Prognostic impact of local radiotherapy on metastatic urothelial carcinoma patients receiving systemic chemotherapy

OBJECTIVE

To clarify the prognostic impact of local radiotherapy on metastatic urothelial carcinoma patients treated by systemic chemotherapy.

METHODS

Of the 228 metastatic urothelial carcinoma patients treated with systemic chemotherapy, 97 received radiotherapy mainly to metastatic sites. In patients for whom the purpose of radiotherapy was not specified, more than 50 Gy irradiation was considered to be for disease consolidation for survival analysis, while less than 50 Gy was categorized as palliation. According to the Kaplan-Meier method, we analysed overall survival from the initiation of treatment for metastatic urothelial carcinoma until death or the last follow-up, using the log-rank test to assess the significance of differences. The Cox model was applied for prognostic factor analysis.

RESULTS

Overall, there was no significant difference in survival between patients with and those without radiotherapy (P = 0.1532). When analysing the patients undergoing consolidative radiotherapy separately, these 25 patients showed significantly longer survival than the 72 patients with palliative radiotherapy (P = 0.0047), with a 3-year overall survival of 43.3%. Of the present cohort, 22 underwent metastasectomy for disease consolidation, and there was no overlapping case between the metastasectomy cohort and cohort receiving consolidative radiotherapy. After controlling for four independent prognostic factors (sex, performance status, haemoglobin level and number of organs with metastasis) in our previous study, radiotherapy for disease consolidation showed a marginal value (hazard ratio = 0.666, P = 0.0966), while metastasectomy remained significant (hazard ratio = 0.358, P = 0.0006).

CONCLUSIONS

In the selected patients, long-term disease control could be achieved after consolidative radiotherapy for metastatic urothelial carcinoma disease. Our observations suggest that local ablative therapy (surgery or radiotherapy) could facilitate long-term disease control. However, the treatment decision should be individualized because of the lack of randomized control trials.

The evaluation of human papillomavirus DNA testing in primary screening for cervical lesions in a large Japanese population

To examine the utility of human papillomavirus (HPV) DNA testing for the screening of cervical cancer and its precursors, a prospective cohort study was performed in which a total of 8156 women with a median age of 36 years were enrolled. Two smear samples scraped from the uterine cervix were served for Papanicolaou test and HPV DNA testing (Hybrid Capture-II system). HPV-positive samples were further examined for HPV subtype using a DNA microarray chip. Women with cytologic abnormality or those with high-risk HPV DNA were further examined by colposcopy to determine histologic diagnosis. High-risk HPV DNA was detected in 11% of the general population, with higher prevalence of specific types, including 52, 16, 58, 51, 56, and 18. As expected, younger women were likely to have increased frequency of HPV infection. Notably, HPV DNA testing detected all 45 cases of cervical intraepithelial neoplasia (CIN) 3, while cytologic findings were negative in 6 of these cases. It is of particular interest that CIN was commonly associated with multiple HPV types, while invasive cancers had a single type of HPV. In terms of both sensitivity and positive predictive value in detecting the CIN, HPV DNA testing is superior to cytology. However, most importantly, HPV DNA testing in combination with cytology significantly improved the efficacy to CIN screening.

The evaluation of human papillomavirus DNA testing in primary screening for cervical lesions in a large Japanese population

To examine the utility of human papillomavirus (HPV) DNA testing for the screening of cervical cancer and its precursors, a prospective cohort study was performed in which a total of 8156 women with a median age of 36 years were enrolled. Two smear samples scraped from the uterine cervix were served for Papanicolaou test and HPV DNA testing (Hybrid Capture-II system). HPV-positive samples were further examined for HPV subtype using a DNA microarry chip. Women with cytologic abnormality or those with high-risk HPV DNA were further examined by colposcopy to determine histologic diagnosis. High-risk HPV DNA was detected in 11% of the general population, with higher prevalence of specific types, including 52, 16, 58, 51, 56, and 18. As expected, younger women were likely to have increased frequency of HPV infection. Notably, HPV DNA testing detected all 45 cases of cervical intraepithelial neoplasia (CIN) 3, while cytologic findings were negative in 6 of these cases. It is of particular interest that CIN was commonly associated with multiple HPV types, while invasive cancers had a single type of HPV. In terms of both sensitivity and positive predictive value in detecting the CIN, HPV DNA testing is superior to cytology. However, most importantly, HPV DNA testing in combination with cytology significantly improved the efficacy to CIN screening.

