Ability of young women to recall past body size and age at menarche.

OBJECTIVE: The ability of young women (n = 132, average age 17 years) to recall body size and age at menarche was examined. The use of body silhouettes to assist women in recalling their body size at menarche and to represent their current body size was also evaluated. RESEARCH METHODS AND PROCEDURES: Subjects, who previously participated in a cohort study, were asked to recall height and weight at the time of menarche, to select body silhouettes that best reflected their body shape at the time of menarche and their current body shape, and to recall age at menarche. Two sets of body silhouettes were developed, one representative of an adult body shape and another representative of an adolescent body shape. RESULTS: Pearson correlation coefficients between the adult and adolescent body figures and actual body mass index (BMI; kg/m(2)) at the time of menarche were not significantly different (r = 0.82 for adult figures vs. r = 0.72 for adolescent figures, p > 0.05). The correlation between actual BMI at the time of menarche and body silhouette (r = 0.77, all subjects) was similar to the correlation between actual and recalled BMI at the time of menarche (r = 0.83) as well as the correlation between current BMI and current body silhouette (r = 0.75). Recalled and actual ages at menarche were highly correlated (r = 0.83). DISCUSSION: The recall of body shape was considered to be a less precise measure of body size than asking about height and weight, but use of body silhouettes may offer advantages in certain situations.

Multicenter phase Ib/II trial of the radiation enhancer motexafin gadolinium in patients with brain metastases.

PURPOSE: Motexafin gadolinium is a magnetic resonance imaging (MRI)--detectable redox active drug that localizes selectively in tumor cells and enhances the effect of radiation therapy. This phase Ib/II trial of motexafin gadolinium, administered concurrently with 30 Gy in 10 fractions whole-brain radiation therapy (WBRT), was conducted to determine maximum-tolerated dose (MTD), dose-limiting toxicity, pharmacokinetics, and biolocalization in patients with brain metastases. Additional endpoints were radiologic response rate and survival. PATIENTS AND METHODS: Motexafin gadolinium was administered before each radiation treatment in this open-label, multicenter, international trial. In phase Ib, drug dose was escalated until the MTD was exceeded. In phase II, drug was evaluated in a narrow dose range. RESULTS: In phase Ib, the motexafin gadolinium dose was escalated in 39 patients (0.3 mg/kg to 8.4 mg/kg). In phase II, 22 patients received 5 mg/kg to 6.3 mg/kg motexafin gadolinium. Ten once-daily treatments were well tolerated. The MTD was 6.3 mg/kg, with dose-limiting reversible liver toxicity. Motexafin gadolinium's tumor selectivity was established using MRI. The radiologic response rate was 72% in phase II. Median survival was 4.7 months for all patients, 5.4 months for recursive partitioning analysis (RPA) class 2 patients, and 3.8 months for RPA class 3 patients. One-year actuarial survival for all patients was 25%. CONCLUSION: Motexafin gadolinium was well tolerated at doses up to 6.3 mg/kg, was selectively accumulated in tumors, and, when combined with WBRT of 30 Gy in 10 fractions, was associated with a high radiologic response rate.

Deciding on radiation therapy for prostate cancer: the physician's perspective.

Multiple treatment options are available for the radiation therapy of prostate cancer including whole pelvic radiotherapy (WPRT), prostate-only radiotherapy (PORT), three-dimensional conformal radiotherapy (3DCRT), intensity modulated radiotherapy (IMRT), as well as proton or neutron beam based therapies and brachytherapy. Numerous technical variations hamper objective assessment of these different treatment modalities. These variations are extensive and often subtle (dose to the prostate, the dose per fraction, number and size of fields, the photon energy, patient positioning, prostatic motion, the use of immobilization devices, 2D or 3D planning for treatment, and others) may cause interpretive uncertainty. Despite this confusion, there is some consensus. Prostate-specific antigen (PSA) nadirs, as well as pretreatment PSA levels, significantly alter outcome. Low-risk patients do well no matter which treatment they receive, although the question of dose-escalation therapy to improve results remains unanswered. High-risk patients do poorly regardless of treatment, although the addition of androgen ablation and dose-escalation therapy may improve results. Quality of life (QOL) studies continue to show a problem for radical prostatectomy (RP) patients secondary to impotence and incontinence and a problem for radiotherapy patients due to gastrointestinal (GI) disturbances. Patients can have access to any specific study through technologies such as the Internet. Although this information can be useful, the subtleties of each different article are usually beyond the understanding of most patients. This report examines some of the new radiotherapy modalities as well as corrects some misconceptions regarding radiotherapy results and morbidity. In addition, we discuss some studies comparing surgery and radiotherapy and attempt to objectively compare different radiation therapy strategies for localized prostate cancer.

