 47(1), 99-101 To investigate whether whole brain irradiation might be replaced by focalized irradiation after resection of a single brain metastasis in patients where extracranial tumor control is deemed to be obtained ... [more ?] To investigate
whether whole brain irradiation might be replaced by focalized
irradiation after resection of a single brain metastasis in patients
where extracranial tumor control is deemed to be obtained. Patients
and methods: Twelve patients were introduced in a phase I/II prospective
study of conformal postoperative external irradiation after resection
of a solitary brain metastasis. The radiation treatment consisted
of 50.4 Gy (1.8 Gy per fraction, five fractions per week). The
planning target volume consisted of the tumor bed and a 2 cm safety
margin. All treatments were optimized with head immobilization,
dedicated tomodensitometry and computer assisted three-dimensional
treatment planning. Results: The median survival was 7.2 months
(range 2.4–50.4 months). Eleven of the 12 patients died.
Eight of the 12 patients presented intracranial recurrence and
seven died as a consequence of intracranial tumor progression.
Conclusions: Focalized external irradiation cannot serve as a
reasonable alternative to whole brain radiotherapy (WBRT) even
for patients with apparently one single resected brain metastasis.
The dogma of ‘one metastasis=multiple metastases' seems to
be confirmed. [less ?] Scientific
conference (1998, March 04) in Radiation
Research (1998), 149(4), in Radiotherapy
& Oncology (1998), 48(Supp1), 73 in Radiotherapy & Oncology (1998), 47 Abstract Purpose: To investigate whether whole brain irradiation might be replaced by focalized irradiation after resection of a single brain metastasis in patients where extracranial tumor control is ... [more ?] Abstract Purpose:
To investigate whether whole brain irradiation might be replaced
by focalized irradiation after resection of a single brain metastasis
in patients where extracranial tumor control is deemed to be obtained.
Patients and methods: Twelve patients were introduced in a phase
I/II prospective study of conformal postoperative external irradiation
after resection of a solitary brain metastasis. The radiation
treatment consisted of 50.4 Gy (1.8 Gy per fraction, five fractions
per week). The planning target volume consisted of the tumor bed
and a 2 cm safety margin. All treatments were optimized with head
immobilization, dedicated tomodensitometry and computer assisted
three-dimensional treatment planning. Results: The median survival
was 7.2 months (range 2.4–50.4 months). Eleven of the 12
patients died. Eight of the 12 patients presented intracranial
recurrence and seven died as a consequence of intracranial tumor
progression. Conclusions: Focalized external irradiation cannot
serve as a reasonable alternative to whole brain radiotherapy
(WBRT) even for patients with apparently one single resected brain
metastasis. The dogma of ‘one metastasis=multiple metastases'
seems to be confirmed. [less ?] in Radiotherapy & Oncology (1998), 46(3), 263-268 Abstract Purpose: This retrospective study was undertaken to clarify the role of high energy external beam radiation therapy (EBRT) and to determine its safety and efficacy on local control and visual ... [more ?] Abstract Purpose:
This retrospective study was undertaken to clarify the role of
high energy external beam radiation therapy (EBRT) and to determine
its safety and efficacy on local control and visual acuity in
patients suffering from choroidal metastases (CM). Materials and
methods: The records of 58 consecutive patients treated with EBRT
between 1970 and 1993 were analyzed. The female to male ratio
was 2.9 and the median age was 59 years (range 40–81 years).
Thirty-six patients (62%) had unilateral CM and 22 patients had
bilateral CM. The mean number of lesions per eye was two. Retinal
detachment was present in 65% of cases. The primary tumour (PT)
was breast carcinoma for 38 patients (75%), lung carcinoma for
10 patients (17%) and gastrointestinal, genitourinary or unknown
PT for the remaining 10 patients. The median interval of time
between the PT and the CM was 55 months (range 0–228 months).
All patients were treated with megavoltage irradiation. The median
prescribed dose was 35.5 Gy (range 20–53 Gy) normalized at
a 2 Gy per fraction schedule with an a/b value of 10 Gy. Various
techniques were used and whenever possible the lens was spared.
Ten patients with unilateral disease were treated in both eyes.
Results: The tumour response was slow. When assessed after 3 months
or more, the complete response rate was 53% with significantly
better results for doses higher than 35.5 Gy (72 versus 33%; P
= 0.009). Visual acuity was improved or stabilized in 62% of patients,
with also significantly better results when doses higher than
35.5 Gy (P = 0.014) were administered. Amongst 26 patients with
unilateral CM who had no elective contralateral irradiation, three
developed metastasis in the opposite eye versus none of the 10
patients who had bilateral irradiation. Five complications occurred
(three cataracts, one retinopathy and one glaucoma). Conclusion:
Radiation therapy is an efficient and safe palliative treatment
for choroidal metastases and it helps the preservation of vision.
Thus, there is a major impact on the quality of life in a group
of patients with an almost uniformly fatal prognosis. Both tumour
response and visual acuity are significantly improved if doses
higher than 35.5 Gy are administered. Whenever possible, a lens
sparing technique should be used. Ó 1998 Elsevier Science
Ireland Ltd. [less ?] in Cancer Radiotherapie (1998), 2 Le traitement des cancers du col utérin repose sur la radiothérapie et la chirurgie. Le pronostic des formes évoluées a conduit à proposer différentes modalités d’association dont seuls les traitements ... [more ?] Le traitement
des cancers du col utérin repose sur la radiothérapie
et la chirurgie. Le pronostic des formes évoluées
a conduit à proposer différentes modalités
d’association dont seuls les traitements concomitants ont
montré un intérêt. Les associations de radiothérapie
et d’un radiosensibilisant n’ont pas apporté,
de bénéfice, voire abouti à des résultats
inférieurs à ceux de l’irradiation exclusive.
L’Hydroxyurée et la Mitomycine C ont été
largement testées, seules ou en association, sans qu’elles
puissent être retenues comme efficaces. Des associations
modernes et des essais récents, il peut être établi
que seul le Cisplatine (et peut-être ses dérivés)
peut être retenu dans !es propositions thérapeutiques
futures. 1998 Elsevier, Paris [less ?] in Cancer Research (1998), 58 Antitumor and radiosensitizing effects of (E)-2'-deoxy-2'-(fluoromethylene) cytidine (FMdC), a novel inhibitor of ribonucleotide reducÃase, were evaluated on nude mice bearing s.c. human C33-A cervix ... [more ?] Antitumor
and radiosensitizing effects of (E)-2'-deoxy-2'-(fluoromethylene)
cytidine (FMdC), a novel inhibitor of ribonucleotide reducÃase,
were evaluated on nude mice bearing s.c. human C33-A cervix cancer
and I -H7 MG glioblastoma xenografts. FMdC given once daily has
a dosedependent antitumor effect. The maximum tolerated dose in
the mice was reached with 10 daily i.p. administrations of 10
mg/kg over 12 days. In the case of radiotherapy (RT) alone (10
fractions over 12 days), the radiation dose required to produce
local tumor control in 50% of the treated C33-A xenografts was
51.0 Gy. When combined with FMdC, the radiation dose required
to produce local tumor control was reduced to 41.4 and 38.2 Gy,
at respective doses of 5 and 10 mg/kg given i.p. l h before each
irradiation. The corresponding enhancement ratios (ERs) were 1.2
and 1.3, respec tively. In U-87 MG xenografts, when 5-20 mg/kg
FMdC combined with 30 or 40 Gy of RT, the combination treatment
produced a significantly increased growth delay as compared with
RT alone (P £0.002). The ERs of 5, 10, and 20 mg/kg
FMdC at a dose of 30 Gy were 2.0, 1.4, and 1.8, respectively.
At the 40-Gy level, ERs of 10 and 20 mg/kg FMdC were 1.4 and 1.7.
When FMdC was combined with 50 Gy of RT, an increased long-term
remission rate of 80-88.9% was observed, as compared with 25%
for RT alone (P <0.05). FMdC produced moderate myelosuppression
in the mice bearing cervix cancer, whereas leukocytosis occurred
in the mice bearing glioblastoma at a low dose. Slightly increased
skin toxicity (only with U-87 MG tumor) was observed, as compared
with RT alone. In conclusion, FMdC is a potent cytotoxic agent
and able to modify the radiation response of C33-A and U-87 MG
xenografts. [less ?] in International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society (1998), 83(3), 449-456 BACKGROUND. This study was conducted to determine whether the paranasal extension of a primary non-Hodgkin’s lymphoma (NHL) of the nasal cavity has any deleterious effect on patient outcome. METHODS. One ... [more ?] BACKGROUND.
This study was conducted to determine whether the paranasal extension
of a primary non-Hodgkin’s lymphoma (NHL) of the nasal cavity
has any deleterious effect on patient outcome. METHODS. One hundred
and seventy-five patients with previously untreated nasal NHL
were reviewed. There were 2 with low grade, 107 with intermediate
grade, 17 with high grade, and 49 with unclassifiable lymphomas.
In 48 cases the immunophenotype was available and 46 were T-cell
lymphoma. According to the Ann Arbor system, there were 133 patients
with Stage IE, 28 with Stage IIE, 4 with Stage IIIE, and 10 with
Stage IVE lymphomas. Stage IE was subdivided into limited Stage
IE (i.e., confined to the nasal cavity [67 patients]) or extensive
Stage IE (i.e., presenting with extension beyond the nasal cavity
[66 patients]). For patients with limited Stage IE disease the
treatment of choice was radiotherapy with or without chemotherapy.
In patients with extensive Stage IE disease, treatment was comprised
of a combination of chemotherapy and radiotherapy or radiotherapy
alone. For patients with a more advanced stage of disease (IIE–IVE),
chemotherapy was an integral part of the treatment and was completed
by irradiation, especially for patients with Stage IIE disease.
RESULTS. The actuarial overall survival (OS) and disease free
survival (DFS) rates at 5 years for the whole group were 65% and
57%, respectively. The 5-year OS and DFS rates were influenced
by stage, with a gradual decrease from 75% and 68% for Stage IE
disease to 35% and 28% for Stage IIE disease, and 31% and 19%
for Stage IIIE/IVE disease. Patients with limited Stage IE disease
survived significantly longer (90% 5-year OS) compared with those
with extensive Stage IE disease (57% 5-year OS; P , 0.001). For
67 patients with limited Stage IE disease, the 5-year OS was 89%
with radiotherapy alone and 92% with radiotherapy and chemotherapy,
whereas for 66 patients with extensive Stage IE disease, the 5-year
OS was 54% with radiotherapy and 58% with combined modality therapy
or chemotherapy (P . 0.05). CONCLUSIONS. The prognosis of patients
with primary NHL of the nasal cavity is stage dependent. In this
large cohort of Stage IE patients, it was demonstrated that the
paranasal local extension was a significant prognostic factor
associated with poorer treatment outcome. The authors believe
that Ann Arbor Stage IE should be subclassified further into limited
and extensive Stage IE. The addition of chemotherapy did not appear
to modify significantly the survival of patients with either limited
or extensive Stage IE disease. The extranodal progression observed
in patients with extensive Stage IE and Stage IIE-IVE disease
clearly illustrates the need for improvement of systemic treatment.
Cancer 1998;83:449–56. [less ?] in International
Journal of Radiation, Oncology, Biology, Physics (1998), 42(Supplément),
135 in Radiotherapy
& Oncology (1998), 48(Supp1), 103 in Radiotherapy
& Oncology (1998), 48(Supp1), 27 in Radiotherapy
& Oncology (1998), 48(1), 45 in Bulletin
du Cancer. Radiothérapie : Journal de la Société
Française du Cancer : Organe de la Société
Française de Radiothérapie Oncologique (1997) in International Journal of Radiation, Oncology, Biology, Physics (1997), 38(2), 343-350 Image : The purpose of this study was to analyze prognosis and treatment results for seminoma arising in corrected and uncorrected inguinal cryptorchidism (SCIC and SUIC). Image : We reviewed 66 patients ... [more ?] Prognostic
factors in urothelial renal pelvis and ureter tumors: A multicenter
Rare Cancer Network study in International
Journal of Radiation, Oncology, Biology, Physics (1997), 3(2(supp)),
290 in Bulletin
du Cancer. Radiothérapie : Journal de la Société
Française du Cancer : Organe de la Société
Française de Radiothérapie Oncologique (1997), 1 in International
Journal of Radiation, Oncology, Biology, Physics (1997), 39(2
(supp1)), 257 in International Journal of Gynecology & Obstetrics (1997), 57 of the cervix treated by radical radiation therapy. Method; Three hundred and sixty patients with FIG0 stage IB-IIIB carcinoma of the cervix were treated in Lausanne (Switzerland) with external radiation ... [more ?] of the cervix
treated by radical radiation therapy. Method; Three hundred and
sixty patients with FIG0 stage IB-IIIB carcinoma of the cervix
were treated in Lausanne (Switzerland) with external radiation
and brachytherapy as first line therapy. Median therapy duration
was 45 days. Patients were classified according to the duration
of the therapies, taking 60 days (the 75th percentile) as an arbitrary
cut-off. Results: The 5-year survival was 61% (SE. = 3%) for the
therapy duration group of less than 60 days and 53% (SE. = 7%)
for the group of more than 60 days. In terms of univariate hazard
ratio (HR), the relative difference between the hvo groups corresponds
to a 50% increase of deaths (HR = 1.53, 95% CI = 1.03-2.28) for
the longer therapy duration group (P = 0.044). In a multivariate
analysis, the magnitude of estimated relative hazards for the
longer therapies are confirmed though significance was reduced
(HR = 1.52, 95% CI = 0.94-2.45, P = 0.084). Conclusion: These
findings suggesthat short treatment duration is a factor associated
with longer survival in carcinoma of the cervix. 0 1997 International
Federation of Gynecology and Obstetrics [less ?] in Acta Oncologica (1997) The potential of zalcitabine (ddC) to act as an ionizing radiation response modifier was tested on exponentially growing human cancer cells in vitro. Two human cell lines, WiDr (colon) and MCF-7 (breast ... [more ?] The potential
of zalcitabine (ddC) to act as an ionizing radiation response
modifier was tested on exponentially growing human cancer cells
in vitro. Two human cell lines, WiDr (colon) and MCF-7 (breast)
were exposed to ddC at 10 p M concentration for various lengths
of tide (18, 24, 48 and 72 h). On the WiDr cell line the dual
effect of concentration and duration of exposure prior to irradiation
was investigated. Experimental endpoints were clonogenicity and
viability, as measured by colony formation assay (CFA) and MTT
assay respectively. The impact on cell-cycle distribution prior
to irradiation was assessed by flow cytometry using a double labeling
technique (propidium iodide and bromodeoxyuridine pulse label).
A significant reduction in surviving fraction and viability was
observed for WiDr-cells irradiated after pre-exposure to 10 pM
for 18, 48 and 72 h as compared to corresponding irradiated controls.
At lower concentrations (1 and 5 pM), the radiosensitizing effect
was only significant after a 72-h exposure (assessed by CFA).
For MCF-7, ddC induced a significant modification of the dose
response only with 24 and 48 h preincubation. However, the overall
effect was less pronounced as compared to WiDr. Cell-cycle analysis
showed accumulation in S-phase, 48 and 72 h after treatment with
10 pM ddC in the WiDr cells, with a progressive shift to late
S-phase as shown by the biparametric analysis. The degree of radiosensitization
is cell-line dependent with the most important sensitization observed
on the most <<radioresistant cell line>>, ix., the
cell line with the lowest alpha value and highest SF 2 (WiDr).
For WiDr, radiosensitization by ddC depends on the duration of
exposure and the concentration of the drug. Received 29 February
1996 Accepted 10 December 1996 [less ?] in International Journal of Radiation, Oncology, Biology, Physics (1997), 38(2), 351-357 Purpose: To analyze the clinical characteristics, prognosis, and treatment outcome of pelvic cryptorchid seminoma (PCS), and to determine whether whole abdominal-pelvic irradiation for Stage I disease is ... [more ?] Purpose: To
analyze the clinical characteristics, prognosis, and treatment
outcome of pelvic cryptorchid seminoma (PCS), and to determine
whether whole abdominal-pelvic irradiation for Stage I disease
is necessary. Methods and Materials: From 1958 to 1991,60 patients
with PCS were treated at the Cancer Hospital of Chinese Academy
of Medical Sciences, Beijing. They presented with a lower abdominal
mass and showed a predominance for the right side. A high proportion
of patients with PCS [ 26 of 60 (43% )] had metastatic disease,
compared to 20% of those with scrotal seminoma, and there was
a tendency toward a higher frequency of pelvic nodal metastases.
