PubMed Health⌕ Search

Biomedical subjects

Luca Incrocci

Publications and source records attributed to Luca Incrocci.

13 recordsLinked to original sources
PubMed2006

A randomized, double-blind, placebo-controlled, cross-over study to assess the efficacy of tadalafil (Cialis) in the treatment of erectile dysfunction following three-dimensional conformal external-beam radiotherapy for prostatic carcinoma.

PURPOSE: Erectile dysfunction after three-dimensional conformal external-beam radiotherapy (3DCRT) for prostatic carcinoma is reported in as many as 64% of those patients. The purpose of this study was to determine the efficacy of the oral drug tadalafil (Cialis) in patients with erectile dysfunction after radiotherapy for prostatic carcinoma. METHODS AND MATERIALS: Patients (N=358) who completed radiotherapy at least 12 months before the study were approached by mail. All patients had been treated by 3DCRT; 60 patients were included and entered a double-blind, placebo-controlled, cross-over study lasting 12 weeks. They received 20 mg of tadalafil or placebo for 6 weeks. Drug or placebo was taken on demand at patient's discretion, with no restrictions regarding the consumption of alcohol or food, at least once a week and no more than once daily. At 6 weeks patients crossed over to the alternative treatment. Data were collected using the Sexual Encounter Profile (SEP) and the International Index of Erectile Function (IIEF) questionnaires. Side effects were also recorded. RESULTS: Mean age at study entry was 69 years. All patients completed the study. For almost all questions of the IIEF questionnaire there was a significant increase in mean scores from baseline with tadalafil, but not with placebo. Sixty-seven percent of the patients reported an improvement of erectile function with tadalafil (placebo: 20%), and 48% reported successful intercourse with tadalafil (placebo: 9%) (p<0.0001). Side effects were mild or moderate. CONCLUSIONS: Tadalafil is an effective treatment for erectile dysfunction after 3DCRT for prostatic carcinoma with successful intercourse reported in almost 50% of the patients, and it is well tolerated.

Aged↗
PubMed2006

Dose-response in radiotherapy for localized prostate cancer: results of the Dutch multicenter randomized phase III trial comparing 68 Gy of radiotherapy with 78 Gy.

PURPOSE: To determine whether a dose of 78 Gy improves outcome compared with a conventional dose of 68 Gy for prostate cancer patients treated with three-dimensional conformal radiotherapy. PATIENTS AND METHODS: Between June 1997 and February 2003, stage T1b-4 prostate cancer patients were enrolled onto a multicenter randomized trial comparing 68 Gy with 78 Gy. Patients were stratified by institution, age, (neo)adjuvant hormonal therapy (HT), and treatment group. Four treatment groups (with specific radiation volumes) were defined based on the probability of seminal vesicle involvement. The primary end point was freedom from failure (FFF). Failure was defined as clinical failure or biochemical failure, according to the American Society of Therapeutic Radiation Oncology definition. Other end points were freedom from clinical failure (FFCF), overall survival (OS), and toxicity. RESULTS: Median follow-up time was 51 months. Of the 669 enrolled patients, 664 were included in the analysis. HT was prescribed for 143 patients. FFF was significantly better in the 78-Gy arm compared with the 68-Gy arm (5-year FFF rate, 64% v 54%, respectively), with an adjusted hazard ratio of 0.74 (P = .02). No significant differences in FFCF or OS were seen between the treatment arms. There was no difference in late genitourinary toxicity of Radiation Therapy Oncology Group and European Organisation for Research and Treatment of Cancer grade 2 or more and a slightly higher nonsignificant incidence of late gastrointestinal toxicity of grade 2 or more. CONCLUSION: This multicenter randomized trial shows a significantly improved FFF in prostate cancer patients treated with a higher dose of radiotherapy.

Aged↗
PubMed2005

Sexual function after external-beam radiotherapy for prostate cancer: what do we know?

