Analysis of lupin seed protein digestibility using gel electrophoresis and immunoblots

Proteins from the seeds of 12 cultivars of three lupin species were analyzed by gel electrophoresis. Similarities between cultivars of the same species were noted. Antibodies raised against the three major globular proteins, conglutin alpha, beta, and gamma, of Lupinus albus cv. Ultra were used to probe immunoblots of crude extracts. The immunoblots revealed variations between cultivars not previously resolved and identified which protein-subunits were derived from which conglutin. In vitro digestibility studies were done on four of the lupin cultivars. During the digestion of these cultivars, the large protein units were shown to be degraded to smaller intermediates with specific molecular sizes. Some of the intermediate protein subunits were identified as being derived from conglutin beta. The digestibility of the four cultivars, based on the amount of identifiable protein in the ruminal fluid digest at 9 and 24 h, showed Ultra > Primorski > Juno > Danja. From this study a novel system of analyzing protein digestibility was devised.

Effect of mash or pelleted supplements containing crab meal on intake and weight gains of beef cattle

Yearling beef steers showed a progressive decrease in rate of gain as crab meal replaced 33, 66 and 100% of supplemented soybean meal. The crab meal was highly resistant to degradation in sacco but was well digested in the whole tract of sheep. Rumen fluid from sheep fed crab meal was as effective for fiber digestion in vitro as that from sheep fed a similar diet without crab meal. It was concluded that the lower feed intake observed with cattle fed crab meal was not due to inhibition of fiber digestion. In a second experiment, there was no improvement in cattle performance when the crab meal was treated with the antioxidant ethoxyquin. Oxidation of crab meal that could lead to rancidity does not appear to be a problem, as adding ethoxyquin did not affect cattle performance. In a third experiment, pelleting a crab meal–alfalfa meal supplement increased intake from 1.22 kg d−1 to 1.64 kg d−1 (P < 0.01), and pelleting a crab meal–barley supplement increased intake from 1.55 kg d−1 to 1.80 kg d−1 (P < 0.05). In a fourth experiment, pelleting the crab meal supplement again largely overcame the depressing effects of crab meal on intake and weight gains. It was concluded that crab meal is a useful supplement for young cattle, provided they can be induced to consume it. Pelleting the crab meal supplement is one way of overcoming the lower intake and weight gains associated with feeding it as a mash. Key words: Crab meal, intake, digestibility, beef cattle, pelleting

Composition, digestibility and rumen degradability of crab meal

The nutritive value of dried shellfish waste (referred to as crab meal) produced in New Brunswick in the mid-1980s was evaluated by physical, chemical and biological assays. Typically the crab meal was high in ash content (about 50%), consisting mainly of calcium carbonate and contained about 20% chitin, 25% crude protein (CP) and less than 2% lipid material. The meal could be separated by screening into a coarse fraction high in ash and chitin and a fine fraction lower in ash and higher in CP. Although the reactivity rate of crab meal ash was not as high as that of similar sized limestone particles (42 vs. 30.4 min for particles that passed a 500-μm screen but were retained on a 300-μm screen), it was high enough to suggest crab meal could be a useful rumen buffer. The CP of crab meal was highly resistant to degradation in the rumen in sacco. Less than 18% of the crab meal CP disappeared from bags suspended in the rumen for 24 h, compared with more than 87% for soybean meal and full-fat canola seed. The digestibility of crab meal dry matter by sheep was only 34.3 ± 3.7%, but the CP digestibility was 69.6 ± 4.1%. The chemical and physical attributes assayed and the results of the in sacco and sheep digestibility trials all suggest that crab meal should be a useful supplement for diets low in digestible undergraded protein. However its inclusion in a supplement for beef calves fed legume silage resulted in lower feed consumption and rate of gain (P < 0.01). Feeding soybean meal or full-fat canola resulted in a significant increase (P < 0.01) in feed efficiency, compared with calves fed the control and crab meal supplements. It was concluded that crab meal produced in New Brunswick would be a useful supplement for beef cattle if problems of palatability could be overcome. Key words: Crab meal, rumen degradability, digestibility, protein, palatability

Ovarian irradiation and prednisone following surgery and radiotherapy for carcinoma of the breast

Following mastectomy, patients aged 35 to 76 years with operable breast cancer underwent postoperative irradiation of the chest wall and regional lymph nodes. They were then assigned at random to receive no further therapy (NT), ovarian irradiation (R) 2000 rads in 5 days, or ovarian irradiation in the same dosage plus prednisone (R + P) 7.5 mg daily for up to five years. A total of 703 eligible patients received the randomly assigned treatment. The median follow up was 21 years with a range of 14 to 25 years. Overall, there was a delay in recurrence (p = 0.03) and survival was prolonged (p = 0.19) for patients who received R, but in neither case was the difference significant after adjusting for the multiplicity in our data. Overall, patients who received R + P experienced a significant delay in recurrence (p = 0.0003) and a significantly prolonged survival (p = 0.005), even after adjusting for multiple comparisons. In premenopausal patients who received R, the recurrence of breast cancer was delayed and survival prolonged, but not significantly. In premenopausal women aged 45 years or more, R + P therapy significantly prolonged survival (p = 0.0004), while the delay in recurrence although significant (p = 0.02) was only marginally so after allowance for multiple comparisons. No value was demonstrated for ovarian irradiation with or without prednisone therapy in postmenopausal patients. A new finding in this review was that contralateral breast cancer as the first failure was reduced by R + P compared to NT in the overall group.

