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Biomedical subjects

L Marmiroli

Publications and source records attributed to L Marmiroli.

At least 19 recordsLinked to original sources
PubMed2003

Dosimetric, mechanical, and geometric verification of conformal dynamic arc treatment.

A conformal dynamic arc (CD-arc) technique has been implemented at the S. Giovanni Calibita-Fatebenefratelli Hospital Radiotherapy Center. This technique is performed by rotational beams and a dynamic multileaf collimator (DMLC): during the treatment delivery the gantry rotates and the field shape, formed by the DMLC changes continuously. The aim of this study was to perform dosimetric, mechanical, and geometric verification to ensure that the dose calculated by a commercial treatment planning system and administered to the patient was correct, before and during the clinical use of this technique. Absolute dose values, at the isocenter and at other points placed in dose heterogeneity zone, have been verified with an ionization chamber in a solid homogeneous phantom. In uniform dose regions measured dose values resulted in agreements with the calculated doses within 2%. Isodose distributions have also been determined by radiographic films and compared with those predicted by the planning system. Distance to agreement between calculated and measured isodoses in dose gradient zone was within 2 mm. In conclusion, our results demonstrated the feasibility and the accuracy of the CD-arc technique for achieving highly conformal dose distributions. Up till now 20 patients have been treated with CD-arc therapy.

Humans↗
PubMed1999

Preoperative chemoradiation with cisplatin and 5-fluorouracil for extraperitoneal T3 rectal cancer: acute toxicity, tumor response, sphincter preservation.

PURPOSE: To evaluate the impact of preoperative external radiation therapy intensified by systemic chemotherapy including bolus cisplatin (c-DDP) and 4-day infusional 5-fluorouracil (PLAFUR-4) on tumor response and sphincter preservation in patients with extraperitoneal T3 rectal cancer with acceptable toxicity, and to compare the results to our previous experience with bolus mitomycin c (MMC) and 4-day infusion 5-FU (FUMIR). METHODS AND MATERIALS: Between October 1995 and March 1998, 40 consecutive patients with resectable extraperitoneal adenocarcinoma of the rectum were treated with preoperative chemoradiation: slow infusion i.v. c-DDP, 60 mg/m2, day 1 and 29 plus 24-h continuous infusion i.v. 5-fluorouracil (5-FU) 1000 mg/m2, days 1-4 and 29-32, and concurrent external beam radiotherapy (45 Gy whole pelvis followed by 5.4 Gy boost). All but 3 patients had T3 disease. Surgery was performed 6-8 weeks after the end of chemoradiation. RESULTS: No patient had Grade 4 acute toxicity. Grade 3 hematological toxicity was observed only in 2 (5%) patients. No patient had major gastrointestinal, skin, or urological acute toxicity. All patients had radical surgery. There was no perioperative mortality; perioperative morbidity rate was 12%. Overall, 23% (9 of 40) of patients had a complete pathological response and 10% (4 of 40) of patients had rare isolated residual cancer cells (Tmic). Comparing the stage at the diagnostic workup with the pathological stage, tumor downstaging was observed in 27 (68%) patients; nodal status downstaging was detected in 24 (60%) patients. Thirty-four (85%) patients had a sphincter-saving surgical procedure. In 4 of 10 (40%) patients who were definitive candidates for an abdominoperineal resection (APR), the sphincter was preserved, as it was in 13 of 13 (100%) probable candidates. Lengthening of the distance between the anorectal ring and the lower pole of the tumor > or =20 mm was observed in 9 (23%) patients. None of the patients had soilage after the sphincter-saving procedure. In our previous experience with FUMIR the complete pathological response was 9%, the sphincter-saving surgical procedure was performed in 66% cases, and the Grade 3+ toxicity was observed in 13% of patients. CONCLUSIONS: The addition of c-DDP to 5-FU (PLAFUR-4) in a neoadjuvant radiochemotherapy schedule improved the pathological response rate in comparison with our previous experience. Toxicity was low indeed, thus we commenced another study adding one more day of 5-FU infusion (PLAFUR-5) to further improve our results.

Adult↗
PubMed1995

Prolonged continuous infusion of carboplatin and concomitant radiotherapy in advanced head and neck cancer. A phase I study.

