Radiotherapy and ovarian carcinoma. Experience in 139 patients

Between 1969 and the end of 1984, 104 patients with stage I to III ovarian carcinoma were referred for treatment. All patients had surgery before referral. There were 42 stage I, 32 stage II and 30 stage III patients. In one third of the patients the previous surgery was incomplete. Another 35 patients with advanced (stage IV) ovarian carcinoma or with an abdomino-pelvic recurrence after surgery were referred for palliative treatment. Distribution of the patients according to age, stage and histologic type was not different from the series reported in the literature. Radiation therapy was given over the pelvis up to 45 Gy midline dose. A lumbo-aortic field, 25 Gy up to the diaphragm, was added for stage III patients. Five year survival after complete surgery was respectively 80.5%, 65.5% and 33.3% for stage I, II and III. After incomplete surgery the data dropped to 70%, 33% and 6.6%. Overall five year survival is nevertheless 57.6%. These results are compared to similar published series (surgery and radiotherapy). The outcome is very similar. Adjuvant radiation therapy in adequate dose over the pelvis is worthwhile for ovarian carcinoma stage I-II, and with lumbo-aortic irradiation for stage III, providing surgery was aggressive.     

Axonal transport of rubidium and thallium in the olfactory nerve of mice

Following intranasal administration of radioactive (86)Rb(+) and (201)Tl(+) in mice, we observed this direct transport via the olfactory nerve pathway. The (86)RbCl and (201)TlCl solutions were administered to two groups of mice, the unilateral intranasal and intravenous administration groups. After sacrifice, their heads were divided into the right and left side, which were then subdivided into seven parts; the nasal mucosa and brain regions were separated. Following the unilateral intranasal administration, uptake after 6 h by the olfactory bulb was significantly higher on the ipsilateral side ((86)Rb, 0.7 %dose; (201)Tl, 0.5 %dose) than on the contralateral side ((86)Rb, 0.08 %dose; (201)Tl, 0.15 %dose). Moreover, the (86)Rb and (201)Tl that accumulated in the olfactory bulb were gradually transported to other brain regions of the olfactory tract, the telencephalon and the diencephalon on the side corresponding to the nostril used for administration. Significant differences were observed between the right and left side of the brain regions 6 and 12 h after administration. Further, (201)Tl autoradiography clearly showed striped patterns of dense accumulation, localized in the region around the glomerular layer and granule cell layer of the olfactory bulb and around the olfactory cortex. These results provide clear evidence of axonal transport via the olfactory nerve pathway, from nasal cavity to the olfactory bulb, as well as to the olfactory cortex through the synaptic junctions. The olfactory transport of the (86)Rb(+) and (201)Tl(+) is thought to represent the behavior of K(+) in the olfactory system.     

Use of the BrainLAB ExacTrac X-Ray 6D System in Image-Guided Radiotherapy

The ExacTrac X-Ray 6D image-guided radiotherapy (IGRT) system will be described and its performance evaluated. The system is mainly an integration of 2 subsystems: (1) an infrared (IR)-based optical positioning system (ExacTrac) and (2) a radiographic kV x-ray imaging system (X-Ray 6D). The infrared system consists of 2 IR cameras, which are used to monitor reflective body markers placed on the patient's skin to assist in patient initial setup, and an IR reflective reference star, which is attached to the treatment couch and can assist in couch movement with spatial resolution to better than 0.3 mm. The radiographic kV devices consist of 2 oblique x-ray imagers to obtain high-quality radiographs for patient position verification and adjustment. The position verification is made by fusing the radiographs with the simulation CT images using either 3 degree-of-freedom (3D) or 6 degree-of-freedom (6D) fusion algorithms. The position adjustment is performed using the infrared system according to the verification results. The reliability of the fusion algorithm will be described based on phantom and patient studies. The results indicated that the 6D fusion method is better compared to the 3D method if there are rotational deviations between the simulation and setup positions. Recently, the system has been augmented with the capabilities for image-guided positioning of targets in motion due to respiration and for gated treatment of those targets. The infrared markers provide a respiratory signal for tracking and gating of the treatment beam, with the x-ray system providing periodic confirmation of patient position relative to the gating window throughout the duration of the gated delivery.     

