[Electronic dataflow management in radiotherapy: routine use of the DICOM-RT protocol]. / Gestion électronique du flux de données en radiothérapie: utilisation en routine du protocole DICOM-RT.

The DICOM standard protocol of medical image exchange and its extensions to radiotherapy data has been implemented in order to enable electronic communication between all modalities within our radiology and radiotherapy departments. The network architecture used for radiotherapy includes as basic elements one CT simulator, several treatment planning systems, one linear accelerator fitted with multileaf collimator, one electronic portal imaging system and several laser imagers. As customary in radiotherapy departments, our equipments are heterogeneous with respect to manufacturers and computer operating systems. Choosing to resort to the DICOM-RT protocol spared us the acquisition of a proprietary information system because its elementary inter-connectivity characteristics can effectively be used for dataflow management. It has the advantage to minimally change the user's way of working since the electronic data transfer is taking place sequentially from one workstation to the other in a manner analogous to what is done with the paper document. Quality assurance management of treatments is simplified by the electronic nature of the transfers from the CT-simulation down to the accelerator since modalities interfaces, instead of users, are performing consistency checks. This process results in substantial time saving, but the DICOM computer interface is requiring a better skill that the one needed for operating standard office software. The DICOM-RT protocol is presently missing some functionality necessary for its integration into our hospital information system. Our experience is however showing that it represents a viable and promising solution for a small radiotherapy department.

Comparison of an LH-RH analogue (Goeserelin acetate, 'Zoladex') with combined androgen blockade in advanced prostate cancer: final survival results of an international multicentre randomized-trial. International Prostate Cancer Study Group.

OBJECTIVE: The aim of this study was to compare the effects of the nonsteroidal antiandrogen flutamide plus the LH-RH analogue goserelin acetate (combined androgen blockade [CAB]) with goserelin acetate alone in patients with advanced prostate cancer. The original analyses at 25 and 56 months of follow-up have been reported previously, and here we report the final survival analysis after 10 years of follow-up. METHODS: 589 patients with advanced prostate cancer (55% with metastatic [M1] and 45% with locally advanced [M0] disease) were randomized to receive goserelin acetate 3.6 mg either alone or in combination with flutamide (250 mg three times daily). RESULTS: A total of 583 patients were included in the analysis. There was a small, but nonsignificant, benefit for CAB compared with goserelin acetate alone in all patients with respect to survival (hazard ratio 0.88, 95% CI 0.73, 1.06). Subgroup analysis of M0 and M1 patients showed similar results (M0: hazard ratio 0.92, 95% CI 0.68, 1.25; M1: hazard ratio 0.85, 95% CI 0.66, 1. 08). The treatment effect was not significantly different for M0 and M1 patients (p = 0.685). CONCLUSIONS: In this large randomized trial containing significant numbers of M0 patients, after 10 years there was a small but nonsignificant benefit for CAB over castration alone.

[Interleukin 10 and chronic vitritis in a case of ocular lymphoma]. / Interleukine-10 et vitrite chronique dans un cas de lymphome oculaire.

The authors report on a 46 year-old patient who presented with a chronic unilateral vitritis. A diagnosis of cerebral lymphoma was made 4 years earlier and a maxillary sinus recurrence was treated with chemotherapy and radiotherapy. A vitrectomy was performed and the level of Interleukin-10, a lymphoma cells growth factor, was found very high, giving a clue for the lymphomatous cause of the vitritis.

Reiter's syndrome after intravesical Bacillus Calmette-Guérin treatment for superficial bladder carcinoma.

A 64-year-old woman developed acute Reiter's syndrome 4 weeks after the start of intravesical Bacillus Calmette-Guérin immunotherapy for a recurrent superficial bladder carcinoma. The absence of any other cause suggests that the bacillus played an etiopathogenic role in this HLA-B27-positive patient.

Oral ondansetron in the prophylaxis of nausea and vomiting induced by cyclophosphamide, methotrexate and 5-fluorouracil (CMF) in women with breast cancer. Results of a prospective, randomized, double-blind, placebo-controlled study.

BACKGROUND: The combination of cyclophosphamide, methotrexate and 5-fluorouracil (CMF) is a widely used chemotherapy regimen in breast cancer patients. However, the control of nausea and vomiting induced by oral CMF is a rarely examined problem. Therefore we felt a randomized, placebo controlled study justified in order to improve currently available antiemetic therapy. SUBJECTS AND METHODS: In a randomised double-blind trial ondansetron given orally, 8 mg three times a day for 15 days, was compared with placebo in 82 breast cancer patients receiving chemotherapy with CMF (cyclophosphamide 100 mg/m2 orally days 1-14, methotrexate 40 mg/m2 i.v. days 1 and 8 and 5-fluorouracil 600 mg/m2 i.v. days 1 and 8). The patients recorded nausea and the number of vomits and retches daily on diary cards. Forty-two patients received ondansetron and 40 received placebo. RESULTS: Significantly more patients who received ondansetron experienced neither vomiting nor retching (emesis) compared to those receiving placebo over a 15 day treatment period (60% vs. 35%, p = 0.027). The difference, with 95% confidence limits, was estimated at 25 (4.45%). Furthermore, there was a trend in favour of ondansetron in the control of nausea. Ondansetron was well tolerated, with 25 patients (59%) reporting at least 1 adverse event compared to 18 patients (45%) receiving placebo (p = 0.191). CONCLUSION: The results indicate that ondansetron given orally for 15 days is safe and effective in the control of emesis induced by CMF. It is however too early to recommend ondansetron as standard antiemetic therapy for oral CMF, as the treatment of nausea and vomiting in this setting has not been studied thoroughly enough.