Antibody responses of growing beef cattle fed silage diets with and without selenium supplementation

The relationships between blood Se levels and glutathione peroxidase (GSH-Px) activities and the ability of cattle to produce antibodies in response to antigen challenges with sheep red blood cells (SRBC) and ovalbumin (OA) were examined in a two-phase experiment with yearling beef cattle. There were no treatment effects on weight gains, feed intake or efficiency of feed conversion in either phase. In phase 1, cattle fed the unsupplemented control diet had lower (P ≤ 0.05) blood Se levels and GSH-Px activities by week 8 than cattle fed Se-fertilized forage, but neither was different (P > 0.05) from those of cattle fed Se-enriched yeast or inorganic Se. Antibody titers resulting from injection of SRBC at week 4 of the experiment peaked about 3 wk after injection, then declined. Differences due to Se treatment were small. The same animals were used in phase 2, where half of the animals on each of the four treatments of phase 1 were fed a supplement with Se-enriched yeast and the other half were fed an unsupplemented control. Differences in blood Se levels and GSH-Px activities due to phase-1 treatments persisted throughout phase 2. Differences due to phase-2 treatments were apparent after 9 wk. The cattle were challenged with OA at week 12 and at week 17 with both OA and SRBC. Differences in antibody titer due to Se treatment were small but tended to be higher (P > 0.05) in the Se-supplemented cattle. These results support the suggestion that blood Se levels over 100 μg L−1 are needed to maintain optimum immunocompetence. Key words: Selenium, glutathione peroxidase, immunocompetence, cattle, antibody

Radiotherapy alone in breast cancer. Analysis of tumor and lymph node radiation doses and treatment-related complications. The experience of the Gustave-Roussy Institute and the Princess Margaret Hospital

This retrospective analysis was conducted on breast cancer patients treated by radiotherapy alone at The Princess Margaret Hospital and at the Institut Gustave-Roussy. These patients had either operable tumors, but were unfit for general anesthesia, or had inoperable tumors due to local contraindications to surgery. Previous results showed that a radiation dose increase of 15 Gy can decrease the relative risk of tumor or lymph node recurrence twofold. In this third report, the same data were analyzed to determine the treatment-related complication rates and to correlate these to the radiation dose levels. Overall results were analyzed on 453 patients, but detailed analyses on complications were conducted on 372 patients not developing local recurrence in the first 6 months of follow-up. Each complication was graded on a 3-level previously defined scale. Most frequent complications were skin changes of different degrees, which were usually asymptomatic. More disabling complications were arm edema, impaired shoulder mobility, rib fractures and brachial plexopathy. The incidence of disabling complications was low. The only factor significantly increasing the risk of complications was the radiation dose level to the tumor and axilla. Technical factors such as overlapping fields should also be taken into account. As the more effective control of tumor and lymph nodes obtained in patients treated with higher radiation doses is counterbalanced by an increase in the complication rate, the dose to be delivered for each patient should be carefully chosen according to individual risk factors.

The effect of supplemental protein source on ammonia levels in rumen fluid and blood and intake of alfalfa silage by beef cattle

Growing beef cattle fed legume silage were supplemented with urea, soybean meal, fishmeal or a barley-based control in two experiments. In the first experiment, the concentrates were fed before the silage and in the second the silage and concentrates were mixed at feeding. In exp. 1 there were no significant (P > 0.05) effects of CP supplement on feed intake, weight gains or feed efficiency, although animals fed fishmeal gained the most and those fed urea the least. Rumen fluid ammonia N (RFNH3-N) increased more after feeding urea and soybean meal than the control or fishmeal supplements. Blood urea N (BUN) levels changed in parallel with RFNH3-N levels but the magnitude of change was reduced to about half. Blood ammonia N (BNH3-N) levels showed statistically significant changes only with the urea supplement. Cattle fed urea took longer to consume their supplement than those fed the other supplements. In exp. 2 there was no effect of supplement on gains or feed conversion. Animals fed the control supplement consumed more dry matter than those fed fishmeal (P < 0.05). Cattle fed the control supplement had lower RFNH3-N and BUN than those fed the other supplements (P < 0.01) but differences among the sources of CP were small. The urea supplement resulted in a higher BNH3-N than the control or fishmeal supplements (P < 0.05). There was no apparent effect of treatment on blood glucose level in either experiment. It was concluded that cattle adjust their daily eating pattern to maintain BNH3-N levels within physiological limits; that intake of silage dry matter is limited by level of non-protein N and rumen degradable protein; and that provision of bypass protein can improve efficiency of feed conversion of high-silage diets even when depressing feed intake. Key words: Alfalfa, silage, protein supplement, nitrogen, intake

Effects of raw pea flour on nutrient digestibility and immune responses in the preruminant calf