Calcification of the olfactory bulbs in three patients with hyposmia

An estimated two million Americans suffer from chemosensory disorders. We present the clinical and imaging findings in three hyposmic patients with bilateral olfactory bulb calcification detected by CT. To our knowledge, these are the first cases of olfactory bulb calcification reported in the literature. A review of the literature concerning calcification of cranial nerves, olfactory neuritis, and the potential etiology and clinical significance of olfactory bulb calcification in our patients is presented.     

Radiotherapy treatment planning for prostate cancer in patients with prosthetic hips.

Patients diagnosed with prostate cancer may also have a prosthetic hip. When planning radiotherapy for these patients, one must consider the attenuation of the dose when the beam passes through the prosthetic hip. It is best to avoid administration of radiation to the target through the prosthesis. Example treatment plans are evaluated. The potential advantages and disadvantages of each plan are reviewed.     

放射治疗对乳腺癌患者血浆中microRNAs表达的影响

目的 分析乳腺癌放疗患者血浆中miR-210-3p、miR-221-3p、miR-21-5p、miR-150-5p的表达水平的变化,为寻找非均匀辐射致损伤的早期生物标记物提供实验依据。方法 选取乳腺癌患者13例,于放疗前(0 Gy)、放疗2、10、20和30 Gy后的24 h采血。采用实时荧光定量PCR(qRT-PCR)法检测受检者血浆miRNAs的表达水平。结果 不同剂量照射后miR-210-3p、miR-221-3p、miR-21-5p的表达差异无统计学意义(P>0.05)。miR-150-5p 2 Gy照射后与照射前表达水平差异无统计学意义,但随着照射剂量增加,其表达水平显著下调,分别为照射前的0.808、0.605、0.565(χ²=18.76,P<0.05)。而在人表皮生长因子受体2(HER2)、雌激素受体(ER)、孕激素受体(PR)的阴性组和阳性组中,miR-150-5p表达差异均无统计学意义(P>0.05)。结论 电离辐射可诱导miR-150表达显著下调,且存在一定的剂量依赖关系。     

Radiotherapy in elderly patients with inoperable esophageal cancer

Background

Radiation oncologists increasingly face elderly cancer patients impaired by comorbidities and reduced performance status. As less data are available for this particular group of patients, the aim of the study was to assess the prognosis of inoperable esophageal cancer patients ≥?70?years undergoing definitive radiotherapy or radiochemotherapy.

Patients and treatment protocol

Patients aged ≥?70 with inoperable carcinoma of the esophagus undergoing definitive radio(chemo)therapy between 1995 and 2006 at the University of Cologne were included retrospectively. Maximal total dose of radiotherapy administered was 63?Gy (5?×?1.8?Gy/week). Chemotherapy consisted of cisplatin (20?mg/m² on days 1–5 and days 29–33) and 5-fluorouracil (650–1,000?mg/m² on days 1–5 and days 29–33). Efficacy was compared with a cohort of 152?patients <?70?years treated with the same protocol during the same time period.

Results

A total of 51?patients aged ?≥?70 with inoperable cancer of the esophagus undergoing definitive therapy were identified (stage I/II 23.5%, stage III 56.9%, stage IV 9.8%; squamous cell carcinoma 74.5%, adenocarcinoma 25.5%). While 15?patients (29.4%) received combined radiochemotherapy (RCT), 40?patients (70.6%) were treated with radiotherapy alone (RT). Median progression-free survival (PFS) was 9.5?months; median overall survival (OS) was 13.9?months. Patients treated with RCT had a 2-year OS rate of 53.3% compared with 16.7% for RT patients (p?=?0.039). The 2-year OS for clinically lymph node negative patients was 38.5% compared with 21.2% for lymph node positive patients (p?=?0.072). Median OS was not significantly different between patients ≥?70?years versus the patient cohort (n?=?152) aged <?70?years (13.9 vs. 7.2?months, p?=?0.072) but PFS showed a significant difference (4.9 vs. 9.5?months, p?=?0.026) in favor of the >?70?years group.

Conclusion

Prognosis in elderly patients with inoperable esophageal cancer undergoing definitive radiotherapy/radiochemotherapy is limited, although it is not inferior to patients <?70?years.     

