How do waiting times affect radiation dose fractionation schedules?

The purpose of the present paper was to evaluate the changing patterns of dose prescription at the Queensland Radium Institute from 1995 to 1998 inclusive. Data were analysed from the treatment files collected on each patient and these were compared with data on delay time. There has been an increased use of shorter fractionation schedules in the period studied. Paradoxically, radical treatments have become longer. The average number of fractions for all patients was 17.4 and for palliative treatments it was 7.4. The monthly delay varied from 0 to 22 working days and the average was 7 working days. When fraction number was compared to treatment delay, there was a negative linear correlation (R = -0.25). The correlation was stronger (R = -0.467) when palliative treatments were compared, indicating that clinicians were more prepared to alter palliative treatments in the presence of a treatment delay than curative ones.

Late effects of radiation therapy for prostate carcinoma: the patient's perspective of bladder, bowel and sexual morbidity.

The patients' perceptions of the late effects of radiation therapy for carcinoma of the prostate on bladder, bowel and sexual function were determined by using a self-administered questionnaire which was posted in June 1996 to patients who had been treated for carcinoma of the prostate between February 1993 and April 1994 at the Herston centre of the Queensland Radium Institute. The questions were based on the SOMA-LENT subjective scales. Moderate bladder morbidity was reported by 15% of patients, with 2% reporting major morbidity. Moderate bowel morbidity was reported by 19% of patients with 2% reporting major morbidity, the major symptoms being bowel urgency and mucus discharge. Sexual function was a problem, with 72% of patients reporting dissatisfaction with their current level of sexual activity.

A phase III double-blind randomised study of rectal sucralfate suspension in the prevention of acute radiation proctitis.

BACKGROUND AND PURPOSE: A limited number of studies have suggested that oral sucralfate reduces the acute and late gastro-intestinal side-effects of pelvic radiotherapy and sucralfate enemas ameliorate symptoms of chronic proctitis. Sucralfate may act via local bFGF at the mucosal level in promoting angiogenesis and reducing epithelial associated microvascular injury. This multi-institutional study was designed to test the hypothesis that sucralfate given as an enema would have a significant protective effect against acute radiation induced rectal injury by direct application to the mucosa. MATERIALS AND METHODS: Eighty-six patients having radiotherapy for localised carcinoma of the prostate were randomised in a double-blind placebo-controlled study to receive either 15 ml of placebo suspension or 3 g of sucralfate in 15 ml suspension, given as a once daily enema during and for 2 weeks following radiotherapy. Assessment was based on the EORTC/RTOG acute toxicity criteria and a patient self-assessment diary. RESULTS: There was no significant difference between placebo and sucralfate for peak incidences of EORTC/RTOG proctitis. For the placebo and sucralfate arms 95 and 88% (difference 7 +/- 11%) suffered some degree of proctitis, with 71 and 61% (difference 10 +/- 19%) reaching grade 2, respectively. The median period to onset of grade 2 proctitis was 33.5 and 36 days, with the median duration being 9.5 and 15 days, respectively, again these difference being non-significant. Thirty-five and 37% of patients rated the effect of radiotherapy on bowel habit as 'a lot' with a moderate or severe effect on normal daily living in 52 and 49%, respectively. CONCLUSION: This study suggests that sucralfate given as a once daily enema does not substantially reduce the incidence of symptoms associated with acute radiation proctitis and its routine clinical use cannot be recommended. This cohort of patients will be followed to determine if any difference develops in relation to late toxicity.

Acute morbidity of radiation therapy for prostate carcinoma.

The acute morbidity of high dose radiation therapy for carcinoma of the prostate in a group of 169 patients treated between February 1993 and April 1994 was examined. Morbidity was determined at the start of therapy, then weekly during therapy and at 1, 2, 3, 6 and 12 months after therapy. Morbidity was examined from the view of the treating doctor and the patients. Morbidity was found to peak at the end of the treatment. From the radiation oncologist's perspective, 80-85% of patients experienced significant bladder and bowel morbidity. The level of acute morbidity was acceptable and there was only one patient that was admitted to hospital for symptomatic control of his acute reaction. Recovery was practically complete after 3 months for both bladder and bowel morbidity. Fifty per cent of patients experienced dysuria, 75% perianal discomfort and 87% frequency at the end of the treatment. Most of the individual factors recovered following radiation but urinary frequency and perianal discomfort were the most persistent problems.

