Influencing effect of heat-treatment on radon emanation and exhalation characteristic of red mud

The reuse of industrial by-products is important for members of numerous industrial sectors. However, though the benefits of reuse are evident from an economical point of view, some compounds in these materials can have a negative effect on users' health. In this study, the radon emanation and exhalation features of red mud were surveyed using heat-treatment (100-1200 °C). As a result of the 1200°C-treated samples, massic radon exhalation capacity reduced from 75 ± 10 mBq kg(-1) h(-1) to 7 ± 4 mBq kg(-1) h(-1), approximately 10% of the initial exhalation rate. To find an explanation for internal structural changes, the porosity features of the heat-treated samples were also investigated. It was found that the cumulative pore volume reduced significantly in less than 100 nm, which can explain the reduced massic exhalation capacity in the high temperature treated range mentioned above. SEM snapshots were taken of the surfaces of the samples as visual evidence for superficial morphological changes. It was found that the surface of the high temperature treated samples had changed, proving the decrement of open pores on the surface.

Post-operative management of primary glioblastoma multiforme in patients over 60 years of age

BACKGROUND AND PURPOSE

Optimal treatment for elderly patients with glioblastoma multiforme is not well defined. We evaluated the efficacy of post-operative radiotherapy with or without concomitant and/or adjuvant temozolomide in patient, aged > or = 60 years to assess survival and identify prognostic factors of survival.

METHODS

A retrospective analysis of overall survival and progression-free survival in patients with newly diagnosed glioblastoma multiforme aged > or = 60 years treated with post-operative radiotherapy with or without temozolomide chemotherapy was conducted at our institutions. Prognostic factors were determined by univariate and multivariate analyses.

RESULTS

Of 75 study participants (54.7% male; median age at first diagnosis, 65.1 years), 29 (38.7%) underwent gross total resection, whereas others underwent partial resection or biopsy only. All but 1 patient received radiotherapy. Twenty patients received concomitant temozolomic e only. Adjuvant temozolomide (1-50 cycles) was administered in 42 patients; 16 received > or = 6 cycles. Median overall survival was 10.3 months. One- and 2-year overall survival rates were 42.6% and 6.7%, respectively. Median progression-free survival was 4.1 months. Radiochemotherapy was generally well tolerated. Median overall survival was 15.3 and 29.6 months for patients who received 6-12 cycles and >12 cycles of adjuvant temozolomide, respectively. There were no significant differences in overall survival between age groups (60-64, 65-69, and > or = 70 years). Adjuvant temozolomide, Karnofsky performance status > or = 70, and additional surgery after progression were significant prognostic factors of longer overall survival (p<0.05).

CONCLUSIONS

Radiochemotherapy, including > or = 6 cycles of adjuvant temozolomide, was safe and prolonged survival of glioblastoma patients aged > or = 60 years. Aggressive therapy should not be withheld from patients aged > or = 60 years with good performance status because of age.

Autologous dendritic cell based adoptive immunotherapy of patients with colorectal cancer-A phase I-II study

Dendritic cell-based active immunotherapies of cancer patients are aimed to provoke the proliferation and differentiation of tumor-specific CD4(+) and CD8(+) T-lymphocytes towards protective effector cells. Isolation and in vitro differentiation of circulating blood monocytes has been established a reasonable platform for adoptively transferred DC-based immunotherapies. In the present study the safety and tolerability of vaccination by autologous tumor cell lysates (oncolysate)- or carcinoembriogenic antigen (CEA)-loaded DCs in patients with colorectal cancer was investigated in a phase I-II trial. The study included 12 patients with histologically confirmed colorectal cancer (Dukes B2-C stages). Six of the patients received oncolysate-pulsed, whereas the other six received recombinant CEA-loaded autologous DCs. The potential of the tumor antigen-loaded DCs to provoke the patient's immune system was studied both in vivo and in vitro. The clinical outcome of the therapy evaluated after 7 years revealed that none of the six patients treated with oncolysate-loaded DCs showed relapse of colorectal cancer, whereas three out of the six patients treated with CEA-loaded DCs died because of tumor relapse. Immunization with both the oncolysate- and the CEA-loaded autologous DCs induced measurable immune responses, which could be detected in vivo by cutaneous reactions and in vitro by lymphocyte proliferation assay. Our results show that vaccination by autologous DCs loaded with autologous oncolysates containing various tumor antigens represents a well tolerated therapeutic modality in patients with colorectal cancer without any detectable adverse effects. Demonstration of the efficacy of such therapy needs further studies with increased number of patients.

Correlations between clinicopathological parameters and molecular signatures of primary tumors for patients with stage T3n0 colorectal adenocarcinomas: a single center retrospective study on 100 cases

BACKGROUND/AIMS

To examine the clinical and protein expression characteristics of tumor tissues for prediction of prognosis in colorectal cancer (CRC).

METHODOLOGY

We retrospectively analyzed the clinicopathological data of patients with stage T3N0 CRC, operated between 1997-2003 and the surgical materials for the relation between disease prognosis and p53, p21, p16, β-catenin, E-cadherin, EGFR, hMLH1, hMSH2 and TS protein expressions.

RESULTS

A significantly shorter 3-year disease free survival was observed in patients under the age of 50. The worst 5-year overall survival (OS) observed for patients over 70. Tumor localization and number of processed lymph nodes significantly affected prognosis. The EGFR, hMSH2 and TS expressions and the 5-fluorouracyl treatment were not found to be of prognostic value; p53 and p21 positivity had significantly worse survival. When β-catenin membrane expression disappeared on tumor cells, the 5-year OS rate decreased and time to metastasis shortened significantly. Membrane β-catenin expression, processed lymph nodes number and age were detected as independent prognostic markers.

CONCLUSIONS

These results suggest that the evaluation of a clinicopathological profile, based on age, tumor localization, number of examined lymph nodes, p53, p21 and E-cadherin β-catenin expression appears to be useful in identifying high risk patients.