Dupuytren's contracture. Radiotherapy in the early stages

Conventional radiotherapy is the treatment of choice for the early stages of the Dupuytren contracture. The conventional semi-deep therapy is more favorable than the soft ray technique and the moulage technique. 62 patients have been treated at Erlangen; 33 out of them (46 irradiated hands) with a minimum observation time of 18 months have been evaluated. The pathologic process was stopped in 98% of the cases. 85% of the patients showed an improvement of troubles by regression of tubercules and cords, pains and sensation of pressure. A recurrence was observed only in one patient at the edge of the irradiated volume.     

Neuroblastoma of the tail of the pancreas. Apropos of a case

We describe the case of a four-year-old child who presented a neuroblastoma of the tail of the pancreas. Diagnosis was evoked on computer tomography and confirmed thanks to the pathological examination of the resected tumour. Malignant tumours of the pancreas are rare in children and most of the cases are carcinoma. Three cases of pancreatic neuroblastoma have been described. Evolution and prognosis depend on the staging once the diagnosis is established.     

Neuroblastoma: dose-related sensitivity of MIBG scanning in detection.

Iodine-131 metaiodobenzylguanidine (MIBG) has shown effectiveness as a systemic radiotherapeutic agent in neuroblastoma. The authors postulated a likely dose-related relationship of MIBG sensitivity when it was administered for neuroblastoma detection. They studied this relationship in neuroblastoma patients who underwent scanning after receiving diagnostic and therapeutic doses of MIBG in temporal proximity. Seven patients with stage IV disease received a total of 14 therapeutic administrations of I-131 MIBG (150-350 mCi [5,550-12,950 MBq]/m2 per treatment). Posttherapy scans were obtained at 3 and at 5-7 days. Diagnostic MIBG scans had been obtained no more than 4 weeks before the start of therapy. Use of diagnostic MIBG scanning led to underestimation of the tumor burden by 50% compared with use of posttherapy scanning. This difference may be an important consideration in selecting therapeutic strategies for individual patients. It further suggests that use of much larger diagnostic doses of MIBG is a rational strategy in histologically confirmed cases of advanced disease.     

Radiotherapy of cerebral metastases of breast cancer. Clinical experience with 67 patients

Sixty-seven cases of brain metastases from breast carcinoma treated in the period from January 1969 to June 1986 with radiotherapy (high energies on homogeneous volume, 250-300 kV grid roentgenoherapy) have been evaluated retrospectively. Performance status improvement, evaluated according to Order's stages, with increased quality of life has been obtained in 66% of the patients. Results do not appear to be substantially affected from the different techniques and methods of irradiation. However the importance of implementing and performing the radiotherapy treatment in such a way to keep as high as possible the benefit/risk ratio is stressed, owing to the possibility to observe a few long survival patients after brain metastases occurrence.     

Radiotherapy of orbital pseudotumor.

Recent advances in ultrasound and computed tomography have permitted localization of orbital lesions, and sophisticated high-energy irradiation techniques facilitate improved dose distribution without significant damage to normal tissue. Three patients treated for orbital pseudotumor are discussed.     

Radiotherapy dose calculations in the presence of hip prostheses.

The high density and atomic number of hip prostheses for patients undergoing pelvic radiotherapy challenge our ability to accurately calculate dose. A new clinical dose calculation algorithm, Monte Carlo, will allow accurate calculation of the radiation transport both within and beyond hip prostheses. The aim of this research was to investigate, for both phantom and patient geometries, the capability of various dose calculation algorithms to yield accurate treatment plans. Dose distributions in phantom and patient geometries with high atomic number prostheses were calculated using Monte Carlo, superposition, pencil beam, and no-heterogeneity correction algorithms. The phantom dose distributions were analyzed by depth dose and dose profile curves. The patient dose distributions were analyzed by isodose curves, dose-volume histograms (DVHs) and tumor control probability/normal tissue complication probability (TCP/NTCP) calculations. Monte Carlo calculations predicted the dose enhancement and reduction at the proximal and distal prosthesis interfaces respectively, whereas superposition and pencil beam calculations did not. However, further from the prosthesis, the differences between the dose calculation algorithms diminished. Treatment plans calculated with superposition showed similar isodose curves, DVHs, and TCP/NTCP as the Monte Carlo plans, except in the bladder, where Monte Carlo predicted a slightly lower dose. Treatment plans calculated with either the pencil beam method or with no heterogeneity correction differed significantly from the Monte Carlo plans.