Combined external radiotherapy and brachytherapy of brain tumors: a review.
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Brachytherapy↗
Biomedical subjects
A Turriziani
Publications and source records attributed to A Turriziani.
Concomitant radiochemotherapy in rectal cancer: methodology and indications.
Concomitant radiochemotherapy (CRC) is based on the administration of chemotherapeutic agents concurrently with radiation therapy. It is aimed at the spatial cooperation of radiotherapy (ERT) and chemotherapy and the enhancement of the local action of radiotherapy. In this study the role of ERT enhancement in the treatment of rectal cancer, is analyzed. 5FU is the commonly used drug. Clinical and experimental evidence indicates radiotherapy to be enhanced when the drug is administered in continuous infusion after radiation and for a suitable dose of 5FU. In these conditions, toxicity is usually mild. In contrast, when the drug is administered as bolus, the experimental evidence seems to indicate only additivity. However the clinical experience has shown an improvement in local control and survival at the expense of a higher toxicity. In patients with resectable lesions at high risk for local recurrence, randomized CRC studies have shown a high rate of local control between 85% and 90%, a 5-year survival between 55% and 60%, significantly better as compared to control arms: exclusive surgery (GITSG7 175), exclusive ERT (NCCTG), bolus CRC (Intergroup). Acute toxicity is mostly hematological and gastrointestinal. In patients with lesions unresectable for cure, CRC allows high surgical radicality (85-90%). Complete pathologic response is 4 to 20%. Local control is high (80-90%) and 3-year survival is 70 to 90%. Grade 3-4 acute gastrointestinal toxicity was shown to be higher in combinations with bolus 5FU. In recurrence CRC has been used for palliation. Control of pain to the pelvis was similar to that achieved with radiotherapy alone. In a single experience was CRC used preoperatively and results seem encouraging.
Combined Modality Therapy↗
Combined radiation and chemotherapy in lung cancer: preliminary results.
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Adult↗
Combined radiation and chemotherapy in locally advanced rectal cancer: preliminary results.
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Adenocarcinoma↗
Carcinoma of the pancreatic head area. Therapy: concomitant radiochemotherapy.
A series of studies carried out by the Gastrointestinal Tumor Study Group have shown the efficacy of the combination of external beam radiotherapy (ERT) and 5-fluorouracil (5-FU) chemotherapy (CHEM) in unresectable and resectable tumors of the exocrine pancreas. In the former in particular, this method was shown to be superior to ERT alone as well as to polychemotherapy alone. In these studies 5-FU was administered during (concomitant chemotherapy: C-CHEM) or after ERT (adjuvant chemotherapy: A-CHEM). This led several authors to consider this combined treatment as reference standard for pancreatic carcinoma. Its prognosis is still definitely poor because of the difficult local eradication as well as because of the frequent early distant spread, especially at the abdominal level (hepatic and peritoneal). An improvement of present results may stem from the combination of ERT+C-CHEM +/- A-CHEM with methods of dose intensification at the local level (e.g. IORT) concurrently with the use of treatments aiming at a better control of the abdominal spread (e.g. ERT+C-CHEM for prophylaxis of the liver or upper abdomen).
Antimetabolites, Antineoplastic↗
Carcinoma of the pancreatic head area: follow-up.
Preliminary results of a planned follow-up schedule based on periodic clinicoinstrumental controls applied to a population of 73 patients with pancreatic cancer undergoing combined modality treatments modulated according to the different prognosis, are reported. The following considerations are stressed: 1) the feasibility of scheduled controls is confirmed by the low rate (1.4%) of patients lost to follow-up in spite of the rapidly fatal course of the disease, characterized by the deteriorating performance status in most patients; 2) radiologic exams should be performed in the same center where the patients were initially staged by a team experienced in the natural history of this disease and aware of the difficulties in assessing the treatment, surgery in particular; 3) supportive care plays a major role in patients followed-up for the frequent onset of symptoms which impact on the quality of life; 4) the interdisciplinary collaboration between surgeons, oncologists, radiotherapists, endoscopists and experts in nutrition and pain relief plays a major role.
Aged↗
Quality assurance procedures in radiotherapy of lung cancer.
Problems of a correct approach to radiation therapy of lung cancer are reported. The identification of factors related to the site and function (respiratory motion, critical organs etc) allows systematization of a Quality Assurance procedure in treatment planning and implementation. Already in the diagnostic phase modern technology (CT, MRI) can supply useful information for a more correct staging and consequently for a more suitable treatment, while in the therapeutic phase it helps in the identification of irradiation volumes (simulation), in the use of treatment plans on CT imaging (multislide, 3D), in the use of conformal therapy able to increase the target dose while sparing the critical organs, and in checking correct patient set-up.
Humans↗
Quality assurance in radiotherapy of neoplasms of the upper abdomen.
Neoplasms of the upper abdomen involve complex problems for radiotherapy. In fact, the anatomical structures are close to each other, lymphatic vessels are numerous and complex, there are organs of low radiation tolerance whose reciprocal position is of difficult assessment and finally there is high visceral mobility due to the diaphragmatic movements. Moreover most organs cannot be identified with the simulator and bone references are of little use. Therefore, treatment of these sites requires the routine application of quality assurance programs, checks of treatment reproducibility, in particular: In a number of clinical settings, CT study of the region (in treatment position) must be included in treatment planning and set-up with simulator and fluoroscopy. Before, during, and after radiotherapy, clinical exams and laboratory tests should be performed to assess the integrity of critical organs.
