[Change of body composition in an 81 year old runner in a 100 km run]

An 81-year-old runner completed successfully a 100-km-run within 19 h 45 min one year after coronary artery bypass surgery in recently diagnosed atherosclerotic coronary heart disease. Prior and shortly after the run, percent body fat, lean body mass, skeletal muscle mass and percent body water were determined non invasively both by the bioelectrical impedance analysis (BIA) and the traditional anthropometrical method. In addition, blood and urine samples were collected in order to evaluate fluid homeostasis. Proton nuclear magnetic resonance ((1)H-NMR) spectroscopy of the urine was performed in order to detect changes in metabolites of carbohydrate, fat and protein metabolism. Body mass increased by 1.9 kg, calculated skeletal muscle mass increased by 0.1 kg, calculated fat mass from anthropometric method decreased by 0.2 kg and from BIA by 3.1 kg. Calculated body water from BIA increased by 1.2 l and plasma volume decreased by 19%. Haematocrit, nitrogen urea, urinary specific gravity decreased whilst sodium increased. (1)H-NMR spectroscopy revealed an increase of ketone bodies after the run. To demonstrate a decrease of skeletal muscle mass after a 100-km-run, we should wait with the measurements of body masses until body water has reached pre race value. The increase of body water is unclear. In future studies, additional methods should be performed to provide information whether skeletal muscle mass decreased after endurance performance and whether metabolites of skeletal muscle mass degradation may impair renal function.

[12 hours running results in a decrease of the subcutaneous adipose tissue]

A runner has completed 80 km in a 12-hour run. Prior and shortly after the run, fat and skeletal muscle mass were determined non invasively both by the bioelectrical impedance analysis and the classic skin fold method. In addition, blood and urine samples were taken in order to assess fluid balance. By applying the bioelectrical impedance analysis, the runner has increased body mass by 1.5 kg, fat-free body mass by 4.2 kg and muscle mass by 1.0 kg, whereas fat mass decreased by 4.4 kg. Since body water increased by 4.9 l, the determination of haematocrit, haemoglobin and sodium showed a haemodilution and the specific gravity of urine indicated no dehydration, we assume a substantial decrease of subcutaneous adipose tissue for energy production and intracellular oedemas. The difference between determining fat mass with the skin fold method or with the bioelectrical impedance analysis is discussed.

Breast radiation dose estimates compared to measured doses from involved field radiotherapy (IFRT) or mantle fields for early stage Hodgkin lymphoma (ESHL)

18503

Background Breast cancer risk after mantle irradiation has prompted concern regarding the use of IFRT for ESHL. As breast cancer risk is radiation dose related, reliable estimates of breast radiation dose from IFRT might aid individual patient risk assessment. However, estimates of breast dose from radiation scatter/leakage beyond the involved field, using standard computer algorithms, are of uncertain accuracy. The aims of this study were to compare computer estimates with measured breast dose, and to compare breast dose from mantle and neck IFRT. Methods A phantom with breast tissue equivalent was used to determine breast dose using computerized treatment planning (CMS XiO), and to perform measurements within the phantom breast tissue using thermoluminescent dosimetry (TLD). These measurements were made for mantle fields and (neck) IFRT. Results Computer estimates and TLD measurements of breast dose in centigray (cGY) are shown for IFRT and mantle treatment, for a prescribed dose of 3000cGy, using 6MV X-rays from a Varian 21eX linear accelerator. Conclusions Breast dose from neck IFRT was lower than from mantle treatment by an order of magnitude, but being well outside the treatment field, was not accurately estimated by our computer algorithm. Work in progress will examine breast dose from mediastinal IFRT and involved node irradiation. Modifications to the planning algorithm may improve accuracy of dose estimates at a distance from the primary field, allowing routine breast dose estimates for patients. Ultimately, utilisation of dose-risk data may allow risk modelling and risk-benefit analysis of IFRT for ESHL in individual patients.