A phase II study of cisplatin and docetaxel administered as three consecutive weekly infusions for advanced non-small-cell lung cancer in elderly patients

BACKGROUND

To evaluate the efficacy and safety of treatments for advanced non-small-cell lung cancer in elderly patients aged 75 years or older, we conducted a phase II study of cisplatin and docetaxel administered in three consecutive weekly infusions.

PATIENTS AND METHODS

The eligibility criteria for the study included the presence of chemotherapy-naive advanced non-small-cell lung cancer, age > or =75 years, Eastern Cooperative Oncology Group performance status of 0 or 1, a measurable lesion, adequate organ functions and signed informed consent. The chemotherapy regimen consisted of cisplatin (25 mg/m(2)) and docetaxel (20 mg/m(2)) on days 1, 8 and 15 every 4 weeks.

RESULTS

Between February 2000 and March 2002, 34 elderly patients with non-small-cell lung cancer were enrolled in the study and 33 patients were treated. Two complete responses and 15 partial responses were obtained for an objective response rate of 52% in 33 treated patients. The median survival period was 15.8 months, and the 1-year survival rate was 64%. Toxicities were mild with no grade 4 toxicities. Only grade 3 leukopenia (6%), neutropenia (12%), anemia (3%), hyponatremia (3%) and nausea/vomiting (3%) were observed.

CONCLUSION

Cisplatin and docetaxel administered in three consecutive weekly infusions was safe and effective for the treatment of elderly patients with chemotherapy-naive non-small-cell lung cancer.

Room temperature phosphorescence of 6-bromo-2-naphthol in micelles of poly(ethylene oxide)-poly(propylene oxide)-poly(ethylene oxide) block copolymers and in their mixed aggregates with sodium dodecyl sulfate

Room temperature phosphorescence (RTP) of 6-bromo-2-naphthol has been investigated in aqueous micellar solutions of poly(ethylene oxide)-poly(propylene oxide)-poly(ethylene oxide) block copolymers as well as in their mixed aggregates with sodium dodecyl sulfate. RTP of the phosphorophor was enhanced to some extent in the micelles of the block copolymers. However, marked enhancement of RTP was observed in the mixed aggregates. The enhancement of RTP is attributed to effective incorporation of the phosphorophor into the micelles and the aggregates, resulting in suppression of nonradiative deactivation of the phosphorescent state.

The presence of specialized epithelial cells on the bronchus-associated lymphoid tissue (BALT) in the mouse

The aggregation of lymphoid cells in the bronchial mucosa has been named the bronchus-associated lymphoid tissue (BALT) and investigated in comparison with the gut-associated lymphoid tissue (GALT). To elucidate precisely the structure and function of the BALT, the present study examined the age-related change in the mouse BALT by light microscopy. We also observed the characteristics of the overlying epithelium, especially the lectin-binding properties of the epithelial cells, by the combined use of light microscopy (LM), scanning electron microscopy (SEM) and transmission electron microscopy (TEM). By LM, lymphoid aggregates were not recognizable in the bronchial mucosa of young (8-10 week-old) mice, while they were commonly found at the second to fourth branching portions of the bronchial tree in older (32-40 week-old) mice. The epithelium overlying the lymphoid aggregates of the mature mice often contained a large number of mononuclear cells. Lectin cytochemistry revealed that UEA1 (Ulex europaeus agglutinin 1) positive cells were not only restricted to the overlying epithelium of the BALT in the older mice but also found in a cell group in the mucous epithelium at the branching portions in the young mice. Comparison between the LM and SEM images of the UEA1-stained whole mount specimens clarified the surface morphology of the lectin-stained epithelial cells, showing them to be non-ciliated cells with a large number of short microvillous projections on the apical surface. TEM studies further demonstrated that the UEA1 reaction products appeared on the plasma membrane of the non-ciliated cells which often enfolded lymphocytes in the old mice. Latex microbeads, which were administrated intratracheally, were selectively taken up by the UEA1-positive cells of the BALT. These results indicate that the mouse BALT has specialized epithelial cells similar to the UEA1 positive M cells in the GALT and probably functions as a part of the mucosal immune system. This study also showed the possibility that the UEA1 positive cells appear in the mucous epithelium before the formation of the BALT.