Quality of life in general and sexual functioning in particular have become very important in cancer patients. Due to modern surgical techniques, improved quality of drugs for chemotherapy and very modern radiation techniques, more patients can be successfully treated without largely compromising sexual functioning. One can assume that because of the life-threatening nature of cancer, sexual activity is not important to patients and their partners, but this is not true. Prostate cancer has become the most common non-skin malignant neoplasm in older men in Western countries. In this paper, we discuss the various methods used to evaluate erectile and sexual dysfunction and the definition of potency. Data on the etiology of erectile dysfunction after external-beam radiotherapy for prostate cancer is reviewed, and the literature is been summarized. Patients should be offered sexual counseling and informed about the availability of effective treatments for erectile dysfunction, such as sildenafil, intracavernosal injection, and vacuum devices. Cancer affects quality of life and sexual function. The challenge for oncologists is to address this with compassion.

Humans↗
PubMed2005

Adjuvant 5-FU-based chemoradiotherapy for patients undergoing R-1/R-2 resections for pancreatic cancer.

BACKGROUND: Pancreatic cancer is the fifth leading cause of cancer-related death worldwide. Among patients treated with surgery alone, liver metastasis occurs in up to 50%, peritoneal recurrence in 25%, and local recurrence occurs in 50-80% of all patients who underwent resection. Even after a macroscopically curative resection, tumour cells might be observed by microscopy at one or more edges of the resected specimen in 20-51% (R-1) which might account for the high local recurrence. AIM OF THE STUDY: An analysis was performed in 54 patients who underwent an irradical resection (R-1 and R-2) for pancreatic cancer. 33 patients were treated with chemoradiotherapy. To evaluate the effect of therapy on survival and recurrence, this group was retrospectively compared to a group of 21 patients that did not receive chemoradiotherapy. METHODS: Radiotherapy consisted of 50 Gy external upper abdomen radiation in two courses of 3 weeks, concomitant with intravenous 5-FU 25 mg/kg/24 h continuously on the first 4 days of each treatment course. Follow-up was performed mainly by CT scanning and occasionally by US and was completed for all but 1 patient. RESULTS: The treatment protocol was completed in all patients without complications. Local recurrence was found in 6 (18%) patients in the group of patients who received adjuvant therapy versus 16 (48%) patients in the group that did not receive adjuvant therapy (p = 0.001). The median survival time for the treated group was 12.8 vs. 13.7 months in the group that did not receive chemoradiotherapy (p = 0.9). Three (9%) patients are still alive 140, 88 and 70 months after receiving surgery and adjuvant treatment. CONCLUSION: Adjuvant chemoradiotherapy clearly gives a significant better local control. However, treatment with 5-FU and radiotherapy does not improve survival due to distant metastases. This therapy probably prolongs survival in only a few patients. More effective treatment methods have to be designed to prevent metastatic disease and improve survival.

Aged↗
PubMed2005

Radiation therapy for prostate cancer and erectile (dys)function: the role of imaging.

Incidence of erectile dysfunction (ED) after radiotherapy reported in the literature varies from 7 to 72% after external-beam radiotherapy to 5-51% after brachytherapy. Most of these studies are retrospective, the definition of ED is variable and sexual functioning is frequently assessed by asking only one question. Already in the 1980's it was suggested that post-radiation ED was attributable to vascular damage. The most reliable method to assess vasculogenic ED is the use of the Doppler ultrasound. More recently, many studies have assessed the relationship between radiation dose and volume of the penile bulb and post-radiation ED, though the outcome is controversial. The penile structures and the neurovascular bundles are best seen on magnetic resonance imaging (MRI). Therefore the use of a computer tomography scan/MRI image fusion can result in reducing the planning target volume and consequently the radiation dose to the penile bulb and bodies. If radiation induces vascular damage that causes ED, any means of reducing the dose to the pelvic vascular structures would likely decrease ED, therefore new radiation techniques such as the intensity modulated radiation therapy or the implant of fiducial markers can help decrease the margins and therefore ED.

Brachytherapy↗
PubMed2005

Psychosexual factors that differentiate men with inhibited ejaculation from men with no dysfunction or another sexual dysfunction.