Two milk substitute diets for which the protein was provided either exclusively by skim milk powder (control) or partially (34%) by dehulled raw pea flour were given for 2 and 4 wk, respectively, to five preruminant calves, each fitted with a reentrant ileocecal cannula. Ileal apparent digestibility was lower with the pea diet during wk 1 than with the control diet. Four of the cannulated calves exhibited significant intolerance to the pea diet, resulting in lower digestibility during wk 4. In contrast, fecal digestibility of the pea diet, measured in four additional calves without reentrant cannulas, did not significantly decrease between wk 1 and 4. The AA composition of ileal digesta from the first group of calves did not vary greatly, suggesting that the differences observed in their apparent digestibility of proteins were due mainly to changes in the loss of endogenous proteins. However, pea legumin survived digestion in the small intestine in amounts generally equivalent to 1 to 3% of intake. Most of that undigested fraction was smaller than the native legumin: 40 to 200 kDa instead of 360 kDa. Also, a 45-kDa fragment was detected in the urine. Increased intestinal permeability could have favored the development of the high systemic anti-pea antibody titers that were observed in all of the calves.

Effect of moisture level on ensiling characteristics of alfalfa in big bales or chopped and compacted in plastic tubes

Alfalfa was ensiled at 270 (wet) or 400 (control) g DM kg−1 as long forage in plastic-wrapped big round bales (bale) or chopped (1.25 cm) and compacted (bag). The pH of the bag silages were lower (P < 0.01) throughout the 60-d observation period and stabilized at 4.7 ± 0.1 by day 3. The pH of the bale silages fell gradually to 5.5 by day 60. Lactic acid content was initially higher (P < 0.01) in the bag silages but by day 10 it was similar in the two types of silage. Acetic acid contents also were higher (P < 0.01) in bag than in bale silages and in wet than in control at day 1 and these differences persisted through day 60. Protein degradation was extensive in all silages as indicated by NH3-N and non-protein N contents at day 60 but it was more extensive in bale than in bag (P < 0.01) and in wet than in control (P < 0.05) silages. Lactobacilli counts were higher (P < 0.05) in bag than in bale silages at day 3 but the differences did not persist. Yeast and Clostridia counts and butyric acid contents were higher in bale than in bag silages in later stages of fermentation. None of the silages was well preserved, probably because of the low water-soluble carbohydrate content of the forage, but all were well accepted by sheep. Digestibility of the ADF fraction was higher (P < 0.05) for bale than for bag silages. Key words: Big bale, silage, ensiling characteristics, moisture level, bagged silage

Analysis of complications in patients treated with abdomino-pelvic radiation therapy for ovarian carcinoma

Between 1971 and 1985, 598 patients with ovarian carcinoma were treated with abdomino-pelvic radiation therapy. Acute complications included nausea and vomiting in 364 patients (61%) which were severe in 36, and diarrhea in 407 patients (68%), severe in 35. Leukopenia (less than 2.0 x 10(9) cells/liter) and thrombocytopenia (less than 100 x 10(9) cells/liter) occurred in 64 patients (11%) each. Treatment interruptions occurred in 136 patients (23%), and 62 patients (10%) did not complete treatment. In both situations the most common cause was myelosuppression. Late complications included chronic diarrhea in 85 patients (14%), transient hepatic enzyme elevation in 224 (44%), and symptomatic basal pneumonitis in 23 (4%). Serious late bowel complications were infrequent: 25 patients (4.2%) developed bowel obstruction and 16 required operation. Multivariate analysis was unable to determine any significant prognostic factors for bowel obstruction; however, the moving-strip technique of radiation therapy was associated with a significantly greater risk of developing chronic diarrhea, pneumonitis, and hepatic enzyme elevation than was the open beam technique. We conclude that abdomino-pelvic radiation therapy as used in these patients is associated with modest acute complications and a low risk of serious late toxicity.

Complications of whole abdominal and pelvic radiotherapy following chemotherapy for advanced ovarian cancer

We examined the records of 105 patients with advanced ovarian cancer who had been treated with cisplatin combination chemotherapy followed by abdominopelvic radiotherapy. The purpose was to define the morbidity of this approach, and identify those factors predictive of toxicity. Acute toxicity resulting in delay or failure to complete treatment was most commonly due to myelosuppression. Nine of 105 patients (8.6%) required surgery for bowel obstruction that was not due to recurrent disease, 3 had an episode of bowel obstruction that settled conservatively, and a further 5 underwent surgery for obstruction due to recurrent tumor. The presence of both a dose of abdominopelvic radiotherapy over 2250 cGy, as well as a second-look laparotomy prior to radiotherapy, was associated with an increased risk of serious bowel complications. The increased frequency of late bowel morbidity seen in the combined modality group is likely explained by the presence of these two factors, rather than the exposure to chemotherapeutic agents per se. These observations are supported by the published literature.