Three-dimensional cytoarchitecture of rat pulmonary venous walls: a light and scanning electron microscopic study

The three-dimensional architecture of the rat pulmonary veins was studied by light microscopy (LM) and scanning electron microscopy (SEM). For LM, the left lungs were fixed with formalin, sectioned and immunostained with an anti-alpha-smooth muscle actin (alpha-SMA) antibody in addition to conventional staining. For SEM, the specimens were fixed with glutaraldehyde and immersed in 30% KOH solution for 8 min followed by treatment of collagenase solution for more than 5 h. By LM, the smooth muscle cells stained with anti-alpha-SMA showed discontinuous, periodical thickenings of circular bundles in the wall of the venules, but they became thin and continuous in the larger vessels (or veins) that had a cardiac muscle layer on the outside. Under SEM, the smooth muscle cells formed circular-oriented bundles at constant intervals along the venules less than 100 microm in diameter. These bundles had circumferential constrictions in the lumen. The cardiac muscle cells, which appeared in large pulmonary veins of more than 100 microm, ran in a circular or oblique direction and completely surrounded the vessel wall outside of the thin continuous layer of smooth muscle cells. The muscle arrangements were considered to play a significant role in the return blood flow in rat pulmonary veins.

Effects of dopaminergic agonists on plasma luteinizing hormone-releasing hormone (LRH) and gonadotropins in man

To try to determine the site and mode of action of dopamine (DA) on the secretion of gonadotropins in humans, 4 series of studies were performed in 19 healthy volunteers (7 healthy males, 5 females in follicular phase and 7 postmenopausal females). The intravenous infusion of DA at the rate of 4 micrograms/kg/min decreased plasma LH levels to 75.9 +/- 3.7 (mean +/- SE)% of the initial levels. The oral administration of 500 mg of levodopa (Dopa) also suppressed the concentration of plasma LH to 73.0 +/- 3.5%, but the pretreatment with two doses of 100 mg each of carbidopa (CD), a peripheral dopa decarboxylase inhibitor, attenuated this suppressing effect of Dopa on LH levels (nadir 82.4 +/- 4.1). Plasma FSH were not significantly altered by these drugs. On the other hand, the concentration of endogenous LRH in peripheral blood remained unchanged throughout the studies. The administration of CD alone had no effect on any of these 3 parameters. These results would suggest the direct suppressing effect of DA on pituitary gonadotrophs, although the modulation at the level of the hypothalamus also cannot be ruled out.

[Clinical study on dosage schedule of tobramycin: controlled comparison between 180 mg b.i.d. and t.i.d]