Abdominal Neoplasms↗
Organ preservation in the management of lung cancer.
Organ preservation as protection of the patient's quality of life in the modern approach to oncology, is a primary objective together with local control and survival. This objective can be attained through the optimization of therapeutic procedures and an interdisciplinary approach directed towards the best result of combined modality therapy. There are districts and organs where preservation is already well-established in terms of results to be achieved (breast, gastrointestinal apparatus, head-neck, prostate, bladder, soft tissue sarcoma, eye tumors). For other sites of disease, as carcinomas of the lung, still at present, systematization of a therapeutic program including organ preservation among its objectives to ensure an acceptable quality of life, is necessary. First trends towards this direction, in diseases not treatable with surgery alone, consider combined radiotherapy with or without surgery for better control without increased toxicity. Monitoring of the quality of life together with the already standardized parameters of local control and survival used in the evaluation of results, is desirable in these patients.
Carcinoma↗
Organ preservation in carcinoma of the anal canal.
Over a 9-year period, 52 patients with anal carcinoma were observed: there were 18 males and 34 females (ratio: 1:1.9); mean age was 62 years. In 37 patients (71%) the neoplasm origin was in the anal canal, in the margin in 14 (27%) and a coaclogenic form was located in the lower rectum in one. 39 patients (75%) showed an epidermoid carcinoma and 13 (25%) an adenocarcinoma. Treatment consisted in two cycles of 5FU (1000 mg/m2/24 h, day 1-4), mitomycin C (10 mg/m2 bolus, day 1) plus radiotherapy (23.4 Gy, split course with 4- week rest). At 6-8 weeks, brachytherapy was performed for epidermoid lesions of the anal canal and margin while adenocarcinomas were referred to surgery. Sphincter preservation at 5 years was 64%. In epidermoid carcinomas sphincter preservation was 69% vs 45% in adenocarcinomas (p = 0.17). In patients treated with a curative intent and presenting with epidermoid carcinoma of the anal canal, sphincter preservation was 77% vs no patient with adenocarcinoma of the anal canal. In 53% of patients with epidermoid carcinoma of the anal margin there was sphincter preservation. Overall 5-year survival was 62%, better for epidermoid carcinoma (69% vs 36%; p = 0.02) but similar as for the site (anal canal:62%; anal margin:60%).
Adenocarcinoma↗
Organ preservation and quality of life: the quality of life of patients undergoing radiation therapy.
In the definition of quality of life (QL) conventional medical indicators (rate of cure, disease-free survival, side-effects, costs) should be combined with those of the patient's personality the impact of the disease, the level of satisfaction, the general health conditions. This assessment being complex, obviously needs an integration of competences for correct decision making in diagnosis and treatment. In oncology, numerous attempts have been made towards the systematization of toxicity in radiotherapy based on physical and functional rather than multidimensional criteria. However the categorization of possible side-effects according to scoring systems already marks an improvement towards the quality assurance of care and thus the patient's quality of life.
Humans↗
Radiotherapy, local control and survival in lung cancer.
Better local control in locally advanced IIIA-B non small cell lung cancer, not considered for surgery, can be achieved through therapy intensification with non conventional fractionation of radiation dose, concomitant boost to the tumor volume, conformal therapy and combined modality therapy. All these procedures tend to produce an improved response, which, if stable in time, may also improve local control and survival. The reported experiences define a positive and encouraging trend on which new guidelines for a more suitable definition of standard therapies for the disease can be modulated.
Carcinoma, Non-Small-Cell Lung↗
Radiotherapy and local control in rectal cancer.
Recurrence is a stage in the natural history of rectal cancer. Preoperative radiotherapy or postoperative radiochemotherapy lower the rate of recurrence, improving local control. From 1980 to 1997, at the "Divisione di Radioterapia" of the "Università Cattolica del S. Cuore" of Rome 380 patients with rectal cancer of early clinical stage T2-3, candidates for surgery for cure, underwent radiation therapy. 119 patients underwent postoperative radiotherapy (45-50 Gy); 45 patients underwent "sandwich" radiotherapy (45 Gy:27 Gy before and 28 Gy after surgery), of whom 7 were treated with preoperative radiotherapy alone; 145 patients underwent preoperative concomitant radiochemotherapy according to 3 different protocols, radiotherapy (38 Gy) combined with mitomycin C and 5-FU; radiotherapy (50.4 Gy) combined with cisplatin and 5-FU; radiotherapy (45 Gy) combined with 5-FU and folinic acid. 71 patients were treated with preoperative radiotherapy (38 Gy) combined with IORT (10 Gy). Median follow-up was 6 years. Overall local control was 85% at 3 years, 83% at 5 years, 81% at 10 years. The rate of local control at 5 years was: 76% for postoperative radiotherapy, 83% for "sandwich" radiotherapy, 84% for preoperative radiochemotherapy and 93% for preoperative radiotherapy combined with IORT. Local control was shown to be significantly better with preoperative treatment as compared to postoperative treatment (p = 0.02). The incidence of metastases was 35% in the patients with local recurrence and 16% in those with local control. The difference in survival was highly significant in patients with local control as compared to those with local recurrence: at 5 years 87% and 32% respectively. Patients with local control showed a lower incidence of metastasis and a better survival.
Antineoplastic Combined Chemotherapy Protocols↗