Forage conservation in round bales or silage bags: effect on ensiling characteristics and animal performance

In the first of two experiments to determine the ensiling characteristics of big bale silage, forage was ensiled in round bales (1.2 m diameter × 1.2 m length) at 350–400 (wetter) or 450–500 (drier) g kg−1 dry matter (DM) content by wrapping in plastic. Initial fermentation was more rapid in the wetter bales, as shown by a more rapid and extensive drop in pH and increase in concentration of lactic and acetic acids. The initial lactic acid bacteria (LAB) log counts ranged from 105 and 107 units and were higher for the wetter bales through day 9. By day 58, counts had declined and there were no differences due to moisture level. Water soluble carbohydrate content was higher (P < 0.01) for the drier bales. Ammonia N was higher (P < 0.01) in the wetter bales. Non-protein nitrogen (NPN) did not differ (P > 0.05) due to moisture level at day 9 or day 58. In the second experiment, bales ensiled at (mean ± SE) 390 ± 90 g kg−1 DM content (bale silage) were compared for ensiling characteristics and nutritive value with similar forage chopped and packed in a plastic bag (bag silage). The bag silage had a faster and more extensive drop in pH and increase in concentrations of lactic and acetic acids. Temperatures were approximately 6 °C higher in the bag than in the bale silages over the first 30 d. LAB counts increased faster in the bag silage and then declined and were lower (P < 0.05) than in the bale silage at day 60. Clostridia counts were low in the bag silage and in some bales but exceeded 106 viable spores in other bales. There were no differences between the two silages in digestibility by sheep. However, beef calves fed the bag silage gained more weight with better feed efficiency than those fed bale silage (P < 0.01). Calves fed the bale silage responded to protein (soybean meal) supplementation with increased gain and improved feed conversion, but there was no response with the bag silage. The bag silage had, on average, less NPN (468 vs. 585 g kg−1 total N) than the bale silage. Key words: Silage, big round bales, bag, protein supplementation, cattle performance

Comparisons of responses in whole blood and plasma selenium levels during selenium depletion and repletion of growing cattle

Cattle with high or moderate Se status were used in two Se repletion-depletion studies to compare response in Se content of whole blood or plasma. Changes in whole blood values gave a better indication of current Se intake because the magnitude of change was greater than in plasma and values did not plateau at as low a level of intake. Key words: Selenium, cattle, whole blood, plasma

Response of growing cattle to supplementation with organically bound or inorganic sources of selenium or yeast cultures

Bioavailability of organically bound and inorganic Se sources differ, the organic form being absorbed more efficiently. Dairy and beef calves (250 kg initial weight) were given a low Se diet alone or supplemented with sodium selenite (1 mg Se d−1; inorganic Se), a Se-enriched yeast (1.5 g yeast d−1 providing 1 mg of Se; organic Se), a live yeast culture (1.5 g d−1) or autoclaved yeast culture (1.5 g d−1). The latter treatments were included to determine the response to yeast per se. There were no treatment effects on rate of weight gain or efficiency of feed conversion by the calves. The Se souces had no effect on digestibility of the diet by sheep. The inorganic Se supplement increased the level of whole blood Se and glutathione peroxidase (GSH-Px) activity at a linear rate with time up to 3 mo from the start of supplementation. The effect of organic Se was sustained for 4 mo and both indices of Se status in blood were higher (P < 0.01) for calves fed the organic Se than for those fed inorganic Se after 4 mo (124 vs. 96 units of GSH-Px activity g−1 haemoglobin and 141 vs. 102 μg Se L−1 of whole blood). The values near the beginning of the trial were higher (P < 0.01) for Holstein calves than for beef calves but both groups showed the same response to source of Se. Subsequently, levels declined for Holstein and increased for beef calves given diets without supplemental Se. The results showed that Se supplementation for 4 mo had no effect on animal performance; that more than 4 mo are required to fully deplete or replete blood Se and GSH-Px; and, that supplemental organic Se gives higher (P < 0.01) blood Se and GSH-Px activity than does inorganic Se. Key words: Organic selenium, calves, glutathione peroxidase

Outcome of patients with unfavorable optimally cytoreduced ovarian cancer treated with chemotherapy and whole abdominal radiation

There is a subgroup of patients with Stage II or III ovarian cancer whose survival is poor despite optimal cytoreduction of tumor and abdominopelvic radiation. This study examined whether the survival of these patients, who have tumor with unfavorable histopathological characteristics and/or small residual disease, could be improved by giving chemotherapy before radiation. Forty-four out of fifty-one eligible patients, seen between 1981 and 1985, with Stage II or III disease were entered into the study. Following six courses of cisplatin-based chemotherapy, 33 (75%) received abdominopelvic radiotherapy. Survival was compared to that of 48 eligible matched control patients, treated with radiation between 1978 and 1981. The median follow-up is 6.6 years. The median survival was extended from 2.4 to 5.7 years (P = 0.13), and 42.6% of patients receiving combined therapy were free of relapse at 5 years, compared to 21.6% (P = 0.03) in the historical control group, treated with abdominopelvic irradiation alone. Only 2 of 44 patients in the combined group required surgery for bowel obstruction, as did 1 of 48 in the control group. Tolerance and toxicity of the combined approach were acceptable. Although we cannot be certain that the entire benefit we observed was not attributable to the chemotherapy alone, there is evidence that the radiotherapy may have been additive. Chemotherapy followed by abdominopelvic radiotherapy seems a reasonable management policy in these patients.

