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Biomedical subjects

M Amichetti

Publications and source records attributed to M Amichetti.

At least 37 records · Page 2Linked to original sources
PubMed1993

Cisplatin, hyperthermia, and radiation (trimodal therapy) in patients with locally advanced head and neck tumors: a phase I-II study.

PURPOSE: Hyperthermia is now being widely used to treat clinical malignancies especially combined with radiotherapy and more rarely with chemotherapy. The combination of heat, radiation, and chemotherapy (trimodality) can lead to potent interaction. The present Phase I-II study was conducted to evaluate the feasibility and acute toxicity of a combination of cisplatin, hyperthermia, and irradiation in the treatment of superficial cervical nodal metastases from head and neck cancer. METHODS AND MATERIALS: Eighteen patients with measurable neck metastases from previously untreated squamous cell head and neck tumors were entered into the trial. Therapy consisted of a conventional irradiation (total dose 70 Gy, 2 Gy five times a week) combined with a weekly administration of 20 mg/m2 iv of cisplatin and a total of two sessions of local external microwave hyperthermia (desired temperature of 42.5 degrees C for 30 min). RESULTS: Feasibility of the treatment was demonstrated. Acute local toxicity was mild; no thermal blisters or ulcerations were reported and only two patients experienced local pain during hyperthermia. Cutaneous toxicity appeared greater than in our previous studies with irradiation plus hyperthermia and irradiation plus cisplatin. Systemic toxicity was moderate with major toxic effects observed in three patients (World Health Organization (WHO) grade 3 anaemia). Even though it was not an aim of the study to evaluate the nodal response, we observed a complete response rate of 72.2% (95% confidence interval 51-93.4%), 16.6% of partial response and 11.1% of no change. CONCLUSION: The study confirms the feasibility of the combination of cisplatin, heat, and radiation with an acceptable toxicity profile. The trimodal therapy deserves further evaluation as a way to enhance the efficacy of irradiation in the treatment of nodal metastases from head and neck tumors.

Adult↗
PubMed1992

Small cell carcinoma of the urinary bladder. Report of two cases and review of the literature.

Undifferentiated small cell carcinoma of the bladder is a rare but aggressive subset of urinary tract neoplasms. Analogous to small-cell carcinoma of the lung, this tumor frequently exhibits neuroendocrine differentiation. We report the 92nd and 93rd case of small cell carcinoma of the bladder reported in the literature with characteristic cytologic, histologic, histochemical, and ultrastructural features. The patients were treated initially with chemotherapy, but after a brief clinical course died for progression of disease and for myocardial infarction, respectively. The pathologic and clinical features and therapeutic options of the cases described in the literature are reviewed.

Carcinoma, Small Cell↗
PubMed1991

Treatment patterns in elderly patients (greater than or equal to 70 years) with breast carcinoma. A retrospective study of the Gruppo Oncologico Clinico Cooperativo del nord-Est (GOCCNE).

The pattern of treatment used in elderly women affected by breast carcinoma was evaluated in a retrospective study by the North-East Clinical Cooperative Group in Italy (GOCCNE). Six divisions were involved in the study. The medical records of 115 elderly women were reviewed; the women's median age was 75 years (range, 70-93). Surgery was used in 70/72 operable patients (97%), although limited surgery plus radiotherapy was used in only 7.5%. Most stage II patients were treated with adjuvant tamoxifen, as were younger postmenopausal patients, according to the guidelines of the Bethesda Consensus Meeting. Comorbid conditions are of particular concern in therapy planning, considering that more stage III patients died of competing causes than for disease progression. The role of chemotherapy was very marginal.

Age Factors↗
PubMed1991

Late metastases of cutaneous melanoma: case report and literature review.

The development of delayed metastases, although rare, is well documented in patients with invasive cutaneous melanoma. Only 24 cases, including ours, are clearly documented in the literature. We describe a 56-year-old woman who had an acral lentiginous melanoma of the right hand (thickness 1.2 mm). Thirteen years after excision and postoperative irradiation, a subcutaneous metastasis developed in the right arm. One year later the patient died with disseminated bone metastases. This case, as with most of those with delayed metastases, has typical features: female sex; location at a site other than the back, arm, neck, or scalp; and primary tumor thickness between 1.2 and 2.5 mm.

Arm↗
PubMed1991

Local-regional recurrences of breast cancer: treatment with radiation therapy and local microwave hyperthermia.

