Bone marrow transplantation for leukemia in Genova.
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Adolescent↗
Biomedical subjects
V Vitale
Publications and source records attributed to V Vitale.
[Ewing's sarcoma. Results of treatment in 16 consecutive cases].
In the period January 1974-August 1981, 16 previously untreated cases of Ewing's Sarcoma have been diagnosed at the Giannina Gaslini Children's Hospital Genova. Eight were male, eight female. Median age at diagnosis was 11 years. Two patients presented with a unique metastatic lesion, in the right lung and in an illiac lymph node, respectively. Fourteen patients have been initially treated with local radiotherapy (dosages ranging form 4,800 to 6,600 rads) in association with antiblastic polichemotherapy utilizing 4 drugs (Adriamycin, Actinomycin D, Vincristine, Cyclophosphamide). The Rosen et al.'s T-2 protocol was adopted, modifying the initial phase in order to give more weight to Adriamycin and reduce the toxic effects related to radio-chemotherapy combination. Two patients bearing a costal primary were immediately treated with a more complex and aggressive chemotherapy (T-6 Protocol), followed by local irradiation (in one case preceded by surgical ablation) and then chemotherapy again (T-2 protocol, second phase) for 10 months. Treatment determined a fast subjective relief in the 13 symptomatic patients. All 16 cases achieved a status of complete remission. Four of them subsequently relapsed: locally in two, in distant sites in the remaining 2. All 4 died 12-27 months form diagnosis. Twelve patients are presently alive without evidence of disease at 3-92 months (median 37 months) following diagnosis. Treatment has caused early and delayed toxicity in all cases. However, the entity of these complications varied considerably from one patient to an other. Age at diagnosis and site of primary tumor were the factors most relevant in this respect.
Adolescent↗
Prophylactic brain irradiation: still an open question (review).
Prophylactic cranial irradiation (PCI) is still an open question despite the fact that ten randomized trials have been published in the past, addressing its impact on overall survival, disease-free survival and incidence of brain recurrences. The majority of these trials allow us to conclude that PCI is only useful in reducing the rate of brain recurrences, without any impact on survival. Nevertheless, there are some isolated monoinstitutional papers indicating a positive impact on survival. As all the published trials vary in the schedule and timing of cranial irradiation, patient selection and systemic treatment, all these factors can explain the impossibility of demonstrating survival effects in individual studies and the difficulty of collecting homogeneous data from their overview. However, even the limited benefit of a reduction in the rate of CNS relapses, shown by most of these studies, appears important due to the poor symptom relief and quality of life of the patients treated for clinically evident brain metastases. The occurrence of late CNS toxicity in prophylactically irradiated patients may hamper a clinical advantage in these individuals.
Brain↗
[The prognostic role of the parameters of cellular kinetics in head and neck tumors treated solely by radiotherapy].
Cell cycle and cell population characteristics, as obtained for head and neck cancers by flow-cytometry analysis of a single tumor sample, after in vivo bromodeoxyuridine (Burd) infusion, were proposed for their prognostic value and for their potentials for radiotherapy planning (conventional vs accelerated) and monitoring. DNA ploidy, the S phase fraction labeling index (LI), and duration (Ts) as well as cell population potential doubling time (Tpot) were measured in 42 head and neck squamous cell carcinoma patients and analyzed along with histopathological and clinical data. Twenty-seven patients received standard radiotherapy (70 Gy/35 fractions/7 weeks) whereas 15 patients were treated with the concomitant boost technique (75 Gy/40 fr/6 weeks). The univariate analysis of 31 patients, for whom all the cell kinetic parameters were available, indicated that local control probability was strongly affected by lymph node status (p = 0.05) and by potential doubling time (p = 0.04). Patients having tumor Tpot < 5 days had markedly lower two-year local control rate (13%) than patients with Tpot > 5 days (68%). Furthermore, tumors with Tpot < or = 5 days exhibited a trend toward better local control after concomitant boost regimen compared with the patients treated with standard regimen (p = 0.06). These preliminary results point out that Tpot could play a role as additional prognostic factor influencing disease outcome in head and neck carcinomas treated by radiotherapy. In patients with fast growth-rate tumors (Tpot < or = 5 days) a more aggressive radiotherapy combination or chemo-radiotherapy should be suggested.
