Do inflammatory processes contribute to radiation induced erythema observed in the skin of humans?

Background: Two prospective trials were designed to determine whether there may be a role for inflammatory mediators in human skin erythema at both high and low doses per fraction and for 'out of field' effects.

Methods: Trial 1. Effects of topical indomethacin (1%) and hydrocortisone (1%) applied before and during radiotherapy were compared for erythema induced by 20 Gy in four fractions (n = 26, 6 MV).

How should we introduce high-dose chemotherapeutic strategies into the adjuvant management of high-risk breast cancer in Australasia?

Background: Development of bone marrow support techniques has altered the standard chemotherapeutic management of haematological malignancies, and these techniques are now being increasingly utilized in solid tumours. In breast cancer, survival benefits have resulted from conventional dose adjuvant chemotherapy, but outcomes remain poor in many women with high-risk disease. Improved response rates with high-dose chemotherapy (HDC) in metastatic disease have led to the investigation of these techniques in adjuvant therapy of high-risk localized disease.

A phase III double-blind randomised study of rectal sucralfate suspension in the prevention of acute radiation proctitis.

Background And Purpose: A limited number of studies have suggested that oral sucralfate reduces the acute and late gastro-intestinal side-effects of pelvic radiotherapy and sucralfate enemas ameliorate symptoms of chronic proctitis. Sucralfate may act via local bFGF at the mucosal level in promoting angiogenesis and reducing epithelial associated microvascular injury. This multi-institutional study was designed to test the hypothesis that sucralfate given as an enema would have a significant protective effect against acute radiation induced rectal injury by direct application to the mucosa.

Normal variation in cutaneous blood content and red blood cell velocity in humans.

This study was designed to determine normal variations in cutaneous blood content, red blood cell content and skin thickness in healthy human volunteers. The blood content (BC) of human skin and the velocity of red blood cells (RBV) has been comprehensively mapped over 30 anatomical sites in 28 volunteers between the age of 7 and 77 years using reflectance spectrophotometry (RFS) and laser Doppler (LD) techniques respectively. Total skin thickness, which may have a relationship with blood content, has been mapped at the same anatomical sites in six of the volunteers using two-dimensional array, 12 MHz ultrasound equipment.

A combined modality approach to the management of oesophageal cancer.

This study aims to update the experience of multimodality approaches in the management of oesophageal cancer that have been adopted in several Australian and New Zealand hospitals. Between 1984 and 1985, 92 patients received pre-operative radiotherapy (30-36 Gy over 3 weeks) and one of two chemotherapy regimes (one or two courses of i.v.

Response of human hair cortical cells to fractionated radiotherapy.

Hair cortical cell counting (HCCC) represents a non-invasive, in-vivo measure of cell kill in the human integument. Sixty-six patients undergoing conventionally fractionated, external beam radiotherapy for early stage carcinoma of the prostate had groin hair samples counted. This technique is a sensitive and reproducible measure of radiation effect and may have applicability as an in-vivo prediction tool or in the field of biological dosimetry.

TLD extrapolation for skin dose determination in vivo.

Prediction of skin reactions requires knowledge of the dose at various depths in the human skin. Using thermoluminescence dosimeters of three different thicknesses, the dose can be extrapolated to the surface and interpolated between the different depths. A TLD holder was designed for these TLD extrapolation measurements on patients during treatment which allowed measurements of entrance and exit skin dose with a day to day variability of +/-7% (S.

Mucosal regeneration during radiotherapy. Trans Tasman Radiation Oncology Group (TROG).

Background And Purpose: Regeneration of the aerodigestive mucosa is known to occur during conventionally fractionated radiotherapy. The circumstances surrounding its time of onset and magnitude are not well understood, however.

Material And Methods: Mucosal reactions were observed in 100 patients undergoing conventionally fractionated treatment at 2 Gy/day over 7 weeks and 88 receiving accelerated treatment at 1.

Concurrent chemoradiation for oesophageal cancer: factors influencing myelotoxicity.

Concurrent chemotherapy and radiation (CT/RT) for localized oesophageal cancer can cause life-threatening myelosuppression. This non-randomized study examines 95 patients from three Australasian centres treated on the Trans-Tasman Radiation Oncology "definitive' chemoradiation study. Duration of fluorouracil infusion and patient age were independently predictive of myelotoxicity after the first cycle of CT/RT.

Factors influencing outcome following radio-chemotherapy for oesophageal cancer. The Trans Tasman Radiation Oncology Group (TROG).

Background And Purposes: To define new directions, the Trans Tasman Radiation Oncology Group (TROG) has conducted a detailed analysis of its unrandomised experience with radio-chemotherapy in oesophageal cancer.

Methods And Patients: Since 1984, 373 patients with oesophageal cancer have been treated on three prospective, but unrandomised, protocols involving radiation with concurrent cisplatin and infusional fluorouracil. Centres in Australia and New Zealand have contributed patients.

Underprediction of human skin erythema at low doses per fraction by the linear quadratic model.

Background And Purpose: The erythematous response of human skin to radiotherapy has proven useful for testing the predictions of the linear quadratic (LQ) model in terms of fractionation sensitivity and repair half time. No formal investigation of the response of human skin to doses less than 2 Gy per fraction has occurred. This study aims to test the validity of the LQ model for human skin at doses ranging from 0.

Low dose rate teletherapy: updated tumour response.