Outcome analysis of localized gastrointestinal lymphoma treated with surgery and postoperative irradiation

One hundred thirteen patients with localized gastrointestinal lymphoma treated by surgery and postoperative irradiation between 1967 and 1985 were reviewed. At 15 years, actuarial survival of this group was 40.6%, with a cause-specific survival of 69.2% and a relapse-free rate of 64%. Two-thirds of relapses occurred at distant sites. In Stage IA and IIA patients with no residuum or with positive resection margins, (N = 90) only site of involvement and stage predicted for relapse. Age, histologic subtype group, and depth of bowel wall invasion did not affect relapse risk. In the very favorable group (Stage IA, IIA, no residuum or microscopic residuum), 8.4% of patients with stomach lymphoma relapsed compared to 25% of patients with small bowel lymphoma. The risk of early relapse was higher in those with Stage IIA small bowel lymphoma than those with Stage IA small bowel lymphoma. We continue to recommend adjuvant abdominal irradiation for patients with Stage IA, IIA completely resected stomach lymphoma and Stage IA completely resected small bowel lymphoma. We recommend combined modality therapy for patients with completely resected Stage IIA small bowel lymphoma and all other localized gastrointestinal lymphoma where visible residual disease is present.

Prognostic factors in patients with stage I epithelial ovarian cancer

We analyzed factors predictive of relapse risk in patients with stage I invasive epithelial ovarian cancer: 252 patients from the Princess Margaret Hospital provided a data base for hypothesis generation, and data on 267 patients from the Norwegian Radium Hospital were used for hypothesis testing. The outcomes in most analyses in the two series were very similar, validating the following conclusions. Differentiation (grade) was the most powerful predictor of relapse, followed by dense adherence (which resulted in outcomes equivalent to those in stage II) and, finally, large-volume ascites. When the effects of these three factors were accounted for, then none of the following were prognostic: bilaterality (stage Ib), cyst rupture (stage Ic), capsular penetration (stage Ic), tumor size, histologic subtype, patient age, year of diagnosis, and postoperative therapy. These results allow simplification of stage I substaging, as only differentiation, dense adherence, and large-volume ascites (? peritoneal cytology) need be considered. The 5-year relapse-free rate was 98% in patients with grade 1 tumors in whom both dense adherence and large-volume ascites were absent. These patients are adequately treated by operation alone. Although the relapse risk was high enough in the remaining patients to warrant postoperative treatment, a significant benefit could be shown only for a small subset of patients, namely those with densely adherent tumors treated with abdominopelvic radiotherapy. In grades 2 and 3, none of the therapies used in either series was superior to pelvic radiotherapy or operation alone.

Patterns of disease in localized extranodal lymphomas

The site of origin of lymphoid tissue is an important determinant of lymphocyte migration patterns. The association of gastrointestinal (GI) and Waldeyer's ring lymphoma and the unique lymphocyte migration pattern of gut-associated lymphoid tissue (GALT) have been previously described. To establish whether predictive clinical patterns of disease occur in localized Non-Hodgkin's lymphoma, survival and relapse patterns for 496 patients with stage I and II non-Hodgkin's lymphoma (NHL) treated with loco-regional irradiation (XRT) alone were examined. We identified 139 patients with GALT lymphoma (defined as arising from primitive gut and including Waldeyers' ring, thyroid, and GI lymphomas) and 87 patients with extranodal non-gut-associated lymphoma (ENL). Survival and relapse data were assessed in multifactorial analysis to correct for previously identified other prognostic variables. GALT lymphomas (GALT-L) have a survival advantage compared with other ENL (P = .017) independent of stage and histology. A difference in distant relapse (DR) rate between GALT-L and other ENL (P = .0002) was also identified. The presentation site of localized extranodal NHL is predictive of clinical behavior and is an independent determinant of outcome. This may be an expression of lymphocytic origin and determinants of migration patterns.

Role of radiation therapy in localized non-Hodgkin's lymphoma

Relapse occurs in 50% of patients receiving radiation for clinical stage (C.S.) I and II nodal and extranodal non-Hodgkin's lymphoma (N.H.L.). Prior to the introduction of intensive chemotherapy those failing primary control with irradiation and most of those who relapsed died of their disease with a resultant overall mortality of 50%. An analysis of Princess Margaret Hospital results with radiation for C.S. I and II N.H.L. between January 1967 and December 1978 revealed that tumour bulk, age, stage and histology were of independent prognostic significance. It was possible to group patients using combinations of these attributes so that each group encompassed only patients with similar outcomes. Such prognostic groups were identified separately within the low grade and the intermediate plus high grade categories of the Working Formulation. Patients with a high probability of cure with radiation were so defined. Also those patients in whom chemotherapy would be optimal initial therapy were also defined. Such patients were in the intermediate plus high grade histology groups. Thirty percent of all patients with low grade histology lymphoma had an actuarial survival of 83%, and relapse-free rate of 63% at 10 years. By implication, approximately 20% of all patients with these histologies seen at the Princess Margaret Hospital for the same time period achieved prolonged relapse-free survival by localized therapy. This is at variance with the implications of staging from studies where laparotomy and multiple bone marrow biopsies have been used. Such aggressive staging procedures suggest truly localised disease in only 5-6% of patients with low grade lymphoma. A significant relationship between radiation dose and disease control was demonstrated only for patients with intermediate and high grade lymphoma of medium or large bulk. A minimum tumour dose of 30 Gy was required for optimal local control with radiation.

