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Biomedical subjects

A Cerrotta

Publications and source records attributed to A Cerrotta.

15 recordsLinked to original sources
PubMed2002

Concurrent radiotherapy and weekly paclitaxel for locally advanced or recurrent squamous cell carcinoma of the uterine cervix. A pilot study with intensification of dose.

OBJECTIVE: This study included patients with inoperable primary or recurrent cervical cancer whose treatment plan called for exclusive radiotherapy. The endopoints of the study were to confirm the feasibility of concurrent radiotherapy and paclitaxel in relation to potential acute toxicity and to evaluate if an increase of complete local control might be obtained with the association of paclitaxel to radiotherapy as a radiosensitizer. METHODS: Twenty patients (13 new cases, stage IIB-III, and 7 with pelvic recurrences) were enrolled and, with exclusion of one recurrence, 19 were evaluable for acute toxicity and response. In new cases, radiotherapy was conventionally administered: 50.4 Gy/28 fractions by external beam (whole pelvis) followed by intracavitary cesium or reduced transcutaneous field. In recurrences, radiotherapy was performed with external beam only through individualized fields. Paclitaxel was administered weekly at the dose of 40 mg/m2 or 60 mg/m2 during the entire course of external radiotherapy. RESULTS: Complete regression (CR) as defined by clinical and imaging examinations was achieved in eight of the 13 new cases (62%) and in four of the six recurrences (66%), for a total complete response rate equal to 63%. Five patients (3 treated with 40 mg/m2 and 2 with 60 mg/m2) experienced grade 3 small bowel toxicity, one patient treated with 40 mg/m2 grade 3 bladder toxicity and one patient treated with 60 mg/m2 had grade 4 mucositis. Out of 12 CR patients at the end of treatment, ten maintain complete local remission for a median follow-up of 47 months but two have developed distant metastases. CONCLUSION: The results confirm that this approach is feasible and suggest the use of paclitaxel as radiosensitizer in locally advanced cervical cancer.

Adult↗
PubMed1999

Long-term results of sequential chemotherapy-radiotherapy-chemotherapy in locally advanced squamous cell carcinoma of the uterine cervix.

PURPOSE OF INVESTIGATION: In order to evaluate the impact of sequential chemotherapy-radiotherapy-chemotherapy on local control and survival, a follow-up study was carried out 12 years after the treatment of 22 patients with FIGO stage IIB-III squamous cell cervical cancer. METHODS: Patients were submitted to three cycles of induction chemotherapy (cisplatin and bleomycin) followed by whole pelvis irradiation and central boost with endocavitary brachytherapy. Ten patients underwent three further cycles of chemotherapy after radiotherapy. All patients were maintained by regular follow-up. Only one patient was lost 48 months after treatment. RESULTS: At the end of treatment complete response was obtained in 14 patients (63.5%). Four of these recurred locally, and one at also distance. Eight patients failed to obtain a complete response. Twelve patients died from disease and one patient died from other causes. Nine of 22 (41%) patients are alive without evidence of disease with a median follow-up of 134 months. Acute toxicity was mild, while two severe late complications were observed. CONCLUSIONS: The achievement of complete remission at the end of treatment is important in terms of life expectancy. Further chemotherapy appears useful for patients who do not reach complete local remission after radiotherapy.

Adult↗
PubMed1998

Treatment planning for radiotherapy in northern Italy: a survey by the National AIFB-AIRO Committee on 3D-Treatment Planning. Italian Association for Biomedical Physics. Italian Association for Radiation Oncology.

BACKGROUND AND PURPOSE: A survey was performed in 1996 to investigate the structures and the process of radiation therapy treatment planning in clinical practice within northern Italy, with particular emphasis on the current and future implementation of 3D equipment and techniques. MATERIALS AND METHODS: Of 57 existing radiation therapy (RT) centres covering a population of 25 million people (45% of the total population of Italy) and treating over 58,000 cancer patients (70% of the cancer cases in Italy) each year, 46 centres were deemed eligible for the survey; a questionnaire was sent to a medical physicist working in each eligible RT centre, 40 of whom responded, making the basis for this report. RESULTS: A dedicated CT scanner was available in 25% of the responding centres and a total of 49 radiation therapy planning systems (RTPS) were reported; none of the RTPS were able to perform 3D calculations, but 50% of the centres had an advanced 2D or 2.5D system. Connection between CT scan and RTPS was by tape or disk in 62% of centres. Immobilization devices were used frequently for head and neck patients (88% of centres), but not for lung (16%) or prostate cancer (24%) patients; the number of contoured slices was largely variable, exceeding 10 in only about 30% of the responding centres. The average working time per patient seemed to closely reflect the number of slices used and the number of critical organs contoured. Finally, the majority of the responding physicists did not favour the use of more than 20 CT slices for 3D treatment planning, nor did they forecast a general spread of this technique in the next 2-3 years. CONCLUSIONS: This survey has shown (1) a heterogeneous picture, with 20% of centres ready to implement 3D techniques and 20% of centres lacking the possibility of planning treatments and (2) a general difficulty in coping with the workload represented by 3D treatment planning.

