West Michigan Cancer Center

Importance: Improved screening methods for women with dense breasts are needed because of their increased risk of breast cancer and of failed early diagnosis by screening mammography. Objective: To compare the screening performance of abbreviated breast magnetic resonance imaging (MRI) and digital breast tomosynthesis (DBT) in women with dense breasts. Design, Setting, and Participants: Cross-sectional study with longitudinal follow-up at 48 academic, community hospital, and private practice sites in the United States and Germany, conducted between December 2016 and November 2017 among average-risk women aged 40 to 75 years with heterogeneously dense or extremely dense breasts undergoing routine screening. Follow-up ascertainment of cancer diagnoses was complete through September 12, 2019. Exposures: All women underwent screening by both DBT and abbreviated breast MRI, performed in randomized order and read independently to avoid interpretation bias. Main Outcomes and Measures: The primary end point was the invasive cancer detection rate. Secondary outcomes included sensitivity, specificity, additional imaging recommendation rate, and positive predictive value (PPV) of biopsy, using invasive cancer and ductal carcinoma in situ (DCIS) to define a positive reference standard. All outcomes are reported at the participant level. Pathology of core or surgical biopsy was the reference standard for cancer detection rate and PPV; interval cancers reported until the next annual screen were included in the reference standard for sensitivity and specificity. Results: Among 1516 enrolled women, 1444 (median age, 54 [range, 40-75] years) completed both examinations and were included in the analysis. The reference standard was positive for invasive cancer with or without DCIS in 17 women and for DCIS alone in another 6. No interval cancers were observed during follow-up. Abbreviated breast MRI detected all 17 women with invasive cancer and 5 of 6 women with DCIS. Digital breast tomosynthesis detected 7 of 17 women with invasive cancer and 2 of 6 women with DCIS. The invasive cancer detection rate was 11.8 (95% CI, 7.4-18.8) per 1000 women for abbreviated breast MRI vs 4.8 (95% CI, 2.4-10.0) per 1000 women for DBT, a difference of 7 (95% CI, 2.2-11.6) per 1000 women (exact McNemar P = .002). For detection of invasive cancer and DCIS, sensitivity was 95.7% (95% CI, 79.0%-99.2%) with abbreviated breast MRI vs 39.1% (95% CI, 22.2%-59.2%) with DBT (P = .001) and specificity was 86.7% (95% CI, 84.8%-88.4%) vs 97.4% (95% CI, 96.5%-98.1%), respectively (P < .001). The additional imaging recommendation rate was 7.5% (95% CI, 6.2%-9.0%) with abbreviated breast MRI vs 10.1% (95% CI, 8.7%-11.8%) with DBT (P = .02) and the PPV was 19.6% (95% CI, 13.2%-28.2%) vs 31.0% (95% CI, 17.0%-49.7%), respectively (P = .15). Conclusions and Relevance: Among women with dense breasts undergoing screening, abbreviated breast MRI, compared with DBT, was associated with a significantly higher rate of invasive breast cancer detection. Further research is needed to better understand the relationship between screening methods and clinical outcome. Trial Registration: ClinicalTrials.gov Identifier: NCT02933489.

Optically stimulated luminescent dosimeters, OSLDs, are plastic disks infused with aluminum oxide doped with carbon (Al2O3 : C). These disks are encased in a light-tight plastic holder. Crystals of Al2O3 : C when exposed to ionizing radiation store energy that is released as luminescence (420 nm) when the OSLD is illuminated with stimulation light (540 nm). The intensity of the luminescence depends on the dose absorbed by the OSLD and the intensity of the stimulation light. OSLDs used in this work were InLight/OSL Dot dosimeters, which were read with a MicroStar reader (Landauer, Inc., Glenwood, IL). The following are dosimetric properties of the OSLD that were determined: After a single irradiation, repeated readings cause the signal to decrease by 0.05% per reading; the signal could be discharged by greater than 98% by illuminating them for more than 45 s with a 150 W tungsten-halogen light; after irradiation there was a transient signal that decayed with a 0.8 min halftime; after the transient signal decay the signal was stable for days; repeated irradiations and readings of an individual OSLD gave a signal with a coefficient of variation of 0.6%; the dose sensitivity of OSLDs from a batch of detectors has a coefficient of variation of 0.9%, response was linear with absorbed dose over a test range of 1-300 cGy; above 300 cGy a small supra-linear behavior occurs; there was no dose-per-pulse dependence over a 388-fold range; there was no dependence on radiation energy or mode for 6 and 15 MV x rays and 6-20 MeV electrons; for Ir-192 gamma rays OSLD had 6% higher sensitivity; the dose sensitivity was unchanged up to an accumulated dose of 20 Gy and thereafter decreased by 4% per 10 Gy of additional accumulated dose; dose sensitivity was not dependent on the angle of incidence of radiation; the OSLD in its light-tight case has an intrinsic buildup of 0.04 g/cm2; dose sensitivity of the OSLD was not dependent on temperature at the time of irradiation in the range of 10-40 degrees C. The clinical use of OSLDs for in vivo dosimetric measurements is shown to be feasible.