A Phase I study on conventional radiotherapy and concomitant infusional chemotherapy with carboplatin (CBDCA) was initiated in order to evaluate the toxicity and feasibility of this combined treatment. Twenty-one patients with advanced head and neck carcinoma entered the study: 9 patients (Group A) received a 14-day infusion of 30 mg/m2 of CBDCA daily and 12 (Group B), a 21-day infusion beginning from the first day of radiotherapy. Total doses of 420 and 630 mg/m2 were given to group A and B, respectively. RT total dose ranged from 65 to 70 Gy with standard fractionation (180 cGy/5d/w). Major side effects observed were hematologic and mucosal. In group A grade 3 leukopenia was observed in five patients, grade 3 thrombocytopenia in one, and grade 3 mucositis in 2. In group B hematologic toxicity was severe: grade 3 and 4 leukopenia was seen in 4 and 3 patients, respectively; 3 patients had grade 3 and 2 patients grade 4 thrombocytopenia with a late appearance of nadir. Severe grade 3 mucositis was observed in 6 patients. Nineteen patients were evaluable for tumor response: 7/17 patients with stage III-IV disease achieved a CR and 8 a PR. According to our experience, prolonged infusion with CBDCA during conventional RT courses is feasible, though a certain level of toxicity remains. A 30 mg/m2 daily dose for 21-day infusion is associated with severe hematologic toxicity, while 14-day infusion can be considered the maximum tolerable dose. Whether CBDCA infusion has any advantage over bolus is yet to be confirmed.

Adult↗
PubMed1988

Primary mediastinal seminoma.

Two new cases of primary mediastinal seminoma are presented and 126 cases from the literature are analysed. Radiotherapy, alone or combined with surgery, is thought by some authors to be the treatment of choice and the role of chemotherapy is uncertain. We propose a classification by which it is possible to compare various therapeutic approaches and to establish their value.

Adult↗
PubMedDate not supplied

Supportive care in radiotherapy: a review.

The normal tissue tolerance and the related early side effects represent the main constraint on the total radiation dose which can be administered to the target volume. The most common disorders during radiotherapy or chemo-radiotherapy are summarized in this review. Since in the recent years great advances have been made towards the improvement of acute tolerance, practically every adverse symptoms can be controlled or lowered with an adequate treatment. Some suggestions are reported in order to prevent or lower the degree and the incidence of major complications, specifically mucositis-related symptoms like stomatitis, diarrhea, cystitis. Possibly, a multicenter effort is to be made in order to optimize the quality of supportive care for irradiated patients in all radiation therapy centers.

Appetite↗
PubMedDate not supplied

[Supportive therapy in oncology].

The current trend towards a more intensive cancer treatment is possible thanks to the availability of a really important and effective supportive care. It is our opinion that it would be essential for the junior staff in oncology, for the practitioners, but also for the knowledge of anyone contributing in different ways to give the cancer treatment, to have reference points to give also the best supportive care. With this aim we thought to start a study, in Italy, to investigate, first, which is the supportive care used in the most common acute toxicities during or immediately after cancer therapy. We decided to begin with a survey addressed to hematologists, medical oncologists, radiotherapists; 105 centers were contacted. In order to have a high number of people able to answer to different clinical questions we decided to use Internet to communicate with participating centers without moving people. The final goal of the project is to formulate guidelines in supportive care, but also to promote the use of Internet as much as possible in the medical world with the aim to make easier every kind of communication and exchange of information.

Computer Communication Networks↗
PubMedDate not supplied

[Supportive care in oncology].

It is extremely important to deliver treatments, both in medical oncology and in radiation oncology, in compliance with the due dose intensity, in order to achieve the best results in terms of clinical response and local control and, often, also in terms of survival. Supportive care is one of the tools for the achievement of this goal, permitting the delivery of aggressive therapies and the improvement of Quality of Life. It is the aim of the Tsonc study to evaluate what the main therapeutic trend is, on the ground of a survey performed in 105 medical oncology, radiation oncology, and haematology centres. For this assessment the WHO/INH and RTOG common toxicity criteria were adopted, even knowing that these score systems had been developed for reporting acute/subacute toxicity and not to choose the therapeutic approach. However, these scales give us the possibility to refer to highly validated systems and provide participants with a common language. Thirty-two items of toxicity were listed, and each item included 2 to 4 degrees of severity so to report supportive care accordingly. The present paper reports the criteria of choice of the scales and symptoms and the schedule of the queries.

