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Biomedical subjects

M Amichetti

Publications and source records attributed to M Amichetti.

53 records · Page 3Linked to original sources
PubMed1986

Neoadjuvant chemotherapy with vincristine, bleomycin and methotrexate combined with radiotherapy in advanced head and neck squamous cell carcinoma.

From September 1980 to August 1981, 25 patients with advanced head and neck squamous cell carcinoma were treated at the Centro Oncologico, Trento, by a chemo-radiotherapeutic combination. The treatment protocol consisted of 4-6 courses of VBM (vincristine, bleomycin and methotrexate) followed by conventional radiotherapy (65 Gy). Only to VBM responders (15 patients) were administered 10 cycles of vincristine-methotrexate. At the end of induction chemotherapy an overall response of 60% (12% complete, 48% partial) was obtained. At the end of radiotherapy the responses were 52.5% complete and 35.5% partial, for an overall response of 88%. The overall survival at 60 months was 8%. This combined approach, in spite of the satisfactory immediate local response rate, does not offer advantages for survival in comparison to conventional treatment modalities.

Adult↗
PubMed1982

Local microwave hyperthermia in cancer therapy. Preliminary report.

From February 1981 to September 1981, 16 patients (19 fields) with histologically proven malignancy (10 squamous carcinoma, 4 melanoma, 1 adenocarcinoma, 1 chordoma) were treated with hyperthermia combined with radiotherapy or chemotherapy (1 patient). There were 5 females and 11 males; average age was 65 years, range 45 to 94 years; 15 patients had a Karnofsky index greater than 50%. Hyperthermia (42.5 44.0 degrees C) was induced by 250 MHz to 1 GHz microwaves (BSD - 1000 Unit). Thermometry was performed by means of non-perturbing probes placed in intratumorally inserted catheters and by measurement of skin temperatures. After hyperthermia plus radiotherapy (18 fields), 9 patients showed 100% response, 5 a volume regression of more than 50%, 3 less than 50% and 1 no change. After chemotherapy plus hyperthermia, 1 patient showed no change. No significant side effects were observed (3 skin burns in 147 hyperthermia treatment sessions).

Aged↗
PubMedDate not supplied

Hyperthermia and radiotherapy for inoperable squamous cell carcinoma metastatic to cervical lymph nodes from an unknown primary site.

INTRODUCTION: Neck node metastases from an unknown primary carcinoma represent an infrequent but challenging problem for oncologists. The management of such patients is controversial, but radiotherapy alone or as part of a multimodal approach is often indicated. Patients with inoperable lesions usually receive radiotherapy alone at palliative doses. In an attempt to increase local control in patients with locally advanced neck disease from an unknown primary carcinoma, local hyperthermia was combined with definitive radiotherapy. MATERIAL AND METHODS: Between 1982 and 1993, radiotherapy and local microwave hyperthermia were used to treat 15 patients with metastatic neck nodes from an unknown primary site. The patients had previously undergone only biopsy or fine needle biopsy, and showed no signs of metastases beyond the clavicle. Radiation to the nodes and the potentially primary sites in the head and neck was delivered by a 6 MV linear accelerator or a Cobalt 60 unit, to a total dose of 57.50-74.40 Gy (median 70 Gy). Hyperthermia was added using a BSD 1000 unit at an operating frequency of 280-300 MHz for 2-7 sessions (mean 3.1; median 2) at a desired minimum temperature of 42.5 degrees C. Two patients also received i.v. cisplatin 20 mg/m2/week as a radiosensitizer. RESULTS: Nine patients achieved a complete, and four a partial response for an overall response rate of 86.5%. Acute and late toxicity was mild: four patients experienced pain during hyperthermia, two moist cutaneous desquamation, and one cutaneous necrosis. The actuarial probability of maintaining local control at 5 years is 64.5% and the actuarial overall survival 29%. Five patients developed distant metastases and died of disease, two experienced nodal recurrence and two died of other unrelated causes. CONCLUSION: The addition of local microwave hyperthermia to radiotherapy in the treatment of metastatic squamous cell carcinoma of the neck in patients with an unknown primary site leads to good local control with moderate toxicity. No definite conclusions are possible because of the small number of patients involved in this phase II trial.

Aged↗
PubMedDate not supplied

Prognostic significance of cervical lymph nodes density evaluated by contrasted computer tomography in head and neck squamous cell carcinoma treated with hyperthermia and radiotherapy.

