Search

Background/purpose: To augment the accuracy of stereotactic body radiation therapy (SBRT), a variety of image guidance systems are used for patient positioning and target localization. Clinical outcomes evaluating these systems, especially frameless image-guided systems, are still limited. This article aims to describe and evaluate our frameless image-guided SBRT technique for lung tumors., Methods: Between 2007 and 2009, 85 pulmonary tumors (50 primaries and 35 metastases) were treated with SBRT using daily image guidance for patient positioning and target localization in lieu of a body frame. Four-dimensional computed tomography (4DCT) or an in-house protocol for integrated 4D positron emission computed tomography (4DPET/CT) was used for planning simulation., Results: Median follow-up was 17 months (range, 4-42). Median overall survival (OS) was 31 months (95% CI, 26-34), and median local failure-free survival was 30 months (95% CI, 18-32). At last follow-up, 9 of 83 evaluable lesions failed locally. Actuarial local control at 24 months was 87% (95% CI, 75-98) and was significantly worse for metastatic lesions (95% vs. 74%; P = .045; log-rank test). No acute or late toxicities (grade ≥ 4) were observed., Conclusions: Frameless image-guided SBRT is a feasible, safe, and effective treatment for lung tumors., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Purpose: To report our institutional experience using image-guided stereotactic body radiation therapy (SBRT) for early stage lung cancer, including an analysis into factors associated with nodal and distant failures (NF, DF)., Methods: Forty-eight patients with early-stage primary lung cancer were treated with image-guided SBRT between 2007 and 2009. Median prescription dose was 48 Gy in 4 fractions. Toxicity was graded according to the NCI CTCAE v3.0 scale., Results: Local failure was detected in two lesions and actuarial 24-month local control was 95%. At 24 months, the cumulative incidence of NF was 6%, and DF was 29%. Larger lesions (>3 cm) and younger age (<70 years) were the only factors found to be significantly correlated with increased DF (p=0.005 and p=0.015, respectively). A single grade ≥ 3 toxicity was observed. After adjusting for age and lesion size, distant failure was significantly associated with a poorer OS (Cox regression, p=0.0059)., Conclusion: Image-guided SBRT can produce excellent LC rates with minimal toxicity. Distant failure was a major determinant of OS and the most common pattern of failure, indicating a potential role for systemic therapy in younger patients with large lesions., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Purpose: To evaluate the efficacy of mitogen-activated protein kinase/extracellular signal-related kinase kinase inhibitor PD-0325901 in advanced non-small cell lung cancer patients who had experienced treatment failure after, or were refractory to, standard systemic therapy., Experimental Design: This open-label, phase II study initially evaluated 15 mg PD-0325901 twice daily administered intermittently (3 weeks on/1 week off; schedule A). As this schedule was not well tolerated, a second schedule was introduced as follows: 5 days on/2 days off for 3 weeks, followed by 1 week off (schedule B). The primary end point was objective response., Results: All patients had received prior systemic therapy (median of two regimens, including epidermal growth factor receptor inhibitors in 26%). Of 13 patients treated on schedule A, three discontinued due to adverse events (blurred vision, fatigue, and hallucinations, respectively). Twenty-one patients received schedule B. Main toxicities included diarrhea, fatigue, rash, vomiting, nausea, and reversible visual disturbances. Hematologic toxicity consisted mainly of mild-to-moderate anemia, without neutropenia. Chemistry abnormalities were rare. Mean (coefficient of variation) PD-0325901 trough plasma concentrations were 100 ng/mL (52%) and 173 ng/mL (73%) for schedules A and B, respectively, above the minimum target concentration established in preclinical studies (16.5 ng/mL). There were no objective responses. Seven patients had stable disease. Median (95% confidence interval) progression-free survival was 1.8 months (1.5-1.9) and overall survival was 7.8 months (4.5-13.9)., Conclusions: PD-0325901 did not meet its primary efficacy end point. Future studies should focus on PD-0325901 schedule, rational combination strategies, and enrichment of patient selection based on mode of action.

The authors examined serum in patients with ovarian cancer (OC; a disseminated process), ovarian cystadenoma (OCA), or external endometriosis (EM) before treatment and in apparently healthy females (a control) for the content of some acute-phase proteins and cytokines to clarify the specific features of changes in their concentrations in relation to the type of the proliferative process. It was shown that in OC, there were significant reductions in the levels of alpha2-macroglobulin (MG), plasmin (PL), alpha1-antitrypsin (AT) and statistically significantly increases in the content of lactoferrin (LF), interleukin (IL)-6, IL-8, Ig, and the regulatory transport complex of P--M. In M, the concentrations of AT were lower and those of IL-6, IL-8, and PL-MG were higher (to a lesser degree than those in OC). In OCA, the levels of MG and IgA were increased; those of IL-8 and PL-MG were decreased. The concentrations of interferon and IgM were unchanged in all groups. The findings suggest that difefrent proliferative processes initially provoke a number of changes of varying magnitude and even directions in the serum levels of inflammation reactants, which should be borne in mind when conducting clinical tests in the intraoperative and, probably, postoperative periods.

