Prognostic index for primary adenocarcinoma of the urinary bladder.

AIM: To determine the working independent prognostic factors and the prognostic index of adenocarcinoma of the urinary bladder. The effect of adding postoperative radiotherapy to radical cystectomy on this prognostic index was also investigated. PATIENTS AND METHODS: Two hundred and sixteen patients having adenocarcinoma of the urinary bladder were treated with radical cystectomy and pelvic lymphadenectomy with (82 patients) or without (134) postoperative radiotherapy. Postoperative radiotherapy (PORT) was given to the whole pelvis in a dose of 50 Gy/25 fractions over 5 weeks, and started 4-10 weeks after surgery. RESULTS: The 5-year disease-free survival rate was 44 +/- 4% for the whole group. Postoperative radiotherapy improved the disease-free survival significantly from 33 +/- 6% for cystectomy alone Introduction to 58 +/- 6% for PORT patients (P = 0.002). The independent prognostic factors for DFS were the pathological stage, histological subtypes, nodal involvement and the addition of postoperative radiotherapy. The stratification of patients using prognostic indices according to the pathological findings produces identifiable prognostic groups. Postoperative radiotherapy improved the DFS significantly in the intermediate and high risk indices (p = 0.0004 and 0.0002 respectively). CONCLUSIONS: The identified prognostic indices with their prognostic group could be used not only as a predictor of disease-free survival but also as a good predictor for the need to add adjuvant therapy in adenocarcinoma of the urinary bladder.

Dose rate definition with microSelectron-HDR and Selectron-MDR in brachytherapy for carcinoma of the cervix.

BACKGROUND: Reproducibility of dose rate at point A is the main characteristic of Manchester system for dose prescription for cancer cervix brachytherapy. Here, we investigated dose rate variations at point A in the application of Selectron-MDR and microSelectron-HDR. MATERIALS AND METHODS: All applications were compared for their physical aspects (loading and geometry). Two points A(rev) and A(or) (revised and original definitions) were checked for dose rate variations. Here we proposed a tool "dose rate radium equivalent" (Ra-eq.DR) to cancel the effect of source decay on the variation of dose rate values. RESULTS: Both techniques showed very similar geometry, tandem-ovoid loading ratio, and Ra-eq.DR at A(rev) and A(or). However, the best reproducibility of dose rate was achieved with A(or). Also, time variable-dose rate definition affected the difference between the 2 treatments modalities. CONCLUSIONS: Clear definition of both the point of dose prescription and the time variable used for dose rate calculation are important for brachytherapy for cancer of the cervix.

HDR and MDR intracavitary treatment for carcinoma of the uterine cervix. A prospective randomized study.

AIM: Treatment of carcinoma of the uterine cervix by remote afterloading brachytherapy has been accompanied with new isotopes having dose rates different from the classical low-dose rate (LDR) radium source. The dose rate conversion factor from LDR to high-dose rate (HDR) found to be around 0.54 in most studies. As regards medium-dose rate (MDR) brachytherapy, the published data are very few and the experience is still short. In this study the experience of Osaka University Hospital with micro-HDR-Selectron and Selectron-MDR, as a preliminary report of the clinical trial, is presented. PATIENTS AND METHOD: From August 1991 through April 1993, a total of 45 patients with carcinoma of the uterine cervix were randomly allocated to either microSelectron-HDR or Selectron-MDR at the Osaka University Hospital. As regards HDR, dose to point A was adjusted to 32 Gy (for stages I and II). 30 Gy/4 fractions, and 22.5 Gy/3 fractions, for stages III, and IV, respectively. The corresponding values in case of MDR were 35.6, 34 Gy/4 fractions, and 25.5 Gy/3 fractions. External irradiation, according to the stage, was the same in the 2 groups. Nucletron Planning System (NPS) was used for pre-treatment dose calculation at point A, rectal and bladder wall. The dose rate at point A ranged from 24 to 75.6 cGy/min for the HDR group, while for the MDR group ranged among 174.8 to 229.6 cGy/h. RESULTS: The 3-year survival and loco-regional control rates for both modalities were nearly equivalent (62% and 67% for HDR and 68% and 74% for MDR). The cumulative rectal and bladder complication rates were the same in both groups (29% at 3 years), with only 1 patient (MDR-group) developed grade 3 rectal and bladder complication. In this study, point A dose rate correction factor from LDR to HDR was 0.53 and 0.6 from LDR to MDR. CONCLUSIONS: From the previous reports from Osaka University Medical School, as well as others, HDR was proposed as an alternative to LDR brachytherapy for treatment of carcinoma of the uterine cervix. In this report, Selectron-MDR was nearly equivalent to the microSelectron-HDR as regards survival and loco-regional control rates as well as radiation-induced complication. This is a preliminary report, and the study still needs larger number of patients, and longer follow-up period.

Lack of correlation between gallbladder opacification in delayed CT and contrast-associated nephropathy.

The objective of our study was to determine the correlation between gallbladder opacification by delayed CT and contrast-associated nephropathy (CAN). Delayed CT after angiography was performed in 269 patients. Gallbladder opacification was defined when the CT value in gallbladder was more than 30 HU. Positive renal dysfunction was recognized as CAN which defined as an increase in serum creatinine level > 0.3 mg/dl and > 20 % on days 1, 3, or 7. Gallbladder opacification appeared in 154 of 269 (57 %) patients and CAN in 35 (13 %) patients. Of 117 patients without gallbladder opacification, 17 CAN (14 %) were recognized, and of 152 patients with gallbladder opacification, 18 CAN (12 %) were recognized. No significant correlation existed between delayed gallbladder opacification and CAN.