[The emotions of oncologists]

Emotions are parts of organizational reality to an ever increasing extent. Importantly, they are not just tools in the hand of healthcare workers to achieve better physician / healthcare professional-to-patient interactions but intrinsic processes and characteristics with psychic, cognitive and somatic actions. For a thorough investigation of the issue, a PANAS-X questionnaire was used to examine the emotions of 187 physicians and other healthcare professionals, all engaged in oncology, in 2009. The research succeeded in exploring the overall emotional state oncology professionals had assumed in relation with their job as well as enabled the authors of this study to draw the respondents' emotional map and assess their fundamental emotional attitudes. Furthermore, the authors managed to identify groups of respondents that had felt more intense positive, and/or less intense negative emotions that are socially accepted than others. They included those of senior experienced oncologists, males, individuals with families, childless individuals, ward workers, and skilled professionals. According to the findings, the range of emotions an oncologist experiences / feels intently during his everyday work is dependent upon a great number of factors.

[Prophylaxis of chemotherapy-induced vomiting and nausea]

Chemotherapy-induced vomiting and nausea is the most common adverse event of anticancer therapy. In different guide-lines (MASCC, NCCN, ESMO and ASCO) antiemetic prophylaxis is directed toward the emetogenic potential of the chemotherapy and the type of vomiting and nausea. Chemotherapeutic agents are classified into four emetic risk groups: high, moderate, low, and minimal. Steroids, dexamethasone, metoclopramide, cannabinoids, benzodiazepines, 5-HT3 receptor antagonists (ondansetron, granisetron, tropisetron) and a new group of antiemetics, the neurokinin1 receptor antagonists are used to prevent anticipatory, acute and delayed vomiting and nausea. This paper examines evidence-based recommendations for optimal use of antiemetics.

Tumor-associated antigens in systemic sclerosis and systemic lupus erythematosus: associations with organ manifestations, immunolaboratory markers and disease activity indices

BACKGROUND

Some tumor-associated antigens (TAAs) are expressed on inflammatory cells. We previously detected increased production of CA15-3, CA19-9 and CA125 in rheumatoid arthritis (RA). The production of some TAAs may also be increased in patients with systemic sclerosis (SSc), systemic lupus erythematosus (SLE) and other connective tissue diseases. Some of these TAAs contain sialylated carbohydrate motifs and they are involved in tumor-associated cell adhesion and metastasis.

OBJECTIVES

We assessed levels of TAAs in the sera of SSc, SLE patients, patients with infectious diseases and healthy subjects. Serum TAA levels were correlated with each other, as well as with disease activity markers and organ involvement.

METHODS

TAAs including CEA, CA15-3, CA72-4, CA125 and CA19-9 were assessed by immunoassay in the sera of 92 patients with SSc, 40 patients with SLE, 50 age- and sex-matched healthy controls, as well as with 40 patients with current bacterial or viral infections. Normal upper limits for these TAAs were 3.4 mg/l, 25 kU/l, 6.9 kU/l, 35 kU/l and 34 kU/l, respectively.

RESULTS

There were significantly more SSc patients showing abnormally high levels of CA19-9 (8.8% vs 2.0%), CA125 (11.0% vs 6.0%) and CA15-3 (28.4% vs 14.0%) in comparison to controls (p < 0.05). In SLE, significantly more patients had elevated levels of CEA (32.5% vs 20.0%), CA19-9 (7.5% vs 2.0%), CA125 (15.0% vs 6.0%) and CA72-4 (15.0% vs 8.0%) than did controls (p < 0.05). The mean absolute serum levels of CEA (6.6+/-1.7 vs 1.8+/-1.4 mg/l) and CA15-3 (22.9 +/- 1.8 vs 18.6 +/- 2.2 kU/l) were also significantly higher in SSc compared to controls (p < 0.05). We found numerous correlations between the serum levels of different TAAs within the SSc and SLE population. Among SSc patients, serum CEA (R = 0.290; p = 0.005), CA15-3 (R = 0.260; p = 0.020) and CA19-9 (R = 0.257; p = 0.013) correlated with renal involvement. Serum CA15-3 also correlated with joint involvement (R = 0.329; p = 0.003), ANA positivity (R = 0.288; p = 0.010) and CRP levels (R = 0.407; p < 0.001). Within the SLE population, serum CA72-4 correlated with central nervous involvement (R = 0.624; p = 0.004) and CA125 correlated with the SLEDAI composite activity index (R = 0.666; p = 0.002). Patients with infections exerted serum TAA patterns similar to healthy controls.

CONCLUSION

The concentration of some TAAs may be elevated in the sera of patients with SSc or SLE in comparison to healthy subjects. Pathogenically, most of these TAAs contain carbohydrate motifs and thus they may be involved in inflammation-associated adhesive events. Furthermore, the production of some TAAs may correlate with organ involvement or disease activity in scleroderma or lupus.

[Anti-VEGF therapy with bevacizumab in breast cancer]

The growth of new blood vessels, angiogenesis is important for tumour progression and metastasis. Vascular endothelial growth factor (VEGF) plays multiple roles in cancer development. Due to it the VEGF seems to be an optimal therapeutic target in breast cancer therapy. The plasma level of this growth factor is highest early in disease suggests that anti-VEGF agents may provide their greatest benefit in firts-line chemotherapy with metastatic breast cancer (MBC). A phase III trial, E2100 evaluated weekly paclitaxel with or without bevacizumab (Avastin), the specific humanised anti-VEGF monoclonal antibody in patients with previously untreated locally recurrent or MBC, doubling of progression-free survival for all patient subgroups. Bevacizumab is generally well tolerated. The most common adverse events observed in trials hypertension, proteinuria, and wound-healing complications, most of which are grade 1-2 in severity. The registration of bevacizumab for MBC therapy brings new hope for patients. Novel approach of bevacizumab for MBC would be combination chemotherapy and different targeted therapies. Phase III clinical trials of bevacizumab are ongoing in different stages in different settings.