There were 34 Stage I, 6 Stage IIA, 11 Stage IIB, 5 Stage III,
and 4 Stage IV patients. Of these 60 patients, 56 underwent laparotomy
with or without cryptorchiectomy (37 radical orchiectomy, 7 partial
orchiectomy, and 12 biopsy of the primary or cervical node), and
4 cervical node biopsy only. All patients were further treated
with radiotherapy, chemotherapy, or a combination of both. Patients
with Stage I and II disease received radiotherapy, whereas patients
with Stage III and IV were treated with chemotherapy. Results:
The overall and disease-free survivals at 5 and 10 years were
92% and 87%, and 88% and 84%, respectively. The 5- and lo-year
survivals were 100% for Stage I, 94% and 87% for Stage II, and
56% and 42% for Stage III/IV, respectively @ < 0.05). Volume
of irradiation, i.e., whole abdominal-pelvic radiotherapy ( 10
patients), versus hockey-stick encompassing paraaortic, ipsilateral
iliac nodes and the primary tumor or tumor bed (17) did not influence
outcome in Stage I patients. Five patients relapsed within 2-12
years after treatment, and four of these patients were successfully
salvaged. Four patients developed a second malignant tumor and
died. Conclusion: Stage I and II PCS can he adequately controlled
by radiotherapy regardless of the surgical procedure. Whole abdominal-pelvic
irradiation for Stage I and IIA disease is not required, and fields
can be limited to the paraaortic, ipsilateral iliac nodes and
primary tumor or tumor bed. We recommend platinum-based chemotherapy
for Stage IIB-IV PCS. 0 1997 Elsevier Science Inc. [less ?] in Cancer Research (1997), 57 Antitumor and radiosensitizing effects of (E).2'-deoxy.2'-(fluromethyl ene) cytidine (FMdC), a novel inhibitor of ribonucleotide reductase, were evaluated on nude mice bearing s.c. xenografts and liver ... [more ?] Antitumor
and radiosensitizing effects of (E).2'-deoxy.2'-(fluromethyl ene)
cytidine (FMdC), a novel inhibitor of ribonucleotide reductase,
were evaluated on nude mice bearing s.c. xenografts and liver
metastases of a human colon carcinoma. FMdC given once daily or
twice weekly has a dose-dependent antitumor effect. The maximum
tolerated dose In the mice was reached with 10 mgi'kg applied
daily over 12 days. Twice weekly administration of FMdC reduced
its toxicity but lowered the antitumor effect. Treatment of preestablished
liver micrometastases obtained via intrasplenic injection of tumor
cells, with 5 or 10 mgfkg FMdC, signifi candy prolonged the survival
of the mice as compared to controls (P < 0.025 and P < 0.001,
respectively). Ten mg/kg resulted in longer survival than S mg/kg
FMdC (P < 0.05). Radiotherapy alone of s.c. xenografts (10
fractions over 12 days) yielded the radiation dose required to
produce local tumor control in 50% of the treated mice (TCD@O)of
43.0 Gy. When combined with FMdC, TCDsawas reduced to 22.5 and
19.0 Gy at doses of 5 and 10 mg/kg given i.p. 1 h before each
irradiation, respec tively. The corresponding enhancement ratios
were 1.91 and 2.43, respec lively. FMdC produced moderate and
reversible myelosuppression. When 5 mg/kg FMdC was combined with
irradiation, there was no increased skin or hematological toxicity
as compared to radiotherapy or FMdC alone. At the 10 mg/kg level,
however, lower leukocyte counts were observed. These results show
that FMdC appears to be a potent anticancer drug and radiosensitizer
[less ?] in Cancer Research (1997), 57 Timing effects of radioimmunotherapy (HIT) combined with external beam radiotherapy (RT) were assessed In human colon carcinoma xe nografts. Initially, dose effects offractlonated RT and RIT were ... [more ?] Timing effects
of radioimmunotherapy (HIT) combined with external beam radiotherapy
(RT) were assessed In human colon carcinoma xe nografts. Initially,
dose effects offractlonated RT and RIT were evaluated separately.
Then, 30 Gy RT (10 fractions over 12 days) were combined with
three weekly Lv. injections of 200 g@Ci of 131I-labeled anti-carcino
embryonic antigen monoclonal antibodies in four different treatment
schedules. RIT was given either prior to, concurrently, Immediately
after, or 2 weeks after RT administration. The longest regrowth
delay (RD) of 105 days was observed in mice treated by concurrent
administration of RT and lilT, whereas the RDs of RT and RIT alone
were 34 and 20 days, respectively. The three sequential combination
treatments produced sig nificantly shorter RDs ranging from 62
to 70 days. The tumor response represented by the minimal volume
(MV) also showed that concurrent administration of RT and RIT
gave the best result, with a mean MV of 4.5% as compared to MVs
from 26 to 53% for the three sequential treatments. The results
were confirmed In a second experiment, In which a RT of 40 Gy
was combined with an identical lilT as above (three injections
of 200 g&Ci of ‘31I-labeled monoclonal antibodies).
At compa rable toxicity levels, the maximum tolerated RT or BIT
alone gave shorter RDs and less tumor shrinkage compared to slinultaneous
RT+RIT. These results may be useful for designing clinical protocols
ofcombined RIT and RT. [less ?] in International Journal of Radiation, Oncology, Biology, Physics (1997), 36 Purpose: The purpose of this study was to analyze prognosis and treatment results for seminoma arising in corrected and uncorrected inguinal cryptorchidism (SCIC and SUIC). Methods and Materials: We ... [more ?] Purpose: The
purpose of this study was to analyze prognosis and treatment results
for seminoma arising in corrected and uncorrected inguinal cryptorchidism
(SCIC and SUIC). Methods and Materials: We reviewed 66 patients
with inguinal seminomas between June 1958 and December 1991 at
the Cancer Hospital and Institute of Chinese Academy of Medical
Sciences. Of these patients, 23 had prior orchiopexy and 43 presented
with an inguinal form of cryptorchidism. At presentation, 17 of
66 (26%) patients had nodal metastases. This nodal involvement
was 30% (7 of 23) for SCIC and 23% (10 of 43) for SUIC, respectively.
These numbers are comparable with those in a series of patients
treated for scrotal seminoma at our institution (26% vs. 20%).
However, 3 of 23 (13%) patients who had prior orchiopexy presented
with inguinal nodal metastasis as compared with 0 of 43 patients
with SUIC or 4 of 237 patients with scrotal seminoma (p < .05).
There were 49 stage I, 5 stage IIA, 8 stage IIB, 3 stage III,
and 1 stage IV patients. All patients underwent radical orchiectomy
and received further radiotherapy, chemotherapy, or both. Patients
with stage I and stage II disease were treated primarily with
radiotherapy, whereas patients with stage III and IV disease were
treated with chemotherapy. Results: The overall and disease-free
survival at 5 and 10 years was 94% and 92%, 89% and 87%, respectively.
The overall 5- and lo-year survival by stage was 100% and 100%
for stage I, and 77% and 68% for stage II, respectively @ <
.05). There was no significant difference in survival between
SUIC and SCIC (93% vs. 96% at 5 years). Four patients developed
relapse. Two of these four patients experienced relapse at the
inguinal area, due to a marginal miss. Three of four patients
with relapse were successfully salvaged, and one died of disease.
Conclusion: Our results indicate that prognosis for inguinal seminoma
is excellent and similar to that of scrotal seminoma. Postorchiectomy
radiotherapy can be considered as the standard treatment for stage
I and IIA inguinal seminoma. We recommend routinely including
the para-aortic and ipsilateral pelvic nodes. 0 1997 Elsevier
Science Inc. [less ?] in Radiotherapy & Oncology (1997), 45 Abstract Background and purpose: This work was undertaken to improve the definition of target volumes for radiosurgery using the angiographic and CT data. Materials and methods: The basis of this new ... [more ?] Abstract Background
and purpose: This work was undertaken to improve the definition
of target volumes for radiosurgery using the angiographic and
CT data. Materials and methods: The basis of this new method is
to combine both imaging modalities and to compare them in each
representation, i.e. to plot the volume obtained by angiography
on CT images and also the contours defined by the CT on angiographic
films. To obtain the angiographic volume, the radiographs are
taken at several incidence angles. The X-ray sources position
and the position of the films are determined using rectangular
markers, then the intersection of all the loci of the target volume
are calculated. Results: Verifications with a phantom show the
accuracy of the procedure and the benefit obtained by increasing
the number of angles of incidence in the angiographic imaging.
The centre of gravity of the experimental target could be localized
to an accuracy of better than 0.4 mm. The method was used in 11
clinical cases with excellent clinical results. Conclusions: The
method can be easily applied and improves the delineation of target
volumes in radiosurgery. CT data counterbalances the relative
weakness of angiography concerning the three-dimensional geometry.
Angiography adds useful information on the blood flow that is
not shown in CT. Almost all the presented clinical cases benefit
from the technique described here. [less ?] in International
Journal of Radiation, Oncology, Biology, Physics (1997), 39(2
(Supplément)), 295 in Médecine et Hygiène (1996), 54(2121), 1241-1245 La mort cellulaire active (apoptose) est un phénomène ubiquitaire dans les organismes multicellulaires. L'apoptose joue un rôle essentiel dans la genèse d'un cancer et dans la réponse au traitement ... [more ?] La mort cellulaire
active (apoptose) est un phénomène ubiquitaire dans
les organismes multicellulaires. L'apoptose joue un rôle
essentiel dans la genèse d'un cancer et dans la réponse
au traitement oncologique. Les radiations ionisantes sont capables
d'induire une mort mitotique et une mort apoptotique. Nous définissons
les caractéristiques radiobiologiques de chaque type de
mort cellulaire et situons l'importance de l'apoptose pour la
réponse tumorale aux radiations ionisantes. La modulation
de ce «suicide cellulaire» devrait permettre une amélioration
de l'index thérapeutique mais ceci implique une connaissance
approfondie des mécanismes qui règlent l'apoptose
[less ?] in Radiotherapy
& Oncology (1996), 43(Supp 1), 6 in Gynecologic
Oncology (1996), 60 in European Journal of Obstetrics & Gynecology & Reproductive Biology (1996) Objective: To verify the influence of age on the prognosis of cervix carcinoma. Study design: Five hundred and sixty eight patients treated for a FIGO stage IB-IVA with radical irradiation in the Centre ... [more ?] Objective:
To verify the influence of age on the prognosis of cervix carcinoma.
Study design: Five hundred and sixty eight patients treated for
a FIGO stage IB-IVA with radical irradiation in the Centre Hospitalier
Universitaire Vaudois of Lausanne were subdivided according to
the following age categories: _<45, 46-60, 61-69 and > 70
years. Taking the 46-60 years age group as the reference, the
hazard ratios (HR) of death and corresponding 95% confidence intervals
(95% CI) were estimated by means of a Cox multivariate analysis.
Results: The 5-year survival rates were, respectively, 57%, 67%,
60% and 45%. For the youngest women the risk of death was significantly
increased (HR = 2.00, 95% CI [1.32-3.00]) and was even more accentuated
in advanced stages. Conclusion: Age under 45 years is a bad prognostic
factor in carcinoma of the cervix. [less ?] in International
Journal of Radiation, Oncology, Biology, Physics (1996), 36(1
(supp1)), 383 in International
Journal of Radiation, Oncology, Biology, Physics (1996), 36(1(supp1)),
384 in Radiotherapy
& Oncology (1996), 40(Supp 1), 55 in Radiotherapy
& Oncology (1996), 40(Supplément 1), 135 in Chemical Modifiers of Cancer Treatment (1995, August 22) Le traitement
oncologique : polémique ou consensus ? in Médecine et Hygiène (1995), 53(2076), 1371-1377 Les avis en oncologie sont souvent divergents. Ils illustrent un manque de «standard» thérapeutique bien établi. Cette revue a pour but de définir certaines de ces divergences fortement colorées par la ... [more ?] Les avis en
oncologie sont souvent divergents. Ils illustrent un manque de
«standard» thérapeutique bien établi.
Cette revue a pour but de définir certaines de ces divergences
fortement colorées par la spécialisation du médecin
consulté. Ces divergences cesseront d'exister à
condition de conduire des essais randomisés. Le praticien
généraliste a un rôle prépondérant
à jouer dans la motivation des malades afin qu'ils acceptent
l'idée de ce genre d'étude. [less ?] in Médecine et Hygiène (1995), 53(2088), 2002--2009 La radiochirurgie, appelée radiothérapie stéréotaxique lorsqu'il s'agit d'un traitement fractionné, s'effectue en Suisse depuis 1993, soit par accélérateur linéaire modifié, soit par Gamma Knife. Par ... [more ?] La radiochirurgie,
appelée radiothérapie stéréotaxique
lorsqu'il s'agit d'un traitement fractionné, s'effectue
en Suisse depuis 1993, soit par accélérateur linéaire
modifié, soit par Gamma Knife. Par cette technique on arrive
à administrer une dose élevée de radiations
à des lésions intracrâniennes circonscrites
d'une taille de 3 à 4 cm au maximum, tout en ménageant
les tissus normaux avoisinants. Lorsque les lésions sont
plus grandes, mal délimitées, ou de forme irrégulière,
c'est la radiothérapie conventionnelle et conformationnelle
qui offre une meilleure répartition des doses. Les principales
lésions considérées pour la radiochirurgie
sont les malformations artérioveineuses, les métastases
cérébrales solitaires, les méningiomes de
la base, les schwannomes vestibulaires et certaines récidives
focales de gliomes. [less ?] in European
Journal of Cancer (1995), 31(A), 844-6 in Acta Oncologica (1995) Abstract The potential effect of AZT as a thymidine analogue on radiation response in vitro was investigated. Two human cell lines (WiDr and HeLa) were used. The effect of 10 ?M AZT on exponentially ... [more ?] Abstract The
potential effect of AZT as a thymidine analogue on radiation response
in vitro was investigated. Two human cell lines (WiDr and HeLa)
were used. The effect of 10 ?M AZT on exponentially growing cells
was studied after different exposure times (24, 48 and 72 h).
The surviving fraction (clonogenic assay) or metabolic activity
(MTT assay) after irradiation of AZT-exposed cells, was compared
to unexposed irradiated controls. Flow cytometry was used to assess
the cell-cycle effect of pre-exposure of exponentially growing
cells to AZT. AZT had a radioprotective effect for all experimental
time points as far as WiDr was concerned. For HeLa the effect
was significant at 24 h. Cell-cycle analysis showed a significant
accumulation in S-phase at 72 h for WiDr. For HeLa there was a
significant accumulation in S-phase at 48 h. We conclude that
under the reported experimental conditions, AZT as a thymidine
analogue seems to reduce the cytotoxic effect of irradiation.
[less ?] in Cancer Research (1995), 55 The effect of combined radioimmunotherapy (RIT) and fractionated external beam radiotherapy (RT) was assessed in two human colon cancer xenografts, Col 12 and LS174T in nude mice. These tumors were ... [more ?] The effect
of combined radioimmunotherapy (RIT) and fractionated external
beam radiotherapy (RT) was assessed in two human colon cancer
xenografts, Col 12 and LS174T in nude mice. These tumors were
selected for being resistant to RIT alone, as is usually the case
in the clinical situation. Tumor-bearing mice were treated with
a combination of five X-ray fractions over 5 days followed by
RIT with two doses of 1.5 mCi 131I-labeled anticarcinoembryonic
antigen monoclonal antibody F(ab')2. In Col 12 and LS174T, RIT
alone achieved a regrowth delay similar to that of fractionated
RT with total doses of 28 and 26 Gy, respectively. In both tumor
types, an additive therapeutic effect, measured as increased regrowth
delay or local control, was observed when combining RT of different
dose levels with RIT. Normal tissue responses were assessed by
monitoring acute peak skin reactions and blood cell count. Bone
marrow depression for the combination treatment was similar to
that of RIT alone; relative to skin, at equitoxic levels, no mice
bearing Col 12 tumors were locally controlled with a 32 Gy RT
dose alone, while this RT combined with RIT gave a local control
of 100%. These studies show a therapeutic benefit when external
beam RT is combined with RIT. [less ?] in European Journal of Cancer Prevention (1995) A prospective trial was performed to better assess the risk of nausea and vomiting and the rescue value of tropisetron (TRO), a 5HT3 receptor antagonist, in 88 patients undergoing fractionated ... [more ?] A prospective
trial was performed to better assess the risk of nausea and vomiting
and the rescue value of tropisetron (TRO), a 5HT3 receptor antagonist,
in 88 patients undergoing fractionated radiotherapy to the abdomen
or to large supradiaphragmatic fields and failing a first anti-emetic
trial with metoclopramide (MET). Nausea was graded 0 (absent),
1 (mild), 2 (moderate) and 3 (severe). Nausea requiring anti-emetics
(L grade 2) was present in 64% of the patients. MET was able to
control nausea (I grade 1) in 26 of 58 patients (45%) who developed
1 grade 2 nausea during radiation treatment (2 patients vomiting
without nausea included). 34 patients required TRO, and 31 experienced
immediate relief. However, nausea (1 grade 2) recurred in 7 patients
from 1 to 3 weeks after starting, TRO. Sex, age, field type and
field size (cm*) did not influence the incidence and severity
of nausea and vomiting. Only 24188 patients vomited after starting
radiotherapy. MET helped to eliminate emesis in one third of these
patients. TRO helped to control vomiting in 73% of the salvaged
patients. Constipation was observed in 8 patients on TRO and was
a reason to stop the medication in 4 cases. [less ?] in International Journal of Radiation, Oncology, Biology, Physics (1995), 32(1), 181-188 Purpose: To demonstrate the feasibility of preoperative Hyperfractionated Accelerated RadioTherapy (preop-HART) in rectal cancer and to explain the rationales to switch from postoperative HART to ... [more ?] Purpose: To
demonstrate the feasibility of preoperative Hyperfractionated
Accelerated RadioTherapy (preop-HART) in rectal cancer and to
explain the rationales to switch from postoperative HART to preoperative
HART. Methods and 1989. In trial Materials: Fifty-two consecutive
patients were introduced in successive Phase I trials since 89-01.
m&operative HART (48 Gv in 3 weeks) was applied in 20 patients.
