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Biomedical subjects

V Valentini

Publications and source records attributed to V Valentini.

At least 109 records · Page 6Linked to original sources
PubMedDate not supplied

[Role of computerized tomography in the definition of the area to be irradiated in bone metastases].

In the Department of Radiology of the Catholic University S. Cuore in Rome, a review was made of 342 CT examinations with a view towards optimizing the therapeutic planning in patients affected by bone metastases. All patients were submitted to radiological positioning and then to CT evaluation in order to assess the volume to be treated. In 224 cases it was not necessary to perform wide CT examination (3-5 standard tomograms being enough, 2 of which at the superior and inferior margins of the planned field). In the second group of 118 patients it was necessary to perform CT (serial axial scans)--increasing by 1-1.5 cm--up to the superior and inferior margins of the lesion. The existence of 2 types of lesions was confirmed: those involving mainly bony structures and those infiltrating the soft tissues. CT evaluation allowed the definition of the target volume to the real extension of the lesion in 14% of the whole of cases, while in the group of 118 cases studied more thoroughly, the percentage went up to 41%. CT allowed a better assessment of secondary bone lesions, especially in kidney and lung neoplasms. The metastatic site that required a more frequent modification of the irradiation field was the chest. To conclude, the authors emphasize the importance of CT in assessing the target volume, especially in those cases in which conventional radiology does not allow a reliable evaluation of the lesion, possibly compromising the local monitoring of the disease.

Bone Neoplasms↗
PubMedDate not supplied

Radiotherapy in rectal cancer: stage of the disease and therapeutic approach.

Rectal cancer requires treatments tailored according to the stage of the disease at diagnosis. In stage I lesions exclusive surgery is the elective treatment. Radiotherapy is used in those cases where the site of the lesion would sacrifice sphincter function. When the features of neoplasm are favourable (size < 5 cm, grading 1-2, histological type adenocarcinoma) local excision and postoperative radiotherapy enable to achieve results comparable to those of radical surgery. In operable lesions (T3-T4 (vagina) N0-2, M0) at high risk for local recurrence, high dose preoperative radiotherapy in some randomized studies has shown a significant improvement in local control and survival with a low toxicity, especially in patients undergoing radical surgery. Concomitant chemotherapy in postoperative radiotherapy has significantly improved local control and survival as compared to radiotherapy alone. Continuous infusion appears to reduce the toxicity, which is otherwise high. Randomized studies of preoperative radiochemotherapy vs radiation alone or vs postoperative radiochemotherapy are in progress in various Centers. Intensification with radiotherapy alone (IORT, fractionation) is also under study. In lesions unresectable for cure (T4, N0-3, M0) radiotherapy alone or combined with surgery did not show significant results. Intensification with concomitant chemotherapy and/or with IORT has enabled over 70% local control and 50% 5-year survival.

Adenocarcinoma↗
PubMedDate not supplied

Combined modality therapy in low risk (T2N0) rectal cancer.

The authors' experience with local excision (LE) and adjuvant radiotherapy in the treatment of selected cases of rectal cancer, is reported. 41 patients with distal rectal cancer underwent elective LE for cure. Selection criteria were: the site of tumor in the lower rectum, exophytic growth, maximum diameter equal to or lower than 4 cm, tumor "freely" mobile on the rectal wall, clinical staging T1-2 N0M0, histological grading G1-2. Patients shown to be T2 on definitive histology underwent adjuvant radiotherapy to the site of tumor and to pelvic lymph nodes. LE was performed via transanal route under general anesthesia. Operative mortality was 0% and morbidity 7.3%. In 37 cases (90%) surgery was considered radical and curative. The incidence of local recurrence was 5.4%, overall evidence of disease 8.1%, cancer-specific mortality 5.4% and 5-year actuarial survival 90%. The combination with radiotherapy has achieved similar results in T1 (22 cases) and T2 (15 cases) tumors. It is concluded that LE combined with radiotherapy in T2 tumors in selected cases represent a valid therapeutic alternative to more demolitive surgery.

Adenocarcinoma↗
PubMedDate not supplied

Combined modality staging of high risk rectal cancer.

The personal experience with the radiologic staging of high risk rectal cancer undergoing preoperative treatment is reported. 61 patients shown to be affected by locally advanced (T3-T4, N+with any T) rectal tumors on combined modality staging, underwent restaging 4-5 weeks after treatment. In all patients liver US, pelvic CT and colorectal enema were performed before and after treatment. In 22 patients with low rectal cancer transrectal sonography was performed. In 19 patients pelvic MRI was performed. The 61 patients were considered operable on second staging and thus referred to surgery. Subsequent control on histology has confirmed the diagnostic accuracy of the single procedures and of their combination. US was shown to be of high accuracy in the evaluation of T (90.8%) and of high predictive value for N. CT accuracy (84%) and MRI accuracy (78.9%) was lower because both tend to overstaging in the evaluation of T of rectal tumors undergoing preoperative treatment. Low CT accuracy (64%) and MRI accuracy (58%) was observed for N. There was optimum agreement between histology and imaging in the assessment of tumor shrinkage, well visualized by rectal enema which supported combined restaging with 88% accuracy for T.

