Limited Margins Using Modern Radiotherapy Techniques Does Not Increase Marginal Failure Rate of Glioblastoma

PURPOSE: We investigate the patterns of failure in the treatment of glioblastoma(GBM) based on clinical target volume(CTV) margin size,dose delivered to the site of initial failure,and the use of temozolomide and intensity-modulated radiotherapy(IMRT).METHODS: Between August 2000 and May 2010,161 patients with GBM were treated with radiotherapy with or without concurrent temozolomide.Patients were treated with CTV expansions that ranged from 5 to 20 mm using a shrinking field technique.Patterns of failure and time to progression and overall survival were compared based on CTV margin,use of temozolomide,and use of IMRT.Kaplan Meier analysis was used to estimate survival times,and χ test was used for comparison of cohorts.RESULTS: For patients treated with 5-,10-,and 15-to 20-mm CTV,79%,77%,and 86% experienced failures in the 60 Gy volume,respectively.Forty-eight percent,55%,and 66% of patients with 5-,10-,and 15-to 20-mm CTV experienced failures in the 46 Gy volume,respectively.There was no statistical difference between patients treated with 5-,10-,15-to 20-mm margins with regard to 60 Gy failure(P=0.76),46 Gy failure(P=0.51),or marginal failure(P=0.73).Eighty percent of patients receiving temozolomide experienced failures in the 60 Gy volume.There was no increased likelihood of marginal failures in patients receiving IMRT(P =0.97).CONCLUSIONS: Modern treatment techniques including use of concurrent temozolmide,limited CTV margin size,and IMRT have not greatly changed the patterns of failure of GBM.     

Social adjustment among Chinese women following breast cancer surgery

Background: How breast cancer surgery affects social adjustment among Chinese women is unknown, as are factors predicting such adjustment. Methods: 405 Chinese women receiving surgery for localized breast cancer completed Social Adjustment Scales (Ch‐SAS) at 1‐, 4‐ and 8‐months post‐operatively. Subscale scores were regressed on baseline (days 3–12 post‐operatively) measures of treatment decision‐making difficulty (TDMD), self‐efficacy (GSeS), consultation satisfaction (C‐MISS‐R), psychological (CHQ‐12) and physical distress (PD), and 1‐month follow‐up optimism (C‐LOT‐R), and disappointment (E‐OI), fully adjusted for demographic and clinical factors. Results: All Ch‐SAS subscales except appearance & sexuality changed significantly over 8‐months follow‐up: Enjoyment of social activities (F=27.38, df 2, p<0.001) and self‐image (F=3.63, df 2, p=0.027) improved slightly. Family interaction (F=26.63, df 2, p<0.001) and interaction with friends (F=3.37, df 2, p=0.035) declined slightly. Family and friends interaction subscales were predominantly predicted by high self‐efficacy and optimism, whereas self‐image and appearance & sexuality subscales were predominantly predicted by low treatment outcome disappointment, TDM difficulties, baseline psychological morbidity and high self‐efficacy. Enjoyment of social activities was predicted by low baseline psychological distress and concurrent physical symptom distress. Conclusion: High self‐efficacy and optimism predicted women who have better social relationships with friends and family. Higher self‐efficacy, low TDM difficulties, less disappointment with treatment outcome and low psychological and physical distress predicted better adjustment to self‐image and body image. Copyright © 2009 John Wiley & Sons, Ltd.     

血脂监测在防治Ⅱ型糖尿病患者继发动脉粥样硬化中的意义

目的探讨血脂代谢紊乱跟Ⅱ型糖尿病(ⅡDM)患者继发动脉粥样硬化并症的关系。方法采用奥林巴斯Au-640全自动生化分析仪,测定Ⅱ型糖尿病患者和健康对照组的空腹血糖(GLU)、胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、载脂蛋白Al(ApoAl)和载脂蛋白B100(ApoBloo),并进行统计、比较并与患者的病情进行对比分祈,并对高血糖、血脂组患者跟踪观察、治疗。结果Ⅱ型糖尿病组同健康对照组比较、Ⅱ型糖尿病患者中有合并症组跟无合并症组、高血糖组跟血糖正常组比较,CHO、TG和ApoBloo的含量均升高(P<0.05),而HDL-C和ApoAI含量降低(P<0.05)。而高血糖、血脂组患者,已经初步出现或在随后的观察中出现了动脉粥样硬化等相关的临床表征,且治疗效果不佳。结论Ⅱ型糖尿病患者血脂的异常,特别是CHO、TG的大幅升高,提示患者在出现动脉硬化性心血管合并症之前,体内已经具备了诱发合并症的生化基础,应早期采取针性治疗和预防措施。     

Glomerular filtration rate in transplantation patients: estimation of renal function using Tc-99m DTPA

The clinical assessment of a transplanted kidney is often difficult, especially in the immediate postoperative period. The biochemical parameters used to monitor renal function change slowly and can take several days to reflect the actual renal status. We have modified a technique for determining the glomerular filtration rate (GFR) from a Tc-99m DTPA renal scan and have found that it correlates with the actual GFR throughout the postoperative course. In addition, we describe a method for changing dose calibrator measurements into administered counts. This technique for determining the GFR provides a quick and accurate assessment of renal function and is useful to guide therapeutic decisions.     