Genetic transformation of green bean callus via Agrobacterium mediated DNA transfer.

Kanamycin resistant callus was produced from leaf disc or hypocotyl expiants of green bean (Phaseolus vulgaris L.) when cultured on a defined medium containing 50 mg/l kanamycin after 4 days of co-cultivation with Agrobacterium tumefaciens strain EHA101 containing the binary vector pKYLX71GUS. The presence of neomycin phosphotransferase II (NPT-II) in crude cellular extracts from the kanamycin resistant callus was confirmed by ELISA. The expression of the ß-glucuronidase (GUS) reporter gene was confirmed by histochemical and fluorimetric analyses. Southern blot border analysis confirmed the integration of the foreign DNA. In addition to the evidence obtained from Southern analysis, the absence of Agrobacterium in the transformed callus cultures was confirmed by microscopic observation and through test cultures. Using the above protocol, bean callus cultures were also transformed with a bean chalcone synthase promoter-GUS fusion. These cultures, when treated with the elicitor glutathione, showed higher levels of GUS expression than the unelicited callus clumps.

Central neurocytoma.

One case of central neurocytoma is presented. A review of the literature suggests that the condition is more common than previously recognised. The pathological features are discussed and the role of surgery and radiotherapy in the management of the condition is discussed.

Does the extent of surgery make a difference in high grade malignant astrocytoma?

This paper examines the effect of patient age, tumour grade and extent of surgery on the outcome of treatment of 278 patients with high grade malignant gliomas referred to the Queensland Radium Institute between 1980 and 1987. The aim was to determine whether the extent of surgical resection alters survival rates. The extent of surgery had no effect on survival except for those patients with grade 3 tumours in whom a total excision was possible. Those in whom only a biopsy was done did not have a worse prognosis. Grading was found to be of importance, as patients with grade 3 tumours had a better survival than those with grade 4 tumours. In grade 4 tumours, those under 30 years of age had a better survival than those over 30 years, whereas with grade 3 tumours there was a gradation of age effect (under 40 years best, then 40-49 years, and those 50 years and over doing worst.

Radiation in the treatment of high grade malignant gliomas in Queensland.

Two hundred and seventy eight patients with histologically proven grade 3 or grade 4 astrocytomas were referred to the Queensland Radium Institute for consideration of radiotherapy between January 1980 and December 1987. The role of radiation in the management of these tumours was examined with respect to the effects of field size, dose and age. It was found that field size did not have a significant effect on survival; in particular whole brain irradiation for patients with grade 4 tumours was not a significant advantage. The doses used at the Queensland Radium Institute produce similar survivals to those used in other centres. The effect of age was significant. For grade 3 tumours there was a survival advantage to those under 50 years receiving radiation, but not to those above that age. For grade 4 tumours, the survival advantage was for those under 60 years, but those over 60 years did seem to get some benefit although the difference did not reach significance. It is suggested that, as the tumour is generally incurable, these patients may be better served by a short simple palliative course of radiation.

The treatment of low grade cerebral astrocytomas by radiotherapy in Queensland.

The records of 108 adult patients with supratentorial low grade astrocytoma presenting between 1/1/80 and 31/12/87 were examined for the following factors which might affect survival: patient age, extent of surgical resection, site of tumour, tumour grade, radiation field size and radiation dose. Univariate analysis showed that patient age, field size and radiation dose were significant prognostic factors, but with multivariate analysis only patient age and radiation field size were significant independent variables. It is possible that field size is a proxy variable for tumour size.

The role of radiotherapy in the control of midbrain tumours.

This study examined 37 patients who were referred to the Queensland Radium Institute between 1980 and 1989 with tumours of the midbrain to determine if there were any factors which were associated with an improved prognosis. In those patients in whom histology was available, the grade of the tumour was of importance. High grade tumours had a shorter survival than low grade tumours. There was a dose response effect with increasing survival as the dose increased from less than 45Gy up to 50Gy. There were no deaths beyond two years, implying that two year survival is an indicator of long term survival.