PURPOSE: A new type of in vivo dosimeter, an optically stimulated luminescent dosimeter (OSLD), has now become commercially available for clinical use. The OSLD is a plastic disk infused with aluminum oxide doped with carbon (Al2O3:C). Crystals of Al2O3:C, when exposed to ionizing radiation, store energy that is released as luminescence (420 nm) when the OSLD is illuminated with stimulation light (540 nm). The intensity of the luminescence depends on the dose absorbed by the OSLD and the intensity of the stimulation light. The effects of accumulated dose on OSLD response were investigated. METHODS: The OSLDs used in this work were nanodot dosimeters, which were read with a MicroStar reader (Landauer, Inc., Glenwood, IL). Dose to the OSLDs was delivered by 6 MV x rays and gamma rays from Co-60 and Ir-192. The signal on the OSLDs after irradiation is removed by optical annealing with a 150 W tungsten-halogen lamp or a 14 W compact fluorescent lamp was investigated. RESULTS: It was found that OSLD response to dose was supralinear and this response was altered with the amount of accumulated dose to the OSLD. The OSLD response can be modeled by a quadratic and an exponential equation. For accumulated doses up to 60 Gy, the OSLD sensitivity (counts/dose) decreases and the extent of supralinear increases. Above 60 Gy of accumulated dose the sensitivity increases and the extent of supralinearity decreases or reaches a plateau, depending on how the OSLDs were optically annealed. With preirradiation of OSLDs with greater than 1 kGy, it is found that the sensitivity reaches a plateau 2.5 folds greater than that of an OSLD with no accumulated dose and the supralinearity disappears. A regeneration of the luminescence signal in the dark after full optical annealing occurs with a half time of about two days. The extent of this regeneration signal depends on the amount of accumulated dose. CONCLUSIONS: For in vivo dosimetric measurements, a precision of +/- 0.5% can be achieved if the sensitivity and extent of supralinearity is established for each OSLD and use. Methods are presented for accomplishing this task.

Prostate cancer is the leading cancer diagnosis and second leading cause of cancer-related mortality for men in the United States. Due to the increased prevalence of prostate cancer in men older than 50 years, men at risk for prostate cancer represent the same population of men who are at greatest risk for metabolic syndrome, diabetes mellitus, and coronary artery disease (CAD). In addition to risk factors for CAD that are applicable to the general population, men with prostate cancer can be at increased risk for CAD due to long-term androgen deprivation therapy (ADT) administered as treatment for prostate cancer. Men undergo ADT by medical (drug therapy) or surgical (castration) means. Luteinizing hormone-releasing hormone (LHRH) agonists are the primary drug therapies used for ADT. Commercially available LHRH agonists are goserelin, histrelin, leuprolide, and triptorelin. Body composition changes, hyperlipidemia, insulin resistance, metabolic syndrome, and acute coronary syndrome are all reported adverse effects of ADT, which are consequences of reduced levels of circulating testosterone. Metabolic and body composition changes associated with ADT arise within months of beginning medical ADT and persist after discontinuation of therapy. To better understand the increased risk of metabolic syndrome, diabetes, and heart disease in patients undergoing ADT for prostate cancer, we performed a MEDLINE search (1986-2008) to identify pertinent studies and reports. Additional citations were obtained from the articles retrieved from the literature search. We found that the increased risk for serious cardiovascular disease becomes evident within months of beginning ADT. Pharmacists should provide counseling to these patients on primary disease prevention. Men receiving ADT should be monitored routinely for signs and symptoms of metabolic syndrome, diabetes, and CAD. Healthy lifestyle practices should be encouraged, and physical therapy should be considered for these patients.

