Weight loss
The role of palliative radiotherapy in locally advanced non-small cell lung cancer.

Cetingoz R, Kentli S, Uruk O, Demirtas E, Sen M, Kinay M.

Dokuz Eylul University Hospital, Department of Radiation Oncology, Yzmir, Turkey. riza.cetingoz deu.edu.tr

The aim of this study was to evaluate retrospectively the treatment results of non-small cell lung cancer (NSCLC) patients treated with palliative intent in Dokuz Eylul University Hospital, Radiation Oncology Department. One hundred and fifteen inoperable, non-metastatic and symptomatic NSCLC patients were treated with palliative radiotherapy (PRT) between July 1991 and May 2000. PRT was used in patients with low performance status, weight loss more than 10% within last 6 months, secondary malignancies, co-morbid diseases and socio-economic problems. Parallelly opposed isocentric antero-posterior fields including both the parenchymal and mediastinal masses were used. 10-55 Gy total doses were delivered in 1-23 fractions with a median of 30 Gy. Nineteen patients received systemic chemotherapy before PRT. Survival analysis was made from the treatment beginning date, and subjective palliation rates were assessed according to clinical improvements in symptomatology evaluated 1-6 weeks after PRT. The median follow-up time was 28 weeks (1-234 weeks). Totally, 245 disease-related symptoms were detected in 115 patients. Overall "improvement" in symptomatology was found to be 90% (221/245) with a "near-total response" rate of 46% (113/245). Hemoptysis was the best palliated symptom. Median survival time was 30 weeks. Karnofsky performance status (KPS) (p=0.015), weight loss (p=0.0015), histologic tumor type (p=0.0024) and tumor size (p=0.02) were found to effect overall survival rates significantly in uni-variant analysis. Multi-variant analysis revealed statistically significant effect with histological tumor type and weight loss status. Only 16% of patients (3/19) showed partial and 5% (1/19) complete response to systemic treatment. Median survival time was 46 weeks in this group. In conclusion, this retrospective study of patients with poor prognostic factors confirms that PRT is an effective treatment modality in symptomatic locally advanced NSCLC patients resulting in 90% symptomatic improvement rate and a median survival of 30 weeks.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11949846&dopt=Abstract weight loss



Weight loss
Postoperative body-weight loss and survival after curative resection for gastric cancer.

Yu W, Seo BY, Chung HY.

Department of Surgery, School of Medicine, Kyungpook National University, 50 Samduk-dong, Taegu, 700-721, Korea. wyu knu.ac.kr

BACKGROUND: Body-weight loss has been reported as a poor prognostic factor for some malignancies. The purpose of this study was to evaluate the prognostic value of postoperative body-weight loss in patients with gastric cancer. METHODS: In 564 patients who underwent curative resection for gastric cancer, usual body-weight, body-weight at the time of resection and that 6 and 12 months after resection were recorded prospectively. RESULTS: The 5-year survival rate of patients who lost more than 5 per cent of their 6-month postoperative weight by 12 months after resection was 63 per cent while that of patients who maintained 95 per cent or more of their 6-month postoperative weight was 84 per cent (P < 0.001). Multivariate analysis revealed that serosal invasion, nodal metastasis, body-weight loss during the second 6-month interval after resection and extent of gastric resection were independent prognostic indicators. CONCLUSION: When a patient loses body-weight during the second 6-month interval after curative resection for gastric cancer, recurrent disease should be suspected.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11952589&dopt=Abstract weight loss



Weight loss
Acute toxicity and treatment interruption related to electron and photon craniospinal irradiation in pediatric patients treated at the University of Texas M. D. Anderson Cancer Center.

Chang EL, Allen P, Wu C, Ater J, Kuttesch J, Maor MH.

Department of Radiation Oncology, University of Texas, M. D. Anderson Cancer Center, Houston, TX, USA. echang mdanderson.org

