Acute toxicity of conventional radiation therapy for high-risk prostate cancer in EORTC trial 22863

OBJECTIVES

We analysed the acute toxicity observed in the European Organisation for Research and Treatment of Cancer (EORTC) randomised trial 22863 comparing conventional external irradiation with or without an agonist analogue of gonadotropin-releasing hormone in high-risk prostate cancer patients.

METHODS

Four hundred five patients that received a dose of at least 30 Gy were considered evaluable for acute toxicity assessment. Toxicity was grouped in a few categories: general, genito-urinary, and lower gastro-intestinal. Univariate and multivariate analyses were performed using the World Health Organisation (WHO) toxicity score and grouping together toxicity scores in different bimodal and trimodal groups.

RESULTS

Overall, our data show that age, previous surgery and irradiation dose are important predictive factors for acute toxicity, but not the use of combined hormone therapy. Fifteen percent of patients suffered of moderate to severe acute toxicity (WHO G3-G4). Life threatening toxicity was observed in six cases (1.5%).

CONCLUSIONS

The assessment of toxicity combining in different groups the original five scores scale produced conflicting results similar to those commonly reported in literature. Interpretation of the role of pre-treatment factors with uneven distribution in the study requires careful evaluation. These data obtained with conventional curative irradiation of high-risk prostate cancer patients are proposed for comparison with results achieved using modern state-of-the-art irradiation techniques.

Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial

BACKGROUND

We did a randomised phase III trial comparing external irradiation alone and external irradiation combined with an analogue of luteinising-hormone releasing hormone (LHRH) to investigate the added value of long-term androgen suppression in locally advanced prostate cancer.

METHODS

Between 1987 and 1995, 415 patients were randomly assigned radiotherapy alone or radiotherapy plus immediate androgen suppression. Eligible patients had T1-2 tumours of WHO grade 3 or T3-4 N0-1 M0 tumours; the median age of participants was 71 years (range 51-80). In both treatment groups, 50 Gy radiation was delivered to the pelvis over 5 weeks, and 20 Gy over 2 weeks as a prostatic boost. Goserelin (3.6 mg subcutaneously every 4 weeks) was started on the first day of irradiation and continued for 3 years; cyproterone acetate (150 mg orally) was given for 1 month starting 1 week before the first goserelin injection. The primary endpoint was clinical disease-free survival. Analyses were by intention to treat.

FINDINGS

412 patients had evaluable data, with median follow-up of 66 months (range 1-126). 5-year clinical disease-free survival was 40% (95% CI 32-48) in the radiotherapy-alone group and 74% (67-81) in the combined-treatment group (p=0.0001). 5-year overall survival was 62% (52-72) and 78% (72-84), respectively (p=0.0002) and 5-year specific survival 79% (72-86) and 94% (90-98).

INTERPRETATION

Immediate androgen suppression with an LHRH analogue given during and for 3 years after external irradiation improves disease-free and overall survival of patients with locally advanced prostate cancer.

Quality assurance of the EORTC trial 22911. A phase III study of post-operative external radiotherapy in pathological stage T3N0 prostatic carcinoma: the dummy run

INTRODUCTION

A dry run of a clinical trial (EORTC 22911) is presented in which 12 centres have participated. These are the centres which have contributed the largest number of patients to the trial.

MATERIAL AND METHODS

Each participating centre received data from a suitable patient. Investigators were asked to plan and 'treat' the patient according to the protocol guidelines and return the data for evaluation of compliance.

RESULTS

The results show that compliance to the protocol guidelines was generally good. There were a few minor deviations in the dose and fractionation schedule, in the volume reduction for the booster dose and in the dose prescription point. None of these deviations will affect the outcome of the study. The most important observation is the large inter-centre variation in target volumes.

CONCLUSIONS

The results of this study underlines the need for a strict definition of the target volume and the adoption of the ICRU 50 recommendations in future protocols.

