A small scale, qualitative focus group to investigate the psychosocial support needs of teenage young adult cancer patients undergoing radiotherapy in Wales.

PURPOSE: The purpose of this study was to evaluate the psychosocial support needs of teenage young adult cancer patients undergoing radiotherapy in Wales. METHOD: A focus group interview was utilised to encourage dialogue and collect rich data. Transcripts were analysed through open coding and content analysis. Emergent themes in terms of psychosocial tensions were identified and categorised as external stressors and intrinsic anxieties. FINDINGS: All participants indicated a desire to maintain their identity as individuals and resume as normal a life as possible throughout the treatment process and beyond. Peer support was deemed as vital to achieving this goal. Participants demonstrated a distinct sense of unity and group cohesion throughout the session with suggestions that they considered themselves to be very different from what they thought of as 'usual cancer patients'. A range of information was offered prior to radiotherapy however there was variation in the efficacy of this provision between centres. At variance with literature, issues related to body image were not overtly demonstrated as significant. Support services provided by external organisations were not being signposted. CONCLUSION: Psychosocial support is vital to the psychological recovery and wellbeing of young adult cancer patients. Findings suggest that issues related to peer support and age appropriate services and information are not being addressed within current service provision. Key staff within radiotherapy should be identified to ensure that the specific needs of this distinct patient group are met.

Use of a tissue expander and a polyglactic acid (Vicryl) mesh to reduce radiation enteritis: case report and literature review.

Management of stage IV rhabdomyosarcoma comprises systemic chemotherapy with local control by conservative surgery and radiotherapy. Abdominal radiotherapy may lead to radiation enteritis causing such serious morbidity as malabsorption, fistulae or stricture formation. The risk increases with the dose of radiation and length of bowel involved. Various methods have been utilised to displace the bowel from the radiation field. Usually these are applied in patients requiring pelvic irradiation. We report a case of metastatic alveolar rhabdomyosarcoma requiring radiotherapy to the right renal bed. Effective displacement of small bowel from the tumour site was achieved by a combined use of a tissue expander and Vicryl mesh. There were no complications from the surgery. This is the first report discussing combined use of a tissue expander and Vicryl mesh to aid radiotherapy to the renal fossa in a paediatric patient.

Tumor, normal tissue, and plasma pharmacokinetic studies of fluorouracil biomodulation with N-phosphonacetyl-L-aspartate, folinic acid, and interferon alfa.

PURPOSE: To evaluate the effect of N-phosphonacetyl-L-aspartate (PALA), folinic acid (FA), and interferon alfa (IFN-alpha) biomodulation on plasma fluorouracil (5FU) pharmacokinetics and tumor and liver radioactivity uptake and retention after [18F]-fluorouracil (5-[18F]-FU) administration. PATIENTS AND METHODS: Twenty-one paired pharmacokinetic studies were completed on patients with colorectal, gastric, and hepatocellular cancer, utilizing positron emission tomography (PET), which allowed the acquisition of tumor, normal tissue, and plasma pharmacokinetic data and tumor blood flow (TBF) measurements. The first PET study was completed when the patient was biomodulator-naive and was repeated on day 8 after the patient had been treated with either PALA, FA, or IFN-alpha in recognized schedules. RESULTS: TBF was an important determinant of tumor radioactivity uptake (r = .90; P < .001) and retention (r = .96; P < .001), for which radioactivity represents a composite signal of 5-[18F]-FU and [18F]-labeled metabolites and catabolites. After treatment with PALA, TBF decreased (four of four patients; P = .043), as did tumor radioactivity exposure (five of five patients; P = .0437), with no change in plasma 5FU clearance. With FA treatment, there were no differences observed in whole-body metabolism, plasma 5FU clearance, or tumor and liver pharmacokinetics. IFN-alpha had measurable effects on TBF and 5-[18F]-FU metabolism but had no apparent affect on liver blood flow. CONCLUSION: The administration of PALA and IFN-alpha produced measurable changes in plasma, tumor, and liver pharmacokinetics after 5-[18F]-FU administration. No changes were observed after FA administration. In vivo effects may negate the anticipated therapeutic advantage of 5FU biomodulation with some agents.

New techniques in the pharmacokinetic analysis of cancer drugs. IV. Positron emission tomography.

Positron emission tomography is a powerful tool for the absolute quantification of injected positron emitting radiotracer concentration within tissues in vivo. Very detailed spatiotemporal data can be obtained without biopsy sampling. Most chemotherapeutic agents can be labelled with a positron emitter, and human tissue and tumour pharmacokinetics can be obtained non-invasively. Its main limitations are the inability to discriminate metabolites, the short half-life of the isotopes used and the specialized equipment required. Despite this, PET has the potential to make a major contribution in the study of the pharmacokinetics of anti-cancer drugs.

Positron emission tomography for tumour assessment.

As positron emission tomography (PET) is outside of the main theme of this conference, it is necessary to outline what it offers as a method for assessing tissue function in vivo. This is followed by illustrations of how PET has and is being used to study the physiology and biochemistry of tumours and pharmacokinetics and pharmacology of anticancer agents. Strategies are offered as to how PET may be used for the development of new chemotherapeutic agents.