Adjuvant radiation therapy for adenocarcinoma of the rectum

The potential for electron transfer quenching of rose bengal triplet (3RB2-) to compete with energy transfer quenching by oxygen was evaluated. Rate constants for oxidative and reductive quenching were measured in buffered aqueous solution, acetonitrile and in small unilamellar liposomes using laser flash photolysis. Biologically relevant quenchers were used that varied widely in structure, reduction potential and charge. Radical ion yields (phi i) were measured by monitoring the absorption of the rose bengal semireduced (RB.3-) and semioxidized (RB.-) radicals. The results in solution were analyzed as a function of the free energy for electron transfer (delta G) calculated using the Weller equation including electrostatic terms. Exothermic oxidative quenching was about 10-fold faster than exothermic reductive quenching in aqueous solution. The quenching rate constants decreased as delta G approached zero in both aqueous and acetonitrile solution. Exceptions to these generalizations were observed that could be rationalized by specific steric or electrostatic effects or by a change in mechanism. The results suggest that electron transfer reactions with some potential quenchers in cells could compete with formation of singlet oxygen [O2(1 delta g)]. Values of phi i were generally greater for reductive quenching and, for oxidative quenching, greater in acetonitrile than in buffer. Electron transfer quenching of 3RB2- in liposomes, below the phase transition temperature was slower than in solution for both lipid-soluble and water-soluble quenchers indicating that these reactions may not compete with formation of O2(1 delta g) during cell photosensitization.     

Rectal injuries following radiation therapy for cervical cancer

Injuries of the rectal wall were examined up to 327 days in patients with uterus cancers after radiation therapy with 60Co gamma-rays. Various types of morphological changes were observed at the end of the therapy and the changes could be seen even 327 days after therapy with doses of 3,240-6,040 rad. The percentage of goblet cells in the rectal wall fluctuated for about 50 days after therapy and then became stable, but was slightly less than pre-irradiation level. The changes in the percentage seemed to represent radiation damages to the epithelial cells in the wall. The late effects in the blood vessels were probably more important than damages to the epithelial cells in the wall.     

Intraarterial chemotherapy combined with radiation therapy for advanced cancer of the uterine cervix

The results of intraarterial chemotherapy (IACT) combined with definitive radiation therapy for 23 advanced and bulky carcinomas of uterine cervix are reported. IA-CT with cisplatin 50 mg and doxorubicin 30 mg was administered by one shot method in bilateral internal iliac arteries. The protocol consisted of one to three treatment session every 3 weeks. Nine of eleven patients with clinical stage III achieved a complete local response (82%), and the 3- and 5-year survival in these cases were 72% and 72%, respectively. These results were superior to the response (58%), 3- and 5-year survivals (68%, 58%) obtained in 19 patients treated mainly with radiation therapy alone. The side effect of grade 2 and 3 for the intestine, such as ileus and hemorrhagic colitis, was noted in 3 patients (15%). In addition, 3 of 8 patients with radical surgery and postoperative radiation therapy after IA-CT developed insufficient fracture of pelvic bone. These complications accompanied by IA-CT combined with radiation therapy and/or surgery increased slightly, compared with that by the previous therapy without IA-CT, but were not critical. The results suggest that IA-CT following radiation therapy is effective to improve the prognosis of patients with Stage III cervical cancer.     

Squamous cell carcinoma of the thoracic esophagus following radiation therapy for breast cancer

Between 1981 and 1995, 4 patients (3 females, 1 male; aged 48-80) were diagnosed with squamous cell carcinoma of the esophagus, following mediastinal irradiation for breast cancer. The interval between irradiation and the presentation of esophageal cancer was 10.75 years on average (7-19). The treatment consisted of: radiotherapy only; a partial esophagectomy with proximal gastrectomy without post-operative radiotherapy; laser photocoagulation for a superficial tumor; and, palliative treatment including gastrostomy, tracheal photocoagulation and chemotherapy for 1 patient suffering from advanced stage cancer with tracheal invasion, respectively. Radiotherapy of the esophageal cancer (exclusive or adjuvant) should take into account previous esophageal radiation therapy. The indications of curative excision surgery are the same as for other types of esophageal cancer, but the anastomoses should be performed in a non-irradiated area. Excision by esophageal stripping without thoracotomy is contraindicated because of the presence of peri-esophageal sclerosis. Preventive measures in radiation therapy for breast cancer are suggested.     

