Efficacy of low-dose radiotherapy in painful gonarthritis: experiences from a retrospective East German bicenter study.

PURPOSE: To evaluate the efficacy of low-dose radiotherapy in painful gonarthritis. METHODS: We assessed the medical records of 1037 patients with painful gonarthritis who had undergone low-dose radiotherapy between 1981 and 2008. The subjective patient perception of the response to irradiation as graded immediately or up to two months after the completion of a radiotherapy series was evaluated and correlated with age, gender, radiological grading and the duration of symptoms before radiotherapy. Moreover, we performed a mail survey to obtain additional long-term follow-up information and received one hundred and six evaluable questionnaires. RESULTS: We assessed 1659 series of radiotherapy in 1037 patients. In 79.3% of the cases the patients experienced a slight, marked or complete pain relief immediately or up to two months after the completion of radiotherapy. Gender, age and the duration of pain before radiotherapy did not have a significant influence on the response to irradiation. In contrast, severe signs of osteoarthritis were associated with more effective pain relief. In more than 50% of the patients who reported a positive response to irradiation a sustained period of symptomatic improvement was observed. CONCLUSIONS: Our results confirm that low-dose radiotherapy is an effective treatment for painful osteoarthritis of the knee. In contrast to an earlier retrospective study, severe signs of osteoarthritis constituted a positive prognostic factor for the response to irradiation. A randomized trial is urgently required to compare radiotherapy with other treatment modalities.

Helmet mold-based surface brachytherapy for homogeneous scalp treatment: a case report.

UNLABELLED: BACKGROUND/CASE REPORT: External-beam radiotherapy of complex-shaped areas is sometimes difficult to realize. In a patient with chronic lymphatic leukemia (CLL) infiltrates of the skin of the whole scalp, conventional external-beam radiotherapy with electrons or photons was not able to treat the target sufficiently. Thus, the authors developed a brachytherapy moulage technique using a customized helmet (polyethylene) with flexible interstitial plastic applicators and irradiated the target very homogeneously with a microselectron (192)Ir HDR (high-dose-rate) source (2.0 Gy daily fractionated; 36.0 Gy total dose related to the reference points in 3 mm focus depth). Technical difficulties, CT-supported three-dimensional conformal treatment planning, and verification with TLD probe measurements are described. The treatment was well tolerated and resulted in complete local remission of the CLL infiltrates within a follow-up of 30 months. CONCLUSION: The presented treatment of lymphoma infiltrates at the scalp by HDR moulage techniques is exceptional but safe and practicable to achieve local tumor control.

Radiochemotherapy followed by gemcitabine and capecitabine in extrahepatic bile duct cancer: a phase I/II trial.

OBJECTIVE: Both radiotherapy and chemotherapy with gemcitabine and capecitabine have efficacy in biliary cancer. Our aim was to determine the toxicity and efficacy of a postoperative regimen combining both treatment modalities in extrahepatic bile duct cancer. METHODS: Patients were eligible after surgery for extrahepatic bile duct adenocarcinoma. Surgery included resection of lymph node positive cancer, incomplete resections and diagnostic laparotomy in unresectable tumors. Patients received a fractionated radiotherapy of 49.6 Gy accompanied by gemcitabine once a week. After a 2-week rest, patients were treated with gemcitabine and capecitabine on a 3-week cycle. The treatment continued for 6 cycles in nonmeasurable disease or until disease progression or intolerable toxicity. RESULTS: There were 18 patients (resection/laparotomy 7/11) enrolled between August 2003 and April 2005. Radiotherapy was completed in all patients and a total of 66 cycles of chemotherapy was applied. Fatigue and nausea were the most common mild adverse events. Grade 3 and 4 toxicity was rare after resection but frequent in unresectable disease and consisted of fatigue, nausea, duodenal ulcer, cachexia, and cholangitis in 1, 2, 2, 4, and 4 patients, respectively. We observed a 50% disease stabilization rate in patients with measurable disease. Median overall survival was 7.9 months in patients with unresectable tumors. Median overall survival in patients after resection has not been reached at a median follow-up of 19.5 months. CONCLUSIONS: Radiochemotherapy using gemcitabine followed by gemcitabine and capecitabine is an active regimen with manageable toxicity after resection of extrahepatic bile duct cancer but has significant toxicity in unresectable disease.

