Modification of the chemically induced inflammation assay reveals the Janus face of a phenol rich fulvic acid

Inflammation is an essential process as a reaction towards infections or wounding. Exposure to hazardous environmental pollutants can lead to chronic inflammations, where the resolving phase is delayed or blocked. Very contradictory studies have been reported on the pro- and anti-inflammatory effects of humic substances (HSs) leading to significant disagreements between researchers. To a certain extent, this can be attributed to the chemical heterogeneity of this group of xenobiotics. Here we show for the first time that pro- and anti-inflammatory effects can occur by one HSs. We adapted an assay that uses green fluorescence-labeled zebrafish larvae and CuSO₄ to indue an inflammation. In wild-type larvae, exposure to 50 µM CuSO₄ for 2 h activated the production of reactive oxygen species, which can be monitored with a fluorescence dye (H2DCFDA) and a microplate reader. This allows not only the use of wild-type fish but also a temporal separation of copper exposure and inflammatory substance while retaining the high throughput. This modified assay was then used to evaluate the inflammatory properties of a fulvic acid (FA). We found, that the aromatic structure of the FA protects from inflammation at 5 and 50 mg C/L, while the persistent free radicals enhance the copper-induced inflammation at ≥ 300 mg C/L.

Fulvic acid accelerates hatching and stimulates antioxidative protection and the innate immune response in zebrafish larvae

Aquaculture plays a pivotal role in covering dietary animal protein demands and restocking endangered fish populations. However, high mortality takes place at the earliest life stages: prior and immediately after hatching. Improving growth and health parameters by immunostimulants is widely used in older fish, but rarely studied in larvae. Fulvic acids (FAs) are natural substances found in soil and water. Using zebrafish as a model organism, we evaluated the effects of exposure to a FA at concentrations ranging from 1 to 500 mg C/L (mg dissolved organic carbon per liter) on embryonic development. Furthermore, the concentration of reactive oxygen species (ROS) inside the larvae as well as the molecular mechanisms involved in growth, immune response, and antioxidative protection were determined at 5, 50, and 500 mg C/L. 20 to 200 mg C/L accelerated the hatching, which was mediated by increased expression of ifg-1, gh, and he1-α. Furthermore, lyz and mpx were significantly increased at 5 and 50 mg C/L. A concentration of 500 mg C/L induced genes involved in the protection against ROS (nrf-2, keap-1, cat, sod-1), increased the concentration of ROS inside the larvae and caused tissue damage and mortality. Interestingly, 50 mg C/L activated ROS protection as well (nrf-2, sod-2), while no increase of ROS was found in the larvae. Our results show, that FA at low to medium concentrations can increase the health of larvae, but becomes detrimental at higher concentrations.

Innate immunity, oxidative stress and body indices of Eurasian perch Perca fluviatilis after two weeks of exposure to artificial light at night

Artificial light at night (ALAN) can disrupt biological rhythms of fish and other vertebrates by changing the light information of the nocturnal environment. Disrupted biorhythms can impair the immune system of vertebrates as it has been shown for conditions with continuous illumination or long-day photoperiod in many vertebrates, including fish. Nonetheless, this has not been shown so far for typical ALAN scenarios with high light intensities during day and low light intensities at night. Therefore, in this study, proxies for the innate immune system and oxidative stress as well as body indices of Eurasian perch Perca fluviatilis were measured under a wide range of intensities of nocturnal illumination. The authors found no changes in parameters of the innate immune system and no significant changes in proxies for oxidative stress after 2-week exposures to nocturnal illuminance ranging from 0.01 lx to 1 lx in one experiment or from 1 lx to 100 lx in a second experiment. A decrease in the hepato-somatic index at the highest tested light intensity of 100 lx compared to the dark control was the only significant difference in all parameters among treatments. After 2 weeks of exposure, ALAN does not seem to seriously challenge the innate immune system and seems to cause less oxidative stress than expected. The results of this study contradict the findings from other studies applying continuous illumination or long-day photoperiod and highlight the importance of further research in this field. Because ALAN represents a sustained modulation of the environment that may have cumulative effects over time, long-term studies are required for a better understanding of how ALAN modulates the health of fish.

Encapsulation of Anguillicola crassus reduces the abundance of adult parasite stages in the European eel (Anguilla anguilla)

Encapsulation of the parasitic nematode Anguillicola crassus Kuwahara, Niimi & Hagaki is commonly observed in its native host, the Japanese eel (Anguilla japonica Temminck & Schlegel). Encapsulation has also been described in a novel host, the European eel (A. anguilla L.), and there is evidence that encapsulation frequency has increased since the introduction of A. crassus. We examined whether encapsulation of A. crassus provides an advantage to its novel host in Lake Müggelsee, NE Germany. We provide the first evidence that encapsulation was associated with reduced abundance of adult A. crassus. This pattern was consistent in samples taken 3 months apart. There was no influence of infection on the expression of the two metabolic genes studied, but the number of capsules was negatively correlated with the expression of two mhc II genes of the adaptive immune response, suggesting a reduced activation. Interestingly, eels that encapsulated A. crassus had higher abundances of two native parasites compared with non-encapsulating eels. We propose that the response of A. anguilla to infection by A. crassus may interfere with its reaction to other co-occurring parasites.

Phenol-rich fulvic acid as a water additive enhances growth, reduces stress, and stimulates the immune system of fish in aquaculture

Aquaculture has become imperative to cover the demands for dietary animal protein. Simultaneously, it has to overcome prejudices from excessive use of antibiotics and environmental impacts. Natural supplements are traditionally applied orally. In this study, we demonstrated another pathway: the gills. Humic substances are immunostimulants and a natural part of every aquatic ecosystem, making them ideal to be used as bath stimulants. Five and 50 mg C/L of a fulvic acid-rich humic substance was added for 28 days to the water of juvenile rainbow trout (Oncorhynchus mykiss). This fulvic acid is characterized by a high content of phenolic moieties with persistent free radicals and a high electron exchange capacity. The high concentration of the fulvic acid significantly increased growth and reduced the food conversion ratio and the response to a handling-stressor. Phagocytosis and potential killing activity of head kidney leukocytes were increased, as well as the total oxyradical scavenging capacity (TOSC) and lysozyme activity in the gills. In conclusion, immunostimulation via gills is possible with our fulvic acid, and the high phenolic content improved overall health and stress resistance of fish.