INTRODUCTION: A correlation between node hypodensity assessed by means of computer tomography (CT) and resistance to both chemotherapy and radiation therapy (XRT) in advanced head and neck tumours has been suggested in the literature. The outcome of a retrospective series of 50 patients with head and neck squamous cell carcinoma (SCC) and cervical nodes metastases treated with combined hyperthermia (HT) and definitive XRT was reviewed to investigate if node density confirmed its prognostic value. MATERIALS AND METHOD: For all patients, a pre-treatment contrasted CT scan performed at the Institution between 1987-1993 was available. The density of the largest node (> 2cm) was compared to that of adjacent nuchal muscles. Nodes with hypodense areas present in more than one third of the total volume were considered necrotic nodes. RESULTS: The patients were divided in two groups (with and without nodal necrosis), well balanced in terms of potential prognostic factors. No significant difference in overall nodal response rate, local control and survival was found in the two groups of patients. CONCLUSION: Nodal density assessed by contrasted CT scan in the series did not result in a significant prognostic factor in patients with SCC node metastases treated with HT and XRT. It is suggested that HT could act as a radiosensitizer in the treatment of hypodense (at CT scan) metastatic nodes overcoming the radioresistance of necrotic, presumably hypoxic nodal metastases.

Aged↗
PubMedDate not supplied

Postirradiation sarcoma in a patient treated for testicular seminoma.

A patient with a sarcoma of the left groin at a site where a prior seminoma had been irradiated is presented. Very few postirradiation sarcomas are described in patients treated with radiation therapy for testicular cancers, even if an increased risk of second malignancies has been reported. In contrast with the highly aggressive clinical course of postirradiation sarcomas, an early discovery of the lesion allowed a radical surgical approach with a presumable cure of the patient. A continuous and precise follow-up of patients irradiated for seminoma is suggested.

Adult↗
PubMedDate not supplied

Long-term cosmetic outcome and toxicity in patients treated with quadrantectomy and radiation therapy for early-stage breast cancer.

Breast conservation treatment followed, if useful, by adjuvant therapy is the treatment of choice in early breast cancer. Late cosmetic outcome and toxicity are important in comparing conservative treatment to mastectomy. We reviewed the records of 225 patients treated from 1981 to 1988 with a median follow-up of 74 months (range 12-156 months). Cosmetic results, either reported by the physician (82.4%) or by the patients themselves (81.5%), were generally excellent or good, and tended to decline with time (69 and 75.5%, respectively). Toxicity was mild with arm edema (14.6%) being the most frequent symptom. No severe toxicities were observed. We conclude that overall cosmesis has been acceptable in this series and that a low rate of long-term toxicity can be expected with this conservative approach.

Breast Neoplasms↗
PubMedDate not supplied

Quality of life in patients with early stage breast carcinoma treated with conservation surgery and radiotherapy. An Italian monoinstitutional study.

AIMS: To evaluate the quality of life (QOL) in patients with early stage invasive carcinoma of the breast treated with conservative surgery and postoperative irradiation. METHODS: A mailed survey to examine QOL was conducted in 227 subjects with breast cancer treated in 1990 and 1994 with conservation surgery plus definitive irradiation. The self-compiled questionnaire was developed based on a series of 38 items assessing six core areas of QOL. Furthermore, the patients were requested to evaluate the degree of information provided by the medical staff concerning the disease, the treatment and related side effects and to evaluate the effects of the treatment on their social, overall QOL, and health status. RESULTS: The questionnaire was completed by 156 patients (68.7%) who had a median age of 56 years (range, 28-75 years) at the time of treatment and 59 years (range, 31-82 years) at the time of the study. The physical condition was reported to be good. Data relating to sexual life were provided by more than 90% of the patients. Some limitations in sexuality, some interference with sexual desire, and some modifications during intercourse were reported by 11, 11, and 10 patients, respectively. The subjective evaluations of the cosmetic results of the therapies were judged good-excellent by 56% of the patients, 12 (8%) only had a negative perception of their body image. Twenty-five percent of the sample declared that they felt tense, 19% nervous, 18% lonely, 27% anxious and 16% depressed. Only six patients (4%) declared that the treatment had had a bad on their social life, and 18 (11%) thought that their health status has been affected by the treatment. A worsening of QOL due to the disease or the treatment was reported by 8% of the responders. The amount of information received concerning the treatment and its side effects was considered sufficient by most of the patients. CONCLUSIONS: The results of the study revealed a satisfactory health-related QOL in patients treated with breast conservation and postoperative irradiation. A preserved favorable body image and lack of a negative impact on sexuality was observed, even though about half of the patients reported a negative judgement on esthetic outcome. Some patients had persistent psychosocial concerns. No significant additional problems attributable to radiation therapy capable of affecting QOL outcomes were reported.

