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Early changes in collagen gene expression in mouse lung associated with late radiation fibrosis
190
Radiation Oncology, Biology, Physics
Volume 24, Supplement 1
Materials
and Methods: The apparatus consists of two video cameras controlled by a personal computer and a patient fixed landmark system. Position and spatial orientation of the landmarks are registered by the cameras and processed for real-time calculation of the position of a target point relative to its position in an initialization step. The target’s position is assumed to be invariant with respect to the landmark system. The method underlying the algorithms is known as ‘Photogrammetry’. Results:
We have performed two series of 30 measurements of patient movement in two different immobilization devices, respectively. Results refer to a target point situated near the base of the skull. Movements in the order of 0.05 mm caused by breathing could easily be detected. The algorithm dependent resolution in time is 12 milliseconds at maximum. As a measure of set-up uncertainty of an immobilization device, we took the empirical variances of the distributions of the mean values of the motion measurements for the three translational degrees of freedom. This made sense, since all data of a series of 30 measurements referred to a single initialization of the cameras. For one of the devices under investigation, the head mask developed in the German Cancer Research Center, we found values of (0.9,0.8,0.9) mm. whereas for a standard thermoplast device in clinical use we measured (1.6,3.5,1.4) mm. Conclusion: The described apparatus is a powerful tool for measuring the position and orientation of a patient’s head. Together with a controlling device for patient positioning this instrumentation could meet the requirements for fractionated stereotactic radiotherapy.
112 ERYTHROPOIETIN
INCREASES
HEMOGLOBIN
IN
CANCER
PATIENTS
DURING
RADIATION
THERAPY
Robert S. Lavey, M.D., M.P.H. UCLA Department of Radiation Oncology and Jonsson Comprehensive
Cancer Center, Los Angeles, CA 90024
Purpose: Several prospective and retrospective studies of cancer patients treated with primary radiation therapy (RT) have found a correlation between hemoglobin (Hgb) level and both local control and survival. Hgb levels above 13-14 g/dl during RT are associated with improved control of a variety of tumors even after stratification by tumor stage, histologic grade, and sex. Despite the potential survival advantage, most RT patients with Hgb concentrations below 13 g/dl are not given red blood cell transfusions due to possible toxicity. Erythropoietin is the primary stimulant for erythropoiesis in humans. This clinical trial tested whether the administration of recombinant human erythropoietin (rhEpo) to patients undergoing RT would increase their Hgb level without adverse effects. Materials and Methods: Adult patients scheduled to receive RT with curative intent for a primary cancer located in the head, neck, or thorax and who had a Hgb less than 13.5 g/d1 were eligible for the trial. Exclusionary criteria included uncontrolled hypertension, prior or concurrent chemotherapy, and a primary hematologic or bleeding disorder. Patients in the experimental arm received 150-300 U/kg rhEpo (Ortho Biotech, Raritan, New Jersy) SQ three times weekly and 325 mg ferrous sulfate p.o. three times daily from their day of simulation until their hemoglobin exceeded 15.0 g/dl or they completed RT. Controls received ferrous sulfate without rhEpo. Participation in the trial did not affect the prescribed RT regimen. Response to rhEpo was measured weekly during treatment and in follow-up by physical examination, vital sign measurements, blood tests, and quality of life self-assessments. Results: Twenty-four patients, 14 women and 10 men, of age 25-84 years are available for analysis, 14 in the rhEpo group and 10 in the control group. The mean&s.d. baseline Hgb was 12.Ok1.2 g/d1 (range 8.8 - 13.1) in the rhEpo and 12.O;tO.g (range 10.8 - 13.3) in the control group. All of the patients had endogenous Epo and reticulocyte counts that were inappropriately low for their Hgb level. Most had a normal serum iron level and iron binding capacity and a normal or high serum ferritin. The meanks.d. change in Hgb during RT was +31.7&15.7% (range +10.2 - +61.5%) in the rhEpo and -1.0&O% (range -9.9 - +5.6%) in the control group (pc 0.001). Among the rhEpo patients, 93% reached a Hgb level of 14.0 g/dl within a mean of 1725 days after the initial Epo injection and 86% exceeded 15.0 g/dl within a mean of 24k8 days after starting Epo. Reticulocyte counts increased sharply during the first week in all 14 rhEpo patients from a mean of 1.3~0.5% to 3.4&0.8% and declined within days after the cessation of rhEpo. Hgb levels gradually decreased in the rhEpo patients during the months following treatment, but remained constant in the control group. Patient age and sex were not associated with the response to rhEpo. rhEpo had no significant effect on white blood cell or platelet count, liver or renal function tests, or blood pressure. No adverse effects were noted. rhEpo significantly increases the Hgb level in patients undergoing radiation therapy for Conclusion: supradiaphragmatic tumors without interfering with their course of therapy or causing adverse effects. Clinical trials to determine whether the elevation of Hgb by rhEpo during RT results in increased tumor control are warranted.