Spontaneous intramural haematoma of the oesophagus: CT and MRI appearances

A 64-year-old man with history of ischaemic heart disease and coronary artery bypass graft surgery, but no history of peptic ulcer or liver disease, presented with retrosternal pain and coffee-ground vomitus. Endoscopy revealed a long column of bluish discolouration with normal mucosa interpreted as a grade IV oesophageal varix. Computed tomography showed a non-enhancing low-density submucosal columnar lesion in the mid- and lower oesophagus consistent with a submucosal haematoma. This resolved on follow-up at 10 days. The magnetic resonance features of intermediate signal intensity on T1 -weighted images and hyperintense signal on T2-weighted images of this lesion are also highlighted.     

Value of CT in the preoperative assessment of lung cancer: a survey of thoracic surgeons

Practicing thoracic surgeons were randomly surveyed to evaluate how computed tomography (CT) has influenced the preoperative evaluation of bronchogenic carcinoma. Thirty-six percent of the 529 respondents routinely requested CT and 62% did so selectively. Approximately 40% indicated that CT provided useful information in most cases. Nearly all surgeons (98.7%) do not rely on the identification of enlarged lymph nodes with CT to spare the patient surgical staging; however, 77.5% are influenced by CT results in their staging procedures. Fifty-seven percent reported that a negative CT study eliminates surgical staging entirely unless the patient has a "coin lesion," in which case 75% are willing to proceed directly to thoracotomy. For surgeons who use CT selectively, an abnormal mediastinal contour on the radiograph was the most frequent radiologic abnormality to prompt CT (85%). Thirty-seven percent are influenced by tumor histology in their decision to request CT. There was little difference in the pattern of CT use between university and community hospital surgeons.     

Pigmented eccrine poromas: expression of melanocyte-stimulating cytokines by tumour cells does not always result in melanocyte colonization

Background Although eccrine poroma (EP) occurs preferentially in palmoplantar areas, pigmented variants of EP have not been documented on the palms and soles. Objectives We seek to confirm the notion regarding lack of pigmented EP on palmoplantar areas and determine whether the absence of pigmentation in palmoplantar EPs is due to lack of expression of melanocyte‐stimulating cytokines by tumour cells. Methods We searched the PubMed and Web of Science databases (1966–2006) for reports of pigmented EPs. In addition, a total of 17 EPs were collected from our pathology department. The presence of melanin was examined with haematoxylin‐eosin sections, and melanocyte colonization was shown by immunohistochemical stains for tyrosinase. In addition, immunohistochemical staining with antibodies to melanocyte‐stimulating cytokines, including endothelin‐1, stem cell factor, and nerve growth factor, was done on these tumours. Results A review of the literature revealed 15 pigmented EP reports, none of which were located in palmoplantar areas. Among 17 EPs collected from our pathology department, 7 occurred in palmoplantar areas and 10 in non‐palmoplantar areas. Three of the palmoplantar EPs and three of the non‐palmoplantar EPs showed positive staining with melanocyte‐stimulating cytokines. However, none of the palmoplantar EPs contained melanocytes or melanin pigment, wheras the three non‐palmoplantar EPs that stained positively with melanocyte‐stimulating cytokines were colonized with melanocytes and showed pigmentation clinically. Conclusions The expression of melanocyte‐stimulating factors by tumour cells is associated with melanocyte colonization in non‐palmoplantar EPs but not palmoplantar EPs. Therefore, the presence of melanocyte‐stimulating cytokines per se is not sufficient by itself to induce melanocyte colonization. Certain characteristics of palmoplantar skin, such as the dermal components of these anatomical sites, may play a role in inhibiting melanocyte colonization of EPs.     

Chemotherapy for advanced (stage IIIB and stage IV) non-small cell lung cancer: The Hong Kong perspective

Abstract Non-small cell lung cancer (NSCLC) accounts for about 80% of all primary lung cancers, and 60% of cases present as advanced stages IIIB and IV disease. Traditionally, treatment of stages IIIB and IV disease was only symptomatic (including radiotherapy) and supportive care, and cytotoxic chemotherapy was relatively ineffective. Our initial clinical trials, using MACC, FuAM, FAM, Hi-FAM and cisplatin-VP16, gave response rates of 5–20% and a stabilization rate of 7–25%, with no impact on median survival. Our most recent chemotherapy regimen MIP (mitomycin-C, ifosfamide and cisplatin) proved to be more effective with a 44% response rate and a 28% stabilzation rate, and produced a significantly longer median survival (32 weeks) than best supportive care alone (19.5 weeks, P < 0.05). The response rate further increased to 62.5% with dose intensification and GM-CSF support. Chemotherapy can now be recommended to motivated, well-informed patients with good performance status in institutions with experience in cancer chemotherapy on a protocol basis. The most recent addition of new effective cytotoxic agents such as paclitaxel, docetaxel, gemitabine and vinorelbine gave promising results in NSCLC, and optimal combinations and dose schedules are being defined by multicentred studies.