Long-term outcomes of patients with localized rectal cancer treated with chemoradiation or radiotherapy alone because of medical inoperability or patient refusal.

PURPOSE: The standard management of rectal cancer continues to be defined by the results of randomized, clinical trials exploring the optimal timing and use of adjuvant chemotherapy and radiation therapy in relation to surgery. The patient with rectal cancer who is elderly and/or has significant comorbidities and the patient who refuses surgery are clinical contexts for which there is limited current data to guide decision making. METHODS: A retrospective analysis was performed at six Australian centers of patients with rectal cancer treated with radiation therapy or chemoradiation alone because of excessive operative risk or patient refusal of surgery. RESULTS: We identified 48 patients treated between August 1998 and June 2005 with a median age of 76 (range, 49-94) years. Twenty-four patients (50 percent) were considered medically inoperable and 24 patients refused surgery. Treatment was with chemoradiation (with 5-fluorouracil) in 36 patients and radiotherapy alone in 12 patients; 93 percent completed the planned therapy. A clinical complete response was seen in 56 percent and a partial response in 30 percent of patients. At a median follow-up of 49 months, 18 patients have disease progression, including 10 of 24 in the medically inoperable group and 8 of 24 in the refused surgery group. Of the 25 deceased patients, 16 died from progressive disease and 9 from noncancer causes. CONCLUSIONS: Chemoradiation or radiotherapy alone is a safe alternative that results in significant progression-free and overall survival times in patients who are considered medically inoperable or refuse to undergo surgery. Ultimately, however, many patients will progress.

Cognitive function, iron status, and hemoglobin concentration in obese dieting women.

OBJECTIVE: To determine the relationships between cognitive function and iron status in dieting obese women. DESIGN: Longitudinal weight loss study (repeated measures within-subject design) with 3 weeks of baseline, 15 weeks of 50% caloric restriction, and 3 weeks of weight stabilization. Dietary iron was fed at twice the US Recommended Dietary Allowance with half of the iron from food sources and half from an oral supplement. SETTING: This was a free-living study with the exception that subjects came to the research center for one meal per day and were provided all other meals and snacks to take home. SUBJECTS: Healthy, premenopausal, obese women (mean BMI=31.5) were recruited through local newspaper, poster and radio advertising. Twenty-four women volunteers were recruited and 14 completed the study. MEASUREMENTS: Cognitive function, iron and hematological status, height, body weights and body composition were measured at baseline; at weeks 5, 10, and 15 of the energy restriction period; and at the end of weight stabilization. Computerized cognitive tests included: Bakan vigilance task, two finger tapping, simple reaction time, immediate word recall, and a focused attention task. Iron status and hematological measures included: serum iron, total iron binding capacity (TIBC), transferrin saturation, serum ferritin, hemoglobin (Hb), hematocrit, red cell count, MCV, MCH, MCHC, and RDW. RESULTS: A significant reduction in Hb, hematocrit, and red blood cell count occurred across the study. Hb at the end of the study was positively correlated (r=0.72, P < 0.01) with mean performance on a measure of sustained attention. Transferrin saturation also correlated positively to sustained attention task performance for those subjects whose Hb declined across the study (r=0.86, P < 0.01). CONCLUSIONS: These findings suggest that dieting diminishes iron status in obese women, even when sufficient dietary iron is available, and that the inability to sustain attention may be an early sign of developing iron deficiency in dieting women.

Effects of a carotene-deficient diet on measures of oxidative susceptibility and superoxide dismutase activity in adult women.

The effect of consuming a low carotene diet (approximately 60 micrograms carotene/day) on oxidative susceptibility and superoxide dismutase (SOD) activity in women living in a metabolic research unit was evaluated. The diet had sufficient vitamins A, E, and C. The women ate the diet supplemented with 1500 micrograms/day beta-carotene for 4 days (baseline), then the unsupplemented diet for 68 days (depletion), followed by the diet supplemented with > 15,000 micrograms/day carotene for 28 days (repletion). Production of hexanal, pentanal, and pentane by copper-oxidized plasma low density lipoproteins from carotene-depleted women was greater than their production of these compounds when repleted with carotene. Erythrocyte SOD activity was depressed in carotene-depleted women; it recovered with repletion. Thiobarbituric acid reactive substances in plasma of carotene-depleted women were elevated and diminished with repletion. Dietary carotene seems to be needed, not only as a precursor of vitamin A, but also to inhibit oxidative damage and decrease oxidation susceptibility.

Nutrient content of the diet when the fat is reduced.

When the fat content of the typical US diet was reduced from 40 to 44% of total energy (en %) to approximately 25 en % there was a marked improvement in the overall nutrient content of the diet. Cholesterol, saturated fatty acid, and monounsaturated fatty acid intake were decreased and the polyunsaturated fatty acid content was moderately increased. This kind of dietary change was achieved without changing the usual intake of meats, dairy products, fish, and eggs. As the amount of fat was decreased, carbohydrates in the form of grains, fruits, and vegetables were increased, providing an improvement in the vitamin and mineral content of the diet. Vitamin C, thiamin, riboflavin, niacin, B-6, B-12, and folates increased in the 25 en % diet. Potassium, calcium, magnesium, phosphorus, iron, zinc, and copper intake also increased when the dietary fat decreased.