Combined radiation and chemotherapy in lung cancer: preliminary results.
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Adult↗
Biomedical subjects
M Balducci
Publications and source records attributed to M Balducci.
Brachytherapy in prostatic carcinoma: technical considerations.
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Brachytherapy↗
Carcinoma of the pancreatic head area. Therapy: concomitant radiochemotherapy.
A series of studies carried out by the Gastrointestinal Tumor Study Group have shown the efficacy of the combination of external beam radiotherapy (ERT) and 5-fluorouracil (5-FU) chemotherapy (CHEM) in unresectable and resectable tumors of the exocrine pancreas. In the former in particular, this method was shown to be superior to ERT alone as well as to polychemotherapy alone. In these studies 5-FU was administered during (concomitant chemotherapy: C-CHEM) or after ERT (adjuvant chemotherapy: A-CHEM). This led several authors to consider this combined treatment as reference standard for pancreatic carcinoma. Its prognosis is still definitely poor because of the difficult local eradication as well as because of the frequent early distant spread, especially at the abdominal level (hepatic and peritoneal). An improvement of present results may stem from the combination of ERT+C-CHEM +/- A-CHEM with methods of dose intensification at the local level (e.g. IORT) concurrently with the use of treatments aiming at a better control of the abdominal spread (e.g. ERT+C-CHEM for prophylaxis of the liver or upper abdomen).
Antimetabolites, Antineoplastic↗
START: an advanced radiation therapy information system.
START is an advanced radiation therapy information system (RTIS) which connects direct information technology present in the devices with indirect information technology for clinical, administrative, information management integrated with the hospital information system (HIS). The following objectives are pursued: to support decision making in treatment planning and functional and information integration with the rest of the hospital; to enhance organizational efficiency of a Radiation Therapy Department; to facilitate the statistical evaluation of clinical data and managerial performance assessment; to ensure the safety and confidentiality of used data. For its development a working method based on the involvement of all operators of the Radiation Therapy Department, was applied. Its introduction in the work activity was gradual, trying to reuse and integrate the existing information applications. The START information flow identifies four major phases: admission, visit of admission, planning, therapy. The system main functionalities available to the radiotherapist are: clinical history/medical report linking function; folder function; planning function; tracking function; electronic mail and banner function; statistical function; management function. Functions available to the radiotherapy technician are: the room daily list function; management function: to the nurse the following functions are available: patient directing function; management function. START is a departmental client (pc-windows)-server (unix) developed on an integrated database of all information of interest (clinical, organizational and administrative) coherent with the standard and with a modular architecture which can evolve with additional functionalities in subsequent times. For a more thorough evaluation of its impact on the daily activity of a radiation therapy facility, a prolonged clinical validation is in progress.
Medical Records Systems, Computerized↗
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↗
Quality assurance procedures in radiotherapy of breast cancer.
In breast cancer, the multidisciplinary therapeutic approach is most commonly used. Radiotherapy, involving neoplastic targets and healthy tissue tolerance already modified by other treatments, in the various phases is burdened with problems and uncertainties which condition treatment quality. Within the four phases of prescription, planning, implementation and follow-up, the authors analyze some uncertainties that impact on the quality of radiation treatment complementary to conservative surgery. PRESCRIPTION: it is the phase where the radiotherapist defines the target volume and the dose to be delivered. Uncertainties remain in CTV2 definition (boost); the not frequent placement of metal clips within the surgical cavity and the not perfect correlation between surgical scar and tumor bed, make their identification not always ready. Moreover, the combination with other therapies creates problems also in dose prescription. PLANNING: in CTV1 treatment (breast) particular precautions are necessary to decrease the dose contribution at the pulmonary level and avoid that the breast advances towards the supraclavicular region in the supine position. For CTV2, the interstitial boost is indicated especially in patients with a large breast and deep cancer and in cases of non radical surgery, while external beam boost, most commonly used, is performed with electron beams including the pectoral fascia in the 90% isodose. IMPLEMENTATION: to prevent or limit the incidence of possible random and/or systematic errors during treatment, suitable procedures are required. FOLLOW-UP: it enables the assessment of therapeutic results in terms of efficacy and side-effects. Some controversies still remain on implementation modalities: intensive vs clinical.
Breast Neoplasms↗
Quality assurance in radiotherapy of prostatic cancer.
External beam radiotherapy is a widely experimented treatment modality in prostatic cancer. Recently published studies have documented a close dependence of clinical results, in terms of local control and toxicity in particular, on radiation therapy quality. Efforts to improve results of conventional radiotherapy were directed towards the identification of new therapeutic modalities (conformal therapy, fast neutron radiotherapy, neoadjuvant hormonotherapy) as well as towards the optimization of treatment accuracy. In this respect, the following procedures have been particularly effective: 1. the systematic use of CT and retrograde urethrography in PTV definition; 2. immobilization systems which allow a significant reduction in positioning errors; 3. checks before and during treatment by "portal imaging" which allow the identification and correction of a relevant percentage of inaccuracies. The general evolution in treatment planning occurred in recent years has introduced into prostatic cancer radiotherapy new methods and calculation algorithms. While at present the use of new and at the same time complex techniques makes the need for quality assurance of radiation treatments increasingly critical, it is in any case a daily requirement even in most conventional routine treatments.
Humans↗
[Out-of-the-hospital care for terminal cancer patients. Clinical and organizational features. Our experience].
Home care for terminal oncological patients is, in Italy and in many other highly developed countries, a rapidly expanding part of the health system. At the time of writing it would appear to be the most valid response to the mounting economic and social demands of the population. The present paper has two purposes: 1) to propose an integrated home care operating model for the cancer patient that comprises various operating stages: a) recruitment of patients on the basis of the seriousness of the cancer, life expectancy and socioeconomic conditions of the family; b) interdisciplinary planning of a personalized care project; c) implementation of an integrated care programme at the home of the patient; d) periodic control of the project team; e) periodic professional courses for health personnel; 2) to illustrate our specific clinical expertise in the sector, in 16 months of activity (October 94-February 96) during which we handled on a home basis 27 cancer patients at an advanced stage of the disease; specifically, we describe the main internal-oncological and palliative type problems encountered during the home care period; 3) finally, to highlight in terms of cost/benefit ratio the economic advantages of home compared to the traditional hospitalization care model.
Adult↗
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↗
Organ preservation in the treatment of brain tumors.
Within the many histological forms, the preservation of function in the central nervous system has always been predominant. However, the limited or null therapeutic interval for high grade gliomas enables organ preservation in small neoplasms only. In case of favorable histology (e.g. dysgerminoma, low grade small glioma), organ preservation is feasible with adequate techniques. When local control is predominant (e.g. neoplasms of eye) the techniques are long known but applied in very few Centers.
Astrocytoma↗
Radiotherapy, local control and survival in brain tumors.
High grade glial brain tumors and brain metastases are a complex subject with still unsatisfactory therapeutic results for the frequent absence of early and precise diagnosis as well as for the limited therapeutic interval between the tumor and presumed healthy tissues. The therapeutic problems of cellular hypoxia, the rapid recovery of sublethal damage for neoplastic cells, the rapid regrowth, have led to a number of efforts to deliver the dose of radiotherapy in various associations. The constant technological trend to increase the high dose gradient to the peripheral tumor, is reported.
Brain Neoplasms↗
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↗