[Table: see text]

No significant financial relationships to disclose.

Radiotherapy for low-grade gastric marginal zone lymphoma: a retrospective study

BACKGROUND

We evaluated the efficacy and toxicity of radiotherapy (RT) in patients with low-grade gastric marginal zone lymphoma.

METHODS

A retrospective review of consecutive cases of gastric marginal zone lymphoma treated by radical RT at the Peter MacCallum Cancer Centre and Radiation Oncology Victoria between January 1980 and September 2003 was carried out.

RESULTS

Eighteen patients (11 men and 7 women) were identified. The median age at commencement of RT was 65 years (range 42-84 years). Prior treatment included Helicobacter pylori eradication in 12 patients, chemotherapy in 7 and surgery in 2, whereas 2 patients had no prior therapy. The median time to progression after commencement of last treatment before RT was 4.8 months (range 0-129.4 months). The radiation fields included the stomach plus perigastric and coeliac nodes in 15 patients (83%), stomach plus spleen in 2 patients (11%) and stomach plus para-aortic nodes in 1 patient (6%). The median RT dose was 30 Gy (range 30-36 Gy) in a median 20 fractions (range 17-24 fractions). One patient required treatment interruption for acute toxicity. A complete response on post-RT biopsies was achieved in 17 of 18 patients (94%). With a median follow up of 4.5 years after RT, 3 of these 17 patients (18%) have had a recurrence. At the last follow up, 11 patients were alive in continuous complete histological remission. No late renal toxicity was identified.

CONCLUSION

Radiotherapy is an effective, well-tolerated treatment for patients with low-grade gastric marginal zone lymphoma, including those who have had prior therapy.

Positron emission tomography of stage IV mucosa-associated lymphoid tissue lymphoma confined to the four major salivary glands

In a patient with stage IVA marginal zone lymphoma, (18)F-fluorodeoxyglucose-positron emission tomography indicated that the disease was confined to the four major salivary glands. The positron emission tomography findings encouraged the use of radiotherapy with curative intent in this case. After 30 Gy of external beam radiotherapy to the parotid and submandibular glands, the patient entered a complete remission and remains free from progression more than 4 years later.

[Metabolic syndrome and erectile dysfunction. Epidemiologic associations and pathogenetic links]

There is abundant evidence for the association between erectile dysfunction (ED) and the traditional atherosclerotic risk factors, such as dyslipidemia, hypertension, glucose intolerance, and obesity, that make up the metabolic syndrome. Recent findings have demonstrated a linear relationship between the number of these risk factors and the prevalence of ED. There is also growing evidence that endothelial dysfunction characterized by decreased bioavailability of nitrogen monoxide (NO) and a proinflammatory, prothrombotic, and proliferative phenotype is the common pathogenetic pathway linking ED to peripheral vascular diseases. Since ED often occurs several years before any clinical manifestation of systemic cardiovascular disease, ED should be seen as a warning of early atherosclerotic disease and an opportunity for doctor and patient to initiate preventive measures.

Reduced left ventricular mass after treatment of obese patients with sibutramine: An echocardiographic multicentre study

AIM

In obesity, left ventricular hypertrophy is frequently observed, especially in the presence of hypertension. Following body weight reduction, the left ventricular mass (LVM) is reduced. It is not known to which extent this occurs after treatment with sibutramine.

METHODS

In this multicentre trial, 195 male and female patients (18-65 years of age, body mass index 30-40 kg/m2) were treated for 12 weeks with either 15 mg/day sibutramine or placebo. They were advised to follow mildly hypocaloric reducing diets. Exclusion criteria were blood pressure values >180/110 mmHg and tachycardia (heart rate > or =100 beats/min). Echocardiography in M-mode was performed to determine LVM as well as systolic function.