Gene expression response to a nematode parasite in novel and native eel hosts

Invasive parasites are involved in population declines of new host species worldwide. The high susceptibilities observed in many novel hosts have been attributed to the lack of protective immunity to the parasites which native hosts acquired during their shared evolution. We experimentally infected Japanese eels (Anguilla japonica) and European eels (Anguilla anguilla) with Anguillicola crassus, a nematode parasite that is native to the Japanese eel and invasive in the European eel. We inferred gene expression changes in head kidney tissue from both species, using RNA-seq data to determine the responses at two time points during the early stages of infection (3 and 23 days postinfection). At both time points, the novel host modified the expression of a larger and functionally more diverse set of genes than the native host. Strikingly, the native host regulated immune gene expression only at the earlier time point and to a small extent while the novel host regulated these genes at both time points. A low number of differentially expressed immune genes, especially in the native host, suggest that a systemic immune response was of minor importance during the early stages of infection. Transcript abundance of genes involved in cell respiration was reduced in the novel host which may affect its ability to cope with harsh conditions and energetically demanding activities. The observed gene expression changes in response to a novel parasite that we observed in a fish follow a general pattern observed in amphibians and mammals, and suggest that the disruption of physiological processes, rather than the absence of an immediate immune response, is responsible for the higher susceptibility of the novel host.

Potash mining effluents and ion imbalances cause transient stress in adult common roach, Rutilus rutilus

A present ecological issue causing secondary salinization in different countries is the discharge of effluents by the potash mining industry. In Germany, the River Werra is used as a sink for potash mining discharges containing high concentrations of ions, predominantly Cl^-, K⁺, Na⁺, and Mg²⁺ resulting in a strong decline of the biodiversity and abundance of local species. However, hardly anything is known about the acute and chronic physiological effects of high concentrations and imbalances of ions being prevalent in potash mining effluents in fish. Therefore, the stress response and selected immune and growth parameters were investigated in standardized laboratory experiments. A native freshwater fish species, Rutilus rutilus, was exposed to concentrations of the high currently allowed (HT) and lowered future thresholds (LT) and three different ion solutions (containing high Mg²⁺ (Mg), high K⁺ (K) and high Mg²⁺+K⁺ (Mg+K) concentrations) for four different exposure times (24 h, 7 d, 21 d, 8 wk). Tank water (additionally after 9 and 12 h) and plasma cortisol, glucose and protein, hematocrit and hemoglobin were determined after each exposure time. Furthermore, plasma lysozyme and head kidney leucocyte respiratory burst activity (only after 21 d) were evaluated as well as growth parameters. A transient stress response was induced in almost all groups. Tank water cortisol was elevated after 9 h in HT, LT and Mg+K and in HT after 12 h, whereas glucose concentrations increased after 24 h in all exposure groups except K. HT led to enhanced hematocrit and hemoglobin content after 24 h. Plasma protein, immune system and growth were not affected in any group. None of the ion solutions induced acute toxicity but most triggered typical acute stress reactions. Rather the sum of high ion concentrations than single ions challenged the fish. Even though the effects observed in adult roach were only transient and indicate acclimatization under laboratory conditions, adverse effects observed in the river are evident and further research on physiological endpoints including reproductive parameters and impacts on younger life stages seem to be needed to scientifically base protective thresholds.

Application of low-frequency sonophoresis and reduction of antibiotics in the aquatic systems

A major concern in aquaculture is the use of chemical therapeutics, such as antibiotics, because of their impact on the environment as well as on the fish product. As a potential tool for reducing antibiotic use, we tested the application of low-frequency ultrasound as a method for enhancing antibiotic uptake. Rainbow trout juveniles (Oncorhynchus mykiss) were exposed to two different concentrations of oxytetracycline (OTC), flumequine (FLU) and florfenicol (FLO), administered by bath after the application of ultrasound. After exposure, concentrations of these substances were measured in the liver and blood of treated fish. Results showed that the ultrasound treatment can significantly increase the uptake for all three antibiotics. The uptake of OTC for example, in fish exposed to an OTC concentration of 20 mg L^-1 after prior treatment with ultrasound, was similar to the OTC concentrations in their liver and blood to fish exposed to 100 mg L^-1 without sonication. For FLU and FLO, the use of ultrasound caused significant differences of uptake in the liver at high antibiotic concentrations. This suggests that the use of ultrasound as a technique to deliver antibiotics to fish can ultimately reduce the amount of antibiotics discharged into the aquatic environment.

The adjuvant effect of low frequency ultrasound when applied with an inactivated Aeromonas salmonicida vaccine to rainbow trout (Oncorhynchus mykiss)

Vaccine adjuvants are classified according to their properties of either inducing the persistence of antigens within the animal after immunisation and/or activation of the animal's immune response. The adjuvant effect of low intensity low frequency sonophoresis (LFS) was tested in rainbow trout using an Aeromonas salmonicida bacterin vaccine administered by immersion vaccination using LFS at 37 kHz. The adjuvant effect obtained with LFS was compared with that of normal immersion or intraperitoneal injection vaccination. Quantitative PCR was used to measure bacterial DNA in vaccinated fish up to 35 days post-vaccination, while RT-qPCR was used to assess gene expression during the early and late immune response post-vaccination. Results showed that antigen uptake in the gills was significantly higher in the group exposed to low intensity LFS compared to the other two vaccination groups 15 min post-vaccination, but this initially high uptake did not persist over the rest of the experiment. In the kidney, by comparison, the vast majority of the samples analysed did not show the presence or persistence of the bacterin. Showing that the route of vaccine uptake using the A. salmonicida bacterin, does not influence the persistence of the bacterin in the gills or the kidney. On the other hand, LFS induced a higher inflammatory response and T-helper cell activation, characterized by a significant up-regulation of interleukin-8 (IL-8), IL-1ß and CD-4, respectively. The expression of Ig-M, Ig-T and Ig-D was up-regulated in gills (being significant for Ig-M), but not in the spleen and kidney of the sonicated group. Conversely, Ig-M was up-regulated in the spleen of the non-sonicated groups, but not in the sonicated group. This highlights the ability of ultrasound to enhance mucosal immunity. It remains to be established whether the up-regulation of Ig-M in gills would be sufficient to offer protection in fish infected with A. salmonicida.

Nematode eel parasite found inside acanthocephalan cysts--a "Trojan horse" strategy?