OBJECTIVE: To compare the efficacy of etoricoxib 30 mg with the generally maximum recommended dose of celecoxib, 200 mg, in the treatment of osteoarthritis (OA) in two identically designed studies. METHODS: Two multi-centre, 26-week, double-blind, placebo-controlled, non-inferiority studies were conducted, enrolling patients who were prior non-steroidal anti-inflammatory drug (NSAID) or acetaminophen users. There were 599 patients in study 1 and 608 patients in study 2 randomized 4:4:1:1 to etoricoxib 30 mg qd, celecoxib 200 mg qd or one of two placebo groups for 12 weeks. After 12 weeks, placebo patients were evenly distributed to etoricoxib or celecoxib based on their initial enrollment randomization schedule. The primary hypothesis was that etoricoxib 30 mg would be at least as effective as celecoxib 200 mg for the time-weighted average change from baseline over 12 weeks for Western Ontario and McMaster (WOMAC) Pain Subscale, WOMAC Physical Function Subscale and Patient Global Assessment of Disease Status. Active treatments were also assessed over the full 26 weeks. Adverse experiences were collected for safety assessment. RESULTS: In both studies, etoricoxib was non-inferior to celecoxib for all three efficacy outcomes over 12 and 26 weeks; both were superior to placebo (P < 0.001) for all three outcomes in each study over 12 weeks. The safety and tolerability of etoricoxib 30 mg qd and celecoxib 200 mg qd were similar over 12 and 26 weeks. CONCLUSIONS: Etoricoxib 30 mg qd was at least as effective as celecoxib 200 mg qd and had similar safety in the treatment of knee and hip OA; both were superior to placebo. ClinicalTrials.gov Identifiers: NCT00092768; NCT00092791.

PURPOSE: To measure patient-specific-QA dose distributions with a 2D array of diodes, the MapCHECK, for the dose delivered, with step-and-shoot and rotational IMRT. METHODS: Two MapCHECKs were used that had different styles of diode connection. These MapCHECKs were used in their original manufactured configuration and in a modified configuration. The modification made in the clinic consists of filling air gaps with sheets of Lucite that had custom-machined slots for the diodes and by adding pieces of copper to offset the intrinsic asymmetry of the diodes. The MapCHECKs were housed in a tight-fitting phantom fabricated from solid water. Measurements were made on IMRT treatment plans delivered with Varian linear accelerators with step-and-shoot and RapidArc methods, and a TomoTherapy machine with helical delivery. Patient plans and QA plans were developed with the XiO, Eclipse, and TomoTherapy planning systems. All MapCHECK data were analyzed with its commercially available software. RESULTS: Kilovoltage CT imaging of the MapCHECK in its phantom has streak artifacts from high atomic number components. These artifacts must be corrected in order to obtain accurate calculation of dose. The original MapCHECK is found to have an angular dependence of +/- 20%. A modification of the MapCHECK has been made that reduces the angular dependence to +/- 2%. Proper compensation for attenuation by the treatment couch is also necessary for accurate results. The modified MapCHECK has been successfully used for doing patient-specific QA for IMRT treatments delivered with step-and-shoot, TomoTherapy, and RapidArc methods. Treatment plans that require large amounts of fluence from the 90 degrees and 270 degrees directions have significantly better QA measurements when made with modified MapCHECKs. CONCLUSIONS: When properly modified, the MapCHECK response becomes isotropic. It can then be used for patient-specific QA measurements for IMRT treatments delivered with step-and-shoot and rotational techniques such as helical Tomotherapy and RapidArc.

STUDY OBJECTIVES: To examine the effect of three titration schedules on the tolerability of tramadol, and to determine whether slow titration would reduce the frequency of drug discontinuation due to adverse events. DESIGN: Multicenter, outpatient, double-blind, parallel study. SETTING: Twenty-eight outpatient study centers. SUBJECTS: Four hundred sixty-five patients with chronic joint pain Interventions. Patients were randomized into one of four treatment groups for 14 days: placebo, or tramadol dosage titrated at 1, 4, or 10 days to achieve the study target dosage of 200 mg/day. They continued taking their dosage of nonsteroidal antiinflammatory drug during the study. Each group was examined to determine if slower titration resulted in a statistically significant trend toward fewer discontinuations due to nausea and/or vomiting and dizziness and/or vertigo. Discontinuation due to any adverse event was similarly analyzed. If the trend was statistically significant, pairwise comparisons were performed to determine the statistical significance among titration rates. MEASUREMENTS AND MAIN RESULTS: A statistically significant trend was seen toward fewer discontinuations as a result of nausea/vomiting, dizziness/vertigo, and any adverse event as the titration rate decreased. Patients with 10-day titration rate required the fewest discontinuations, and this rate was statistically significantly different from both the 1- and 4-day rates for discontinuations. CONCLUSION: A slower rate of initiating tramadol therapy (50-mg increments every 3 days) improved tolerability with significantly fewer discontinuations due to dizziness or vertigo.