Prognostic groups for management of localized Hodgkin's disease

Two hundred fifty-two patients receiving radical irradiation for clinical stages I and II Hodgkin's disease between 1968 to 1977 had an actuarial ten-year survival rate of 78% and a relapse-free rate of 61%. Sixty-seven patients receiving chemotherapy followed by radiation had a 78% survival rate and a 63% relapse-free rate. Independent prognostic factors for survival and relapse were age, stage, and histology. Disease bulk was predictive only of relapse. Neither site of presentation above or below the diaphragm nor presence of mediastinal involvement was predictive for survival or relapse; however, patients with large mediastinal masses (greater than or equal to 10 cm absolute diameter) had a significantly higher intrathoracic failure rate with conventional mantle irradiation. Analysis of failure, according to age, clinical stage, and histologic type, showed three groups of patients defined according to the risk of relapse with radiation therapy: those with isolated upper cervical stage IA disease (group 1, relapse rate 8%), younger patients with localized stages I and II disease of favorable histologic type (group 2, relapse rate 35%), and older patients with extensive or symptomatic stages I and II disease of less favorable histologic type (group 3, relapse rate 70%). Subsequent analysis of radiation treatment volume indicates that the use of upper abdominal irradiation for patients in group No. 2 could yield results equivalent to those achieved with radiation therapy for surgically staged patients.

Ovarian cancer: contribution of radiation therapy to patient management. Erskine memorial lecture, 1983

Ovarian cancer may be treated with radiation therapy, surgery, chemotherapy, or a combination. To evaluate the contribution of radiation therapy to patient management the cure rate must be estimated; data are presented suggesting that the 5-year survival rate provides a reasonable estimate of the cure rate. Multiple prognostic factors have been shown to affect outcome. A study of patients treated since 1971 showed that stage and postoperative residuum could be used to divide patients into two subgroups, a "poor prognosis" group and a "good prognosis" group; a multifactorial grouping of patients in the good prognosis group who were treated postoperatively with radiation therapy only was further able to divide patients into low-risk, intermediate-risk, and high-risk groups. Studies of radiation therapy for different subgroups are discussed; abdominopelvic irradiation has been shown to improve survival for approximately one-third of patients with cancer of the ovary.

Quality assurance in radiation therapy: clinical and physical aspects. Future plans: clinical

On a national scale in Canada, the members of the Canadian Association of Radiologists, Section of Radiation Oncology, plan to continue their outcome analyses. Nevertheless, there is considerable activity within many of the cancer centers in establishing quality assurance for all aspects of clinical practice, not just related to the technique of radiation therapy. Studies from the Princess Margaret Hospital will be used as examples to illustrate the need for quality assurance in: (a) diagnosis and evaluation of patients; (b) decision making with respect to treatment; (c) technical components of radiation therapy; and (d) outcome analysis, particularly an analysis of failures. For the future, there are two major objectives related to quality assurance. One is related to those patients with cancers who have a high probability of being cured. In this situation, achieving optimal treatment must be the objective and quality assurance must be directed at determining what is optimal treatment. For those patients in whom cure is still not commonly reached, the objective will be to determine why failures are occurring and whether radiation therapy technique can decrease the relapse rate.

Quality assurance in radiation therapy: clinical and physical aspects. Quality assurance: past and present in Canada

Quality assurance in any clinical field must involve the three components of clinical care: (a) diagnosis and evaluation of patients; (b) medical decision making and treatment; and (c) outcome analysis. Nationally, there have been five annual reviews of outcome from all cancer centers following radiation therapy for cancer at various sites. These reviews are voluntary and organized through the Canadian Association of Radiologists. The objective is to determine if there are any major differences in outcome across the country, and if so, can such differences be related to the population treated or technique used. So far no major differences have been noted, although the reviews have led to improved communication between centers and constructive discussions of dose and technique. There is a National Tumour Reference Centre funded by the National Cancer Institute of Canada (NCIC) to provide assistance in establishing diagnostic criteria in pathology. Ontario has been active through the Ontario Cancer Treatment & Research Foundation and the Ontario Cancer Institute in establishing UICC TNM staging and reporting, together with an evaluative program for this staging system. All other quality assurance programs take place at the level of local centers.

Prognostic factors in nodular lymphomas: a multivariate analysis based on the Princess Margaret Hospital experience

A total of 1,394 patients with non-Hodgkin's lymphoma were treated at the Princess Margaret Hospital between January 1, 1967 and December 31, 1978. Overall actuarial survival of 525 patients with nodular lymphomas was 40% at 12 years; survival of patients with localized (Stage I & III) nodular lymphomas treated with radical radiation therapy was 58%. Significant prognostic factors defined by multivariate analysis included patient's age, stage, histology, tumor bulk, and presence of B symptoms. By combining prognostic factors we have identified distinct prognostic groups within the overall population. Patients with Stage I & II disease, small or medium bulk, less than 70 years of age achieved 92% 12 year actuarial survival and a 73% relapse-free rate in 12 years of follow-up. These patients represent groups highly curable with irradiation.