BACKGROUND

The invasive eel parasite Anguillicoloides crassus (syn. Anguillicola crassus) is considered one of the major causes for the decline of the European eel (Anguilla anguilla) panmictic population. It impairs the swim bladder function and reduces swimming performance of its host. The life cycle of this parasite involves different intermediate and paratenic hosts. Despite an efficient immune system of the paratenic fish hosts acting against infections with A. crassus, levels of parasitized eels remain high in European river systems. Recently, the round goby Neogobius melanostomus (Gobiidae) has become dominant in many rivers in Europe and is still spreading at a rapid pace. This highly invasive species might potentially act as an important, so far neglected paratenic fish host for A. crassus.

METHODS

Based on own observations and earlier single sightings of A. crassus in N. melanostomus, 60 fresh individuals of N. melanostomus were caught in the Rhine River and examined to assess the infection levels with metazoan parasites, especially A. crassus. Glycerin preparations were used for parasite identification.

RESULTS

The parasite most frequently found in N. melanostomus was the acanthocephalan Pomphorhynchus sp. (subadult stage) which occurred mainly encysted in the mesenteries and liver. Every third gobiid (P = 31.7%) was infected by A. crassus larvae (L3) which exclusively occurred inside the acanthocephalan cysts. No intact or degenerated larvae of A. crassus were detected elsewhere in the goby, neither in the body cavity and mesenteries nor in other organs. Affected cysts contained the acanthocephalan larvae and 1-12 (mI =3) living A. crassus larvae. Additionally, encysted larvae of the nematode Raphidascaris acus were detected in the gobies, but only in the body cavity and not inside the acanthocephalan cysts.

CONCLUSIONS

Based on our observations, we suggest that A. crassus might actively bypass the immune response of N. melanostomus by invading the cysts of acanthocephalan parasites of the genus Pomphorhynchus using them as "Trojan horses". Providing that eels prey on the highly abundant round goby and that the latter transfers viable infective larvae of A. crassus, the new paratenic host might have a strong impact on the epidemiology of A. crassus.

Der Aktivierungsquerschnitt von Silicium-30 für thermische Neutronen

Durch gleichzeitige Aktivierung von Gold und Silicium im Wasserreflektor des Reaktors wurde der Wirkungsquerschnitt der Reaktion 30Si (n,γ) 31Si für thermische Neutronen zu σ0= (103 ± 3) mbarn bestimmt.

Enhanced Aeromonas salmonicida bacterin uptake and side effects caused by low frequency sonophoresis in rainbow trout (Oncorhynchus mykiss)

Low frequency sonophoresis (LFS) has been recognized as one of the most advanced technologies in transdermal delivery of substances, due to the modification of the stratum corneum lipid bilayer, in focal skin applications in mammals. Based on these findings, LFS has been suggested as a potential technology to be used for enhancement in immersion fish vaccination. In contrast to mammals where LFS is applied to discrete regions of the skin, in fish the whole individual needs to be exposed for practical purposes. The current study evaluated the impact of LFS at 37 kHz on the uptake of an Aeromonas salmonicida bacterin and side effects of the treatment in rainbow trout. Quantitative real time PCR (qPCR) and immunohistochemistry were used to examine the bacterin uptake into skin and gill tissue. Side effects were assessed by behavioural examination, histology and blood serum analysis. The sonication intensity of 171 mW/cm² was enough for increasing skin permeability, but caused heavy erratic swimming and gill haemorrhages. Sonication intensities as low as 105 mW/cm² did not modify skin permeability and enhanced the bacterin uptake into the gill tissue by factor 15 compared to conventional immersion. Following sonication, the gill permeability for the bacterin decreased after 20 min and 120 min by factor 3 and 2, respectively. However, during sonication, erratic swimming of the fish raised some concerns. Further reduction of the sonication intensity to 57 mW/cm² did not induce erratic swimming, and the bacterin uptake into the gill tissue was still increased by factor 3. In addition, a decreasing albumin-globulin ratio in the serum of the rainbow trout within 40 min revealed that LFS leads to an inflammatory response. Consequently, based on both increased bacterin uptake and the inflammatory response, low intensity LFS has the potential to enhance vaccine immunity without significant side effects.

Low frequency ultrasound and UV-C for elimination of pathogens in recirculating aquaculture systems

Low frequency ultrasound (LFUS) was evaluated as a novel disinfection technique within recirculating aquaculture systems both individually and combined with UV-C. Dose-dependent inactivation rates were determined for the total viable counts and model organisms representing different taxa of common fish parasites: the ciliate Paramecium sp., second larval stage (L2) of the nematode Anguillicola crassus and metanauplii of Artemia sp. Application of LFUS up to 19 kJ/L did not reduce the number of colony forming units (CFU), whilst UV-C irradiation was highly effective. Pre-treatment with LFUS reduced the mean size of suspended solids in aquaculture water and thus increased the germicidal effect of UV-C by up to 0.6 log units. LFUS was effective against the eukaryotic organisms, and the dose-dependent inactivation could be well described by functions of an exponential decay. However, the efficiency of LFUS differed greatly between species. A LFUS dose of 1.9 kJ/L (consumed energy) was sufficient to inactivate Artemia by 99%, but a ten times higher dose was necessary to inactivate 95% and 81% of Paramecium and Anguillicola larvae, respectively. In clear water, the energetic efficiency of UV-C (emitted by a low pressure lamp) against Paramecium and Anguillicola larvae was higher compared to LFUS, but LFUS was more efficient against Artemia. However, the efficiency of LFUS against ciliates or nematode larvae would be similar or even higher than UV-C in highly turbid water or if less efficient medium pressure lamps are used. This study shows that LFUS can be applied safely at energy densities that are effective against a wide range of parasites like ciliates, nematodes and crustaceans. The combination of LFUS and UV-C could provide an appropriate water treatment with regards to all relevant pathogens in recirculating aquaculture systems.

Progestogens cause immunosuppression of stimulated carp (Cyprinus carpio L.) leukocytes in vitro

The involvement of steroid hormones in direct and indirect regulation and modulation of immune responses is well recognized in mammals. Here, we demonstrate that progestogens are capable of influencing the innate immunity in fish as well. Therefore, we confirmed the known immunosuppressive effects of natural progesterone (P4), and compared them to influences of 17alpha,20beta-dihydroxy progesterone (DHP4) and the synthetic progestins, medroxyprogesterone acetate (MPA) and levonorgestrel (LEV), on NO release by in vitro-stimulated carp leukocytes derived from both, head and trunk kidney, respectively. DHP4 known as the main maturation-inducing steroid in many teleosts potently inhibited the NO release by carp leukocytes. The synthetic progestin MPA, which may also be environmentally relevant due to its world-wide use in hormonal contraception, significantly decreased NO formation by head and trunk kidney cells. In contrast, LEV showed no significant influence on NO release by head and trunk kidney leukocytes. The observed immunosuppressive actions of progestogens on NO production were compared to the known impairment by natural and synthetic glucocorticoids. Determining the potential impact of progestogens on mRNA expression of iNOS by means of semi-quantitative reverse transcription polymerase chain reactions (RT-PCR) revealed downregulation of proinflammatory type I immune response characteristics at high concentrations. These findings demonstrate for the first time that similar to the known effects of natural progesterone synthetic progestogens are also able to influence immune signaling cascades in fish, and provide evidence that these steroids are capable of influencing mRNA expression of iNOS. The induction of a regulatory type II immune response by progestogens is a striking example of interference of female steroid-mediated events with the piscine immune system. Furthermore, the identification of a partial sequence of a membrane-associated progestogen receptor (mPR) in carp leukocytes by RT-PCR indicates a specific mechanism underlying the observed effects of progestogens on these immune cells.