LBA661 Background: Liposomal irinotecan administered with 5-fluorouracil/leucovorin (5-FU/LV) is approved in the USA and Europe for mPDAC following progression with gemcitabine-based therapy. A phase 1/2 study (Wainberg et al. Eur J Cancer 2021;151:14–24; NCT02551991) demonstrated promising anti-tumor activity in patients with mPDAC who received first-line liposomal irinotecan 50 mg/m 2 + 5-FU 2400 mg/m 2 + LV 400 mg/m 2 + oxaliplatin 60 mg/m 2 (NALIRIFOX). Herein, we present results from NAPOLI-3 (NCT04083235), a randomized, open-label, phase 3 study investigating the efficacy and safety of NALIRIFOX compared with nab-paclitaxel + gemcitabine as first-line therapy in patients with mPDAC. Methods: Eligible patients with histopathologically/cytologically confirmed untreated metastatic PDAC were randomized (1:1) to receive NALIRIFOX on days 1 and 15 of a 28-day cycle or nab-paclitaxel 125 mg/m 2 + gemcitabine 1000 mg/m 2 (Gem+NabP) on days 1, 8 and 15 of a 28-day cycle. Randomization was stratified by ECOG performance status, geographic region and presence or absence of liver metastases. The primary endpoint was overall survival (OS); secondary endpoints were progression-free survival (PFS), overall response rate (ORR) and safety. OS was evaluated when ≥ 543 events were observed using a stratified log-rank test with an overall 1-sided significance level of 0.025. Results: Overall, 770 patients (NALIRIFOX, n = 383; Gem+NabP, n = 387) were included. Baseline characteristics were well balanced between arms. At a median follow-up of 16.1 months, 544 events had occurred. The median OS was 11.1 months in the NALIFIROX arm as compared with 9.2 months in the Gem+NabP arm (HR 0.84 [95% CI 0.71–0.99]; p = 0.04); PFS was also significantly improved (7.4 months vs 5.6 months; HR 0.70 [0.59–0.84]; p = 0.0001). Grade 3/4 treatment-emergent adverse events (TEAEs) with ≥ 10% frequency in patients receiving NALIRIFOX versus Gem+NabP included diarrhea (20.3% vs 4.5%), nausea (11.9% vs 2.6%), hypokalemia (15.1% vs 4.0%), anemia (10.5% vs 17.4%) and neutropenia (14.1% vs 24.5%). Conclusions: First-line NALIRIFOX demonstrated clinically meaningful and statistically significant improvement in OS and PFS compared with Gem+NabP in treatment-naïve patients with mPDAC. The safety profile of NALIRIFOX was manageable and consistent with the profiles of the treatment components. Funding: Funded by Ipsen. Clinical trial information: NCT04083235 .[Table: see text]

This chapter starts from the UN Decade of Education for Sustainable Development (DESD) Final Report’s call that in Higher Education, ‘more than scaling up of good practice’ and ‘greater attention to systemic approaches to curriculum change and capacity building for leaders will be needed’ (UNESCO 2014a, p. 31). It recognises this need and the additional, rather profound reform and transformation of educational policy and practice that is required to meet the heightened expectations of education in an increasingly volatile, conflict laden, and challenging world. The emphasis is on clarification and framing of work to date and identification of relevant research gaps. In particular, it addresses the current status of the literature on competencies in ESD, which is characterised by a sea of labels, terminological confusion, and relative inattention to pedaogogic implications. The research outlined is both a critical inquiry into the status of work to date on sustainability competencies and a practical inquiry into the possibility of innovative and transformative institutional strategies and pedagogies around a suite of specific competencies. To this end, the early stages of an international and cross-institutional pilot project collaboration designed to help realize the UN’s ambitious Sustainable Development Goals (SDGs) and UNESCO’s Global Action Plan (GAP) (UNESCO 2014b), is described briefly

Breastfeeding outcomes of 121 primiparas enrolled in a larger study were examined to determine the impact of cesarean delivery on time of first breastfeeding. Mothers giving birth by cesarean had a later first breastfeeding and expressed less satisfaction with the birth experience than did those who delivered vaginally. No relationships were found between delivery type and duration of breastfeeding or pain or fatigue related to breastfeeding. Time of first breastfeeding was not related to breastfeeding duration. Although some investigators have reported that mothers who have cesarean deliveries or delayed first feeding are less successful at breastfeeding, the high level of commitment to breastfeeding in this sample may have overcome the effect of perinatal events.

