AbstractThe clinical utility of magnetic resonance imaging (MRI) in judging therapeutic response of bone metastases was evaluated in 18 patients with advanced breast cancer. Treatment efficacy was assessed by MRI and conventional methods such as plain radiograph, bone scan, pain and analgesic scale, and serum CAl5–3. The response by MRI was evaluated mainly on TI -weighted sequences by measuring the volume of the bone lesion and soft tissue component. The patient was assumed to be a conventional responder if a complete or partial response was observed in any of the conventional methods described above. Response was most concordant between plain radiographs and MRI findings (91%, 10/11, 95% confidence interval [CI]: 58.7–99.8). The rate of concordance was 61% (11/18, 95% CI 35.8–82.7) for all conventional methods and MRI. MRI revealed response in four patients in whom progressive disease was observed by bone scan and the marker response was not measurable. This pilot study suggests that posttherapy evaluation with MRI may provide useful clinical information in breast cancer patients with bone metastases and may be a valuable adjunct to conventional methods with conflicting results.
The mechanisms responsible for the rapid increases in levels of gonadotropin and steroid hormones upon administration of cisplatin to rats are not clearly understood. In the present study, the morphologic effects of cisplatin on the testis and the relationship of these changes to serum hormone levels were studied in adult rats. Upon administration of a single dose (5 mg/kg) of cisplatin, the levels of testosterone in the peripheral blood decreased and the level of luteinizing hormone (LH) increased. After 3 days, significant damage to the germinal epithelium became detectable by morphologic examination. In Leydig and Sertoli cells, dilatation of the endoplasmic reticulum, structural changes in mitochondria and an increase in the numbers of inclusion bodies were detected. Although blood-testis barriers between Sertoli cells were normal, the relationship between germinal cells and the relationship between germinal cells and Sertoli cells were distorted. It is concluded that damage to Leydig cells and withdrawal of the controlling effects of the germinal epithelium on the LH-Leydig cell axis could explain the changes in serum hormone levels.
7270 Background: The aim of this study is to evaluate the efficacy of an induction regimen consisting of carboplatin and weekly paclitaxel followed by concomitant chemotherapy and thoracic irradiation in patients with NSCLC. Methods: Twenty-four patients with stage III NSCLC, who were not amenable to curative surgery and ECOG PS ≤2 were administered an induction combination consisting of carboplatin at an AUC 6 mg.ml/min on D1 and 21 and weekly paclitaxel at 100 mg/m2 for 5 consequtive weeks starting on D1.Those without evidence of progressive disease in the form of metastatic involvement were given thoracic irradiation starting on day 50, reaching a total dose of 60 Gy with 180 cGy daily fractions for 5 weeks and an accelerated boost of 150 cGy/fr delivered to the tumor area over the last two weeks. Paclitaxel was given concurrently during irradiation at 60 mg/m2 on days 50, 57, 64,71 and 78. The median age of the patient group was 51.5 years, (37–71). Nine patients (37.5%) had an ECOG PS of 0, while the remaining 15 had a PS of 1. The majority had squamous cell histology (n=13, 54.2%), and 9 patients had adenocarcinoma (37.5%).Results: After a median follow-up period of 9 (1–25) months, 13 patients experienced progression (54.2%), 5 of which progressed while on treatment and eight patients (33.3%) died. Two patients did not complete the planned treatment schedule; 1 patient had an anaphylactic reaction to paclitaxel infusion and the other withdrew consent. Overall response rate after completion of the protocol was 62.5% (2: complete response, 13: partial response). The most frequent side effect of concomitant chemoradiation was oesaphagitis, encountered in 16 patients. Grade 3–4 toxicity during both phases of treatment were: oesaphagitis in 4 patients (16.7%), mucositis in 1 (4.2%), anemia in 1 and neutropenia in 1 patient. Conclusions: This treatment protocol consisting of an induction combination followed by concomitant chemoradiation is a feasible regimen with a tolerable toxicity profile in patients with locally advanced NSCLC. No significant financial relationships to disclose.
Malignant thymomas are usually confined to the mediastinum at the time of diagnosis and follow-up. Distant metastasis is distinctly rare. This is the first clinical case report of a thoracic malignant thymoma with distant soft-tissue metastasis that involves the retrovesical area to include the seminal vesicle.
This phase II study evaluates the efficacy and toxicity of a prolonged schedule second-line and third-line treatment of oral VP16 in patients with measurable advanced ovarian cancer resistant to, or relapsed following, platinum-based chemotherapy. Twenty-two eligible women with progressive or relapsed ovarian cancer resistant to platinum-based therapy were included in this study. All the patients had received more than one prior treatment, and had evidence of disease progression within 6 months of the previous chemotherapy. Eleven patients had received more than two different chemotherapy regimens. Fifteen patients had received consolidation therapy with intraperitoneal cisplatin after an initial treatment course with six cycles of a platinum-based combination regimen. All patients with measurable disease observed in abdominal computed tomography scans were given oral VP16 at a daily dose of 50 mg/m2 for 14 consecutive days with 4 weekly intervals. Among 22 assessable patients, there were one complete response (CR) and three partial responses (PR), so the objective response rate, which is the addition of CR and PR rates, was 18%. Seven patients (32%) had stable disease. Median duration of response and stable disease was 2.5 months (range: 1–10 months). Overall median survival was 11 months from study entry (range: 3–36 months). Toxicity for most patients was mild, but a few severe myelotoxicities occurred, and there were no treatment-related deaths. According to World Health Organization toxicity criteria grade III/IV thrombocytopenia was seen in 4 of 22 patients, grade III/IV neutropenia in 6 of 22 patients, and grade III anemia was observed in 3 of 22 patients. Nonhematologic toxicity was mild, and mucositis was the most frequently observed nonhematologic toxicity. Oral etoposide has considerable activity with a tolerable toxicity profile for the treatment of platinum-resistant epithelial ovarian cancer.
