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Maurizio Valeriani

Publications and source records attributed to Maurizio Valeriani.

10 recordsLinked to original sources
PubMed2006

Radiotherapy and sequential temozolomide compared with radiotherapy with concomitant and sequential temozolomide in the treatment of newly diagnosed glioblastoma multiforme.

Our objective was to determine and compare effects of sequential temozolomide vs. concomitant plus sequential temozolomide with conventional radiotherapy, in patients with newly diagnosed glioblastoma multiforme, comparing two independent trials. Sixty-four patients were treated on two consecutive separate phase II studies that used identical eligibility criteria and the same radiotherapy (60 Gy, 2 Gy/day, after surgery) and adjuvant temozolomide (200 mg/m/day for 5 days/28 days until progression), but differed in the absence or presence of a concomitant treatment with temozolomide (75 mg/m/day) during radiotherapy. In the first protocol (1999-2002), 21 patients (median age of 64 years) received radiotherapy alone and sequential temozolomide; in the succeeding protocol (2002-2004), 43 patients (median age of 61 years) with similar characteristics received radiotherapy with concomitant and sequential temozolomide. Median number of adjuvant cycles was five in both trials. Median survival was similar in both studies (18 vs. 17.4 months); overall survival rates at 6, 12, 18 and 24 months of all the population were 89, 69, 45 and 24%. No statistically significant differences were found among prognostic factors considered. Hematologic toxicities were mild and similar, with grade 3-4 neutropenia in 5-7% and grade 3-4 thrombocytopenia in 7-10% of patients in the sequential phases, and grade 3-4 thrombocytopenia in 7% in the concomitant phase of temozolomide. We confirmed that temozolomide combined with radiotherapy is well tolerated and provides a survival advantage compared with historical data using radiotherapy alone. Nevertheless, a concomitant use of temozolomide during radiotherapy does not seem to improve survival, although it does not increase toxicity.

Aged↗
PubMed2004

Pain evaluation and management: a survey of Italian radiotherapists.

GOALS: The objective of this study was to assess the knowledge possessed and the attitudes held by Italian radiotherapists regarding evaluation and treatment of pain. METHODS: One hundred and twenty-six radiotherapists completed a 16-item questionnaire that was specifically designed to investigate three main topics: the attention paid to pain, the use of analgesics, and pain in children. Chi-square or Fisher's exact text was employed to evaluate differences based on position (staff/resident), age (<35 or >35 years old), availability of consultants in pain therapy and/or palliative care, colleagues with main interest in palliative care among their own staff, and region of residence (north/center/south of Italy). RESULTS: Overall percentage of correct answers was 76.6% (range 34.9-94.4%). Correct answers by groups of items were: attention paid to pain 77.3%, use of analgesics 81.5%, and pain in children 63.7%. CONCLUSION: Results of the survey demonstrate that knowledge and attitudes of Italian radiotherapists towards the approach to and treatment of pain can be considered satisfactory.

Adult↗
PubMed2003

Short course radiation therapy for elderly cancer patients. Evidences from the literature review.

The choice of the appropriate treatment strategy for elderly cancer patients may be a difficult challenge. Radiation therapy is commonly offered to these patients, but treatment duration may represent a limiting factor, as many patients cannot tolerate a conventional course of radiotherapy (RT) due to age-related medical or logistic problems. Hypofractionated RT may represent a very convenient choice, but it entails an increased risk of late toxicity occurrence. We made a literature review to define the possible role of hypofractionated RT for elderly cancer patients. As expected, we found out that short irradiation schedules are more commonly employed for treatments with palliative aims but a more widespread use of these regimes is still controversial. The lack of prospective trials tailored for these patients makes even more difficult to tailor the choice of treatment on standardised treatment guidelines. Nevertheless our review highlights that for several tumour types RT can be scheduled conveniently and effectively in order to achieve local disease control and/or symptom relief with the least discomfort and treatment-related morbidity for elderly patients.

Aged↗
PubMedDate not supplied

Neoadjuvant chemoradiation for locally advanced carcinoma of the rectum.