[Study of career motivators affecting the emotional labour of health care professionals in oncology]

In the course of their everyday work health care professionals (HCPs) often have to change their true feelings. The literature labels this performance as emotional labor. This article is presenting data on the characteristics of HCPs' most endangered by the negative consequences of emotional labor. Our simple choice question survey was conducted at Debrecen University Medical Healthcare Center with the help of 50 oncology HCPs volunteers. Nearly 90% of the HCPs examined change their true feelings in the course of work. It is very difficult to classify those threatened by the negative upshot of this emotional labor. Due to our research we found appalling differences of work motivation that were tightly interconnected with the respondents' emotional labor and their perceived role/emotional expectations. We succeeded in establishing three clusters and defining each cluster's characteristics. Figures suggest that only somewhat more than the half of the HCPs is authentic professional helper, and 45% of them does not or only slightly perceive the patients' demands concerning their work. Therefore, it is important that the work environment does not only assist the work of HCPs by professional means, but along emotional dimensions as well.

Increased production of the soluble tumor-associated antigens CA19-9, CA125, and CA15-3 in rheumatoid arthritis: potential adhesion molecules in synovial inflammation?

Some tumor-associated antigens (TAAs) are expressed on inflammatory cells. We previously detected carcinoembryonic antigen (CEA; CD66) in the rheumatoid (RA) synovium. The production of CEA, CA19-9, CA125, and CA15.3, may be increased in patients with RA, scleroderma, lupus, and Sjögren's syndrome (SS). Some of these TAAs contain sialylated carbohydrate motifs and they are involved in tumor-associated cell adhesion and metastasis. We assessed levels of TAAs in the sera of RA patients and healthy subjects. Serum TAA levels were correlated with disease markers including serum rheumatoid factor (RF), C-reactive protein (CRP), and anti-CCP antibody levels, DAS28, age disease duration. TAAs including CEA, CA15-3, CA72-4, CA125, and CA19-9, and neuron-specific enolase (NSE) were assessed by immunoassay in the sera of 75 patients with RA and 50 age- and sex-matched healthy controls. Normal upper limits for these TAAs were 3.4 microg/L, 25 kU/L, 6.9 kU/L, 35 kU/L, 34 kU/L, and 16.3 microg/L, respectively. There were significantly more RA patients showing abnormally high levels of CA125 (10.8% versus 7.1%), CA19-9 (8.1% versus 0%), and CA15-3 (17.6% versus 14.3%) in comparison to controls (P < 0.05). The mean absolute serum levels of CA125 (23.9 +/- 1.8 versus 16.8 +/- 2.2 kU/L) and CA19-9 (14.2 +/- 1.2 versus 10.5 +/- 1.6 kU/L) were also significantly higher in RA compared to controls (P < 0.05). Among RA patients, serum CEA showed significant correlation with RF (r = 0.270; P < 0.05). None of the assessed TAAs showed any correlation with CRP, anti-CCP, DAS28, age or disease duration. The concentration of some TAAs may be elevated in the sera of patients with established RA in comparison to healthy subjects. CEA, CA19-9, CA125, and CA15-3 contain carbohydrate motifs and thus they may be involved in synovitis-associated adhesive events. Furthermore, some TAAs, such as CEA, may also correlate with prognostic factors, such as serum RF levels.

[Complex treatment of inflammatory breast cancer]

Inflammatory breast cancer represents 2-5% of all malignant breast lesions. Its rapid progression, the rather short medical history of the disease is unique and seems to be very typical. The combined modality treatment of inflammatory breast cancer is a special challenge for the medical oncologists. Preoperative chemotherapy is of great importance. After getting fair remission, surgery and radiotherapy should be delivered. With combined modality therapy the 5-year overall survival is about 50%. Knowing more pharmaco-genomic details on the disease and delivering new medicaments the effectiveness of the treatment will be further enhanced.

[The results of ovarian cancer therapy in the Hungarian Centers in 2002-2003]

Authors presented data of treatment results and course of disease in 487 ovarian cancer patients treated by primary surgery and paclitaxel-carboplatin combination chemotherapy between July 1, 2002 and December 31, 2003.

PATIENTS

Most of our patients (87.8%) belonged to the age-group between 40-70 years. Distribution of their histological diagnosis was as 69.6% serous, 10.7% mucinous, 5.1% endometrial and 4.7% undifferentiated carcinoma. The grade distribution was found as 8.4% grade 1, 40.9% grade 2 and 35.9% grade 3.

RESULTS

The primary surgery was evaluated as optimal in 41.7%, suboptimal in 37.3% and exploration was performed in 21.1%. Most patients started chemotherapy 20 days after surgery and 74.2% of them got six courses. During the evaluation period 61 intervallum laparotomies were performed, and resulted on 55.7% optimal debulking. Complete remission was found in 58.9%, and partial remission in 14.7% of patients. This treatment resulted on a complete remission in 40.9% at the follow-up of 12 months.

[Results in 42 non-resectable NSCLC IIA-B patients with initial concurrent Taxotere-Cisplatin chemoradiotherapy]

GOALS

A prospective multicenter study to treat non-small cell lung cancer (NSCLC) with inductive chemoradiotherapy for improving chances of operability. If used as first-line therapy, combined treatment improves survival and it is well tolerated with a low rate of side effects.

PATIENTS

42 patients with stage IIIA-B NSCLC from which 36 could be followed.

METHODS

A full dose Taxotere-Cisplatin chemotherapy was given to patients with concurrent radiotherapy in 2 Gy fractions up to 60 Gy via conformal irradiation.

RESULTS

Local response was very high and 40.47% of patients became operable while in inoperable cases consolidation chemotherapy showed similar results as other protocols. We also found a low rate of side effects. The high rate of brain metastasis suggests that prophylactic cranial irradiation (PCI) should be considered.

Malignancies and soluble tumor antigens in rheumatic diseases

Paraneoplastic symptoms, caused by a malignancy, but not directly related to invasion by the tumor or its metastases are the result of a wide variety of tumor-derived biologic mediators like hormones, peptides, antibodies, cytotoxic lymphocytes, autocrine and paracrine mediators. Recognition of paraneoplastic syndromes is important, as it may lead to an early diagnosis of cancer. There is some evidence that systemic inflammatory diseases, such as rheumatoid arthritis (RA), lupus, scleroderma or dermatomyositis may increase the risk for the development of malignancies, predominantly lymphoproliferative disorders. However, reports are somewhat controversial. Immunosuppressive and cytotoxic drugs used in antirheumatic therapy, such as methotrexate, cyclophosphamide, azathioprine or anti-TNF biologicals may also lead to the development of such tumors. Tumor-associated antigens may be produced by inflammatory cells and their production may be increased in RA and other autoimmune diseases.