Mortality and hospitalization in myelodysplastic syndromes (MDS) using the SEER-Medicare linked database

7091

Background: Mortality in patients with MDS is high, and most require transfusions, emergency department (ED) visits, and hospitalizations. The relationship between these outcomes with the key complications of MDS (anemia, neutropenia, thrombocytopenia) has not been well studied. Methods: Patients who were ≥ 66 years at MDS diagnosis in 2001 or 2002 were identified from SEER registries. Those with both Medicare Part A and B were followed until death or the end of 2005. Mortality, transfusions, ED visits, and hospitalizations were based on Medicare data. The presence of complications was based on diagnosis codes, transfusions, and medication use. Kaplan-Meier incidence was estimated for each outcome. Factors associated with each outcome were based on multivariable Cox models with baseline age, gender, race, co-morbidity level, socio-economic status indicators, and time-varying covariates for each complication. Results: In 1,863 MDS patients, the 3-month incidence of transfusion, ED and hospitalization was 45%, 41%, and 62%, and 3-year incidence was 75%, 87%, and 91% respectively. Median survival was 22 months. The 3-year incidence of anemia, thrombocytopenia and neutropenia was 89%, 37%, and 15% respectively. See table for multivariate results. Conclusions: Starting shortly after diagnosis, MDS patients have high rates of transfusions, ED visits, and hospitalizations. Diagnoses of anemia, neutropenia, and thrombocytopenia are strongly associated with this utilization. The presence of anemia and thrombocytopenia are important independent risk factors for death.

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Total societal costs attributable to the prevention of recurrent HER2+ breast cancer

Abstract #6101

Introduction: Adjuvant therapies are available to prevent breast cancer recurrence that may reduce morbidity and mortality. However, the associated savings to society have not been quantified, particularly for HER2+ patients. Methods: We reviewed the literature (PubMed) to estimate the costs attributable to breast cancer recurrence including direct (medical and non-medical) and indirect (loss income, productivity, informal care) costs. The following sources were used to estimate the recurrence cost. The 10-year average direct medical costs of recurrence were obtained from an analysis of SEER-Medicare data (Stokes 2008). This study compared women with recurrence to similar women without recurrence and accounts for differential costs associated with survival (ie, it did not estimate only the cost of treating recurrent cancer). In the initial year after cancer diagnosis, women required an additional 66 hours of personal time to obtain medical services (Yabroff 2007). After recurrence, an excess of 9% of patients would leave the work force if they were aged 50-64 (Lidgren 2007). Women were found to take an additional 8.5 months away from work during the 3 years following a recurrence compared with those without recurrence (Drolet 2005). The intensity of informal care was similar (0.8 hour/week) in the first year after recurrence as it was for women without recurrence (Lidgren 2007). The valuation of utilization was conducted from a societal perspective and costs reported as 2008 US dollars. Because certain costs were relevant to specific ages, we estimated costs in 3 age cohorts (30-49, 50-69, and ≥70). Lost income from early retirement was calculated as the number of years retired from work before the age 65 times the annual average income derived using the national average wage and benefit data. Patient time required for receiving care, time absent from work, and caregiver time were also valued in the same way. We combined this information into a simulation used to estimate the number of HER2+ women diagnosed in one calendar year in the United States, and whose recurrence could be prevented with trastuzumab. The model accounted for variability of clinical and economic inputs by sampling from distributions using 5,000 replications. The mean costs per person and the middle 95% of the distribution were reported. Results: For ages 50-69, early retirement costs were $39,600. Costs due to work absences were $41,600 (age 30-49) and were $31,200 (age 50-69). The total societal costs attributable to a single recurrence were $60,400 ($32,000 to $129,000) for ages 30-49, $89,600 ($45,000 to $203,000) for ages 50-69, and $18,900 ($13,000 to $25,000) for ages ≥70. Overall, the savings from preventing recurrence with trastuzumab were estimated at over $167 million ($70 million to $385 million) per year of diagnosed cases of HER2+ tumors. Conclusion: Therapies that can prevent breast cancer recurrence can lead to substantial savings to society and represent a considerable opportunity cost.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6101.

Estimating recurrences prevented from using trastuzumab in adjuvant breast cancer in the United States

Abstract #2107

Introduction: Trastuzumab was recently approved for adjuvant use in HER2+ breast cancer. Adjuvant treatment should result in a reduction in recurrences, but this has not been estimated from a US population perspective. Methods: We estimated the number of HER2+ breast cancers in the US in 2005 using SEER data. Because HER2 status is not available in SEER, the number of HER2+ patients was estimated using the known relationship between HER2 status and both estrogen receptor (ER) and progesterone receptor (PR) status. Patients with no ER or PR results were assumed to have no HER2 testing. HER2+ proportions for remaining ER+/PR+, ER+/PR-, ER-/PR+ and ER-/PR- patients were estimated from published data and applied to patients diagnosed in the 17 SEER registries. The resulting rates were applied to the 2005 US female population counts. Estimated HER2+ patient counts were stratified by nodal status (+/-), and age (30-50, 50-70, and >70 years). Patients with significant underlying cardiovascular (CV) disease were assumed not to use trastuzumab. Underlying recurrence rates were pooled across studies that compared doxorubicin and cyclophosphamide followed by a taxane (AC-T) versus the same regimen plus 52 weeks of trastuzumab (AC-TH). Rates were stratified by nodal status. The relative risk of recurrence with trastuzumab (0.53) was assumed to be constant across subgroups based on published data, and assumed to persist for 5 years. One study (NSABP B-31) estimated the proportion experiencing a CV event (primarily defined as ejection fraction decline below threshold or dyspnea with normal activity) based on 5-year follow-up. Probabilistic model inputs were used to reflect the likelihood of possible values where possible. The results were run using 5,000 replications and reported as the mean and middle 95% of the distribution using @Risk (Palisade Corp., Ithaca, NY). Results: The model estimated that there are approximately 28,500 (95% interval 26,400 to 31,500) patients who could be diagnosed with HER2+ breast cancer in one year in the US, 6,128 (95% interval 4,292 to 8,600) of whom will have a recurrence within 5 years, and up to 2,619 of whom (95% interval 1,506 to 3,701) who could be prevented from disease recurrence with trastuzumab use. The number of patients who might experience a CV event is approximately 941 (95% interval 510 to 1,395) giving a ratio of 2.7 recurrences prevented for every CV event (95% interval 1.4 to 5.6). Conclusion: Trastuzumab is capable of preventing at least 2,600 recurrences within 5 years after its initial year of use. Its most clinically important side effect, a CV event, is likely to appear once for every 2.7 recurrences that are prevented, although many cases are asymptomatic and reversible. Extrapolated over 20 years, targeting HER2+ tumors in the adjuvant setting could prevent as many as 50,000 HER2+ patients from recurrence with important clinical, humanistic and economic consequences for patients, physicians and payors.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2107.

