The Study of the Distribution of Dose in Radiotherapy with the Aid of Electronic Computers

The authors comment on the utilization of electronic computers as a means of obtaining, quickly and efficiently, the distribution of dose in radiotherapy, with consequent facilitation of the planning procedure. The authors describe the plan of operation and its flow chart. During recent years, electronic computers have been the object of studies with a view to using them in the planning of teleradiation treatment. In this respect much work was done by Tsien, by Professor Theodor Sterling and associates of the University of Cincinnatti, by research workers from the University of Gothenburg, by Dr. Ruheri Perez-Tamayo and companions from the Penrose Cancer Hospital, and by Dr. J. Laughlin and collaborators of the New York Memorial Hospital. As we know, the planning of radiotherapy for deep lesions is quite complex, due to the slight difference in sensitivity between the malignant tissues which should be destroyed and the circumjacent healthy ones, which are often vital and more sensitive than the blastoma itself, and which should be protected. It is up to the radiotherapist, after exhaustively studying the structure and location of the tumour and its relations with the surrounding tissues, to divide the amount of radiation into several “entrance doors”– fields situated at various places on the surface of the body and which, from different angles, shed their rays in the direction of the neoplasia. In determining the openings of the diaphragm, the angles of incidence, and the weights of the contributions from each field, he should concentrate on the region aimed at, the sum of the destructive effects of such radiation beams, since their doses are summable. In order to know the distribution of the dose throughout the irradiated region, it is necessary to verify the values of the sums of the various beams in a sufficiently large number of points and situated not only on the tumour but also on the adjacent healthy structures. Sometimes, once the disposition is known (the isodose curves having been made), points. of overdosage, distortions, deviations and other defects are noted. It is up to the radiotherapist to analyse and find the cause of error and to make a new distribution, thus reinitiating the planning process and studying the new procedure. If it is true that the intensity diminishes-in relation to the distance of the source, the distribution of the amount of radiation in one beam is, however, complex: it depends on the dimensions of the source, on the collirnation device, on the distance source-skin, on the medium, on the spectral composition of the radiation. On a plane perpendicular to the axis the dose varies up to more than 20%, since the radiation emission is not isotropic and the distance to the source is greater on the borders, the diffusion is quantitatively different in the centre and on the limits of the field, and the more peripheral rays go through a greater thickness of filter, as they go through it at an oblique angle. Consequently, the action of the various beams on the region treated produces a distribution of dose which is difficult to calculate and entails a great deal of work. Lack of means capable of making the calculations quickly leads the radiotherapist to the repetition of pre-established techniques (often without the required exactitude), giving rise to the error resulting from the alterations proper to each case, of the dimensions of the patient and of the lesion and its relations with adjacent tissues. The alternative, the solution by graphic method starting from curves traced on transparent paper, is an exceedingly slow process, tiring, and not very exact, for it is impossible to calculate in this way more than a small number of doses in spaced points. Electronic computers fulfil the need for performing these complicated and slow mathematical operations in short periods of time. The utilization of the computer makes it possible to determine, within a short time, the dose in a great number of points; it gives the specialist the opportunity to make several studies for the same case and select the most convenient planning, thus perfecting the techniques; it also brings about greater safety, both in the number of points calculated and in the precision of the results.     

The Radiology of Cyanotic Congenital Heart Disease

A consideration of the radiological contribution to the diagnosis and management of the three common forms of cyanotic congenital heart disease is presented. The infant with tetralogy of Fallot or pulmonary atresia with ventricular septal defect is usually studied before palliative surgery is undertaken. The site of obstruction to pulmonary blood flow and the presence of suitable pulmonary arteries to receive an anastomosis must be established. In the older patient presenting for repair detailed assessment of the intracardiac anatomy as well as the sites of obstruction and routes of filling of the pulmonary arteries is desiiable. Some variations of the anatomy of ventricular septal defect in tetralogy of Fallot are described. Following a brief consideration of the relationship of straightforward transposition of the great vessels to the normal state and to the partial transposition complexes, the radiological assessment of the neonatal infant with transposition is presented. The diagnosis of transposition, the state of the interventricular septum, and the state of the ductus arteriosus must be established and sometimes pulmonary stenosis excluded to assist in the selection of the most suitable palliation. Before correction, a complete anatomical assessment of intracardiac anatomy, including detail of the outflow tracts, is necessary.     

