Albert S. DeNittis

A multi-institutional study of Internet utilization by radiation oncology patients

PURPOSE Studies describing the use of the Internet by radiation oncology patients are lacking. This multi-institutional study of cancer patients presenting to academic (AC), community (CO), and veterans (VA) radiation oncology centers was designed to analyze the use of the Internet, demographic factors related to utilization, and barriers to access to the Internet. METHODS AND MATERIALS A questionnaire evaluating the use of the Internet was administered to 921 consecutive patients presenting to radiation oncology centers at AC, CO, and VA medical centers. The study included 436 AC patients (47%), 284 CO patients (31%), and 201 VA patients (22%). A computer was available at home to 427 patients (46%), and 337 patients (37%) had E-mail access. The mean age of the patient population was 64 (range = 14-93). Males represented 70% of the patient population. The most common diagnoses included prostate cancer (33%), breast cancer (13%), and lung cancer (11%). RESULTS Overall, 265/921 patients (29%) were using the Internet to find cancer-related information. The Internet was used by 42% of AC patients, 25% of CO patients, and only 5% of VA patients (p < 0.0001). A computer was available at home in 62% AC vs. 45% CO vs. 12% VA patients (p < 0.0001). Patients < 60 years were much more likely to use the Internet than older patients (p < 0.0001). Most of the Internet users considered the information either very reliable (22%) or somewhat reliable (70%). Unconventional medical therapies were purchased over the Internet by 12% of computer users. CONCLUSIONS A significant number of cancer patients seen in radiation oncology departments at academic and community medical centers utilize the Internet to obtain information about cancer. Radiation oncologists must familiarize themselves with this resource because of the large number of patients using the Internet. Veterans lack the computerized access to this information and are thus underserved by this important resource.

NRG Oncology Radiation Therapy Oncology Group 0822: A Phase 2 Study of Preoperative Chemoradiation Therapy Using Intensity Modulated Radiation Therapy in Combination With Capecitabine and Oxaliplatin for Patients With Locally Advanced Rectal Cancer

PURPOSE To evaluate the rate of gastrointestinal (GI) toxicity of neoadjuvant chemoradiation with capecitabine, oxaliplatin, and intensity modulated radiation therapy (IMRT) in cT3-4 rectal cancer. METHODS AND MATERIALS Patients with localized, nonmetastatic T3 or T4 rectal cancer <12 cm from the anal verge were enrolled in a prospective, multi-institutional, single-arm study of preoperative chemoradiation. Patients received 45 Gy with IMRT in 25 fractions, followed by a 3-dimensional conformal boost of 5.4 Gy in 3 fractions with concurrent capecitabine/oxaliplatin (CAPOX). Surgery was performed 4 to 8 weeks after the completion of therapy. Patients were recommended to receive FOLFOX chemotherapy after surgery. The primary endpoint of the study was acute grade 2 to 5 GI toxicity. Seventy-one patients provided 80% probability to detect at least a 12% reduction in the specified GI toxicity with the treatment of CAPOX and IMRT, at a significance level of .10 (1-sided). RESULTS Seventy-nine patients were accrued, of whom 68 were evaluable. Sixty-one patients (89.7%) had cT3 disease, and 37 (54.4%) had cN (+) disease. Postoperative chemotherapy was given to 42 of 68 patients. Fifty-eight patients had target contours drawn per protocol, 5 patients with acceptable variation, and 5 patients with unacceptable variations. Thirty-five patients (51.5%) experienced grade ≥ 2 GI toxicity, 12 patients (17.6%) experienced grade 3 or 4 diarrhea, and pCR was achieved in 10 patients (14.7%). With a median follow-up time of 3.98 years, the 4-year rate of locoregional failure was 7.4% (95% confidence interval [CI]: 1.0%-13.7%). The 4-year rates of OS and DFS were 82.9% (95% CI: 70.1%-90.6%) and 60.6% (95% CI: 47.5%-71.4%), respectively. CONCLUSION The use of IMRT in neoadjuvant chemoradiation for rectal cancer did not reduce the rate of GI toxicity.

Neural tube formation in the mouse: a morphometric and computerized three-dimensional reconstruction study of the relationship between apical constriction of neuroepithelial cells and the shape of the neuroepithelium.

SummaryMorphornetry and computerized three-dimensional reconstruction were used to study the relationship between apical constriction of neuroepithelial cells and the pattern of bending of the neuroepithelium in the developing neural tube of the 12-somite mouse embryo. The neuroepithelium of the mouse exhibits prominent regional variations in size and shape along the embryo axis. The complex shape of most of the cephalic neural tube (e.g., forebrain and midbrain) is due to the coexistence of concave and convex bending sites whereas more caudal regions (e.g., hindbrain and spinal cord) generally lack sites of convex bending and have a relatively simple shape. The apical morphology of neuroepithelial cells was found to be correlated more closely with the local status of bending of the neuroepithelium than with the specific region of the neural tube in which they are located. In areas of enhanced apical constriction, microfilament bundles were particularly prominent. Morphornetry revealed that patterns of bending of the neuroepithelium were correlated almost exactly with those of apical constriction throughout the forming neural tube. These findings support the idea that apical constriction of neuroepithelial cells, resulting from tension generated by microfilament bundles, plays a major role in bending of the neuroepithelium during neural tube formation in the mouse.

Complete remission of nonresectable pancreatic cancer after infusional colloidal phosphorus-32 brachytherapy, external beam radiation therapy, and 5-fluorouracil: a preliminary report.