The swimbladder nematodeAnguillicola crassusin the European eelAnguilla anguillaand the Japanese eelAnguilla japonica: differences in susceptibility and immunity between a recently colonized host and the original host

The swimbladder nematodeAnguillicola crassusoriginates from Asia where it is a parasite of the Japanese eelAnguilla japonica. After its introduction to Europe about 25 years ago, the parasite spread rapidly within the indigenous populations of the European eelAnguilla anguillaand subsequently the prevalence and mean intensity appeared to stabilize. Under experimental and aquaculture conditions the naïve new host appears to be more susceptible toA. crassuscompared to the original host. Both eel species develop a immune response againstA. crassus. The antibody response is well characterized for the European eel, but poorly characterized for the Japanese eel. It remains unclear if antibodies have any protective function againstA. crassus. Encapsulation of larvae ofA. crassuscan be observed in naturally infected European eels. However, encapsulation of larvae following experimental infection has not been detected in European eels, but only in Japanese eels. Reinfection experiments and intraperitoneal injection ofA. crassushomogenates failed to demonstrate the development of acquired immunity in European eels. Immunization with irradiated third stage larvae provided preliminary evidence for acquired immunity againstA. crassusin the Japanese eel, but not in the European eel.

Anguillicola papernai (Nematoda: Anguillicolidae) and other helminths parasitizing the African longfin eel Anguilla mossambica

The swim bladder nematode Anguillicola papernai Moravec & Taraschewski, 1988 has been investigated as regards its occurrence in longfin eels Anguilla mossambica (Peters) in rivers in South Africa. A. papernai revealed a prevalence of around 50% and a mean intensity of about 6 adult worms at 1 sampling site but were less abundant in 3 others. Field observations suggest a more narrow habitat preference than that of Anguillicola crassus and a seasonal pattern of abundance. African longfin eels harboured a poor helminth community. In addition to A. papernai, 2 gastro-intestinal nematodes occurred, the stomach worm Heliconema longissimum Ortlepp, 1923 as the dominant species, and the intestinal Paraquimperia africana Moravec, Boomker & Taraschewski, 2000. Experiments were undertaken using European eels Anguilla anguilla (Linnaeus) and copepods as laboratory hosts. The morphology of larvae and adult parasites obtained from these experimental hosts is described. The ultrastructure of adult worms recovered from wild longfin eels was studied. The 'papilla-like excrescences of fibrous structure' on the adult worms' cuticle, as mentioned in the original description, are in fact the attachment points of thick cords of fibers interconnecting the epicuticle with the hypodermis. Such a structure has not yet been described from any other species of Anguillicola Yamaguti, 1935. At present in South Africa, Mozambique and Madagascar attempts are on the way to establish an eel management like in Asia and Europe including eel farming. In this context, care should be taken to prevent the introduction of non-endemic eel parasites into Africa and Madagascar. On the other hand, the future commercial management of African eel species should not lead to the spread of A. papernai or other parasites of African eel species to Europe or elsewhere. In this study A. papernai has been experimentally demonstrated to be capable of reproducing in the European eel and of using European copepods as intermediate hosts.

Differences in susceptibility of the European eel (Anguilla anguilla) and the Japanese eel (Anguilla japonica) to the swim-bladder nematode Anguillicola crassus

The swim-bladder nematode Anguillicola crassus originates from the Far East where it is a parasite of the Japanese eel (Anguilla japonica). After A. crassus was introduced to Europe, it became a predominant parasite of the European eel (Anguilla anguilla). A study performed with experimentally infected eels (98 days, 23 degrees C) revealed significant differences in the susceptibility of the two eel species to this parasite. The recovery rate of 30 administered infective A. crassus larvae (L3) from A. japonica was less than half of that from A. anguilla (33.2% and 13.8%, respectively). Almost 60% of the worms recovered from A. japonica were found as dead, encapsulated and necrotic larvae in the swimbladder wall. In contrast, no dead larvae were found in A. anguilla. Additionally, the development of the worms was shown to be significantly slower in A. japonica compared with A. anguilla. The lower survival rate of the worms, together with their slower development, resulted in a significantly lower adult worm burden (11 and 428 mg wet weight, respectively) and in a decreased reproductive success in A. japonica compared with A. anguilla. These results demonstrate that the original host, A. japonica, possesses more effective defence mechanisms against A. crassus than does the non-adapted host, A. anguilla.

Individual and combined effects of cadmium and 3,3,4,4,5-pentachlorobiphenyl (PCB 126) on the humoral immune response in European eel (Anguilla anguilla) experimentally infected with larvae of Anguillicola crassus (Nematoda)

The individual and combined effects of cadmium (Cd) and 3,3',4,4',5-pentachlorobiphenyl (PCB 126) on the antibody response of fish against metazoan parasites were tested. Eels experimentally infected with the swim bladder nematode Anguillicola crassus were exposed to sublethal concentrations of Cd and PCB 126. Cd was added to the water resulting in an effective concentration of 21.7 +/- 12.8 microg/l (mean +/- S.D.). PCB 126 was applied orally at a dose of approximately 100 ng PCB 126 per g body weight. At the end of the experiment, 76 days post-infection (p.i.), eels were found to be infected with 2-3 worms. Immunoblot analyses revealed that the body wall of adult worms was the most suitable crude antigen, and was subsequently used for an ELISA to evaluate the immune response of A. anguilla under various conditions. A significant increase of Anguillicola-specific antibodies in the peripheral blood was first detected 61 days p.i., indicating that it was not the invasive larvae but the adult worms which elicit the antibody response. The presence of Cd in the concentrations applied did not appear to modulate the production of antibodies. In contrast, the exposure to PCB 126 resulted in a complete suppression of the antibody response. A similar effect was also found for the combined exposure of the infected eels to Cd and PCB 126. A suppressed immune response, as demonstrated here, may be the reason why hosts exposed to environmental pollution became often much more easily infected than unexposed conspecifics.