Late rectal sequelae following definitive radiation therapy for carcinoma of the uterine cervix: a dosimetric analysis

OBJECTIVE: The structure of the collagen scar during healing of a myocardial infarction is a determinant of the function of the remodeled tissue. We hypothesize that the passive deformations of both scar and normal tissue are related to the underlying collagen uncoiling as the tissue stretches, and that the unloaded tortuosity of the collagen may be a determinant of tissue stiffness at low ventricular pressure. Hence collagen uncoiling and tissue strain were measured during passive loading in normal tissue, and in healing infarct tissue. METHODS: Left ventricles of rats were infarcted by ligation of the left anterior descending artery for 2 weeks. Surface strains were measured during passive inflation in the scar region in one set of excised hearts, and other arrested hearts were fixed at different ventricular pressures, after which collagen tortuosity was measured in the infarcted and normal tissue. RESULTS: Passive loading strains were smaller in the scar in both the fiber and cross-fiber directions. Tortuosity decreased with load in normal and infarcted tissue, with fibrils tending to straighten more in the scar tissue at higher pressures (1.056 +/- 0.009 vs. 1.024 +/- 0.009 at P = 20 mmHg) with similar tortuosities at zero pressure (1.110 +/- 0.012 vs. 1.098 +/- 0.019). The decrease in tortuosity with strain was greater for the infarcted tissue. CONCLUSIONS: The greater stiffness of infarcted tissue at low pressure is not due to 'straightened' collagen fibers, and there may be a different three-dimensional structure of infarct vs. normal coiled collagen fibers which can affect the material properties of these tissues.     

Malabsorption following radiation therapy

Gastrointestinal injury is known to occur following radiation therapy of tumors in the abdominopelvic compartment. Chronic radiation changes may be associated with diarrhea and malabsorption. A patient with transitional cell carcinoma of the bladder developed diarrhea following radiotherapy and was treated symptomatically for nine years with the assumption that the diarrhea was secondary to radiation enteritis. Further evaluation including endoscopic cholangiopancreatography, revealed pancreatic insufficiency with steatorrhea as the probable cause of the patient's diarrhea. Although temporally related to radiation therapy, the etiology of his pancreatic insufficiency remains speculative. All patients developing diarrhea and/or malabsorption following radiotherapy should be evaluated thoroughly for treatable causes.     

Lung cancer after radiation therapy for breast cancer

BACKGROUND: Radiation, including radiation therapy (RT) for a variety of conditions, is known to be a lung carcinogen. METHODS: Data from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute for 1973-1986 were utilized to investigate whether RT for breast cancer affects the risk of subsequent lung cancer. The relative risk was calculated by comparing the incidence rate in patients with irradiated breast cancer with that in those with nonirradiated breast cancer. RESULTS: It was found that the risk of lung cancer overall was increased in women who underwent irradiation compared with those who were not irradiated 10 years after the initial breast cancer diagnosis with a relative risk of 2.0 (95% confidence interval, 1.0-4.3). In addition, the risk of lung cancer was in the ipsilateral lung compared with the contralateral lung for irradiated women. This increase was observed after 10 years for lung cancer overall and for the three major histologic subgroups (small cell, squamous cell, and adenocarcinoma). Specific information on RT doses and treatment plans and cigarette smoking were not available. CONCLUSIONS: It was concluded that RT for breast cancer may increase the risk of lung cancer after a latency period of 10 years.     

Prognostic implications of downstaging following preoperative radiation therapy for operable T3-T4 rectal cancer

PURPOSE: Squamous cancer of the upper aerodigestive tract is a disheartening disease. Despite our best efforts, the long-term survival rate remains only 15% to 40%, and surgical cures often decrease the quality of life owing to the loss of swallowing and speech organs. A better understanding of tumor dynamics and the discovery that thiosulfate can neutralize cisplatin led us to develop a treatment plan that combines a rapid superselective high-dose intraarterial delivery of cisplatin (CDDP), simultaneous intravenous infusion of its antagonist, thiosulfate, and radiation therapy. METHODS: Patients with advanced head and neck squamous cancer were entered into the protocol after a multidisciplinary evaluation that included CT or MR imaging. Forty-two patients constituted the first cohort. After baseline angiography, an arterial acceptance test determined the maximum infusion rate that the tumor's nutrient artery would accept. CDDP was then infused at that rate, usually within 3 to 5 minutes, while the antagonist thiosulfate was given intravenously. In the second cohort of 85 patients with stage 3 or 4 previously untreated and unresectable disease, local radiation was added to the treatment plan. The radiation dose (180-200 cGy/d x 35) was delivered regionally on the basis of the known radiosensitizing effect of CDDP. RESULTS: Cohort 1 allowed us to develop the infusion technique and to establish a dose quantity and delivery frequency. When 150 mg/m2 was administered weekly for 4 weeks, no severe toxicity was found. In cohort 2, 72 (92%) of the remaining 78 patients had complete disappearance of their tumor. Seventeen severe toxic events were associated with 323 femoral catheterizations. One patient died of pulmonary embolus, precluding follow-up evaluation. Six patients had neurologic sequelae, three with transient and three with permanent strokes. CONCLUSION: Rapid superselective chemotherapy with CDDP combined with a circulatory systemic antagonist allowed delivery of an antitumoral drug directly into the lesion while protecting the kidneys and bone marrow from the agent's systemic effects. Use of a dose regimen of 150 mg CDDP/m2 per week for 4 weeks resulted in the disappearance of a large percentage of advanced squamous cancers.     