Plant regeneration through somatic embryogenesis in the forage grass Caucasian bluestem (Bothriochloa caucasica).

Plantlets were regenerated from cultured seed explants of the forage grass Caucasian bluestem [Bothriochloa caucasica (Trin.) C.E. Hubbard] via somatic embryogenesis. Embryogenic callus was produced in four weeks when surface sterilized seeds were cultured on a medium containing MS-salts, B-5 vitamins, 12 mM L-proline, 2% sucrose, 0.8% agar and 5µM 2,4-D. Plantlets were regenerated in 6-8 weeks after culture initiation. Healthy root and shoot systems were produced within three weeks after the plantlets were transferred to a medium lacking 2,4-D. Approximately 95% of the plantlets survived greenhouse acclimation and produced healthy plants and viable seeds. Caucasian bluestem callus cultures exhibit natural resistance to kanamycin. High levels of kanamycin (up to 800 mg/l) did not completely inhibit callus growth. However, the regeneration of healthy-plantlets was completely inhibited by kanamycin even at low levels (50 mg/l).

Stable ploidy levels in long-term callus cultures of loblolly pine.

Ploidy levels were calculated for callus cultures of loblolly pine (Pinus taeda L.), based on nuclear DNA content measured by Feulgen cytophotometry. The nuclear DNA content of initial stem explants showed a predominant 2C condition with less 3C and 4C, in ratios approximating those expected from diploid cells as they replicate DNA in the mitotic cell cycle. Cells with higher ploidy were produced during callus initiation, as indicated by a sharp reduction in the 2C population and a concomitant increase in higher DNA levels up to 8C. A gradual decrease in the higher ploidy levels occurred in subsequent subculture intervals, so that by 18 weeks the diploid nuclear DNA distribution was again observed, with complete elimination of DNA levels greater than 4C. Established callus cultures derived from stem or embryo explants and cultured on three different nutrient media for 48-76 weeks also showed the diploid nuclear DNA distribution with no indication of polyploid cells.

Intracranial meningeal chondrosarcoma--probable mesenchymal type.

A 12 year old girl with episodes of left hemiparesis for 9 months was found to have a large, partly calcified brain tumour which at craniotomy presented on the parasagittal and medial surfaces of the right frontal lobe. No dural or falx attachment could be found and naked eye removal of the tumour was achieved. At a second craniotomy 10 weeks later there was recurrent tumour attached to the falx and involving the sagittal sinus. She died 5 months later. Pathologically, almost all this malignant intracranial neoplasm comprised differentiated cartilaginous tumour. Although only a very small amount of undifferentiated mesenchymal tissue was found in the surgical material available for histological study, it is suggested the tumour can be regarded as a predominantly mature mesenchymal chondrosarcoma of the meninges.

Spontaneous regression of metastases from testicular tumours. A report of six cases from one centre.

In a review of the cases of testicular tumours treated at the Christie Hospital between 1961 and 1974 there are six cases with spontaneous regression of metastases, which are now reported. In this period, 827 cases of testicular tumour have been treated giving an incidence of spontaneous regression of 0.72%, which is considerably higher than previously reported. One of the cases appears to be pure seminoma; spontaneous regression of metastases from seminoma has not been reported previously.

Primary lymphoreticular tumours in the orbit.

This paper reviews 46 cases of primary lymphoreticular tumours presenting in the orbit treated at the Christie Hospital between 1932 and 1969. Primary control of the orbital disease was readily achieved with a single exposure of 800 rad of orthovoltage X-rays to a single anterior field of 7 cm diameter and no case recurred in the orbit. The extent of the disease is a more important factor than the exact histological diagnosis in determining the prognosis, but none of five cases of benign lymphoma has developed disease elsewhere in a period of 5-7 years after treatment. The prognosis is good with a crude five-year survival of 54 percent, but if the disease is initially confined to the orbit 70 percent survive five years.

Biophysical differentiation between lymphocytes from healthy donors, patients with malignant diseases and other disorders.

Changes in the structuredness of the cytoplasmic matrix (SCM) of human lymphocytes induced by PHA, CaBP and EF were studied with the technique of fluorescence polarization. The study suggests that the SCM test may offer a new and fast technique for the detection of malignant growth.