Effects of crude extracts of Mucuna pruriens (Fabaceae) and Carica papaya (Caricaceae) against the protozoan fish parasite Ichthyophthirius multifiliis

The ciliate Ichthyophthirius multifiliis is among the most pathogenic parasites of fish maintained in captivity. In the present study, the effects of the crude methanolic extract of leaves of Mucuna pruriens and the petroleum-ether extract of seeds of Carica papaya against I. multifiliis were investigated under in vivo and in vitro conditions. Goldfish (Carassius auratus auratus) infected with the parasites were immersed for 72 h in baths with M. pruriens extract, and for 96 h in baths with C. papaya extract. There was a 90% reduction in numbers of I. multifiliis on fish after treatment in baths of each plant extract at 200 mg l(-1 )compared to untreated controls. Consequently, parasite-induced fish mortality was reduced significantly. A complete interruption of trophont recruitment was achieved by immersion in the M. pruriens extract. In vitro tests led to a 100% mortality of I. multifiliis in 150 mg/l M. pruriens extract, and in 200 mg/l of C. papaya extract after 6 h. Although the active constituents of the medicinal plant extracts are still unknown, we have demonstrated that they have potential for effective control of I. multifiliis.

Quality-of-life outcomes after primary androgen deprivation therapy: results from the Prostate Cancer Outcomes Study

PURPOSE

To compare health-related quality-of-life outcomes after primary androgen deprivation (AD) therapy with orchiectomy versus luteinizing hormone-releasing hormone (LHRH) agonists for patients with prostate cancer.

PATIENTS AND METHODS

Men (n = 431) newly diagnosed with all stages of prostate cancer from six geographic regions who participated in the Prostate Cancer Outcomes Study and who received primary AD therapy but no other treatments within 12 months of initial diagnosis were included in a study of health outcomes. Comparisons were statistically adjusted for patient sociodemographic and clinical characteristics, timing of therapy, and use of combined androgen blockade.

RESULTS

More than half of the patients receiving primary AD therapy had been initially diagnosed with clinically localized prostate cancer. Among these patients, almost two thirds were at high risk of progression on the basis of prognostic factors. Sexual function outcomes were similar by treatment group both before and after implementation of AD therapy. LHRH patients reported more breast swelling than did orchiectomy patients (24.9% v 9.7%, P <.01). LHRH patients reported more physical discomfort and worry because of cancer or its treatment than did orchiectomy patients. LHRH patients assessed their overall health as fair or poor more frequently than did orchiectomy patients (35.4% v 28.1%, P =.01) and also were less likely to consider themselves free of prostate cancer after treatment.

CONCLUSION

Most endocrine-related health outcomes are similar after surgical versus medical primary hormonal therapy. Stage at diagnosis had little effect on outcomes. These results provide representative information comparing surgical and medical AD therapy that may be used by physicians and patients to inform treatment decisions.

Induction of stress by the swimbladder nematode Anguillicola crassus in European eels, Anguilla anguilla, after repeated experimental infection

The purpose of this study was to determine under laboratory conditions over a period of 311 days if infection with the nematode Anguillicola crassus induces stress in European eels (Anguilla anguilla), and stimulates the endocrine stress axis as measured by serum cortisol levels. Eels were experimentally infected with 3rd-stage larvae (L3) in different doses to simulate natural conditions with varying infection pressures. Blood samples were drawn from the caudal vein every 2 weeks and serum cortisol concentrations were determined by radioimmunoassay (RIA). The results showed that the application of L3 resulted in a significant increase in the cortisol levels. The period of time at which elevated cortisol values were observed was consistent with the time of larval development and the appearance of adult A. crassus. Thus, there is a stress response to the larval and young adult stages, but no chronic response to older adults. Therefore, it is likely that infection of eels under natural conditions especially with a high number of larvae may be a considerable stressor, in combination with different environmental factors like water temperature, pH, oxygen concentration, pollution and interindividual relationships.

Evaluation of an ELISA and immunoblotting for studying the humoral immune response in Anguillicola crassus infected European eel Anguilla anguilla

The applicability of an enzyme-linked immunosorbent assay (ELISA) for the detection of anguillicolosis in feral eels was examined using a crude antigen preparation from the body wall of adult Anguillicola crassus. The screening consisted of samples from 100 feral European eels Anguilla anguilla. As a reference the actual status of infection was determined by dissection of the eels' swim-bladders. The ELISA results were compared with a background value calculated from the results obtained from 43 non-infected farm eels. The screened samples had a high prevalence of A. crassus (83 %); however, the specificity and the negative predictive value of the ELISA were low compared to the high positive predictive value. Nonetheless, the reproducibility (precision) of the test was satisfactory, and for the non-infected reference group specificity was 97.7 %. Although the ELISA, as used in the present study, is not applicable for diagnostic purposes, it represents a useful tool for the investigation of the specific humoral immune response of eels against A. crassus under controlled experimental conditions. Immunoblots using crude antigen preparations from different parts of adult A. crassus as well as a crude somatic third-stage (L3) antigen preparation illustrated that only antigens associated with the body wall of adult A. crassus are potentially suitable for diagnostic purposes. Despite the fact that antibodies against Raphidascaris acus cross-reacted with 3 body wall antigens of A. crassus, the most encouraging results were obtained with the antigen preparation from the outer cuticle of adult A. crassus which yielded a conspicuous, broad band at about 100 kDa.

Humoral immune response of European eel Anguilla anguilla experimentally infected with Anguillicola crassus

A humoral immune response of the European eel Anguilla anguilla elicited by an experimental infection was demonstrated for the first time against the swimbladder nematode Anguillicola crassus. Eels were experimentally infected once or repeatedly and the antibody response was observed over a period of 325 d. Specific antibodies against A. crassus in the peripheral blood of the eels were measured using an ELISA and the immunoblot technique. Anti-A. crassus antibodies were first observed 8 wk post infection, and appeared to be independent of both the number of infective third stage larvae (L3) administered and the frequency of administration. However, individual eels showed great differences in the course of the antibody response. The late appearance of antibodies in the peripheral blood supports the hypothesis that not the invading L3 but rather the adult parasites elicit the production of specific antibodies. A stage-specific antibody response against the L3 was not observed. Main antigens are located in the body wall, especially in the gelatinous outer cuticle, of adult A. crassus.

