Late reactions after postoperative high-dose-rate intravaginal brachytherapy for endometrial cancer: a comparison of standardized and individualized target volumes.

PURPOSE: To compare retrospectively two treatment protocols for postoperative intravaginal brachytherapy as to frequency of late radiation reactions and vaginal recurrence of disease. METHODS AND MATERIALS: Two hundred seventeen patients with Stage I-II endometrial carcinoma underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy, followed by high-dose-rate (HDR) intracavitary irradiation, 5.5 Gy x 4 (22 Gy), to the upper 5 cm of the vagina. From 1988 to August 1991, the reference isodose was at 5 mm from the mucosal surface (standard treatment, 96 pts). From September 1991 to June 1996, the reference isodoses were chosen at 3 mm, 4 mm, or 5 mm depth depending on a clinical estimation of the mucosal thickness (individualized treatment, 121 pts). Maximum bladder and rectum doses were calculated from orthogonal X-ray films. RESULTS: The patients were followed for 3 to 10 years. The rate of late vaginal reactions Grade 1 and 2 were 26% and 8%, respectively, after standard treatment, vs. 17% and 1% after individualized treatment (p = 0.005). Bladder reaction rates were 9% Grade 1 and 1% Grade 2 after standard treatment vs. 1% Grade 1 after individualized treatment (p = 0.005). Rectum reactions Grade 1 were seen in 5% and 1%, respectively. No Grade 3 reactions were observed. The reactions appeared after a median time interval of 9 months and 11 months, respectively. The rate of vaginal reactions was strongly correlated to the dose on the surface of the vaginal applicator, and the bladder reaction rate correlated with the calculated maximum bladder dose. Local vaginal recurrences were seen in 1 patient (1.0%) in the standard treatment group and in 3 patients (2.5%) in the individualized treatment group (p = 0.78). CONCLUSIONS: By individualizing the depth of the reference dose in the vaginal mucosa according to its thickness and avoiding applicators with small diameters, the rate of reactions can be reduced without any significant increase in vaginal recurrences.

Changes in radiation sensitivity and steroid receptor content induced by hormonal agents and ionizing radiation in breast cancer cells in vitro.

Possible influences of tamoxifen and estradiol on in vitro radiation sensitivity and cellular receptor content after irradiation and/or tamoxifen treatment were studied in breast cancer cell lines; estrogen receptor (ER) and progesterone receptor (PgR) positive cell lines MCF-7 and MCF-7/TAM(R)-1 and the ER and PgR negative cell line MDA-MB-231. The tamoxifen resistant MCF-7/TAM(R)-1 cells were more resistant to ionizing radiation than the MCF-7 and MDA-MB-231 cells. Exposure to tamoxifen made the MCF-7 cells more radiation resistant, while estradiol made the MDA-MB-231 cells more radiation sensitive. A radiation dose of 6 Gy reduced the ER content in cytosol in both MCF-7 and MCF-7/TAM(R)-1 cells, but brought no alterations to the PgR content. In MCF-7/TAM(R)-1 cells tamoxifen exposure significantly increased the ER and reduced the PgR content, an effect not observed in the MCF-7 cells. To conclude, the present study indicates that irradiation and tamoxifen may modify the ER and PgR content in cytosol in breast cancer cells. Hormonal treatment may alter the radiation sensitivity, even in ER negative cells, suggesting that hormonal agents may act both via receptor and non-receptor binding mechanisms.

Corticosteroids and lung surfactant levels in adult male rats.

Following lung instillation in adult male rats of 3.4 mumol hexavalent chromium (K2Cr2O7) dissolved in 0.5 ml of 0.9% NaCl, increased levels of lung surfactant could be detected after 48 h. The blood serum concentration of corticosterone was elevated in these animals. Blood serum thyroxine and triiodothyronine showed an initial increase after lung instillation of hexavalent chromium followed by a decline. Metabolism of testosterone by the alveolar macrophages to 17 beta-hydroxy-5 alpha-androstane-3-one and 5 alpha-androstane-3 alpha, 17 beta-diol was reduced 6 and 12 h after the K2Cr2O7 instillation, which was also associated with damage of lung cell function and decreased uptake by the alveolar macrophages of Candida albicans particles. As early as 12 h after s.c. administration of 400 micrograms dexamethasone/100 g body wt, increased levels of lung surfactant could be measured. At this time the lungs showed no signs of cellular damage, and metabolism of testosterone as well as uptake of Candida albicans particles by the alveolar macrophages were normal. Lower s.c. doses of dexamethasone did not result in raising the levels of lung surfactant in 12 h. Within 12 h after s.c. administration of large doses of testosterone, dihydrotestosterone or dehydroepiandrosterone no measurable effects on the levels of lung surfactant could be measured. Since animals treated with dexamethasone (200 micrograms/100 g body wt) or long-acting synthetic ACTH (100 micrograms i.m. Synacthen Depot/100 g body wt) for 5 days after lung instillation of K2Cr2O7 had extremely high levels of lung surfactant, it is concluded that the corticosteroids in adult rats may help to create augmented surfactant levels following lung intoxication. This could proceed via stimulation of surfactant production and reduction of surfactant removal. Different aspects of lung surfactant metabolism are discussed.