Prognostic assessment of PTK activity in T1-T2, N0-N1, M0 breast cancer: a multicentric retrospective study

Protein tyrosine kinases (PTKs) play a major role in the transduction of intracellular mitogenic signal. PTKs are also involved in the process of cellular transformation. A number of studies have reported increased PTK activities in cytosolic fractions from human breast carcinoma. However, the possible pronostic value of these activities is difficult to establish from these studies, mostly conducted on limited numbers of patients. In order to clear up the issue, we have investigated a large series of patients with a long follow-up, using a retrospective multicentric study (894 breast cancers T1-T2, N0-N1, M0; median follow-up: 67 months). PTKs were measured using a radioenzymatic assay as described in our previously report. We confirmed the already observed correlation between PTK activities and Scarff-Bloom grading (p < 10(-5)), negative estrogen receptor (ER), and progesterone receptor (PR) status. By contrast, we found in this study a correlation between PTK values and clinical nodal status (p = 0.00027) not showed in our precedent analysis. In Cox multivariate analysis, PTK activity does not emerge as a significant pronostic parameter. On the other hand, tumor PTK activity assay may prove of great interest in clinical research using newly developed tyrosine kinase inhibitors in order to assess their biological impact and eventually to predict the responsiveness to these new therapeutic agents.

Prognostic factors for survival in adult patients with cerebral low-grade glioma

PURPOSE

To identify prognostic factors for survival in adult patients with cerebral low-grade glioma (LGG), to derive a prognostic scoring system, and to validate results using an independent data set.

PATIENTS AND METHODS

European Organization for Research and Treatment of Cancer (EORTC) trial 22844 and EORTC trial 22845 are the largest phase III trials ever carried out in adult patients with LGG. The trials were designed to investigate the dosage and timing of postoperative radiotherapy in LGG. Cox analysis was performed on 322 patients from EORTC trial 22844 (construction set), and the results were validated on 288 patients from trial 22845 (validation set). Patients with pilocytic astrocytomas were excluded from this prognostic factor analysis.

RESULTS

Multivariate analysis on the construction set showed that age > or = 40 years, astrocytoma histology subtype, largest diameter of the tumor > or = 6 cm, tumor crossing the midline, and presence of neurologic deficit before surgery were unfavorable prognostic factors for survival. The total number of unfavorable factors present can be used to determine the prognostic score. Presence of up to two of these factors identifies the low-risk group, whereas a higher score identifies high-risk patients. The validity of the multivariate model and of the scoring system was confirmed in the validation set.

CONCLUSION

In adult patients with LGG, older age, astrocytoma histology, presence of neurologic deficits before surgery, largest tumor diameter, and tumor crossing the midline were important prognostic factors for survival. These factors can be used to identify low-risk and high-risk patients.

Estimating survival gain for economic evaluations with survival time as principal endpoint: a cost-effectiveness analysis of adding early hormonal therapy to radiotherapy in patients with locally advanced prostate cancer

The problem of estimating expected outcomes for the economic evaluation of treatments for which the outcome of principal interest is (quality adjusted) survival time has so far not received sufficient attention in the literature. The best estimate of expected survival is mean survival time, but with censored survival data, the true survival time for all the subjects is not known, so the mean is not defined.A possible solution to this estimation problem is illustrated by a retrospective cost-effectiveness analysis of the addition of hormonal therapy to standard radiotherapy for patients with locally advanced prostate cancer. A recently proposed method is used to approach the problem caused by censored cost data, and the impact of uncertainty is assessed by bootstrap resampling techniques. Mean survival time is estimated by a restricted means analysis with the time point of restriction determined by statistical criteria. When average total costs and mean survival time is evaluated at this time point of restriction, the result is that the combined therapy (radiotherapy plus hormonal therapy) increases mean survival time by about 1 year, while reducing the costs per patient for the French health insurance system by 12 700 FF. The time point of restriction may also be determined by other criteria and mean survival time may be estimated by extrapolating the survival curves by means of various parametric survival distributions. We show that the exact results of the economic evaluation are decisively determined by the restriction time point chosen and the approach taken to estimate mean survival time.

[Yield of colonoscopy by indication and consequences for colorectal polyp and cancer screening: a prospective survey in Isère, France]

AIM

The aim of this study was to determine yields of colonoscopy by indication, especially after a positive Hemoccult test, in the Isère area in southeastern France where a mass screening campaign for colorectal cancer using the Hemoccult test was conducted in women aged 50 to 69 years.

METHOD

This prospective survey was conducted with the participation of all gastroenterologists in the Isère department. Information about indications of all colonoscopies performed and their results were collected.

RESULTS

The study involved 1,779 colonoscopies performed for: digestive symptoms (40%), surveillance of colon disease (22%), hematochezia (18%), a family history of colon cancer (10%), anemia, poor general condition or metastasis (4%), and a positive test for blood in the stool (3%). The presence of a pathological colonic condition was significantly related to age (11% of cancers or large polyps after 50 years compared to 3% before), sex (10% of the women with lesions and 15% of the men) and the reason for prescription: after the age 50 a cancer or a large polyp was found in 27% of the cases if the colonoscopy was performed for anemia, metastasis or poor general condition, 21% for hematochezia, 20% for a positive test, 8% for digestive symptoms, and 2% because of a family history.

