Rectal planning risk volume correlation with acute and late toxicity in 3-dimensional conformal radiation therapy for prostate cancer.

The purpose of this study was to evaluate rectum motion during 3-Dimensional conformal radiation therapy (3D-CRT) in prostate cancer patients, to derive a planning volume at risk (PRV) and to correlate the PRV dose-volume histograms (DVH) with treatment complications.This study was conducted in two phases. Initially, the PRV was defined prospectively in 50 consecutive prostate cancer patients (Group 1) who received a radical course of 3-D CRT. Then, the obtained PRV was used in the radiotherapy planning of these same 50 patients plus another 59 prostate cancer patients (Group 2) previously treated between 2004 and 2008. All these patients' data, including the rectum and PRV DVHs, were correlated to acute and late complications, according to the Common Toxicity Criteria (CTC) v4.0.The largest displacement occurred in the anterior axis. Long-term gastrointestinal (GI) complications grade ≥ 2 were seen in 9.2% of the cases. Factors that influenced acute GI reactions were: doses at 25% (p 5 0.011) and 40% (p 5 0.005) of the rectum volume and at 40% of the PRV (p 5 0.012). The dose at 25% of the rectum volume (p 5 0.033) and acute complications ≥ grade 2 (p 5 0.018) were prognostic factors for long-term complications. The PRV DVH did not correlate with late toxicity. The rectum showed a significant inter-fraction motion during 3D-CRT for prostate cancer. PRV dose correlated with acute gastrointestinal complications and may be a useful tool to predict and reduce their occurrence.

Early nuclear alterations and immunohistochemical expression of Ki-67, Erb-B2, vascular endothelial growth factor (VEGF), transforming growth factor (TGF-beta1) and integrine-linked kinase (ILK) two days after tamoxifen in breast carcinoma.

The purpose of the present study was to evaluate breast carcinoma samples before and two days after treatment with tamoxifen in order to analyse early histopathological alterations--particularlynuclear alterations-- as well as immunohistochemical expression of Ki-67, Erb-B2, VEGF, TGF-beta1 and ILK proteins. Twenty one cases of invasive ductal and lobular breast carcinoma were studied. Patients were submitted to biopsy of the lesion and, after confirmation of the diagnosis, they received 20 mg of tamoxifen a day, beginning two days before surgery. The samples obtained during biopsy and after surgery were stained with HE for histopathological diagnosis. Estrogen receptor was positive in 18 cases and negative in 3. The immunohistochemical method was applied for the detection of Ki-67, Erb-B2, protein, vascular endothelial growth factor (VEGF), transforming growth factor beta (TGF-beta1) and integrin linked kinase (ILK). Two days after tamoxifen treatment, the following results were observed: 1) decrease in the cell volume, chomatine condensation, nucleoli less evident and clearly defined nuclear limits; 2) significant reduction in the expression of Erb-B2 protein and significant increase in the expression of TGF-beta1 protein; 3) expression of others proteins (Ki-67, VEGF and ILK) was not altered during the indicated time frame. Our results suggest that analyzing nuclear alterations and expression of Erb-B2 and TGF-beta1 proteins would be useful to assess the initial response to tamoxifen.

[Squamous cell carcinoma of the canal anal]. / Carcinoma espinocelular de canal anal: análise de 11 casos.

BACKGROUND: Anal cancer is an uncommon malignancy accounting for only a small (4%) percentage of intestinal cancer. The authors described the clinical aspects and the treatment of the patients with squamous cell carcinoma of the canal anal. PATIENTS: Eleven patients with squamous cell carcinoma treated among 1995 and 1999, were analyzed retrospectively. Nine were women and two were men. The mean age was 57.6 years old (range 35-82 years old). RESULTS: The most common symptoms were rectal bleeding, local tumor and pain. Six of them had previous anal benign disease and two had metastases at the diagnosis. All were submitted to systemic chemotherapy with 5-fluorouracil and mitomycin and radiotherapy with 4500 cGy. Four patients had residual disease after chemo radiation and salvage surgery with abdominoperineal resection was done. Three patients had recurrence and four died from the disease. CONCLUSION: Most of our patients were women. The chemo radiation can be a curable treatment in patients with local disease; conversely in patients with residual disease, abdominoperineal resection must be done. Although anal cancer is an often curable disease, four patients died because the diagnosis was done in advanced stage.

Clinical management of six cases of low-risk primary tonsillar non-Hodgkin's lymphoma.

