PALLIATION AND LIFE QUALITY IN LUNG-CANCER - HOW GOOD ARE CLINICIAN AT JUDGING TREATMENT OUTCOME

A recent trial by the MRC Lung Cancer Working Party used physician assessments to compare two palliative schedules of radiotherapy in lung cancer. A prospective study has been undertaken on a subset of these trial patients to see how physician assessments of symptomatic relief and general condition correlate with patient perception of therapeutic response. In 40 patients followed up monthly from presentation until close to death, good agreement was found between doctors and patients on change in specific physical symptoms and overall physical condition. Doctors were poor judges of life quality at presentation but appeared able to identify relative improvement or deterioration in overall quality of life. In conclusion, physician assessments may constitute valid end-points for radiotherapy trials comparing palliative schedules in lung cance

Letter. Intensity-modulated radiotherapy for the treatment of breast cancer

In the systematic review of intensity-modulated radiotherapy (IMRT) in the treatment of breast cancer reported in Clinical Oncology by Dayes and colleagues [1], the only prospective randomised clinical trial (n = 306) testing forward-planned IMRT to have reported a 5 year outcome for adverse effects [2] was excluded on the spurious grounds that no outcomes of interest were reported (Appendix 3). In this trial, the control arm patients were 1.7 times more likely to have a change in breast appearance than the IMRT arm patients after adjustment for the year of photographic assessment (95% confidence interval 1.2–2.5, P = 0.008)

Palliation and life quality in lung cancer; how good are clinicians at judging treatment outcome?

A recent trial by the MRC Lung Cancer Working Party used physician assessments to compare two palliative schedules of radiotherapy in lung cancer. A prospective study has been undertaken on a subset of these trial patients to see how physician assessments of symptomatic relief and general condition correlate with patient perception of therapeutic response. In 40 patients followed up monthly from presentation until close to death, good agreement was found between doctors and patients on change in specific physical symptoms and overall physical condition. Doctors were poor judges of life quality at presentation but appeared able to identify relative improvement or deterioration in overall quality of life. In conclusion, physician assessments may constitute valid end-points for radiotherapy trials comparing palliative schedules in lung cancer

Increased collagen production in fibroblasts cultured from irradiated skin and effect of TGF β1– clinical study

Fibrosis in normal tissues is a common and dose-limiting late complication of radiotherapy at many cancer sites, but its pathogenesis is poorly understood. We undertook a controlled study of the effect of irradiation on the collagen production of fibroblasts cultured from skin biopsies taken from patients undergoing radiotherapy treatment. Eight weeks after a single 8 Gy fraction using 300 kV X-rays, five patients treated at the Royal Marsden Hospital underwent biopsy of the irradiated site and of the contralateral, unirradiated body site. Fibroblasts from irradiated and control, unirradiated sites were cultured in vitro, and collagen production rates were measured during a 48-hour incubation under standardized conditions and in the presence and absence of transforming growth factor β1(TGF β1), 1 ng/ml, using HPLC. Collagen production was elevated in cells cultured from irradiated skin; median collagen production rates 61.16 pmoles hydroxyproline/105cells/hour in irradiated cells, 39.78 pmoles hydroxyproline/105cells/hour in unirradiated cells, P = 0.016 (Mann–Whitney U-test). In fibroblasts from unirradiated sites, collagen production rates were increased by the addition of TGF β1; however, in three of the cell lines cultured from irradiated sites this effect of TGF β1 on collagen production was not observed. © 2000 Cancer Research Campaig