http://nova.newcastle.edu.au/vital/access/services/Feed ${session.getAttribute("locale")} 5 http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:8029 Background and purpose: Biological mechanisms underlying radiation induced erythema remain largely unknown, with no simple way to accurately predict or prevent extreme cases. Based on the recent findings in patients suffering from chronic urticaria, we sought to determine if similar mechanisms of hypercoagulation contributed to comparable skin reactions during radiotherapy. Materials and methods: Plasma levels of prothrombin factor 1+2 (F1+2), D-dimers and plasminogen activator inhibitor-1 (Pai-1) were tested in 32 women undergoing irradiation following breast conserving surgery for early breast cancer. Reflectance spectrophotometry was used to objectively assess erythema throughout the treatment by measuring the amount of light reflected from the skin surface as a function of wavelength. Correlations between peak levels of erythema and plasma biomarkers were then assessed. Results: Individual peak reflectance readings generally occurred between day 29 of treatment and 2 weeks post radiotherapy, and represented a median increase of 66% (range: 11–146%; p < 0.001) from baseline. Peak reflectance correlated with F1+2 and Pai-1 levels measured both at baseline and day 29 of treatment, and multivariate analysis indicated that these two baseline measurements were the best predictors of peak reflectance, accounting for 59% of the variability in erythema (p = 0.000004). Conclusions: Patients with signs of intravascular thrombin generation are at higher risk of radiotherapy-induced skin reactions, providing a new therapeutic avenue for possibly predicting and preventing this side effect of cancer treatment. 2011-07-01T04:50:07.842Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7930 Primary CNS lymphoma is an enigmatic and challenging disease—its uncertainties begin with aetiology and extend to the potential for treatment-related toxicity years later. The malignant lymphocytes' tropism for the CNS remains unexplained, both in terms of disease origin and the low incidence of systemic relapse. Presentation ranges from many months of intermittent vague neurological symptoms to rapidly progressive severe sensorimotor and cognitive impairment. Pathological diagnosis can be a problem and hampered by the empirical use of corticosteroids. In The Lancet today, Andrés Ferreri and colleagues from the International Extranodal Lymphoma Study Group (IELSG) present only the second randomised trial reported in primary CNS lymphoma. The investigators conclude that the addition of high-dose cytarabine to high-dose methotrexate improved disease response. In this study, 77% (33/43) of responding patients also received whole-brain irradiation as part of their primary therapy. The addition of cytarabine was also associated with improved overall survival, which confirmed the benefit suggested in the retrospective analysis by the same study group. The investigators are to be commended for their contribution to the evidence-base in this rare disease. Successfully completing clinical trials in common cancers is difficult enough, and opinions on treatment in primary CNS lymphoma are polarised. Patients' median age is about 60 years with many older than 70 years. This age group is historically under-represented in clinical trials and, in patients with primary CNS lymphoma, at highest risk of treatment-related complications. 2011-06-23T23:31:49.330Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7132 A prospective study was conducted to determine whether any relationship exists between skin erythema, fatigue and biological factors during and after adjuvant radiotherapy for early breast cancer. Breast erythema was assessed objectively using reflectance spectrophotometry. Fatigue was recorded utilising the functional assessment of cancer therapy fatigue subscale. A number of potential systemic indicators (biological factors) of the effects of radiotherapy was measured, including circulating cytokines, coagulation factors, peripheral blood indices and biochemistry. Measurements for erythema, fatigue and biological factors were taken at baseline and intervals during and following completion of radiotherapy. A total of 52 eligible patients was included in the analysis. Breast erythema was shown to progressively increase during treatment, peaking on day 36 and returning to baseline by 4 months postirradiation. Fatigue also progressively increased during treatment, reaching a plateau between day 22 and 2 weeks post-radiotherapy. A statistically significant association was demonstrated between total breast erythema and fatigue at days 4, 8, 22 and 29 of irradiation and 2 and 6 weeks post-radiotherapy. When only the increase in erythema attributable to radiotherapy was considered, statistically significant associations remained for day 4 of irradiation and 2 and 6 weeks post-radiotherapy. When multiple time points were considered together, an association between increased erythema and fatigue was present only postradiotherapy. No relationship was demonstrated between the biological factors and erythema or fatigue during radiotherapy. This study demonstrates a significant and consistent relationship between radiotherapy-induced breast erythema and fatigue, particularly in the period immediately following breast irradiation. 2011-02-02T23:10:10.096Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5009 Aim: This retrospective review was conducted to compare outcomes using different fractionation schedules for early stage glottic cancer treated with radiotherapy between 1991 and 2003. Methods: The records of 87 patients with either T1 or T2 squamous cell carcinomas of the glottic larynx were analysed, dividing the patients into those treated with a hypofractionated schedule, mostly 51 Gy/16# (<53 Gy) and standard fractionation, minimum 60 Gy/30# in 2 Gy fractions. The median follow up was 4 years and 7 months. Results: Local control at 5 years was 81% with standard fractionation vs 93% in the hypofractionated group (P = 0.1). Laryngectomy free survival at 5 years was 78% with standard fractionation versus 95% in the hypofractionated arm (P = 0.017). Overall survival at 5 years was 65% with standard fractionation versus 74% in the hypofractionated arm (P = 0.55). Conclusion: In early stage glottic cancer, a hypofractionated course of radiotherapy has been shown to be a safe and possibly more effective treatment compared with standard fractionation. 2010-04-27T04:45:15.621Z ]]>