Biomedical subjects

G Bacci

Publications and source records attributed to G Bacci.

At least 217 records · Page 12Linked to original sources

PubMedDate not supplied

The prognostic value of serum alkaline phosphatase in osteosarcoma of the limbs.

The values for serum alkaline phosphatase were evaluated in 340 patients affected with osteosarcoma of the limbs. The percentage of patients with high values for the enzyme at the onset of disease was significantly higher in the 69 cases who presented with metastases at the time of diagnosis, as compared to the 271 cases in which the neoplasm still appeared to be localized (81% vs 62%: p less than 0.001). In this last group of patients, treated with neoadjuvant chemotherapy, an evident relationship between values for alkaline phosphatase and prognosis was demonstrated. The percentage of patients who developed metastases was in fact 22% in the group with normal serum values for the enzyme at the onset of the disease and 40% for the patients with high values of the same (P less than 0.001). These data confirm the prognostic value for serum alkaline phosphatase in osteosarcoma, which should be taken into consideration when planning chemotherapy and in classifying patients for randomized therapeutic studies.

Adolescent↗

PubMedDate not supplied

The evolution of integrated treatment of soft tissue sarcoma at the Rizzoli Orthopaedic Institute.

The authors take into consideration all types of treatment used at the Rizzoli Orthopaedic Institute and in associated centers over the last 40 years for soft tissue sarcoma of the limbs. For each clinical study the most up-to-date results are reported with statistical evaluations. From the first protocol that used adriamycin alone and up to the beginning of the eighties, we then go on to a second-generation study in the nineties that used adriamycin and ifosphamide at a high dosage. The pilot study that was used at the end of the nineties to evaluate the validity of the use of chemotherapy and radiotherapy is considered, as is the study currently being conducted by the Italian Sarcoma Group. Conclusions based on our vast previous experience lead us to believe that adjuvant chemotherapy must be used for all patients with high-risk soft tissue sarcoma within clinical trials.

Chemotherapy, Adjuvant↗

PubMedDate not supplied

Neoadjuvant chemotherapy for the treatment of osteosarcoma of the extremities: a comparison of results obtained in single-institution and multicenter trials.

Osteosarcoma is a rare tumor. In multicentric trials on the neoadjuvant treatment of this neoplasm many of the single institutions involved have the opportunity to treat a small number of cases (the average for all of the studies was less than 1 case per year). In order to verify whether this can change the percentage of amputations avoided and prognosis, a review of the current literature was carried out, concerning neoadjuvant treatment of osteosarcoma of the extremities. The results obtained in 9 multicentric trials and in 12 mono-institutional trials were evaluated. It was observed that in mono-institutional studies the percentage of patients treated by conservative surgery instead of aggressive surgery (73% vs 55%) and the disease-free survival 5 years after surgery (73% vs 55%; p < 0.0001) are significantly higher as compared to what was observed for patients treated in multicentric trials. Based on these differences, the authors conclude that it would be opportune to direct patients with osteosarcoma of the extremities to the best centers that each year treat large numbers of patients with musculoskeletal tumors.

Antineoplastic Combined Chemotherapy Protocols↗

PubMedDate not supplied

Multicentric osteosarcoma. Report of 5 cases.

Multiple foci of osteosarcoma are found in several pathological conditions: skip metastases, late bone metastases from osteosarcoma, so called metachronous osteosarcoma and multicentric osteosarcoma. The authors describe five cases with multicentric osteosarcoma of the skeleton. These lesions differ from classic osteosarcoma for their clinical and radiographical features. They generally arise in younger patients and are always sclerotic on X-rays and histological evaluation. Our data, as reported in literature, underline the poor prognosis of this disease.

Adolescent↗

PubMedDate not supplied

Neoadjuvant chemotherapy for the treatment of osteosarcoma of the limbs. Preliminary results in 100 patients treated preoperatively with high doses of methotrexate i.v. followed by cisplatin (i.a.) and adriamycin.

One-hundred patients affected with non-metastatic osteosarcoma of the limbs were treated according to a new adjuvant chemotherapy protocol. Preoperative treatment consisted in high doses of methotrexate (i.v.), followed after one week by cisplatin continuous intra-arterial infusion for 72 hours and adriamycin in intravenous infusion for 8 hours. There was good clinical and radiographic response in all of the cases, and conservative treatment was used in 86 cases (86%). A postsurgery histological examination of the segment showed "good" necrosis (greater than 90%) in 75 patients (75%). The incidence of "good" necroses obtained with this protocol was significantly higher as compared to that observed previously at our Center when a preoperative chemotherapy scheme was used, which involved methotrexate and cisplatin alone. Up until now, patients with a good histological response to preoperative chemotherapy have always had an excellent prognosis. Thus, it is our belief that the 23% increase in good histological responses observed must correspond to an increase in the percentage of healing. The preliminary results (83% of patients with no signs of disease) seem to encourage our hypothesis.

Adolescent↗

PubMedDate not supplied

The role of surgery in the treatment of localized Ewing's sarcoma.

This study includes 193 patients affected with localized Ewing's sarcoma and treated at the Rizzoli Orthopaedic Institute between April 1972 and May 1988. It is the purpose of this study to evaluate the efficacy of surgical treatment with regard to the prognosis of patients affected with E.S. and to define its indications as well as its limits as compared with radiotherapy. Ninety patients were treated surgically: 13 underwent amputation (localization of the disease in the leg and foot), 4 underwent debulking, 48 had resection of the tumor without any reconstruction (expendable bones), while for 25 other patients resection of the tumor required alloplastic or allograft replacement. In cases of E.S. localized in the pelvis and spine, surgery did not obtain improvement in prognosis. In the other sites, the percentage of disease-free patients increased from 57% to 72% in cases where surgery +/- radiotherapy was used instead of radiotherapy alone, while the percentage of local recurrences decreased from 18% to 5.5%, respectively. As for functional results, the highest incidence of excellent to good scores was obtained with surgery associated with radiotherapy (69%). The incidence of complications was only slightly different for the two groups.

Amputation, Surgical↗

PubMedDate not supplied

Total body bone scan in the evaluation of tumor response to preoperative chemotherapy in the treatment of osteosarcoma.

With the introduction of preoperative (neoadjuvant) chemotherapy in the treatment of osteosarcoma, an early preoperative evaluation of the effectiveness of chemotherapy is essential, so that treatment may be modified in cases which are not responsive, and so that the surgical margin may be planned. The authors evaluate the accuracy of total body bone scan with Tc99m MDP in determining response to chemotherapy in 43 patients affected with osteosarcoma of the limbs, and preoperatively submitted to two cycles of chemotherapy with MTX i.v. and CDP i.a. All of the cases were submitted to a double bone scan examination, before and after preoperative chemotherapy. A bone scan evaluation using a qualitative method was compared to the percentage of necrosis observed in the tumorous tissue by histological examination carried out after surgery. In 58% of the cases the two values corresponded perfectly, in 28% of the cases bone scan evaluation overestimated response, and in 14% it underestimated it. In order to obtain quantitative preoperative data on response to chemotherapy in osteosarcoma, orientation towards the use of more sophisticated bone scan methods seems to be necessary, with computerized analysis of captation by dynamic measurement after infusion of Tc99m MDP or by radiocompounds with intracellular fixation such as Ga 67.

Adolescent↗

PubMedDate not supplied