Radiation Oncology, Biology, Physics
Volume 24, Supplement 1
Materials
and Methods: The apparatus consists of two video cameras controlled by a personal computer and a patient fixed landmark system. Position and spatial orientation of the landmarks are registered by the cameras and processed for real-time calculation of the position of a target point relative to its position in an initialization step. The target’s position is assumed to be invariant with respect to the landmark system. The method underlying the algorithms is known as ‘Photogrammetry’. Results:
We have performed two series of 30 measurements of patient movement in two different immobilization devices, respectively. Results refer to a target point situated near the base of the skull. Movements in the order of 0.05 mm caused by breathing could easily be detected. The algorithm dependent resolution in time is 12 milliseconds at maximum. As a measure of set-up uncertainty of an immobilization device, we took the empirical variances of the distributions of the mean values of the motion measurements for the three translational degrees of freedom. This made sense, since all data of a series of 30 measurements referred to a single initialization of the cameras. For one of the devices under investigation, the head mask developed in the German Cancer Research Center, we found values of (0.9,0.8,0.9) mm. whereas for a standard thermoplast device in clinical use we measured (1.6,3.5,1.4) mm. Conclusion: The described apparatus is a powerful tool for measuring the position and orientation of a patient’s head. Together with a controlling device for patient positioning this instrumentation could meet the requirements for fractionated stereotactic radiotherapy.
112 ERYTHROPOIETIN
INCREASES
HEMOGLOBIN
IN
CANCER
PATIENTS
DURING
RADIATION
THERAPY
Robert S. Lavey, M.D., M.P.H. UCLA Department of Radiation Oncology and Jonsson Comprehensive
Cancer Center, Los Angeles, CA 90024
Purpose: Several prospective and retrospective studies of cancer patients treated with primary radiation therapy (RT) have found a correlation between hemoglobin (Hgb) level and both local control and survival. Hgb levels above 13-14 g/dl during RT are associated with improved control of a variety of tumors even after stratification by tumor stage, histologic grade, and sex. Despite the potential survival advantage, most RT patients with Hgb concentrations below 13 g/dl are not given red blood cell transfusions due to possible toxicity. Erythropoietin is the primary stimulant for erythropoiesis in humans. This clinical trial tested whether the administration of recombinant human erythropoietin (rhEpo) to patients undergoing RT would increase their Hgb level without adverse effects. Materials and Methods: Adult patients scheduled to receive RT with curative intent for a primary cancer located in the head, neck, or thorax and who had a Hgb less than 13.5 g/d1 were eligible for the trial. Exclusionary criteria included uncontrolled hypertension, prior or concurrent chemotherapy, and a primary hematologic or bleeding disorder. Patients in the experimental arm received 150-300 U/kg rhEpo (Ortho Biotech, Raritan, New Jersy) SQ three times weekly and 325 mg ferrous sulfate p.o. three times daily from their day of simulation until their hemoglobin exceeded 15.0 g/dl or they completed RT. Controls received ferrous sulfate without rhEpo. Participation in the trial did not affect the prescribed RT regimen. Response to rhEpo was measured weekly during treatment and in follow-up by physical examination, vital sign measurements, blood tests, and quality of life self-assessments. Results: Twenty-four patients, 14 women and 10 men, of age 25-84 years are available for analysis, 14 in the rhEpo group and 10 in the control group. The mean&s.d. baseline Hgb was 12.Ok1.2 g/d1 (range 8.8 - 13.1) in the rhEpo and 12.O;tO.g (range 10.8 - 13.3) in the control group. All of the patients had endogenous Epo and reticulocyte counts that were inappropriately low for their Hgb level. Most had a normal serum iron level and iron binding capacity and a normal or high serum ferritin. The meanks.d. change in Hgb during RT was +31.7&15.7% (range +10.2 - +61.5%) in the rhEpo and -1.0&O% (range -9.9 - +5.6%) in the control group (pc 0.001). Among the rhEpo patients, 93% reached a Hgb level of 14.0 g/dl within a mean of 1725 days after the initial Epo injection and 86% exceeded 15.0 g/dl within a mean of 24k8 days after starting Epo. Reticulocyte counts increased sharply during the first week in all 14 rhEpo patients from a mean of 1.3~0.5% to 3.4&0.8% and declined within days after the cessation of rhEpo. Hgb levels gradually decreased in the rhEpo patients during the months following treatment, but remained constant in the control group. Patient age and sex were not associated with the response to rhEpo. rhEpo had no significant effect on white blood cell or platelet count, liver or renal function tests, or blood pressure. No adverse effects were noted. rhEpo significantly increases the Hgb level in patients undergoing radiation therapy for Conclusion: supradiaphragmatic tumors without interfering with their course of therapy or causing adverse effects. Clinical trials to determine whether the elevation of Hgb by rhEpo during RT results in increased tumor control are warranted.