From October 1981 through September 1988, 31 local-regional recurrences of breast cancer in 26 patients were treated at the Oncology Center in Trento, Italy, with a combination of external radiation therapy (XRT) and superficial local microwave hyperthermia (Ht). The mean total XRT dose was 37.40 Gy, ranging from 19.80 to 60.00 Gy, depending on the extent of previous irradiation. Ht was delivered using the same superficial mw applicator, operating at frequencies between 280 and 480 MHz. The goal was to obtain a minimum intra- and peritumoral temperature of 42.5 degrees C for 30 min. Ht was applied immediately after XRT, 2 or 3 times per week for a total of 1-9 sessions (median 2). Thirty lesions (97%) could be evaluated for response 3 months after the end of the combined treatment. Twenty (66.6%) complete responses, seven (23.3%) partial responses, and three (10%) with no change were observed. No significant acute local side effects were noted, with the exception of two thermal burns and one ulceration. Patients achieving complete response show actuarial long-term local control of 87.8% at 3 years. In our experience, Ht combined with a low/moderate XRT dose may be particularly valuable in the palliation of recurrences in previously irradiated regions. Excellent response rates can be obtained when Ht is combined with a radical dose of irradiation.

Aged↗
PubMed1991

[Radiotherapy, radiotherapy combined with surgery, radiotherapy combined with chemotherapy in the treatment of carcinoma of the pyriform sinus. A retrospective study].

A rectrospective analysis was performed of the results of 104 consecutive patients with carcinoma of the pyriform sinus, who underwent radiation therapy. Thirty-four patients underwent radical surgery and postoperative radiation therapy (group 1); 36 patients received radical radiation therapy alone (group 2); neoadjuvant chemotherapy was administered prior to full-dose radiation to 20 patients (group 3); 14 patients received palliative radiation therapy (group 4). Loco-regional control and survival rates at 5 years were 60.4% and 34.3% in group 1, 23.8% and 23.8% in group 2, 17.5% and 23.8% in group 3; no patients in group 4 survived at 5 years. Patients in group 1 experienced significantly better survival and local control than those in groups 2 and 3. No differences were observed between groups 2 and 3. Loco-regional recurrence was the main cause of failure in group 2 (69.4%) and 3 (70.0%). In group 1, 20.3% of cases developed distant metastases. Overall 5-year survival rate was 23.7%, confirming the poor prognosis of this disease. These results provide further support to the need of improving prevention and early diagnosis to improve both results and outcome in patients with carcinoma of the pyriform sinus.

Adult↗
PubMed1990

Radiation therapy of carotid body tumors.

Chemodectomas of carotid artery bifurcation are generally managed with surgery, irradiation being reserved for inoperable, bulky, and recurrent tumors. Probably due to this "pretreatment" selection of patients, chemodectomas are anedoctally considered radioresistant tumors, although this concept is not supported by the recent literature. From 1968 to 1987, 13 carotid body tumors in seven patients were treated with irradiation as sole treatment (10 lesions) or as postoperative modality (three lesions). Familial occurrence and bilateral presentation were observed in 3 of 7 and in 6 of 7 patients, respectively. Total dose of irradiation was of 46-60 Gy (median 50 Gy, mean 52.25 Gy) with dose per fraction of 1.8-2.5 Gy. Local control (subjective or objective) was obtained in all the patients. Clinical results following World Health Organization (WHO) criteria were: 3 of 13 complete response, 7 of 13 partial response and 3 of 13 no change. Follow-up range is 1-19 years. Acute side effects were minimal and mid- or long-term toxicity was absent.

Adult↗
PubMed1990

Metastases to the breast from extramammary malignancies.

Metastases to the breast from all other primary sites are unusual. Twelve female patients were diagnosed between 1971 and 1985 at S. Chiara Hospital-Trento. The majority of these metastases were from malignant melanoma (5) and ovarian cancer (3). In 1 case the lesion was the first sign of malignant disease (adenocarcinoma of the kidney). The development of a breast metastasis is revealed, in our experience, as a negative prognostic factor. Recognition of these lesions as being metastatic is useful in avoiding unnecessary radical operative procedures.

Adolescent↗
PubMed1990

[Radical radiation therapy of carcinoma of the rhinopharynx: analysis of 80 cases].

From 1976 to 1987, 98 patients affected with nasopharyngeal carcinoma were observed at the Oncology Center, Trento, Italy. Eighty of them were treated with radical radiation therapy (average total dose: 6432 Gy, range: 5500-7400 Gy) on primary tumor and positive neck nodes. The clinically negative neck received 5000 Gy. Each dose ranged from 180 to 250 Gy. Fifty-nine patients were treated with the split-course technique with an interval of about 15 days after receiving 4000 cGy. The patients were 60 males and 20 females, their age ranging 17-81 years (mean: 57 years). Histology diagnosed squamous cell carcinoma in 15 cases and undifferentiated carcinoma in 65 cases. All patients were staged according to TNM (UICC, 1978) criteria. Ten patients were stage I/II. Complete local control was obtained in 81.3% of cases. Actuarial global survival at 10 years was 52%, actuarial relapse-free survival was 49%. Mean follow-up is 33 months (range: 4-122 months). Squamous cell carcinoma at histology and advanced nodal involvement (N2-N3) were negative prognostic factors. Six patients had a relapse in the nasopharynx and 5 in the neck; the incidence of distant failures was 20%. The most frequent mid-/long-term side-effect was xerostomia.

