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F Volterrani

Publications and source records attributed to F Volterrani.

At least 37 records · Page 2Linked to original sources
PubMed1982

Radiotherapy as initial treatment for carcinomas of tonsillar region.

For this study we have reviewed 186 carcinomas of the tonsillar region, i.e., the lateral wall of the oropharynx, treated from January 1959 to December 1973 at this Institute. In 148 patients (79.6%) the primary tumor and the lymphatic areas were treated with 60Co-teletherapy (TCT). In 15 cases (8.1%) the primary lesion was removed by transoral surgery, followed by irradiation of the tonsillar region and lymphatic areas with TCT. In 23 patients (12.3%) the primary tumor was treated with interstitial curietherapy, after which a radical homolateral neck dissection was performed on 10 of them; the neck was not treated in the remaining 13 cases, initially N0. As far as the case initially treated with TCT alone are concerned, disease-free survival at 5 years was 42.5% for T1 cases and under 30% for T2, T3, whereas it was only 6.5% for T4. The most frequent failure cause of TCT was local relapse, isolated or associated with a nodal relapse. Local failures were nearly always central. On the contrary, if the field extension was adequate, there were very few nodal failures, at least in initially N0 or N1 cases. Our study recommends a revision of the current attitude towards the treatment of carcinomas of the tonsillar region.

Aged↗
PubMed1982

Curietherapy of oral cancer.

This work concerns 406 oral carcinomas treated with curietherapy (interstitial applications and surface molds) from January 1959 to December 1970. There were 65 (16.0%) carcinomas of the mucosal surface of checks, 15 of the retromolar areas, alveolus and gingiva, and hard palate (3.7%), 211 of the mobile tongue (51.9%), and 115 of the floor of mouth (28.4%). There were 132 (32.5%) T1 cases, 245 (60.3%) T2 and 29 (7.2%) T3. In 376 cases with adequate follow-up (92.6%) there were 93 (24.7%) local relapses: 83 isolated and 10 associated with a lymph nodal relapse; 49.5% of the local relapses were peripheral with respect to the treated volume (46/93). The incidence of local relapses only slightly differed for initially T1 and T2 cases (respectively 21.8% and 22.7%), whereas it was more than twice as much for initially T3 cases (53.6%). The overall incidence of radionecrotic complications was 22.0% (83/376 cases with adequate follow-up). Altogether the disease-free survival was 41.1% and 31.4% at 5 and 10 years, respectively. We think that local control of practically all treatable oral carcinomas can be obtained with a combined treatment.

Adult↗
PubMed1982

Follow-up of pathological stage I and IIA supradiaphragmatic Hodgkin's disease primarily treated with radiotherapy.

One hundred and fifty-five consecutive previously untreated adult patients with supradiaphragmatic pathologic stage IA (71) and IIA (84) Hodgkin's disease treated only with radiotherapy (RT) at the Istituto Nazionale Tumori of Milano from 1970 to 1978 were reviewed. Staging procedures included lymphangiography and laparotomy in all cases. Most patients were irradiated with a conventional cobalt machine. Mantle fields were adopted for 36.8% of cases, mainly at stage I, whereas 63.2% received mantle plus paraaortal irradiation. Doses were above 40 Gy for involved sites and 35-40 Gy for prophylactically irradiated nodes. Minimum and median follow-up were 30 months and 6 years, respectively. All patients achieved complete remission at the end of RT. As of June 1981, 89 of 155 patients (57.5%) were alive and free from progression, 60.6% at stage I, and 54.8% at stage II. Relapses occurred in 54 of 155 cases (35%) after a median free interval of 21 months. Marginal recurrences accounted for 5.8%, true recurrences for 9%, nodal extensions for 8.4%, and extranodal extensions for 11.6%. Males older than 40 years and mediastinal involvement were correlated with higher relapse rates. Salvage treatment consisted of RT alone in 8 patients and chemotherapy plus or minus RT in 44, whereas 2 patients died before a new treatment could start. As of June 1981, 38 of 54 relapsed patients (70.4%) were alive and disease free, whereas 2 were alive with evidence of disease. Actuarial overall survival at 6 years was 90.3% for all cases, 97.1% for stage I, and 84.8% for stage II. Treatment toxicity was analyzed, and problems concerning surgical staging procedures, optimal RT and role of chemotherapy as primary or salvage treatment were discussed.

Actuarial Analysis↗
PubMed1982

[Modern technics of intracavitary curietherapy of cervical carcinoma].