Data Collection↗
PubMed1997

Analysis of risk factors for mandibular bone radionecrosis after exclusive low dose-rate brachytherapy for oral cancer.

BACKGROUND: Brachytherapy is widely adopted as an exclusive treatment of T1/T2 oral cancer with a high probability of definitive cure. Therefore, any major complication, like mandibular bone necrosis, should be avoided. Many risk factors, either clinical or technical, have been considered in the literature. MATERIALS AND METHODS: One hundred consecutive interstitial iridium LDR treatments for early cancers of the tongue and floor of the mouth performed from January 1989 to November 1993 were reviewed. An analysis of some simple technical parameters (total dose, dose-rate, reference volume, linear activity, total reference kerma) was performed in order to identify the main physical risk factors. Moreover, total dose was recalculated as extrapolated responsive dose for normal tissue complications. RESULTS: Bone necrosis was observed in 10 out of 100 patients with a median follow-up of 38 months. No significant incidence of this complication was observed when tumor site (mobile tongue versus floor of the mouth), dental status or total physical dose were considered. A significant correlation between the incidence of bone necrosis and two main parameters was found, i.e. dose-rate (P < 0.02) and reference volume (P < 0.05). CONCLUSIONS: A threshold value may be suggested both for dose-rate (50 cGy/h) and reference volume (25,000 mm3). Bone necrosis is clearly related to both these parameters since most cases (i.e. 80%) were observed in the subgroup over the volume and dose-rate threshold.

Adult↗
PubMed1995

[Ileal obstruction following radiosurgical treatment for rectosigmoid neoplasm].

A series of 191 patients submitted to adjuvant radiotherapy after surgery for rectal and rectosigmoid carcinoma from January, 1975, to December, 1990, has been analyzed to evaluate the incidence of high grade small bowel late toxicity (grades III/IV according to RTOG/EORTC scoring system). Surgical approach was abdominoperineal Miles resection in 92 patients, while a sphincter preserving bowel resection was performed in 99. The total radiation dose to the pelvis ranged from 40 to 60 Gy in 4 to 8 weeks, with conventional fractionation. Three different beams arrangements were used: two sagittal parallel opposite AP-PA fields in 106 patients, three fields (one posterior sagittal plus two parallel lateral fields) in 56, four fields (box technique) in 29. Fourteen patients (7.3%) developed sequelae grades III/IV: three of them died of toxicity. Average free interval between radiation and complication was 23 months (range: 4-87). The following risk factors were investigated: sex, age, type of surgery on primary rectosigmoid cancer, previous abdominal or pelvic surgery, radiation technique, treated volume, administered radiation dose. Dose was calculated as BED (time corrected biologically equivalent dose) according to the linear quadratic model. The only factors significantly related to late intestinal complications were the beam arrangement and, consequently, the treated volume. Detailed analysis showed that radiation sequelae developed in 12/106 (11.3%) patients treated with the two sagittal fields technique, while small bowel toxicity was observed in only 2/85 (2.3%) patients treated with the three--or four--fields technique. The difference is stastically significant (p < 0.05). Another significant correlation was the ratio between treated volume and late complications incidence observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1992

Cationic content in multiple mammary cysts.

One hundred and ninety-six breast cyst fluid samples from 78 consecutive patients with multiple cysts were subdivided according to the K+/Na+ ratio: type 1 (K+/Na+ ratio > 1) and type 2 (K+/Na+ ratio < or = 1). Cysts of the same type were found in 57.7% of patients (concordant group). Such a finding suggests that in patients bearing multiple cysts, all aspirated fluids need to be classified on the basis of their cationic composition. In the concordant group, type 1 cysts were more frequent than in the discordant group (80.3% vs 59.5%, P = 0.002). High K+/Na+ ratios (> 4.0) were present in 64% of type 1 cysts in the concordant group compared to 37.7% in the discordant group (P = 0.001), which suggests a different activity of the epithelium lining the cyst wall.

Adult↗
PubMed1992

Treatment of breast cancer in elderly women: retrospective analysis of 111 wide lumpectomies performed in a day hospital regimen between 1982 and 1988.

