(P.M.); the Department of Surgery, Krankenhaus der Barmherzigen Brüder, St. Veit an der Glan, Austria (J.T.

There is a persisting significant improvement of pre- versus postoperative CRT on local control; however, there was no effect on overall survival. Integrating more effective systemic treatment into the multimodal therapy has been adopted in the CAO/ARO/AIO-04 trial to possibly reduce distant metastases and improve survival.

No abstract

Complete and intermediate tumor regressions were associated with improved long-term outcome in patients with rectal carcinoma after preoperative CRT independent of clinicopathologic parameters. This classification system needs to be prospectively tested in multiple data sets to validate its reproducibility in a wider setting.

In order to minimize neurological symptoms and treatment-related side-effects, patients with primary or secondary brain tumors receive dexamethasone. The goal of this study was to analyze dosage and duration of dexamethasone intake and to compare the advantages and disadvantages of this medication during the course of radiation therapy (RT). Data from 138 consecutive patients were therefore analyzed retrospectively. During the course of therapy, the dosage of dexamethasone was evaluated, as were the indications for and duration of this treatment, its side-effects and any clinical changes reported during dexamethasone intake. The dosage of dexamethasone was higher at the outset and during RT (median 7-12 mg/day) than at the end of RT (median 1-6 mg/day). The average duration of dexamethasone intake was 23 weeks for patients with primary, and 7 weeks for patients with secondary brain tumors. The most frequent side-effects were a rise in serum glucose level, peripheral edema, psychiatric disorders, and Cushing's syndrome. Life-threatening complications remained rare. Initially, dexamethasone led to good clinical improvement with few side-effects of RT, whereas by the end of RT the symptom relief was slight and toxicity increased. In a group of 13 patients who received no dexamethasone during RT, 12 showed neither RT-related side-effects nor of neurological impairment. Dexamethasone effectively minimizes neurological symptoms and RT-related side-effects in patients with primary and secondary brain tumors. Nevertheless, the side-effects of dexamethasone itself increase over time. For this reason, a generalized dose scheme should not be used. Instead, dosage should be adapted to each patient's individual needs. Future prospective studies will have to determine whether dexamethasone is advantageous on balance or not.

Consequences to reduce interobserver variability are proposed, among others the selection of adequate imaging modalities, intensified radiologic training, and the use of telecommunication tools.

The patient accrual to the trial is satisfactory. Neoadjuvant RCT is well tolerated and bears no higher risk for postoperative morbidity.

Liver damage is a serious clinical complication of ␥-irradiation. We therefore exposed rats to singledose ␥-irradiation (25 Gy) that was focused on the liver. Three to six hours after irradiation, an increased number of neutrophils (but not mononuclear phagocytes) was observed by immunohistochemistry to be attached to portal vessels between and around the portal (myo)fibroblasts (smooth muscle actin and Thy-1 ؉ cells). MCP-1/CCL2 staining was also detected in the portal vessel walls , including some cells of the portal area. CC-chemokine (MCP-1/CCL2 and MCP-3/CCL7) and CXC-chemokine (KC/CXCL1, MIP-2/CXCL2, and LIX/CXCL5) gene expression was significantly induced in total RNA from irradiated livers. In laser capture microdissected samples, an early (1 to 3 hours) up-regulation of CCL2, CXCL1, CXCL8, and CXCR2 gene expression was detected in the portal area but not in the parenchyma; with the exception of CXCL1 gene expression. In addition, treatment with an antibody against MCP-1/CCL2 before irradiation led to an increase in gene expression of interferon-␥ and IP-10/CXCL10 in liver tissue without influencing the recruitment of granulocytes. Indeed, the CCL2, CXCL1, CXCL2, and CXCL5 genes were strongly expressed and further up-regulated in liver (myo)fibroblasts after irradiation (8 Gy). Taken together, these results suggest that ␥-irradiation of the liver induces a transient accumulation of granulocytes within the portal area and that (myo)fibroblasts of the portal vessels may be one of the major sources of the chemokines involved in neutrophil recruitment. Moreover, inhibition of more than one chemokine (eg, CXCL1 and CXCL8) may be necessary to reduce leukocytes recruitment.