Is Extended Volume of External Beam Irradiation Beneficial in Post-esophagectomy High Risk Patients Receiving Combined Chemoradiation Therapy?

OBJECTIVE: To assess the value of extended volume irradiation with anastomotic coverage in high risk resected esophageal cancer patients. METHOD: A retrospective study was undertaken at LRCC from 1989-1999 for high risk resected esophageal cancer patients. Adjuvant treatments consisted of 4 cycles of chemotherapy (epirubicin/fluorouracil/cisplatin or cisplatin/fluorouracil), and local regional irradiation with or without coverage of the anastomotic site. Radiation dose ranged from 45-60Gy at 1.8-2.0 Gy/fraction given with initial anterior-posterior/posterior-anterior arrangement with either extended (with anastomotic coverage) or small (without anastomotic coverage) field followed by oblique fields for boost. RESULT: One hundred eighty-eight charts were reviewed. Seventy-two patients were eligible for post-resection chemoradiation therapy. Three patients had disease progression prior to therapy, and 69 patients were analyzed. There were 81% T3N1 and 13% T2N1. Thirty-four patients had margin involvements (radial 53%; proximal/distal 32%), 65% were adenocarcinoma and 33% were squamous carcinoma. Median followup was 23.6 months (3.4 - 78.4 months). Two year survival was 50%; 5yr 24%. Relapse rate was 62.3% and median time to relapse was 20 months. Recurrence locally to anastomosis or adjacent to anastomosis was 9/43(20.9%) with small field and 2/26(7.7%) with extended field. Of 31 patients with relapse outside anastomosis, 14/20(70%) relapsed locoregional/distal when treated with small field and 3/11(27%) relapsed locoregional/distal when treated with extended field (p=0.02). There was no excess treatment interruption or chronic gastrointestinal toxicity with extended field irradiation. CONCLUSION: There is significant decrease in locoregional/distal relapse with use of extended field in high risk resected esophageal cancer patients

Confinement increases the lifetimes of hydroxyapatite precursors

The mineral component of bone is a carbonated, nonstoichiometric hydroxyapatite (calcium phosphate) that forms in nanometer confinement within collagen fibrils, the principal organic constituent of bone. We here employ a model system to study the effects of confinement on hydroxyapatite precipitation from solution under physiological conditions. In common with earlier studies of calcium carbonate and calcium sulfate precipitation, we find that confinement significantly prolongs the lifetime of metastable phases, here amorphous calcium phosphate (ACP) and octacalcium phosphate (OCP). The effect occurs at surprisingly large separations of up to 1 μm, and at 0.2 μm the lifetime of ACP is extended by at least an order of magnitude. The soluble additive poly(aspartic acid), which in bulk stabilizes ACP, appears to act synergistically with confinement to give a greatly enhanced stability of ACP. The reason for the extended lifetime appears to be different from that found with CaCO3 and CaSO4, and underscores both the variety of mechanisms whereby confinement affects the growth and transformation of solid phases, and the necessity to study a wide range of crystalline systems to build a full understanding of confinement effects. We suggest that in the case of ACP and OCP the extended lifetime of these metastable phases is chiefly due to a slower transport of ions between a dissolving metastable phase, and the more stable, growing phase. These results highlight the potential importance of confinement on biomineralization processes

Mosaic supernumerary ring chromosome 1 in a three-generational family: 10-year follow-up report

Additional small ring chromosome 1 is described with increasing rate of mosaicism in three generations. Ten years after the first examination, the mosaic rates in the patients were strikingly similar. An increase in the expression of phenotypic anomalies was also observed in the successive generations. FISH examinations following microdissection revealed signals which were positive for 1p13 and 1q21 indicating that the ring contained euchromatic segments on both ends. Additionally, array-CGH whole-genome analysis showed a single copy gain corresponding to band 1p12 to band 1q21-1 of chromosome 1 in the patients. The presence of euchromatic material from chromosome 1 in the ring suggests that the relationship between the cytogenetic findings and the clinical manifestation is likely causative. These unique observations might be explained by mitotic loss of the ring at early embryogenesis, and would indicate different mitotic vulnerability of certain chromosome abnormalities at early postzygotic stages versus later during development

Tandem triplication of chromosome 13q14 with inverted interstitial segment in a 4 year old girl.

EDITOR—Application of chromosome painting has enabled confirmation that an additional segment in a presumed tandem duplication originates from the rearranged chromosome. More recent studies to determine more accurately the exact amount of duplication with cosmid FISH probes have, in a few instances, shown that some of the presumed duplications were in fact triplications of smaller segments.1-7 In some of these patients, unequal distances between the FISH signals showed that the middle segment of the tandemly arrayed three segments was in the opposite orientation to the two flanking segments,1 3 4 thus providing clues to the possible mechanism of formation. Here we report on the clinical, cytogenetic, and molecular analysis of a patient displaying the same type of triplication for segment 13q14 including the retinoblastoma gene, again with opposite orientation of the middle segment