Between 1982 and 1988, 111 elderly women with breast cancer but without clinical involvement of the axillary lymph nodes underwent wide lumpectomy in a Day Hospital regimen at the National Cancer Institute of Milan. The patients ranged in age from 70 to 92 years (median, 79). An adjuvant treatment was carried out in all but 9 cases: tamoxifen only in 84 cases, tamoxifen plus radiotherapy in 6 cases, radiotherapy alone in 12 cases. The median duration of follow-up was 44 months (range, 30-109 months). Four patients (3.6%) were lost to follow-up. In the remaining 107 patients, 10 local-regional relapses (9.1%) and 7 distant metastases (6.5%) occurred. Six patients died from the disease, 14 from unrelated conditions. This retrospective study showed that selected elderly patients with breast cancers can be treated successfully under local anesthesia on an outpatient basis. The treatment guarantees local control of the disease, meets the favor of elderly women and consequently improves their quality of life.

Actuarial Analysis↗
PubMed1991

Doppler flowmetry and the diagnosis of breast lumps.

The aim of the study was to ascertain the reliability of a Doppler signal in the diagnosis of breast cancer. Computerized blood flow analysis was performed on 117 patients who presented with a breast lump at the Division of Diagnostic Oncology of the Istituto Nazionale Tumori of Milan. The values of systolic peak and diastolic frequency were evaluated in relation to the histologic diagnosis. Ten patients had a spontaneous regression of the lump and were excluded from the study. The number of evaluable cases with histologic confirmation was 107: 69 carcinomas and 38 benign lesions. Systolic peak values for the 69 carcinomas ranged from 1500 to 7400 Hz, with a mean value of 3243.4 Hz; diastolic frequency ranged from 200 to 3700 Hz, with mean value of 1413.9 Hz. No diagnostic signals were found in 4 breast cancers (false negatives). Twenty-three of 38 benign lesions (60.5%) and 65 of 69 malignant nodes (94.2%) were correctly diagnosed. The Doppler signal with computerized spectral analysis in addition to more specific ultrasonographic parameters could be considered a useful tool in the diagnosis of breast cancer.

Adult↗
PubMed1990

A metastatic breast cancer with an unusual lymphoma-like presentation.

An unusual metastatic breast cancer, characterized at first by a diffuse involvement of the lymph node areas, is described. The relapse of the disease, 3 months after ceasing treatment (CMF schedule for 16 cycles) and with the patient in apparent complete remission, massively involved the bone marrow, sparing the commonest parenchymal sites. The lymphohematogenous diffusion simulated the course of a systemic lymphoma-like disease. The behavior of this case suggests that breast cancer is a polymorphic disease: early diagnosis and treatment can modify the natural course, so no attention is paid to the variety and evolution of the presenting symptoms.

Adult↗
PubMedDate not supplied

Postsurgical policy in stage I testicular seminoma: cost and benefit of prophylactic irradiation in a long-term experience.

The definitive cure rate for clinical stage 1 testicular seminoma is very close to 100%, and prophylactic irradiation of the regional lymph nodes is associated with a low morbidity. Nevertheless, in recent years a "wait-and-see" policy has been proposed by some researchers. We analysed the cost/benefit ratio of radiotherapy (RT) by review of the case histories of 299 patients treated at the Department of Radiotherapy of the Istituto Nazionale per lo Studio e la Cura dei Tumori in Milan from January 1968 to December 1989. The 5-year overall survival was 99% (97.5% at 10 years), while the 10-year disease-free survival was 96%. The recurrence rate was 2.3%, but no patient relapsed in the irradiated areas. Acute toxicity was very moderate with only 4 (1.3%) serious radiation sequelae occurring 6 to 27 years after treatment. However, 9 second malignancies (3%) were observed. Lastly, we have calculated the costs for our National Health Service comparing surveillance policy and prophylactic irradiation.

Adult↗
PubMedDate not supplied

Altered fractionation radiotherapy in lung cancer.

Clinical trials on altered fractionation radiotherapy (RT) regimens currently play a significant role in lung cancer, due to the importance of local control and to the disappointing therapeutic results in this disease. In non-small-cell lung cancer (NSCLC) two strategies are being actively investigated: hyperfractionation with a "curative" aim, and hypofractionation with a palliative aim; in small-cell lung cancer (SCLC) altered fractionation seems to play a minor role at this moment. In this review paper the results of reported randomised trials are summarised and discussed. Conclusions may indicate that through hyperfractionation, particularly if accelerated, clinical outcome of non-metastatic NSCLC patients can be improved; data are however not sufficiently mature to advise its use outside controlled clinical trials. In the palliative setting, hypofractionation should be considered standard treatment.