Combined Modality Therapy↗
PubMedDate not supplied

Intraoperative radiation therapy (IORT) in rectal cancer: methodology and indications.

In intraoperative radiation therapy (IORT) a high dose of radiation is delivered to the tumor or to the tumor bed, thus favouring local control with no significant increase in toxicity. At present it is used to deliver a boost dose of radiation for rectal cancer in protocols which include preoperative external beam radiation therapy (ERT). From various experiences carried out in a number of centers, the technical and methodological features of this procedure have been defined also relatively to cost-effectiveness in terms of a longer surgical treatment, involved specialized staff and resources. At the 5th IORT International Congress held in Lyon in September, 1994, of over 70 clinical studies reported, 15 were on rectal cancer with about 700 patients undergoing IORT. The growing interest in the use of this procedure in rectal cancer is explained by the natural history of the disease, burdened with a high rate of local recurrence, and by the possibility of preventing it with high doses of radiation. In primary tumors unresectable for cure and in local recurrence it is evidenced that ERT+surgery+IORT enable an improvement in local control and survival as compared to ERT alone. Results are better when surgery is radical. Several studies deal with the role of preoperative combined concomitant radiochemotherapy which can favour a radical surgery. A sizeable percentage of these patients will present with metastasis, thus adjuvant chemotherapy seems suitable. A role of IORT is envisaged also for resectable high risk tumors, however results should be confirmed by larger clinical series.

Combined Modality Therapy↗
PubMedDate not supplied

Concomitant radiochemotherapy in rectal cancer: methodology and indications.

Concomitant radiochemotherapy (CRC) is based on the administration of chemotherapeutic agents concurrently with radiation therapy. It is aimed at the spatial cooperation of radiotherapy (ERT) and chemotherapy and the enhancement of the local action of radiotherapy. In this study the role of ERT enhancement in the treatment of rectal cancer, is analyzed. 5FU is the commonly used drug. Clinical and experimental evidence indicates radiotherapy to be enhanced when the drug is administered in continuous infusion after radiation and for a suitable dose of 5FU. In these conditions, toxicity is usually mild. In contrast, when the drug is administered as bolus, the experimental evidence seems to indicate only additivity. However the clinical experience has shown an improvement in local control and survival at the expense of a higher toxicity. In patients with resectable lesions at high risk for local recurrence, randomized CRC studies have shown a high rate of local control between 85% and 90%, a 5-year survival between 55% and 60%, significantly better as compared to control arms: exclusive surgery (GITSG7 175), exclusive ERT (NCCTG), bolus CRC (Intergroup). Acute toxicity is mostly hematological and gastrointestinal. In patients with lesions unresectable for cure, CRC allows high surgical radicality (85-90%). Complete pathologic response is 4 to 20%. Local control is high (80-90%) and 3-year survival is 70 to 90%. Grade 3-4 acute gastrointestinal toxicity was shown to be higher in combinations with bolus 5FU. In recurrence CRC has been used for palliation. Control of pain to the pelvis was similar to that achieved with radiotherapy alone. In a single experience was CRC used preoperatively and results seem encouraging.

Combined Modality Therapy↗
PubMedDate not supplied

[Intraoral reconstruction with radial forearm flap].

The intraoral region include structures that represent a functional matrix for the physiology of this region. The reconstructive problems of this area are centred around difficulties to obtain thin flaps that provide coverage without excessive bulk and uninhibited tongue motion. For this regions the radial forearm flap is particularly suited to intraoral reconstruction because it is thin, minimally hair bearing and with moderate donor site morbidity. The Authors report their experience in 6 cases of intraoral reconstruction with radial forearm flap and analyzes it's surgical, anatomical and anatomopathological features. The advantage, the svantage and the indications of this flap are discussed.

Aged↗
PubMedDate not supplied

[Surgical treatment of hemangioma of bones of the orbito-zygomatic region].

The incidence of intraosseous haemangiomas is very low. The mandible, the zygoma, the maxilla and the frontal bone are the most frequent areas of localization in the craniomaxillofacial region. Pain and swelling are the most important symptoms of these tumors when they are localized in the orbit or in zygoma. Surgery, without preoperative embolization is always the best treatment for intraosseous haemangiomas of the zygoma. The radical removal of the tumor frequently causes a plain aesthetical loss which has to be restored. Calvarial grafts are a good solution to the problem of reconstruction of bone loss. They are easy to prepare, near to the implant zone, and they don't need changes of the patient's position during the operation. The implants fixed by mini- and micro-fixation systems provide a good functional and aesthetical result. The authors, after a review of the literature about intraosseous haemangiomas of the cranio-maxillofacial region, report two cases of intraosseous haemangioma of the zygoma in which removal of the tumor and reconstruction with calvarial grafts has been performed.

Bone Neoplasms↗