Adjuvant therapy for adenocarcinoma of the rectum

Surgical resection continues to be the primary curative modality for patients with adenocarcinoma of the rectum. However, local tumor recurrence in the pelvis and/or distant metastasis may occur in spite of complete excision of grossly visible malignant disease. Surgical and pathologic staging can identify a subset of surgically treated rectal cancer patients at high risk for tumor relapse and death. Irradiation and chemotherapy have been used as adjuvant therapy in conjunction with surgery as single modalities and in combination for patients with high risk rectal cancer. Evidence from controlled clinical trials indicates a significant decrease in local tumor recurrence, and a significant improvement in disease-free and overall survival with the use of combined postoperative irradiation and chemotherapy in this setting. A current national clinical trial in the United States of America is studying whether irradiation can be combined with new chemotherapy regimens which have shown significant therapeutic benefit as surgical adjuvant therapy for patients with high risk colon cancer (5FU + levamisole) and for patients with metastatic colorectal cancer (5FU + leucovorin) to further improve the efficacy of surgical adjuvant therapy for adenocarcinoma of the rectum.

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Resumen La resección quirúrgica continúa siendo la modalidad curativa primaria en pacientes con adenocarcinoma del recto. Sin embargo, la recurrencia local del tumor en la pelvis y/o las metástasis distantes puede ocurrir a pesar de la resección completa de la enfermedad maligna macroscópicamente visible. La estadificación operatoria y patológica puede indentificar un subgrupo de pacientes tratados quirúrgicamente con alto riesgo de relapso tumoral y meserte. La irradiación y la quimioterapia han sido utlizados como terapia adyuvante en unión con la cirugía como modalidades únicas y en combinación para pacientes con cáncer rectal de alto riesgo. La evidencia surgida de ensayos clínicos controlados señala una disminución significativa en las tasas de recurrencia tumoral local, y una superación significativa en las tasas globales de sobrevida y de sobrevida libre de enfermedad con el uso de la combinación postoperatoria de irradiación y quimioterapia. Un ensayo clínico nacional que se ejecute en el momento actual en los Estados Unidos investiga si la irradiación puede ser combinada con los nuevos regímenes quimioterapéuticos que han demostrado beneficio significantivo como terapia quirúrgica adyuvante en pacientes con cáncer de colon de alto riesgo (5 FU + levamisol) y en pacientes con cáncer colorrectal metastásico (5 FU + leucovorin) con el propósito de mejorar aún más la eficicacia de la terapia quirúrgica adyuvante en el adenocarcinoma del recto.

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Résumé La chirurgie est le principal moyen thérapeutique de l'adénocarcinome du rectum. La récidive tumorale pelvienne et/ou à distance peut cependant se produire malgré une résection apparemment complète. Un bilan d'extension chirurgical et anatomopathologique peut identifier un sous-groupe de patients susceptible de présenter une récidive ou d'en mourir. La radio-et chimiothérapie ont été préconisées comme traitement adjuvant après l'exérèse chirurgicale, soit seule, soit combinée, chez cez patients à risque. Les résultats de plusieurs essais thérapeutiques semblent indiquer que la radio-et la chimiothérapie combinée à la chirurgie diminuent significativement le taux de récidives locales et améliorent significativement la survie globale et la survie sans maladie. Un essai actuellement en cours aux Etats-Unis étudie si la radiothérapie peut être utilement combinée avec les nouveaux régimes chimiothérapeutiques ayant fait preuve de leur efficacité chez les patients à risque (5FU + lévamisole) ou chez les patients ayant des métastases (5FU + leucovin).

     

A novel 37-Kd adhesive membrane protein from cloned murine bone marrow stromal cells and cloned murine hematopoietic progenitor cells

The adhesion of hematopoietic progenitor cells to bone marrow stromal cells is critical to hematopoiesis and involves multiple effector molecules. Stromal cell molecules that participate in this interaction were sought by analyzing the detergent-soluble membrane proteins of GBI/6 stromal cells that could be adsorbed by intact FDCP-1 progenitor cells. A single-chain protein from GBI/6 cells having an apparent molecular weight of 37 Kd was selectively adsorbed by FDCP-1 cells. This protein, designated p37, could be surface-radiolabeled and thus appeared to be exposed on the cell membrane. An apparently identical 37- Kd protein was expressed by three stromal cell lines, by Swiss 3T3 fibroblastic cells, and by FDCP-1 and FDCP-2 progenitor cells. p37 was selectively adsorbed from membrane lysates by a variety of murine hematopoietic cells, including erythrocytes, but not by human erythrocytes. Binding of p37 to cells was calcium-dependent, and was not affected by inhibitors of the hematopoietic homing receptor or the cell-binding or heparin-binding functions of fibronectin. It is proposed that p37 may be a novel adhesive molecule expressed on the surface of a variety of hematopoietic cells that could participate in both homotypic and heterotypic interactions of stromal and progenitor cells.     

The diagnostic interview for personality disorders: Interrater and test-retest reliability

The Diagnostic Interview for Personality Disorders (DIPD) is a semistructured interview of 252 questions that encompasses all 11 Axis II disorders described in the DSM-III. Its interrater reliability was assessed using a sample of 43 patients and its test-retest reliability was assessed using a separate sample of 54 patients. Adequate kappas were obtained in both situations for all disorders except schizoid personality disorder, which was never diagnosed. Interrater coefficients ranged from .52 to 1.0, with nine in the excellent range (κ > .75). Test-retest coefficients ranged from .46 to .85, with four in the excellent range. These results compara very favorably to those achieved using the other two Axis II interviews that have appeared in the literature, the Structured Interview for the DSM-III Personality Disorders (SIDP) and the Personality Disorder Examination (PDE).