CONCLUSION

Positive Hemoccult tests represent only a small part of the indications for colonoscopies performed in the Isère department. However, the screening program should be extended to develop its use given its yield which is equivalent to that of hematochezia and much higher than that of digestive symptoms or family history.

Modulation of COX-2 expression by statins in human aortic smooth muscle cells. Involvement of geranylgeranylated proteins

Cyclooxygenase (COX)-2 and COX-1 play an important role in prostacyclin production in vessels and participate in maintaining vascular homeostasis. Statins are inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, which is crucial in cholesterol biosynthesis. Recently, cholesterol-independent effects of statins have been described. In this study, we evaluated the effect of two inhibitors of HMG CoA reductase, mevastatin and lovastatin, on the production of prostacyclin and the expression of COX in human aortic smooth muscle cells. Treatment of cells with 25 microm mevastatin or lovastatin resulted in the induction of COX-2 and increase in prostacyclin production. Mevalonate, the direct metabolite of HMG CoA reductase, and geranylgeranyl-pyrophosphate reversed this effect. GGTI-286, a selective inhibitor of geranylgeranyltransferases, increased COX-2 expression and prostacyclin formation, thus indicating the involvement of geranylgeranylated proteins in the down-regulation of COX-2. Furthermore, Clostridium difficile toxin B, an inhibitor of the Rho GTP-binding protein family, the Rho selective inhibitor C3 transferase, and Y-27632, a selective inhibitor of the Rho-associated kinases, targets of Rho A, increased COX-2 expression whereas the activator of the Rho GTPase, the cytotoxic necrotizing factor 1, blocked interlukin-1alpha-dependent COX-2 induction. These results demonstrate that statins up-regulate COX-2 expression and subsequent prostacyclin formation in human aortic smooth muscle cells in part through inhibition of Rho.

Curved molar root canal preparations using Hero 642 rotary nickel-titanium instruments

AIM

The Bramante method was used to study how the natural curvature of root canals was modified when using the Hero 642 nickel-titanium rotary system.

METHODOLOGY

Twenty-four canals were selected in freshly extracted human mandibular molars. Every root canal had an angle of curvature greater than 20 degrees. Roots were embedded in clear casting resin using a plaster mould. Cross-sectional cuts were made in the apical, middle and coronal thirds of each root. A first group (control) of 12 curved root canals was prepared using stainless steel hand instruments and the step-back technique. A second group of 12 curved root canals was instrumented using the Hero sequence according to the manufacturer's instructions. For each sectioning level, the amount of dentine removed, the change of shape factor and the canal centre displacement were calculated with the aid of a digital image analysis system. The results were subjected to the Mann-Whitney U-test.

RESULTS

No significant difference occurred in the amount of dentine removed, change of shape factor or canal centre displacement in the coronal and middle thirds of the curved canals. In the apical third, transportation was significantly higher (P=0.0171) with stainless steel hand instruments than with the Hero system.

CONCLUSIONS

The original canal shape was maintained better in the apical third of curved canals when using the Hero system in a crown-down technique when compared to a hand preparation technique with stainless steel instruments.

Odontometrical method useful in determining gender and dental alignment

Rao et al.'s method of sex determination, which considers the mandibular canine index (MCI) is one giving satisfactory results. However, they did not take occlusion into consideration. The aim of this study, therefore, was to evaluate the effectiveness of this method with respect to tooth alignment. The study population involved the students enrolled in the University of Nice-Sophia Antipolis. Two hundred and ten girls and 214 boys were randomly sampled (1/20). Both tooth sizes and dental arches were measured using a vernier calliper to calculate MCI for both sexes. The results were compared to standard MCI, taking into account tooth alignment.Rao et al.'s method can only be used in the case of correct lower-anterior dental alignment and by using the standard MCI of the local population.