Adolescent↗
PubMed1989

Squamous cell carcinoma of the oral tongue in patients less than fifteen years of age. Report of a case and review of the literature.

Squamous cell carcinoma of the tongue in patients younger than 15 years of age is an extremely rare occurrence. There are few published series on the management and outcome of these young patients because of the rarity of this disease within this age group. A case of carcinoma of the tongue in a 14-year-old girl, the first reported in Italy in children is presented, with a review of the most relevant literature.

Adolescent↗
PubMed1989

Comparative study of two neoadjuvant protocols (VBM and DDP-BLM) combined with radiation therapy in advanced head and neck cancer.

Forty-five patients with epidermoid cancer of the head and neck were either treated with cisplatin and bleomycin (DDP-BLM) or with vincristine, bleomycin and methotrexate (VBM) as neoadjuvant chemotherapy before radical radiation therapy (XRT). Chemotherapy with DDP-BLM provided a tumoral response of 80% [20% complete response (CR), 60% partial response (PR)]; VBM showed a response of 60% (12% CR, 48% PR). At the end of XRT-program (65 Gy total dose, 2-2.5 Gy dose per fraction, 5 times a week) complete response rates were similar in VBM-pretreated group (52.5%) and DDP-BLM pretreated group (50%). Analysis of survival shows no significant difference between the two inductive schemes: 8% vs 7.5% at 72 months. Our study suggests an increased initial response rate but no advantage in survival with combined therapy in comparison with standard XRT: long-term benefits were not apparent in these two groups of patients.

Adult↗
PubMed1988

Radical radiation alone versus radical radiation plus microwave hyperthermia for N3 (TNM-UICC) neck nodes: a prospective randomized clinical trial.

Between September 1985 and December 1986, 44 N3 (TNM-UICC) metastatic squamous cell cervical lymph-nodes were randomized to receive conventionally fractionated radical irradiation (RT) to a total dose of 64-70 Gy, or conventionally fractionated radical irradiation plus twice a week local microwave hyperthermia (Ht). The two major end points of this study were (a) local control rates evaluated at 3 months after the end of combined therapy and (b) incidence of acute local toxicity. Thirty-six nodes (82%) were evaluable as of December 1986, at which time there was a premature closure of this study due to ethical reasons. An interim analysis had revealed a statistically significant difference in complete response rates in favor of the combined arm (p = 0.0152). The complete response rates were 82.3% (14/17) for the combined treatment arm versus 36.8% (7/19) for the control irradiation arm, leading to an iso-dose thermal enhancement ratio (TER) value of 2.23. Both arms are comparable in average total RT dose delivered (RT: 67.05 Gy; RT + Ht: 67.85 Gy) and in average maximum node diameter (RT arm: 4.81 cm; RT + Ht: 4.88 cm). Acute local toxicities were similar in irradiated and heated plus irradiated neck regions; only one skin burn was observed. As possible treatment related death, one patient in the RT + Ht arm died 2 months after completion of therapy with a carotid rupture associated with extensive tumor necrosis. These results confirm previous non-randomized reports suggesting that hyperthermia in combination with full dose conventionally fractionated irradiation significantly enhances the chance of early local control of fixed N3 neck nodes without exhibiting an increase of acute local toxicity.

Adult↗
PubMed1988

Skeletal scintigraphy and physical examination in the staging of early breast cancer.

The significance of skeletal scintigraphy in staging of early breast cancer is still controversial. The results of bone scanning with 99Tcm diphosphonate and clinical examination in 204 patients with stage I-II breast cancer are reported. Bone scans were positive in 28 cases. However, only one was true positive as confirmed by x-ray examination and/or biopsy, with a detection rate of 0.5%. Physical examination had a detection rate similar to bone scan, but with superior specificity. In our experience bone scan cannot be recommended as a routine staging test in early breast cancer.

Adult↗
PubMed1988

Primary adenoid cystic carcinoma of the Bartholin's gland: a clinical, histological and immunocytochemical study of a case.

Adenoid cystic carcinoma of the Bartholin's gland is a rare tumor. Only 41 cases, to our knowledge, have been described in literature. It is impossible, at present, to determine the best management of this disease. Local recurrence and distant metastases (mainly of the lung) frequently occur. A case of adenoid cystic carcinoma of the Bartholin's gland is looked into with respect to clinical and immunohistochemical characteristics. Radiation therapy is suggested as effective together with surgery. The efficacy of routine lymphadenectomy has not been demonstrated. The case reported is the first described with nodal metastasis as single mode of recurrences presentation.

Adult↗