The F glycoprotein of respiratory syncytial virus in insect cells was produced using a baculovirus expression vector to examine its potential as a subunit vaccine. Two different forms of the F glycoprotein were expressed: the intact F (F) glycoprotein and the truncated (Ft) glycoprotein, in which the COOH-terminal anchor region was deleted. The F glycoprotein remained cell associated, whereas the Ft glycoprotein was secreted into the media of infected cells. In contrast to the processing of the F0 precursor into its F1 and F2 subunits that was observed in mammalian cells, a second cleavage site within the F1 subunit was recognized by the insect cell proteases and resulted in the formation of two F1 subunits. The baculovirus-expressed Ft glycoprotein induced neutralizing antibodies in cotton rats and protected vaccinated animals from challenge with respiratory syncytial virus.

Commercially available surface diodes are found to have as great as +/-12% change in sensitivity with the angle of incidence of radiation. This work is a study of the cause of angular dependence in diode sensitivity and how it can be decreased. A number of different surface diodes were used in these measurements: A commercially available diode and four prototype diodes. A number of the diodes were constructed with the silicon chip, the die, mounted on a circuit board that had a plane of copper on its back side. These diodes had angular dependence of sensitivity as great as +/- 10%. It was hypothesized that the copper plane on the circuit board was the cause of the anisotropy in sensitivity of the diodes. To test this hypothesis, diodes with a new design [Patent No. 61/035,257 (pending)], without a copper back plane, were fabricated and characterized in this work. These diodes were found to have the following characteristics: A dependence on incident angle of radiation of +/- 3.6%; after 10 kGy of pre-irradiation, a 1.6% change in sensitivity for a 260-fold change in dose per pulse; an areal density of 0.08 g/cm2.

Abstract Background: In diffuse large B-cell lymphoma (DLBCL), a MYC-rearrangement (MYC-R) is present in approximately 10% of cases and has been associated with an inferior outcome following R-CHOP chemotherapy. In a previous report that retrospectively analyzed the prognostic impact of a MYC-R on survival following DA-EPOCH-R, patients with a MYC-R had a similar outcome to MYC negative cases (4 year EFS of 83% versus 76% respectively: p=0.46 Ann Oncol 2011 (22) Suppl 4 # 71). We set out to prospectively validate these results in a multicenter study. Methods: Patients were newly diagnosed with DLBCL or B-cell lymphoma unclassifiable (BCL-U) with features intermediate between DLBCL and Burkitt lymphoma (BL). Only cases that harbored a MYC translocation by fluorescent in-situ hybridization (FISH) or conventional cytogenetic testing were included in this report. Treatment consisted of 6 cycles of DA-EPOCH-R. R esults: 52 patients were included in this preliminary analysis. Characteristics were median (range) age 61 (29-80) years; male sex 37 (71%); stage III or IV disease 38 (73%); IPI score 0-2 in 35% versus 3-5 in 65%; HIV positive 4 (7%). Histologic diagnosis was DLBCL in 45 (86%) and BCL-U in 7 (14%). All cases had a MYC-rearrangement. BCL2 was rearranged in 14/31 (45%) and overexpressed by IHC in 24/43 (56%) cases tested. There were 3 deaths secondary to infectious complications and otherwise toxicities were similar to previous reports of the regimen. At a median follow-up time of 14 months, progression-free survival (PFS), time to progression (TTP) and overall survival (OS) were 79%, 86% and 77% respectively for all patients. PFS was 87% and 64% in cases that were FISH positive (double-hit) and IHC positive for BCL2 respectively. Conclusions: Albeit short follow-up, DA-EPOCH-R in MYC-R DLBCL demonstrates promising activity in a multicenter prospective setting. Further analysis of this data is planned with central pathology review of cases and longer follow-up. The principal arm of this study testing the regimen in BL remains open to accrual (NCT01092182). Figure 1 Figure 1. Disclosures LaCasce: Seattle Genetics, Inc.: Research Funding.