In nine patients with locally advanced rectal cancer, considered
unresectable by the surgeon, 32 Gy in 2 weeks was-applied prior
to surgery (trial 89-02). Since 1991, 41.6 Gy in 2.5 weeks has
been applied preoperatively to 23 patients with T3-T4 any N rectal
cancer immediately followed by surgery (trial 91-01). All patients
were irradiated at the department of radiation-oncology with a
four-field box technique (1.6 Gy twice a day and with at least
a 6-h interval between fractions). The minimal accelerating potential
was 6 MV. Acute toxicity was scored according to the World Health
Organization (WHO for skin and small bowel) and the Radiation
Therapy Oncology Group criteria (RTOG for bladder). This was done
weekly during treatment and every 3 months thereafter. Small bowel
volume was estimated by a modiiied “Gallagher’s”
method. Results: Acute toxicity was acceptable both in postoperative
and preoperative setup. The mean acute toxicity ~significantly
lower in trial 91-01 compared to 89-01. This difference was due
to the smaller amount of small bowel in irradiation field and
lower total dose in trial 91-01. Moreover, there was a significantly
reduced delay between surgery and radiotherapy favoring trial
91-01 (median delay 4 days compared to 46 days in trial 89-01).
Nearly all patients in trial 89-02 and 91-01 underwent surgery
(31 out of 32; 97%). Resection margins were negative in 29 out
of 32. Hospitalization duration in trial 91-01 was not significantly
different from trial 89-01 (19 vs. 21 days, respectively). Conclusions:
Hyperfractionated accelerated radiotherapy immediately followed
by surgery is feasible as far as acute toxicity is concerned.
Preoperative HART is favored by a significantly lower acute toxicity
related, in part, to a smaller amount of irradiated small bowel,
and a shorter duration of the delay between radiotherapy and surgery.
Moreover, the hospital stay after preoperative HART is not significantly
increased. [less ?] in European Journal of Cancer (1995), 31A INTRODUCTION IONISING RADIATION is known to induce DNA damage and especially double strand breaks (DSB). Subsequent biological responses, in particular repair, cell cycle arrest, and physiological cell ... [more ?] INTRODUCTION
IONISING RADIATION is known to induce DNA damage and especially
double strand breaks (DSB). Subsequent biological responses, in
particular repair, cell cycle arrest, and physiological cell death
(apoptosis), necessitate recognition of the damage and subsequent
mobilisation of a spectrum of proteins. It has been demonstrated
that intracellular signalling via phosphorylation pathways govern
biological response to radiation exposure [l-9]. We aim to discuss
some of the molecular components now under intensive investigation,
which are involved in these processes and which determine the
genetic basis of radioresistance. [less ?] in Strahlentherapie und Onkologie (1994), 170(4), 206-212 Primary cerebral lymphoma is a rare disease. The aim of this study is to compare the survival of the patients treated with radiotherapy alone vs. patients treated with a combined schedule of radio ... [more ?] Primary cerebral
lymphoma is a rare disease. The aim of this study is to compare
the survival of the patients treated with radiotherapy alone vs.
patients treated with a combined schedule of radio-chemotherapy.
Our results will be compared with currently published data and
main prognostic factors will be briefly discussed. PATIENTS AND
METHODS: Between 1974 and 1990, 27 cases of primary cerebral lymphoma
were diagnosed at our institution. All patients had biopsy-proven
disease, the pathology of which was reviewed for this study. RESULTS:
The overall median survival time was 24 months and one-, two-
and three-year overall survival was 59, 46 and 29% respectively.
The median radiation dose was 46 Gy, ranging from 19.5 to 60 Gy.
The median dose per fraction was 2 Gy (ranging from 1.61 to 3
Gy). The median elapsed treatment time was 32 days (ranging from
three to 45 days). We were not able to demonstrate any statistically
significant difference between patients who received radiotherapy
alone (n = 14, median survival time = 24 months) and those who
received a combination of chemotherapy and radiotherapy (n = 11,
median survival time = 30 months), (p = 0.4). Prognostic factors
of survival were tested using a univariate analysis (Wilcoxon
test). Parameters such as mass appearance (unilobular, p = 0.048),
performance status at the time of the diagnosis (0 to 1, p = 0.014),
and CT imaging (hypodense, p = 0.043) influenced positively survival.
Centroblastic histology (Kiel) was found associated with a negative
prognosis (p = 0.043). CONCLUSION: In our experience, there is
no statistically significant difference of survival between patients
treated with radiotherapy alone or with a combined treatment of
radio-chemotherapy. Other prognostic factors of survival were
discovered, although the analysis was univariate, due to the limited
number of patients. Multicentric prospective studies should be
elaborated in order to optimize the treatment of this disease.
[less ?] in Médecine et Hygiène (1994), 52(2037), 1720-1722 L-hyperthermie consiste en l'élévation de la température du corps ou d'une de ses parties, par des moyens externes au-delà de 41°C. La chaleur a une activité cytotoxique propre et provoque une ... [more ?] L-hyperthermie
consiste en l'élévation de la température
du corps ou d'une de ses parties, par des moyens externes au-delà
de 41°C. La chaleur a une activité cytotoxique propre
et provoque une sensibilisation des cellules aux radiations ionisantes
ou à la chimiothérapie. Le gain thérapeutique
est environ de 2. Seules les tumeurs superficielles peuvent être
traitées adéquatement par les moyens actuels. Les
indications sont la palliation de tumeurs superficielles telles
que les récidives loco-régionales du cancer du sein,
les récidives ganglionnaires de cancers ORL et les cancers
de la peau, en particulier les mélanomes [less ?] in International Journal of Radiation, Oncology, Biology, Physics (1993), 24(4), 885-889 To assess the acute toxicity and hence feasibility of postoperative hyperfractionated accelerated radiotherapy in rectal cancer. METHODS AND MATERIALS: Twenty patients were submitted to accelerated ... [more ?] To assess
the acute toxicity and hence feasibility of postoperative hyperfractionated
accelerated radiotherapy in rectal cancer. METHODS AND MATERIALS:
Twenty patients were submitted to accelerated hyperfractionated
radiotherapy after resection of rectal cancer. A total dose of
48 Gy was given in 3 weeks. Two fractions of 1.6 Gy were used
with a mean interfraction interval of at least 6 hours. The pelvic
volume was treated by a four-field box technique using a linear
accelerator (6-18 MV). Acute toxicity was assessed once per week.
Small bowel and skin toxicity were scored according to the criteria
of the World Health Organization. Bladder toxicity was scored
according to the criteria of the Radiation Therapy Oncology Group.
RESULTS: All the patients underwent the treatment as planned except
one. No patient presented grade 3 or 4 bladder toxicity. There
was only one patient who complained from grade 3 skin toxicity
at the end of the treatment. Fourteen patients had some degree
of intestinal toxicity. This was the most frequently occurring
acute side-effect. Only two out of the fourteen patients had intestinal
toxicity exceeding grade 2. CONCLUSION: Hyperfractionated accelerated
radiotherapy on a pelvic volume is feasible [less ?] in International Journal of Radiation, Oncology, Biology, Physics (1993), 27(1), 17-24 To clarify the controversy about the management and prognosis of human chorionic gonadotropin-producing seminoma, the records of 132 patients with abnormal human chorionic gonadotropin values treated with ... [more ?] To clarify
the controversy about the management and prognosis of human chorionic
gonadotropin-producing seminoma, the records of 132 patients with
abnormal human chorionic gonadotropin values treated with radiotherapy
were analyzed. METHODS AND MATERIALS: The records of 1169 patients
with pure seminoma treated in 10 institutions were screened for
serum or urinary human chorionic gonadotropin. One hundred and
thirty two patients with elevated human chorionic gonadotropin
were found: 96 Stage I, 20 IIA, 7 IIB, 8 III and 1 IV. Median
age was 34 y., mean follow-up was 5.0 years [range 1-12 y]. All
received infradiaphragmatic radiotherapy (median dose 30 Gy),
25 (2 Stage I, 11 IIA, 5 IIB and 7 III) supradiaphragmatic radiotherapy
(median dose: 28.5 Gy) and 10 had also initial chemotherapy (3
Stage IIB 6 III and 1 IV). Patients were allocated to three groups
according to human chorionic gonadotropin values: (a) moderate
elevation: up to 10 times (104 pts), (b) high elevation: 10 to
100 times (20 pts), (c) very high elevation: over 100 times the
upper limit of normal value (8 pts). RESULTS: The proportion of
Stage I, II and III was 76%, 19%, 5% in the ME group versus 50%,
35%, 15% in the high elevation group (p < 0.05). In the very
high elevation group there were 7 Stage I and 1 Stage IV. Of 132
patients, six died (three dead of disease, two suicides, one acquired
immunodeficiency syndrome). The 5 years overall survival probability
was 94%. There were seven recurrences (initial stage: 1 Stage
I, 2 IIB, 3 III and 1 IV). Of these, there were one in-field recurrence,
3 out of field and 3 in both sites. In 5 of 7, the human chorionic
gonadotrophin level was again elevated at recurrence. The 5 years
recurrence-free-survival probability was 94% (98% for Stage I,
100% for Stage IIA and 65% for Stage IIB and III [p < 0.001
between I and IIB + III, p < 0.05 between IIA and IIB + III]).
Four of the 7 recurrences were salvaged by chimiotherapy +/- radiotherapy.
In the high elevation and very high elevation groups, the 5 years
recurrence-free-survival was 88%, vs. 96% for the moderate elevation
group (p = 0.10). CONCLUSION: Based on this series of patients,
human chorionic gonadotropin production is not an unfavorable
prognostic factor in pure seminoma. Even in the subgroups with
high or very high human chorionic gonadotropin levels (who had
a higher proportion of advanced stages), the prognosis remained
excellent. In Stage I and IIA seminoma with abnormal human chorionic
gonadotropin levels, recurrence rate after post-operative radiotherapy
alone is extremely low. [less ?] in Radiotherapy
& Oncology (1993), 28(2), 157-161 in Radiotherapy & Oncology (1993), 28(1), 76-78 Fifty-three patients had 54 third-body areas irradiated for breast and prostate bone metastases using the third-body irradiation technique during a period of 6 years. These patients were previously ... [more ?] Fifty-three
patients had 54 third-body areas irradiated for breast and prostate
bone metastases using the third-body irradiation technique during
a period of 6 years. These patients were previously treated with
chemotherapy, hormonal therapy and limited field irradiation.
Seventy percent responded completely and 24% partially. This modality
is safe and effective for pain relief. [less ?] in Bulletin du Cancer. Radiothérapie : Journal de la Société Française du Cancer : Organe de la Société Française de Radiothérapie Oncologique (1993), 80(1), 13-26 La radiothérapie des sarcomes des tissus mous est revue à travers la littérature. Comme la chirurgie, le traitement actinique fait partie du traitement standard. Comparée à la radiothérapie postopératoire ... [more ?] La radiothérapie
des sarcomes des tissus mous est revue à travers la littérature.
Comme la chirurgie, le traitement actinique fait partie du traitement
standard. Comparée à la radiothérapie postopératoire,
l'approche préopératoire et/ou interstitielle offre
l'avantage potentiel de nécessiter de façon plus
systématique une approche multidisciplinaire ab initio.
Par ailleurs, la radiothérapie préopératoire
implique une irradiation des tissus sains moins importante et
donc une réduction probable de la toxicité. Le contrôle
local et la survie sont comparables pour les deux modalités
radiothérapeutiques. Toutefois, la comparaison entre différentes
séries reste ardue vu l'hétérogénéité
des populations étudiées. Une solution serait d'effectuer
une étude randomisée [less ?] in Bulletin
du Cancer. Radiothérapie : Journal de la Société
Française du Cancer : Organe de la Société
Française de Radiothérapie Oncologique (1993), 80(4),
431-437 in Radiotherapy & Oncology (1993), 28 Forty-four eyes in 38 children were treated between 1963 and 1991 by external radiotherapy for retinoblastoma. Treatment modalities varied widely during this period; in addition to radiotherapy there was ... [more ?] Forty-four
eyes in 38 children were treated between 1963 and 1991 by external
radiotherapy for retinoblastoma. Treatment modalities varied widely
during this period; in addition to radiotherapy there was chemotherapy
(16/44), photocoagulation (14/44), and laser therapy or cryotherapy
(14/44). Treatment technique and dose fractionation also varied
widely; lateral beam technique (39/44) versus anterior or anterior/lateral
beam; doses per fraction ranged from 1 to 4.5 Gy, total doses
from 30 to 61.5 Gy, and overall times from 22 to 49 days. Patients
were followed at 3-month intervals, and actuarial survival at
10 years was 88%, with 62% local control. Ten eyes showed clinical
evidence of retinopathy. A multivariate analysis of factors associated
with increased risk of retinopathy was carried out using the Cox
proportional hazards model and the mixture model of Farewell.
The estimated latent time was 17 months (95% confidence interval,
14-20 months). The only factors found to be significantly associated
with retinopathy were total dose multiplied by dose per fraction,
or total dose normalized to the equivalent total dose in 2-Gy
fractions as estimated from the LQ model, and these gave equivalent
descriptions. There were trends (not significant) for increased
risk of retinopathy when treatments included chemotherapy or photocoagulation,
and for decreased risk (also not significant) when cryotherapy
was used in conjunction with radiotherapy. No significance could
be attached to any of the following: number of sites per eye,
Reese-Ellsworth stage, and family history. We conclude that hypofractionation
carries a significant risk for retinopathy in the treatment of
retinoblastoma. [less ?] in Radiotherapy & Oncology (1992), 24(24), 246-250 Radioresistance and postirradiation repair of potentially lethal damage (PLD repair) are important factors underlying failure to control local disease in cancer. Dipyridamole (DP) is known as a modifier ... [more ?] Radioresistance
and postirradiation repair of potentially lethal damage (PLD repair)
are important factors underlying failure to control local disease
in cancer. Dipyridamole (DP) is known as a modifier of the action
of cytotoxic drugs. We therefore investigated DP as a potential
radiosensitizer and inhibitor of PLD repair in X-irradiated Chinese
hamster ovary (CHO) cells in vitro. Exposure to the drug alone
resulted in a slight reduction of the clonogenic capacity of the
cells. Preincubation for 18 h with 10 and 20 microM DP in cells
subcultured at low density, led to a significant radiosensitization.
