High-dose-rate intracavitary brachytherapy: results of analyses of late rectal complications

: To examine the incidence of radiation-induced late rectal complications by analyzing the data of measured rectal doses in patients with cancer of the uterine cervix treated with high-dose-rate intracavitary brachytherapy.

: We measured doses to the rectum in 105 patients with cancer of the cervix during high-dose-rate intracavitary brachytherapy with a semiconductor dosimeter that can measure five points in the rectum simultaneously. On the basis of these measurements, equivalent doses, to which the biologically equivalent doses were converted as if given as fractionated irradiation at 2 Gy/fraction, were calculated as components of the cumulative dose at five rectal points in intracavitary brachytherapy combined with the external whole pelvic dose.

: The calculated values of equivalent doses for late effects at the rectum ranged from 15 to 100 Gy (median 60 Gy for patients who did not develop complications and 76 Gy for patients who subsequently developed Grade II or III complications). When converted to a graph of absolute rectal complication probability, the data could be fitted to a sigmoid curve. The data showed a very definite dose-response relationship, with a threshold for complications at approximately 50 Gy and the curve starting to rise more steeply at approximately 60 Gy. The steepest part of the curve had a slope equivalent to approximately 4% incidence/1 Gy increase in equivalent doses.

: The radiation tolerance dose, 5% and 50% complication probability, was about 64 and 79 Gy, respectively. Our data almost agree with the prescribed dose for the rectum for the radiation tolerance doses on the basis of the recorded human and animal data. The probability of rectal complications increased drastically after the maximal rectal dose was >60 Gy.     

Clinical studies of immunohistochemical staining of DNA-dependent protein kinase in oropharyngeal and hypopharyngeal carcinomas

PURPOSE: DNA-dependent protein kinase (DNA-PK), a serine/threonine kinase composed of p470 catalytic subunit (DNA-PKcs) and p85/p70 heterodimer (Ku antigen), is considered a critical enzyme in the repair of the DNA double-strand breaks (DSB) that are the major lethal lesions induced by ionizing radiation. We investigated the expression of DNA-PK subunits in human tumors. MATERIALS AND METHODS: We examined immunohistochemically the biopsy specimens of 44 patients with oropharyngeal carcinoma and 32 patients with hypopharyngeal carcinoma who had been treated with radiotherapy. RESULTS: Immunopositivity to Ku85 and DNA-PKcs was found in all patients. The staining of Ku85 and DNA-PKcs was nuclear, with none of the normal epithelial cells or malignant cells exhibiting cytoplasmic or membrane immunoreactivity. Normal epithelial cells were all stained intensely. In tumors, intense nuclear staining of DNA-PKcs was seen in 75 of 76 tumors, while that of Ku85 was seen in all 76 patients. The radiation responses of a primary tumor that was stained weakly with DNA-PKcs were excellent. CONCLUSION: Our results suggest the possibility of predicting the intrinsic radiosensitivity of human tumors in clinics able to perform immunohistochemical analysis of DNA-PK.     

Endoscopic prediction of tumor depth of gastric carcinoma for assessing the indication of its limited resection

Limited surgery for an early gastric carcinoma is advocated, since certain carcinomas have no nodal involvement. However, the endoscopic accuracy of distinguishing each cancer-depth has not been detailed from the standpoint of limited surgery. We retrospectively reviewed a total of 2,628 patients to assess the diagnostic accuracy of their endoscopic infiltration-depth with the nature of the tumors. Endoscopic distinction of early from advanced carcinomas was satisfactory with a reliability of 86.5%, sensitivity of 87.1%, and specificity of 85.9%. In the 1,354 early gastric carcinomas the microscopic infiltration-depth was significantly related to macroscopic appearance, histologic differentiation and tumor size. Accompanying ulcer or scar significantly suggested that the carcinoma had spread vertically and horizontally. Macroscopically elevated and differentiated carcinomas without ulcer are usually limited to the mucosa, and undifferentiated and/or ulcer-positive carcinomas are more invasive than predicted by most present clinical standards. Endoscopically differential diagnosis of the infiltration-depth of gastric carcinomas is reliable, and the indication for limited surgery can be endoscopically determined in many individual patients.     

Delayed enhancement of islet cell carcinomaon dynamic computed tomography: a sign of its malignancy

Dynamic CT of a 53-year-old man revealed a slightly hyperdense tumor at an arterial phase, and it was much enhanced 3.5 min later. Since the histology of the resected specimen revealed tumor thrombi of the vein around the tumor, this sign is probably based on delayed washout of the contrast media from the tumor. Received: 9 July 1996/Accepted: 7 August 1996     

An autopsy case of extra-adrenal malignant pheochromocytoma

An autopsy case of an extra-adrenal malignant pheochromocytoma in a 34-year-old woman is reported. On laparotomy, many advanced stage malignant tumors originating from the paraganglia along the abdominal aorta were found to have invaded the lumbar vertebrae. After a partial resection, Co60 radiation therapy of the paraganglia was instituted, as well as of the metastatic lesions, with little effect. It was found that alpha-methyl-tyrosine was effective in controlling the plasma catecholamine, but had to be discontinued because of an untoward effect (anxiety). The patient subsequently developed intractable hypertension and a paralytic ileus from excess catecholamine secretion. As an alpha 1 adrenergic blocker was not effective, we had to use large doses of phentolamine to control these complications. Despite various intensive therapies, however, the patient died of heart failure resulting from 4 years of severe hypertension.     

Transcatheter arterial embolization of hemangiomas in the perioral region

This paper presents four cases with successful transcatheter arterial embolization (TAE) for oral and perioral hemangiomas. Four TAEs were performed without major complications and the tumors disappeared in one case and decreased in size in the other 3 cases.     

Perspectives on postgenome medicine: Gene therapy for AIDS

Following the introduction of HAART(highly active anti-retroviral therapy) marked decreases in AIDS-related morbidity and mortality have been observed. Despite of the clinical success, recent work suggests that there are persistent viral replication in whom plasma HIV-RNA is consistently below detectable level. Furthermore, some experts even suggest that it will be difficult for many of the patients to continue the HAART because of the long-term side effects and drug resistance. Recent studies that supported the correlation of HIV-specific CD4-T cell(helper) response with the control of viral replication in vivo have promoted the development gene-based immunotherapy. However, further elucidation of viral pathogenesis in the patient under HAART will be required to develop the immunotherapeutic interventions.     

Factors Related to Osteosarcopenia in Kidney Transplant Recipients

Introduction

Sarcopenia and osteopenia are highly prevalent in older patients, and are associated with a high risk for falls, fractures, and further functional decline. However, related factors in kidney transplant recipients suffering from osteosarcopenia, the combination of sarcopenia and osteopenia, remain unknown.