Importance: Understanding whether physicians accurately detect symptoms in patients with breast cancer is important because recognition of symptoms facilitates supportive care, and clinical trials often rely on physician assessments using Common Toxicity Criteria for Adverse Events (CTCAE). Objective: To compare the patient-reported outcomes (PROs) of patients with breast cancer who received radiotherapy from January 1, 2012, to March 31, 2020, with physicians' CTCAE assessments to assess underrecognition of symptoms. Design, Setting, and Participants: This cohort study included a total of 29 practices enrolled in the Michigan Radiation Oncology Quality Consortium quality initiative. Of 13 725 patients with breast cancer who received treatment with radiotherapy after undergoing lumpectomy, 9941 patients (72.4%) completed at least 1 PRO questionnaire during treatment with radiotherapy and were evaluated for the study. Of these, 9868 patients (99.3%) were matched to physician CTCAE assessments that were completed within 3 days of the PRO questionnaires. Exposures: Patient and physician ratings of 4 symptoms (pain, pruritus, edema, and fatigue) were compared. Main Outcomes and Measures: We used multilevel multivariable logistic regression to evaluate factors associated with symptom underrecognition, hypothesizing that it would be more common in racial and ethnic minority groups. Results: Of 9941 patients, all were female, 1655 (16.6%) were Black, 7925 (79.7%) were White, and 361 (3.6%) had Other race and ethnicity (including American Indian/Alaska Native, Arab/Middle Eastern, and Asian), either as self-reported or as indicated in the electronic medical record. A total of 1595 (16.0%) were younger than 50 years, 2874 (28.9%) were age 50 to 59 years, 3353 (33.7%) were age 60 to 69 years, and 2119 (21.3%) were 70 years or older. Underrecognition of symptoms existed in 2094 of 6781 (30.9%) observations of patient-reported moderate/severe pain, 748 of 2039 observations (36.7%) of patient-reported frequent pruritus, 2309 of 4492 observations (51.4%) of patient-reported frequent edema, and 390 of 2079 observations (18.8%) of patient-reported substantial fatigue. Underrecognition of at least 1 symptom occurred at least once for 2933 of 5510 (53.2%) of those who reported at least 1 substantial symptom. Factors independently associated with underrecognition were younger age (younger than 50 years compared with 60-69 years: odds ratio [OR], 1.35; 95% CI, 1.14-1.59; P < .001; age 50-59 years compared with 60-69 years: OR, 1.19; 95% CI, 1.03-1.37; P = .02), race (Black individuals compared with White individuals: OR, 1.56; 95% CI 1.30-1.88; P < .001; individuals with Other race or ethnicity compared with White individuals: OR, 1.52; 95% CI, 1.12-2.07; P = .01), conventional fractionation (OR, 1.26; 95% CI, 1.10-1.45; P = .002), male physician sex (OR, 1.54; 95% CI, 1.20-1.99; P = .002), and 2-field radiotherapy (without a supraclavicular field) (OR, 0.80; 95% CI, 0.67-0.97; P = .02). Conclusions and Relevance: The results of this cohort study suggest that PRO collection may be essential for trials because relying on the CTCAE to detect adverse events may miss important symptoms. Moreover, since physicians in this study systematically missed substantial symptoms in certain patients, including younger patients and Black individuals or those of Other race and ethnicity, improving symptom detection may be a targetable mechanism to reduce disparities.

Abstract The Membrane Invasion Culture System (MICS) assay was adapted for relatively rapid screening of compounds and used to identify anti‐invasive drugs that inhibit human and murine tumor cell migration through a reconstituted basement membrane in vitro . Cell lines demonstrating low and high invasive and metastatic potentials were tested with all compounds for tumoricidal effects prior to evaluation in MICS at non‐cytotoxic doses. The effect on invasive potential in the MICS assay was determined in 3 categories: (1) 48 hr drug pre‐treatment prior to seeding in the MICS (exceptions: 90 min pre‐treatment with pertussis toxin and, for some studies, continuous exposure for 2‐7 days); (2) peptide or prostaglandins 2 hr after seeding and attachment to the membranes in MICS followed by continuous exposure; and (3) cells receiving neither drug nor peptide treatment and serving as controls in each MICS chamber. Since invasion involves cellular motility and deformability, some cytoskeleton disrupting agents were selected. Of these, vincristine, colcemid and colchicine inhibited invasion but taxol did not. Pre‐treatment with cAMP agonists produced conflicting results: dibutyryl cAMP and 8‐(4‐chloro‐phenylthio) cAMP resulted in 50% and 38% reduction in invasion, respectively, whereas 8‐bromo cAMP stimulated invasive potential by 30%. Forskolin and cholera toxin both significantly reduced invasiveness. Pre‐treatment with 5‐azacytidine and araC, to consider the role of methylation and proliferations decreased invasive ability. Anti‐metastatic drugs such as γ‐interferon and razoxane inhibited invasive potential but to varying degrees. Treatment of cells with prostaglandins E 2 , F 2α , A 2 , and D 2 were ineffectual; however, indomethacin mildly inhibits invasion (&lt; 30%). With respect to the cell surface and metastatic potential, pre‐treatment with tunicamycin did not alter invasiveness; whereas pre‐treatment with swainsonine blocked invasion by approximately 50% at 0.3 μg/ml. The inhibition caused by swainsonine was enhanced (to 92%) if cells were continuously exposed to drug and was reversible. Several RGD‐containing peptides which inhibit attachment to various substrates did not modify invasion in the MICS if added after cell attachment was completed. The peptide which inhibits laminin attachment, CDPGYIGSR, inhibited invasion by 48%. Two peptides from the fibrinogen gamma chain were mildly inhibitory and peptides from TGF‐α inhibited invasion &gt;60%. Collectively, these results demonstrate the potential utility of the MICS for prescreening compounds for anti‐invasive potential, and ultimately anti‐metastatic therapy.