RESULTS

Body weight was reduced by 6.9 +/- 0.3 kg under sibutramine and by 2.1 +/- 0.6 kg under placebo; body fat was reduced by 5.2 +/- 0.4 kg and 1.6 +/- 0.7 kg respectively. In the sibutramine group, LVM was reduced by 10.9 +/- 24.2 g; LVM indexed for body surface area was reduced by 2.3 +/- 11.8 g/m2 and LVM indexed for body height was reduced by 2.5 +/- 6.0 g/m(2.7). In the placebo group, LVM and LVM indices were not significantly changed. Changes in LVM correlated with reductions in body weight and initial LVM but not with changes in blood pressure or heart rate.

CONCLUSIONS

After 3 months of treatment with sibutramine, obese patients lost about three times as much of body weight and LVM than patients treated with placebo. Therefore, sibutramine may be recommended not only to reduce body weight but also to obtain a regression of the LVM in obese patients with and without hypertension.

Value of low-dose 2 x 2 Gy palliative radiotherapy in advanced low-grade non-Hodgkin's lymphoma

Low-dose radiotherapy over the last decade has been reported to provide effective palliation for patients with low-grade non-Hodgkin's lymphoma. In this retrospective case series of 10 patients, we report our early experience using low-dose radiotherapy (usually 2 x 2 Gy) for patients with advanced-stage follicular, mucosal associated lymphoid tissue, mantle cell and small lymphocytic lymphomas. Median follow up was 27 weeks. Response rates were high (complete response, 70%; partial response, 20%), the response durable and the toxicity was minimal (no toxicity greater than grade 1). Low-dose irradiation is an effective treatment option for patients with low-grade lymphomas with local symptoms.

A Pilot Randomised Comparison of Dexamethasone 96mg vs 16mg per day for Malignant Spinal-cord Compression Treated by Radiotherapy: TROG 01.05 Superdex Study

AIM

To test the viability of a full-scale randomised comparison of two steroid doses given with radiotherapy for malignant spinal-cord compression (MSCC), to test Internet randomisation and to compare different functional outcome measures.

MATERIALS AND METHODS

A log of screened patients at eight recruiting centres was maintained. Patients were randomised via the Superdex website to either 96 mg or 16 mg daily of dexamethasone. Radiotherapy treatment was 30 Gy in 10 fractions. Outcomes assessed used ambulation, Barthel Index ambulation, Functional Independence Measure (FIM) ambulation and Functional Improvement Score (FIS) at 1 month.

RESULTS

One hundred and thirty-one patients were screened. Ninety-three (71%) were ineligible, 65% of these were because duration of prior steroid use was greater than 12 h, failure to meet strict definition of magnetic resonance imaging, defined MSCC, multi-level disease or previous spinal-cord compression treatment. Twenty of the 38 eligible patients were randomised, including seven outside standard office hours. There was a high rate of serious adverse events (n = 9), but only one was considered likely to be related to study medication. At baseline, 75% were ambulant, 70% had FIM ambulation scores greater than 5 and 50% had Barthel Index ambulation scores greater than 2. At day 28, including all randomised patients (by scoring four dead patients as non-ambulant), ambulation scores by the various definitions were 60%, 45% and 40%, respectively. For the 16 patients evaluable at day 28, the mean FIS was -1.4. Median survival was 69 days and 1-year survival 13%.

CONCLUSION

Web randomisation was successful; however, the high ineligibility rate precludes a full-scale dexamethasone dose trial in Australia. Choice of measure of ambulation has potentially significant effects on outcomes and implications for the design of any future MSCC trials. Referral delays are of concern.