Chordoma: the results of megavoltage radiation therapy

Twenty-four patients with chordoma who received one or more courses of megavoltage radiation therapy following biopsy or incomplete resection were reviewed. The uncorrected survival rate at five years was 62%, and at 10 years was 28%, but most patients had clinically detectable residual chordoma present at the time of death or last follow-up. The duration of symptomatic improvement following irradiation ranged from a few months to 18 years, median 3.5 years. Detailed dose-time and symptomatic response data for 56 patients from this series and from the literature who were treated by conventional daily fractionated megavoltage irradiation show no convincing evidence that symptomatic relief is more likely after high doses than after total doses of only 4000 to 5500 cGy. Patients are rarely cured of chordoma by partial tumor resection and conventional radiation. Four patients received multiple fractions of 100 cGy each day either as retreatment for recurrence, or as initial treatment. Symptomatic responses, and decreases in the size of tumor masses, were seen following total doses ranging from 2000 cGy/20 fractions/5 days/4 X 3 hourly fractions each day to 4000 cGy/40 fractions/12 days/4 X 3 hourly fractions each day. The short duration of follow-up in these patients prevents comparison with conventional fractionation. However, this technique presents one possible new approach for the treatment of chordoma.

Radiation therapy for patients with ovarian cancer

Evidence for an overall improvement in survival for patients with cancer of the ovary is presented. This improvement is from approximately 30% to 40% with a long term survival compatible with cure. The discussion then focuses on how treatment has contributed to that improvement, and in particular the use of radiation therapeutically. The results of the prospective randomized clinical trials at The Princess Margaret Hospital, Toronto, indicate that the use of pelvic and abdominopelvic irradiation for patients other than Stage IA, well differentiated, who have no or small residuum following surgery is curative for a large proportion and is the reason for the improvement in overall survival. Comparison of these results with others in the literature is done and shown not to disprove the findings of the PMH study. Mention is made of newer developments in multifactorial analysis to better define the patients for whom radiation is the treatment of choice currently.

Ovarian irradiation and prednisone following surgery and radiotherapy for carcinoma of the breast

Following mastectomy, patients with operable breast cancer underwent postoperative irradiation of the chest wall and regional lymph nodes. They were then assigned at random to receive no further therapy, ovarian irradiation (2000 rad in five days) or ovarian irradiation in the same dosage plus prednisone, 7.5 mg daily. A total of 705 patients received the randomly assigned treatment and were followed for up to 15 years. In premenopausal patients who received ovarian irradiation, the recurrence of breast cancer was delayed and survival prolonged, but not significantly. In premenopausal women aged 45 years or more, ovarian irradiation plus prednisone therapy significantly delayed the recurrence of breast cancer (p = 0.04) and prolonged survival (p = 0.02). No value was demonstrated for ovarian irradiation with or without prednisone therapy in postmenopausal patients.

Internal mammary lymphoscintigraphy in the assessment of patients with ovarian carcinoma

Radiocolloid internal mammary lymphoscintigraphy (IML) was evaluated in 364 patients with ovarian carcinoma to determine the frequency of abnormalities in post-operative patients, the association between the results of the lymphoscintigram and known clinical prognostic variables, and to establish whether IML yielded predictive information independent of these variables. Results of IML showed a correlation with established clinical prognostic features and yielded independent prognostic information. The sensitivity and specificity of IML in predicting relapse are 51% and 71% respectively, indicating that a single post-operative IML does not predict relapse or freedom from relapse with sufficient accuracy to make it a clinically useful test even though it provides an independent prediction of relapse.

A phase I study of misonidazole and pelvic irradiation in patients with carcinoma of cervix

A Phase I study of oral daily misonidazole (MISO) with conventional pelvic irradiation, has been conducted in patients with carcinoma of the cervix Stages IB, IIB, IIIB and IVA. MISO was administered in daily dosages to sequential groups of patients at doses of 0.15 g/m2, 0.30 g/m2 or 0.45 g/m2 for 22 days over 5 weeks. Sixteen patients were assigned to each dose level. Using a double-blind randomization, they received either placebo (3/16) or MISO (13/16). The major dose-limiting toxicity was peripheral neuropathy (PN). None of the 13 patients receiving 0.15 g/m2 or the 13 receiving 0.3 g/m2 developed PN. However, 6/13 at the 0.45 g/m2 level (total dose less than or equal to 9.9 g/m2) developed PN. Additional patients were entered at this level and a total of 13/26 developed PN, which was considered of clinically significant severity in 9. Symptoms of PN have persisted from 1 week to 10 months, and have been completely reversed in 9/13 patients. Pharmacological parameters were examined for correlation with clinically evident toxicities. Although peak plasma MISO levels and half-lives did not correlate significantly with PN, there was a significant correlation between the calculated "area under the curve" (AUC) and PN. No correlation exists between PN and total urinary excretion of MISO or the O-demethylation product. A daily dose of 0.45 g/m2; MISO (total dose less than or equal to 9.9 g/m2) is considered to produce an acceptable level of toxicity for this patient population.