Carcinoma, Non-Small-Cell Lung↗
PubMedDate not supplied

Interventional radiology and radiotherapy for inoperable cholangiocarcinoma of the extrahepatic bile ducts.

AIMS AND BACKGROUND: To evaluate the effectiveness of external radiation therapy (ERT), alone or combined with endoluminal brachytherapy (BRT), following percutaneous transhepatic biliary drainage (PTBD) in the treatment of patients affected by inoperable cholangiocarcinoma. METHODS & STUDY DESIGN: From September 1980 to June 1996, 130 jaundiced patients affected by inoperable cholangiocarcinoma were submitted to PTBD at the Division of Radiology C of the National Cancer Institute of Milan. Nineteen were excluded from the present analysis due to the short survival after PTBD (< 30 days). The other 111 patients were divided into three groups according to the following therapy: no further treatment after palliative PTBD in 89 patients (80%, group 1); ERT in 10 patients (9%, group 2); ERT plus BRT in 12 patients (11%, group 3). All the ERT + BRT patients were enrolled after 1990 and were treated with high-energy photon beams followed by endobiliary insertion of one or two iridium-192 wires. RESULTS: Median overall survival among the 111 assessable patients was 126 days; for groups 1, 2 and 3 it was 108, 345 and 428 days, respectively. The patients submitted to radiotherapy (ERT alone or ERT + BRT) were evaluated by radiologic examinations after the end of radiation. In group 2, a partial remission in 3 cases, a progression of disease in 1 case, and no change in 6 cases were observed. Among the patients of group 3, complete remission in 5 and partial remission in 7 patients were achieved. In all the patients achieving complete remission, the PTBD could be removed. CONCLUSIONS: The combination of ERT plus BRT improves survival and quality of life of the patients submitted to PTBD for cholangiocarcinoma. Under the technical point of view, radiation treatment is easy to perform, but much caution is required in defining clinical and planning target volumes. Moreover, drainage during the radiation treatment has to be submitted to a very meticulous surveillance.

Adult↗
PubMedDate not supplied

[Transcutaneous radiotherapy combined with low dose intraluminal brachytherapy in the treatment of non-operable neoplastic stenoses of the bile ducts].

Percutaneous biliary drainage is an excellent method to relieve the acute symptoms related to neoplastic stenoses of extrahepatic bile ducts. However, survival rates are low and the quality of life of these patients is poor. High dose irradiation--combined with external beams (ERT) and intraluminal brachytherapy (BRT) through percutaneous drainage--allows effective disease control and, therefore, not only higher survival rates but also a much better quality of life when drainage can be removed after bile duct stenosis resolution. March, 1990, through March, 1993, eleven patients (8 with extrahepatic cholangiocarcinomas and 3 with extrinsic tumors) were treated with combined ERT (40-60 Gy, 6-15 MV X-rays) and intraluminal BRT (6-25 Gy, 192Ir wire, LDR). In 8 patients the biliary stenosis was resolved, completely (CR) in 5 and partially (PR) in 3, as shown by posttreatment cholangiography. In 5 patients biliary drainage could be removed for an average 9 months' period; 3 of 11 patients did not respond to treatment at all (NR). Average overall survival was 14 months: 11 months for NR patients and 16.5 months for CR+PR patients. Treatment complications were acceptable: in two patients only treatment had to be discontinued, both during BRT. Two cases of high grade postirradiation stenosis were observed, both resolved with percutaneous cholangioplasthy.

Aged↗
PubMedDate not supplied

Current controversies in the therapeutic approach to early breast cancer in the elderly.

Over a 7-year period, in 408 patients aged 70 years or more, 413 early breast cancers were treated as follows: quadrantectomy, axillary dissection, and radiotherapy (QUART) in 142 patients, wide lumpectomy plus radiotherapy extended to the axilla in case of palpable nodes (WLRT) in 45 patients and wide lumpectomy alone in 221 patients. Postoperative tamoxifen was given to 251 patients and chemotherapy to 31. Mean follow-up was 54 months. Relapse free survival was similar at 5 years in the three groups (80%); at 10 years it was 80.8% in QUART, 61.3% in WLRT, 51.7% in WL. Locoregional recurrence, as first failure, occurred in 1.4% QUART, 6.5% WLRT and 15.2% WL. In our experience compliance with surgical day-hospital regimen was excellent, while postoperative radiotherapy created some problems, mainly among oldest patients. We support the role of radiotherapy for its positive impact on local control.

Age Factors↗