PURPOSE: It has been reported that diode sensitivity decreases by as much as 2% when the average dose rate set at the accelerator console was decreased from 600 to 40 MU∕min. No explanation was given for this effect in earlier publications. This work is a detailed investigation of this phenomenon: the change of diode sensitivity versus the rate of delivery of dose pulses in the milliseconds and seconds range. METHODS: X-ray beams used in this work had nominal energies of 6 and 15 MV and were generated by linear accelerators. The average dose rate was varied from 25 to 600 MU∕min, which corresponded to time between microsecond-long dose pulses of 60-2.7 ms, respectively. The dose-per-pulse, dpp, was changed by positioning the detector at different source-to-detector distance. A variety of diodes fabricated by a number of manufacturers were tested in this work. Also, diodes in three different MapCHECKs (Sun Nuclear, Melbourne, FL) were tested. RESULTS: For all diodes tested, the diode sensitivity decreases as the average dose rate is decreased, which corresponds to an increase in the pulse period, the time between radiation pulses. A sensitivity decrease as large as 5% is observed for a 60-ms pulse period. The diode sensitivity versus the pulse period is modeled by an empirical exponential function. This function has a fitting parameter, t(eff), defined as the effective lifetime. The values of t(eff) were found to be 1.0-14 s, among the various diodes. For all diodes tested, t(eff) decreases as the dpp decreases and is greater for 15 MV than for 6 MV x rays. The decrease in diode sensitivity after 20 s without radiation can be reversed by as few as 60 radiation pulses. CONCLUSIONS: A decrease in diode sensitivity occurs with a decrease in the average dose rate, which corresponds to an increase in the pulse period of radiation. The sensitivity decrease is modeled by an empirical exponential function that decreases with an effective lifetime, t(eff), of 1.0-14 s. t(eff) varies widely for different diodes, dpp, and x-ray energy. It is hypothesized that the capture of excess minority carriers by charge traps, cause the observed decrease in diode sensitivity. Also, it is hypothesized that the slow reopening of these traps occurs in the hundreds of milliseconds to seconds range at ambient temperature and this underlies the slow decrease in the diode sensitivity. Calibration of a diode is best done at the average dose rate with which it will be used. This is easily accomplished for radiation deliveries in which the average dose rate is a constant. However, for a VMAT delivery the average dose rate is a variable. For measurements made under these conditions diodes can be calibrated with a median or average dose rate which splits the difference in diode sensitivity that is known to occur with changes in average dose rate.

To understand better the molecular nature of the epithelial-mesenchymal interactions that govern folliculogenesis and hair growth, we have studied the behavior of cultured rat dermal papilla cells (rDP), the mesenchymal component of the hair follicle. Basic fibroblast growth factor (bFGF) and platelet-derived growth factor (PDGF) both potentiated the growth of rDP in culture, and transforming growth factor-beta (TGF-beta) inhibited rDP proliferation. Biosynthetic labeling studies demonstrated that both PDGF and bFGF induced synthesis of a major secreted protein(s) with Mr = 55-60 kD. It was noted that PDGF and bFGF differentially regulated synthesis of this major secreted protein; PDGF-mediated induction was found to be transient, while bFGF allowed prolonged synthesis of the protein. Sodium dodecyl sulfate (SDS)-substrate gel analysis of rDP-conditioned media revealed that this protein is a metalloproteinase with casienolytic activity and Mr approximately 51 kD (unreduced). We have identified the growth factor-regulated rDP protein as the matrix metalloproteinase stromelysin by immunoprecipitation. Northern analysis established that increased secretion of stromelysin was accompanied by an increased expression of stromelysin-specific mRNA. Remarkably, stromelysin antisera interfere with stimulation of dermal papilla cell growth, demonstrating that stromelysin production serves a functional role in mitogen-induced proliferation in these cells. These findings provide insight into the mechanism by which the connective tissue remodeling required for formation of hair embryonically and the postembryonic hair cycle may be regulated.