The authors set out the technical innovations which are being used to comply with the three classical aims of endocavitary curietherapy for cervical cancer: the personalization of the irradiation device, protection of staff against exposure risks due to ionizing radiations, planning and control of the irradiation conditions. The personalization of the irradiation device is achieved by preparing a specially shaped vaginal applicator for each patient, and staff protection is ensured by the use of remote-loading techniques and closed circuit television control for in-patients. The planning of the treatments answers to the logic of reproducing the usual curie therapy method with conventional radium-226 sources. In order to control the irradiation conditions, at least the essential part of the treatments must be recognized and expressed: equivalent radium milligrams per hour (MRA h), dose rate (Gy h-1), dimensions of the treated volume and space distribution of the dose.

Brachytherapy↗
PubMed1981

[Evolution of the N0 patients with primary carcinoma of the oral tongue treated by interstitial radiumtherapy (author's transl)].

In a retrospective and not randomized clinical study we have selected 175 cases of squamous carcinoma of the anterior 2/3 of the tongue treated by interstitial radium therapy on the primary from January 1959 to December 1970. At the end of the treatment 64 patients (36.6%) were operated by radical neck dissection in homolateral lymphatic areas and 111 underwent no operation on the neck. The incidence of false negative is 25% (16/64 cases operated) and 3 patients showed lymph nodal and perilymph nodal metastasis (4.7% of the whole number of operated cases). In the following evolution the homolateral lymph nodal relapse are 2 among the 64 operated patients (3.1%) (both were N+) and 36 among the 101 non operated ones of whom a sufficient follow-up is available (greater than or equal to 3 years) (35.6%); in this last group 9 patients initially were T1, 24 were T2, 3 were T3. The data about the clinical evolution and the analysis of survival curves, in the two groups that underwent or not the neck dissection, permit to draw useful parameters for therapeutic planning.

Brachytherapy↗
PubMed1980

Adjuvant postoperative radiotherapy in locally advanced rectal and rectosigmoidal cancer.

A pelvic recurrence is the cause of death in about 1/3 of radically operated patients for rectal and rectosigmoidal cancer without clinical evidence of distant metastases. Preoperative and postoperative radiotherapy are largely used to reduce the incidence of locoregional relapses and to improve disease-free and overall survival and quality of life. Benefits from radiotherapy have been widely demonstrated, and adjuvant postoperative radiotherapy is at present strongly recommended. Twenty-one patients with locally advanced (stage B2, B3, C) rectal (11 cases) and rectosigmoidal cancer (10 cases) were treated with postoperative radiotherapy at the National Cancer Institute of Milan from 1975 to 1978. The pelvis received a median dose of 4500 rad (range, 4000-5200 rad) in 5 to 7 weeks through AP, PA opposed fields; 6 patients received a boost of 1000 rad on the perineum. Median follow-up after surgery is 83 months (range, 24-63 months). Only 1 case (< 5%) had a pelvic recurrence, at the perineum. The expected recurrence rate after surgery alone is 40% and our favorable results after postoperative radiotherapy are comparable with recent data from other institutions. Radiotherapy side effects were moderate and transient; no late damages to small bowel were observed.

Adenocarcinoma↗
PubMed1980

Radiotherapy alone and radiotherapy followed by radical mastectomy in T2 breast cancer.

Ninety-four patients with T2 NO, N1a, N1b, MO were treated with primary radiotherapy (RT) because of old age or poor general conditions. In 32 patients (34%), younger in age and in better general conditions, Halsted radical mastectomy could be performed 5-8 months from starting RT; surgery was not done at random, but decided case by case on the basis of a good response to RT and an improvement of general status. Relapse was documented in 42 patients. Relapse rate was 50% in the group treated with RT alone (high incidence of breast recurrences) and 33% in the group operated on after RT. Distant metastases had the same incidence in the 2 groups, with a median free interval of 14 months. Overall disease-free survival rates at 5 to 10 years were 46% and 35%, respectively; these results are not particularly different from the data of historical series of T2 breast cancer treated with surgery alone. The patients operated on after RT had a significantly better survival, but the results were clearly influenced by the selection of patients. For the future, a safe policy could be a conservative combined treatment consisting of tumorectomy followed by curative RT; adjuvant medical therapy could be scheduled for high-risk patients (N1b).

Adult↗
PubMed1980

[Clinical value of lymphography in cervical cancer (author's transl)].

From January 1961 to June 1978, 417 patients with cervical cancer were submitted to lymphangiography as part of the initial diagnostic work-up. As regards the distribution by clinical stage of the cases under consideration, there were 187 cases in Stage Ib (44.8%) 99 in Stage II (23.7%) and 131 in Stage III plus IV (31.5%). For the early stages preference was given to a radical surgery plus pre- or postoperative radiotherapy combination (154/417 patients, or 36.9%). On the contrary, the cases which were more developed locally or which presented contra-indications to surgery received radiological treatment alone (263/417 cases, or 63.1%). The overall incidence of positive examinations was 29.9% (10.7% in Stage Ib; 28.3% in Stage II; 58.7% in Stage III and 60.0% in Stage IV). The histologic type on its own did not seem to influence the incidence of lymph node metastases detectable by lymphography. In the 145 patients who had surgical exploration, the overall diagnostic accuracy of lymphography was 82.8% with 3 false positive and 22 false negative reports. The para-aortic chains were involved in 28/417 patients (6.7%). For the negative cases, with all the stages mixed together, a 74.7% 5-year survival rate free of disease was recorded, as compared with the 34.5% found for the positive cases (P less than 0.0001). Similar differences was recorded stage by stage.