A phase I trial of high-dose palliative radiotherapy plus concurrent weekly Vinorelbine and Cisplatin in patients with locally advanced and metastatic NSCLC

The role of concurrent chemoradiotherapy (CRT) in patients with non-small-cell lung cancer (NSCLC) unsuitable for radical therapy but who require locoregional treatment has not been defined. The aims of this phase I trial were thus to develop a novel regimen of weekly chemotherapy concurrent with high-dose palliative RT (40 Gy/20 fractions) and assess its tolerability, objective and symptomatic response rates. Eligible patients had stage I–IIIB NSCLC unsuitable for radical RT or limited stage IV disease, ECOG PS⩽1 and required locoregional therapy. Treatment was RT (40 Gy/20 fractions/5 per week) and weekly Vinorelbine plus Cisplatin escalated in six planned dose levels (DLs). At 4 weeks post-RT, patients received two cycles of Cisplatin 80 mg m⁻² day 1+Vinorelbine 25 mg m⁻² days 1, 8, 15. Dose-limiting toxicities (DLTs) were defined in the CRT phase. Disease-related symptoms were assessed by the Lung Cancer Symptom Scale. In all, 24 patients accrued, stage IIIB (n=12) and IV disease (n=10). The highest administered dose was at DL 4, Vinorelbine 30 mg m⁻²+Cisplatin 20 mg m⁻² with DLTs of grade 4 neutropenia in two of three patients. No grade 3 or 4 nonhaematological toxicities were observed. The overall radiological response rate was 65% (n=23: complete response 4% and partial response 61%) and infield FDG-PET responses were seen in 89% (n=18). There was an improvement or stabilisation of symptoms and quality of life. Dose level 3, Vinorelbine 25 mg m⁻²+Cisplatin 20 mg m⁻², is recommended for further assessment. This regimen was tolerable and produced meaningful responses for patients for whom locoregional control is required, but who are unsuitable for radical CRT.

Rolle des Körpergewichts für die Prävention der koronaren Herzkrankheit

The prevalence of obesity has increased considerably in recent years; only one third of our population displays a desirable, healthy weight. Persons with increased body fat mass are in a constant pro-inflammatory and pro-thrombotic condition; in addition they are often insulin-resistant und show cardiovascular risk factors. Therefore, obesity induces the development of atherosclerosis as an independent risk factor as well as a promoter for other risk factors. In addition, congestive heart failure is more frequent in obese subjects. By reducing body weight with a decrease of predominantly visceral fat all risk factors are improved as well as endothelial function. Effects on coronary atherosclerosis and congestive heart disease are until now insufficiently investigated.

Radiotherapy in the management of solitary extramedullary plasmacytoma

BACKGROUND

Solitary extramedullary plasmacytoma (SEP) is a rare tumour for which the standard treatment remains local radiotherapy (RT). We present a study of a multi-institutional experience, between 1980 and 1999, in an attempt to better understand the natural history of SEP and to identify possible prognostic factors.

METHODS

The records at Radiation Oncology Victoria and Peter MacCallum Cancer Centre, Melbourne, were used for the identification of patients. The inclusion criteria were as follows: (i) histological confirmation of clonal plasma cells involving a single extramedullary site with or without lymph node involvement; (ii) no histological evidence of bone marrow involvement; (iii) no evidence of distant bone lesion on radiographic skeletal survey (bone erosions adjacent to the primary thought to be due to contiguous involvement were permitted) and (iv) no anaemia, hypercalcaemia or renal impairment due to plasma cell dyscrasia.

RESULTS

A total of 16 patients was identified, with a median follow up of 66 months (range 12-211 months). The head and neck region accounted for the majority of presentations (88%). Among all patients, a serum mono-clonal paraprotein was found in three patients and bone erosion was identified in seven patients. All patients received local RT, although two patients also received elective nodal irradiation (ENI). The median RT dose was 45 Gy (range 40-50.4 Gy). Local control was achieved in all patients (100%), however, regional recurrence outside the RT fields occurred in 2/16. Multiple myeloma (MM) developed in five patients, all within 5 years. The predicted 10-year myeloma free survival is 75% and 10-year overall survival is 54%.

CONCLUSION

RT can achieve excellent local control of SEP. The rate of conversion to MM is 31%. Moderate dose RT of at least 40 Gy using limited radiation fields is recommended, although ENI should be considered if toxicity is not increased.