Value of whole brain re-irradiation for brain metastases--single centre experience.

AIMS: There is controversy in published studies regarding the role of repeat whole brain radiation (WBRT) for previously irradiated brain metastases. The aim of our retrospective study was to document the practice at Princess Margaret Hospital with respect to the re-irradiation of patients with progressive or recurrent brain metastatic disease after initial WBRT. MATERIALS AND METHODS: A comprehensive computerised database was used to identify patients treated for brain metastases with more than one course of WBRT between 1997 and 2003. Seventy-two patients were treated with WBRT for brain metastases and retreated with WBRT at a later date. The records of these patients were reviewed. RESULTS: The median age was 56.5 years. The most common primary sites were lung (51 patients) and breast (17 patients). The most frequent dose used for the initial radiotherapy was 20 Gy/5 fractions (62 patients). The most common doses of re-irradiation were 25 Gy/10 fractions (22 patients), 20 Gy/10 fractions (12 patients), 15 Gy/5 fractions (11 patients) and 20 Gy/8 fractions (10 patients). Thirty-one per cent of patients experienced a partial clinical response after re-irradiation, as judged by follow-up clinical notes; 27% remained stable; 32% deteriorated after re-irradiation. Patients who had Eastern Cooperative Oncology Group performance status 0-1 at the time of retreatment lived longer. In responders, the mean duration of response was 5.1 months. The median survival after re-irradiation was 4.1 months. One patient was reported as having memory impairment and pituitary insufficiency after 5 months of progression-free survival. CONCLUSION: Repeat radiotherapy may be a useful treatment in carefully selected patients. With increased survival and better systemic options for patients with metastatic disease, more patients may be candidates for consideration of repeat WBRT for recurrent brain metastases, but prospective studies are needed to more clearly document their outcomes.

A comparison of two dose regimens in pancreatic cancer.

Forty-seven patients with pancreatic cancer were treated with two different schedules of 5-fluorouracil (5FU) and leucovorin (LCV): standard and dose-intense schedules. The standard regimen was monthly and the dose intense was biweekly. Partial response was observed in one patient (4%), no change in 12 (48%) and progression of disease in another 12 patients. Clinical benefit, measured by symptomatic improvement, was observed in 19% of all the patients, in 12% of those treated with the standard regimen and in 27% of the intense group. Median survival was 8 months for all the patients. The 1-year survival rate was 32%. Toxicity was mild. There was no survival benefit for the dose intense regimen. These results indicate that clinical benefit can be obtained with 5FU and LCV regimens despite the lack of objective response and that a dose-intense schedule is of little benefit in treating pancreatic cancer.

Comparison of 5-FU and leucovorin to gemcitabine in the treatment of pancreatic cancer.

Gemcitabine has been recently added to the 5-fluorouracil (5-FU) protocol in the treatment of both new and 5-FU refractory patients with pancreatic cancer. We compared the efficacy of gemcitabine versus 5-FU and leucovorin (LCV) in 82 patients with advanced pancreatic cancer. Forty-seven patients received 5-FU and LCV and 35 patients received gemcitabine. Objective responses were documented in 4% on the 5-FU and LCV arm, compared to 9% in the gemcitabine arm. No change was observed in 48% on the 5-FU and LCV arm compared to 20% in the gemcitabine arm. Clinical benefit was observed in 19% on the 5-FU and LCV arm compared to 48% in the gemcitabine arm (p<0. 001). Toxicity was mild and well tolerated in both arms. One-year survival was 32% on the 5-FU and LCV arm and 23% in the gemcitabine arm. These results indicate that gemcitabine had a significantly higher clinical benefit than 5-FU and should be the standard treatment in advanced pancreatic cancer.

Lymph node revealing solution: a rapid method for the fixation of cystectomy specimens.

The objective of this study was to describe the use of the lymph node revealing solution (LNRS) for rapid fixation of total cystectomy specimens, and to compare it with formalin fixation. LNRS is a mixture of 95% ethanol, diethyl ether, glacial acetic acid and buffered formalin (65:20:5:10 v/v) prepared under a fume-hood. Sixteen consecutive cystectomy specimens were fixed for two hours either in LNRS or in buffered formalin. Representative sections were embedded in paraffin, sectioned and stained with H&E, periodic acid Schiff, alcian-blue, and immunostained for cytokeratins 20, high and low molecular weight cytokeratins, prostatic specific antigen, Factor VIII related antigen, s-100 protein, and protein kinase C isoenzymes. Results showed that the tissues were well fixed after 2 hours in LNRS, and were not fixed after 2 hours in formalin. Processing and sectioning of the paraffin blocks of the LNRS fixed tissue was excellent; it was impossible in the sections fixed for 2 hours in formalin. All the stains were excellent after LNRS fixation. We conclude that fixation of cystectomy specimens in LNRS requires only two hours and results in excellent stained slides. It is therefore recommended for cystectomy specimens.

Initial TPS serum level as an indicator of relapse and survival in colorectal cancer.

BACKGROUND: Tissue polypeptide specific antigen (TPS) measures a soluble fragment of cytokeratine 18 and may be regarded as a proliferative marker. MATERIALS AND METHODS: TPS was measured in 173 consecutive patients with colorectal cancer. Median follow up time was 36 months. Of 137 evaluable patients 39 developed metastases (P.D.) and 98 remained with no evidence of disease (N.E.D.). RESULTS: Initial TPS levels were elevated in 75% of P.D. patients compared to 32% of N.E.D. patients (p < 0.001), CEA levels were elevated in 26% of P.D. patients had elevated initial TPS compared to 35.5% of N.E.D. patients (p < 0.001), CEA was elevated in 33.3% of the P.D. patients compared to 1.3% of N.E.D. patients (p < 0.001). Survival and disease free survival were significantly shorter for patients with initial high TPS level. TPS was more sensitive than CEA in predicting relapse. CONCLUSIONS: These preliminary data suggest that TPS may be a prognostic factor for relapse and may help to allocate Dukes'B2 patients for adjuvant chemotherapy.