PURPOSE: To determine the incidence of acute toxicity and treatment interruption associated with electron and photon craniospinal irradiation (CSI) in children treated with or without chemotherapy. MATERIALS AND METHODS: A retrospective study involving a computerized search of the radiotherapy database at the University of Texas M. D. Anderson Cancer Center identified a total of 79 eligible patients </=18 years old who had received electron (n = 46) or photon (n = 33) CSI from October 1980 to March 2000. Acute toxicity was graded according to the 1998 National Cancer Institute Common Toxicity Criteria. Chemotherapy sequencing was categorized as before or after CSI or no chemotherapy. The incidences of weight loss and skin toxicity were recorded and differences in treatment interruption and hematologic values with respect to modality used (electron vs. photon), age (</=6 or >6 years), and sequencing of chemotherapy were compared using chi-square tests. RESULTS: The median age of the electron group was lower than that of the photon group (6.7 years and 11.7 years, respectively). The two groups were otherwise well matched in terms of median spinal dose (31.1 vs. 33.3 Gy), fraction size (1.57 vs. 1.63 Gy), and total treatment time (32.4 vs. 30.7 days). Only 2 patients in each group (photon and electron) had a treatment break (>3 days). The mean number of days interrupted was 0.94 (photon) and 1.1 (electron) (p = 0.72). The electron and photon groups were well balanced in terms of receiving pre-CSI chemotherapy (37% vs. 41%, p = 0.776). Chemotherapy given before radiotherapy vs. after or not at all was associated with an increased incidence of Grade 3-4 leukopenia (76% vs. 49%, p = 0.02), thrombocytopenia (90% vs. 10%, p = 0), and neutropenia (50% vs. 15%, p = 0.005). A younger age was associated with Grade 3-4 thrombocytopenia (29% vs. 8.7%, p = 0.034), and decreased hemoglobin (29% vs. 6.5%, p = 0.014). The incidence of leukocyte depression of Grade 3-4 toxicity was 62% in the electron group and 32% in the photon group (p = 0.018). The incidence of Grade 3-4 platelet toxicity was higher with electrons (21%) than with photons (4%), but the difference was of borderline significance (p = 0.053). The difference in Grade 1-2 weight loss was not statistically significant (86% electron vs. 55% photon groups, p = 0.53), and Grade 3-4 weight loss did not occur within the entire study group. Most patients experienced Grade 0-1 radiation dermatitis with either electrons or photons. CONCLUSION: A younger patient age (</=6 years) and the sequence of chemotherapy before radiotherapy were associated with increased acute hematologic toxicity. Grade 3-4 weight loss, a surrogate for gastrointestinal toxicity, was not observed within the entire population. Despite the increased acute hematologic toxicities associated with CSI in very young children, the vast majority of patients were able to complete photon or electron CSI with minimal to no treatment interruptions. CSI with the electron technique can be used as an alternative to photon CSI in young children, and in our experience does not require the routine use of hematopoietic growth factors.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11958896&dopt=Abstract weight loss



Weight loss
Effect of a fish oil-enriched nutritional supplement on metabolic mediators in patients with pancreatic cancer cachexia.

Barber MD, Fearon KC, Tisdale MJ, McMillan DC, Ross JA.

University Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh EH3 9YW, UK.

Weight loss in advanced cancer patients is refractory to conventional nutritional support. This may be due to metabolic changes mediated by proinflammatory cytokines, hormones, and tumor-derived products. We previously showed that a nutritional supplement enriched with fish oil will reverse weight loss in patients with pancreatic cancer cachexia. The present study examines the effect of this supplement on a number of mediators thought to play a role in cancer cachexia. Twenty weight-losing patients with pancreatic cancer were asked to consume a nutritional supplement providing 600 kcal and 2 g of eicosapentaenoic acid per day. At baseline and after 3 wk, patients were weighed and samples were collected to measure serum concentrations of interleukin (IL)-6 and its soluble receptor tumor necrosis factor receptors I and II, cortisol, insulin, and leptin, peripheral blood mononuclear cell production of IL-1 beta, IL-6, and tumor necrosis factor, and urinary excretion of proteolysis inducing factor. After 3 wk of consumption of the fish oil-enriched nutritional supplement, there was a significant fall in production of IL-6 (from median 16.5 to 13.7 ng/ml, P = 0.015), a rise in serum insulin concentration (from 3.3 to 5.0 mU/l, P = 0.0064), a fall in the cortisol-to-insulin ratio (P = 0.0084), and a fall in the proportion of patients excreting proteolysis inducing factor (from 88% to 40%, P = 0.008). These changes occurred in association with weight gain (median 1 kg, P = 0.024). Various mediators of catabolism in cachexia are modulated by administration of a fish oil-enriched nutritional supplement in pancreatic cancer patients. This may account for the reversal of weight loss in patients consuming this supplement.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11962246&dopt=Abstract weight loss



Weight loss
Five year results of a prospective very low calorie diet or conventional weight loss programme in type 2 diabetes.

Paisey RB, Frost J, Harvey P, Paisey A, Bower L, Paisey RM, Taylor P, Belka I.

