Safety and efficacy of radiotherapy treatment in elderly patients with localized prostate cancer: a retrospective analysis.

The purpose of this study was to evaluate the feasibility and the activity of radiotherapy treatment in patients aged ≥75 with prostate cancer (PC). From January 2000 to December 2007, 107 consecutive patients aged ≥75 years received radiotherapy with radical intent for PC. Eighty-one patients received radiotherapy in combination with a 6 months androgen suppression therapy. Variables considered were age, stage, co-morbidities according to the adult co-morbidity evaluation index (ACE-27) and performance status (PS). The median age was 79.1 years (range 76-87). The 23.4% of patients showed no co-morbidities, while the 46.7% had mild, 23.4% moderate, and 6.5% severe co-morbidities, respectively. All patients completed the planned radiation treatment. At a median follow-up of 37.8 months, the 5-year overall survival rate was 78%. There was a better survival for patients with no or mild co-morbidities (p<0.0001) and a good PS (p=0.009). The actuarial disease-free survival at 60 months was 75.8%. Difference in acute and late toxicity rate was detected between ACE-27 classes for diarrhea and marginally for urinary toxicity, but no difference was detected for different age. We conclude that compliance with radiotherapy is good and rate of toxicity is acceptable in elderly patients. Increasing severity of co-morbidity may sufficiently shorten remaining life expectancy to cancel gains with radical radiotherapy. Further prospective trials are needed to confirm these results.

Glioblastoma in elderly patients: safety and efficacy of adjuvant radiotherapy with concomitant temozolomide.

The aim of this study was to evaluate the impact of radiotherapy plus concomitant and adjuvant temozolomide (TMZ), in terms of feasibility and activity, in elderly patients with glioblastoma. From January 2002 to December 2007, 42 consecutive patients with glioblastoma (27 men and 15 women) aged 65 years or more (median age 71.3 years), received radiotherapy plus concomitant and adjuvant TMZ. Nineteen patients (45.2%) had a Karnofsky index >or=80. Thirty-six patients (85.8%) underwent complete or subtotal resection, while 6 patients (14.2%) were only biopsied. All patients received adjuvant radiotherapy within 4 weeks from surgery. Twenty-two patients (54.8%) underwent adjuvant TMZ. Early discontinuation of concomitant TMZ program due to toxicity was observed in 8 patients. Considered variables were: age, Karnofsky index, surgery versus no surgery, radiation dose, and chemotherapy. At a median follow-up of 10.2 months, the 6- and 12-month overall survival rates were 81.9% and 27.8%, respectively. There was a significantly better survival for patients with a performance status according to Karnofsky >80 (p<0.0001). Actuarial progression-free survival at 6- and 12-month was 46.4% and 9.8%, respectively. Globally, the treatment was well tolerated with no treatment-related toxicity in 69% of patients. In conclusion, in elderly patients, the adjuvant chemo-radiotherapy was well tolerated with an acceptable rate of toxicity, and patients with a good performance status had a significantly better survival. However, further prospective trials are needed to confirm these results.

Responsiveness of irradiated rat anterior pituitary cells to hypothalamic releasing hormones is restored by treatment with growth hormone.

Hypopituitarism is a common sequela of irradiation in cancer patients. Here we report that recombinant human growth hormone (r-hGH) prevents cell death and restores secretory capacity of irradiated rat pituitary cells in vitro. Dispersed rat pituitary cells from male Sprague-Dawley rats, irradiated with a 9-Gy sublethal dose, were incubated with r-hGH before, after, or before and after irradiation. Treatment with GH resulted in increased cell survival, which reached its maximum at the concentration of 5 nM, with an EC(50) of 3.5 nM. Protective effects of GH on pituitary cells were more pronounced in cultures treated before and after irradiation. Similarly, beneficial effects of GH were observed on the secretory capacity of surviving cells. In fact, irradiated pituitary cells treated with GH secreted substantial amounts of GH, luteinizing hormone, follicle-stimulating hormone, prolactin, thyroid-stimulating hormone and adrenocorticotropic hormone in response to specific releasing hormones. Such effects of GH were prevented in the presence of the specific GH receptor antagonists B2036 and G120K. Our results show that r-hGH exerts a specific protective effect on irradiated rat pituitary cells and suggest possible use of GH as an adjuvant agent for prevention of postirradiation hypopituitarism.