Adaptation, Psychological↗
PubMedDate not supplied

Choroidal metastasis from carcinoma of the hypopharynx: a case report.

Choroidal metastasis from primaries other than breast or lung cancer is a rare event. There is no documented case in the literature of choroidal metastases in patients with hypopharynx carcinoma. Early treatment with radiation therapy provides effective palliation by preserving visual function and preventing the need for enucleation. Chemotherapy alone does not seem to be as effective as radiation therapy for patients with choroidal metastases. In this paper a case of choroidal metastasis arising from a primary hypopharynx carcinoma is presented.

Aged↗
PubMedDate not supplied

Subclinical ductal carcinoma in situ of the breast: treatment with conservative surgery and radiotherapy.

AIMS AND BACKGROUND: In spite of the fact that ductal carcinoma in situ (DCIS) of the breast is a frequently encountered clinical problem, there is no consensus about the optimal treatment of clinically occult (i.e., mammographic presentation only) DCIS. Interest in breast conservation therapy has recently increased. Few data are available in Italy on the conservative treatment with surgery and adjuvant postoperative radiotherapy. METHODS: A retrospective multi-institutional study was performed in 15 Radiation Oncology Departments in northern Italy involving 112 women with subclinical DCIS of the breast treated between 1982 and 1993. Age of the patients ranged between 32 and 72 years (median, 50 years). All of them underwent conservative surgery: quadrantectomy in 89, tumorectomy in 11, and wide excision in 12 cases. The most common histologic subtype was comedocarcinoma (37%). The median pathologic size was 10 mm (range 1 to 55 mm). Axillary dissection was performed in 83 cases: all the patients were node negative. All the patients received adjunctive radiation therapy with 60Co units (77%) or 6 MV linear accelerators (23%) for a median total dose to the entire breast of 50 Gy (mean, 49.48 Gy; range, 45-60 Gy). Seventy-six cases (68%) received a boost to the tumor bed at a dose of 8-20 Gy (median 10 Gy) for a minimum tumor dose of 58 Gy. RESULTS: At a median follow-up of 66 months, 8 local recurrences were observed, 4 intraductal and 4 invasive. All recurrent patients had a salvage mastectomy and are alive and free of disease at this writing. The 10-year actuarial overall, cause-specific, and recurrence-free survival was of 98.8%, 100%, and 91%, respectively. CONCLUSIONS: The retrospective multicentric study, with a local control rate of more than 90% at 10 years with 100% cause-specific survival, showed that conservative surgery and adjuvant radiation therapy is a safe and efficacious treatment for patients with occult, non-palpable DCIS.

Adult↗
PubMedDate not supplied

Intracavitary hyperthermia: construction and heat patterns of individualized vaginal prototype applicators.

Patients who have inoperable or previously irradiated cervical recurrences, especially if very confined and alone, pose a challenging problem to the clinician. Low-dose irradiation and hyperthermia seems to be a promising method for salvage treatments in previously treated patients. In order to heat the vaginal apex, individualized prototype applicators utilizing commercial microwave antennas were constructed and tested in muscle equivalent phantom. The technical construction of vaginal applicators followed Pierquin's procedure for gynaecological brachy-therapy moulds: (1) a true negative vaginal print in alginate was made; (2) a positive mould in plaster of Paris was then constructed; (3) a negative vaginal print was produced in plaster of Paris and (4) heat moulding of a 0.1 cm thick sheet of cellulose acetate on the plaster mould was accomplished. Interstitial microwave antennas were inserted within the applicator and kept in place using silk wires or Teflon rings. The external part of the applicator was thermally sealed and protected with silicone. This was particularly useful in cases where an inner cooling system was required. Heat patterns in tissue equivalent phantom materials were determined using non-perturbing probes and infrared thermography. An illustrative clinical case is described.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Use of 5-fluorouracil, epirubicin and mitomycin C (FEM) as adjuvant therapy in node-positive, radically-resected gastric cancer patients: survey of a general hospital experience.

Between 1/1986 and 6/1996, 37 consecutive patients affected by node-positive gastric cancer (GC) were treated with radical surgery and received 5-fluorouracil, epirubicin and mitomycin C (FEM) as adjuvant treatment. Only 57% of the patients received all six cycles and the reasons for treatment withdrawal were mainly related to concomitant pathologies and prolonged leukopenia. After a median follow-up of 39 months, the 3-year disease-free survival, disease-related survival and overall survival were 75.8%, 83.7% and 78.6% respectively. A statistically significant difference in survival was found in the subgroup of patients receiving more than three courses of treatment.