AIMS AND BACKGROUND: The aim of this paper is to confirm the efficacy to reduce incidence of relapses, to increase rates of conservative radical surgery and eventually survival of concomitant neo-adjuvant chemo-radiotherapy. METHODS: From January 1992 to October 1999, 140 stage II (50.7%) and III (49.3%) patients with adenocarcinoma of the rectum were treated with concomitant chemoradiotherapy followed by radical surgery. Treatment consisted of 25 fractions of 180 cGy (5 days per week), for a total dose of 45 Gy on the whole pelvis. Chemotherapy consisted of 5-FU (350 mg/m2) and leucovorin (10 mg/m2) in bolus for 5 days on days 1-5 and 29-33 of radiation. After an interval of 4-6 weeks, all patients were submitted to surgery. RESULTS: The median follow-up was 48 months (median, 1-97). At 5 years the overall survival was 71.3% and relapse-free survival was 79.4%. The rate of local control was 90%. Twenty-two (15.7%) patients developed distant metastases. All patients underwent surgery: 26 (18.6%) local excision, 79 (56.4%) anterior resection, 33 (23.6%) abdomino-perineal resection, and 2 (1.4%) Hartmann resection. Consequently, 107 cases (75.4%) underwent conservative surgery. At the time of surgery, 34 patients had negative specimens (24.3%), 45 were in stage I (32.2%), 31 in stage II (22.1%), 32 in stage III (21.4%). The incidence of any grade 3 acute toxicity (WHO) was 5% diarrhea, 20% tenesmus and 11.4% myelosuppression. CONCLUSIONS: The results of this study confirm good tolerance, minor surgery-related complications and efficacy of this regimen on local and distant disease control, with a high percentage of sphincter-saving surgery.

Adenocarcinoma↗
PubMedDate not supplied

Radiotherapy alone and chemoirradiation in recurrent squamous cell carcinoma of the vulva.

AIM: To evaluate the role of radiotherapy alone or combined with chemotherapy in the treatment of recurrent vulvar cancer, emphasising the prognostic factors and outcomes. MATERIALS AND METHODS: Twenty women with loco-regional recurrence of vulvar carcinoma were retrospectively reviewed. Eleven patients were managed with a combination of chemotherapy and radiotherapy, seven out of these with concomitant radio-chemotherapy and four with neo-adjuvant chemotherapy. Nine patients were submitted to radiotherapy alone. The total dose of radiation therapy ranged from 30 Gy to 70 Gy. RESULTS: The median follow-up was 6 months (range 2-70 months). The 5-year overall and disease-free survival for the entire cohort was 20%. The outcomes included 6 complete response (CR), 10 partial response (PR) and 4 no change (NC). Patients with one site of recurrence and size of lesion < or = 3 cm were long survivors and disease-free at 5 years; all these women received a total dose of radiation therapy > or = 6480 cGy. CONCLUSION: We emphasize the importance of the number, site and diameter of recurrences as prognostic indicators; the outcomes of these patients were also affected by the total dose of radiation therapy.

Aged↗
PubMedDate not supplied

Radiotherapy in the treatment of stage III-IV hypopharyngeal carcinoma.

BACKGROUND: The aim of this study was to evaluate the role of radiation therapy alone, employing standard fractionation, in stage III-IV hypopharyngeal carcinoma. MATERIALS AND METHODS: Fourteen (38.9%) stage III and 22 (61.1%) stage IV patients with hypopharyngeal carcinoma were submitted, with curative intent, to exclusive radiotherapy to the primary tumor and regional draining lymph nodes, level II, III, IV, V and VI. Total dose ranged from 68 to 72 Gy. RESULTS: The 5-year overall survival (OS) and disease-specific survival (DSS) rates were 15.6% and 28.1%, respectively. Five-year OS in stage III and IV patients was, respectively, 33% and 5% (p=0.028) and DSS was, respectively, 50% and 16% (p=0.029). Five-year OS and DSS rate in N0 versus N+ patients were respectively 37.5% and 75% versus 8.3% and 12.5% (p=0.07 and p=0.05). CONCLUSION: Overall survival at 5 years for III-IV hypopharyngeal tumor treated with radiotherapy alone is poor. It is possible that the addition of the best radiation fractionation to the best concurrent chemotherapy may improve the results, with acceptable toxicity.

Aged↗
PubMedDate not supplied

Carcinoma of the vulva: clinical results of exclusive and adjuvant radiotherapy.