AIM: Inhibited or retarded ejaculation (IE) is an uncommon male sexual dysfunction that may result in a lack of sexual fulfillment for both the man and his partner. In this study, we attempted to identify factors that differentiate men with IE from sexually functional controls or from men with other sexual dysfunctions and to specify whether such factors predict self-reported sexual arousal during psychophysiological assessment. METHODS: Each patient underwent psychophysiological assessment and a structured clinical interview based on a standardized questionnaire that included demographic information, psychosexual and medical history, and assessment of current sexual, erectile, and ejaculatory function, including relationship quality and characteristics. RESULTS: Men with IE resemble men with other dysfunctions but are differentiated from controls, in their lower level of relationship satisfaction, greater level of distress, and higher level of health-related problems. Men with IE were further characterized by lower levels of self-reported subjective sexual arousal, despite exhibiting strong penile response during psychophysiological testing and reporting high quality erections across a variety of situations. Also notable, however, were the many factors on which men with IE did not differ from controls. CONCLUSIONS: Taken together, this research helps specify directions for future investigations of men with IE.

Adult↗
PubMed2004

Disorders of orgasm and ejaculation in men.

INTRODUCTION: Ejaculatory/orgasmic disorders, common male sexual dysfunctions, include premature ejaculation, inhibited ejaculation, anejaculation, retrograde ejaculation and anorgasmia. AIM: To provide recommendations/guidelines concerning state-of-the-art knowledge for management of ejaculation/orgasmic disorders in men. METHODS: An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Concerning the Disorders of Ejaculation/Orgasm in Men Committee, there were nine experts from six countries. MAIN OUTCOME MEASURE: Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate. RESULTS: Premature ejaculation management is dependent upon etiology. When secondary to ED, etiology-specific treatment is employed. When lifelong, initial pharmacotherapy (SSRI, topical anesthesia, PDE5 inhibitors) is appropriate. When associated with psychogenic/relationship factors, behavioral therapy is indicated. When acquired, pharmacotherapy and/or behavioral therapies are preferred. Retrograde ejaculation, diagnosed with spermatozoa and fructose in centrifuged post-ejaculatory voided urine, is managed by education, patient reassurance, pharmacotherapy or bladder neck reconstruction. Men with anejaculation or anorgasmia have a biologic failure of emission and/or psychogenic inhibited ejaculation. Men with age-related penile hypoanesthesia should be educated, reassured and be instructed in revised sexual techniques which maximize arousal. CONCLUSIONS: More research is needed in understanding management of men with ejaculation/orgasmic dysfunction.

Anesthetics, Local↗
PubMed2004

Radiotherapy for prostate cancer and sexual functioning.

The incidence of erectile dysfunction after radiotherapy for prostate cancer is high. A multifactorial aetiology has to be considered, taking into account pretreatment erectile function. Patients need to be informed about effective treatments such as sildenafil and intracavernosal injections.

Counseling↗
PubMed2003

Efficacy of sildenafil in an open-label study as a continuation of a double-blind study in the treatment of erectile dysfunction after radiotherapy for prostate cancer.

OBJECTIVES: To determine the efficacy of sildenafil citrate (Viagra) in patients with erectile dysfunction after three-dimensional conformal external beam radiotherapy for prostate cancer. METHODS: Sixty patients treated with radiotherapy for prostate cancer at least 6 months previously, complaining of erectile dysfunction, and not using nitrates were entered into a double-blind, placebo-controlled, crossover study lasting 12 weeks. They received 50 mg of sildenafil or placebo for 2 weeks; at week 2, the dose was increased to 100 mg in the case of an unsatisfactory erectile response. At week 6, patients crossed over to the alternative treatment. Patients were then allowed to enter a 6-week open-label phase using 50 mg of sildenafil in the first 2 weeks, increasing the dose to 100 mg in the case of an insufficient erectile response in the following 4 weeks. Data were collected before trial entry (baseline evaluation) and every 2 or 4 weeks using the International Index of Erectile Function questionnaire. Any side effects were recorded. Two years later, all patients were approached by mail to evaluate their current sexual functioning and possible use of sildenafil. RESULTS: All patients completed the double-blind, crossover study. For nearly all the International Index of Erectile Function questions, sildenafil caused a significant increase in mean scores from baseline. Placebo had no effect. Seventy-seven percent entered the open-label phase; they were the better responders in the double-blind phase. Sildenafil was as equally effective as in the double-blind phase. The side effects were mild or moderate and significantly decreased in the open-label period. Two years after trial entry, 24% still used sildenafil. CONCLUSIONS: Sildenafil is relatively effective in patients with erectile dysfunction after three-dimensional conformal external beam radiotherapy for prostate cancer. New drugs and combination therapies are needed to improve outcome.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2002

Treatment outcome, body image, and sexual functioning after orchiectomy and radiotherapy for Stage I-II testicular seminoma.

