Consecutive 2.0: How to use your tablet for consecutive interpreting (IAPTI Presentation, 2015)
Early phase II study of oral administration of etoposide for 21 consecutive days in patients with...
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156 Abstracts/Lung Cancer 15 (19%) 139-157 squamous cell carcinomas). MRP mRNA levels were quantitated by RNase protection assay and expression of the MRP Mr 190,000 glycoprotein was estimated by immunohistochemistry. Results: Using the MRP-specific monoclonal antibody MRPrl, MRP expression was detected by immunohistochemistry in epithelial cells lining the bronchi in normal lung. In NSCLC approximately 35% of the’samples showed elevated MRP mRNA levels. Based on MRP-specific immunohisto- chemical staining the turnouts were divided into 4 groups: 12% were scored as negative (-1, 14% showed weak cyto plasmic staining of the tumourcelIs( k), 40% hadaclearcytoplastnicstaining( +), andin34% a strong cytoplasmic as well as membranous staining was observed (+ +). MRP expression, as estimated by immunohistochemistry, correlated with the MRP mRNA levels quantitated by RNase protection assay (correlation coefficient = 0.745, p = 0.0009), with MRP mRNA levels (mean f SD) of 3.0 f 1.0 U, 3.5 f 0.7 U, 7.5 + 5.9 U, and 19.3 f 10.7 U, in the (-), (*), and (++) immunohistochemistry expression groups, respectively. Among the squamous cell carcinomas a correlation was observed behveen MRP staining and tumour cell differentiation: the strongest MRP staining was predominantly found in the well differentiated tumours. Conclusions: Hyperexpression of MRP is frequently observed in primary NSCLC, especially in the well differentiated squamous cell carcinomas. Further studies are needed to assess the role of MRP in the mechanism of clinical drug resistance in NSCLC. Early phase II study of oral administration of etoposide for 21 consecutive days in patients with non-small-cell lung cancer Hayasaka S, Kinuwaki E, Nakabayashi T, Saito R, Komatsu H, Nishikawa H. et al. Jpn J Thorac Dis 1995;33: 1367-71. An early phase II clinical study was done to investigate the activity andthesafety oforaladministrationofetoposidefor 21 consecutivedays inpatients with non-small cell lung cancer. An interimanalysiswasdone after registration of 24 cases. One case was a dropout because of an insufficient administration period (4 days). The other 23 cases were complete: they comprised 9 cases of adenocatcinoma, 13 cases of squamous cell carcinoma, and 1 case of large cell carcinoma. Prior therapy had not been given in two cases. The doses used were 50 mg/ person/day in 12 cases and 75 mg/person/day in 11 cases. The response observed was one case of at 50 mglpersonlday to stage IV squamous cell carcinoma, 17 cases were no change, 5 cases were progressing disease, and giving a response rate of4.3 46 in complete cases. Considering those results, we decided that it would he difficult to achieve a 20% response rate by the end of this study, and therefore the study was terminated. The side effects of the regimen were tolerable. In conclusion, etoposide was not active against non-small-cell lung cancer at the dosage and schedule employed. Further investigation is required to obtain a more effective form of therapy. Radiotherapy Intraoperative brachytherapy using gelfoam radioactive plaque implants for resected stage III non-small cell lling cancer with positive margin: A pilot study Nori D, Li X, Pugkhem T. NY Hospital Medical Cenrer of Queens, .56- 45 Main Street, Flushing, NY11355-5095. J Surg Gncol 1995;60:257- 61. Complete surgical resection of stage III non-small cell lung cancer (NSCLC) is at times impossible. Adjuvant radiation therapy is required to sterilize the residual tumor. This study is to investigate the safety, reproducibility, and effectiveness of intraoperative I-125 or Pd-103 Gelfoam plaque implant technique as an adjuvant treatment for resected stage III NSCLC with positive surgical margin. Behveen 1989 and 1993, 12 patients with stage III NSCLC received intraoperative lung implant with radioactive I-125 or Pd-103 pellets. All 12 patients underwent tumor resection, but either gross or microscopic positive margin was found during operation. Radioactive l-125 or Pd-103 seeds were embedded in the Gelfoam plaque. After surgical resection was completed, the radioactive Gelfoam plaque was secured onto the tumor bed either by clips or suture. Either preoperative or postoperative external beam radiation of 45-60 Gy was given to all of the 12 patients. Four patients received chemotherapy. No patient has developed any earlyorlatecomplicationsattributable toimplantprocedureorradiation. The local control rate at last follow-up is 82%. The 2-year overall and cause-specific survival rates are 45% and 5646, respectively. The intraoperative Gelfoam I- 125 or Pd-103 planar implant technique is a safe, reproducible, and effective technique of treatment for