[The modern treatment of colorectal cancer. Present and future]

The modern treatment of colorectal cancer. Present and future. Fluorouracyl has been the mainstay of treatment for colorectal cancer for decades. The addition of folinic acid to 5FU, the use of infusional, rather than bolus 5FU, and the combination of new active agents such as irinotecan and oxaliplatin with 5FU/LV have each led to increase in effectivity. Oral formulations of fluoropyrimidines can replace the infusional 5FU therapy with better convenience. The authors review the current progress with the use of novel molecular targeted therapies that are tumor specific with better toxicity profile than chemotherapy. The integration of the new biological response modifier therapeutic possibilities in the chemotherapy protocols may result prolongation in survival, in metastatic patients the presently 2 years survival will approach 3 years. Combining these drugs with chemotherapeutics in the adjuvant setting we hope to raise further the presently achieved 78% of 3 years disease free survival by oxaliplatin plus 5FU therapy. As the variation of agents has been increased, choosing the most effective treatment strategy has become increasingly complex.

[Curative surgical treatment of inoperable pancreatic cancer after neoadjuvant therapy]

In the treatment of pancreatic cancer only curative resection increases the life expectancy. Radical resection is a high risk operation, but it can be performed with low peri-operational mortality in specialist surgical centres. At the time of diagnosis most patients are in stage (TMN of pancreatic cancer UICC 1997) III or IV, thus curative resection cannot be performed. Neo-adjuvant therapy shrinks the tumour in 60-70%, giving new hope for the patients. In this paper authors present two cases of pancreatic cancer resections. Palliative operations were performed in patients with inoperable pancreatic cancer. Later neo-adjuvant chemotherapy was performed--in these cases it meant chemotherapy--and after that a second, this time curative procedure was performed.

[Status report on the chemotherapy of ovarian cancer at special cancer centers in Hungary (2002-2003)]

Data on the first-line treatment of ovarian cancer in special centers of Hungary 2002 and 2003 are presented, involving 283 and 416 patients, respectively. Patients' age, clinical stage and histological type of the tumor were highly similar to literature data, while grades were different. Surgical effectiveness in case of IIIc staged tumors with >1 cm residual mass was 37%. The ratio of interval laparotomy was about 15%. Overall response rates of the first-line treatment of ovarian cancer was 82%, while the rate of complete remissions was 60%. The authors provide detailed analysis of factors that can improve the chemotherapy of ovarian cancer in Hungary.

Secretory breast cancer in a 7.5-year old boy

Breast cancer is extremely rare in children, and consequently no consensus has been reached on the optimal treatment modalities. The medical history and treatment plan for a 7.5-year old male breast cancer patient is described. Radical mastectomy with sentinel node biopsy was performed in October 2002. As no malignant cells were detected in the sentinel node, and no BRCA1-2 mutations were detected, no further radio- or chemotherapy was performed. A "wait-and-see" policy was decided on. Further treatment will be given if this becomes necessary with the development of metastases.

[Hungarian experience with docetaxel combination (TAC) in the adjuvant treatment of breast cancer. Results of BCIRG 001 randomized, multicentric, phase III trial]

AIM

The authors present the Hungarian interim analysis and experience with the BCIRG 001 randomized, multicentric, phase III clinical trial comparing TAC (docetaxel, doxorubicin, cyclophosphamide) and FAC (5-fluorouracil, doxorubicin, cyclophosphamide) in the adjuvant treatment of node positive breast cancer patients. The results are presented according to international data.

PATIENTS AND METHODS

Three Hungarian centers - St. Margit Hospital, Budapest, National Institute of Oncology, Budapest, Petz Aladár Hospital, Gyôr - participated in the international trial. Between June 1997 and June 1999, 61 patients with node positive breast cancer were enrolled in the study after the surgery. Thirty-four patients were randomized to TAC (75/50/500 mg/m2 6x q3wk) and 27 patients were randomized to FAC (500/50/500 mg/m2 6x q3wk) chemotherapy, with prospective stratification by node (1-3, 4+). In the case of patients with ER and/or PR positive tumours 5 years tamoxifen treatment was started. Radiotherapy was performed after the 6th cycle of chemotherapy.

RESULTS

36 months of follow up was performed. In both arms the hematological toxicity was more frequent. The TAC group showed a higher incidence of neutropenia (76%) compared to the FAC (22%), as well as a higher incidence of febrile neutropenia (26%), without grade 3-4 infection and there were no cases of septic death. Regarding non-hematological toxicity more grade 3-4 nausea and vomiting was observed in the FAC group. At three years follow up, the international results show statistically significant improvement in disease-free survival (82% vs. 74%, p=0.0011) in favour of TAC, and similar tendency was observed in the case of overall survival (92% vs. 87%, p=0.11). This benefit with TAC was seen regardless of hormone receptor status. Due to the low number of Hungarian patients we cannot declare the same results.

CONCLUSIONS

Based on the international analysis TAC was superior to FAC chemotherapy. Additional follow up data will evaluate the role of TAC in the adjuvant setting of early breast cancer treatment. The results indicate that TAC has the potential to be incorporated in the new strategies of adjuvant breast cancer treatments.