CONTEXT: There have been many reports that favor aggressive systemic treatment with chemotherapy and radiotherapy, even for well-localized lymphomas, avoiding the need for tonsillectomy of the normal tonsil. CASE REPORT: We report six cases of primary tonsillar lymphoma with a median patient age of 42 years. There were two lymphoma cases with diffuse large cells, two cases with mixed small and large cells, one with small cells and one indeterminate. They were treated with six cycles of chemotherapy and cervical radiotherapy. All patients achieved durable complete remission. Our data agree with previous reports that suggested that primary tonsillar high-grade B-cell NHL has a good prognosis if aggressively treated.

Granuloma letal da linha média: abordagem clínica e terapêutica de três casos / Lethal midline granuloma: clinical management of three cases

Objetivo. Relato de três casos do GLLM acompanhados pela Disciplina de Hematologia e Hemoterapia da Unifesp-EPM que tiveram boa resposta à terapêutica e evoluçao favorável. Métodos. Após confirmaçao histológica e histoquímica, os pacientes foram submetidos à tratamento quimio e radioterápico com boa resposta terapêutica. Resultados. Atualmente estes pacientes encontram-se em remissao total da doença, com sobrevida média de 45 meses. Conclusao. Levando-se em consideraçao nossa pequena experiência, acreditamos que o tratamento radioterápico e a abordagem quimioterápica inicial agressiva sao fundamentais para uma boa evoluçao deste tipo de linfoma.

Spinal cord compression in beta-thalassemia: follow-up after radiotherapy.

CONTEXT: Spinal cord compression due to extramedullary hematopoiesis is a well-described but rare syndrome encountered in several clinical hematologic disorders, including beta-thalassemia. CASE REPORT: We report the case of a patient with intermediate beta-thalassemia and crural paraparesis due to spinal cord compression by a paravertebral extramedullary mass. She was successfully treated with low-dose radiotherapy and transfusions. After splenectomy, she was regularly followed up for over four years without transfusion or recurrence of spinal cord compression. DISCUSSION: Extramedullary hematopoiesis should be investigated in patients with hematologic disorders and spinal cord symptoms. The rapid recognition and treatment with radiotherapy can dramatically alleviate symptoms.

Acute effects on bone marrow after association between Radiosensitizer and X rays-NN/N method

A histopathological and morphometric study was performed in the bone marrow of mice after association of cisdiamminedi-choroplatinum II (3.0 mg/kg) plus X-rays (103.20 mC/Kg 400R). Rstimation of bone marrow effects was assessed by counting the number of non nucleated-erythrocytes (NN) and nucleated (N) cells, and establishing (NN/N) ratio. The morphomeric method used correlates and makes possible quantification of histopathologic changes of bone marrow through relation of vascular stroma and cellular parenchyma. It can be used as a biological dosimetry parameter and to estimate injury and recovery of hematologic evolution of different myelotoxic agents

Evaluation of the effect of ionizing radiation of mouse hemocytopoietic tissue by reticulocyte count

The effects of exposure to a single, whole body X-ray dose of 154.8 mC/Kg (600 R) on mouse (Mus musculus) hemocytopoietic tissue were analyzed by means of reticulocyte counts in peripheral blood, evaluating indirectly variations of the erythrocyte sector of bone marrow. The efficiency of the method for the evaluation of this tissue was demonstrated, constituting one more radiobiologic parameter to corroborate those existing already

[Ultrastructural and morphometric study of the myeloid parenchyma cells of mice prior and after X-ray exposure]. / Estudo ultra-estrutural e morfométrico de células do parênquima mielóide de camundongos antes e depois da exposição aos raios X.

An electron microscopic study of initial X-ray changes in ultrastructures of bone marrow cells was performed. Such changes reached nucleous and cytoplasm organellas early (1 hour) after radiation, but were more proeminent later on. Subsequent readings (2, 6 hours) showed them more proeminent in cytoplasm structures, and the morphologic appearance was close to normal within 12, 14 days. Quantitative analyses were performed using the marrow recovery coefficient (MRC).

[Evaluation of the effects of ionizing radiation and cyclophosphamide on the bone marrow of mice, by counting non-nucleated and nucleated cells]. / Avaliação dos efeitos da radiação ionizante e da ciclofosfamida na medula óssea de camundongos, pela contagem das células não nucleadas e nucleadas.

Bone marrow injury after exposure to ionizing radiation and cyclophosphamide was evaluated by morphologic analysis and by the ratio erythrocytes/nucleated cells (NN/N). The authors show the efficiency of the method proposed, which can be determined in bone marrow samples of variable and unpredictable size.