The Diabetes Research Group, Torbay Hospital, Torquay, UK. richard.paisey sdevonhc-tr.sweat.nhs.uk

AIMS: To complete 5-year follow-up of an intensive weight loss programme in established type 2 diabetic subjects. METHODS: Forty-five obese type 2 diabetic subjects, Body mass index (BMI) > 30, expressed interest in an intensive weight loss programme. Group 1 comprised 15 who selected very low calorie diet (VLCD), Group 2, 15 selected intensive conventional diet and exercise (ICD), 15 failed to follow either programme. Group sessions of eight to 15 subjects continued weekly for 6 months, then monthly for 12 months with prospective recording at 3, 6 and 12 months and then annually of quality of life, BMI, waist/hip ratio, blood pressure, fasting blood glucose, serum fructosamine and serum lipids. RESULTS: Weight loss was slower in the intensive conventional diet group than in the VLCD group, but better maintained at 5 years: group 1, 4.8 +/- 6 kg; group 2, 8.9 +/- 4 kg. In the intensive conventional diet group, 5 year high-density lipoprotein cholesterol was increased 1.78 +/- 0.26 mmol L-1 vs. 1.10 +/- 0.32 mmol L-1 at baseline, and diastolic blood pressure reduced 74.5 +/- 13.3 vs. 85.5 +/- 13.3 at baseline, both P < 0.05. CONCLUSIONS: Out-patient VLCD treatment proved safe and effective in overweight diabetic subjects but those who chose conventional diet and exercise had a slower but more sustained weight loss. Diabetic patients willing to attempt VLCD may safely lose sufficient weight to allow major surgery, but weight regain is inevitable. Patients willing to undertake a long-term group programme of conventional diet can sustain significant weight loss for 5 years, but still require antidiabetic medication.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11972741&dopt=Abstract weight loss



Weight loss
Gallbladder management in obesity surgery.

Mason EE, Renquist KE.

International Bariatric Surgery Registry, University of Iowa College of Medicine, Department of Surgery, Iowa City, IA, USA. edward-mason uiowa.edu

BACKGROUND: In the 1980s, some surgeons recommended routine cholecystectomy for patients undergoing bariatric surgery. This was based on the high prevalence of gallstones in the obese and concern that rapid weight loss would increase the risk of gallbladder disease. Others recommended waiting for a lower weight and a definite need. With increasing prevalence and severity of obesity and increased use of gastric reduction surgery for weight control, it seemed appropriate to review the current standard of care for cholecystectomy. A survey was also made of ursodeoxycholic acid usage for prevention of gallstone formation. METHODS: Data collected from active contributors for the 28th Report of the International Bariatric Surgery Registry (IBSR) were examined. Two questionnaires were also sent to members of the American Society for Bariatric Surgery (ASBS). The first (Q1) asked about the indications for cholecystectomy. The second (Q2) asked about ursodeoxycholic acid usage for prevention of gallstone formation during rapid weight loss following surgical treatment of obesity. RESULTS: There has been an increase in concurrent cholecystectomy during the last 15 years. Some of this is due to a shift from simple gastric restrictive operations to gastric bypass with gastric restriction. When the most extensive bypass of intestine is used, as in distal Roux-en-Y gastric bypass (RYGBP-X) or biliopancreatic diversion with a duodenal switch (BPD-DS), all patients were reported to have undergone cholecystectomy. Only 30% of surgeons performing standard Roux-en-Y gastric bypass (RYGBP) remove normal-appearing gallbladders. Ursodeoxycholic acid is used to prevent gallstone formation in one-third of patients when a normal-appearing gallbladder is left in place. CONCLUSIONS: Prophylactic cholecystectomy is left to the discretion of the surgeon when RYGBP is used. There has been an increase in cholecystectomy and malabsorptive operations during the last 15 years. When most of the small bowel is bypassed, all remaining gallbladders are removed. For patients with simple restriction operations, normal-appearing gallbladders are usually left in place. Urso-deoxycholic acid during rapid weight loss for prevention of gallstone formation is used in one-third of patients with remaining gallbladders.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11975217&dopt=Abstract weight loss



Weight loss
Analysis of weight loss with the biliopancreatic diversion of Larrad: absolute failures or relative successes?

Sanchez-Cabezudo Diaz-Guerra C, Larrad Jimenez A.

Service of General Surgery and Digestive System, USP San Camilo Hospital, Madrid, Spain. elisapinto terra.es

BACKGROUND: The authors studied whether morbidly obese patients who failed in stated weight loss criteria may be considered absolute failures or relative successes. METHODS: 75 morbidly obese patients underwent biliopancreatic diversion (BPD) of Larrad, with a 4/5 gastrectomy (residual gastric volume 150-200 ml), a biliopancreatic limb divided 50 cm distal to Treitz' ligament, a 50-cm common limb and an alimentary limb of nearly all the bowel length (500-600 cm). Every patient had a follow-up of 5 years. A percent excess weight loss (%EWL) < 50% was considered a "failure". We analyzed the post-surgical changes in the preoperative obesity-related problems in these patients and the causes of the weight loss failure. RESULTS: At 5 years after the BPD of Larrad, 9 patients (12%) had a %EWL < 50%, with a mean %EWL of 36 in these patients. Most of these failed patients were cured or improved of their preoperative illnesses. The 2 males were alcoholics, and 6 of the 7 females had an abnormal psychological examination. Comparing the "failed" patients with the successful group, there is a statistically significant influence (p < 0.01) of lack of satiety, unmarried status, housewife or unemployed. CONCLUSION: Patients judged as a failure by weight loss criteria after bariatric surgery should not be considered absolute failures, because most of their preoperative illnesses were cured or improved, improving their quality of life. Thus, they are "relative successes".