Expression of erythropoietin and erythropoietin receptor in cervical cancer and relationship to survival, hypoxia, and apoptosis.

PURPOSE: Physiologically, hypoxia induces the expression of erythropoietin (Epo) in adult kidney cells. Epo, in turn, acts on the Epo receptor (EpoR) in RBC precursors to stimulate growth and prevent apoptosis. Because hypoxia plays a major role in the malignant progression of tumors and Epo and its receptors have also been detected in malignant tumors, we investigated the expression of Epo and EpoR and their relationship with hypoxia, proliferation, apoptosis, and clinicopathologic variables in cervical cancer. EXPERIMENTAL DESIGN: Intratumoral oxygen measurement and needle biopsies of the tumors were done in 48 patients with cervical cancer. The obtained tissue was analyzed by immunohistochemistry with antibodies against Epo, EpoR, and Ki-67 as well as by terminal deoxynucleotidyl transferase-mediated deoxyuracil triphosphate nick-end labeling assays. RESULTS: Epo and EpoR were expressed in 88% and 92% of samples, respectively. Cervical cancers with higher Epo expression showed a significantly reduced overall survival (3 years, 50.0% versus 80.6%; P = 0.0084). Epo and EpoR expression correlated significantly with apoptosis (r = 0.49, P = 0.001 and r = 0.36, P = 0.021). Furthermore, EpoR expression correlated significantly with tumor size (r = 0.32, P = 0.032) and was significantly associated with the presence of lymphovascular space involvement (P = 0.037). However, we observed no correlation between Epo or EpoR expression and intratumoral hypoxia, although in well-oxygenated tumors, EpoR localized significantly more often to the invasion front (P = 0.047). CONCLUSIONS: This study analyzes Epo/EpoR expression and their relationship with intratumoral pO(2) levels as well as with survival in patients with cervical cancer. The data suggest a critical role of the endogenous Epo/EpoR system in cervical cancer.

Low-dose X-irradiation of adjuvant-induced arthritis in rats. Efficacy of different fractionation schedules.

BACKGROUND AND PURPOSE: Low-dose radiotherapy is widely accepted as a very effective treatment option for inflammatory symptoms associated with painful degenerative joint disorders. Radiation doses and fractionation schedules in practical use are empirical and mainly based on clinical observations. Experimental data are rare. The efficacy of low-dose X-irradiation on adjuvant induced arthritis in rats using different fractionation schemes was investigated in vivo, in order to explore whether there is a dose and fractionation dependence. MATERIAL AND METHODS: Adjuvant arthritis in female Lewis rats (n = 128) was induced by intradermal injection of heat-inactivated Mycobacterium tuberculosis on day 0. Both arthritic hind paws were sham-irradiated (group 1: days 10-14; group 2: days 15-19; group 3: days 22-26) or X-irradiated with either 5 x 1.0 Gy (group 4: days 10-14; group 6: days 15-19; group 8: days 22-26; group 10: days 10, 12, 14, 16, and 18) or 5 x 0.5 Gy (group 5: days 10-14; group 7: days 15-19; group 9: days 22-26; group 11: days 10, 12, 14, 16, and 18; group 12: days 10-14 and 22-26). The clinical parameters arthritis score (AS), hind paw volume (HPV), and body weight were determined. RESULTS: A significant decrease of the clinical arthritis parameters was observed following 5 x 0.5 Gy or 5 x 1.0 Gy during the acute maximum of the inflammatory response (days 15-19). The most pronounced treatment effect was reached after two daily fractionated series of 5 x 0.5 Gy with an early treatment onset (days 10-14) and repetition in interval (days 22-26). After the application of 5 x 1.0 Gy on days 10-14 or in a protracted scheme (days 10, 12, 14, 16, and 18), only a nonsignificant positive trend could be detected. Daily fractionated X-irradiation in the chronic phase of adjuvant arthritis (days 22-26) did not show any positive clinical effect. CONCLUSION: Low-dose radiotherapy is able to prevent a full-blown arthritic reaction if given during the florid phase of adjuvant arthritis. Two series of 5 x 0.5 Gy with an early treatment onset (days 10-14) and repetition in interval (days 22-26) were the most effective treatment schedule in this experimental study.