Cost-effectiveness of the addition of early hormonal therapy in locally advanced prostate cancer: results decisively determined by the cut-off time-point chosen for the analysis

We present a retrospective cost-effectiveness analysis using data from a randomised controlled trial (EORTC 22863) of the addition of early hormonal therapy with a luteinising hormone-releasing hormone (LHRH) analogue to radiotherapy in the treatment of patients with locally advanced prostate cancer. Data on the use of medical resources were extracted from the hospital charts of 90 patients recruited into the trial by one French hospital. Costs are assessed from the viewpoint of the French healthcare financing system and adjusted for censoring. Expected costs per patient of each treatment is related to the expected outcome, mean survival time, estimated by a restricted means analysis. The time point of restriction is determined by statistical criteria. In the base case analysis with a cut-off time point at 8.58 years, the combined therapy group (COMB) had a gain in mean survival time of 1.06 years (7.05 versus 5.99 years) and a reduction of average total costs of 12700 French francs (FF) (58300 FF versus 71000 FF). The analysis of uncertainty uses bootstrap techniques with 5000 replicates to examine the joint distribution of cost and survival outcomes. In 76% of the cases, COMB results in longer mean survival time and lower costs than the radiotherapy group (RT). In cases where COMB therapy raises costs (13% of the cases), it is rarely by more than 20000 FF per patient, no matter the size of the associated survival gain. It is thus highly likely that COMB should be considered a cost-effective option compared with RT for these patients. The exact result of the economic evaluation is decisively determined by the restriction time point selected for the determination of mean survival time, partly also because the average total costs of the two treatments develop entirely differently as a function of the survival time.

Apolipoprotein E4 and coronary heart disease in middle-aged men who smoke: a prospective study

BACKGROUND

The common isoforms of apolipoprotein E (apoE), E2, E3, and E4, are important determinants of plasma lipid concentrations, and the epsilon4 allele is associated with raised risk of coronary heart disease. We investigated whether the effect of smoking on coronary heart disease risk is affected by APOE genotype.

METHODS

We enrolled 3052 middle-aged men who were free of coronary heart disease for prospective cardiovascular surveillance in the second Northwick Park Heart Study (NPHSII). Smoking habit was ascertained at baseline and yearly by questionnaire. APOE genotype was identified by PCR and restriction enzyme digestion. Endpoints were fatal coronary heart disease, non-fatal myocardial infarction, and coronary artery surgery and silent myocardial infarction at follow-up.

FINDINGS

During 18836 person years of surveillance, 96 men had an acute myocardial infarction, 26 needed coronary artery surgery, and 14 had silent myocardial infarctions. Compared with never-smokers, risk of coronary heart disease in ex-smokers was 1.34 (95% CI 0.86-2.08) and in smokers it was 1.94 (1.25-3.01). This risk was independent of other classic risk factors. In never-smokers, risk was closely similar in men with different genotypes. Risk in men homozygous for the epsilon3 allele was 1.74 (1.10-2.77) in ex-smokers and 1.68 (1.01-2.83) in smokers, whereas in men carrying the epsilon4 allele risk was 0.84 (0.40-1.75) and 3.17 (1.82-5.50), respectively, with no significant differences in risk in the epsilon2 carriers. For the epsilon3 group, the genotype effect on risk was no longer significant after adjustment for classic risk factors (including plasma lipids). However, even after adjustment, smokers who were carriers of the epsilon4 allele, showed significantly raised risk of coronary heart disease compared with the non-smoking group (2.79, 1.59-4.91, epsilon4-smoking interaction p=0.007).

INTERPRETATION

Smoking increases the risk of coronary heart disease in men of all genotypes but particularly in men carrying the epsilon4 allele.

S-phase fraction and DNA ploidy in 633 T1T2 breast cancers: a standardized flow cytometric study

The lack of a standardized methodology for quantifying DNA ploidy and S-phase fraction (SPF) by flow cytometry is hindering routine use of these markers in breast cancer management. In a retrospective clinical multicenter study, we validated a standardized flow cytometry protocol. We tested 633 frozen T(1)T(2), N(0)N(1), M(0) breast tumors obtained in four institutions. Cell preparation was standardized, and precise rules for data interpretation were followed. Three SPF classes were defined on the basis of tertiles after adjustment for ploidy. DNA aneuploidy was observed in 61.0% of cases. No significant difference was observed among centers. Aneuploidy and high SPF were associated with large tumor size, node involvement, high histological grade, and hormone receptor negativity. In the overall population (median follow-up, 69 months), patients with medium and high SPF values had shorter disease-free survival (DFS) than those with low SPF values (P < 0.0001). Ploidy had no significant influence. By Cox analysis, SPF, pN, and estrogen receptor status were independent predictors of DFS (P = 0.0002, P = 0.001, and P = 0.05). In node-negative patients, SPF was the only predictor of DFS (P = 0.01), whereas in node-positive patients, the risk of relapse increased with both high SPF (P = 0.003) and estrogen receptor negativity (P = 0.004). Low SPF values distinguished grade II tumors with a particularly good outcome. Our results strongly support the use of SPF in multicenter studies and clinical trials and suggest that node-negative patients with slowly proliferating tumors do not require systemic adjuvant therapy.