PURPOSE: Orchiectomy followed by infradiaphragmatic irradiation is the standard treatment for Stage I-II testicular seminoma in The Netherlands. Because body image and sexual functioning can be affected by treatment, a retrospective study was carried out to assess treatment outcome, body image, and changes in sexuality after orchiectomy and radiotherapy. METHODS AND MATERIALS: The medical charts of 166 patients with Stage I-II testicular seminoma were reviewed. A questionnaire on body image and current sexual functioning regarding the frequency and quality of erections, sexual activity, significance of sex, and changes in sexuality was sent to 157 patients (at a mean of 51 months after treatment). RESULTS: Seventy-eight percent (n = 123, mean age 42 years) completed the questionnaire. During irradiation, almost half of patients experienced nausea and 19% nausea and vomiting. Only 3 patients had disease relapse. After treatment, about 20% reported less interest and pleasure in sex and less sexual activity. Interest in sex, erectile difficulties, and satisfaction with sexual life did not differ from age-matched healthy controls. At the time of the survey, 17% of patients had erectile difficulties, a figure that was significantly higher than before treatment, but which correlated also with age. Twenty percent expressed concerns about fertility, and 52% found their body had changed after treatment. Cancer treatment had negatively influenced sexual life in 32% of the patients. CONCLUSIONS: Orchiectomy with radiotherapy is an effective and well-tolerated treatment for Stage I-II testicular seminoma. Treatment-induced changes in body image and concerns about fertility were detected, but the sexual problems encountered did not seem to differ from those of healthy controls, although baseline data are lacking.

Adolescent↗
PubMed2002

Sexual (dys)function after radiotherapy for prostate cancer: a review.

PURPOSE: Prostate cancer has become the most common nonskin malignant neoplasm in older men in Western countries. As treatment efficacy has improved, issues related to posttherapy quality of life and sexual functioning have become more important. METHODS AND MATERIALS: We discuss the various methods used to evaluate erectile and sexual dysfunction and the definition of potency. The etiologies of erectile dysfunction after external beam radiotherapy and brachytherapy for prostate cancer are also reviewed. The literature is summarized, and comparative studies of radiation and surgery are surveyed briefly. RESULTS: Rates of erectile dysfunction vary from 6 to 84% after external beam radiotherapy and from 0 to 51% after brachytherapy. In most of the studies, the analysis is retrospective, the definition of erectile dysfunction is not clear, only one question about sexual functioning is asked, and nonvalidated instruments are used. The etiology of erectile dysfunction after radiation for prostate cancer is not completely understood. CONCLUSIONS: Because erectile function is only one component of sexual function, it is necessary to assess sexual desire, satisfaction, frequency of intercourse, and other such factors when evaluating the effects of therapy. Patients should be offered sexual counseling and informed about the availability of effective treatments for erectile dysfunction, such as sildenafil, intracavernosal injection, and vacuum devices.

Aged↗
PubMedDate not supplied

Aging and sexual response in the laboratory in patients with erectile dysfunction.

Aging places men at increased risk for erectile problems, particularly beginning around their fifties and sixties. Using a psychophysiological assessment procedure that included visual erotic stimulation, vibrotactile stimulation, and intracavernosal injection, this study tested for possible age effects on erectile response and self-reported sexual arousal in a group of men clinically diagnosed with erectile dysfunction. We controlled for three factors of purported importance to erectile functioning: existing comorbidities, use of specific medications, and current tobacco and alcohol use. Results indicated effects from both age and tobacco use on erectile response, although these effects were not uniform across age groups. For example, age had inconsistent effects on erectile response in patients aged 50 to 90 years; tobacco use had its strongest effect on patients under 50 years of age. In general, such covariates were less able to account for variation in erectile response among patients with more-severe ED. Despite these effects, ED men even in the oldest group showed average penile circumference increases of 28 mm under ICI, an erectile response typically sufficient for vaginal intercourse.

Aged↗