Transurethral radiotherapy for benign prostatic hypertrophy-related urethral obstruction. Dosimetry, ethics, and preliminary results.

The aim of this study is to present our preliminary experience in treating BPH-related urine retention, resistant to other medical treatment, with transurethral brachytherapy. We also deal with dosimetric analysis so as to eliminate ethical concerns about the exposure of patients not suffering from cancer to a certain level of body irradiation. Patients suffering from BPH-related urethral obstruction were treated with two transurethral applications (three weeks apart) of Cs137 MDR, which delivered a total of 16 Gy, at 0.5 cm from the urethral walls (dose rate 5-7 Gy/h). The application was done under ultrasonographic observation. Dosimetric calculation of the radiation exposure of the human body during transurethral radiotherapy (TURT) was performed for patients suffering from prostate cancer and treated with external beam radiotherapy and a boost dose through transurethral brachytherapy. For this purpose we used TLDs on skin surface and dosimetric analysis of X-ray films. Five patients treated for BPH urethral obstruction presented no sign of acute toxicity. All of them were weaned of their indwelling catheter immediately after the end of the first application. Obstruction did not recur within 12-18 months of follow-up. The dose delivered outside the prostate ranges from 1-7 cG, depending upon location. Proximal rectal and bladder walls received 1-2 Gy, a dose that is far from inducing acute or late toxicity. The estimated risk for carcinogenesis is negligible, and the expected benefit for the quality of life transcends the risks. No ethical concern is justified for testing transurethral radiotherapy for BPH-related urethral obstruction. TURT seems to be effective and provides durable results. Further investigation is required.

Reproductive variables, tobacco, ethanol, coffee and somatometry as risk factors for ovarian cancer.

A hospital-based case-control study of ovarian cancer was conducted in Athens from 1989 to 1991. The cases were 189 women, residents of Greater Athens and less than 75 years old, with histologically confirmed common malignant epithelial tumors of the ovary, operated in the 2 major cancer hospitals of the Greater Athens area. Controls were women residents of Greater Athens, less than 75 years old, who had never had cancer or had an ovary removed and who had visited patients hospitalized in the same wards as the ovarian cancer cases at the same time. The data were analyzed by modeling through multiple logistic regression. Statistically significant associations were found with induced menopause without oophorectomy [relative risk (RR) 0.17; 95% confidence interval (CI) 0.04 to 0.72], age at menopause (for an increment of 5 years RR 1.42; CI 1.00 to 2.01), hormone-replacement therapy (RR 5.73; CI 1.07 to 30.80), parity (RR 0.48; CI 0.24-0.96) and, marginally, age at first birth (for an increment of 5 years RR 1.30; CI 0.99 to 1.70). Non-significant but previously suggested or biologically plausible associations were noted with use of oral contraceptives (inverse), weight before onset of the disease (positive), and consumption of more than 2 glasses of alcoholic drinks per day (positive). There were no consistent associations with coffee, tobacco, moderate alcohol intake, broad occupational group, induced abortions, or age at menarche.

Hair dyes, analgesics, tranquilizers and perineal talc application as risk factors for ovarian cancer.

In a hospital-based case-control study of ovarian cancer conducted in Athens (1989-1991), 189 women with histologically confirmed common malignant epithelial tumors of the ovary were compared with 200 hospital visitor controls. All interviews were conducted by personal interview in the 2 participating hospitals and the data were analyzed by modelling through logistic regression, controlling for demographic and reproductive variables. Tranquilizing and hypnotic drugs (mostly diazepam) were not associated with risk of ovarian cancer: the adjusted relative risk (RR) and 95% confidence interval (CI) were 0.96 (0.57 to 1.63), whereas use of analgesics (mostly salicylates) was associated with significantly reduced risk of the disease (RR 0.51; CI 0.26 to 1.02). There was no evidence that perineal application of talc was associated with increased risk (RR 1.05; CI 0.28 to 3.98) but the frequency of reporting talc use was low in the study population. There was a statistically significant (p for trend 0.007) and a dose-dependent association between hair dyeing and risk of ovarian cancer. Compared to never-users, women dyeing their hair up to 4 times per year had a relative risk of 1.74 (0.91 to 3.32) whereas those dyeing their hair 5 or more times per year had a relative risk of 2.16 (1.19 to 3.89).

Alpha 1-antitrypsin and survival in hepatocellular carcinoma.

The association between serum levels of alpha 1-antitrypsin (alpha 1 AT) at the time of diagnosis and survival was studied in a group of 78 patients with confirmed hepatocellular carcinoma (HCC). All 78 patients were followed until the time of death, which occurred in all instances from HCC, with a median time of 6 months and a range of 1-117 months. Cox's proportional hazards model was utilised in the analysis controlling for sex, age, HBsAg status and logarithmically transformed values of alpha-fetoprotein (alpha-FP). Older patients and patients positive for HBsAg have suggestively higher fatality rates (0.05 less than P less than 0.10) whereas in these data sex and AFP levels were not important prognostic factors. Increased levels of serum at alpha 1AT at the time of diagnosis of HCC were statistically significantly (P less than 0.05) related with shorter survival, patients with higher serum alpha 1AT by 200 mg 100 ml-1 having an expected survival time shorter by about 25%.

Tobacco smoking, coffee drinking, and occupation as risk factors for bladder cancer in Greece.

Patients with bladder cancer (250 males and 50 females), consecutively admitted during a 2-year period in the major cancer hospital of Athens, and an equal number of age- and gender-matched comparison patients with orthopedic conditions were interviewed regarding demographic, socioeconomic, and biomedical characteristics, including their occupations and their use of coffee and tobacco prior to the onset of their present disease or condition. Analyses of the data showed that cigarette smoking is an important, statistically significant and dose-dependent risk factor for bladder cancer, particularly in males (tobacco smoking is rare among older Greek women); drinking 2 or more cups of Greek coffee per day appears to be a risk factor for bladder cancer, independent of tobacco smoking, although the association is neither strong nor dose dependent; and a priori specified "high-risk" occupations were associated with an increased rate ratio for bladder cancer among men less than 65 years and among women in general but not among older men. The overall results of this study indicate that the established risk factors for bladder cancer in the United States and in other developed countries are, apparently, equally important for bladder cancer in Greece, despite the differences in composition and conditions of use of Oriental tobacco and Greek coffee and in the activities and exposures to carcinogens in the Greek work place.

Fibrous pseudotumor of the scrotum.

We report a case of a fibrous pseudotumor of the scrotum. This is a relatively rare tumor, which should be considered in the differential diagnosis of testicular and testicular tunica tumors. The latter type is benign and orchiectomy could be avoided.