Diet, body size and menarche in a multiethnic cohort.

A multiethnic cohort of 1378 Southern California school girls aged 8-13 years was followed for 4 years to evaluate factors predicting age at menarche, a risk factor for breast cancer. Height and weight were measured and dietary intake was assessed using a semi-quantitative food frequency questionnaire. Of 939 girls providing data on menarcheal status, 767 were premenarcheal at the start of the study; 679 girls provided acceptable dietary data and were included in the analyses. Cox proportional hazards models were used to assess the relationship between diet, body size, ethnicity and age at menarche. Hispanic, Asian/Pacific Island and African-American girls were more likely to experience early menarche than non-Hispanic white girls. Tall (> 148.6 cm) versus short (< 135.9 cm) girls experienced earlier menarche (relative hazard (RH) = 2.9, 95% confidence interval (CI) 2.1-4.1) as did those with high Quetelet's index (QI, kg m(-2)) (> 20.7) versus low QI (< 16.1) (RH = 2.2, 95% CI 1.7-2.9). Of all the dietary variables analysed, only energy intake was related to age at menarche. High versus low energy intake (> 12,013 kJ vs < 7004 kJ) was associated with a delay in menarche (RH = 0.7, 95% CI 0.5-0.9); this finding was limited to a subset of heavy Hispanic girls who appeared to underreport their dietary intake.

Psychological distress and treatment adherence among children on dialysis.

Among 23 pediatric renal dialysis patients, we obtained self-reported assessments of psychological adjustment and biochemical and subjective ratings of adherence. Findings indicate elevated levels of depressive symptoms and substantial nonadherence. Depressive symptoms were associated with higher levels of hopelessness, more negative self-perceptions, and more depressogenic attributional style. The psychological adjustment measures did not significantly correlate with adherence. Nonsignificant associations among different measures of adherence underscore its multifaceted nature. Implications for monitoring the adjustment of children on dialysis, assessing adherence, and future research are discussed.

Treatment planning for prostate implant with loose seeds.

A new method of treatment planning for the I-125 and Pd-103 permanent interstitial prostate implant is developed, which does not use the traditional nomograms but automatically generates optimized source configurations. An iterative algorithm is used that places one seed at a step. The volume dose of target is calculated at each step to determine the coldest spot where the next source is to be placed, so that the dose uniformity of target is best improved as source placement proceeds. At each step, the total activity required for the seed configuration as so established is calculated by normalizing the minimal dose to the prescribed dose. An optimized configuration is the one that takes the minimized total activity. Around its minimum the total activity has a very small variation with the number of seeds. Consequently multiple clinically acceptable seed configurations with similar total activity but different individual activities are generated simultaneously. In our computer generated treatment plans most of the seeds are distributed in the periphery of the target, similar to the Paterson-Parker pattern of a volume implant.

Palliation of AIDS-related primary lymphoma of the brain: observations from a multi-institutional database.

PURPOSE: To catalogue the presenting symptoms of patients with AIDS who are presumed to have primary central nervous system lymphoma (PCNSL). To document the palliative efficacy of cranial irradiation (RT) relative to the endpoints of complete and overall response for the respective symptoms. METHODS: An analysis of 163 patients with AIDS-related PCNSL who were evaluated at nine urban hospitals was performed. These patients were treated for PCNSL after the establishment of a tissue diagnosis or on a presumptive basis after failing empiric treatment for toxoplasmosis. All patients were treated between 1983 and 1995 with radiotherapy (median dose-fractionation scheme = 3 Gy x 10) and steroids (>90% dexamethasone). Because multiple fractionation schemes were used, prescriptions were converted to biologically effective doses according to the formula, Gy10 = Total Dose x (1 + fractional dose/alpha-beta); using an alpha-beta value of 10. RESULTS: The overall palliative response rate for the entire group was 53%. In univariate analysis, trends were present associating complete response rates with higher performance status (KPS > or = 70 vs. KPS < or = 60 = 17% vs. 5%), female gender (women vs. men = 29% vs. 8%), and the delivery of higher biologically effective doses (BED) of RT (Gy10 > 39 vs. < or = 39 = 20% vs. 5%). In multivariate analysis of factors predicting complete response, both higher KPS and higher BED retained independent significance. A separate univariate analysis identified high performance status (KPS > or = 70 vs. KPS < or = 60 = 71% vs. 47%), and young age (< or = 35 vs. > 35 = 61% vs. 40%) as factors significantly correlating with the endpoint of the overall response. In multivariate analysis, high performance status and the delivery of higher biologically effective doses of irradiation correlated significantly with higher overall response rates. CONCLUSION: Most AIDS patients who develop symptoms from primary lymphoma of the brain can achieve some palliation from a management program that includes cranial irradiation. Young patients with excellent performance status are most likely to respond to treatment. The delivery of higher biologically effective doses of irradiation also may increase the probability of achieving a palliative response.