This report presents an update of tumour response experience in patients with locally advanced head and neck cancer treated on the low dose rate teletherapy project at the Mater Misericordiae Hospital, Newcastle. Long-term progression-free survival figures are disappointing in all dose rate/total dose groupings and offer little encouragement that an improvement in therapeutic ratio can be achieved for head and neck cancer patients using teletherapy apparatus adjusted to treat at low and intermediate dose rates.

Evaluation of rectal shielding in a Henschke system applicator.

Purpose: To assess the effectiveness of avoid shielding in the Henschke intracavitary gynaecologic 3-channel applicator.

Material And Methods: An acrylic phantom was used with our locally modified 3-channel Henschke applicator so that standard treatments with caesium-137 sources could be simulated. Thermoluminescent dosimeters were used to measure point A and rectal doses with and without ovoid shielding to assess the benefits of this shielding.

The follicular non-Hodgkin's lymphomas--II. Prognostic factors: what do they mean?

The Ann Arbor staging classification has long been recognised to have shortcomings when used to stage the follicular lymphomas. To date, the identification of important prognostic variables has not succeeded in producing a superior staging classification that reflects the stages of dissemination of these processes in a way that can be used in the testing of new therapeutic strategies. A fresh look is taken at these factors.

The follicular non-Hodgkin's lymphomas--I. The possibility of cure.

The follicular lymphomas pursue an indolent course in many patients. Long-term follow-up in large series is therefore necessary to establish whether cure is taking place, and if so, at what stage in the dissemination of the disease process it becomes unlikely. The time to, and site of relapse, together with its impact on survival has been studied in 398 patients entered into the British National Lymphoma Investigation limited and disseminated disease trials between 1974 and 1980.

Clinical use of carbon-loaded thermoluminescent dosimeters for skin dose determination.

Purpose: Carbon-loaded thermoluminescent dosimeters (TLDs) are designed for surface/skin dose measurements. Following 4 years in clinical use at the Mater Hospital, the accuracy and clinical usefulness of the carbon-loaded TLDs was assessed.

Methods And Materials: Teflon-based carbon-loaded lithium fluoride (LiF) disks with a diameter of 13 mm were used in the present study.

Factors influencing the degree of erythematous skin reactions in humans.

Dose-response relationships have been studied using an ordinal visual scale and reflectance spectrophotometry data from 123 treatment sites on 110 patients treated with 10 dose fractions over 12-14 days. Dose rates varied between 3 and 240 Gy/h and total doses of between 25 and 41 Gy were given using teletherapy apparatus. We found qualitative scoring of erythematous skin reactions to be subject to considerable inter- and intra-observer variation.

Combined modality therapy for esophageal carcinoma: preliminary results from a large Australasian multicenter study.

Purpose: This report updates local control and survival experience and focuses on treatment toxicity in 294 patients with esophageal cancer who have been treated at six Australasian centers using three prospective unrandomized protocols that used concurrent radiation, cisplatin, and modest dose infusional fluorouracil.

Methods And Materials: Protocol 1--"definitive" chemoradiation. One hundred and thirty-seven patients have been treated with "definitive" radiation to 60 Gy in 6 weeks plus two courses of cisplatin (80 mg/m2) and infusional fluorouracil (800 mg/m2/day over 4 days) during the first and fourth weeks of radiation.

How do we bring an acceptable level of radiotherapy services to a dispersed population?

Radiotherapy referral data from four Australian States confirm that access difficulties contribute to low radiotherapy utilization rates. Access could be improved by the provision of further small treatment centres in moderately large rural or semi-rural population centres. Such a policy, however, could endanger existing standards of radiotherapeutic care unless the potential pitfalls of such an approach are addressed prospectively.

Acute reaction parameters for human oropharyngeal mucosa.

The purpose of this study was to determine the influence of changes in dose rate over the range 0.8-240 Gy/h on acute oropharyngeal mucosal reactions in human subjects, and to estimate the values of the important parameters that influence these reactions. Sixty-one patients requiring radiotherapy to palliate incurable head and neck cancer were treated on a telecaesium unit, using opposing lateral portals to total midline doses, varying between 30 and 42 Gy in 10 daily fractions over 2 weeks, at dose rates of 0.

A perspex flattening filter for a 300k Vp orthovoltage X-ray beam.

For economic reasons modern equipment which produces low to medium energy X-rays covers the whole range of beam qualities from traditional superficial to orthovoltage radiation qualities. A recent trend shows an increasing number of installations of orthovoltage units in the cancer therapy community in the last five years. The use of a single anode for accelerating voltages between 60 and 300 kVp leads to compromises with regards to beam flatness and symmetry in the anode/cathode direction of the Siemens Stabilipan II radiation beam.

Simultaneous adjuvant radiation therapy and chemotherapy in high-risk breast cancer--toxicity and dose modification: a Transtasman Radiation Oncology Group Multi-Institution study.

Purpose: To establish the toxicity profile of simultaneously administered postoperative radiation therapy and CMF chemotherapy as a prelude to a randomized controlled study addressing the sequencing of the two modalities.

Methods And Materials: One hundred and thirty eight breast cancer patients at high risk of locoregional, as well as systemic relapse, who were referred to three centers in Australia and New Zealand were treated with postoperative radiation therapy and chemotherapy simultaneously. Acute toxicity and dose modifications in these patients were compared with 83 patients treated over the same time frame with chemotherapy alone.