硼中子俘获治疗外阴黑色素瘤和生殖器乳腺外Paget病的疗效

背景与目的尽管目前对生殖器区的黑色素瘤和乳腺外Paget病(extramammary Paget’s disease,EMPD)最常推荐的治疗方法是广泛性手术切除病变,但该方法侵害性极高并可导致功能性和性方面的问题。当扩大局部切除术不可行的情况下,替代疗法已被用于进行局部控制。本研究描述了4例接受硼中子俘获治疗(boron neutron capture therapy,BNCT)的生殖器恶性肿瘤患者。方法 4例患者中包括1例外阴黑色素瘤(vulvar melanoma,VM)和3例生殖器EMPD患者。他们于2005至2014年间在Kyoto大学研究堆接受了对二羟基硼酰苯丙氨酸作为硼携带剂的BNCT治疗。他们接受了介于治愈性肿瘤剂量和可耐受的皮肤/黏膜剂量之间的超热中子束照射。结果所有患者在BNCT治疗后均表现出相似的肿瘤和正常组织反应,并在6个月内达到完全缓解。最严重的正常组织反应前2个月内出现,随后逐渐减弱的中度皮肤糜烂,排尿困难或接触性疼痛持续2个月,完全解决需4个月。结论 BNCT治疗VM和EMPD后局部肿瘤得到完全控制。根据我们的临床经验,我们认为BNCT是治疗生殖器区原发性VM和EMPD的一种有前景的方法。

Effects of Heavy Metal Pollution of Apple Orchard Surface Soils Associated with Past Use of Metal-Based Pesticides on Soil Microbial Biomass and Microbial Communities

Apple orchard surface soils in Japan are polluted with copper (Cu), lead (Pb), and arsenic (As) due to long-term use of metal-based pesticides. We investigated the effects of heavy metals accumulated in the surface soils in apple orchards on the microbial biomass and the microbial communities. Soil samples were taken from a chestnut orchard (unpolluted control) and five apple orchards with different degrees of heavy metal pollution. Total concentrations of Cu, Pb, and As in soil ranged from 29 to 931 mg/kg, 35 to 771 mg/kg, and 11 to 198 mg/kg, respectively. The amount of microbial biomass carbon expressed on a soil organic carbon basis decreased with increasing concentrations of heavy metals. Thus, the heavy metals that accumulated in apple orchard surface soils had adverse effects on the soil microbial biomass. The analysis of phospholipid fatty acid (PLFA) composition indicated that the microbial community structure had changed because of the pesticide-derived heavy metals in soil. The relative abundance of gram-positive bacterial marker PLFAs increased and that of fungal marker PLFA decreased with increasing concentrations of heavy metals in soil. Denaturing gradient gel electrophoreses targeting the 16S ribosomal RNA gene of bacteria and the 18S ribosomal RNA gene of fungi also showed shifts in the composition of bacterial and fungal communities induced by soil pollution with heavy metals. However, the diversity of microbial communities was not significantly affected by the heavy metal pollution. This was attributable to the adaptation of the microbial communities in apple orchard surface soils to heavy metals derived from previously used pesticides.

Boron neutron capture therapy for vulvar melanoma and genital extramammary Paget’s disease with curative responses

Background:Although the most commonly recommended treatment for melanoma and extramammary Paget’s disease(EMPD)of the genital region is wide surgical excision of the lesion,the procedure is highly invasive and can lead to functional and sexual problems.Alternative treatments have been used for local control when wide local exci-sion was not feasible.Here,we describe four patients with genital malignancies who were treated with boron neutron capture therapy(BNCT).Methods:The four patients included one patient with vulvar melanoma(VM)and three with genital EMPD.They underwent BNCT at the Kyoto University Research Reactor between 2005 and 2014 using para-boronophenylalanine as the boron delivery agent.They were irradiated with an epithermal neutron beam between the curative tumor dose and the tolerable skin/mucosal doses.Results:All patients showed similar tumor and normal tissue responses following BNCT and achieved complete responses within 6 months.The most severe normal tissue response was moderate skin erosion during the first 2 months,which diminished gradually thereafter.Dysuria or contact pain persisted for 2 months and resolved com-pletely by 4 months.Conclusions:Treating VM and EMPD with BNCT resulted in complete local tumor control.Based on our clinical expe-rience,we conclude that BNCT is a promising treatment for primary VM and EMPD of the genital region.