Fecal incontinence and radiation dose on anal sphincter in patients with locally advanced rectal cancer (LARC) treated with preoperative chemoradiotherapy: a retrospective, single-institutional study

Background. The objective of the study is to determine the correlations among the variables of dose and the sphincter function (SF) in patients with locally advanced rectal cancer treated with preoperative capecitabine/radiotherapy followed by low anterior resection (LAR) + TME. Methods. We retrospectively reviewed 92 consecutive patients with LARC treated at our center with LAR from 2006 and more than 2 years free from disease. We re-contoured the anal sphincters (AS) of patients with the help of the radiologist. SF was assessed with the Wexner scale (0-20 points, being punctuation inversely proportional to annal sphincter functionality). All questionnaires were filled out between January 2010 and December 2012. Dosimetric parameters that have been studied include V20, V30, V40, V50, mean dose (Dmean), minimum dose (Dmin), D90 (dose received by 90% of the sphincter) and D98. Statistical analysis. The correlations among the variables of dose and SF were studied by the Spearman correlation coefficient. Differences in SF relating to maximum doses to the sphincter were assessed by the Mann-Whitney test. Results. Mean Wexner score was 5.5 points higher in those patients with V20 > 0 compared to those for which V20 = 0 (p = 0.008). In a multivariate regression model, results suggest that the effect of V20 on poor anal sphincter control is independent of the effect of distance, with an adjusted OR of 3.42. Conclusions. In order to improve the SF in rectal cancer treated with preoperative radiotherapy/capecitabine followed by conservative surgery, the maximum radiation dose to the AS should be limited, when possible, to <20 Gy (AU)

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Fecal incontinence and radiation dose on anal sphincter in patients with locally advanced rectal cancer (LARC) treated with preoperative chemoradiotherapy: a retrospective, single-institutional study.

BACKGROUND: The objective of the study is to determine the correlations among the variables of dose and the sphincter function (SF) in patients with locally advanced rectal cancer treated with preoperative capecitabine/radiotherapy followed by low anterior resection (LAR) + TME. METHODS: We retrospectively reviewed 92 consecutive patients with LARC treated at our center with LAR from 2006 and more than 2 years free from disease. We re-contoured the anal sphincters (AS) of patients with the help of the radiologist. SF was assessed with the Wexner scale (0-20 points, being punctuation inversely proportional to annal sphincter functionality). All questionnaires were filled out between January 2010 and December 2012. Dosimetric parameters that have been studied include V 20, V 30, V 40, V 50, mean dose (D mean), minimum dose (D min), D 90 (dose received by 90% of the sphincter) and D 98. STATISTICAL ANALYSIS: The correlations among the variables of dose and SF were studied by the Spearman correlation coefficient. Differences in SF relating to maximum doses to the sphincter were assessed by the Mann-Whitney test. RESULTS: Mean Wexner score was 5.5 points higher in those patients with V 20 > 0 compared to those for which V 20 = 0 (p = 0.008). In a multivariate regression model, results suggest that the effect of V 20 on poor anal sphincter control is independent of the effect of distance, with an adjusted OR of 3.42. CONCLUSIONS: In order to improve the SF in rectal cancer treated with preoperative radiotherapy/capecitabine followed by conservative surgery, the maximum radiation dose to the AS should be limited, when possible, to <20 Gy.

Glucagon- and NPY-related peptide-immunoreactive cells in the gut of sea bass (Dicentrarchus labrax L.): a light and electron microscopic study.

Glucagon and peptide of the neuropeptide Y (NPY) family immunoreactivities were studied in the gut of sea bass (Dicentrarchus labrax) using antisera against bovine/porcine glucagon, porcine glucagon, glicentin (10-30), bovine pancreatic polypeptide (PP), peptide tyrosine tyrosine (PYY), salmon PYY (sPYY), and NPY. Glucagon-, glicentin-, PYY-, and NPY-immunoreactive (ir) cells were detected in the stomach, and glucagon-, PP-, PYY-, sPYY-, and NPY-ir cells in the intestine. PP, PYY, and NPY immunoreactivities coexisted in intestinal endocrine cells (NPY-like peptide containing cells), in some of which there was also glucagon immunoreactivity. Preabsorption tests indicated that different products of the glucagon gene(s) are probably expressed in the stomach and intestine of sea bass and that the peptides belonging to the NPY family in the endocrine cells of the intestine are more similar to NPY than to other peptides of this family. Glucagon-ir cells in the stomach, and glucagon/NPY-like containing cells in the intestine, were characterized by conventional and immunogold electron-microscopic techniques. The glucagon cells had secretory granules with a clotted content, the gold particles being observed in both the core and the halo. Glucagon/NPY-like cells showed two types of secretory granules differing in size, both of which were immunogold labeled with anti-NPY and anti-sPYY; the smaller granules were weakly immunogold labeled with anti-glucagon.

Occurrence of somatostatin and insulin immunoreactivities in the stomach of sea bass (Dicentrarchus labrax L.): light and electron microscopic studies.

Somatostatin (SST)- and insulin (INS)-immunoreactive (ir) cells were identified in the gut of sea bass (Dicentrarchus labrax) by immunofluorescence double staining and peroxidase-antiperoxidase (PAP) techniques for light microscopy and by immunogold method for electron microscopy using antisera to mammalian and fish peptides. SST-14 and SST-25 immunoreactivities coexisted in cells mainly located among the mucous neck cells of the gastric glands. Preabsorption controls showed that some SST-25- and, possibly, some SST-14-like peptides appeared in these cells. Immunoreactivity to fish INS, but not to mammalian INS (mINS) or insulin-like growth factor I (mIGF-I), was observed in all the SST-ir cells. The preabsorption controls suggest a cross-reaction of the fish INS antisera with SST-containing or type I cells. These cells displayed ovoid or round secretory granules with fibrous, medium electron-dense or homogeneous osmiophilic materials. Some gastric cells (type II) with round secretory granules of variable electron density, which were gold immunolabeled with bonito INS but not with mINS, mIGF-I, or SST antisera, were also found. INS-related peptide in type II cells of the sea bass stomach is suggested.