Adjuvant therapy of breast cancer with docetaxel-containing combination (TAC)

The adjuvant chemotherapy of breast cancer changed in the past two decades. Docetaxel containing regimens are highly active in metastatic breast cancer. A logical approach was their incorporation into trials of early breast cancer adjuvant therapy. The authors present the Hungarian interim analysis and experience with the BCIRG 001 randomized, multicentric, phase III clinical trial comparing TAC (docetaxel, doxorubicin, cyclophosphamide) and FAC (5-fluorouracil, doxorubicin, cyclophosphamide) in the adjuvant treatment of node positive breast cancer patients. The results are presented compared to the international data. Three Hungarian centers - Szt. Margit Hospital, Budapest, National Institute of Oncology, Budapest, Petz Aladár Hospital, Gyôr - participated in the international trial. Between June 1997 and June 1999, 61 patients with node positive breast cancer were enrolled in the study after the surgery. Thirty-four patients were randomized to TAC (75/50/500 mg/m2 6xq3wk) and 27 patients were randomized to FAC (500/50/500 mg/m2 6x q3wk) chemotherapy, with prospective stratification by node (1-3, 4+). Patients with hormone receptor positive tumors received tamoxifen for 5 years after the chemotherapy. Radiotherapy was performed after the 6th cycle of chemotherapy. 33 months of follow up was performed. In both arms the hematological toxicity was more frequent. The TAC group showed a higher incidence of neutropenia (76%) compared to the FAC (22%), as well as a higher incidence of febrile neutropenia (26 % versus none), without grade 3-4 infection and there was no cases of septic death. More grade 3-4 nausea and vomiting was observed in the FAC group. At three years follow up, results indicated improvement in disease-free survival (88% vs. 76%) in favour of TAC, and similar tendency was observed in the case of overall survival (97% vs. 88%). Based on the international data analysis TAC was superior to FAC chemotherapy, the results show statistically significant differences between the two arms. This benefit with TAC was seen regardless of hormone receptor status. Additional follow up data will evaluate the role of TAC in the adjuvant setting of early breast cancer treatment.

[Effectiveness of doxorubicin-docetaxel or doxorubicin-cyclophosphamide combination in advanced breast cancer with distant metastasis]

Between June 1996 and March 1998 a multinational multicentric phase III randomised comparative study was made for comparing 1. the effectiveness, 2. the adverse events and 3. the quality of life of two combinations i.e. DD versus DC. 18 patients were treated with DD and 15 patients with DC. Age, tumour stage, visceral involvement, receptor status were well matched in the two groups. Good partial remission was obtained in 10 patients treated with DD whereas only seven remissions were seen in the DC arm. Response duration was similar in the 2 arms. No difference in adverse events was observed.

[The role of irinotecan in the treatment of advanced colorectal cancer]

PURPOSE: The purpose of the study was the evaluation of efficacy and the side effects of irinotecan in treatment of advanced colorectal cancer. METHODS: The authors presented their experiences with irinotecan in the treatment of 10 patients suffering from advanced colorectal cancer. The dose of irinotecan was 350 mg/m(2) every 21 days. Seven out of ten patients have taken oral fluoroquinolon to investigate its effect on the incidence of febrile episodes in case of febrile neutropenia. Three out of ten patients did not receive any antibiotic. The authors have examined the efficacy and safety of the treatment. RESULTS: One complete remission was obtained. Authors describe the observed side effects and the administered supportive care against serious complications. DISCUSSION: Serious diarrhoea has not been found in case of these 10 patients. The diarrhoea caused by irinotecan can be stopped by loperamide. The authors give accounts of early and following results.

[Irinotecan--experience with second-line treatment in advanced colorectal cancer]

The prognosis for patients with advanced colorectal cancer who fail to respond to a 5-FU based therapy is poor. About 7% response rate can be achieved with second line therapeutic regiments, the overall survival is about 6-7 months. The aim of authors was to assess the efficacy and toxicity profile of irinotecan (CAMPTO) in patients with advanced colorectal cancer, resistant to 5-FU based chemotherapy. From October 1996 to November 1998 19 previously treated metastatic colorectal cancer patients with documented progression were recruited. Irinotecan was given at a dose of 350 mg/m2 i.v. over 90 min. every 3 week. Tumor response and toxicity were assessed using WHO criteria. Median age: 59.7 years (42-72). Tumor sites: 12/19 colon, 7/19 rectum. 11/19 patients had 1 metastatic site, 8/19 had 2 or more metastatic sites. CR: 0/19, PR: 3/19, MR: 2/19, SD: 10/19, PD: 4/19. Median time to progression was 9.1 months (range 1.5-22). The overall median survival was 15.5 months (range 2.5-37). Grade 3-4 delayed diarrhoea occurred in 26.3% of patients. Grade 3 neutropenia occurred in 15.7% of patients. Preliminary results confirm the clinical value of irinotecan in 5-FU resistant metastatic colorectal cancer with tolerable toxicity profile. Irinotecan should be considered as the basic chemotherapeutic agent for second line treatment of metastatic colorectal cancer.

The efficacy of a combination of etoposide, ifosfamide, and cisplatin in the treatment of patients with soft tissue sarcoma

BACKGROUND

Successful chemotherapy for patients with soft tissue sarcoma (STS) has been limited by a lack of active drugs. The most effective single agents are doxorubicin, dacarbazine, and, more recently, ifosfamide. Previously the most widely used combination has been CYVADIC (cyclophosphamide, vincristine, doxorubicin, and dacarbazine). In one randomized trial, ifosfamide was superior to cyclophosphamide; two nonrandomized studies also reported favorable results. Etoposide monotherapy was successful in 8%; the effectiveness of cisplatin was 5-23%. In view of these findings, the authors treated STS patients with an etoposide, cisplatin, and ifosfamide (VIP) combination.

METHODS

The eligibility criteria included histologically confirmed, inoperable, metastatic or locally recurrent STS; a World Health Organization (WHO) performance status of 0-2; a maximum age of 75 years; and progressive, measurable disease. A total of 104 patients were treated from January 1990 to June 1997. The median age of the patients was 42.4 years. The patients were treated with a combination of etoposide (100mg/m(2) for 5 days), ifosfamide (2000 mg/m(2) for 2 days), and cisplatin (20mg/m(2) for 5 days) once a month via a peripheral vein. The treatment response and the toxicity were assessed according to WHO criteria.

RESULTS

Of 104 evaluable patients, 47 responded. The overall response rate was 46% (complete response: 10%; partial response: 36%). In 43 patients the disease remained stable (41%). Remission duration was 4.6 months. Toxicity was moderate. The main adverse events were alopecia (100%), nausea and vomiting (73%), and leukopenia (29%).