This is a preliminary report of five patients diagnosed with locally advanced nonresectable pancreatic cancer who achieved improved quality of life, delay of local progression, and reduction of biomarker CA 19-9 after infusion of colloidal phosphorus 32 (32P) and administration of combined chemoradiotherapy. A phase II trial using intratumoral colloidal 32P delivery for nonresectable pancreatic cancer without metastases is in progress. Patients initially were given infusions of decadron followed by macroaggregated albumin and 30 mCi colloidal 32P to the interstitial space of the tumor by two infusions 1 week apart. Through this method, doses ranging from 750,000 to 1,800,000 cGy were delivered. After administration of colloidal 32P, external radiation to a dose of 6000 cGy minimum tumor dose, including regional lymph nodes, was given concomitantly with four intravenous infusions of 500 mg bolus 5-fluorouracil on alternating days within the first 2 weeks after initiation of external radiation. All five of these patients demonstrated cessation of local tumor growth or regression of disease on serial computed tomography scans for a minimum of 10 months from completion of therapy. Three of these patients have survived without local disease progression over 24 months from initiation of therapy, with one patient approaching 36 months. CA 19-9 values for all patients declined within weeks after completion of therapy. This new method of isotope delivery has resulted in reduction of tumor volume, normalization of the biomarker CA 19-9, and improved performance status in those patients who have localized nonresectable disease without dissemination.

A new method for delivering radioactive cytotoxic agents in solid cancers

PURPOSE Therapeutic agents such as monoclonal antibodies, radiopharmaceuticals, and radioactive growth factors are limited in effectiveness due to the inability to deposit significant quantities of the agents and for limited periods of time in solid cancer. A new technique based on knowledge of the pathophysiology of solid tumors allows for significant concentration of these agents to accumulate and for a prolonged period of time, thus allowing interaction with the tumor for potentially increased effectiveness. METHODS AND MATERIALS Three agents have been studied: 131I antiferritin monoclonal antibody, colloidal 32P chromic phosphate, and 131I transferrin. The time required for maximal tumor uptake was determined in vitro in tissue culture and was 10 min, 25 min, and 40 min, respectively. The new method of in vivo tumor infusion consisted of a direct intratumoral injection of macroaggregated albumin (MAA) 10,000 particles, followed by the radioactive agents under study. Tumors were infused in vivo using the new technique and compared to intratumoral infused controls. In the instance of radiolabeled antiferritin antibody, intraperitoneal administration and intratumoral infusion were compared to the new technique. In the other two instances, intratumoral infusion was compared to the new method. RESULTS In all instances the direct vascular blockade caused by MAA led to greater deposition of the agent under study for at least 24 h. These results were clinically applied with MAA followed by 32P colloidal chromic phosphate and were consistent with the experimental findings. CONCLUSION A new technique is described that may be carried out in the experimental laboratory and clinic by direct tumor infusion of macroaggregated albumin (MAA), followed by other radioactive agents that will remain localized in solid cancers and will allow for high tumor dose deposition for potentially increased therapeutic efficacy.

Internet utilization by radiation oncology patients

Purpose: Studies describing the use of the Internet by radiation oncology patients are lacking. This multi-institutional study of cancer patients presenting to academic (AC), community (CO) and veterans (VA) radiation oncology centers was designed to analyze the use of the Internet, predictive factors for utilization, and barriers to access to the Internet. Materials and Methods: A questionnaire evaluating the use of the Internet was administered to 921 consecutive patients presenting to radiation oncology departments at AC, CO and VA Medical Centers. The study included 436 AC patients (47%), 284 CO patients (31%), and 201 VA patients (22%). A computer was available at home to 427 patients (46%) and 337 patients (37%) had Email access. The mean age of the patient population was 64 years (range=14-93). Males represented 70% of the patient population. The most common diagnoses included prostate cancer (33%), breast cancer (13%), and lung cancer (11%). Results: Overall, 265/921 patients (29%) were using the Internet to find cancer related information. The Internet was used by 42% of AC patients, 25% of CO patients and only 5% of VA patients (p<.0001). A computer was available at home in 62% AC vs. 45% CO vs. 12% VA patients (p<.0001). Patients < 60 years were much more likely to use the Internet than older patients (p<.0001). Most of the Internet users considered the information either very reliable (22%) or somewhat reliable (70%). Most patients were looking for information regarding treatment of their cancer (90%), management of side effects of treatment (74%), alternative/complementary treatments (65%) and clinical trials (51%). Unconventional medical therapies were purchased over the Internet by 12% of computer users. Products or services for the treatment or management of cancer were purchased online by 12% of Internet users. Conclusion: A significant number of cancer patients seen in radiation oncology departments at academic and community medical centers utilize the Internet to obtain information about cancer. Radiation oncologists must familiarize themselves with this resource because of the large number of patients using the Internet. Veterans lack the computerized access to the Internet and remain underserved by this important resource.

Multimodality in the Management of Adenocarcinoma of the Esophagus

Prior to 1980, due to the relatively low incidence of adenocarcinoma of the esophagus and the use of surgery as the primary modality of treatment, information regarding the efficacy of radiation in esophageal adenocarcinoma was limited. Reports in the literature as early as 1948, distinguish adenocarcinoma of the esophagus as a separate entity from the more commonly seen squamous cell carcinoma. A total of 18 cases of esophageal adenocarcinoma were reported in the literature pre-1980, which involved the use of radiation therapy (4 of which were treated preoperatively and 14 treated with radiotherapy alone). These earlier reports largely failed to report on the treatment schema or type of radiation used.