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11975222&dopt=Abstract weight loss



Weight loss
Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients.

Gagner M, Gentileschi P, de Csepel J, Kini S, Patterson E, Inabnet WB, Herron D, Pomp A.

Division of Laparoscopic Surgery, Mount Sinai School of Medicine, New York, NY, USA. michel.gagner mountsinai.org

BACKGROUND: 10 to 25% of patients undergoing bariatric surgery will require a revision, either for unsatisfactory weight loss or for complications. Reoperation is associated with a higher morbidity and has traditionally been done in open fashion. The purpose of this study was to determine the safety and efficacy of reoperative surgery using a laparoscopic approach. METHODS: A retrospective review of medical records over a 22-month period was conducted. 27 consecutive obesity surgery patients, who had undergone a laparoscopic revision, were identified. 26 of the 27 patients were women. The average age was 40.3 years (range 20 to 58 years) and average original preoperative body mass index (BMI) was 51.6 kg/m2 (range 42 to 66.5). The 27 primary bariatric operations consisted of vertical banded gastroplasty (12), gastric band placement (9) and gastric bypass (6). 17 of them were open procedures. After the primary surgery, the lowest average BMI was 37.6 kg/m2 (range 21 to 52), which increased to 42.7 kg/m2 (range 29 to 56) before reoperation. 24 of the 27 reoperations were indicated for insufficient weight loss. On average, revision was undertaken 52 months after the primary procedure (range 12 to 240 months). RESULTS: 24 of the 27 laparoscopic reoperations were conversions to a gastric bypass. A second reoperation was indicated for insufficient weight loss on four occasions. In one case, conversion to open surgery was required. The average operative time was 232 +/- 18.5 minutes (range 120 to 480) and length of hospital stay was 3.7 days (range 1 to 9). 22% percent of patients (6) experienced complications, including pneumothorax, gastric remnant dilation, gastrojejunostomy stenosis, port-site hernia and protein malnutrition. There was no mortality in the study. The average BMI was 35.9 kg/m2 (range 27 to 45.5) 8 months after surgery (range 1 to 22 months). Compared with a preoperative BMI of 42.7 kg/m2, the weight loss was statistically significant (p < 0.001). CONCLUSION: Our results compare favorably with those reported for open reoperative bariatric surgery. A laparoscopic approach may be considered a feasible and safe alternative to an open operation.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11975224&dopt=Abstract weight loss



Weight loss
Composition (lean and fat tissue) of weight changes in adult Danes.

Heitmann BL, Garby L.

Institute of Preventive Medicine, Copenhagen, University Hospital, Kobenhavn K, Denmark. blh ipm.hosp.dk

BACKGROUND: Weight loss may be associated with unfavorable changes in body composition not compensated for by subsequent weight gain. OBJECTIVE: We examined the composition of weight change in relation to obesity, previous weight changes, weight-loss attempts, and physical activity. DESIGN: Part of the Danish MONICA (Monitoring Trends in Cardiovascular Disease) project, this was a longitudinal population study of changes in weight and body composition, with examinations in 1982-1983, 1987-1988, and 1993-1994. A total of 1236 men and 1200 women aged 35, 45, 55, or 65 y in 1987-1988 participated. Changes in fat and fat-free mass were measured by bioelectrical impedance. RESULTS: Before adjustment for age-related changes, fat-free mass made up 41% of weight lost and 24% of weight gained in men. In women, loss of fat-free mass (35%) was more than double that of gains (15%). After adjustment, the fractions of weight gained as fat-free mass were not significantly different from the fractions lost. These fractions were independent of age, obesity, and weight changes in the previous 5 y; successful weight-loss attempts; and physical activity. Independent of age and degree of obesity, weight changes were associated with greater changes in fat-free mass in men than in women. CONCLUSIONS: These data do not support the theory that weight loss or weight cycling may lead to an unfavorable body composition, nor do they provide a biological explanation for why long-term weight loss is often unsuccessful. However, the metabolic and health consequences of weight change may differ in men and women.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11976157&dopt=Abstract weight loss