Development of Anguillicola crassus (Dracunculoidea, Anguillicolidae) in experimentally infected Balearic congers Ariosoma balearicum (Anguilloidea, Congridae)

The development of Anguillicola crassus in experimentally infected Ariosoma balearicum (Anguilloidea, Congridae) kept in seawater was studied in the laboratory. In parallel trials the effect of water salinity on the development of larval A. crassus in European eels Anguilla anguilla was also investigated using eels kept in seawater of a salinity of 34 per thousand. Both eel species were orally inoculated with L3 larvae of A. crassus and then maintained for up to 3 mo at 18 degrees C in seawater. 110 d post infection, no adult but larval (L3 and L4) stages of A. crassus were detected in the swimbladder wall of Balearic congers, although this period of time was sufficient for the parasites to develop to the adult stage in European eel kept in seawater. The results presented suggest that the definitive host specificity of A. crassus comprises species of the family Anguillidae (i.e. the genus Anguilla), but not members of the Congridae. Theoretically however, A. balearicum might serve as a metaparatenic host. Factors determining the definitive host range of A. crassus remain to be elucidated. Water salinity does not seem to act as a factor affecting definitive host specificity once the parasite has become ingested by the eel.

Richness and diversity of parasite communities in European eels Anguilla anguilla of the River Rhine, Germany, with special reference to helminth parasites

A total of 121 European eels (Anguilla anguilla) from 2 sampling sites on the River Rhine were investigated in respect of their parasite communities. Special attention was given to the swim bladders, intestines, gills and fins of the fish. Twelve different parasite species were found to live in and on the eels. Data from each sampling site were kept separate. Parasites found in descending order of prevalence were: Anguillicola crassus, Trypanosoma granulosum, Myxobolus sp., Paratenuisentis ambiguus, Pseudodactylogyrus sp., Bothriocephalus claviceps, Myxidium giardi, Pomphorhynchus laevis, Trichodina sp., Raphidascaris acus, Acanthocephalus lucii and Acanthocephalus anguillae. Significantly different prevalences were reported for L3 larvae of A. crassus, adult P. ambiguus, B. claviceps and Myxobolus sp. at the 2 sampling sites. The highest number of parasite species was recorded from the intestine, which contained up to 6 different helminths. The coexistence of the acanthocephalans P. laevis and P. ambiguus, which showed clear patterns of distribution within the intestine of the respective hosts, was reported for the first time. Up to 3 different helminth species were found in the intestine of individual fish. Among those, acanthocephalans were the most prevalent worms with the eel-specific parasite P. ambiguus as the dominant species not only of the intestinal but also of the total component communities. Both infra and component communities exhibited low diversity and were dominated by this single species. The evenness reached only approximately 50% or less and it remained unclear why the helminth communities of the eels from the River Rhine with its huge catchment area exhibit such a low parasite diversity and high dominance.

Theoretical Evaluation of Neutron-nucleus Scattering Parameters from Experimental Data in the 6 ≤ A ≤ 60 Mass Region

Systematic calculations of the neutron-nucleus scattering parameters at several neutron energies Ei < 2 keV have been performed for 37 isotopes (6Li,... 59Co) in the mass region of 6 ≤ A ≤ 60, using the large compilation of experimental neutron-nucleus scattering data obtained in Garching. In the first stage of these calculations, the s-wave potential scattering radius R’, the scattering lengths bcoh, b±, and the bound state parameters (Eb, Γγ , gΓ0n) have been calculated for each isotope, employing the general least squares fit (GLSQF) for the experimental and the corresponding theoretical values of the total neutron-nucleus cross sections σexptot(Ei) at several energies Ei, absorption cross sections σabs(Eo) and of the coherent scattering lengths bcoh. The theoretical expressions for these parameters were deduced on the basis of the usual S-matrix formalism with no assumption about the particular shape of the optical model potential. In the second stage of our calculations, the spherical Fiedeldey- Frahn optical potential was employed for the pure theoretical description or the above mentioned neutron-nucleus scattering characteristics. The results obtained have been analyzed and compared with the values deduced from measurements.

The epidemiology of prostate cancer part II: the risk factors

The epidemiology of prostate cancer gives us some clues that its etiology is likely both environmental and genetic. There is extreme country to country variability in prostate cancer mortality. Countries in which dietary fat intake is greater have been shown to have higher prostate cancer mortality rates leaving some to conclude that dietary fat causes prostate cancer. Migration studies show that men moving from Japan and China adopt increased risks of prostate cancer. Second- and third-generation Japanese Americans and Chinese Americans actually have risks of prostate cancer similar to white American men. This is highly suggestive that prostate cancer has an environmental influence. The differences in black-white mortality and newer data suggesting a higher mortality among Jamaican and Brazilian men of African descent suggest there may be a genetic predisposition to prostate cancer. Some have suggested certain polymorphisms increase prostate cancer risk, whereas others are searching for genetic mutations that may increase prostate cancer risk. Africans may have an increased prevalence of these genetic risk factors. Ultimately, the cause of prostate cancer is likely to be a combination of environmental and genetic factors.

The epidemiology of prostate cancer part I: descriptive epidemiology

The incidence and mortality of prostate cancer is highly varied among populations and especially among blacks and whites. The incidence rates of all American populations have dramatically changed over the past 25 years. The recent increase in incidence has been attributed to prostate cancer screening. Although the incidence has increased over the past 25 years, the mortality rates although vastly different between populations have remained rather stable within populations. Prostate cancer is still a disease that primarily afflicts older men. The median age at diagnosis is 71 years for whites and 69 years for blacks. More than 80% are over the age of 65 years. Screening for prostate cancer has dramatically increased the number of men with local disease at diagnosis, but it is unclear whether screening and aggressive treatment have caused a decrease in mortality.