Female↗
PubMed1980

[Prognostic factors and clinical classification criteria of oral carcinomas (author's transl)].

The clinical classification of oral carcinomas presents some points still under discussion. In other respects the main questions about the treatment of these cancers could be resolved by cooperative clinical trials which impose the definition of a common clinical language. With a system based on an original computer program for the compiling, store and process essential data on cancer diseases we analyzed 736 consecutive and unselected oral carcinomas and we studied the prognostic value of main clinical factors. In our series, the main prognostic factors are tumor size, clinical appearance of the primary and clinical status of neck nodes. Sex, age and histological grade are unimportant. From our study we propose to complete the TN classification with two useful clinical criteria distinguishing the exophytic or minimally infiltrating tumors from the deeply infiltrating (greater than 1 cm) and the large metastatic omolateral nodes from the small ones (phi less than 3 cm).

Adult↗
PubMed1979

Feasibility of different combinations of chemotherapy (6 MOPP) plus radiotherapy in Hodgkin's disease.

During a preliminary clinical experience (1973-1977) we experimented three different sequences in associating 6 MOPP cycles (CT) with radiotherapy (RT) for the treatment of stage II and III Hodgkin's disease. A total of 55 consecutive previously untreated patients can be estimated to contribute in defining feasibility, immediate results and toxicity of the combined treatment. In this group of patients RT preceded CT in 20 cases (RT-6 MOPP), the opposite sequence (6 MOPP-RT) was preferred in 16 cases, whilst a split-course CT fitting in the RT (3 MOPP-RT-3 MOPP) was employed in 19 cases. Except for the sequence used with respect to irradiation, the CT was carried out in all the cases according to the classical scheme proposed by De Vita et al. (11). RT was effected with 60Co-teletherapy and a wide field or segmental sequential fields, having variable extension depending on the stage ("extended nodal irradiation" for stage II and III cases with lymph node involvement not below L3; "total nodal irradiation" for the remaining cases in stage III). The programmed doses were 45.0 Gy to the involved areas and 40.0 Gy to the clinically uninvolved regions for the RT-6 MOPP and 6 MOPP-RT groups. Doses of 35.0/30.0 Gy were planned for the 3 MOPP-RT-3 MOPP group. The three different groups are not homogeneous with regard to certain important clinical and pathological characteristics; in fact, a higher quota of stage III patients, with systemic symptoms and spleen positivity is present in the 6 MOPP-RT and 3 MOPP-RT-3 MOPP groups. The combined treatment has achieved a complete clinical remission in 18/20 patients in the RT-6 MOPP group (90.0%), in 12/16 patients of the 6 MOPP-RT group (75.0%), and in 17/19 cases in the 3 MOPP-RT-3 MOPP "sandwich" combination (89.5%). The average overall duration of the treatment was 48 weeks for the sandwich combination, 50 weeks for the RT-6 MOPP group, and 56 weeks for the 6 MOPP-RT association. As regards the sandwich combination, both CT and RT took a reasonable length of time to complete. On the contrary, both the medical treatment and irradiation required an excessively long time and were not well tolerated when preceded by either RT or CT in full doses. In particular, myelosuppression was less acute and prolonged in the 3 MOPP-RT-3 MOPP group, whereas the actual doses of CT and RT were higher than those which can be reached with respect to other groups. Three preliminary cycles of CT considerably reduce the target volumes and complications arising from RT. The first CT time gave an objective response greater than 50% in 9/9 cases of the 3 MOPP-RT-3-MOPP group with mediastinal involvement. In this group, rather considerable pulmonary complications were observed in 3/9 patients (33.3%) with respect to the 40% found for the 6 MOPP-RT group (2/5 cases) and the 67.7% for the RT-6 MOPP group (6/9 cases).

Adolescent↗
PubMed1979

Present status of treatment for invasive cervical carcinoma.