Metabolism of testosterone to 17 beta-hydroxy-5 alpha-androstane-3-one and 5 alpha-androstane-3 alpha, 17 beta-diol in alveolar macrophages from rat lung--II. Effects of intratracheal instillation of 3.4 mumol K2Cr2O7.

Activity of the steroid 5 alpha-reductase in pulmonary alveolar macrophages from adult male rats has been investigated in vitro. Intratracheal instillation of 3.4 mumol K2Cr2O7 lowered the enzyme activity within 6 h, and the reduction was significant on the subsequent 2, 4 and 7 days. The activity of this enzyme was significantly decreased only 6 and 24 h after instillation when measured in the 800 g supernatant fraction of whole lung. Instillation of 3.4 mumol K2Cr2O7 increased serum levels of corticosterone. Serum levels of triiodothyronine and thyroxine decreased except for a transient increase 3 h after the K2Cr2O7 instillation. Subcutaneous administration of 200 micrograms dexamethasone/100 g b.wt, 200 micrograms/100 g b.wt of testosterone, 17 beta-hydroxy-5 alpha-androstane-3-one (5 alpha-DHT), dehydroepiandrosterone or corticosterone had no effect on the 5 alpha-reductase activity of the pulmonary alveolar macrophages within 12 h. The combined treatment with dexamethasone s.c. and intratracheal instillation of 3.4 mumol K2Cr2O7 reduced the steroid 5 alpha-reductase activity in the pulmonary alveolar macrophages to about 25% of controls. Measurement of the steroid 5 alpha-reductase activity in pulmonary alveolar macrophages as an index of lung damage when exposed to toxic material is discussed.

Metabolism of testosterone to 17 beta-hydroxy-5 alpha-androstane-3-one and 5 alpha-androstane-3 alpha, 17 beta-diol in alveolar macrophages from rat lung.

5 alpha-Reduction of testosterone was observed in lung cells obtained by bronchoalveolar lavage (greater than 95% macrophages) from the rats. This activity was inhibited by progesterone and corticosterone. Production of 17 beta-hydroxy-5 alpha-androstane-3-one and 5 alpha-androstane-3 alpha, 17 beta-diol from testosterone was higher in rat pulmonary alveolar macrophages than by the 800 g supernatant fraction of whole lung homogenate from the same animals. Alveolar macrophages from rats treated with the 5 alpha-reductase inhibitor 17 beta-N,N-diethylcarbamoyl-4-aza-4-methyl-5 alpha-androstane-3-one (5 mg/100 g b.w., s.c.) showed decreased metabolism of testosterone to 17 beta-hydroxy-5 alpha-androstane-3-one and 5 alpha-androstane-3 alpha, 17 beta-diol 4 h after treatment. This metabolism was also decreased in alveolar macrophages from rats exposed to potassium dichromate by intratracheal instillation. When bovine alveolar macrophages were incubated with potassium dichromate, 5 alpha-reduction of testosterone decreased significantly. The function of steroid 5 alpha-reduction in alveolar macrophages is currently not known.

Response of bovine alveolar macrophages in vitro to welding fume particles.

Alveolar macrophages (AM) from bovine lungs were exposed in culture to manual metal are (MMA) welding fume particles, chromium (Cr), UICC chrysotile A or anatase for 17-20 hr. All the welding particle samples were more cytotoxic to AM than to anatase. Particles from the welding of mild steel with a rutile-coated electrode were less cytotoxic than those produced with a basic-coated electrode. Particles from the welding of stainless steel were slightly more cytotoxic, and much of this activity was probably due to CrVI. Selective release of N-acetyl-beta-glucosaminidase (beta-NAG) was only detected after exposure of AM to chrysotile. Supplementation of the incubation medium with 10% serum increased the viability of all exposed AM cultures, an effect not produced by serum albumin alone. Incubation of particle samples with dipalmitoyl phosphatidylcholine (DPPC) prior to addition to AM reduced the cytotoxicity of the "rutile" welding particles and of chrysotile.

Biochemical and cytological studies of rat lung after inhalation of methanol vapour.

Rats were examined for changes at the lung surface and in lung tissue after inhalation of methanol vapour for up to 6 weeks at doses of up to 10 000 ppm. No significant changes were found in any of the parameters measured. Methanol vapour therefore does not appear to exert appreciable toxicity at these exposure levels towards rat lung.