In confluent density-inhibited cultures, preincubation alone as
well as pre- and postincubation with 20 microM DP resulted in
a significant inhibition of PLD repair. Dipyridamole and related
compounds may thus be useful tools for modifying and investigating
the response of mammalian cells to radiation. [less ?] in Cancer
(1992), 68(12), 3016-3019 in Strahlentherapie und Onkologie (1992), 168(4), 226229 Il s'agit d'un cas clinique d'un patient présentant un cancer du rectum et de la maladie de Crohn. Adjuvant treatment was considered to be mandatory on the basis of local extension. Traitement adjuvant a ... [more ?]
in Helvetica Chirurgica Acta (1991), 58(3), 345-58 Postoperative radiotherapy is highly effective in the prevention of local recurrence in rectal cancer. Nevertheless, the results remain disappointing for Locally Advanced Rectal Cancer. New approaches ... [more ?] Postoperative
radiotherapy is highly effective in the prevention of local recurrence
in rectal cancer. Nevertheless, the results remain disappointing
for Locally Advanced Rectal Cancer. New approaches include introduction
of chemotherapy to postoperative radiotherapy or combined radiotherapeutic
treatment with preoperative irradiation, surgery and intraoperative
irradiation, along with elective postoperative treatment in function
of surgical and pathological data. Based on recent advances in
radiobiology we are able to modify treatment parameters to enhance
efficacy without increasing the toxicity. The reduction of dose
per fraction, the application of radiosensitizers, the optimal
protection of healthy tissue will increase the therapeutic ratio
while keeping results constant or even reduce the incidence of
local failure. [less ?] in Radiotherapy & Oncology (1991), 21(4), 273-276 We assessed the dose-dependence of repair of potentially lethal damage in Chinese hamster ovary cells x-irradiated in vitro. The recovery ratio (RR) by which survival (SF) of the irradiated cells was ... [more ?] We assessed
the dose-dependence of repair of potentially lethal damage in
Chinese hamster ovary cells x-irradiated in vitro. The recovery
ratio (RR) by which survival (SF) of the irradiated cells was
enhanced increased exponentially with a linear and a quadratic
component, namely xi and psi: RR = e xi D + psi D2. Survival of
irradiated cells can thus be expressed by a combined linear-quadratic
model considering four variable, namely alpha and beta for the
capacity of the cells to accumulate sublethal damage, and xi and
psi for their capacity to repair potentially lethal damage: SF
= e(xi - alpha)D + (psi - beta)D2. [less ?] in Schweizerische Medizinische Wochenschrift (1991), 121(29), 1055-61 The combination of radiotherapy and surgery plays a major role in treating pelvic cancer. However, this technique is chiefly limited by the radiosensitivity of the small bowel following postoperative ... [more ?]
|
The
role of COX-2 in rectal cancer treated with preoperative radiotherapy Coucke, Philippe ULg; BOUZOURENE, Hanifa; PU YAN et al in Virchows Archiv : An International Journal of Pathology (2008), 452(5), 499-505 Radiotherapy is one of the principal modalities of rectal cancer treatment, and the ability to predict radio resistance could potentially improve survival through a targeted treatment approach ... [more] Radiotherapy
is one of the principal modalities of rectal cancer treatment,
and the ability to predict radio resistance could potentially
improve survival through a targeted treatment approach. Cyclooxygenase-2
(COX-2) may protect against damage by irradiation that would justify
the use of COX-2 inhibitors. The purpose of this study was to
investigate the potential role of COX-2 in tumor response and
outcome of patients with rectal cancer treated preoperatively
with radiotherapy. Using immunohistochemistry, we examined COX-2
expression in 88 surgical specimens of rectal cancer treated preoperatively
and in 26 pretherapeutic biopsies. We tested whether COX-2 expression
was correlated with clinico-pathologic parameters and with survival
and local recurrence. COX-2 was expressed in 50% of the pretherapeutic
tumor biopsies and in 88.6% of post-irradiated surgical samples.
COX-2 expression was correlated only with enhanced tumor inflammation
(p=0.03) and with tumor volume exceeding 30 cc (p=0.05). COX-2
was not significantly correlated with patient survival, but none
of the patients with COX-2 negative tumors did recur locally,
whereas 80% of patients with local recurrences have COX-2 positive
tumors. We conclude that COX-2 expression is overexpressed in
the majority of rectal cancers treated with radiotherapy and likely
plays a role in local relapse. [less ?] Carcinome
intracanalaire (in situ) du sein : pouvons-nous raisonnablement
éviter les radiothérapie pour certaines patientes
opérées? in Revue Médicale de Liège (2008), 63 (2) Dans le cadre de la prise en charge multidisciplinaire du carcinome intracanalaire du sein (carcinome intra-canalaire in situ = DCIS = Ductal Carcinoma In Situ), on évoque souvent la possibilité de ... [more ?] Dans le cadre
de la prise en charge multidisciplinaire du carcinome intracanalaire
du sein (carcinome intra-canalaire in situ = DCIS = Ductal Carcinoma
In Situ), on évoque souvent la possibilité de renoncer
à la radiothérapie complémentaire après
un geste de chirurgie conservatrice. S’il est vrai que la
radiothérapie, dans ce contexte, n’apporte pas de
bénéfice en survie, il n’en reste pas moins
qu’on observe à long terme un effet bénéfique
en contrôle local. Il existe un effet significativement
marqué sur le taux de rechute de type DCIS et de type invasif
dans les différentes études randomisées destinées
à éclaircir la problématique du rôle
de la radiothérapie. La question est de savoir si on peut
distinguer un sous-groupe de patientes pour qui le contrôle
local n’est pas modifié par l’adjonction d’une
radiothérapie adjuvante. Pour l’instant, nous ne sommes
pas à même de définir ce sous-groupe, car
les critères de sélection n’ont pas été
mis à l’épreuve dans le cadre d’un essai
randomisé. Faute de ces données, il nous semble
plus adéquat de proposer jusqu’à preuve du
contraire, une radiothérapie aux patientes opérées,
même si l’intervention est a priori radicale, mais
conservatrice, et même si les facteurs pronostiques semblent
plutôt favorables. Cependant, la radiothérapie n’est
pas indiquée après une mastectomie. [less ?] Risk
adaptive treatment in Hodgkin's lympoma: reduction of radiation
dose and irradiated volume in Belgian Journal of Medical Oncology [=BJMO] (2008), 2(2), 85-97 Summary Treatment–related late complications on nontarget normal tissues and appearance of secondary malignancies are well known side-effects induced by effective treatment regimens currently used in the ... [more] Summary Treatment–related
late complications on nontarget normal tissues and appearance
of secondary malignancies are well known side-effects induced
by effective treatment regimens currently used in the curative
approach of early and advanced Hodgkin’s lymphoma. Radiotherapy
(RT) and chemotherapy (CT) can lead to these late complications.
Efforts have been conducted to reduce the morbidity and mortality
related to these treatments. In particular there has been a progressive
shift from radiotherapy used as sole modality to chemotherapy
as first line followed by consolidation radiotherapy. As the side-effects
of radiotherapy are linked to dose, volume and interaction with
chemotherapy, trials have been launched to assess the impact of
modifying the characteristics of the radiation treatment. For
early-stage Hodgkin’s lymphoma radiotherapy cannot be avoided
but dose and volume can be reduced. In advanced Hodgkin’s
lymphoma omitting radiotherapy seems reasonable only in case of
complete response (CR). The clinical trials allowing such a paradigm
shift are highlighted in this review. [less ?] Les
tumeurs de la sphere ORL: standards de traitement et nouvelles
approches en radiotherapie. in Revue Médicale de Liège (2008), 63(3), 141-8 We intend to review the general value of radiotherapy in the management of head and neck cancer. Our aim is to define a treatment protocol which is evidence-based and therefore of use in daily clinical ... [more] We intend
to review the general value of radiotherapy in the management
of head and neck cancer. Our aim is to define a treatment protocol
which is evidence-based and therefore of use in daily clinical
practice. There is general agreement on the efficacy of the concomitant
schedules combining radiotherapy and chemotherapy, both in the
adjuvant setting as well as in the exclusive non-surgical approach.
This however does not preclude further research aiming at optimizing
the therapeutic index. As far as neoadjuvant chemotherapy is concerned,
applied prior to radical local treatment, there are no conclusive
data available which allows us to implement this treatment option
in routine clinical practice. This approach deserves further investigations
and patients should be entered in well designed prospective randomized
trials. [less ?] Les
standards de radiothérapie en gynécologie : cancer
du col utérin in Gunaïkeia (2008), 13(5), 149-153 Sur base de la littérature, nous voulons faire le point sur ce qui peut être considéré comme une approche standard pour le traitement du cancer du col utérin. Nous évoquerons en particulier les questions ... [more] Sur base de
la littérature, nous voulons faire le point sur ce qui
peut être considéré comme une approche standard
pour le traitement du cancer du col utérin. Nous évoquerons
en particulier les questions suivantes: traitement adjuvant après
chirurgie pour les stades précoces, la chirurgie adjuvante
après une première chimio-radiothérapie pour
les stades avancés, la place de la chimiothérapie
néo-adjuvante ainsi que d’autres modalités
destinées à augmenter l’effet anti-tumoral
des radiations ionisantes. Introduction La prise en charge des
cancers dans la sphère gynécologique nécessite
une concertation multidisciplinaire ab initio. En effet, différentes
approches peuvent être envisagées, et il est primordial
de définir avant tout acte thérapeutique la séquence
et la synchronisation des différentes modalités
afin d’assurer au mieux un succès thérapeutique.
La radiothérapie a un rôle central à jouer
dans la prise en charge d’une patiente souffrant d’un
cancer du col utérin. Une revue non exhaustive de la littérature
publiée permet de déterminer sur la base des résultats
d’essais randomisés ce qui peut raisonnablement être
considéré comme une approche «standard».
Cette approche permet aussi de facto de définir quels sont
les points d’ombre qui méritent que l’on conduise
des essais randomisés dessinés spécifiquement
pour répondre à une question précise. Les
tumeurs de la shpère ORL: standards de traitement et nouvelles
approches en radiothérapie. in Revue Médicale de Liège (2008), 63(3) Nous voulons faire le point concernant la place de la radiothérapie et de la radio-chimiothérapie dans les tumeurs de la sphère ORL. Notre but est de déterminer une attitude thérapeutique basée sur l ... [more] Nous voulons
faire le point concernant la place de la radiothérapie
et de la radio-chimiothérapie dans les tumeurs de la sphère
ORL. Notre but est de déterminer une attitude thérapeutique
basée sur l'évidence publiée afin de l'implémenter
de façon systématique dans la pratique journalière.
Le consensus est obtenu concernant l'utilité des associations
concomitantes de radiothérapie et de chimiothérapie
en adjuvant (postopératoire) et en approche curative (sans
chirurgie). Ceci n'exclut toutefois pas la recherche dans le domaine
de l'optimisation de ces modalités thérapeutiques.
Quant à la chimiothérapie néo-adjuvante,
il est admis qu'elle soit utilisée afin de tenter d'éviter
une intervention chirurgicale mutilante, malgré une diminution
de survie. Des essais randomisés doivent confirmer la validité
de cette approche. Les
standards de radiothérapie en gynécologie: cancer
du sein in Onco : Revue Multidisciplinaire d'Oncologie (2008), 2(4), 138-141 Introduction Les cancers gynécologiques, et en particulier les cancers mammaires, bénéficient d’une prise en charge multidisciplinaire et concertée. Dans le contexte multidisciplinaire, la radiothérapie ... [more] Introduction
Les cancers gynécologiques, et en particulier les cancers
mammaires, bénéficient d’une prise en charge
multidisciplinaire et concertée. Dans le contexte multidisciplinaire,
la radiothérapie externe tient un rôle important
visant à consolider en premier lieu le contrôle local
mais également à améliorer la survie. Par
une revue de la littérature nous voulons décrire
les «standards» établis, en particulier pour
la composante radiothérapie de cette approche multidisciplinaire.
Cette recherche de «standards» permet par ailleurs
d’évoquer un certain nombre de questions restées
à ce jour ouvertes et qui méritent d’être
évaluées de façon prospective et randomisée.Conclusions
La radiothérapie externe améliore significativement
le contrôle local, à tel point qu’on ne peut
s’abstenir de la proposer à toute patiente après
chirurgie conservatrice, que ce soit pour une tumeur infiltrante
ou un carcinome intra-canalaire. Après mastectomie, on
retiendra l’indication si on objective une atteinte axillaire
ou si d’autres facteurs sont présents tels que la
taille tumorale, la proximité de la tumeur vis-à-vis
de la marge de résection, l’atteinte cutanée
et la présence d’une large composante d’emboles
lympho-vasculaires. L’impact sur la survie de ce traitement
adjuvant local n’est de loin pas négligeable puisque
finalement comparable en chiffre absolu à l’impact
sur la survie d’un traitement systémique. L’abstention
thérapeutique n’est donc pas de mise, à l’exception
de ces patientes traitées par mastectomie, chez qui aucune
atteinte ganglionnaire n’est objectivée et chez qui
aucun facteur tumoral ou pathologique ne semble indiquer un risque
majoré de récidives locales. L’âge avancé
de la patiente n’est pas une raison suffisante pour prôner
l’abstention thérapeutique (28). La radiothérapie
partielle du sein, très populaire aux USA, mérite
que l’on s’y intéresse dans le cadre d’un
essai prospectif randomisé. [less ?] How
much is enough? in Onco : Revue Multidisciplinaire d'Oncologie (2008), 2(6), 221-222 Le traitement conservateur est une constante dans l’approche oncologique. Des efforts ont été développés afin de conserver au maximum l’intégrité de la fonction et/ou de l’image corporelle. Ce souci de ... [more] Le traitement
conservateur est une constante dans l’approche oncologique.
Des efforts ont été développés afin
de conserver au maximum l’intégrité de la fonction
et/ou de l’image corporelle. Ce souci de sauvegarde se traduit
par des approches thérapeutiques non mutilantes: un exemple
typique est le changement de paradigme thérapeutique au
moment de l’introduction de la chirurgie conservatrice de
la glande mammaire en lieu et place de la mastectomie. Ce concept
de chirurgie non radicale a été possible grâce
à l’association avec la radiothérapie externe
postopératoire. Des essais randomisés ont permis
de valider le concept et de démontrer que le risque de
rechute loco-régionale et ultérieurement la survie
ne sont pas modifiés comparés à une approche
chirurgicale potentiellement délabrante. Ces essais randomisés
ne se sont fort heureusement pas limités aux aspects purement
oncologiques. De façon prospective on a pu déterminer
l’excellence des résultats cosmétiques à
moyen et à long terme. Il est vrai que cette approche par
essais randomisés était un passage indispensable
et a permis de valider ce concept thérapeutique. Il aurait
été pour le moins étonnant de prôner
d’emblée une approche chirurgicale non mutilante mais
oncologiquement complète, si à terme le résultat
esthétique aurait été inférieur à
celui que l’on aurait pu escompter après mastectomie
radicale suivie de reconstruction. [less ?] Les
standards de radiothérapie en gynécologie: cancer
du sein (Gunaikeia) in Gunaïkeia (2008), 13(7), 211-214 Aan de hand van de literatuur willen we een overzicht geven van wat als een standaardbehandeling kan worden beschouwd bij borstkanker. We hebben het vooral over de plaats van radiotherapie bij ductaal ... [more] Aan de hand
van de literatuur willen we een overzicht geven van wat als een
standaardbehandeling kan worden beschouwd bij borstkanker. We
hebben het vooral over de plaats van radiotherapie bij ductaal
carcinoom en over de onmogelijkheid om momenteel een subgroep
van patiënten te definiëren bij wie zou kunnen worden
afgezien van bestraling na de heelkundige ingreep. Voor infiltrerende
borstkanker die met conservatieve borstklierchirurgie wordt behandeld,
nemen we de recente publicaties door over het belang van een boost
op het operatieveld na bestraling van de borstklier. We bespreken
ook het gunstige effect op de overleving van radiotherapie na
mastectomie bij patiënten met klierinvasie, ongeacht het
aantal positieve klieren. Verder behandelen we enkele nog hangende
punten in verband met de praktische aspecten van radiotherapie
zoals het doelvolume en de fractionering. The
role of Cox-2 in rectal cancer treated with preoperative radiotherapy. in Virchows Archiv : An International Journal of Pathology (2008), 452(5), 499-505 Abstract Radiotherapy is one of the principal modalities of rectal cancer treatment, and the ability to predict radio resistance could potentially improve survival through a targeted treatment approach ... [more] Abstract Radiotherapy
is one of the principal modalities of rectal cancer treatment,
and the ability to predict radio resistance could potentially
improve survival through a targeted treatment approach. Cyclooxygenase-2
(COX-2) may protect against damage by irradiation that would justify
the use of COX-2 inhibitors. The purpose of this study was to
investigate the potential role of COX-2 in tumor response and
outcome of patients with rectal cancer treated preoperatively
with radiotherapy. Using immunohistochemistry, we examined COX-2
expression in 88 surgical specimens of rectal cancer treated preoperatively
and in 26 pretherapeutic biopsies. We tested whether COX- 2 expression
was correlated with clinico-pathologic parameters and with survival
and local recurrence. COX-2 was expressed in 50% of the pretherapeutic
tumor biopsies and in 88.6% of post-irradiated surgical samples.