The role of apolipoprotein E in cognitive decline after cardiac operation

BACKGROUND

Recently, Tardiff and colleagues have suggested that the presence of the apolipoprotein E, epsilon4 allele was associated with increased likelihood of cognitive decline after coronary artery bypass grafting. The objective of the current study was to replicate this earlier work using an increased sample size. The increased sample also enabled an analysis by individual genotype in cognitive decline after coronary artery bypass grafting.

METHODS

Apolipoprotein E genotyping was performed on 111 individuals undergoing coronary artery bypass grafting. Each participant underwent a battery of nine neuropsychological tests before operation and 4 to 7 weeks after operation.

RESULTS

Cognitive decline, assessed by both continuous Z change scores and two categoric measures of cognitive deficit, was not significantly associated with either individual apolipoprotein E genotypes or categorization by the presence or absence of the epsilon4 allele. The examination of potential moderating factors did not alter this finding.

CONCLUSIONS

This study suggests that the epsilon4 allele is not associated with cognitive decline in the weeks after coronary artery bypass grafting.

Effect of surface penetrating sealant on surface texture and microhardness of composite resins

The application of Fortify (Bisco, Lombard, IL), an unfilled resin, to the surface of composite resin restorations is intended to fill in defects in the surface that persist despite polishing, improve marginal integrity, and increase these materials' resistance to abrasion. The aim of this study was to observe the surface texture by scanning electron microscopy and measure the microhardness of the surface. For each sample of composite resin covered with glaze, 40 measurements were made of the thickness of the resin. Measurements of the Vickers microhardness included three samples of composite resin, three samples of glaze, and six samples of composite resin covered with glaze. A relationship was established between microhardness and thickness. Scanning electron microscopy showed a noticeable improvement in the surface texture. Nevertheless, areas were seen in which glaze seemed very thin or even completely absent. Measurements of the thickness ranged from 0-70 microm. The mean microhardness of composite resin was 65.8 +/- 0.7, while the mean hardness of glaze was 7.3 +/- 0.7. The microhardness of the double layer was reduced, depending on the thickness of the glazing resin. The capacity of glaze to mask surface defects of composite resin was shown, but it was difficult to obtain a regular surface with liquid resin. The application of this product caused a decrease of the microhardness of the composite resin's surface.

Patient set-up using portal images: 2D/2D image registration using mutual information

OBJECTIVE

Conformal radiation therapy requires accurate patient set-up for each fraction delivery. Electronic portal imaging devices allow the acquisition of portal images just before and even during dose delivery. However, the quantitative interpretation of these images in determining and correcting the patient's position remains uncertain, and automated methods are therefore being developed. Such methods must be usable for the different radiation therapy techniques. They must be robust and as automated as possible for use in clinical routines. This work was undertaken to establish the feasibility of 2D/2D registration for portal/portal and portal/simulator images in radiotherapy.

MATERIALS AND METHODS

This paper describes an automated method based on the combination of calibration algorithms and pixel-based registration algorithms. We present experiments with the different imaging techniques, some of which use a phantom with and without a gold standard. Preliminary results obtained using patient data are also presented and discussed.

RESULTS

The results obtained with a phantom demonstrated that this automated method for 2D/2D registration is fast, accurate, and robust, even in the case of blurred images for small treatment fields.

CONCLUSIONS

Mutual information is a feasible method for 2D/2D portal/portal and portal/simulator image registration in radiotherapy.

Leukotriene D4-induced activation of smooth-muscle cells from human bronchi is partly Ca2+-independent

Cysteine-containing leukotrienes (cysteinyl-LTs) are potent bronchoconstrictors and play a key role in asthma. We found that histamine and LTD4 markedly constrict strips of human bronchi (HB) with similar efficacy. However, in human airway smooth-muscle (HASM) cells, LTD4, at variance with histamine, elicited only a small, transient change in intracellular calcium ion concentration. HASM cells express both Ca2+-dependent and -independent isoforms of protein kinase C (PKC) (i.e., PKC-alpha and PKC-alpha ). Western blot analysis showed that PKC-alpha is activated by histamine and, to a lesser extent, by LTD4, whereas only LTD4 translocates PKC-alpha. This translocation was specifically inhibited by the LTD4 antagonist pobilukast. Phorbol-dibutyrate ester (PDBu) (a PKC activator) contracted HB strips to the same extent in the presence as in the absence of extra- and intracellular Ca2+. In the absence of Ca2+, LTD4 contracted HB strips to the same extent as did PDBu, suggesting the involvement of a Ca2+-independent PKC in LTD4-mediated signal transduction. PDBu-induced desensitization and the PKC inhibitor H7 abolished the slow and sustained LTD4-triggered contraction of HB strips in the absence of Ca2+, although H7 did not greatly affect the response in the presence of the ion. Thus, in human airways, we identified a novel LTD4 transduction mechanism linked to bronchial smooth-muscle contraction, which is partly independent of Ca2+ and involves the activation of PKC-alpha.