CONCLUSIONS

This new combination is promising for the treatment of patients with advanced STS.

[Taxotere phase III trial on the first-line treatment of metastatic breast cancer]

OBJECTIVES: Doxorubicin and taxanes are the most effective agents in the treatment of advanced breast cancer. The aim of the study was to compare the efficacy of Doxorubicin (A) + Docetaxel (T) (AT) and standard Doxorubicin (A) + Cyclophosphamide (C) (AC) chemotherapy. MATERIALS AND METHODS: Results of first-line AT (50/75 mg/m2) and AC (60/600 mg/m2) D 1 q 3 wk, maximum of 8 cycles, were compared. Three Hungarian centers - Petz Aladár County Teaching Hospital, Gyôr, St.Margit Hospital, Budapest, and BAZ County Hospital, Miskolc, with 33 patients participated the international, phase III randomized TAX 306 trial. Between June, 1996 and March, 1998, 429 metastatic breast cancer patients were enrolled in the study. Eligible patients were who had not received prior chemotherapy for advanced disease, and were anthracycline-naive. Objective response rate observed in the AT arm was significantly higher than in the AC arm (ORR: 60% vs. 47%, p=0.008). Time to progression was longer in the AT group (37.1 weeks vs. 31.9 weeks, p=0.0153). Except for higher incidence of neutropenia not requiring dose modification in the AT arm, there were no major differences concerning toxicity. T did not enhance cardiac toxicity induced by A. CONCLUSION: AT results in significantly higher response rate and longer time to progression than AC in advanced breast cancer, even in patients with unfavourable prognosis.

Changes in apoptotic and mitotic activity in rectal carcinoma after short-term cytostatic therapy as possible predictive factors

Fifteen patients with rectal adenocarcinoma were endoscopically biopsied and given short-term [5 fluorouracil (5FU) (600 mg/m2) and Ca-Folinate (60 mg/m2) for two days] cytostatic therapy. Seven days later the tumor was resected or a second biopsy was performed. Apoptotic and mitotic indices were determined in the tumor tissue before and after the short-term chemotherapy. The patients were treated thereafter with long-term, intermittent 5 FU administration and followed up clinically for 4-13 months. Three patients showed progression of the disease, twelve improved or showed no tumor progression. An increase of the apoptotic index and decrease of the mitotic index after the short-term cytostatic treatment were seen in the tumor tissue of responder cases. Non-responders showed increase or no change in mitotic activity, and decrease or no change in apoptotic activity. These findings suggest that apoptotic and mitotic response to short-term cytostatic therapy may be additional predictive factor in rectal adenocarcinoma.

[Low-dose leucovorin and interferon-alpha as modulators of 5-fluorouracil for adjuvant chemotherapy of colorectal cancer]

It has recently been published the results of a prospective, comparative study for adjuvant chemotherapy of 164 colorectal cancer patients. Pathological stages were Dukes B 79, C 85 of the cases. The site of primary tumour was colon 108, rectum 56 of the patients. The treatment protocols were as follows: 425 mg/m2 5-fluorouracil plus 20 mg/m2 leucovorin on days 1-5 at 28 days cycles six times (LV group). The IFN group received the same chemotherapy completed with weekly 3 x 3 MIU interferon alpha. Both treatment groups were well balanced. The mean follow up time was 38.1 months. There were 91 patients of relapse and 65 deaths this time. The time to progression was 15 months in the LV group and 12.7 months in the IFN group (p < 0.05). The mean survival time was 24 months in the LV group compared to 22.3 of the IFN group. The frequency and sites of relapses did not differ statistically between the both groups. The preoperative CEA-level was elevated in 42 cases. The mean survival time was 26.4 months in the cases having normal CEA-level compared to 16.1 months of the cases with high-level (p < 0.001). The side-effects were transient and mild, while in the group treated with interferon were more instances of fever, fatigue, flu-like syndrome, psychic disorders, depression and agitation. The administration of interferon had to be interrupted in 4 cases. The results of interim analysis suggest choosing the so-called Mayo protocol for the standard adjuvant treatment of colorectal cancer.

[Experience with surgical treatment of osteosarcoma]

The authors treated 79 patients with osteosarcoma by surgery and chemotherapy 1975 through 1991. The appearance, localization and differential diagnosis are discussed. Attention is called to the doctor's delay. The effective pre- and postoperative chemotherapy decreased the incidence of the lung metastases and increased the survival rate (71% 3 years overall survival and 41% 5 years survival) and made the limb-sparing surgery possible. The development of the reconstructive surgical technique and new designs of tumor endoprostheses enabled us to perform limb-sparing surgery in more than one third of the cases at the same survival chance. The limb-sparing means a decisive change in the quality of the rehabilitation of the osteosarcoma patients.

Pain killing with calcitonin nasal spray in patients with malignant tumors

The physiological role of calcitonin is the preservation of osseal integrity by reducing the osteoclast activity. On the other hand, this 32 amino acid peptide acts as an analgetic drug in cancer caused by osteolytic metastases. In previous studies using injection form the pain killing activity was observed in 65% of the patients. As medical assistance is required for this treatment form, it was decided to compare the pain reducing activity of nasal spray with the ampule form. It was found that 300 MRC units of nasal spray equalled 100 MRC units injection. The pain killing activity was observed in 53.8% of the patients. The reduction in quantity of other analgetics used daily was 48.5%. The average decrease of the pain duration (in h) was 42.5%. The pain intensity measured by visual analogue scale dropped to 2.13 from 3.00. The results are similar to the analgetic effect observed in the injection form. Taking this into consideration, calcitonin nasal spray is highly recommended instead of ampules.

Follicular cancer of the thyroid gland

Between 1965 and 1987 the authors studied the survival of 169 patients (130 females, 39 males) suffering from follicular thyroid cancer. It is established that the factors favorably influencing the course of the disease are as follows: age below 40 years, female sex, tumor location inside the thyroid capsule. Radical surgery does not affect the survival, though it prolongs the time to the onset of metastases. In women below 40 years of age, iodine treatment performed within 1.5 months following surgery does not increase the effectiveness; therefore, its routine application is not recommended. In case of local metastases associated with hindered swallowing or respiration, external beam radiotherapy is indicated. Hormone substitution ensuring TSH restriction results in improved prognosis.