BACKGROUND: The aim of this study was to evaluate the historical cohort of 61 patients with carcinoma of the vulva, treated with radiation therapy from 1986 to 1997. PATIENTS AND METHODS: Twenty-seven patients were submitted to radiation therapy alone and 34 received radiotherapy post limited surgery in early stages and post radical vulvectomy in advanced stages. The dose range varied from 59 to 63 Gy in post-operative patients and 65 Gy to 71 Gy in curative patients. RESULTS: Five-year Overall Survival (OS) and Disease-Free Survival (DFS) for patients treated with irradiation alone and for those treated with post-operative radiotherapy were 50.8% and 69.7%, respectively, without significant statistical difference. For OS multivariate analysis showed statistical difference for stage and age variables, and for stage variable in the case of DFS. CONCLUSION: In early stage vulvar cancer patients OS and DFS are good, with high control rate and low incidence of adverse effect. In loco-regionally-advanced patients, especially in those with stage IV or with > 2 positive lymph nodes, the outcomes are poor.

Aged↗
PubMedDate not supplied

Dose-finding study of docetaxel added to ifosfamide and cisplatin followed by concomitant capecitabine and radiotherapy in the treatment of locally advanced squamous cell carcinoma of the head and neck.

BACKGROUND: Docetaxel (DOC) is a promising new drug in the management of squamous cell carcinoma of the head and neck. The aim of this phase I study was to determine the toxicity and maximum tolerated dose (MTD) as well as to obtain preliminary data on the activity of DOC combined with fixed doses of ifosfamide (IFO) and cisplatin (CDDP), followed by concomitant capecitabine (C) and radiation therapy in the organ-sparing treatment of patients with locally advanced, inoperable squamous cell carcinoma of the head and neck (A-SCCHN). PATIENTS AND METHODS: Chemotherapy and radiotherapy-naive patients with A-SCCHN were treated in cohorts of three with escalating doses of DOC administered on day 1. The doses of DOC ranged from 40 mg/m2 up to the dose-limiting toxicity (DTL). Fixed doses of IFO (1200 mg/m2) with mesna and CDDP (20 mg/m2) were administered on days 1 to 4, every 4 weeks. Patients who had achieved a response received definitive radiation therapy (6000 cGy) concomitantly with C (1000 mg/m2/day). RESULTS: Twenty-four patients were entered into the study. The MTD of DOC was 70 mg/m2. A total of 99 courses of chemotherapy were given. Grade 3 and 4 hematological toxicities were observed in twelve and nine patients, respectively, while grade 3 gastrointestinal toxicity occurred in four patients. Concomitant C and radiation therapy demonstrated a tolerable toxicity profile. An overall response rate of 83.3% (95% CI: 65.6% to 95.2%) was obtained, with a median time to progression and overall survival of 15.6 and 22.3 months, respectively. CONCLUSION: Out-patient administration of DOC, IFO and CDDP for A-SCCHN was safe and did not affect the ability to administer chemoradiotherapy on schedule. Myelosuppression was the DLT.

Adult↗
PubMedDate not supplied

High-grade gliomas: results in patients treated with adjuvant radiotherapy alone and with adjuvant radio-chemotherapy.

BACKGROUND: Despite advances in the surgical, radiotherapeutic and chemotherapeutic fields, the outcome for patients with high-grade gliomas remains poor. Our experience of patients treated with and without chemotherapy is reported. MATERIALS AND METHODS: From April 1999 to July 2003, 30 patients with high-grade gliomas were treated: 13 received adjuvant radiotherapy (RT) alone whereas 17 received temozolomide 75 mg/m2/d during the irradiation time and 200 mg/m2 daily per 5 consecutive days, every 28 days for three to six cycles, starting 4 weeks after the end of radiotherapy. RESULTS: The median follow-up was 12.5 months. The median overall survival (OS) was 15 months. In patients treated with RT plus chemotherapy, no statistical difference was observed between those who had undergone partial surgical resection and those with total resection (p=0.5128). In patients with glioblastoma multiforme (GBM) treated with combined radiochemotherapy, the median OS was 18 months, while it was 7 months (p=0.0204) in those treated without chemotherapy. Multivariate analysis (Cox model) evidenced statistical differences for performance status (p =0.002) and for the type of adjuvant therapy (p=0.006). CONCLUSION: Radio-chemotherapy plus adjuvant temozolomide seemed to offer the best results in patients not submitted to debulking surgery. The performance status remained the most important prognostic factor. Tolerance to the combined regimen was very good.

Adult↗