[Randomized study comparing zoladex versus zoladex plus flutamide in treatment of advanced cancer of the prostate]. / Etude randomisée comparant Zoladex versus Zoladex + flutamide dans le traitement du cancer avancé de la prostate.

589 patients from 10 countries are recruited into a multicentre randomised trial comparing Zoladex with a combination of Zoladex-Depot + flutamide. Zoladex was administered as a depot injection every 28 days and flutamide was given as 3 x 250 mg tablets daily. Patients with histologically confirmed locally advanced (T3/T4) or metastatic (M1) carcinoma were included. Patients with previous hormonal manipulation and/or chemotherapy were excluded. 65% of patients had metastatic disease. Both treatment groups were balanced (T-category, histology, metastases, performance status). An analysis of subjective and objective response, time to response and time to progression has shown no statistically significant difference. A survival analysis after a median follow-up of 24 months has shown no statistically significant difference between the two treatment groups (p = 0.47).

A multicenter randomized trial comparing the luteinizing hormone-releasing hormone analogue goserelin acetate alone and with flutamide in the treatment of advanced prostate cancer. The International Prostate Cancer Study Group.

A prospective randomized trial was conducted to compare the effects of the nonsteroidal antiandrogen flutamide (250 mg. 3 times daily) plus the luteinizing hormone-releasing hormone analogue goserelin acetate (Zoladex) (3.6 mg. subcutaneous depot injection every 28 days) with goserelin acetate alone in advanced prostatic carcinoma. A total of 571 eligible patients, of whom 57% had distant metastases, showed no difference in subjective or objective response rates, interval to progression, treatment failure or survival after a median followup of 2 years. In the combination group more patients had an early decrease in elevated levels of tumor markers and the small number of patients with an increase in signs and symptoms within the first 4 weeks showed a significant decrease. However, increased gastrointestinal and hepatic toxicity in the combination group resulted in 44 patients being withdrawn from the trial. These results indicate that the combination of goserelin acetate with flutamide provides no long-term clinical benefit in patients with advanced prostatic carcinoma compared to goserelin acetate alone.

Phase I study of cyclohexylamine and lysine salt of mafosfamide.

Mafosfamide is a new oxazaphosphorine that breaks down spontaneously into 4-hydroxy-cyclophosphamide. A phase I trial with cyclohexylamine and lysine salts of mafosfamide was carried out in 16 patients, using weekly IV perfusion. Dose-limiting toxicities were not hematological, but consisted in the development of severe pain along the vein during administration. A particular mucosal syndrome with sneezing and conjunctivitis was seen only after administration of the lysine salt. The dose of 700 mg/m2 per week represents the maximum tolerated dose with this weekly schedule.

Damaging effect of therapeutic radiation on programmable pacemakers.

Two series of present-day pacemakers were tested in vitro with pulsed x-ray radiation. The first series of 12 pacemakers consisted of 10 different types and models of demand pacemakers (VVI). The second series of 13 pacemakers had 9 different types and models of programmable pacemakers. Unlike the first series which showed only mild changes in frequency and pulse width, all but four of the programmable pacemakers presented sudden complete failure after different radiation doses. We conclude that direct pulse radiation at therapeutic levels of programmable pacemakers should be avoided.

Changes in lymph node size following systemic irradiation for malignant lymphoma.

Changes in surface area of lymph nodes visualised on abdominal radiographs following lymphography were measured in 18 patients treated by systemic irradiation for non-Hodgkin's lymphoma. Eleven radiologically normal nodes in testicular tumour patients receiving higher doses of external irradiation were measured for comparison. Following lymphography spontaneous shrinkage by up to 20% of the surface area of the node was observed. Since spontaneous and continual regression of abdominal nodes can occur exceptionally in nodular lymphoma, treatment was deferred until there was evidence of an increase in the size of nodes judged as being involved by lymphoma. Two forms of systemic therapeutic irradiation were employed, total body (TBI) and hemi-body (HBI). The rate of nodal regression with both was comparable but the amount of regression, time to nadir of node size and subsequent growth delay, was greater for HBI than TBI.