抗肿瘤药物敏感试验的实验研究：组织细胞学因素分析

本文从组织细胞学角度,就影响SRCA移植实验的可变因素进行了分析讨论。结果表明:以SRCA作为抗肿瘤药物敏感试验,对于肿瘤类型、取材部位的选择性不强,具有适应范围较广的特点。但对于肿瘤组织细胞本身的质量要求较高,是实验中的重要质量控制因素之一。此外,肿瘤细胞分化的高低与移植成功率也有密切关系,在分析无可评价性实验结果的影响因素时应将其考虑在内。而移植前快速、准确的印片细胞学诊断对控制上述因素的影响有所裨益。     

Relationship between length and surface area of each segment of the large intestine and the incidence of colorectal cancer

In investigating the occurrence and clinical characteristics of diseases of the large intestine, particularly tumors, the number, distribution, and incidence of the lesions were compared between segments of the large intestine. If the distribution and incidence of lesions are correlated with the length or surface area of each segment, the incidence of lesions will be the same throughout the large intestine. If the lesions are unrelated to length or surface area, the factors that affect the occurrence of lesions must be determined and will be characteristic for each segment. However, the length and surface area of each segment of the large intestine and the ratios of each to both the total length and surface area of the large intestine are not clear. In this study the length and surface area of each segment of the large intestine were measured and calculated using the barium enema technique, and the incidence rates of cancer per unit length and surface area of each segment were determined and compared.     

Psychosocial approach of the speech of women in metastatic relapse of a breast cancer: the question of temporality

The "relapse", this word so much dreaded by the patients reached of a cancer because it symbolizes the return of the disease and the treatments in the person's life and his entourage. This diagnosis once established mark the entry into a chronic phase of the cancerous disease, involving the future of people and their report at time. In this context, we believe it is important to identify the subjective and social aspects of the experience of this difficult moment in the course of the disease, by taking account the report at the time of the patients. In this article, we propose a study of these different aspects through a double analysis (lexical thematic manual and with a computer) of semi-structured interviews conducted with patients in metastatic relapse of a breast cancer. The report at time was operationalized at the same time as a variable of personality by using the scale of temporal prospect (PT) Zimbardo Time Perspective Inventory ZTPI and through the different linguistic markers, indicators of meaning in the stories of patients. The results of this double analysis highlight different aspects of the speech of the patients, reflecting investments different in the disease at the time of the relapse and and, depending on age and time profiles of patients. However, these results illustrate the links between some aspects of time focusing on the stories of patients and the strategies of adjustments which result from this, allowing an articulation of these concepts around the notion of control.     

食管癌、胃癌在初诊及完全缓解后复发转移的血液流变学分析

本文对食管癌、胃癌病人初诊及完全缓解后复发转移的血液流变学的观察表明：两组病人的血沉、全血比粘度血沉方程Ｋ值与正常人比较差异均有显著性（Ｐ＜０．０１），两组病人之间差异无显著性。微循环状态中，两组病人之间瘀血情况检验差异有显著性（Ｐ＜０．０１）。随着病情的加重和转移、病程的延长，其血液粘度增高的比例及微循环异常的比例也提高。说明食管癌、胃癌病人血液流变学改变是疾病发展过程中的一个必然趋势。     

Anemia in malignant tumors. Loss of circulating transferrin due to lysosomal storage in human and rat malignant tumors]

The cellular uptake of 67Ga-labelled transferrin was studied in the carcinoma of the human respiratory tract and in the Morris hepatoma 5123 C of the rat. In both types of tumors a positive tumor imaging by 67Ga-transferrin scintigraphy was evident. The intracellular distribution pattern of the radioactivity showed that the incorporated 67Ga-transferrin is accumulated within the lysosomes of the tumors. The uptake of 67Ga-transferrin by the tumor cells resulted in a faster disappearance of the tracer from the blood. The accelerated disappearance of 67Ga-transferrin from the blood showed a direct correlation to the mass of tumor cells. The loss of circulating 67Ga-transferrin from the blood showed a close parallelism to the grade of the anemia observed in the tumor bearing rats. We conclude from these findings that the uptake of transferrin into the tumor cells is one of the factors which are responsible for the anemia observed in malignant diseases.     