Adult↗
PubMedDate not supplied

Ocular metastases from breast carcinoma: A multicentric retrospective study.

Breast cancer may affect the eye and orbit by metastatic neoplastic infiltration, uvea being the most common site of presentation. Management of these cases with radiotherapy is usually gratifying with reported response rate of approximately 75%. A retrospective evaluation of cases treated in five Institutions participating in a collaborative radiation therapy group of north-Italy is reported. Fifty-four cases of metastases to the eye or orbit were referred for radiation therapy to the Departments participating in the survey in the period 1977-1995. There were 49 female patients aged between 28 and 75 years (median, 44 years) at presentation of orbital metastasis. Thirty-eight lesions (70%) were metastases to the choroid, 9 involved other parts of the eye, and 7 patients had orbital metastases. Five of the 49 patients had bilateral choroidal metastases. Radiotherapy was employed with megavoltage equipment. The median total dose delivered was 40 Gy (range, 16-60 Gy). All the patients were treated 5 times per week with fraction sizes ranging from 1.8 to 3.0 Gy (median, 2.0 Gy). Of the 43 evaluable eyes, 34 (79%) showed a definite improvement after radiotherapy. There was a stabilization of the process in 4 patients. The rest (11 lesions) were lost to detailed follow-up of the response of the eye metastases. Twelve patients experienced acute transient cheratoconjunctivitis and in a case a subconjunctival haemorrhage was observed; as late side effects, two cases of chataract were observed during a period of observation of 37 and 117 months. A median survival time of 17 months was observed. The goal of irradiation was to improve vision or at least prevent blindness and enucleation. The palliative effect of irradiation was confirmed with a response rate consistent with the data of the literature on this subject.

Adult↗
PubMedDate not supplied

Primary non-Hodgkin's lymphoma of the female genital tract.

Genital tract lymphoma is a rare disease; information on diagnosis, treatment and outcome are limited. We report on eight patients affected by non-Hodgkin's lymphoma of the genital tract, five from the cervix, two from the vagina and one from the vulva collected between 1987 and 1998. Age at presentation ranged from 36 to 82 (median 67) years. The commonest initial symptom was vaginal bleeding, post coital in 1 patient. Three patients complained of vescical symptoms. Ann Arbor classification was stage IAE for 6 patients. Histology, according to the IWF, was either intermediate grade (4 patients), or high grade (3 patients), not evaluable in one case. Seven patients were treated with chemotherapy (anthracycline based in four) followed by pelvic radiotherapy in five; one patient received irradiation alone. Five patients are currently alive and free of disease with follow-up ranging from 8 to 126 months. Based on our experience in this series, we support a management scheme of combination chemotherapy and radiotherapy for patients with non-Hodgkin's lymphoma of the genital tract.

Adult↗
PubMedDate not supplied

[Quality radiotherapy in rectal cancer].

The quality of radiotherapy significantly impacts on the results of treatment, in patients with rectal carcinoma, especially in terms of acute and late toxicity. Based on this assumption, the Italian Association of Radiation Oncology (AIRO) formulated a document aimed to define the standards of radiation treatment for rectal carcinomas. Two different levels of standard were described: a first level, considered as "minimal requirement", and a second level, considered as "optimal treatment". A retrospective evaluation, based on a questionnaire, revealed that in 1996, in most Italian Centers, patients affected by rectal carcinoma received radiation treatment within the first level of proposed standards. A subsequent analysis concerned the evaluation of the level of treatments applied in 2000. In this paper the radiotherapy standards proposed by the AIRO are described in the different phases of the radiation treatment.

Humans↗
PubMedDate not supplied

[Neoadjuvant radiochemotherapy treatment in locally advanced rectal adenocarcinoma].

A prospective phase II study was conducted to evacuate toxicity and results of preoperative radiochemotherapy in locoregionally advanced rectal cancer (LARC). A total of 33 patients entered the study and received 45 Gy to the pelvis plus a supplemental boost of 5.4-9 Gy concurrently with 5 FU c.i. at a dose of 225-275 mg/m2. Thirty patients were operated after 5-7 weeks (20 anterior resection and 10 abdominoperineal excision). In 14 patients (47%) a downstaging was observed, 5 patients experienced a complete clearance of the primary tumor. After a median of 14 months (range, 5-27), 23 patients, are alive and well. And 8 patients experienced a disease progression (4 local-regional and 4 distant). Our results provide further evidence of the utility and effectiveness of preoperative radiochemotherapy in LARC.

Adenocarcinoma↗