Maliha Edgren

Postoperative radiotherapy after prostatectomy: A review

Purpose: The management of prostate adenocarcinomas using postoperative irradiation is a controversial question. The purpose of this study was to review the literature on the subject. Material and methods: A total of 417 articles dealing with postoperative radiotherapy after radical prostatectomy in English literature (1990-2002) were reviewed in aspects of effect on survival, time of irradiation, risk factors, dose and technique and side effects. Results and discussion: No randomised studies have been performed and therefore no definitive conclusive data can be made concerning the efficiency of the concept. However, postoperative radiotherapy appears to increase local control preferably in pT3/4 prostatic carcinomas with seminal vesicles involvement and/or positive margins and/or high Gleason score and high postoperative PSA level. It has not been shown to improve survival. Severe side effects are reported in a low frequency. However, postoperative irradiation can cause severe side effects and postoperative adjuvant /salvage treatments should be delivered earliest 3-6 months after surgery and the total dose delivered to the prostate bed should be 65-70 r Gy. Postoperative radiotherapy induces improved local control in patients with positive surgical margins and in patients with a local relapse, preferably if the tumour is small (i.e. PSA <1-2 r ng/mL).

Estramustine-Binding Protein (EMBP) in Renal Cell Carcinoma Immunohistochemistry, Immunoscintigraphy and in Vitro Estramustine Effects

The present report shows that the human renal cell carcinoma (RCC) cell lines, A498 and CAKI-2, express the estramustine-binding protein (EMBP). The RCC cell lines investigated were highly sensitive for estramustine, with cell arrest in atypical metaphase. In vitro experiments using a fluorimetric cytotoxicity assay (FMCA) showed a pronounced cytotoxic effect mediated by estramustine. Immunohistochemical analysis of tumour specimens from patients with RCC showed positive staining for EMBP in 12/16 cases. Immunoscintigraphy was performed in an experimental system in nude mice, heterotransplanted with the CAKI-2 cell line. A radiolabelled monoclonal anti-EMBP antibody was used. The results show a specific uptake of the antibody in the RCC tumour, expressed as a percentage of the injected dose per gram tissue, which ranged from 4.03 to 6.9. The results obtained form the basis for clinical studies on the feasibility of utilizing estramustine in the management of RCC. Immunoscintigraphy using the monoclonal anti-EMBP antibody is of potential use for in vivo characterization of the malignancy and in the selection patients suitable for treatment with estramustine.

Patient positioning using artificial intelligence neural networks, trained magnetic field sensors and magnetic implants.

The purpose of this study was to evaluate the precision of a sensor and to ascertain the maximum distance between the sensor and the magnet, in a magnetic positioning system for external beam radiotherapy using a trained artificial intelligence neural network for position determination. Magnetic positioning for radiotherapy, previously described by Lennernäs and Nilsson, is a functional technique, but it is time consuming. The sensors are large and the distance between the sensor and the magnetic implant is limited to short distances. This paper presents a new technique for positioning, using an artificial intelligence neural network, which was trained to position the magnetic implant with at least 0.5 mm resolution in X and Y dimensions. The possibility of using the system for determination in the Z dimension, that is the distance between the magnet and the sensor, was also investigated. After training, this system positioned the magnet with a mean error of maximum 0.15 mm in all dimensions and up to 13 mm from the sensor. Of 400 test positions, 8 determinations had an error larger than 0.5 mm, maximum 0.55 mm. A position was determined in approximately 0.01 s.