胰头癌和壶腹癌的淋巴结转移及病理特点分析

目的:探讨胰头癌和壶腹癌的淋巴结转移及病理特点.方法:回顾性分析201例胰头癌和壶腹癌根治手术后的淋巴结转移及病理特点,χ2检验分析淋巴结转移与病理因素的相关性.结果:201例胰头癌和壶腹癌行胰十二指肠切除术,淋巴结转移率分别为32.65%(16/49),30.92%(47/152),其转移淋巴结累及部位基本相同,其中88.89%(32/36)单个淋巴结转移位于胰十二指肠周围.x2检验显示壶腹癌淋巴结转移相关的病理因素有:肿瘤直径(P=0.002),肿瘤分化程度(P=0.012),十二指肠壁浸润(P=0.008),T分期(P=0.000),胰腺受侵(P=0.005),胰头癌与上述病理因素无关,但神经浸润比例高.结论:胰头癌的淋巴结转移及病理特点与壶腹癌有所不同,手术方式的应有所区别,胰头癌应行扩大根治性手术切除.     

Alterations in carbohydrate metabolizing enzymes induced by hormones during the process of carcinogenesis

The effects were studied of hydrocortisone and 1-triiodothyronine on the activity of the key enzymes of glycolysis, gluconeogenesis and the glucose phosphate pathway in the liver, during the process of hepatocarcinogenesis induced in male Wistar rats and C3HA mice by N-nitrosodiethylamine. It was found that the effects of hydrocortisone and of thyroid hormone depend on the time of administration of the carcinogen and on the stage of the carcinogenic process in the liver. The effect of hormones on the enzymes studied decreased with the development of tumours in the liver.     

Klaas Breur Medal lecture 1985. The growth and progression of human tumors: implications for management strategy

The natural history of human cancers can be stimulated assuming an exponential growth pattern. This simple model shows that the duration of the tumor growth during the occult phase is always much shorter than the interval between the carcinogenic stimulus and the clinical emergence of the tumor; this is consistent with the existence of several stages of precancerous lesions which precede the development of the neoplastic clone. Metastatic spread can be simulated and a model of tumor growth can be used to predict the proportion of patients in whom metastatic dissemination can be avoided by an earlier diagnosis. The model predicts also that in the subsets of patients in whom metastatic spread occurs early the occult metastases will be large at the time of the treatment of the primary tumor and therefore adjuvant chemotherapy (CT) will be less effective; this is in keeping with clinical data. The model can also help to understand the relationship between the local control of a tumor and the cure of the patient, and to explain the discrepancy between the great reduction in the local incidence of local recurrence obtained with post-operative radiotherapy and its relatively small impact on survival. However, this simple model is insufficient to explain several features of the course of a human cancer, in particular the heterogeneity of the neoplastic cell population and the inexorable tendency for some cancers to progress towards a more malignant type and to become progressively more resistant to any treatment. Genetic instability appears to be an essential characteristic of human cancers and variations in its degree may be the cause of differences in the aggressiveness and in the severity of the various types of cancers. The recent advances in the molecular biology of cancers has already given to clinicians new and powerful prognostic indicators. These will probably, in the near future help, towards a better understanding of the biology of tumor growth and tumor progression.     