Effect of toremifene in breast cancer patients. Preliminary communication

Toremifene, an antiestrogenic drug administered at three dose levels (60, 120, and 300 mg/day) was investigated in 17 postmenopausal patients with advanced breast cancer previously treated with hormonal and/or cytostatic therapy. The drug proved to be well tolerated at all dose levels without any serious side effects even on prolonged administration. Neither response nor side effects have shown any dose dependency in this small group of patients.

Coincidental papillary carcinoma of the thyroid in two sisters

A coincidentally occurring papillary cancer of the thyroid in two sisters is discussed. No clinical, biochemical or chromosomal changes were found in these cases which could have shown any inheritable feature. It is concluded that, in contrast with the previous data, the simultaneous manifestation is not a peculiar feature but a fortuitous appearance.

[Follow up of thyroglobulin levels in patients with surgically treated, highly differentiated thyroid cancer]

The highly differentiated thyroid tumours account for 0.80 percent of all human malignancies. The papillary and follicular tumour tissues of this tumour type are relatively benign, hormone dependent and beside their treatment specificity they secrete the tumour specific thyreoglobulin. Thus it becomes possible to follow the development of metastases, the effectiveness of therapy applied as well as the history of the disease. The authors studied the change of thyreoglobulin level in 153 patients with highly differentiated thyroid cancer. In 29 of 32 metastatic patients pathologically elevated (70 to 100 ng/ml) thyreoglobulin level was observed. This proves the 91 percent specificity of the method in verified metastatic tumours. Compared to the total body scintigraphy 3 false negative cases were found. The authors establish that, irrespective of the site of metastasis, the thyreoglobulin level is higher in the follicular than in the papillary subtype. It is concluded that the measurement of the serum thyreoglobulin level is a suitable marker of the highly differentiated thyroid cancer since it represents the local recurrence of distant metastases with a significant increase while the therapy-resultant tumour diminution with a marked decrease, respectively.

[Trends in the hormonal therapy of thyroid cancer]

The highly differentiated thyroid cancers account for 0.70% of malignancies. Their management is primarily hormonal, in addition to the percutaneous irradiation and application of iodine isotope. This method is not aimed at the inhibition of the potential artificial hypothyreosis but mainly at the prevention of the tumour development or tumorous dissemination. The authors, in case of their 28 patients with the above diagnosis, tried to clarify if the TRH-tolerance TSH-level determination promotes the optimal patient management, the ideal hormone substitution lasting for several years. Their results suggest that the drugs containing L-thyroxin prove to be most effective in the clinical practice. Their optimal dose is 2.8-3.0 micrograms/kg. The study of the TRH-sensitized TSH-level does not primarily facilitate the ideal hormone substitution but may decrease the "unnecessary" amount of thyroid hormone-containing drugs. In view of the fact that the hormonal treatment may last even several decades for a patient, the authors considering economic points as well, do not reject the TRH-tolerance TSH-study. In their opinion the more favourable solution may be provided by the wide-scale application of the IRMA-TSH.

Postoperative thyroglobulin level determination to follow up patients with highly differentiated thyroid cancer

The highly differentiated thyroid tumours account for 0.80% of all human malignancies. The papillary and follicular tumour tissues of this tumour type are relatively benign, hormone-dependent and beside their treatment specificity they secrete the tumour-specific thyroglobulin. This it becomes possible to follow the development of metastases, the effectiveness of therapy applied as well as the history of the disease. The authors studied the change of thyroglobulin level in 153 patients with highly differentiated thyroid cancer. In 29 of 32 metastatic patients a pathologically elevated (70-100 ng/ml) thyroglobulin level was observed. This proves the 91% specificity of the method in verified metastatic tumours. Compared to the total body scintigraphy 3 false-negative and 6 false-positive cases were found. The authors establish that, irrespective of the site of metastasis, the thyroglobulin level is higher in the follicular than in the papillary subtype. It is concluded that the measurement of the serum thyroglobulin level is a suitable marker of the highly differentiated thyroid cancer since it indicates local recurrence or distant metastases by a significant increase while therapy-resultant tumour diminution is accompanied by a marked decrease.

Activity of epirubicin in combination chemotherapy of advanced ovarian cancer. Results of the South-East European Oncology Group (SEEOG) Study

The therapeutic efficacy of the combination of cyclophosphamide + epirubicin + cisplatin was evaluated in 107 previously treated or untreated patients with advanced ovarian cancer. The overall response rate was 58.8%, complete remission 36.4% (mean duration-7.62 months) and partial remission 22.4% (mean duration-6.74 months). The response was rated in function of age, menopausal status, performance status and previous therapy. Toxicity (in case of 109 patients) was evaluated according to the WHO recommendation. The similar therapeutic effectiveness and less toxicity of the above drug combination compared to CAP regimen is demonstrated.

Pain killing with calcitonin in patients with malignant tumours

The most essential role of Miacalcic (Calcitonin Sandoz), a 32-amino-acids peptide, is the preservation of osseal integrity. Based on this physiological fact it is assumed that this hormone may have a bone-regenerating effect in bone metastasis formation and sometimes in other malignancies. Though no considerable calcium incorporation could be revealed in our 58 patient treated with Miacalcic, a marked relief of pain was observed in 65.5% of the patients. For objectivation of the subjective pain sensation, the decrease in the quantity of other analgetics used daily, duration of pain and changes of its intensity were studied. These figures were 35.4% on the average, from 12.5-6 h and 23.6%, respectively. The pain-killing character of Miacalcic cannot be explained, but the following assumptions are made: (1) it partially inhibits the synthesis of algogenous peptides; (2) with its possibly cytostatic effect it inhibits the cell proliferation in loco and normalizes the internal pressure of the destroyed region, and (3) by conversion into beta-endorphin it exerts its effect centrally. Compared to the pain-killing effect, the simultaneous improvement of the quality of life seems to be even more essential. It has been proved earlier that a hormone physiologically present, when applied in a high dose, has an analgetic effect, i.e. by utilizing the endogenous substance of the organism, relief of pain can be achieved. We should like to point out that Miacalcic is the only analgetic agent capable of ensuring relief of pain with a simultaneous improvement of the quality of life. Accordingly, the application of Miacalcic in patients suffering from malignant tumours is highly recommended.

