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Biomedical subjects

G Mantini

Publications and source records attributed to G Mantini.

At least 37 records · Page 2Linked to original sources
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Advances in the treatment of lung cancer: economic and organizational aspects.

The organizational optimization in radiotherapy tends to a correct balance of quality of service and containment of health care expenditure; this goal is necessarily correlated with the real potentialities available to each center while considering the possible clinical benefits for the patient. In lung cancer, outcomes achieved with radiation therapy are encouraging in terms of local control and survival when treatment is performed with the available modern technology whose costs from an exclusively economic analysis are shown to be still quite high. In an assessment focused on clinical outcomes, better local control, higher survival and improved quality of life represent tangible benefits: this has a positive impact on community costs and may represent a high priority goal for health care providers, yielding a benefit that can be quantified with the most recent analyses of health care economy.

Costs and Cost Analysis↗
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Research trends in the treatment of colorectal cancer.

Colorectal carcinoma ranks second in incidence after lung cancer in males and breast carcinoma in females. Within the clinical research on this tumor, new molecules of antineoplastic agents and new combined modality treatments have been introduced. From the examination of ongoing protocols some trends can be identified: the interest in immunotherapy and genetic therapy, frequently tested in combination with chemotherapy; the effort at the optimization of the administration of antineoplastic agents in the most common sites of metastatic lesions by hepatic or intraperitoneal infusion; the trend to a more aggressive treatment of metastastatic lesions with hyperthermia and cryoablation as well with the combination of systemic therapy and surgery. As far as radiotherapy is concerned, the main goals of clinical research seem represented by the need to optimize combined modality therapy in T3-4 rectal carcinoma both in terms of pre- and postoperative radiotherapy timing as well as of the combination with adjuvant chemotherapy. There is a growing interest in new drugs which in the future may replace the conventional 5-fluorouracil in concurrent chemoradiation.

Colorectal Neoplasms↗
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Quality handbook in radiotherapy: personal experience.

The Quality Handbook includes the description of the activities carried out in Radiotherapy and the methodology used to ensure the Quality Assurance according to the principles indicated in national and international documents of reference and the recommendations of accreditation agencies. The structure of the Quality Handbook, the main aspects of single chapters, the selected quality indicators undergoing inspections are analysed and procedures to be followed for changes and updating of the Quality Handbook are described. The Quality Assurance program is illustrated in another article of this issue.

Humans↗
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Quality assurance in radiotherapy: personal experience.

The approach to the implementation of a Quality Assurance Program applied from 1 October 2000 at the Radiotherapy Service of the "Università Cattolica del S. Cuore, Policlinico "A. Gemelli" of Rome, is described. Some major aspects of this program are analyzed.

Humans↗
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Quality handbook in radiotherapy. Brachytherapy: personal experience.

Brachytherapy is a conventional method of radiation therapy characterized by peculiar technical, clinical, operational and radioprotection problems. Therefore, the management of a service or department of brachytherapy requires a specific organization aimed at Quality Assurance. In this report, the personal experience with the drawing up of a Quality Handbook of brachytherapy with reference to the method used and the structure of the document, is described.

Brachytherapy↗
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Combined modality therapy of resectable high risk rectal cancer.

Aim of this phase I-II study was to evaluate the efficacy of preoperative concomitant radiochemotherapy in resectable high risk (TNM stage: II and III) rectal tumors, 64 patients entered the study: 37 had low rectal cancer, 27 mid-rectal cancer. 50 patients were clinically staged as stage III (Dukes C) and 14 as stage II (Dukes B). Treatment protocol included bolus mitomycin C at the dose of 10 mg/m2 on day 1 and 5FU continuous infusion at the daily dose of 1000 mg/m2 on day 1, 2, 3, 4. Concomitant external radiotherapy up to a dose of 3780 cGy was delivered at the daily dose of 180 cGy. Surgery was performed 4 to 5 weeks after radiation therapy (RT). Before surgery all patients were clinically restaged to evaluate the response to concomitant radiochemotherapy. Treatment compliance was 97%. Toxicity was 27% prevalently shown as bone marrow depletion and radiodermatitis. In 37 patients (61%) there was 50% reduction (partial response) of neoplastic volume. In 5 patients (8%) no neoplastic cells were evidenced in the surgical specimen on histology (complete response). The distance between the lower margin of the tumor and the internal anal orifice increased in 72% of cases. Postoperative morbidity was 28%. The incidence of anastomotic dehiscences was 8.7% over 46 anterior resections. Postoperative mortality was nil. Definitive staging evidenced 24 patients (39%) stage I or with no evidence of tumor. The incidence of local recurrence was 5% and that of distant metastasis 8%.

Antibiotics, Antineoplastic↗
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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↗
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[ECG monitoring in full-term infants. Analysis of the rhythm and variability of heart rate].

BACKGROUND: Heart Rate (HR) and Heart Rate Variability (HRV) depend on the neural control to the heart. HRV can be measured from 24-hours function. Little information is available on cardiac rhythm and on autonomic nervous control to the heart at birth. The aims of the study weew: 1) to study the cardiac rhythm in healthy newborn babies; 2) to asses the normal values for HRV at birth. METHODS: We studied 20 full term healthy newborn babies. Newborns underwent 24-hours ECG-Holter monitoring. Analysis was performed by a 750 A Del Mar Avionics Analyzer. We determined: Heart Rate (HR), number of extrasystoles, Standard Deviation of all R-R intervals over 24 hours (SDNN) and mean hourly HRV (HRVM). Results about HRV were matched with those of 50 healthy adults. RESULTS: 1) Average HR in the newborn babies was 108 (range: 55-198); we found high prevalence of supraventricular extrasystoles. 2) We determined reference value for HRV. SDNN was 55 +/- 17 ms in newborns. SDNN of adults was 132 +/- 25 ms (44% higher than in newborns; p < 0.001). HRVM was 46 +/- 14 ms in newborns and 76 +/- 14 ms (p < 0.001). CONCLUSION: 1) Larger intervals of HR in newborn babies compared to literature data and an high prevalence of supraventricular arrhythmias in full term healthy newborn babies. 2) Reference values for HRV in newborn babies. The low values of HRV confirm the immaturity of autonomic cardiac control.

Adult↗
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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↗
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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↗
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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↗