stage III NSCLC with positive surgical margin. Encouraging local control and survival are achieved in patients treated with this technique. This technique will compliment standard adjuvant treatments to further improve local control in resected stage III lung cancer. The accuracy of CT-based inhomogeneity corrections and in yivo dosimetry for the treatment of lung cancer EssersM, LansonJH, LeunensG, SchnabelT, MijnheerBJ. Department ofRadiotherapy, Netherkmds CancerInstitute, Anroni van LeeuwerJloek Huis. Plesmanlaan 121, 1066 CX Amsrerdam. Radiother Oncol 1995;37: 199-208. Purpose: To determine the accuracy of dose calculations based on CT-densities for lung cancer patients irradiated with an anterioposterior parallel-opposed treatment technique and toevaluate, for this technique, the use of diodes and an Electronic Portal Imaging Device (EPID) for absoluteexitdoseandrelativetrsnsmissiondoseverification, respectively. Materials and methods: Dose calculations were performed using a 3- dimensional treatment planning system, using CT-densities orassuming the patient to be water-equivalent. A simple inhomogeneity correction model was used to take CT-densities into account. For 22 patients, entrance and exit dose calculations at the central beam axis and at several off-axis positions were compared with diode measurements. For 12 patients, diode exit dose measurements and exit dose calculations were compared with EPID transmission dose values. Resulfs: Using water- equivalent calculations, the actual exit dose value under lung was, on average, underestimated by 30%) with an overall spread of 10% (1 SD) in the ratio of measurement and calculation. Using inhomogeneity corrections, the exit dose was, on average, overestimated by 4%. with an overall spread of 6 R (1 SD). Gnly 2 96 of the average deviation was due to the inhomogeneity correction model. Theother 2 46 resulted from a small inaccuracy in beam fit parameters and the fact that lack of backscatter is not taken into account by the calculation model. Organ motion, resulting from the ventilatory or cardiac cycle, caused an estimated uncertainty in calculated exit dose of 2.5 96 (1 SD). The most important-reason for the large overall spread was, however, the inaccuracy involved in point measurements, of about 4% (1 SD), which resulted from the systematic and random deviation in patient set-up and therefore in the diode position with respect to patient anatomy. Transmission and exit dose values agreed with an average difference of 1.1%. Transmission dose profiles also showed good agreement with calculated exit dose profiles. Conclusions: The study shows that, for this treatment technique, the dose in the thorax region is quite accurately predicted using CT-based dose calculations and a simple heterogeneity correction model. Point detectors such as diodes are not suitable for exit dose verification in regions with inhomogeneities. The EPID has the advantage that the dose can be measured in the entire irradiation field,
Transcript of Early phase II study of oral administration of etoposide for 21 consecutive days in patients with...
156 Abstracts/Lung Cancer 15 (19%) 139-157
squamous cell carcinomas). MRP mRNA levels were quantitated by RNase protection assay and expression of the MRP Mr 190,000 glycoprotein was estimated by immunohistochemistry. Results: Using the MRP-specific monoclonal antibody MRPrl, MRP expression was detected by immunohistochemistry in epithelial cells lining the bronchi in normal lung. In NSCLC approximately 35% of the’samples showed elevated MRP mRNA levels. Based on MRP-specific immunohisto- chemical staining the turnouts were divided into 4 groups: 12% were scored as negative (-1, 14% showed weak cyto plasmic staining of the tumourcelIs( k), 40% hadaclearcytoplastnicstaining( +), andin34% a strong cytoplasmic as well as membranous staining was observed (+ +). MRP expression, as estimated by immunohistochemistry, correlated with the MRP mRNA levels quantitated by RNase protection assay (correlation coefficient = 0.745, p = 0.0009), with MRP mRNA levels (mean f SD) of 3.0 f 1.0 U, 3.5 f 0.7 U, 7.5 + 5.9 U, and 19.3 f 10.7 U, in the (-), (*), and (++) immunohistochemistry expression groups, respectively. Among the squamous cell carcinomas a correlation was observed behveen MRP staining and tumour cell differentiation: the strongest MRP staining was predominantly found in the well differentiated tumours. Conclusions: Hyperexpression of MRP is frequently observed in primary NSCLC, especially in the well differentiated squamous cell carcinomas. Further studies are needed to assess the role of MRP in the mechanism of clinical drug resistance in NSCLC.
Early phase II study of oral administration of etoposide for 21 consecutive days in patients with non-small-cell lung cancer Hayasaka S, Kinuwaki E, Nakabayashi T, Saito R, Komatsu H, Nishikawa H. et al. Jpn J Thorac Dis 1995;33: 1367-71.