Neuroendocrine small cell uterine cervix cancer in pregnancy: long-term survival following combined therapy

The presence of enterobacterial repetitive intergenic consensus (ERIC) sequences was demonstrated for the first time in the genome of Mycobacterium tuberculosis; these sequences have been found in transcribed regions of the chromosomes of gram-negative bacteria. In this study genetic diversity among clinical isolates of M. tuberculosis was determined by PCR with ERIC primers (ERIC-PCR). The study isolates comprised 71 clinical isolates collected from Sardinia, Italy. ERIC-PCR was able to identify 59 distinct profiles. The results obtained were compared with IS6110 and PCR-GTG fingerprinting. We found that the level of differentiation obtained by ERIC-PCR is greater than that obtained by IS6110 fingerprinting and comparable to that obtained by PCR-GTG. This method of fingerprinting is rapid and sensitive and can be applied to the study of the epidemiology of M. tuberculosis infections, especially when IS6110 fingerprinting is not of any help.     

Results of radiation therapy for limited small-cell lung cancer

Results of radiotherapy were reviewed in 68 patients with limited small-cell lung cancer from the aspect of local control. Thirty-one patients achieved CR (46%), while the other 31 remained at PR. The 1-, 2-, 3-, and 5-year cumulative survival rates were 57%, 28%, 21%, and 16%, respectively, for 15 months in MST. Thirty-six patients developed local recurrence (53%) and 46 had distant metastasis (68%). The thirty-one patients with CR had a 43% 2-year-survival rate and 23 months in MST. The remaining 37 patients (PR + NC) had respective figures of 13% and 13 months (p < 0.025). There was no statistically significant difference between radiation dose and local thoracic failure among the patients. Of the 31 patients with CR, 28 had achieved CR at 45Gy (17 received 55Gy or more, and 11 less than 55Gy). In the former, the local control rate, 2-year-survival and MST were 94%, 53% and 44 months, while in the latter these were 45%, 27% and 17 months, respectively. Thirty-five patients were irradiated by the shrinking field technique according to tumor reduction; however, this technique did not influence the treatment results. To obtain better results, it is first necessary to achieve CR at initial chemo-radiotherapy. As to irradiation, randomized trials between 50Gy and 60Gy would require patients with CR at 45Gy.     

The radiation therapy of skin cancer of the face

Results of three-year radiotherapy are assessed in 586 patients with skin cancer, with tumors localized on the skin of the face in 484 of these. The results of treatment were found to depend on the histological structure of the tumor and disease stage: 100% cure was attained in patients with basal-cell carcinomas and T1 stage, whereas only 7% of patients with T4 stage were cured; in patients with squamous-cell carcinoma these figures were, respectively, 96.2 and 10%.     

Carcinoembryonic antigen in patients treated with radiation therapy for invasive squamous cell carcinoma of the uterine cervix

Plasma carcinoembryonic antigen (CEA) levels in 75 patients with invasive cervical cancer were measured during and after radiation therapy. Initial CEA levels were elevated in 65% of the patients, the incidence varying with stage of disease. Of the 32 patients followed during therapy, CEA levels rose in 26 (81%). CEA values after therapy in the same 32 patients showed three patterns: (1) decline to normal, associated with a disease-free state; (2) decline but not to normal, associated with heavy cigarette smoking or persistent disease; and (3) decline to normal, followed by a rise to abnormal, associated with tumor recurrence. Elevation of CEA levels preceded recognition of recurrent cervical cancer by as much as 4 months in five of seven patients.