Subcutaneous administration of amifostine is well tolerated, effectively reduces radiotherapy's early toxicity, and prevents delays in radiotherapy. The subcutaneous route is much simpler and saves time compared with the intravenous route of administration and can be safely and effectively applied in the daily, busy radiotherapy practice.

The blood–brain barrier is a major obstacle for the chemotherapeutic drugs to effectively reach primary or secondary brain tumours. Stealth® liposomal drugs are highly accumulated in tumoural tissues. In the present study we investigated the relative accumulation of99mTc-DTPA radiolabelled stealth® liposomal doxorubicin (Caelyx®) in 10 patients with metastatic brain tumours and five patients with brain glioblastoma undergoing radiotherapy. Patients with metastatic brain lesions were treated with 10 consecutive fractions of radiotherapy (whole brain, 3 Gy/fraction, day 1–12) followed by a booster dose of 9 Gy (3 Gy/fraction, day 21–23). Caelyx®, at a dose of 25 mg mg–2was given on day 1 and on day 21. Radiolabelled Caelyx® accumulation was 13–19 times higher in the glioblastomas and 7–13 times higher in the metastatic lesions, as compared to the normal brain. The drug accumulation in the tumoural areas was 40–60% of the accumulation in the bone marrow of the skull bones. The normal brain radioactivity was <4% of the bone marrow, confirming an important shielding effect of the blood–brain barrier in the normal but not in the tumoural tissue. Four of 10 patients with metastatic lesions showed a complete response in CT-scan performed 2 months following therapy. There was no severe toxicity related to radiotherapy or to chemotherapy noted. It is concluded that stealth® liposomal drugs selectively overcome the blood–brain barrier in the tumoural areas. The clinical importance of this observation is now under investigation. © 2000 Cancer Research Campaign

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Summary Docetaxel has shown remarkable radiosensitizing in vitro properties. In a previous phase I/II dose escalation study in nonsmall-cell lung cancer (NSCLC) we observed a high response rate after concomitant boost radiotherapy and weekly docetaxel. The maximum tolerated dose was 30 mg m -2 week -1 . In the present phase II study we evaluated whether weekly docetaxel and conventionally fractionated radiotherapy could be better tolerated and equally effective in the treatment of locally advanced NSCLC. Thirty-five patients with T3, T4/N2, T3/M0-staged disease were recruited. Docetaxel (30 mg m -2 ) was given as a 30 min infusion once a week. Asthenia and radiation-induced oesophagitis were the main side-effects of the regimen enforcing 2-week treatment delay in 6/35 (17%) patients and minor delay (3-7 days) in another 11/35 (31%) patients. Neutrophil, platelet and haemoglobin toxicity was minimal, but pronounced lymphocytopenia was observed. Complete response (CR) of the chest disease was observed in 12/35 (34%) patients and partial response in 16/35 (46%). Although not statistically significant (P = 0.19), a higher CR rate (8/18; 44%) was observed in patients who accomplished their therapy within the scheduled treatment time (44-47 days) as compared to patients that interrupted their treatment for several days due to treatment-related toxicity (CR 4/17; 23%). The overall survival and the local progression-free survival at 1 year was 48% and 60% respectively. We conclude that docetaxel combination with radiotherapy is a promising approach for the management of locally advanced NSCLC that results in high CR rate. Further trials with docetaxel-based radiochemotherapy should integrate accelerated radiotherapy together with cytoprotection.

Although pelvic radiotherapy, either alone or combined with chemotherapy, has proved to be successful in the treatment of patients with rectal, gynecological and urologic cancer, it is not devoid of side effects. Among patients receiving pelvic radiotherapy more than 70% develop acute inflammatory changes causing gastrointestinal symptoms during treatment. The most frequently reported symptom related to radiation-induced intestinal mucositis is diarrhea. Among nutritional interventions used to manage radiation-induced diarrhoea, probiotics has gained popularity. This term describes organisms and substances that improve microbial balance in the intestines. Although encouraging results have been obtained in clinical trials, the potential of oral probiotics to manage gastrointestinal symptoms needs further research. The article also outlines recent patents related to probiotics therapy to reduce radiation induced mocositis.