Results of treating Hodgkin's disease without a policy of laparotomy staging

Results of the treatment of 780 primary patients with Hodgkin's disease at the Princess Margaret Hospital (PMH) between 1968 and 1977 are analyzed. Treatment decisions were based on the evaluation of the extent of disease by clinical methods. A marked improvement in relapse-free survival and overall survival was observed for 1973-1977 as compared to 1968-1972. This improvement did not result from differences in the distribution of important prognostic attributes (clinical stage, pathology, and age) between the two periods, and there was no improvement in our ability to rescue relapsed patients. Improved relapse-free and overall survival during the second period was observed for all stages in patients less than 50 years of age, but not in the older group. The improved survival of patients treated between 1973 and 1977 is attributed to more effective initial therapy, which reduced the fraction of patients who relapsed. These observations provide indirect evidence that relapse has a negative effect on prognosis, and that the initial treatment of patients with Hodgkin's disease should be designed to reduce the risk of relapse to a minimum without causing an unacceptable increase in late complications. The observed/expected incidence of acute leukemia and non-Hodgkin's lymphoma in the PMH series was increased to 41.9 and 13.9 respectively. The question of whether a policy of doing routine staging laparotomies improves the results of treatment of patients with Hodgkin's disease is considered only in general terms by comparing the total PMH series with the total Stanford Medical Center series of patients treated between 1968 and 1977. Relapse-free survival at 10 years is 48.9% and 66.8% respectively, at the two institutions, while overall survival at 10 years is identified.

Neurotoxic radiosensitizers and head and neck cancer patients--how many will benefit?

The causes for the exclusion of patients from a Phase I dose tolerance study of metronidazole as a hypoxic cell sensitizing agent in patients receiving radiation therapy for head and neck cancer have been reviewed. One hundred and fifty nine consecutive patients were assessed between October 1979 and December 1980 according to eligibility criteria decided upon prior to the study. Only 26 (23%) of 111 patients treated with radical radiation therapy entered the Phase I study. The major reasons for exclusion were a history of prior nervous system abnormality, age over 70, and refusal by some patients to participate in the study. The criteria used for patient selection for studies of hypoxic cell sensitizers (and other investigational agents) must be known so that data from each study can be assessed appropriately before being extrapolated to the general patient population. Clinical trials should be designed to take into account factors that might influence patient entry.

Non-Hodgkin lymphoma of the testis

Sixteen patients (median age 67 yrs.) with non-Hodgkin lymphoma of the testis were studied. Twelve of these patients had disease that was classified as local (Stages IE and IIE). Eight patients had diffuse histiocytic lymphoma, 6 had diffuse poorly differentiated lymphocytic lymphoma, 1 had both lymphoma and seminoma, and 1 had nodular poorly differentiated lymphocytic lymphoma. The overall median survival was 9.5 months. Para-aortic nodal involvement was the factor that had the strongest prognostic influence with the management methods used. Median survival without para-aortic nodal involvement was 57+ months, but with such involvement it was 6 months (p = 0.002). There is a high probability of generalized disease if lymphoma can be detected in the para-aortic nodes. For patients with Stages IE and IIE disease, radical radiation therapy is the preferred treatment. For those with disseminated disease, chemotherapy, with irradiation reserved for symptomatic and bulky localized deposits, is the recommended method of management.

Effect of fermentation and formalin preservation on the protein component of bovine colostrum

Colostrum was inoculated with Streptococcus lactis or yogurt culture or preserved with .1% (vol/vol) formalin in two separate experiments. All preparations then were stored at ambient temperature for 24 days. With increasing storage time, a larger proportion of the total colostrum nitrogen was not precipitated in 10% (wt/vol) trichloroacetic acid. By day 24, this represented 30 to 35% for the fermented samples and 10 to 15% for the formalin preserved samples. The majority of this nonprecipitable nitrogen was amino acids and small peptides. Most of the nitrogen in colostrum even after 24 days of storage should be nutritionally useful to the calf because even the nonprecipitable portion is amino acids and peptides.

An approach to classifying prognostic factors related to survival experience for non-Hodgkin's lymphoma patients: based on a series of 982 patients: 1967-1975

The survival experience of 982 non-Hodgkin's lymphoma patients registered at Princess Margaret Hospital, Toronto, between 1967 and 1975, was studied. Prognostic groups were obtained by means of a classification procedure based on standard statistical techniques; the variables utilized in the classification were ones of known reproducibility which could be measured with little inconvenience to the patient. The results show that these prognostic groups give better information than the Ann Arbor staging classification in the sense that the survival curves are clearly separated and "good prognosis" and "poor prognosis" groups are clearly identified. Implications for therapy planning are briefly discussed.

Alkali-resistant hemoglobin (HbF) in cancer patients

Elevated levels of alkali-resistant (fetal) hemoglobin were found in patients with cancer, in the absence of any overt hematologic disorders. This phenomenon was observed most frequently in patients with gonadal tumors and appears to reflect tumor burden and activity of disease.

Chemical changes in bovine colostrum preserved with formalin or by fermentation

Fresh bovine colstrum from second and third milkings postpartum was inoculated with either a yogurt culture or Streptococcus lactis or preserved with .1% formalin in two separate experiments. There was a rapid decrease in pH of the fermented samples which corresponded to decreased lactose concentrations and increased lactate and titratable acidity. Titratable acidity in the fermented colostrums increased further after 10 days from the production of volatile fatty acids, but pH did not decrease. The pH of the yogurt fermentations in Experiment 2 decreased to 3.8, and the continued increase in titratable acidity was from lactic acid rather than volatile fatty acids. The lowest pH of all other fermentations was 4.1. The extent of metabolism of the formalin-preserved colostrum was much less than for the colostrum fermented by either culture.