A group of specialized mesenchymal cells located at the root of the mammalian hair follicle, known as the follicular or dermal papillary cells, are involved in regulating the hair cycle, during which keratinocytes of the lower follicle undergo proliferation, degeneration and regrowth. Using the arbitrarily primed-PCR approach, we have identified a 1.3 kb messenger RNA that is present in large quantities in cultured rat follicular papillary cells, but not in skin fibroblasts. This mRNA encodes nexin 1, a potent protease inhibitor that can inactivate several growth-modulating serine proteases including thrombin, urokinase and tissue plasminogen activator. In situ hybridization showed that nexin 1 message is accumulated in the follicular papilla cells of anagen follicles, but is undetectable in keratinocytes or other skin mesenchymal cells. In addition, nexin 1 message level varies widely among several immortalized rat vibrissa papillary cell lines, and these levels correlate well with the reported abilities of these cell lines to support in vivo follicular reconstitution. These results suggest a possible role of nexin 1 in regulating hair follicular growth.

PURPOSE: To show the feasibility of clinical implementation of OSLDs for high dose-rate (HDR) in vivo dosimetry for gynecological and breast patients. To discuss how the OSLDs were characterized for an Ir-192 source, taking into account low gamma energy and high dose gradients. To describe differences caused by the dose calculation formalism of treatment planning systems. METHODS: OSLD irradiations were made using the GammaMedplus iX Ir-192 HDR, Varian Medical Systems, Milpitas, CA. BrachyVision versions 8.9 and 10.0, Varian Medical Systems, Milpitas, CA, were used for calculations. Version 8.9 used the TG-43 algorithm and version 10.0 used the Acuros algorithm. The OSLDs (InLight Nanodots) were characterized for Ir-192. Various phantoms were created to assess calculated and measured doses and the angular dependence and self-absorption of the Nanodots. Following successful phantom measurements, patient measurements for gynecological patients and breast cancer patients were made and compared to calculated doses. RESULTS: The OSLD sensitivity to Ir-192 compared to 6 MV is between 1.10 and 1.25, is unique to each detector, and changes with accumulated dose. The measured doses were compared to those predicted by the treatment planning system and found to be in agreement for the gynecological patients to within measurement uncertainty. The range of differences between the measured and Acuros calculated doses was -10%-14%. For the breast patients, there was a discrepancy of -4.4% to +6.5% between the measured and calculated doses at the skin surface when the Acuros algorithm was used. These differences were within experimental uncertainty due to (random) error in the location of the detector with respect to the treatment catheter. CONCLUSIONS: OSLDs can be successfully used for HDR in vivo dosimetry. However, for the measurements to be meaningful one must account for the angular dependence, volume-averaging, and the greater sensitivity to Ir-192 gamma rays than to 6 MV x-rays if 6 MV x-rays were used for OSLD calibration. The limitations of the treatment planning algorithm must be understood, especially for surface dose measurements. Use of in vivo dosimetry for HDR brachytherapy treatments is feasible and has the potential to detect and prevent gross errors. In vivo HDR brachytherapy should be included as part of the QA for a HDR brachytherapy program.

Adozelesin (U-73975) is an extremely potent cytotoxic agent which causes 90% lethality, after 2 h exposure in vitro, of Chinese hamster ovary and lung (CHO and V79), mouse melanoma (B16), and human ovarian carcinoma (A2780) cells at 0.33, 0.19, 0.2, and 0.025 ng/ml, respectively. Under similar conditions, Adriamycin and cisplatin had 90% lethality values in CHO cells of 150 ng/ml (= 249 nM) and 6800 ng/ml (= 2266 nM), respectively. The relative drug sensitivity of the cell lines (A2780 > V79, B16, CHO) was correlated to the relative amounts of [3H]adozelesin alkylated to DNA. The greater sensitivity of A2780 was due to (a) greater DNA alkylation at different drug doses and (b) greater intrinsic sensitivity of A2780 which resulted in greater cell kill at comparable DNA alkylation. Phase specific toxicity studies show that adozelesin was least lethal to CHO cells in mitosis and very early G1. Lethality increased as cells progressed through G1 and was maximal in late G1 and early S. Mitotic cells had lower drug uptake and correspondingly less drug binding to DNA than G1 or S-phase cells. However, based on the amount of drug alkylated per micrograms of DNA, cells in M, G1, and S were equally sensitive. Therefore, the lower sensitivity of M-phase cells was due to lower drug uptake. Adozelesin had three different effects on progression of CHO, V79, B16, and A2780 through the cell cycle: (a) slowed progression through S which resulted in significantly increasing the percentage of S-phase cells. This effect was transient; (b) cell progression was blocked in G2 for a long time period; (c) the response of the cell lines to the G2 block differed. CHO and V79 cells escaped G2 block by dividing and entered the diploid DNA cycle or did not undergo cytokinesis and became tetraploid. On the contrary, B16 and A2780 cells remained blocked in G2 and did not become tetraploid. Cell progression was inhibited in a similar manner when a synchronized population of M, G1, or S-phase cells were exposed to adozelesin.