COX-2 expression was correlated only with enhanced tumor inflammation
(p=0.03) and with tumor volume exceeding 30 cc (p=0.05). COX-2
was not significantly correlated with patient survival, but none
of the patients with COX-2 negative tumors did recur locally,
whereas 80% of patients with local recurrences have COX-2 positive
tumors. We conclude that COX-2 expression is overexpressed in
the majority of rectal cancers treated with radiotherapy and likely
plays a role in local relapse. [less ?] Innovations
technologiques en radiothérapie-oncologie in Revue Médicale de Liège (2007), 62 (5-6) InnovatIve technologIes In radIatIon oncology SUMMARY : At present, radiation oncology is again flourishing thanks to the development of highly accurate techniques as intensity modulated radiation therapy ... [more] InnovatIve
technologIes In radIatIon oncology SUMMARY : At present, radiation
oncology is again flourishing thanks to the development of highly
accurate techniques as intensity modulated radiation therapy,
stereotactic radiation therapy and hadrontherapy. These therapeutic
modalities are made possible by the advent of image guided radiation
therapy and respiratory gating that allows a better patient repositioning
during the irradiation and between fractions. Nowadays, thanks
to these recent technological advances, one can more easily conceive
dose escalation, hypofractionation and combined treatment of radiation
with sensitizing drugs and this together with a better protection
of normal tissue aiming at, simultaneously, improved tumour control
and better quality of life. This article describes these innovative
technologies that, when integrated to other anti-tumoral therapeutic
modalities, seem to be very promising. Keywords : - [less ?] Simultaneous
alteration of the de novo and salvage pathway to the deoxynucleoside
thriphosphate pool by (E)-2'-deoxy-(fluoromethylene)cytidine (FMDC)
and zidovudine (AZT) results in increased radiosensitivity in
vitro. in Acta Oncologica (2007), 46 Abstract To test whether a thymidine analog zidovudine (=AZT), is able to modify the radiosensitizing effects of (E)-2'-Deoxy-(fluoromethylene)cytidine (FMdC). A human colon cancer cell line Widr was ... [more] Abstract To
test whether a thymidine analog zidovudine (=AZT), is able to
modify the radiosensitizing effects of (E)-2'-Deoxy-(fluoromethylene)cytidine
(FMdC). A human colon cancer cell line Widr was exposed for 48
hours prior to irradiation to FMdC. Zidovudine was added at various
concentrations immediately before irradiation. We measured cell
survival and the effect of FMdC, AZT and FMdC + AZT on deoxynucleotide
triphosphate pool. FMdC results in a significant increase of radiosensitivity.
The enhancement ratios (ER =surviving fraction irradiated cells/surviving
fraction drug treated and irradiated cells), obtained by FMdC
or AZT alone are significantly increased by the combination of
both compounds. Adding FMdC to AZT yields enhancement ratios ranging
from 1.25 to 2.26. FMdC reduces dATP significantly, with a corresponding
increase of TTP, dCTP and dGTP. This increase of TTP, dCTP and
dGTP is abolished with the addition of AZT. Adding AZT to FMdC
results in a significant increase of the radiosensitizing effect
of FMdC. This combination appears to reduce the reactive enhancement
of TTP, dCTP and dGTP induced by FMdC while it does not affect
the inhibitory effect on dATP. [less ?] Effect
of timing of surgery on survival after preoperative hyperfractionated
accelerated radiotherapy (HART) for locally advanced rectal cancer
(LARC): Is it a matter of days? in Acta Oncologica (2006), 45(8), 1086-1093 We intend to analyse retrospectively whether the time interval ("gap duration" = GD) between preoperative radiotherapy and surgery in locally advanced rectal cancer (LARC) has an impact on overall ... [more] We intend
to analyse retrospectively whether the time interval ("gap
duration" = GD) between preoperative radiotherapy and surgery
in locally advanced rectal cancer (LARC) has an impact on overall
survival (OS), cancer specific survival (CSS), disease free survival
(DFS) and local control (LC). Two hundred seventy nine patients
with LARC were entered in Trial 93-01 (hyperfractionated accelerated
radiotherapy 41.6 Gy/26 Fx BID) shortly followed by surgery. From
these 250 patients are fully assessable. The median GD of 5 days
was used as a discriminator. The median follow-up for all patients
was 39 months. GD > 5 days was a significant discriminator
for actuarial 5-years OS (69% vs 47%, p = 0.002), CSS (82% vs
57%, p = 0.0007), DFS (62% vs 41%, p = 0.0003) but not for LC
(93% vs 90%, p = non-significant). In multivariate analysis, the
following factors independently predict outcome; for OS: age,
GD, circumferential margin (CM) and nodal stage (ypN); for CSS:
GD, ypN and vascular invasion (VI); for DFS: CEA, distance to
anal verge, GD, ypN and VI; for LC: CM only. Gap duration predicts
survival outcome but not local control. The patients submitted
to surgery after a median delay of more than 5 days had a significantly
better outcome. [less ?] CPT-11
and concomitant hyperfractionated accelerated radiotherapy induce
efficient local control in rectal cancer patients: results from
a phase II in British Journal of Cancer (2006), 95(6), 710-716 Patients with rectal cancer are at high risk of disease recurrence despite neoadjuvant radiochemotherapy with 5-Fluorouracil (5FU), a regimen that is now widely applied. In order to develop a regimen with ... [more] Patients with
rectal cancer are at high risk of disease recurrence despite neoadjuvant
radiochemotherapy with 5-Fluorouracil (5FU), a regimen that is
now widely applied. In order to develop a regimen with increased
antitumour activity, we previously established the recommended
dose of neoadjuvant CPT-11 (three times weekly 90 mgm 2) concomitant
to hyperfractionated accelerated radiotherapy (HART) followed
by surgery within 1 week. Thirty-three patients (20 men) with
a locally advanced adenocarcinoma of the rectum were enrolled
in this prospective phase II trial (1 cT2, 29 cT3, 3 cT4 and 21
cNþ). Median age was 60 years (range 43–75 years).
All patients received all three injections of CPT-11 and all but
two patients completed radiotherapy as planned. Surgery with total
mesorectal excision (TME) was performed within 1 week (range 2–15
days). The preoperative chemoradiotherapy was overall well tolerated,
24% of the patients experienced grade 3 diarrhoea that was easily
manageable. At a median follow-up of 2 years no local recurrence
occurred, however, nine patients developed distant metastases.
The 2-year disease-free survival was 66% (95% confidence interval
0.48–0.83). Neoadjuvant CPT-11 and HART allow for excellent
local control; however, distant relapse remains a concern in this
patient population. British Journal of Cancer (2006) 95, 710–716.
doi:10.1038/sj.bjc.6603322 www.bjcancer.com Published online 29
August 2006 & 2006 Cancer Research UK [less ?] in Radiotherapy & Oncology (2006), 79 Abstract Background and purpose: We aim to report on local control in a phase II trial on preoperative hyperfractionated and accelerated radiotherapy schedule (HART) in locally advanced resectable rectal ... [more ?] Abstract Background
and purpose: We aim to report on local control in a phase II trial
on preoperative hyperfractionated and accelerated radiotherapy
schedule (HART) in locally advanced resectable rectal cancer (LARC).
This fractionation schedule was designed to keep the overall treatment
time (OTT) as short as possible. Patients and methods: This is
a prospective trial on patients with UICC stages II and III rectal
cancer. The patients were submitted to a total dose of 41.6 Gy,
delivered in 2.5 weeks at 1.6 Gy per fraction twice a day with
a 6-h interfraction interval. Surgery was performed within 1 week
after the end of irradiation. Adjuvant chemotherapy was delivered
in a subset of patients. Results: Two hundred and seventy nine
patients were entered and 250 are fully assessable, with a median
follow-up of 39 months. The 5-years actuarial local control (LC)
rate is 91.7%. The overall survival (OS) is 59.6%. The freedom
from disease relapse (FDR) is 71.5%. Downstaging was observed
in 38% of the tumors. Conclusion: The actuarial LC at 5 years
is 91.7%, although we are dealing with stages II–III LARC,
mainly located in the lower rectum (median distanceZ5 cm). The
pattern of failure is dominated by distant metastases and treatment
intensification will obviously require a systemic approach. q
2006 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and
Oncology 79 (2006) 52–58. [less ?] in British Journal of Cancer (2006), 95 Patients with rectal cancer are at high risk of disease recurrence despite neoadjuvant radiochemotherapy with 5-Fluorouracil (5FU), a regimen that is now widely applied. In order to develop a regimen with ... [more ?] Patients with
rectal cancer are at high risk of disease recurrence despite neoadjuvant
radiochemotherapy with 5-Fluorouracil (5FU), a regimen that is
now widely applied. In order to develop a regimen with increased
antitumour activity, we previously established the recommended
dose of neoadjuvant CPT-11 (three times weekly 90 mgm 2) concomitant
to hyperfractionated accelerated radiotherapy (HART) followed
by surgery within 1 week. Thirty-three patients (20 men) with
a locally advanced adenocarcinoma of the rectum were enrolled
in this prospective phase II trial (1 cT2, 29 cT3, 3 cT4 and 21
cNþ). Median age was 60 years (range 43– 75 years).
All patients received all three injections of CPT-11 and all but
two patients completed radiotherapy as planned. Surgery with total
mesorectal excision (TME) was performed within 1 week (range 2–15
days). The preoperative chemoradiotherapy was overall well tolerated,
24% of the patients experienced grade 3 diarrhoea that was easily
manageable. At a median follow-up of 2 years no local recurrence
occurred, however, nine patients developed distant metastases.
The 2-year disease-free survival was 66% (95% confidence interval
0.48–0.83). Neoadjuvant CPT-11 and HART allow for excellent
local control; however, distant relapse remains a concern in this
patient population. [less ?] in Radiotherapy & Oncology (2005) Background and purpose We aim to report on local control in a phase II trial on preoperative hyperfractionated and accelerated radiotherapy schedule (HART) in locally advanced resectable rectal cancer ... [more ?] Background
and purpose We aim to report on local control in a phase II trial
on preoperative hyperfractionated and accelerated radiotherapy
schedule (HART) in locally advanced resectable rectal cancer (LARC).
This fractionation schedule was designed to keep the overall treatment
time (OTT) as short as possible. Patients and methods This is
a prospective trial on patients with UICC stages II and III rectal
cancer. The patients were submitted to a total dose of 41.6 Gy,
delivered in 2.5 weeks at 1.6 Gy per fraction twice a day with
a 6-h interfraction interval. Surgery was performed within 1 week
after the end of irradiation. Adjuvant chemotherapy was delivered
in a subset of patients. Results Two hundred and seventy nine
patients were entered and 250 are fully assessable, with a median
follow-up of 39 months. The 5-years actuarial local control (LC)
rate is 91.7%. The overall survival (OS) is 59.6%. The freedom
from disease relapse (FDR) is 71.5%. Downstaging was observed
in 38% of the tumors. Conclusion The actuarial LC at 5 years is
91.7%, although we are dealing with stages II–III LARC, mainly
located in the lower rectum (median distance=5 cm). The pattern
of failure is dominated by distant metastases and treatment intensification
will obviously require a systemic approach. [less ?] in Heart (2005), 91 Vascular brachytherapy (VBT) is the only proven treatment option for patients with in-stent restenosis. In seven randomised trials with almost 1500 patients that evaluated {gamma} (five studies) and ß ... [more ?] Vascular brachytherapy
(VBT) is the only proven treatment option for patients with in-stent
restenosis. In seven randomised trials with almost 1500 patients
that evaluated {gamma} (five studies) and ß (two trials)
irradiation, target vessel failure reduction ranged from 73% to
34% by VBT compared with conventional angioplasty.1 However, the
reported restenosis rates with the active treatment still varied
between 17% and 32%.1 We therefore postulated that repeat VBT
is safe and efficacious for preventing refractory in-stent restenosis
in high risk patients with failed VBT. METHODS Beginning in January
1999, VBT was applied for all patients with in-stent restenosis.
VBT was systematically performed with intravascular ultrasound
(IVUS) guidance. The repeat procedure was performed with a strontium/yttrium-90
source train (BetaCath, Novoste, Norcross, Georgia, USA). The
design and application of this catheter have been described previously.2
The dosimetry was based on the manufacturer’s recommendations
but taking into account not the angiographic vessel reference
diameter but the external elastic membrane diameter (as determined
by IVUS). The mean dose delivered at 2 mm from the source centre
was 23.3 (2.2) Gy during the index procedure and 25.3 (2.2) Gy
during the repeat intervention. Percutaneous coronary intervention
(PCI) was performed according to standard clinical practice. Failed
VBT was defined as angina recurrence combined with target vessel
failure (as documented by any repeat angiography: premature depending
on early symptom recurrence or at the planned six month control).
Repeat VBT was considered for patients estimated to be at high
risk for refractory in-stent restenosis or if they had a prognostic
risk—that is, diffuse or ostial in-stent restenosis or total
occlusion, or proximal left anterior descending artery stenosis.
Focal edge effect stenoses and non-prognostic lesion locations
in symptomatic patients were treated by conventional PCI. Written
informed consent was obtained from all patients before intervention.
The study was approved by the hospital ethics committee. All VBT
patients were prospectively entered in a dedicated database by
a person not taking part in the interventions. A combined antiplatelet
treatment (aspirin 100 mg and clopidogrel 75 mg daily) was prescribed
for at least six months after the index procedure and for one
year after the second VBT. Control angiography was mandatory at
six months in all VBT patients and systematic long term clinical
follow up was carried out. RESULTS Between July 1998 and March
2003, 251 VBT interventions were performed at our institution:
22 patients were treated for primary restenosis prevention and
229 patients for in-stent restenosis. VBT failed in 34 patients
(14.8%): 23 underwent conventional PCI and 11 underwent repeat
VBT. The baseline clinical and angiographic demographics were
comparable for both groups. Concerning the repeat VBT group, mean
(SD) age was 60 (7) years, nine patients were men, and two had
diabetes. All patients who underwent a repeat procedure had incapacitating
angina pectoris. Angina recurred at 7 (2) months (range 4–10)
after the first, failed VBT. The restenosis pattern (table 1Go)
was diffuse in the majority of patients at the first presentation
and remained diffuse with exacerbation to total occlusion in two
patients. In the focal restenosis group, two patients had ostial
in-stent restenosis. The cause of recurrent in-stent restenosis
was an evident geographical miss in two patients (a focal and
a diffuse pattern case). IVUS and angioplasty were successful
before irradiation therapy in all patients. During repeat VBT,
a 40 mm source train was used in seven patients and a pullback
technique was required in two because of the length of the restenotic
segment. No additional stents were implanted and no evidence of
geographical miss was seen at repeat intervention. Table 1Go shows
quantitative coronary angiography and IVUS data. During the index
procedure, the minimum in-stent luminal area increased from mean
(SD) 5.8 (1.8) to 7.5 (1.4) mm2. This area was maintained at the
repeat intervention at 7.8 (2.1) mm2 and further expanded to 8.9
(1.8) mm2. All repeat interventions were technically successful
and there were no adverse clinical events during the in-hospital
phase. [less ?] in Revue Médicale de la Suisse Romande (2004), 124(1), 51-54 La gynécomastie secondaire au traitement par anti-androgènes, est une complication fréquente des traitements hormonaux utilisés pour les patients souffrant de cancer prostatique. Cette gynécomastie est le ... [more ?] La gynécomastie
secondaire au traitement par anti-androgènes, est une complication
fréquente des traitements hormonaux utilisés pour
les patients souffrant de cancer prostatique. Cette gynécomastie
est le résultat d'un déséquilibre hormonal
entre les oestrogènes et les androgènes. On peut
raisonnablement estimer que l'incidence de cette gynécomastie
va augmenter compte tenu de l'effet bénéfique de
la manipulation hormonale sur le devenir des patients atteints
d'un cancer de la prostate. La gynécomastie, souvent associée
à la mastodynie, a un effet délétère
sur la qualité de vie. Si la chirurgie est une option thérapeutique
pour les formes installées et irréversible, caractérisée
par une composante de hyalinisation et fibrose dominant le tableau
histologique, la radiothérapie reste le traitement de choix
pour les formes précoces, voire même à titre
prophylactique dans les groupes de patients à haut risque.
C'est un traitement simple et efficace, peu toxique et bénéfique
en qualité de vie et ceci a été confirmé
par des essais randomisés. L'approche médicamenteuse
n'a pas encore démontré son efficacité ni
son innocuité et de toute façon aucune substance
médicamenteuse n'a été enregistrée
pour cette indication. [less ?] in European Journal of Cancer (2004) (E)-20-Deoxy-20-(fluoromethylene) cytidine (FMdC), an inhibitor of ribonucleotide diphosphate reductase (RR), is a potent radiation-sensitiser acting through alterations in the deoxyribonucleoside ... [more ?] Decreased
local control following radiation therapy alone in early stage
glottic carcinoma with anterior commissure extention. in Sonderbande zur Strahlentherapie und Onkologie (2004), 2 Purpose: To assess the patterns of failure in the treatment of early-stage squamous cell carcinoma of the glottic larynx. Patients and Methods: Between 1983–2000, 122 consecutive patients treated for ... [more ?] Purpose: To
assess the patterns of failure in the treatment of early-stage
squamous cell carcinoma of the glottic larynx. Patients and Methods:
Between 1983–2000, 122 consecutive patients treated for early
laryngeal cancer (UICC T1N0 and T2N0) by radical radiation therapy
(RT) were retrospectively studied. Male-to-female ratio was 106
: 16, and median age 62 years (35–92 years). There were 68
patients with T1a, 18 with T1b, and 36 with T2 tumors. Diagnosis
was made by biopsy in 104 patients, and by laser vaporization
or stripping in 18. Treatment planning consisted of three-dimensional
(3-D) conformal RT in 49 (40%) patients including nine patients
irradiated using arytenoid protection. A median dose of 70 Gy
(60–74 Gy) was given (2 Gy/fraction) over a median period
of 46 days (21–79 days). Median follow-up period was 85 months.