The results are presented of a retrospective clinical study carried out on 341 patients affected with cancer of the uterine cervix, with lymphography in the pretreatment diagnostic work-up, treated in our Institute from January 1961 to December 1976. The clinical classification of the patients studied was: 157 cases in Stage I (46.0%), 95 cases in Stage II (27.9%), and 89 cases in Stages III and IV (26.1%). During the period considered, the therapeutic approach for carcinoma of the cervix was practically constant and in line with the therapeutic policy most frequently followed for these neoplasms. For the early stages (9/341 patients or 27.6%) preference was given to a radical surgery and postoperative radiotherapy combination; for borderline cases and "bulky" and "barrel-shaped" lesions, radiotherapy usually preceded surgical treatment to enlarge its indications and improve its results (36/341 patients or 10.5%). The cases that were more developed locally or that presented contraindications to surgery received radiological treatment alone (211/341 patients or 61.9%). Radiotherapy treatment consisted of radium therapy performed with a single application of 226Ra conventional sources, followed by percutaneous irradiation with 60Co-teletherapy in the more developed cases and/or in the presence of lymph node metastases. All the patients were submitted to diagnostic lymphography at the onset of the treatment and 92 (26.9%) had lymph node metastases. In the framework of this clinical review, the 5-year disease-free survival from onset of the treatment varied from 88.2% for the cases at Stage Ib occult, 72.5% for the cases at Stage Ib, 63.8% for the Stage II cases, to 40.5% for the cases at Stage III and IV. The presence of a pathologic report at lymphography makes a considerable difference in terms of disease-free, long-term survival after treatment

Adenocarcinoma↗
PubMed1979

The value of radiotherapy in the treatment of vaginal carcinoma.

Herein we report the retrospective survey of 48 consecutive unselected cases of vaginal carcinoma, mainly treated with radiotherapy in our Institute from 1959 to 1970. In this series irradiation was delivered almost always with a single and continuous application of sources of radium 226. Radiumtherapy treatment varied according to the extension in surface of the neoplasm, the clinical stage and especially the vaginal step involvement, considering the length of the organ. Despite the very good immediate response, failures of treatment locally or in paravaginal and pelvic areas were frequently observed, and success of the treatment after a brief follow-up was poor. The actuarial survival was 41.6% and 33.3% at 3 and 5 years, respectively. Stage I cases showed at the follow-up better therapeutic results (48.6% survival at 5 years) than stage II and III cases (28.3%). The poorest results were observed in neoplasms extended to the whole vagina, and all these patients died within 4 years of the beginning of treatment. This report stresses that radiotherapy of vaginal carcinomas demands individualization and a properly planned therapeutic program that combines external irradiation with renewed techniques of low dose rate and continuous irradiation with radioactive sources.

Adult↗
PubMed1979

A computerized cancer patient information system.

The purpose of this study was to realize a computer system for cancer data automatic processing. A clinical research in oncological practice is usually time consuming and often not reliable or deceiving because of a number of various errors. Until now, only a few information systems have been specifically designed for cancer data processing, and these have a limited capacity of autonomous data elaboration. Our system, based on an original computer program, can compile, store and process essential data on cancer diseases, with a high degree of reliability and high speed of elaboration. Input and output of this system are simplified and user oriented, without limitations for the subject at study on clinical research, and no particular training of the physicians involved is necessary.

Computers↗
PubMed1979

Ewing's sarcoma: an approach to radiological diagnosis.

All the pertinent radiographs of 83 patients with histologically proven Ewing's sarcoma were reviewed. Forty-nine patients were in the pediatric age group, and 34 were adults. The mean age, the symptoms and time from symptoms to diagnosis were evaluated in the 2 groups. The site of primary involvement was in 54% the long bones, 35% the flat bones, 8% the small bones and 3% extraosseous. For the primary site we considered the diagnostic results of the standard radiographic investigations and in some cases the usefulness of angiography, xeroradiography and telethermography. At presentation we also evaluated the possible diffusion of the disease with standard radiographic surveys (chest and skeletal, including limbs) and with foot lymphography in selected cases. In this way, 57 patients (69%) were considered to have localized disease. In this group, we also considered the value of the periodic radiographic follow-up, which enabled us to disclose the appearance of metastases (chest 64%, bone 54%, lymph nodes 11%) in 28 cases (49%). Finally, we made a comparison of the different radiologic and epidemiologic findings between children and adults.

Adolescent↗
PubMed1979

Basal-cell tumors of the lumbar skin after radiotherapy for arthrosis.

Twenty-three cases of basal-cell tumor of the skin arising in the lumbar-sacral region after repeated irradiations in anti-inflammatory doses for arthrosis are discussed. The involved cutaneous region had been submitted to a number of roentgenotherapy cycles, varying from a minimum of 2 to a maximum of 10. The total dose absorbed at skin level varied between 14.4 and 72.0 Gy, administered over 2 to 6 years. Thirteen to 30 years (median, 19) had elapsed since the end of the irradiations. This observation compels a critical re-evaluation to be made concerning certain radiotherapy indications. The treatment of these lesions involves some problems: radiotherapy is made difficult by the coexistence of often serious dystrophic lesions on the surrounding skin, and surgery is often unsuccessful. The topic application of 5-fluorouracil ointment seems to achieve good results.

Administration, Topical↗