Delayed gastrointestinal complications after combined modality therapy of childhood rhabdomyosarcoma.
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252Cf (Cf) was used to treat tumors of the cervix and uterus with neutron brachytherapy (NT) in an ongoing clinical trial. Tandem and ovoids insertions were used and combinations of single and multiple applications along with high dose whole pelvic irradiation. Dosimetric analysis of treated cases for patterns of tissue dose were carried out. Tissue dose for Cf-NT was, in general, high for neutron components in the central pelvis only, and fell off rapidly with distance from the applicators. The majority and balance of therapeutic dose was contributed by low linear energy transfer (LET) high energy photon beam radiation to the whole pelvis. Comparison with fast neutron beam therapy (NBT) isodose curves showed that much more homogeneous neutron dose was delivered to the pelvic tumor and organs by NBT. Complication frequency has been reported to be higher for neutron beam therapy than for Cf-NT. It appears that the higher integral neutron biological dose to normal tissues for NBT compared to intracavitary Cf-NT probably contributed to the frequency of side effects.
Treatment related morbidity, recorded in patients entered onto a RTOG phase III study (testing the value of periaortic irradiation in locally advanced carcinoma of the prostate), has been correlated with radiotherapeutic parameters to identify and quantify the relationship with treatment volumes, doses, and techniques. Between 1976 and 1983 a total of 526 analyzable cases were entered onto the study. The study design entailed randomization to either pelvic irradiation followed by a prostate boost or pelvic and periaortic irradiation followed by a prostate boost. Periaortic irradiation was not associated with a significantly increased incidence of bowel injuries manifested by diarrhea. No correlation between the total dose to the regional lymphatics (ranging from 4400 to 5100 cGy) and the incidence of bowel and bladder injuries could be established. Doses to the prostate in excess of 7000 cGy have not resulted in a significantly increased incidence of bladder injuries, but have been associated with a significant increase in the incidence of bowel injuries manifested by diarrhea. The techniques of pelvic irradiation did not seem to significantly influence the incidence of bowel or bladder complications. The technique of delivery of the prostatic boost did seem to influence the incidence of bowel injuries. This refers to the lateral boost technique and the perineal boost technique which have been associated with a higher incidence of diarrhea. All of the conclusions based on this analysis are applicable only to treatment volumes and dose ranges used in this study and to conventional fractionation of 180 to 200 cGy per day.
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Prostaglandins, leukotrienes and mono-hydroxy acid products of arachidonic acid were measured in mucus of freshly recovered morning stools of a patient with an exacerbation of ulcerative proctocolitis. Eicosanoids in ether extracts were separated by high performance liquid chromatography and amounts determined by radioimmunoassay. Four hydroxy-eicosatetraenoic acids were detected, of which the most important one was identified as 15-hydroxy eicosatetraenoic acid (530 ng/g mucus). Leukotriene B4 was also present (21 ng/g mucus) and small amounts of immunoreactive leukotriene C4 (less than 0.8 ng/g mucus). The prostaglandins 6-keto-PGF1 alpha and PGE2 and thromboxane B2 were found in amounts of 3.7, 2.0 and 9.2 ng/g mucus, respectively.
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PURPOSE: To present preliminary outcomes of pulsed dose rate brachytherapy (PDR-BT), external beam radiotherapy (EBRT), and hormonal manipulation, for prostate cancer. PATIENTS AND METHODS: Between December 1999 and January 2005, 165 consecutive patients with Stage T1-T3, N0, M0 prostate cancer were treated. Hormones were used in every patient. Median follow-up was 36 months. Risk groups were low (either Stage < or =T2a, +/- Gleason score < or =6, +/- Prostate-Specific Antigen [PSA] level < or =10 ng/mL); intermediate (either Stage T2b,c, +/- Gleason score 7, +/- PSA 10-20 ng/mL); and high (either Stage T3, +/- Gleason score 8-10, +/- PSA >20 ng/mL). RESULTS: At 3 years, Radiotherapy Oncology Group (RTOG) Grade 3 and 4 genito-urinary toxicity was 4% and 1.4%; RTOG Grade 3 and 4 gastro-intestinal toxicity was 2.6% and 0%, respectively. Erectile preservation was 61%. Overall survival was 93% (154 of 165) and cause-specific survival was 98% (162 of 165). At 3 years, disease free survival (DFS) was 93% (153 of 165). DFS for low-, intermediate-, and high-risk groups was 100%, 97%, and 81%, respectively (chi(2) (2) = 16.02, p = 0.0003). The nadir plus 2 ng/mL definition (chi(2) (2) = 14.49, p = 0.0007) best predicted clinical failure, having the lowest false-positive rate (3 of 165). The nadir plus 2 ng/mL PSA-progression-free survival (PSA-PFS) rate was 100%, 95%, and 87% for the low-, intermediate, and high-risk groups, respectively. Overall ASTRO PSA-PFS rate was 88%. CONCLUSIONS: Pulsed dose rate brachytherapy plus EBRT is effective in treating localized prostate cancer, with acceptable toxicity. However, a median 5-year PSA-PFS follow-up is required before providing a solid recommendation. This preliminary information supports continued use.
In sexually transmitted infections and more precisely in uncomplicated urethritis and cervicitis, the two infectious agents most commonly identified in France are Neisseria gonorrhoeae (gonococci) and Chlamydia trachomatis, alone or associated. The resistance of N. gonorrhoeae to ciprofloxacin has reached over 20 % in France. A new national strategy for the therapeutic management of probabilistic treatment applied to uncomplicated urethritis and cervicitis is required. Bacteriological sampling before treatment is mandatory. Anti-gonococcal probabilistic treatment is a monodose using one of the following molecules: third generation cephalosporin: ceftriaxone (intra-muscular or intra-venous), cefixime (oral); aminoside: spectinomycin (intra- muscular); fluoroquinolone (bacteriologically controlled): ciprofloxacin (oral); An oral anti-Chlamydia treatment must be associated: azithromycin (monodose); or doxycycline (standard treatment). Blood tests (screening for syphilis, HIV infection, hepatitis B, hepatitis C) must be performed taking into account the delay for sero-conversion. Hepatitis B vaccination must be offered to any non-immunized patient. Protected intercourse (using condoms) must be recommended.
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Rectal folds are seen best in the lateral view. Normal values for the thickness of the folds have been established by measuring these in patients with a diagnosis of irritable bowel syndrome who had no evidence of rectal disease. In severe ulcerative colitis the valves disappear, but they are present earlier in the disease. The first barium enema examination in patients with ulcerative colitis was assessed. When the valve thickness could be measured in these patients it showed values significantly greater than normal. It is uncommon for this finding to be the sole indicator of disease. Patients with Crohn's disease of the rectum showed no increase in the fold thickness. This observation may be helpful in distinguishing between these two forms of colitis.
The Christie Hospital installed a Selectron afterloading machine in 1979. By early 1982 it became apparent that patients treated for carcinoma of the cervix using the Selectron had developed a high incidence of morbidity compared with patients treated by the standard Manchester radium technique. Initially, the majority opinion was that the patients had been overdosed, because little or no allowance had been made for the higher dose rate of 137Cs. The results of investigation suggest, however, that the main factor responsible for the morbidity was a change in technique, previously unrecognised, in that the rigid 137Cs applicators facilitate the use of a much higher proportion of long intrauterine tubes and larger vaginal components than used to be the case with radium. The evidence for this and the probable mechanism of the resulting damage are discussed.
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