Results: The 5-year overall, cancer-specific, and disease-free
survival amounted to 80%, 94%, and 70%, respectively. 5-year local
control was 83%. Median time to local recurrence in 19 patients
was 13 months (5–58 months). Salvage treatment consisted
of surgery in 17 patients (one patient refused salvage and one
was inoperable; total laryngectomy in eleven, and partial laryngectomy
or cordectomy in six patients). Six patients died because of laryngeal
cancer. Univariate analyses revealed that prognostic factors negatively
influencing local control were anterior commissure extension,
arytenoid protection, and total RT dose < 66 Gy. Among the
factors analyzed, multivariate analysis (Cox model) demonstrated
that anterior commissure extension, arytenoid protection, and
male gender were the worst independent prognostic factors in terms
of local control. Conclusion: For early-stage laryngeal cancer,
outcome after RT is excellent. In case of anterior commissure
extension, surgery or higher RT doses are warranted. Because of
a high relapse risk, arytenoid protection should not be attempted.
[less ?] in Turkish
Journal of Cancer (2004), 34(1), 11-18 in Journal of Invasive Cardiology (The) (2003, December), 15(12), 706-709 At present, vascular brachytherapy is the only efficient therapy for in-stent restenosis. Nevertheless, edge restenosis often related to geographical miss has been identified as a major limitation of the ... [more ?] At present,
vascular brachytherapy is the only efficient therapy for in-stent
restenosis. Nevertheless, edge restenosis often related to geographical
miss has been identified as a major limitation of the technique.
The non-slippery cutting balloon has the potential to limit vascular
barotraumas, which, together with low-dose irradiation at both
ends of the radioactive source, are the prerequisite for geographical
miss. This prospective study aimed to examine the efficacy of
combining cutting balloon angioplasty and brachytherapy for in-stent
restenosis. The Radiation in Europe NOvoste (RENO) registry prospectively
tracked all patients who had been treated by coronary ?-radiation
with the Beta-Cath System (Novoste Corporation, Brussels, Belgium)
but were not included in a randomized radiation trial. A subgroup
of patients with in-stent restenosis treated by cutting balloon
angioplasty and coronary ?-radiation (group 1, n = 166) was prospectively
defined, and clinical outcomes of patients at 6 months were compared
with those of patients treated by conventional angioplasty and
coronary ?-radiation (group 2, n = 712). At 6-month follow-up,
there was a significant difference between groups 1 and 2 in target
vessel revascularization (10.2% versus 16.6% respectively; p =
0.04) and in the incidence of major adverse clinical events (MACE)
including death, myocardial infarction, and revascularization
(10.8% versus 19.2%; p = 0.01). This observation was confirmed
by a multivariate analysis indicating a lower risk for MACE at
6 months (odds ratio: 0.49; confidence intervals: 0.27-0.88; p
= 0.02). Compared to conventional angioplasty, cutting balloon
angioplasty prior to coronary beta-radiation with the Beta-Cath
System seems to improve the 6-month clinical outcome in patients
with in-stent restenosis. [less ?] in International
Journal of Radiation, Oncology, Biology, Physics (2003), 55(2),
551-552 in Bulletin du Cancer. Radiothérapie : Journal de la Société Française du Cancer : Organe de la Société Française de Radiothérapie Oncologique (2003), 7 Abstract Purpose. – To assess the feasibility and efficacy of accelerated postoperative radiation therapy (RT) in patients with squamous-cell carcinoma of the head and neck (SCCHN). Patients and methods ... [more ?] Abstract Purpose.
– To assess the feasibility and efficacy of accelerated postoperative
radiation therapy (RT) in patients with squamous-cell carcinoma
of the head and neck (SCCHN). Patients and methods. – Between
December 1997 and July 2001, 68 patients (male to female ratio:
52/16; median age: 60-years (range: 43–81) with pT1-pT4 and/or
pN0-pN3 SCCHN (24 oropharynx, 19 oral cavity, 13 hypopharynx,
5 larynx, 3 unknown primary, 2 maxillary sinus, and 2 salivary
gland) were included in this prospective study. Postoperative
RT was indicated because extracapsular infiltration (ECI) * Auteur
correspondant. Adresse e-mail : abderrahim.zouhair@chuv.hospvd.ch
(A. Zouhair). Cancer/Radiothérapie 7 (2003) 231–236
www.elsevier.com/locate/canrad © 2003 Éditions scientifiques
et médicales Elsevier SAS. Tous droits réservés.
doi:10.1016/S1278-3218(03)00041-6 was observed in 20 (29%), positive
surgical margins (PSM) in 20 (29%) or both in 23 patients (34%).
Treatment consisted of external beam RT 66 Gy in 5 weeks and 3
days. Median follow-up was 15 months. Results. – According
to CTC 2.0, acute morbidity was acceptable: grade 3 mucositis
was observed in 15 (22%) patients, grade 3 dysphagia in 19 (28%)
patients, grade 3 skin erythema in 21 (31%) patients with a median
weight loss of 3.1 kg (range: 0–16). No grade 4 toxicity
was observed. Median time to relapse was 13 months; we observed
only three (4%) local and four (6%) regional relapses, whereas
eight (12%) patients developed distant metastases without any
evidence of locoregional recurrence. The 2 years overall-, disease-free
survival, and actuarial locoregional control rates were 85, 73
and 83% respectively. Conclusion. – The reduction of the
overall treatment time using postoperative accelerated RT with
weekly concomitant boost (six fractions per week) is feasible
with local control rates comparable to that of published data.
Acute RT-related morbidity is acceptable. [less ?] in International Journal of Radiation, Oncology, Biology, Physics (2003), 56(5), 1288-1294 Purpose: Patients with locally advanced rectal carcinoma are at risk for both local recurrence and distant metastases. We demonstrated the efficacy of preoperative hyperfractionated accelerated ... [more ?] Purpose: Patients
with locally advanced rectal carcinoma are at risk for both local
recurrence and distant metastases. We demonstrated the efficacy
of preoperative hyperfractionated accelerated radiotherapy (HART).
In this Phase I trial, we aimed at introducing chemotherapy early
in the treatment course with both intrinsic antitumor activity
and a radiosensitizer effect. Methods and Materials: Twenty-eight
patients (19 males; median age 63, range 28–75) with advanced
rectal carcinoma (cT3: 24; cT4: 4; cN : 12; M1: 5) were enrolled,
including 8 patients treated at the maximally tolerated dose.
Escalating doses of CPT-11 (30–105 mg/m2/week) were given
on Days 1, 8, and 15, and concomitant HART (41.6 Gy, 1.6 Gy bid
13 days) started on Day 8. Surgery was to be performed within
1 week after the end of radiochemotherapy. Results: Twenty-six
patients completed all preoperative radiochemotherapy as scheduled;
all patients underwent surgery. Dose-limiting toxicity was diarrhea
Grade 3 occurring at dose level 6 (105 mg/m2). Hematotoxicity
was mild, with only 1 patient experiencing Grade 3 neutropenia.
Postoperative complications (30 days) occurred in 7 patients,
with an anastomotic leak rate of 22%. Conclusions: The recommended
Phase II dose of CPT-11 in this setting is 90 mg/m2/week. Further
Phase II exploration at this dose is warranted. © 2003 Elsevier
Inc. [less ?] in European Journal of Cancer (2003), 39 Abstract The European Organization for Research and Treatment of Cancer (EORTC) 22861 randomised trial established that combined radiochemotherapy is the standard treatment for locally advanced anal ... [more ?] Abstract The
European Organization for Research and Treatment of Cancer (EORTC)
22861 randomised trial established that combined radiochemotherapy
is the standard treatment for locally advanced anal cancer. This
EORTC phase II study (#22953) tests the feasibility of reducing
the gap between sequences to 2 weeks, to deliver Mitomycin C (MMC)
in each radiotherapy sequence and 5-FU continuously during the
treatment. The first sequence consisted of 36 Gy over 4 weeks.
5-FU 200 mg/m2/days 1–26, MMC 10 mg/m2/day 1 gap 16 days.
Then a second sequence of 23.4 Gy over 17 days, 5-FU 200 mg/m2/days
1–17 and, MMC 10 mg/m2/day 1 was given. 43 patients with
a World Health Organization (WHO) status of 0 (n=27) or 1 (n=16)
and with T2-T4, N0-3 tumours were included. Compliance with the
planned treatment, doses and duration was 93%. The complete response
rate was 90.7%. Grade 3 toxicities of 28, 12 and 2% were observed
for skin, diarrhoea and haematological toxicities, respectively.
The 3-year estimated rates for trials 22861 and 22953 are: 68
and 88% for local control; 72 and 81% for colostomy-free interval,
62 and 84% for severe late toxicity-free interval, and 70 and
81% for survival, respectively. The 22953 scheme is feasible and
the results are promising. This is now considered as the new standard
scheme by the EORTC. [less ?] in Human Pathology (2003), 34(6), 541-548 This study examines the prognostic significance of pathologic factors in patients with primary locally advanced rectal cancer treated prospectively with preoperative radiotherapy. From 1992 to 1998, 104 ... [more ?] This study
examines the prognostic significance of pathologic factors in
patients with primary locally advanced rectal cancer treated prospectively
with preoperative radiotherapy. From 1992 to 1998, 104 patients
with rectal cancer of grades T3 or T4 and any N underwent preoperative
radiotherapy followed by surgical resection. Survival curves were
estimated according to the Kaplan-Meier method. Correlation of
outcome with clinicopathologic variables (pathologic tumor and
lymph node staging, histology, radial resection margin [RRM],
clearance, vessel involvement, and tumor regression grade [TRG],
quantitated in 5 grades) was evaluated using the Cox proportional
hazards model. None of the patients achieved a histologically
confirmed complete pathologic response, but 79% of the patients
showed partial tumor regression (TRG2–4) and 21% did not
show any tumor regression (TRG5). Among the tumors, 22% were of
a mucinous type. The RRM was free of tumor in 76% of the surgical
specimens. The median clearance was 2 mm. Vascular invasion was
present in 37 cases (36%). In the univariate analysis, lymph node
metastases, absence of tumor regression, positive RRM, and vascular
invasion were correlated with adverse overall survival and diseasefree
survival; absence of tumor regression, positive RRM, and clearance
<2 mm were correlated with local recurrences; and advanced
pT stage was correlated only with disease-free survival. However,
in the multivariate analysis, only lymph node metastases and RRM
were independent prognostic factors for overall survival and disease-free
survival, and clearance <2 mm was an independent prognostic
factor for local control. Pathologic parameters remain strong
determinants of local recurrence and survival in locally advanced
rectal cancer, treated preoperatively with hyperfractionated and
accelerated radiotherapy. We show that patients with advanced
pT, positive lymph nodes, vascular invasion, positive RRM, clearance
<2 mm, or absence of tumor regression are known to have poor
clinical outcome. HUM PATHOL 34:541-548. © 2003 Elsevier
Inc. All rights reserved. Abbreviations: , computed tomography;
DFS, disease-free survival; HART, hyperfractionated accelerated
radiotherapy; OS, overall survival; RRM, radial resection margin;
TRG, tumor regression grade. [less ?] in International Journal of Radiation, Oncology, Biology, Physics (2003), 55(4), 1019-1026 Purpose: To assess, by a European registry trial, the clinical event rate in patients with discrete stenotic lesions of coronary arteries (de novo or restenotic) in single or multiple vessels (native or ... [more ?] Purpose: To
assess, by a European registry trial, the clinical event rate
in patients with discrete stenotic lesions of coronary arteries
(de novo or restenotic) in single or multiple vessels (native
or bypass grafts) treated with -radiation. Methods and Materials:
Between April 1999 and September 2000, 1098 consecutive patients
treated in 46 centers in Europe and the Middle East with the Novoste
Beta-Cath System were included in Registry Novoste (RENO). Results:
Six-month follow-up data were obtained for 1085 patients. Of 1174
target lesions, 94.1% were located in native vessels and 5.9%
in a bypass graft; 17.7% were de novo lesions, 4.1% were restenotic,
and 77.7% were in-stent restenotic lesions. Intravascular brachytherapy
was technically successful in 95.9% of lesions. Multisegmental
irradiation, using a manual pullback stepping maneuver to treat
longer lesions, was used in 16.3% of the procedures. The in-hospital
rate of major adverse cardiac events was 1.8%. At 6 months, the
rate was 18.7%. Angiographic follow-up was available for 70.4%
of the patients. Nonocclusive restenosis was seen in 18.8% and
total occlusion in 5.7% of patients. A combined end point for
late (30–180 days) definitive or suspected target vessel
closure was reached in 5.4%, but with only 2% of clinical events.
Multivariate analysis was performed for major adverse cardiac
events and late thrombosis. Conclusion: Data obtained from the
multicenter RENO registry study, derived from a large cohort of
unselected consecutive patients, suggest that the good results
of recent randomized controlled clinical trials can be replicated
in routine clinical practice. © 2003 Elsevier Science Inc.
[less ?] in Radiotherapy
& Oncology (2002), 64(supp 1), 248 in Radiotherapy
& Oncology (2002), 64(supp 1), 243-244 in Cancer (2002), 94(4), 1121-1130 BACKGROUND: Locally advanced rectal carcinoma has a poor prognosis. However, since the introduction of preoperative radiotherapy, the outcome of patients with rectal carcinoma has been reported to have ... [more ?] BACKGROUND:
Locally advanced rectal carcinoma has a poor prognosis. However,
since the introduction of preoperative radiotherapy, the outcome
of patients with rectal carcinoma has been reported to have improved.
Nevertheless, to the authors’ knowledge few data are available
regarding the histopathologic response to radiotherapy as assessed
on surgical specimens as a potential predictive factor for outcome.
METHODS: To estimate the effect of radiotherapy on rectal carcinoma,
the authors retrospectively reviewed the surgical specimens of
102 patients with T3-4, N0 or N1 rectal carcinoma and 1 patient
with T2 but N1 rectal carcinoma. All patients were treated preoperatively
with a hyperfractionated accelerated radiotherapy schedule in
a prospective protocol (Trial 93-01). Using a standardized approach,
tumor regression was graded using a system that varies from Grade
1 (tumor regression Grade [TRG] 1) when complete tumor regression
is observed to Grade 5 (TRG5) when no tumor regression is observed.
RESULTS: Radiotherapy resulted in tumor downstaging in 43% of
the patients. There were 2 pT1 tumors (2%), 21 pT2 tumors (20%),
66 pT3 tumors (64%), and 14 pT4 tumors (14%) after treatment.
Regional lymph nodes were involved in 55 patients (53%). None
of the patients demonstrated a complete tumor regression after
radiotherapy, but in 79% of the specimens a partial tumor regression
was observed (TRG1: 0%; TRG2: 20%; TRG3: 39%; TRG4: 20%; and TRG5:
21%). The median actuarial overall survival (OS) and disease-free
survival (DFS) were 52 months. Actuarial local recurrence rates
at 2 years and 5 years were 6.4% and 7.6%, respectively. Univariate
analysis showed the actuarial DFS to be significantly lower in
patients with lymph node metastases (P 0.0004) and advanced pT
stages (pT3-4) (P 0.03). A favorable outcome for OS, DFS, and
local control was observed in patients with TRG2-4 (i.e., responders)
compared with patients with TRG5 (i.e., nonresponders), but also
in patients with low residual tumor cell density (TRG2, 3, and
4). On multivariate analysis, TRG remained an independent prognostic
indicator for local tumor control. CONCLUSIONS. Tumor regression
as well as residual tumor cell density were found to be predictive
factors of survival in rectal carcinoma patients after preoperative
radiotherapy. Even after preoperative radiotherapy, the pathologic
stage of the surgical specimen remained a prognostic factor. The
use of a standardized approach for pathologic evaluation must
be implemented to allow comparison between the results of various
treatment approaches. [less ?] in Catheterization and Cardiovascular Interventions (2002), 55(2), 233-236 More than 70% of percutaneous coronary interventions are followed by a stent implantation. In-stent restenosis still occurs in 20-30% of patients and remains a therapeutic challenge. At present only ... [more ?] More than
70% of percutaneous coronary interventions are followed by a stent
implantation. In-stent restenosis still occurs in 20-30% of patients
and remains a therapeutic challenge. At present only vascular
brachytherapy has been shown to be an effective treatment option.
We report here one case of recurrent in-stent restenosis after
vascular brachytherapy that was successfully treated by a second
beta radiation treatment. Cathet Cardiovasc Intervent 2002;55:233–236.
© 2002 Wiley-Liss, Inc. [less ?] in Cancer (2002), 95(5), 1003-1008 BACKGROUND. Metallothioneins (MT) are low-molecular weight, metal-binding proteins that play a role in cellular proliferation and differentiation, as well as in cellular defense mechanisms. They act as ... [more ?] BACKGROUND.