Performance status and age as independent predictors of survival among AIDS patients with primary CNS lymphoma: a multivariate analysis of a multi-institutional experience.

PURPOSE: There is limited information about the outcome of AIDS patients with primary central nervous system lymphoma treated with definitive irradiation. The purpose of this study was to determine factors associated with increased survival in such patients. METHODS: An analysis was performed of 163 patients with AIDS who were evaluated at nine urban hospitals. These patients were treated for primary central nervous system lymphoma after the establishment of a tissue diagnosis or on a presumptive basis after failing empiric treatment for toxoplasmosis. All patients were treated between 1983 and 1995 with radiotherapy (median dose-fractionation scheme = 3 Gy x 10) and steroids (> 90% dexamethasone). Because multiple fractionation schemes were used, prescriptions were converted to biologically effective dose according to the formula Gy10 = Total Dose x (1 + fractional dose/alpha-beta), using an alpha-beta of 10. RESULTS: Longer median survival times were associated with high Karnofsky performance status (KPS > or = 70 vs < or = 60: 181 vs 77 days), young age (< 35 vs > 35: 162 vs 61 days), and high total definitive irradiation doses (> 39 Gy10 vs < 39 Gy10: 162 vs 40 days). Tissue diagnosis, gender, race, number of lesions (solitary vs multiple), and the presence of other cancers did not influence outcome. In multivariate analysis, young age, high Karnofsky performance status, and the delivery of higher biologically effective doses of irradiation retained independent significance relative to the endpoint of survival. CONCLUSIONS: Even at urban tertiary medical centers, few AIDS patients with intracranial lesions undergo biopsies to establish a precise tissue diagnosis. Survival following definitive irradiation is strongly related to two pretreatment factors (young age, high performance status) and one treatment factor (total biologically effective dose of cranial radiotherapy). These variables should be considered in selecting patients for definitive irradiation and in designing future studies.

A simple manual method of repositioning small bowel during pelvic irradiation.

Small intestine is often unnecessarily irradiated during radiotherapy because it lies near tumor volumes and thus may be dose limiting. Repositioning of normal tissues can sometimes be accomplished by mechanical rather than invasive surgical techniques. At our institution, physical displacement of small bowel tissues was carried out on a population of patients with good result. Patients suffering from prostatic, cervical, and rectal carcinoma were treated using a custom built and padded block composed of rigid Styrofoam. The block, in most cases, successfully displaced significant amounts of healthy tissues from treatment fields. Maximum displacement of bowel was accomplished at the time of simulation using fluoroscopy and manual positioning of the device. The optimum displacement position and location of the Small Bowel Displacement Device (SBDD) were recorded by means of orthogonal radiographs. The device was affixed to a piece of mylar that had been previously scribed with an X and Y coordinate system, which could be used to permanently anchor the SBDD to its position of maximum displacement. Displacements of as much as 4.0 to 5.0 cm were noted on most patients. Patients generally tolerated the device well as long as they were able to lie prone. Patients with recent abdominal surgery were less likely to tolerate the SBDD, and omental slings or meshes generally precluded movement of the small bowel.

Perceived change in food frequency among women at elevated risk of breast cancer.

Survey reports indicate that women perceive that their diets have changed in ways consistent with dietary guidelines recommended by national agencies. We have attempted to determine whether perceived change in food intake is a useful tool for estimation of either past intake or pattern of change in food consumption. Twin sisters of breast cancer patients, at obvious high risk of breast cancer, were aware of dietary guidelines concerning cancer, as indicated by beliefs about specific foods that should be increased or decreased to prevent cancer. Perception of change, as reported by them, was not found to be a reliable indicator of actual change in food frequency, as measured by the difference between sequential food frequency questionnaires. Consumption of high-fat foods was observed to have decreased over the interval, regardless of perceived change in consumption. Moreover, prediction of past food frequency on the basis of perceived change and current intake combined resulted in a less accurate appraisal of past diet than did the use of current intake alone. Perceived change in food frequency appears to be biased in different ways for different foods and seems to be influenced by beliefs about the role of diet in cancer. Studies of etiology should probably not rely on such methods.

External beam irradiation versus 125 iodine implant in the definitive treatment of prostate carcinoma.