梨状窝癌侵犯喉结构的病理研究

目的：探讨梨状窝癌侵犯喉结构的规律，为保留喉功能的梨状窝癌的手术治疗提供病理学依据。方法：应用石蜡包埋大体标本连续切片的方法，对26例梨状窝癌全喉及次全喉切除的标本进行了研究。结果：位于梨状窝内侧壁的肿瘤容易向喉腔扩展，声门旁间隙及甲状软骨是最易受侵犯的喉结构，环状软骨受侵较少；会厌及全厌前间隙的侵犯未见超过中线，声门旁间隙及会厌前间隙的侵犯途径有两个，肿瘤沿杓会厌襞向前及在甲状软骨板内侧直接向前侵犯声门旁间隙；肿瘤沿杓会厌襞向内上方及在甲状软骨板内侧上部侵入会厌前间隙。结论：声门旁间隙及会厌前间隙的受侵并不是喉部分切除的禁忌证，大部分位于状窝外侧壁的肿瘤及部分梨状窝内侧壁的肿瘤保留喉功能是可行的。     

The evaluation of cancer control measures

The assessment of a screening procedure falls into two parts. The first is the development of a test and the establishment of criteria of specificity and sensitivity. The second stage is that of the application of the test to the general population, demanding attention to the natural history of the disease and to the usefulness and simplicity of the test itself. The decision to organize a screening programme has usually to be taken on the basis of incomplete information and in the setting of a population subjected to constant change. It is the hope of the Committee on Cancer Prevention and Detection of the UICC that the conclusions from the Symposium will prove helpful to all who face such decisions.     

Protease inhibitor suppression of colon and anal gland carcinogenesis induced by dimethylhydrazine

In the present study, we examined the ability of chymostatin, a highly specific inhibitor of chymotrypsin, to suppress dimethylhydrazine-induced colon carcinogenesis, and the dose-response relationship for an extract of soybeans containing the Bowman-Birk inhibitor (BBI) to suppress dimethylhydrazine-induced colon carcinogenesis, when added to the diet of mice. Our results showed that: (i) diets containing 0.1% BBI reduced the incidence of adenocarcinomas of the colon approximately 50%, but had no effect on the incidence of squamous cell carcinomas of the anal gland; (ii) the suppressive effect requires protease inhibitor activity, as the autoclaved BBI, in which all protease inhibitory activity has been destroyed, was ineffective at suppressing the incidence of adenocarcinomas; (iii) chymostatin suppressed the incidence of squamous cell carcinomas of the anal gland, but not adenocarcinomas of the colon; and (iv) the growth rates of the animals were the same in each of the experimental groups. Our results indicate that the levels of anticarcinogenic protease inhibitors present in the diets of these animals do not have any adverse effects on the growth or general health of the animals.     

Hormone-dependent human tumors express the fms gene-product

Human mammary and thyroid tumors as well as peripheral blood cells of the same patients were examined for the amplification of oncogene fins and the expression of its product. Of the 7 mammary tumors analyzed, amplification of fms was observed in 6 (86%) mammary tumor DNAs, while no amplification was seen in 5 thyroid tumors and 7 peripheral blood cell DNAs tested. None of the mammary and thyroid tumors showed any rearrangement of the fms gene. Investigations of the expression of the product of fms in various human tumors were carried out following the method of immunohistochemical staining in which polyclonal antibody to the fms gene product was used. The incidence of the expression of fms gene product in the tumors of mammary and thyroid glands, prostate and ovary, the hormone-dependent organs, was 38-97%, whereas fms protein was found to be present only in 20 and 42% of the tumors from hormone-independent organs, the brain and the bladder. Expression of the fms gene product was not detectable in normal tissue surrounding the tumor tissue in any of the cases examined. These results suggest that the expression of the product of fms may be associated with the development of some tumors of hormone responsive organs, especially the breast and thus the fms gene product may be a valuable marker for human mammary tumors.     

Factors influencing the results of treating trophoblastic tumor patients]

To assess prognostic factors the author has analysed the clinical data on 127 patients, subjected to three variants of the treatment (chemotherapy - in 72, surgery+chemotherapy - in 34, surgery+chemotherapy+radiotherapy - in 21). The following factors have been examined: patients' age, a duration of the affection symptoms in relation to their pregnancy prior to the disease, issues of pregnancy preceding the disease, the size of the primary focus (the uterus), the degree of the process spread, the height of the CH level in diurnal urine before the treatment, the method of initial therapy. Based on the data obtained, it was demonstrated that aside of the tumor morphological structure and the extent of the process spread the results of the treatment are influenced by a sum of clinical signs of the disease, which shound in prognostication.     