Host cell and virus strain differences in synthesis of immediate early polypeptides in HSV-1 infected cells

The synthesis of the immediate early (IE) polypeptides was analysed in primary rabbit kidney (RK) cells and a stable line of rabbit lung (ZP) cells infected with the syncytial (syn) strain HSZP and the non-syn strain KOS of herpes simplex virus type 1 (HSV-1). Results showed the following: After cycloheximide reversal the infection of RK and ZP cells with HSZP strain led to synthesis of five IE polypeptides (175K, 136K, 87K, 68K, and 63K), while infection of both cell cultures with the KOS strain led to synthesis of significantly reduced amounts of the IE polypeptides. The ability to switch on the expression of non-alpha viral genes was impaired in RK cells infected with the HSZP strain. The IE polypeptides were still detectable without any sign of the non-IE polypeptide synthesis 4 hr after cycloheximide reversal. The observed failure of the IE HSZP polypeptides to undergo posttranslational modification in ZP cells may be the consequence of this phenomenon. In contrast to the KOS IE mRNAs, the HSZP IE mRNAs exhibited a pronounced functional stability in both cell cultures. The IE polypeptides were still synthesized in HSZP-infected cells which had been incubated for 19 hr after cycloheximide reversal in the presence of actinomycin D (Act D). The HSZP strain failed to suppress the host polypeptide synthesis in RK but not in ZP cells. However, the HSZP strain, in contrast to the KOS strain, proved to be defective with respect to the early shutoff of host polypeptide synthesis in both cell cultures.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative studies on activation of latent herpes simplex virus in rabbits

Latent infection was established in 113 rabbits by inoculation of herpes simplex virus type 1 (HSV-1) strain Kupka into the right scarified cornea. In animals succumbed from 88-387 days post-infection (p.i.), HSV-1 was detected in the cultured right cornea (RC) fragments of 2 out 45 rabbits (4.4%), while the cultured right trigeminal ganglion (RTG) fragments yielded virus in 60 out 70 animals (85.7%). Spontaneous virus shedding occurred nearly in the half (35) of 74 animals followed for a mean of 211 days; providing that swabbing of both eyes was made 1-2 times weekly, the positive isolation rate was 1.3% (73 out total 5648 samples). The following treatments were used for provocation: cyclophosphamide (CPA) alone, mechanical trauma to cornea in association with local administration of either xylene or adrenalin, and a combination of both CPA administration and corneal irritation. In the course of these treatments continued for 4-8 days, virus was reisolated in 9 out 59 rabbits, the average positive isolation rate from RC being 6.9% (29 out 420 samples). HSV-specific antigens were searched for in about 56 000 semiserial sections prepared from noncultured as well as cultured samples of RC, both Gasserian ganglia and brainstem coming from 87 rabbits with established latency, of which 42 underwent provocation. By direct fluorescent antibody (FA) staining single neurons positive for structural HSV antigens were found in 14% of noncultured RTG samples from untreated rabbits as compared to 37% of such samples from animals subjected to provocation. In the course of above treatments, explanted RC fragments were positive in 17 out of 42 animals (40.4%) indicating a 9-fold increase in comparison to non-stimulated rabbits. The results confirm the absence of any virus, either infectious or covert, at the inoculation site in 95.6% of rabbits autopsied later than 12 weeks p.i. They also imply that a reversed transport of HSV occurred upon either spontaneous of artificial virus activations.

Protein synthesis in pig kidney cells infected with herpes simplex virus type 1

Two polypeptides of apparent mol. mass 87,000 and 35,000 were identified in pig kidney cells infected with herpes simplex virus type 1 (HSV-1) after reversing the cycloheximide block. The synthesis of the polypeptide 87,000 declined from 22 hr post infection (p.i.). Its production was prevented by actinomycin D added to the infected cells after removal of cycloheximide. Evidence is presented that the polypeptide 35,000 may be of the cellular origin.

The continuing problem of herpes simplex virus persistence

While the main interest in the pathogenesis of herpes simplex virus (HSV) in the sixties had been focussed on acute infections, in the seventies latent infection has become the main foal of investigation. Despite of overwhelming literature, the HSV persistence has remained a continuing problem from the practical as well as theoretical points of view. Nevertheless, the following conclusions can be made: 1) HSV spreads along nerves inside as well as outside axons; 2) it resides in a non-productive form for lifelong in the sensory or vegetative ganglia; and 3) it is intermittently activated when causing peripheral virus shedding or recurrent disease. The persistence of HSV DNA in neurons may be associated with a limited transcription and translation, but the ganglia in a great majority of subjects are uninfectious during the latency period.

Restricted replication of herpes simplex virus type 1 in pig kidney cells

Pig kidney (PK) cells infected with herpes simplex virus type 1 (HSV-1) strains HSZP and RO, respectively, synthesized low amounts of infectious virus; virus-specific antigens detected by immunofluorescence (IF) staining were seen only in a small proportion of cells. When propagated in 2-4 subsequent passages, PK cells infected with the HSZP strain (PK-HSZP cells) became free of infectious virus and virus-specific antigens as detected by IF staining. In contrast, PK cells infected with the RO strain (PK-RO cells) permanently harboured the infectious virus and virus-specific antigens in the course of 10 subsequent passages. The latter were detectable 48-72 hr after seeding. The constantly low virus yields were significantly enhanced when restrictive PK cells were mixed with permissive ZP cells. Cocultivation of variable amount of PK cells (at the 2nd, 5th and 7th passages) with a constant number of ZP cells showed that 10(2)-10(3) PK cells were necessary to transfer the HSV to indicator cells. Immediate early and early HSV-1 coded antigens were seen by IF in the nuclei of a small proportion of PK-RO cells; similarly, virion and nucleocapsid antigens were found in the nuclei and cytoplasm of a few cells of the PK-RO monolayers.