We reviewed the record of all 983 patients seen at the Hahnemann University, Department of Radiation Oncology for evaluation of prostate cancer during the megavoltage era. We compared the results of 276 patients who were treated definitively with either external beam irradiation or Iodine 125 implantation. The groups were similar in most prognostic characteristics. Where appropriate, multivariate statistical techniques were used to compensate for the effects of differences in grade and stage between the two groups. There were striking differences between implant and external beam patients in both local failure rates and disease-free survival, mostly attributable to poor local control in the implant patients. Thirty-eight percent of the Stage A and B implant patients failed locally in the first 5 years whereas only 5% of a comparable group of external beam patients did so. A2 patients, however, exhibited similar disease-free survival in both cohorts. Complication rates were 11% in the implant group and 19% in the external beam group. We conclude that there are serious doubts about the efficacy of Iodine 125 implantation in maintaining local control, and that this translates into worse relapse-free survival. By contrast, local control and relapse-free survival may be satisfactory in the A2 patients, and complication rates may be lower with implant. The above suggests that Iodine 125 interstitial implantation is well suited to only a minority of early stage prostate cancer patients and that most patients with Stage B and C prostatic carcinoma should be treated with either external beam irradiation or with radical prostatectomy.

The radiation therapy of early stage cutaneous T-cell lymphoma.

Results of different radiotherapy schedules used for early stage (T1-2, N0-1, M0) cutaneous T-cell lymphoma (CTCL) are compared in a series of 45 patients (22 patients treated with high dose total skin electron beam therapy (TSEB) with curative intent, 18 patients treated with palliative radiotherapy, and 5 patients treated with high dose local electron beam). At 3, 5, and 10 years after diagnosis the high dose TSEB treatment group had a probability of overall survival of 91%, 86%, and 75%, respectively, compared with 94%, 88%, and 88% for the palliative treatment group. The complete response (CR) rate for the high dose TSEB treatment group was 82% (18/22), compared with a 57% (4/7) complete response rate for seven patients in the palliative group who received low dose TSEB (less than 25 Gy in 6-7 weeks) followed by daily application of topical mechlorethamine hydrochloride (HN2). However, the probability of continued remission at 3, 5, and 10 years was 44%, 44%, and 33%, respectively, for the high dose TSEB group and 25%, 25%, and 0%, respectively, for the low dose TSEB + HN2 group. The median disease-free survival was 17.5 months for the high dose TSEB group versus 5.5 months for the low dose TSEB + HN2 group. The five patients who were treated with high doses of local electrons to a single local field had an overall survival rate of 80%, a median survival rate of 64 months, and a median length of continued remission of 31 months. These results indicate that high-dose electron beam can result in long-term disease-free survival in patients with localized and limited extent skin involvement with cutaneous T-cell lymphoma.

Confounding factors in clinical studies of gliomas.

Clinical investigation of gliomas is difficult because the investigator must compensate for factors that confound data analysis. The investigation of glioma therapy is affected by a number of factors that influence the outcome of the patients' disease: the tumor grade and location, the extent of surgical resection, the dose and portal for radiation therapy, and the patient's functional status at presentation. Either an observational or an experimental (clinical trial) strategy may be used to compensate for confounding factors. Matching for the characteristics known to influence disease history strengthens the conclusions from an observational study, but cannot compensate for unknown influences. Randomization in a clinical trial will minimize unknown influences, but clinical trials are not always feasible. To be conclusive, glioma studies should either match patient populations for known confounding factors in an observational study or randomize patients in a clinical trial.

Clinical predictors of computed tomography in epileptic children.

The purpose of this study was to determine which clinical characteristics correlated with abnormal computed tomographic (CT) scans in epileptic children. Thirty variables were examined. Of these, four variables (presence of inherited or congenital disease, focal motor findings, developmental delay, and early onset of seizures) correlated with CT scan outcome. Partial seizures per se were not highly associated with abnormal CT scans. A crude decision rule based on these results correctly classified the CT scan result in 94% of the patients who were clinically predicted not to have a parenchymal abnormality.

Spinal cord lesions in tuberous sclerosis.

Spinal cord involvement is not widely recognized as part of the tuberous sclerosis complex. Necropsy study of the spinal cord from 2 patients revealed abnormalities in both. These consisted of clusters of abnormal fiber-forming astrocytes in gray and in white matter, bizarre giant glial forms in white matter in one patient, and neuronal loss. Myelin sheaths in subpial zones were also swollen and slightly fragmented in one patient. Reports of similar studies are sparse. Some investigators have also noted glial proliferation and white matter changes, although the latter most likely represented Wallerian degeneration.