An early phase II clinical study was done to investigate the activity andthesafety oforaladministrationofetoposidefor 21 consecutivedays inpatients with non-small cell lung cancer. An interimanalysiswasdone after registration of 24 cases. One case was a dropout because of an insufficient administration period (4 days). The other 23 cases were complete: they comprised 9 cases of adenocatcinoma, 13 cases of squamous cell carcinoma, and 1 case of large cell carcinoma. Prior therapy had not been given in two cases. The doses used were 50 mg/ person/day in 12 cases and 75 mg/person/day in 11 cases. The response observed was one case of at 50 mglpersonlday to stage IV squamous cell carcinoma, 17 cases were no change, 5 cases were progressing disease, and giving a response rate of4.3 46 in complete cases. Considering those results, we decided that it would he difficult to achieve a 20% response rate by the end of this study, and therefore the study was terminated. The side effects of the regimen were tolerable. In conclusion, etoposide was not active against non-small-cell lung cancer at the dosage and schedule employed. Further investigation is required to obtain a more effective form of therapy.
Radiotherapy
Intraoperative brachytherapy using gelfoam radioactive plaque implants for resected stage III non-small cell lling cancer with positive margin: A pilot study Nori D, Li X, Pugkhem T. NY Hospital Medical Cenrer of Queens, .56- 45 Main Street, Flushing, NY11355-5095. J Surg Gncol 1995;60:257- 61.
Complete surgical resection of stage III non-small cell lung cancer (NSCLC) is at times impossible. Adjuvant radiation therapy is required to sterilize the residual tumor. This study is to investigate the safety, reproducibility, and effectiveness of intraoperative I-125 or Pd-103
Gelfoam plaque implant technique as an adjuvant treatment for resected stage III NSCLC with positive surgical margin. Behveen 1989 and 1993, 12 patients with stage III NSCLC received intraoperative lung implant with radioactive I-125 or Pd-103 pellets. All 12 patients underwent tumor resection, but either gross or microscopic positive margin was found during operation. Radioactive l-125 or Pd-103 seeds were embedded in the Gelfoam plaque. After surgical resection was completed, the radioactive Gelfoam plaque was secured onto the tumor bed either by clips or suture. Either preoperative or postoperative external beam radiation of 45-60 Gy was given to all of the 12 patients. Four patients received chemotherapy. No patient has developed any earlyorlatecomplicationsattributable toimplantprocedureorradiation. The local control rate at last follow-up is 82%. The 2-year overall and cause-specific survival rates are 45% and 5646, respectively. The intraoperative Gelfoam I- 125 or Pd-103 planar implant technique is a safe, reproducible, and effective technique of treatment for stage III NSCLC with positive surgical margin. Encouraging local control and survival are achieved in patients treated with this technique. This technique will compliment standard adjuvant treatments to further improve local control in resected stage III lung cancer.
The accuracy of CT-based inhomogeneity corrections and in yivo dosimetry for the treatment of lung cancer EssersM, LansonJH, LeunensG, SchnabelT, MijnheerBJ. Department ofRadiotherapy, Netherkmds CancerInstitute, Anroni van LeeuwerJloek Huis. Plesmanlaan 121, 1066 CX Amsrerdam. Radiother Oncol 1995;37: 199-208.
Purpose: To determine the accuracy of dose calculations based on CT-densities for lung cancer patients irradiated with an anterioposterior parallel-opposed treatment technique and toevaluate, for this technique, the use of diodes and an Electronic Portal Imaging Device (EPID) for absoluteexitdoseandrelativetrsnsmissiondoseverification, respectively. Materials and methods: Dose calculations were performed using a 3- dimensional treatment planning system, using CT-densities orassuming the patient to be water-equivalent. A simple inhomogeneity correction model was used to take CT-densities into account. For 22 patients, entrance and exit dose calculations at the central beam axis and at several off-axis positions were compared with diode measurements. For 12 patients, diode exit dose measurements and exit dose calculations were compared with EPID transmission dose values. Resulfs: Using water- equivalent calculations, the actual exit dose value under lung was, on average, underestimated by 30%) with an overall spread of 10% (1 SD) in the ratio of measurement and calculation. Using inhomogeneity corrections, the exit dose was, on average, overestimated by 4%. with an overall spread of 6 R (1 SD). Gnly 2 96 of the average deviation was due to the inhomogeneity correction model. Theother 2 46 resulted from a small inaccuracy in beam fit parameters and the fact that lack of backscatter is not taken into account by the calculation model. Organ motion, resulting from the ventilatory or cardiac cycle, caused an estimated uncertainty in calculated exit dose of 2.5 96 (1 SD). The most important-reason for the large overall spread was, however, the inaccuracy involved in point measurements, of about 4% (1 SD), which resulted from the systematic and random deviation in patient set-up and therefore in the diode position with respect to patient anatomy. Transmission and exit dose values agreed with an average difference of 1.1%. Transmission dose profiles also showed good agreement with calculated exit dose profiles. Conclusions: The study shows that, for this treatment technique, the dose in the thorax region is quite accurately predicted using CT-based dose calculations and a simple heterogeneity correction model. Point detectors such as diodes are not suitable for exit dose verification in regions with inhomogeneities. The EPID has the advantage that the dose can be measured in the entire irradiation field,