Metallothioneins (MT) are low-molecular weight, metal-binding
proteins that play a role in cellular proliferation and differentiation,
as well as in cellular defense mechanisms. They act as scavengers
of free radicals produced by irradiation. A number of in vitro
and in vivo studies have linked overexpression of cellular MT
with tumor cell resistance to radiation. This is the first study
that investigates whether MT expression is involved in the radioresistance
of rectal carcinoma. METHODS. Using a mouse monoclonal antibody,
MT expression was analyzed by immunohistochemistry on surgical
samples (n 85) from 85 patients with locally advanced rectal carcinoma
who were treated preoperatively with a hyperfractionated and accelerated
radiotherapy schedule and on tumor biopsies (n 13) obtained before
treatment. The potential correlations between MT expression and
pathologic variables and survival were examined. RESULTS. MT were
expressed strongly in both the cytoplasm and nucleus of tumor
cells in 7 biopsy and 42 surgical samples. A comparison of MT
expression in biopsy and surgical specimens showed that MT expression
did not change after irradiation in most cases. Against all expectations,
MT were expressed more frequently in tumors from responders than
in those from the nonresponders (P 0.02). There was no correlation
between MT expression and tumor stage, histology after radiotherapy,
or survival. CONCLUSION. These findings do not support the hypothesis
that MT overexpression at the end of radiotherapy is a marker
for radiation resistance. Cancer 2002;95: 1003–8. ©
2002 American Cancer Society. DOI 10.1002/cncr.10780 [less ?] in Modern Pathology : An Official Journal of the United States & Canadian Academy of Pathology, Inc (2002), 15(9), 998-1004 Development of a soft-tissue sarcoma is an infrequent but well-known long-term complication of radiotherapy. Malignant fibrous histiocytomas, extraskeletal osteosarcomas, fibrosarcomas, malignant ... [more ?] Development
of a soft-tissue sarcoma is an infrequent but well-known long-term
complication of radiotherapy. Malignant fibrous histiocytomas,
extraskeletal osteosarcomas, fibrosarcomas, malignant peripheral
nerve sheath tumors, and angiosarcomas are most frequently encountered.
Radiationassociated synovial sarcomas are exceptional. We report
the clinicopathologic, immunohistochemical, and molecular features
of two radiationassociated synovial sarcomas. One tumor developed
in a 42-year-old female 17 years after external irradiation was
given for breast carcinoma; the other occurred in a 34-year-old
female who was irradiated at the age of 7 years for a nonneoplastic
condition of the left hand. Both lesions showed morphologic features
of monophasic spindle cell synovial sarcoma, were immunoreactive
for cytokeratins, epithelial membrane antigen, CD99, CD117 (c-kit),
and bcl-2 and bore the t(X;18) (SYT-SSX1) translocation. We conclude
that synovial sarcoma has to be added to the list of radiation-associated
soft-tissue sarcomas. Mod Pathol 2002;15(9):998–1004 [less
?] in Cancer (2002), 94(4), 1121-1130 BACKGROUND: Locally advanced rectal carcinoma has a poor prognosis. However, since the introduction of preoperative radiotherapy, the outcome of patients with rectal carcinoma has been reported to have ... [more ?] BACKGROUND:
Locally advanced rectal carcinoma has a poor prognosis. However,
since the introduction of preoperative radiotherapy, the outcome
of patients with rectal carcinoma has been reported to have improved.
Nevertheless, to the authors’ knowledge few data are available
regarding the histopathologic response to radiotherapy as assessed
on surgical specimens as a potential predictive factor for outcome.
METHODS: To estimate the effect of radiotherapy on rectal carcinoma,
the authors retrospectively reviewed the surgical specimens of
102 patients with T3-4, N0 or N1 rectal carcinoma and 1 patient
with T2 but N1 rectal carcinoma. All patients were treated preoperatively
with a hyperfractionated accelerated radiotherapy schedule in
a prospective protocol (Trial 93-01). Using a standardized approach,
tumor regression was graded using a system that varies from Grade
1 (tumor regression Grade [TRG] 1) when complete tumor regression
is observed to Grade 5 (TRG5) when no tumor regression is observed.
RESULTS: Radiotherapy resulted in tumor downstaging in 43% of
the patients. There were 2 pT1 tumors (2%), 21 pT2 tumors (20%),
66 pT3 tumors (64%), and 14 pT4 tumors (14%) after treatment.
Regional lymph nodes were involved in 55 patients (53%). None
of the patients demonstrated a complete tumor regression after
radiotherapy, but in 79% of the specimens a partial tumor regression
was observed (TRG1: 0%; TRG2: 20%; TRG3: 39%; TRG4: 20%; and TRG5:
21%). The median actuarial overall survival (OS) and disease-free
survival (DFS) were 52 months. Actuarial local recurrence rates
at 2 years and 5 years were 6.4% and 7.6%, respectively. Univariate
analysis showed the actuarial DFS to be significantly lower in
patients with lymph node metastases (P 0.0004) and advanced pT
stages (pT3-4) (P 0.03). A favorable outcome for OS, DFS, and
local control was observed in patients with TRG2-4 (i.e., responders)
compared with patients with TRG5 (i.e., nonresponders), but also
in patients with low residual tumor cell density (TRG2, 3, and
4). On multivariate analysis, TRG remained an independent prognostic
indicator for local tumor control. CONCLUSIONS. Tumor regression
as well as residual tumor cell density were found to be predictive
factors of survival in rectal carcinoma patients after preoperative
radiotherapy. Even after preoperative radiotherapy, the pathologic
stage of the surgical specimen remained a prognostic factor. The
use of a standardized approach for pathologic evaluation must
be implemented to allow comparison between the results of various
treatment approaches. Cancer 2002;94:1121–30. © 2002
American Cancer Society. DOI 10.1002/cncr.103271121 © 2002
[less ?] in Médecine
et Hygiène (2001), (3000), in Radiation Research (2001), 155(1), This study addressed the potential radiosensitizing effect of nicotinamide and/or carbogen on human glioblastoma xenografts in nude mice. U-87MG and LN-Z308 tumors were irradiated with either 20 fractions ... [more ?] This study
addressed the potential radiosensitizing effect of nicotinamide
and/or carbogen on human glioblastoma xenografts in nude mice.
U-87MG and LN-Z308 tumors were irradiated with either 20 fractions
over 12 days or 5 fractions over 5 days in air-breathing mice,
mice injected with nicotinamide, mice breathing carbogen, or mice
receiving nicotinamide plus carbogen. The responses to treatment
were assessed using local control and moist desquamation. In U-87MG
tumors, the enhancement ratios (ERs) at the radiation dose required
to produce local tumor control in 50% of the treated mice (TCD50)
with nicotinamide and/or carbogen ranged from 1.13 to 1.24 for
irradiation in 20 fractions over 12 days. In LN-Z308 tumors, the
ERs at the TCD50 with nicotinamide and/or carbogen ranged from
1.22 to 1.40 for irradiation in 5 fractions over 5 days and from
1.11 to 1.30 in 20 fractions over 12 days, respectively. Skin
injury was slightly enhanced, with ERs ranged from 1.06 to 1.15
when radiation was combined with carbogen and/or nicotinamide.
Thus carbogen and nicotinamide can slightly improve the radiation
response of human glioblastoma xenografts. [less ?] in Praxis (2001), 90 The treatment for cardiovascular disease, especially the treatment of coronary stenosis, has been continously improving during the last decades. Routine use of angioplasty was improved by the use of ... [more ?] The treatment
for cardiovascular disease, especially the treatment of coronary
stenosis, has been continously improving during the last decades.
Routine use of angioplasty was improved by the use of coronary
stenting further reducing cardiac morbidity. However, the incidence
of restenosis after cardiovascular angioplasty remains high. The
restenosis process is mainly explained by neo-intimal proliferation.
Therefore, the utility of ionizing radiation has been systematically
investigated in order to reduce proliferation of the neointimal
tissue. Radiation therapy turns out to be a very efficient approach
in reducing the rate of both de novo lesions as well as of instant
restenosis. Recent clinical data from randomized trials confirm
the utility of intracoronary radiation therapy and change the
treatment standards in interventional cardiology. [less ?] in Médecine et Hygiène (2001), 59(2342), 853-858 Le traitement des maladies cardiovasculalres, et plus spécifiquement la prise en charge des patients avec des sténoses vasculalres, qu'elles soient cardiaques ou périphériques, est en train d'être modifié ... [more ?] 33 RENO: A
European surveillance registry of coronary brachytherapy with
the NovosteTM Beta-CathTM System in Radiotherapy
& Oncology (2001), 60(supp 1), 12 in Langenbeck's Archives of Surgery (2001), 136 Hypothesis: Pelvic irradiation adversely affects anal sphincter function after proctectomy with coloanal anastomosis for low rectal and middle rectal (,10 cm from the anal verge) tumors. Design: Case ... [more ?] Hypothesis:
Pelvic irradiation adversely affects anal sphincter function after
proctectomy with coloanal anastomosis for low rectal and middle
rectal (,10 cm from the anal verge) tumors. Design: Case-control
study. Setting: Private, tertiary care referral center. Patients:
Patients treated for low rectal adenocarcinoma between January
1, 1994, and October 31, 1999. Interventions: Anal manometric
data were prospectively collected at the time of initial diagnosis
and before ileostomy closure. Main Outcome Measures: Mean and
maximum resting pressures (RPs) and squeeze pressures, threshold
volume for sensation, and maximal tolerable volume. Results: Twenty-three
patients in the surgery group and 19 in the chemoradiotherapy
group were considered for [less ?] in European Journal of Cancer (2001), 37 Abstract To assess the prognostic factors and the outcome in patients with squamous-cell carcinoma of the penis, a retrospective review of 41 consecutive patients with non-metastatic invasive carcinoma of ... [more ?] Abstract To
assess the prognostic factors and the outcome in patients with
squamous-cell carcinoma of the penis, a retrospective review of
41 consecutive patients with non-metastatic invasive carcinoma
of the penis, treated between 1962 and 1994, was performed. The
median age was 59 years (range: 35±76 years). According
to the International Union Against Cancer (UICC) 1997 classi®cation,
there were 12 (29%) T1, 24 (59%) T2, 4 (10%) T3 and 1 TX (2%)
tumours. The N-classi®cation was distributed as follows: 29
(71%) patients with N0, 8 (20%) with N1, 3 (7%) with N2 and 1
(2%) with N3. Forty-four per cent (n=18) of the patients underwent
surgery: partial penectomy with (n=4) or without (n=12) lymph
node dissection, or total penectomy with (n=1) or without (n=1)
lymph node dissection. 23 patients were treated with radiation
therapy alone, and all but 4 of the patients who were operated
upon received postoperative radiation therapy (n=14). The median
follow-up period was 70 months (range 20±331 months). In
a median period of 12 months (range 5±139 months), 63%
(n=26) of the patients relapsed (local in 18, locoregional in
2, regional in 3 and distant in 3). Local failure (stump in the
operated patients, and the tumour bed in those treated with primary
radiation therapy) was observed in 4 out of 16 (25%) patients
treated with partial penectomy postoperative radiotherapy versus
14 out of 23 (61%) treated with primary radiotherapy (P=0.06).
15 (83%) out of 18 local failures were successfully salvaged with
surgery. In all patients, 5- and 10-year survival rates were 57%
(95% con®dence interval (CI), 41±73%) and 38% (95%
CI, 21± 55%), respectively. The 5-year local and locoregional
rates were 57% (95% CI, 41±73%) and 48% (95% CI, 32±64%),
respectively. In patients treated with primary radiotherapy, 5-
and 10-year probabilities of surviving with penis preservation
were 36% (95% CI, 22±50%) and 18% (95% CI, 2±34%),
respectively. In multivariate analyses, survival was signi®cantly
in¯uenced by the N-classi®- cation, and surgery was the
only independent factor predicting the locoregional control. We
conclude that, in patients with squa- mous-cell carcinoma of the
penis, local control is better in patients treated with surgery.
However, there seems to be no di erence in terms of survival between
patients treated by surgery and those treated by primary radiotherapy
salvage surgery, with 39% having organ preservation. [less ?] in International Journal of Radiation, Oncology, Biology, Physics (2001), 49(5), 1505-1516 INTRODUCTION The one-and-a-half day Young Investigators Workshop was held in the Holiday Inn, Bethesda, August 1–2, 2000. Using the SCAROP mailing list and recommendations from department chiefs ... [more ?] INTRODUCTION
The one-and-a-half day Young Investigators Workshop was held in
the Holiday Inn, Bethesda, August 1–2, 2000. Using the SCAROP
mailing list and recommendations from department chiefs, approximately
55 “early-career” physicianscientists were invited to
attend the workshop. Table 1 includes the participants. The goals
of the meeting were: c To bring together radiation oncology physician-scientists
who were in the early part of their career to discuss research
ideas and opportunities as well as potential barriers to progress
for the field and for young-investigator careers. c To help develop
camaraderie among and a critical-mass of a new generation of physician-scientists
with interests ranging from technology development, to basic and
translational research, to outcomes research and analysis. c To
help the young investigators gain familiarity with the NIH grant
programs. c To prepare a “white paper” with their vision
and ideas for potential opportunities for the future. If possible,
a shortand long-term agenda were to be proposed. The first morning
included presentations from a variety of NCI programs. Three breakout
sessions were held in the afternoon. Breakout Group Reports were
discussed by the entire group the following morning. A fourth
discussion topic on “Barriers To a Successful Research Career”
was conducted by the entire group. Drafts of this entire Workshop
Report were circulated to the participants. The final document
represents the efforts of the entire Young Investigators Workshop
and provides the perspective from the point of view of the investigators
who have many years to invest in the future of radiation oncology.
The Radiation Research Program (RRP) is grateful to all the participants
for a lively workshop and to the session co-chairs for the timely
preparation of this report. [less ?] in Gastroentérologie Clinique et Biologique (2001), 25 Le traitement adjuvant des cancers du rectum a pour buts de stériliser la maladie résiduelle infra-clinique et d’améliorer le contrôle local. Depuis plus de 20 ans, des milliers de malades ont été inclus ... [more ?] Le traitement
adjuvant des cancers du rectum a pour buts de stériliser
la maladie résiduelle infra-clinique et d’améliorer
le contrôle local. Depuis plus de 20 ans, des milliers de
malades ont été inclus dans des études randomisées,
visant d’abord à mettre en évidence un gain
de survie et une réduction des récidives loco-régionales,
en relation avec la radiothérapie pré- ou postopératoire,
combinée ou non à la chimiothérapie. Les
conséquences en termes de qualité de vie de ces
traitements ont pourtant été peu étudiées,
et la tolérance fonctionnelle du néo-rectum et de
l’appareil sphinctérien à la radiothérapie
restent mal connues [1]. Les difficultés liées à
l’étude des effets de l’irradiation sur les tissus
normaux, ainsi que la variabilité inter-individuelle de
la réponse à la radiothérapie, s’ajoutent
et rendent le sujet plus complexe encore. Les radiothérapeutes
adaptent leur technique afin de réduire autant que possible
la dose administrée aux tissus normaux avoisinant la tumeur.
Dans le cas de l’irradiation du petit bassin, c’est
l’intestin grêle qui a longtemps été
considéré comme la structure à risque de
complications, alors que l’atteinte du sphincter anal était
rarement mentionnée [2]. Malgré les répercussions
importantes de la dysfonction ano-rectale sur la qualité
de vie des malades, l’atteinte du sphincter anal par la radiothérapie
est restée un aspect négligé du traitement
adjuvant des cancers du petit bassin [3]. Cet article a pour but,
à travers une revue de la littérature, de mettre
en évidence les effets qualitatifs et quantitatifs de la
radiothérapie sur la fonction du sphincter anal, ainsi
que de proposer une modification de la technique actuelle d’irradiation
des cancers du bas rectum. [less ?] in Journal of Interventional Cardiology (2000), 13(6), 425-429 Endovascular brachytherapy after percutaneous coronary intervention (PCI), is becoming a standard approach for the treatment and prevention of restenosis. A variety of technical approaches are currently ... [more ?] Endovascular
brachytherapy after percutaneous coronary intervention (PCI),
is becoming a standard approach for the treatment and prevention
of restenosis. A variety of technical approaches are currently
available to deliver ionizing irradiation to the vascular target.
Basically two kinds of radioactive isotopes are available that
emit gamma radiation (photons) or beta radiation (electrons).