大肠癌淋巴结转移的相关病理因素368例分析

目的　探讨大肠癌淋巴结转移相关的病理学因素。方法　对 3 68例大肠癌切除标本按统一标准 ,进行组织学分类、浸润深度、癌周淋巴细胞反应等项检查 ,探讨其与淋巴结内癌转移的关系。结果　淋巴结内癌转移率为 3 3 4% ,其中肠旁组淋巴结转移率占 77 2 % ,肠系膜淋巴结及系膜动脉结扎处淋巴结转移率占 17 9%和 4 9%。癌肿长径 >6cm及浸润深度达浆膜外 ,癌周淋巴细胞反应强度 > 时癌转移率最高 (P <0 0 0 5 ) ,组织学分级级别越高 ,癌转移率越高。组织类型与癌转移率有明显相关性 (P <0 0 5 ) ;结论　大肠癌淋巴结内癌转移以肠旁组为主 ,常为逐站转移 ,转移率与肿瘤大小、浸润深度呈正相关 ,与分化程度及淋巴细胞反应强度呈负相关 ,与组织学类型有明显相关性。     

系统性干预对脑原发性恶性胶质瘤手术患者应激反应、心理状态、术后疼痛及生活质量的影响

目的 探讨系统性干预对脑原发性恶性胶质瘤手术患者应激反应、心理状态、术后疼痛及生活质量的影响.方法 根据干预方法的不同将98例脑原发性恶性胶质瘤患者分为观察组(n=56)和对照组(n=42),对照组患者进行常规干预,观察组患者在对照组的基础上进行系统性干预.比较入院时和手术开始15 min时两组患者的心率(HR)和平均...     

survivin蛋白在脑胶质瘤的表达及其意义

目的:探讨survivin蛋白在脑胶质瘤的表达情况及其与肿瘤恶性程度之间的关系。方法:应用免疫组织化学方法检测40例脑胶质瘤标本survivin蛋白的表达强度、阳性细胞百分比及其与胶质瘤组织学分级之间的关系。结果:survivin蛋白表达阳性染色主要位于脑胶质瘤细胞的胞浆,并与脑胶质瘤的组织学分级相关,各级之间有显著性差异(P<0.05),随着脑胶质瘤恶性程度增高,survivin的表达强度和阳性细胞百分比也随之逐渐增加。结论:survivin蛋白在脑胶质瘤呈过度表达,并与脑胶质瘤的恶性程度密切相关。     

Retinoids and breast cancer: From basic studies to the clinic and back again

All-trans retinoic acid (ATRA) is the most important active metabolite of vitamin A controlling segmentation in the developing organism and the homeostasis of various tissues in the adult. ATRA as well as natural and synthetic derivatives, collectively known as retinoids, are also promising agents in the treatment and chemoprevention of different types of neoplasia including breast cancer. The major aim of the present article is to review the basic knowledge acquired on the anti-tumor activity of classic retinoids, like ATRA, in mammary tumors, focusing on the underlying cellular and molecular mechanisms and the determinants of retinoid sensitivity/resistance. In the first part, an analysis of the large number of pre-clinical studies available is provided, stressing the point that this has resulted in a limited number of clinical trials. This is followed by an overview of the knowledge acquired on the role played by the retinoid nuclear receptors in the anti-tumor responses triggered by retinoids. The body of the article emphasizes the potential of ATRA and derivatives in modulating and in being influenced by some of the most relevant cellular pathways involved in the growth and progression of breast cancer. We review the studies centering on the cross-talk between retinoids and some of the growth-factor pathways which control the homeostasis of the mammary tumor cell. In addition, we consider the cross-talk with relevant intra-cellular second messenger pathways. The information provided lays the foundation for the development of rational and retinoid-based therapeutic strategies to be used for the management of breast cancer.