Antineoplastic Agents↗
PubMedDate not supplied

The impact of the new organization on the management of breast cancer.

The radical change in the health care service now going on for some years requires the commitment of medical specialists, as well as the acquisition of an adequate knowledge of the economic implications associated to the therapeutic choice. Among primary objectives of health care management in the field of breast cancer, the best cost-effective strategy and the rationalization and standardization of diagnostic and therapeutic approaches, should be identified. Problems related to breast cancer are examined for effective, efficient and economic optimization.

Breast Neoplasms↗
PubMedDate not supplied

Head and neck cancer: new trends in research and clinical practice.

Head and neck cancer represents an interesting subject of research in the third millennium. Apart from basic research (molecular biology, genic therapies etc.) which it shares with other neoplasms, a number of studies are in progress in the field of clinical research. In particular trials of combined radiation and chemotherapy with one or several drugs are being carried out and they will certainly provide definitive results in the field of clinical application. Further acquisitions will be provided by the studies on non conventional dose fractionation and the application of intensity modulated radiotherapy. Finally, the first studies on chemoprevention in patients with malignant or precancerous lesions of the head and neck will be soon concluded.

Head and Neck Neoplasms↗
PubMedDate not supplied

[Vascular, pulmonary and neoplastic pathology in a construction worker. Problems of etiological diagnosis].

Although etiological diagnosis represent a major issue in occupational health, it is frequently difficult to achieve because of the concurrent effect of a multitude of both work-related and non-work-related pathogenic factors. A construction worker, exposed for over 20 years to silica and silicate dust, asbestos dust and vibrations transmitted through the hand-arm axis, complained of dyspnoea a cough and peripheral paraesthesia. Two years later he developed scleroderma-like skin lesions in the appendages, and a small-cell bronchogenic carcinoma was subsequently revealed by radiological and bronchoscopic examination. The analysis of a single case failed to provide any substantial support for the hypothesis that scleroderma and lung cancer have an occupational origin; however, we believe it is significant that occupational exposure to chemical and physical agents inhibiting the immune response is often observed in association with some kinds of immune abnormalities, such as those of scleroderma and oat-cell cancer.

Asbestos↗
PubMedDate not supplied

Quality assurance in radiotherapy of head and neck tumors.

Radiation therapy represents an extensively experimented treatment modality for head and neck tumors. Recent studies have documented a close dependence of clinical results, especially in terms of local control and toxicity, on the radiation therapy quality. Thus the effort to improve the results of conventional radiotherapy has been achieved with the identification of new therapeutic modalities (non conventional fractionation, conformal therapy, fast neutron radiotherapy, concomitant or neoadiuvant chemotherapy) as well as with constant optimization of the accuracy of used procedures. Among them the following should be mentioned: 1) the systematic use of immobilization systems which enable a significant reduction in positioning errors; 2) checks before and during treatment by portal imaging which enable to identify and correct a relevant percentage of inaccuracies; 3) "in vivo" dosimetry which enables an overall assessment of treatment accuracy. The general evolution of the radiobiological knowledge occurred in recent years has introduced into radiotherapy of head and neck tumors new schemes of fractionation and new modalities of combination with other therapeutic procedures. Furthermore, while the widespread use of complex irradiation procedures calls for the urgent need of quality assurance of radiation treatments, this is by all means a mandatory requirement even in the most conventional clinical practice.

Head and Neck Neoplasms↗
PubMedDate not supplied

Preoperative radiotherapy in the conservative treatment for breast cancer.

Aim of this study was to evaluate the feasibility, therapeutic effectiveness and toxicity of a non conventional radiation therapy (180 cGy twice a day for a total dose of 36 Gy in 2 weeks in the treatment of breast cancer inoperable with conservative surgery as first choice. Ten patients were studied. Results were as follows: complete response: 20%, partial response: 70%; no change: 10%. Acute toxicity was negligible and late toxicity, after a mean 46-month follow-up, was practically absent; the cosmetic result was definitely good. The radiobiology and kinetic features of breast cancer indicate that the potential of accelerated treatment should be further explored, this fractionation being suitable for optimal combined modality treatment with preoperative chemotherapy.

Adult↗