The pitfalls and solutions for the optimization of dosimetry are
discussed. As might be expected, the inhomogeneous dose distribution
across the target volume results in recurrence by underdosage
or in complications because of overdosage. Moreover, uniformization
of the target definition and reporting of the dose distribution
in endovascular brachytherapy is a prerequisite for comparison
between the results of the various clinical trials and is absolutely
necessary to improve the therapeutic efficacy of this new approach
in the prevention of restenosis after coronary angioplasty with
or without stenting. (J Interven Cardiol2000; 13:425430) [less
?] in European Journal of Obstetrics & Gynecology & Reproductive Biology (2000), 88 Abstract Objective : To analyse the effect of differentiation on disease-free survival (DFS) and overall survival (OS) in patients with stage I adenocarcinoma of the endometrium. Patients and methods ... [more ?] Abstract Objective
: To analyse the effect of differentiation on disease-free survival
(DFS) and overall survival (OS) in patients with stage I adenocarcinoma
of the endometrium. Patients and methods : From 1979 to 1995,
350 patients with FIGO stage IA–IC with well (G1), moderately
(G2) or poorly (G3) differentiated tumors were treated with surgery
and high dose-rate brachytherapy with or without external radiation.
Median age was 65 years (39–86 years). Results : The 5-year
DFS was 8863% for the G1 tumors, 7764% for the G2 tumors, and
6767% for the G3 tumors (P50.0049). With regard to the events
contributing to DFS, the 5-year cumulative percentage of local
relapse was 4.6% for the G1 tumors, 9.0% for the G2 tumors, and
4.6% (P50.027) for the G3 tumors. Cumulative percentage of metastasis
was 1.4, 6.3 and 7.2% (P,0.001), respectively, whereas percentages
of death were 6.0, 7.9 and 20.7% (P,0.001). The 5-year OS was
9163, 8364 and 7667%, respectively (P50.0018). In terms of multivariate
hazard ratios (HR), the relative differences between the three
differentiation groups correspond to an increase of 77% of the
risk of occurrence of either of the three events considered for
the DFS (HR51.77, 95% Cl [0.94–3.33]), (P50.078) for the
G2 tumors and of 163% (HR52.63, 95% Cl [1.27–5.43]), (P50.009)
for the G3 tumors with respect to the G1 tumors. The estimated
relative hazards for OS are, respectively, in line with those
for DFS: HR51.51 (P50.282) for the G2 tumors; and HR53.37 (P50.003)
for the G3 tumors. Conclusion : Patients with grade 1 tumors are
those least exposed to either local relapse, metastasis, or death.
In contrast patients with grade 2 tumors seem to be at higher
risk of metastasis, whereas patients with grade 3 tumors appear
at higher risk of death. Since we have looked at the first of
three competing events (local relapse, metastasis and death),
this suggests that patients with grade 3 tumors probably progress
to death so fast that local relapse, if any, cannot be observed.
Ó 2000 Elsevier Science Ireland Ltd. All rights reserved.
[less ?] in Radiotherapy & Oncology (2000), 54 Abstract Background: The treatment outcome of advanced stage uterine cervical carcinoma remains unsatisfactory. In order to elaborate a novel trial within The Radiotherapy Cooperative Group (RCG) of the ... [more ?] Abstract Background:
The treatment outcome of advanced stage uterine cervical carcinoma
remains unsatisfactory. In order to elaborate a novel trial within
The Radiotherapy Cooperative Group (RCG) of the European Organization
for Research and Treatment of Cancer (EORTC), we conducted a survey
in 1997±1998 to determine the variability of pre-treatment
assessment and treatment options. The variability of choosing
surgery, de®ned radiation therapy techniques and chemotherapy
are investigated, as well as the center's choices of future treatment
strategies. Methods: Fifty two of 81 RCG centers from the RCG
have participated in the survey. As one would expect, there is
a large variation in the techniques used for pretreatment evaluation
and treatment options. There is no `standard' for reporting acute
and late side effects. Chemotherapy is used neither systematically
nor uniformly, and some centers continue to use neadjuvant chemotherapy
modalities. Results: Furthermore, the survey reveals that there
is a strong demand for the reduction of overall treatment-time,
for clinical investigation of novel combined modality treatment
strategies, especially chemo±radiation therapy, and also
for the use of new radiation sensitizers. Conclusion:We conclude
that a more homogeneous approach to the pretreatment evaluation
as well as treatment techniques is required in order to allow
adequate quality control in any future trial of the RCG in the
EORTC.q2000 Elsevier Science Ireland Ltd. All rights reserved.
[less ?] in Catheterization and Cardiovascular Interventions (2000), 51(4), 422-429 To determine the feasibility and safety of an intracoronary beta-radiation device in preventing the recurrence of in-stent restenosis (ISR) after successful angioplasty, we studied 37 patients treated ... [more ?] To determine
the feasibility and safety of an intracoronary beta-radiation
device in preventing the recurrence of in-stent restenosis (ISR)
after successful angioplasty, we studied 37 patients treated with
beta-radiation (30-mm strontium-90 source) after angioplasty.
The mean reference diameter was 2.9 ± 0.5 mm, and 62% of
lesions were diffuse, including four total occlusions. Beta-radiation
was successfully delivered in 36 of 37 (97%) cases. Over the course
of 7.1 ± 4.5 mo follow-up, there were no myocardial infarctions
and three deaths: one from preexisting malignancy, one from progressive
cardiac failure, and one from sudden cardiac death. Target vessel
revascularization (TVR) was performed in seven of 36 (19%) patients.
Thirty patients underwent angiography at 6 mo; three (10%) experienced
restenosis (diameter stenosis > 50%) at the target site, four
(13%) had edge stenoses, and two (7%) had late (> 1 mo) thrombotic
occlusions. Beta-radiation for ISR is associated with encouragingly
low rates of target lesion restenosis and TVR. Further improvements
are needed to solve the limitations of the edge effect and late
occlusion. [less ?] Scientific
conference (1999, March 04) in Revue Médicale
Suisse (1999), 760 in Revue Médicale
Suisse (1999), 760 in Médecine et Hygiène (1999), 54(2238), 100-111 En 1998, plusieurs études ont clarifié ou confirmé l'effet positif de la radiothérapie dans le cancer du sein in situ, dans différents types de lymphomes non hodgkinien et hodgkinien, et dans le cancer ... [more ?] En 1998, plusieurs
études ont clarifié ou confirmé l'effet positif
de la radiothérapie dans le cancer du sein in situ, dans
différents types de lymphomes non hodgkinien et hodgkinien,
et dans le cancer bronchique à petites cellules. Deux métaanalyses
par contre semblent remettre en cause la radiothérapie,
dans la maladie de Hodgkin de stade avancé et dans l'approche
postopératoire du cancer ronchique à non petites
cellules. Ces méta-analyses comportent toutefois d'importantes
faiblesses et doivent être interprétées de
façon critique. Dans le domaine technique de la radio-oncologie,
les progrès spectaculaires de la planification assistée
par ordinateur et l'intégration de l'imagerie IRM peuvent
maintenant s'appliquer aussi à la curiethérapie.
Enfin, la radiothéraple dans les affections non oncologiques
suscite un nouvel intérêt, comme par exemple la curiethérapie
intracoronarienne, un traitement prometteur pour prévenir
la resténose coronarienne. [less ?] in Médecine et Hygiène (1999), 57(2240), 213-217 Même si aucune acquisition nouvelle n'est venue embaumer l'atmosphère encore trop souvent grisâtre de l'oncologie gastro-intestinale en 1998, la nécessité d'un consilium préthérapeutique associant ... [more ?] Même
si aucune acquisition nouvelle n'est venue embaumer l'atmosphère
encore trop souvent grisâtre de l'oncologie gastro-intestinale
en 1998, la nécessité d'un consilium préthérapeutique
associant chirurgiens, endoscopeurs, oncologues et radio-oncologues
s'impose avec encore plus de fermeté, pour tous les cancers
digestifs. Les patients devraient autant que possible être
inclus dans des protocoles d'études bien conduits et bénéficier
d'une chirurgie oncologique optimale. [less ?] in Radiation
Research (1999), 152(5), in Radiotherapy & Oncology (1999), 50 Purpose: The aim of this study was to assess the potential of pre-treatment cell kinetic parameters to predict outcome in head and neck cancer patients treated by conventional radiotherapy. Materials and ... [more ?] Purpose: The
aim of this study was to assess the potential of pre-treatment
cell kinetic parameters to predict outcome in head and neck cancer
patients treated by conventional radiotherapy. Materials and methods:
Data from 11 different centers were pooled. Inclusion criteria
were such that the patients received radiotherapy alone, and that
the radiotherapy was given in an overall time of at least 6 weeks
with a dose of at least 60 Gy. All patients received a tracer
dose of either iododeoxyuridine (IdUrd) or bromodeoxyuridine (BrdUrd)
intravenously prior to treatment and a tumor biopsy was taken
several hours later. The cell kinetic parameters labeling index
(LI), DNA synthesis time (Ts) and potential doubling time (Tpot)
were subsequently calculated from flow cytometry data, obtained
on the biopsies using antibodies against I/BrdUrd incorporated
into DNA. Each center carried out their own flow cytometry analysis.
Results: From the 11 centers, a total of 476 patients conforming
to the inclusion criteria were analyzed. Median values for overall
time and total dose were 49 days and 69 Gy, respectively. Fifty
one percent of patients had local recurrences and 53% patients
had died, the majority from their disease. Median follow-up was
20 months; being 30 months for surviving patients. Multivariate
analysis revealed that T-stage, maximum tumor diameter, differentiation
grade, N-stage, tumor localization and overall time correlated
with locoregional control, in decreasing order of significance.
For the cell kinetic parameters, univariate analysis showed that
only LI was significantly associated with local control (P=0.02),
with higher values correlating with a worse outcome. Ts showed
some evidence that patients with longer values did worse, but
this was not significant (P=0.06). Tpot showed no trend (P=0.8).
When assessing survival in a univariate analysis, neither LI nor
Tpot associated with outcome (P=0.4, 0.4, respectively). Surprisingly,
Ts did correlate with survival, with longer values being worse
(P=0.02). In the multivariate analysis of local control, LI lost
its significance (P=0.16). Conclusions: The only pretreatment
kinetic parameter for which some evidence was found for an association
with local control (the best end-point for testing the present
hypothesis) was LI, not Tpot, and this evidence disappeared in
a multivariate analysis. It therefore appears that pretreatment
cell kinetic measurements carried out using flow cytometry, only
provide a relatively weak predictor of outcome after radiotherapy
in head and neck cancer. [less ?] in British Journal of Cancer (1999), 79(2), 323-332 Summary We compared the flow cytometric measurement and analysis of the potential doubling time ( Tpot) between three centres involved in the National Cancer Institute (NCI) protocol T92-0045. The primary ... [more ?] Summary We
compared the flow cytometric measurement and analysis of the potential
doubling time ( Tpot) between three centres involved in the National
Cancer Institute (NCI) protocol T92-0045. The primary purpose
was to understand and minimize the variation within the measurement.
A total of 102 specimens were selected at random from patients
entered into the trial. Samples were prepared, stained, run and
analysed in each centre and a single set of data analysed by all
three centres. Analysis of the disc data set revealed that the
measurement of labelling index (LI) was robust and reproducible.
The estimation of duration of S-phase ( Ts) was subject to errors
of profile interpretation, particularly DNA ploidy status, and
analysis. The LI dominated the variation in Tpot such that the
level of final agreement, after removal of outliers and ploidy
agreement, reached correlation coefficients of 0.9. The sample
data showed poor agreement within each of the components of the
measurement. There was some improvement when ploidy was in agreement,
but correlation coefficients failed to exceed values of 0.5 for
Tpot. The data suggest that observer-associated analysis of Ts
and tissue processing and tumour heterogeneity were the major
causes of variability in the Tpot measurement. The first two aspects
can be standardized and minimized, but heterogeneity will remain
a problem with biopsy techniques. [less ?] in International Journal of Radiation, Oncology, Biology, Physics (1999), 45(3), 707-714 Purpose: A retrospective study of radiation-induced apoptosis in CD4 and CD8 T-lymphocytes, from 12 cancer patients who displayed enhanced toxicity to radiation therapy and 9 ataxia telangiectasia ... [more ?] Purpose: A
retrospective study of radiation-induced apoptosis in CD4 and
CD8 T-lymphocytes, from 12 cancer patients who displayed enhanced
toxicity to radiation therapy and 9 ataxia telangiectasia patients,
was performed to test for altered response compared to healthy
blood-donors and normal cancer patients. Methods and Materials:
Three milliliters of heparinized blood from each donor was sent
via express post to the Paul Scherrer Institute (PSI) for subsequent
examination. The blood was diluted 1:10 in RPMI medium, irradiated
with 0-, 2-, or 9-Gy X-rays, and incubated for 48 h. CD4 and CD8
T-lymphocytes were then labeled using FITC-conjugated antibodies,
erythrocytes were lysed, and the DNA stained with propidium iodide.
Subsequently, cells were analyzed using a Becton Dickinson FACScan
flow cytometer. Radiation-induced apoptosis was recognized in
leukocytes as reduced DNA content attributed to apoptosis-associated
changes in chromatin structure. Apoptosis was confirmed by light
microscopy, electron microscopy, and by the use of commercially
available apoptosis detection kits (in situ nick translation and
Annexin V). Data from hypersensitive individuals were compared
to a standard database of 105 healthy blood-donors, and a database
of 48 cancer patient blood donors who displayed normal toxicity
to radiation therapy. To integrate radiosensitivity results from
CD4 and CD8 T-lymphocytes after 2 and 9 Gy, z-score analyses were
performed. Results: A cohort of 12 hypersensitive patients was
evaluated; 8 showed enhanced early toxicity, 3 showed enhanced
late toxicity, and 1 showed both. The cohort displayed less radiation-induced
apoptosis (21.8 s) than average age-matched donors. A cohort of
9 ataxia telangiectasia homozygotes displayed even less apoptosis
(23.6 s). Conclusion: The leukocyte apoptosis assay appears to
be a useful predictor of individuals likely to display increased
toxicity to radiation therapy; however, validation of this requires
a prospective study. © 1999 Elsevier Science Inc. [less ?] in International Journal of Radiation, Oncology, Biology, Physics (1999), 45(5), 1151-1156 Purpose: To evaluate a hyperfractionated and accelerated radiotherapy (HART) protocol in patients with inoperable non-small cell lung carcinoma (NSCLC) who were ineligible for combination ... [more ?] Purpose: To
evaluate a hyperfractionated and accelerated radiotherapy (HART)
protocol in patients with inoperable non-small cell lung carcinoma
(NSCLC) who were ineligible for combination radiochemotherapy
studies. Methods and Materials: From February 1989 through August
1994, 23 patients ineligible for available combined modality protocols
in our institution were enrolled and treated with HART, consisting
of 63 Gy given in 42 fractions of 1.5 Gy each, twice daily, with
a minimum time interval of 6 h between fractions, 5 days a week,
over an elapsed time of 4.2 weeks, or 29 days. There was no planned
interruption. Results: The 1-, 2-, and 3-year survival rates were
61%, 39%, and 19%, respectively, with a median survival of 16.8
months. At the time of analysis, 4 patients are alive and 19 have
died, 16 from NSCLC and 3 from cardiacdisease. Overall response
rate was 48%, with 22% of patients achieving a complete response
and 26% a partial response. Correlation between acute response
rate and survival was poor. First site of relapse was local-regional
in 8 patients (35%), distant in 6 patients (26%), and local-regional
and distant in 4 (17%) patients. One patient had Grade IV and
2 had Grade III esophagitis. One patient presented with chronic
Grade III lung toxicity. There were no treatment-related deaths.
Conclusion: In this group of 23 patients ineligible for radiochemotherapy,
this HART regime was quite feasible and was followed by little
toxicity. Results in this particularly poor prognosis NSCLC patient
category should be compared to series with a similar patient profile;
however, median survival is at least similar to that obtained
in recent series of combination radiochemotherapy. © 1999
Elsevier Science Inc. [less ?] in International Journal of Cancer = Journal International du Cancer (1999), 80 (E)-28-deoxy-28-(fluoromethylene) cytidine (FMdC), a novel inhibitor of ribonucleotide-diphosphate reductase, has been shown to have anti-tumor activity against solid tumors and sensitize tumor cells to ... [more ?]
|
||
Home About MHL Hospitals | Specialist Centres Scanning | Dialysis Health Insurance News / Press Useful Links Research Contact
(c)
Medilux Healthcare Limited. 2003 - 2011. All rights reserved
VAT No 887 9818 33 Comp Reg in England
5925249 Webmaster -
Steven Warren
s.warren@mhlhealth.com
PRIVACY
DISCLAIMER Medilux Healthcare Limited markets medical products and services on behalf of Manufacturers and Providers. We may discuss with patients and their doctors in general terms their potential suitability for a stated condition but we do not examine or diagnose patients or conduct tests or analysis, nor are we authorised to commit our Principals to any diagnosis, outcome or precise costing or to enter into any formal or informal agreement on their behalf. Customers contract with our Principals directly and we will not be liable in any way for the success, failure or other outcome of any treatment or the accuracy of diagnosis given.