The efficacy and safety of tobramycin (TOB) administration at 90 mg twice a day (90 mg group) to patients with respiratory tract infections (RTI) were objectively investigated by means of a well-controlled comparative study. The results in this 90 mg group were compared with the case of administering 3 times a day of 60 mg each (60 mg group) as the control. In both of these patient groups, TOB was administered by intramuscular injection for 10 consecutive days. This study included 85 patients (90 mg group: 43 patients; 60 mg group: 42 patients). The Committee, however, excluded 19 patients consisting of 13 cases of infection other than RTI and 6 cases of out of protocol drug administration. Thus, 66 patients (90 mg group: 32 patients; 60 mg group: 34 patients) were used for the efficacy analysis. All 85 patients were used, however, for the evaluation of the safety of TOB and for the usefulness of TOB as judged by the physicians in charge. A brief summary of the results is presented below. The cases employed by the Committee consisted of 8 and 17 cases in the 90 mg and 60 mg groups, respectively, with bacterial pneumonia and lung abscess, and 24 and 17 cases in the 90 mg and 60 mg groups, respectively, with chronic RTI. There was a tendency for the distribution of disease cases in the 2 drug groups to be significant. Within the chronic RTI disease classification, the number of patients with chronic bronchitis was almost equal in the 2 drug groups; 16 cases in the 90 mg group and 15 cases in the 60 mg group. However, secondary infections were diagnosed in 8 cases in the 90 mg group and 2 cases in the 60 mg group. The clinical efficacy judged for all cases investigated by the Committee showed efficacy ratios of 56.3% for the 90 mg group and 70.6% for the 60 mg group. The difference between the 2 drug groups was not statistically significant. In the treatment of bacterial pneumonia and lung abscess, the efficacy rate in the 90 mg group was 87.5%, while it was 88.2% in the 60 mg group; these high values were practically identical. Against chronic RTI, the efficacy rates were 45.8% in the 90 mg group and 52.9% in the 60 mg group; within that disease classification, the efficacy rates against the chronic bronchitis cases were nearly the same at 43.8% and 46.7%, respectively. These data showed no statistically significant differences between the 2 drug administration groups. (ABSTRACT TRUNCATED AT 400 WORDS)

[Double-blind comparative clinical evaluation of cefamandole and cefmetazole in the treatment of respiratory tract infections]

Cefamandole sodium (CMD), a new cephalosporin-derivative, was synthesized in the Laboratory of Eli-Lilly Co. Ltd. U.S.A. in 1972. CMD, which is several times more active than cefmetazole (CMZ, a cephamycin antibiotic) against Gram-positive cocci, is only as active as the latter antibiotic against Gram-negative bacilli. Against Haemophilus influenzae, CMD exhibits an antimicrobial activity which is as strong as that of ampicillin sodium. Our previous comparative tests on efficacy and safety of CMD versus cefazolin (CEZ) demonstrated that CMD was as effective and safe as CEZ in the treatment of respiratory tract infections. In the present clinical trial, the efficacy and safety of CMD are evaluated by a comparative double blind method using CMZ, a more recently synthesized cephamycin antibiotic, as a reference drug. For this purpose, a comparative double blind study was carried out in 50 institutions and clinics in Tohoku and Hokkaido districts in Japan. A total of 272 inpatients, who was aged over 16 years and was diagnosed as having pneumonia, lung abscess or acute infectious exacerbation of chronic obstructive pulmonary diseases, was included in this trial. They received 2 g of CMD or CMZ twice a day by intravenous drip infusions, as a rule, for 14 days. Of these patients, 264 (133 received CMD and 131 CMZ) were available for the evaluation of safety and usefulness. Two hundred and thirty-eight patients (122 received CMD and 116 CMZ) were adopted for the evaluation of efficacy. Prior to the treatment, there was no significant difference with respect to age, sex, severity of infection and underlying diseases between subjects in 2 treatment groups. An excellent or good clinical response was obtained in 82% of the patients treated with CMD, and in 81% of those treated with CMZ. Thus, there was no significant difference in cure rate between 2 treatment groups. However, an excellent clinical response was found in 12.3% of the patients treated with CMD, whereas only in 4.3% of those treated with CMZ. This difference in percentage of excellent clinical response between 2 treatment groups was statistically significant (P less than 0.05). Of the 87 patients with moderate to severe infection who were treated with CMD, 13 showed an excellent response. Only 4 of 90 patients treated with CMZ showed an excellent response. Statistically the difference in the rate of excellent response between these 2 groups was significant (P less than 0.05).(ABSTRACT TRUNCATED AT 400 WORDS)