[Absorbed dose during helical acquisition CT. Effect of acquisition parameters]

PURPOSE

European directive 97/43 specifies that the dose delivered to the patient during a radiological procedure should be estimated. In order to prepare for implementation of this new regulation, we have studied the dose delivered during spiral CT acquisition.

MATERIALS AND METHODS

We have studied the influence of slice thickness, pitch, tube voltage and intensity, and acquisition volume length. We present measurements for single and dual detector CT scanners. We used a pencil ionization chamber to measure air kerma. We measured absorbed dose in water with a waterproof ionization chamber set in a semi-customized phantom filled with water. Chambers were set on the rotation axis of the CT scanners. We studied the dose outside the acquisition volume.

RESULTS

We quantified the influence of each parameter on the absorbed dose. We used our measurements to calculate the dose for different acquisition protocols. Also we evaluated the dose to organs distant from the acquisition area.

CONCLUSION

This study is one step toward a systematic estimation of the dose delivered to patient during helical CT exams. To use these results in daily practice, we have to develop software using our measurements.

Effect of endogenous and exogenous prostaglandin E(2) on interleukin-1 beta-induced cyclooxygenase-2 expression in human airway smooth-muscle cells

We studied the effect of endogenous and exogenous prostaglandin E(2) (PGE(2)), a metabolite of arachidonic acid through the cyclooxygenase (COX) pathway, on interleukin (IL)-1 beta-induced COX-2 expression, using primary cultures of human bronchial smooth-muscle cells (HBSMC). Treatment with exogenous PGE(2) resulted in enhanced expression of IL-1 beta-induced COX-2 protein and messenger RNA (mRNA) as compared with the effect of the cytokine per se. Inhibition of PGE(2) production with a nonselective COX inhibitor (flurbiprofen, 10 microM) resulted in a significant reduction in IL-1 beta- induced COX-2 expression, supporting a role of endogenous COX metabolites in the modulation of COX-2 expression. None of the experimental conditions used in the study affected the expression of constitutive cyclooxygenase (COX-1). Treatment with cycloheximide to inhibit translation, and with dexamethasone or actinomycin D to inhibit transcription, linked the effect of PGE(2) to the transcriptional level of COX-2 mRNA rather than to a potential effect on protein and/or mRNA stabilization. PGE(2) increased adenylate cyclase activity in a concentration dependent manner, and forskolin, a direct activator of adenylate cyclase, caused a marked increase in IL-1 beta-dependent COX-2, suggesting the existence of a causal relationship between the two events. The same results were observed with salbutamol, a bronchodilator that acts by increasing cyclic adenosine monophosphate. The effect of PGE(2) on COX-2 expression may contribute to the hypothesized antiinflammatory role of PGE(2) in human airways, providing a self-amplifying loop leading to increased biosynthesis of PGE(2) during an inflammatory event.

[Multidisciplinary approach in the treatment of localized forms of cancer of the prostate]

Localized prostate cancer can be treated by surgery, 3D conformal radiotherapy, brachytherapy: age, clinical stage, Gleason grade, baseline PSA, multidisciplinary approach enable physicians to tailor the therapeutic strategy. Patients are more informed of therapeutic morbidity and health related quality of life and want to give their feeling. Clinical research remains mandatory to set up the treatment policy with more objectivity.

[Image fusion methods for the repositioning of the patient in radiotherapy]

Conformal radiotherapy requires the accurate and reproducible setup of the patient for each fraction delivery. Megavoltage imaging could enable this. This requires the development of image processing and data fusion algorithms. We describe an automated method based on the use of mutual information for registration. Such a method does not require any preliminary segmentation of the images. This method has been extensively tested on phantom as well as on some patient data. The obtained results demonstrated that this automated method for 2D/2D registration is rapid, accurate and robust even in the case of blurred images for small treatment fields.