The blood concentrations of various inflammatory reactants were studied in female participants of the in-vitro fertilization (IVF) programs depending on the outcome. Comparison of the obtained values with the values characteristic of healthy women and with the levels of the above reactants in patients with subacute inflammatory diseases of the uterine appendages indicated that females with IVF failures had elevated levels of lactoferrin and circulating alpha2-macroglobulin-IgG complexes and decreased concentrations of IgG as in women with a localized pyodestructive process in the appendages, but in women having effective IVF, the levels of the study proteins did not differ from those in healthy donors. The authors recommend that the above indices should be used as criteria substantiating the need for additional sanitation and anti-inflammatory therapy before initiating the IVF program.

The authors studied the concentration of pregnancy-associated alpha2-glycoprotein (PA alpha2GP), a sensitive marker of estrogen-dependent tumors, and the association of its level with the serum content of a number of hormones: follicle-stimulating hormone, luteinizing hormone, estradiol (E-2), dehydroepiandrosterone sulfate (DEAS-S), and testosterone in females receiving the groups of drugs containing: 1) estradiol valerate; 2) 17beta-estradiol, and 3) tibolone. The type of the active ingredient of a drug and the duration of its administration were shown to differently affect both the concentration of hypothalamopituitary hormones and steroid sex hormones and the level of PA alpha2GP). The latter increased significantly in Group 1 and insignificantly in Group 2 and did not differ from the normal values in Group 3, at the same time the concentration of E-2 elevated in Groups 1 and 2, rather than in Group 3; the level of DEAS-S increased in Groups 2 and 3 irrespective of the duration of use. Moreover, there were elevated levels of testosterone in Group 3 and those of DEAS-S in Group 1 only when the drugs were administered for 3-6 months. A number of correlations were found in the levels of PA alpha2GP with those of steroid hormones. The authors consider that individual monitoring of the level of PA alpha2GP in the females who need hormonal therapy in menopause provides a useful guide to choosing a drug, monitoring its use efficiency, and preventing malignant proliferation in proper time.

Intravascular lymphoma is a rare aggressive systemic neoplasm with neurological and cutaneous presentation, which commonly eludes the diagnosis ante mortem. We document a case of intravascular lymphoma in a 65-year-old man who presented with altered mental status, fevers and weight loss. The diagnosis was made by random skin biopsies demonstrating an intravascular, CD20 positive cellular infiltrate. Initial treatment consisted of cyclophosphamide, vincristine, doxorubicin, prednisone and rituximab. Because of disease progression, the therapy was switched to weekly rituximab after the first cycle. A complete response was observed with resolution of symptoms and laboratory abnormalities. The patient remains in remission 3 years after completion of therapy. This is the first case report to describe a sustained remission following single-agent rituximab in the patient with neurologic involvement of intravascular lymphoma who failed antracycline-based therapy. Single-agent rituximab has activity in this disease and may be considered as a treatment option.

Myelodysplastic syndrome (MDS) progresses into acute leukaemia with a variable time course. We analysed 45 newly diagnosed patients and found that the expression of the Src homology 2 domain-containing tyrosine phosphatase 1 (SHP1) had a significant impact on disease severity, progression and overall prognosis. Global or lineage-specific loss of SHP1 was observed by immunohistochemistry in bone marrow biopsies of MDS patients who progressed rapidly (P = 0.0021) and had shorter survival (P < 0.001). Cox regression analysis demonstrated that SHP1 expression in megakaryocytes had prognostic relevance for time to progression (P = 0.009) and overall survival (P = 0.001).

Altogether 125 children with connective tissue dysplasia and mitral valve prolapse were subjected to clinical and echographic examinations. Dilation of the aortic root, elevation of pulmonary artery pressure and derangement of myocardial contractility were discovered. These disorders occurred as a result of disseminated connective tissue abnormalities. It is noted that children with connective tissue dysplasia and mitral valve prolapse require prophylactic medical examination because of progressive alterations on the part of the cardiovascular system with age.

The levels of pregnancy-associated alpha 2-glycoprotein (alpha 2-GP) were measured in the blood sera of puerperants with physiologic postpartum and postoperative (after cesarean section) periods, and with those complicated with pyoseptic diseases. alpha 2-GP levels were changed in the blood sera of puerperants with postpartum infectious diseases. The authors discuss the possibility of predicting the postpartum complications with the use of alpha 2-GP measurements.

The prevalence of perinatal encephalopathy is shown to be significantly increased. This pathology is associated with involvement of the brain and spinal cord and the whole organism with subsequent development of cerebral dysfunction and somatic disease. Medicamentous therapy is aimed at improving the trophics of the damaged tissues and elimination of edema. The role played by the district pediatrician in the follow-up of children with the discussed disease is considered to be of special significance.

Twenty children with systemic lupus erythematosus (SLE) and 13 children with systemic scleroderma were examined by electrocardiography, tetrapolar chest rheography, rheopulmonography and echocardiography. Half of the cases manifested pulmonary hypertension, which was more appreciable in SLE patients. The results of rheopulmonographic and echocardiographic research methods turned out highly comparable.

238 children with diffuse connective tissue diseases were clinically examined with the use of echography. The presence was documented of characteristic morphofunctional changes in the heart in collagen diseases. Characteristic haemodynamic changes (predominantly contraction disturbances in systemic lupus erythematodes and dermatomyositis, and relaxation disturbances in systemic scleroderma) were identified.