Radioprotective effects of the association thymopentin-interleukin-1 alpha in the C57BL/6 mouse.

We investigated whether thymopentin, a synthetic pentapeptide derivative of thymopoietin, could enhance the protective effect of interleukin-1 alpha when both administered prior to sublethal irradiation in the C57BL/6 mouse. Thymopentin (10 mg/kg/day/7 days) was injected intraperitoneally in groups of C57BL/6 mice. Then, interleukin-1 alpha was administered on day 7. Twenty hr later, all groups were given whole body sublethal irradiation of 750 rad by 60Co elements. In some groups of mice, treatment with thymopentin was continued for 1 week after irradiation. Efficacy of the combination treatment was assessed by evaluation of mortality, as well as by histologic examination of the brain, testis, bone marrow, heart and spleen. The combination of relatively low doses of interleukin-1 alpha (700 U) with thymopentin yielded a survival which was nearly that observed with interleukin-1 alpha (1000 U) given alone (about 100%). The optimal effect was observed in animals treated for 15 days with thymopentin, either in combination or alone. In addition, incidence and severity of histological lesions were also lower in animals with the some treatment schedule. Our results suggest that the combined treatment thymopentin-interleukin-1 alpha prevents radiation damage in the mouse.

Phase II double-blind randomized study of lonidamine and radiotherapy in epidermoid carcinoma of the lung.

Patients with non metastatic squamous cell lung cancer were treated with radiotherapy (RT) plus lonidamine (LND) or placebo (PLAC), according to a randomized double-blind study design. Treatment with lonidamine 150 mg t.i.d. (27 patients) or placebo (23 patients) started 3 days before RT, lasted up to 7 months. Partial responses were observed in 14 and 6 patients respectively in the LND + RT and PLAC + RT groups. Statistical analysis of the survival curves showed no significant difference between the LND + RT (median 311 days) and PLAC + RT (median 193 days) groups. Stage III patients survived significantly longer (p less than 0.05) when treated with LND + RT (median 318 days) than with PLAC + RT (median 163 days). No synergistic toxic effects between radiation and LND were noted. To confirm these data a new and larger multicentric study is now in progress.

A radio-isotopic investigation of the morphological and functional changes in pathological conditions of the synovial membrane of the knee joint.

Patients with hydrarthrosis of the knee, whatever its origin, always exhibit a change in synovial permeability. This can be detected by scintigraphy (visualization of the site and extent of the hydrarthrosis) and scintimetric investigation. In the present study, patients with hydrarthrosis of the knee of a degenerative, inflammatory or traumatic origin, received an appropriate dose of 99mTc pertechnetate, and a gamma camera was used as the detector. At the same time a scintimetric study was carried out to provide a quantitative assessment of the rate of absorption of the radio-isotope. This indicates the functional state of the synovial membrane. The results of these investigations are of value both in diagnosis and in treatment.

Radioisotopic evaluation of the treatment of Sudek's syndrome with calcitonin.

The authors report their investigations in ten patients suffering from Sudek's syndrome of the foot, studied by the use of the radioosteotrope 99mTc-Pirophosphate. Through this radioindicator it has been possible to evaluate qualitatively (scintigraphy) as well as quantitatively (scintimetry) the modifications of the metabolism induced by the administration of calcitonin. The evaluation, whose radioisotopic method is described in detail, has been carried out at various intervals during treatment with calcitonin (from two to six months). The normalization of the readjustment of the bone generally corresponded with marked clinical recovery of the patient.