Impact of low water temperature on the development of Anguillicola crassus in the final host Anguilla anguilla

The effect of low water temperatures on the development and viability of larval and adult Anguillicola crassus (Nematoda) in the final host Anguilla anguilla was studied. European eels were experimentally infected with A. crassus and then maintained for 4 mo at 4, 9, 10, and 19 degrees C. Larval development showed a temperature-dependent pattern and was significantly retarded at low temperatures. Third-stage larvae survived a 4 mo period at 4 degrees C without being affected, although they were not able to invade the swimbladder wall at this temperature. In contrast, adult worms were severely harmed during a 4 mo period at 4 degrees C, as reflected by increased mortality and decreased growth and reproductivity as compared to the worms maintained for the same period at 18 degrees C. Starvation for the eels at 4 mo at 19 degrees C did not affect the development and growth of the nematode. The experimentally obtained results support the hypothesis that the spread of A. crassus in boreal regions, e.g. Northern Europe, is restricted by the natural ambient temperature regimes.

Distribution and prevalence of Anguillicola crassus (Nematoda) in eels Anguilla anguilla of the rivers Rhine and Naab, Germany

Over a period of 2 yr eels were collected at several sites along the river Rhine as well as from adjacent waters and examined for Anguillicola crassus in the swimbladder. Additionally eels were collected once from a site on the river Naab (Danube system). All eels were searched for both juvenile and adult stages of A. crassus, revealing prevalences of 80% in eels from the river Rhine and 39% in eels from the river Naab. The mean intensities were 5.6 and 7.7, respectively. With respect to the prevalence and mean intensity of infection, no significant differences were observed between the different sampling sites in the Rhine system. Neither the prevalence nor the intensity showed significant seasonal patterns. Further, no correlation between the condition factor of the eels and intensity of infection with A. crassus could be found. Of all eels examined, 28% showed pathological alterations of the swimbladder.

Chlorine and sodium perfusion and electrolyte balance in human tissue and tumours before and during neutron and photon radiotherapy

Radiotherapy with nuclear reactor fission neutrons was applied in 49 cases of pretreated patients with superficial metastases or relapses from primary carcinoma. Measurements of the decay rates of the radiation-induced radioactivity of 49Ca, 38Cl and 24Na in the irradiated tissue resulted in values for the simultaneous local kinetics of chlorine and sodium, and in approximate data on the electrolyte masses. The electrolytes were present in non-exchangeable and exchangeable compartments of soft tissue. Exchange times of the intravascular to extravascular turnover and the frequencies of the exchange fractions were determined for a series of irradiations. The results have been interpreted in terms of the mean electrolyte exchange rates, of a standardized functional blood flow, and of the supply capacity of the vascular system. In the average of all cases, the regional perfusion was reduced by about 30% by irradiation up to 14 Gy (equivalent photon dose = 45 Gy) connected with an increase in the non-exchangeable fractions. After fractionated doses higher than 14 Gy, functional blood flow and supply capacity increased to 120%, and fixed electrolytes were removed from the irradiated tissue. Data on electrolyte kinetics and vascularity are compared with the literature.

Anorexia/cachexia in patients with HIV: lessons for the oncologist

Early intervention and attention to nutritional status are essential in patients with cachexia. Identification of reversible causes of decreased energy intake and/or weight loss is the first step in treatment. When such factors cannot be identified, pharmacologic interventions should be considered. To date, megestrol acetate is the most effective appetite stimulant. Appetite and weight gain occur to a greater and more rapid degree as megestrol dose increases. Unfortunately, the weight gain is due predominantly to an increase in fat mass. Whether this is due to a lack of exercise in the face of increased caloric intake and/or to the hypogonadal effects of megestrol acetate is being tested in ongoing clinical trials. Anabolic agents, particularly growth hormone, are exciting potential therapies. No data are yet available on alternate doses and schedules of growth hormone or on its effect in patients with decreased oral intake. Current studies addressing combination therapy with anabolic agents and appetite stimulants should clarify their respective therapeutic roles.

In vivo neutron activation analysis of sodium and chlorine in tumor tissue after fast neutron therapy

In 12 patients with recurrences and metastases of different primaries (head and neck cancer, breast cancer, malignant melanoma, and osteosarcoma) who were treated with reactor fission neutrons the photon emission of irradiated tissue was measured after each radiotherapy fraction. Spectral analyses of the decay rates resulted in data for the exchange of sodium (Na) and chlorine (Cl) between the irradiated tissue and the body. About 60% of Na and Cl exchanged rapidly with a turnover half-life of 13 +/- 2 min. New defined mass exchange rates for Na and Cl amount to an average of 0.8 mval/min/kg of soft tissue. At the beginning of radiotherapy the turnover of the electrolytes in tissues with large tumor volumes was about twice that in tissues with small tumor volumes. Depending on the dose, neutron therapy led in all cases to variation in the metabolism. A maximum of Cl exchange and a minimum of Na exchange occurred after 10 Gy of neutrons (group of six previously untreated patients) or after 85 Gy (photon equivalent dose) of combined photon-neutron therapy. A significant increase in non-exchangeable fraction of Na from about 40 to 80% was observed in three tumors after a neutron dose of 10 Gy administered in five fractions correlated with a rapid reduction of tissue within 4 weeks after end of therapy. These results demonstrate for the first time the local response of the electrolyte metabolism to radiotherapy.

Relationship of acute gastrointestinal toxicity and the volume of irradiated small bowel in patients receiving combined modality therapy for rectal cancer

PURPOSE

To determine the relationship between acute gastrointestinal (GI) toxicity during the combined modality segment and the volume of small bowel in the pelvic radiation field in patients who receive either preoperative or postoperative therapy for rectal cancer.

PATIENTS AND METHODS

The patient population was derived from four consecutive phase I dose-escalation trials. Combined modality therapy included fluorouracil (5-FU), leucovorin ([LV] bolus daily x 5, days 1 and 29), and pelvic radiation.

RESULTS

Twenty patients who received postoperative therapy had a larger volume of small bowel in the pelvic radiation field as compared with 60 who received preoperative therapy (462 +/- 129 v 212 +/- 44 cm3, P = .002). The most significant relationship between acute GI toxicity and volume of small bowel was seen in 12 patients who were treated on the preoperative sequential low-dose LV trial, all of whom received the maximum-tolerated dose (MTD) of 5-FU. The volume of small bowel in patients who experienced grade 3+ toxicity was 731 +/- 274 cm3, as compared with 145 +/- 58 in those who experienced grade 0 to 2 toxicity (P = .005). Likewise, logistic regression analysis showed that 26 patients who received the MTD of 5-FU had the most significant association between GI toxicity and volume of small bowel (P = .036).

CONCLUSION

Our data suggest that the volume of small bowel in the pelvic radiation field may be dose-limiting in the delivery of high-dose 5-FU when combined with LV and radiation therapy.