Actuarial Analysis↗
In vivo cell kinetics in elderly patients affected by squamous cell carcinoma of the head and neck.
The purpose of the study was to determine whether pretreatment tumor cell kinetics can predict local control in elderly patients affected by squamous cell carcinoma of the head and neck (SCC-HN) and help guide different therapeutic modalities. Over a 6-year period, 52 patients with stage II to IV SCC-HN and aged more than 70 years were given an infusion of bromodeoxyuridine (BrdUrd) 6 hours prior to tumor biopsy sampling. The simultaneous labeling S phase fraction (LI) and duration (Ts) as well as potential doubling time (Tpot) were measured with flow cytometric analysis of BrdUrd and DNA content. Patients were then treated as follows: 14 with conventional radiotherapy; 13 with partly accelerated radiotherapy; 11 with chemoradiotherapy; 14 with surgery plus adjuvant radiotherapy. Univariate analysis showed that, independently of treatment type, patients with fast growing SCCs-HN characterized by Tpot value < or = 5 days had a lower three-year local control than patients with slow growing tumors with Tpot value > 5 days. Our results also demonstrated that surgery or chemoradiotherapy were effective treatments for fast growing tumors. Radiotherapy alone, instead, was more effective for slow growing tumors. Our data suggest that in vivo cell kinetics may play a role as additional prognostic factor for elderly patients with SCC-HN and predict the outcome of different treatments.
Aged↗
Predictive factors for outcome in invasive bladder cancer treated with alternating chemoradiotherapy.
PURPOSE: In order to select patients properly for a bladder preservation program, this retrospective study aimed to evaluate the predictive role of pretreatment- and treatment-related factors in a group of patients with invasive bladder cancer treated with alternating chemoradiotherapy at a single institution. METHODS AND MATERIALS: From 1986 to 1994, 72 patients with invasive bladder cancer, stages T1 poorly differentiated or T2-4M0 refusing surgery or not eligible for surgery, were treated with alternating chemoradiotherapy. Each patient had a pretreatment cystoscopy with an attempted complete transurethral resection of the bladder tumor (TURB). The treatment schedule consisted of chemotherapy (cisplatin, 5-fluorouracil, or methotrexate) alternated with radiotherapy. Over the years, the treatment schedule was modified with respect to the total number of chemotherapy cycles, the type of chemotherapy drugs, the dose per fraction and total dose of radiation therapy, and the presence of a planned treatment gap at midtreatment. Treatments were aligned in order of their received average relative dose intensities of both chemotherapy (ARDICT) and radiotherapy (RDIRT). RESULTS: Twenty-two patients (76%) developed infiltrative bladder recurrences for an estimated 5-year pelvic control rate of 68% +/- 6%; 5-year actuarial survival with intact bladder is 40% +/- 6%. Obstructive uropathy at diagnosis, residual disease after TURB, and ARDICT value equal or below the median were independent predictive factors for pelvic failure, with hazard ratios of 2.87 (95% confidence interval [CI], 1.16-7.04), 8.13 (95% CI, 2.74-24.1), and 3.36 (95% CI, 1.29-8.74), respectively. A more detailed model including interactions among these factors showed that the negative prognostic effect of obstructive uropathy at diagnosis was not modified by ARDICT or TURB resection; on the contrary, the risk of local failure for patients with incomplete TURB was markedly affected by different levels of ARDICT. Also, a trend toward a better local outcome was observed for patients with RDIRT above the median. Hydronephrosis and incomplete TURB were also independent predictors of distant metastases and overall survival, but no effect was found for ARDICT on these endpoints. DISCUSSION: As a result of this analysis we believe that (1) patients with obstructive uropathy should not be offered a bladder-sparing approach, (2) gross total TURB of the primary tumor should be maximized, (3) prompt surgery should be considered for patients with incomplete TURB who are not compliant with the combined-modality treatment, and (4) the intrinsic value of dose intensity of both chemotherapy and radiotherapy should be confirmed in a prospective, controlled study.
Adult↗
Organ preservation in the management of bladder and prostate cancer.
Optimal management of bladder cancer is still controversial. With radiotherapy organ preservation is achieved in 30% of patients in the absence of unfavorable factors. Better results are achieved with accelerated fractionation, neoadjuvant chemotherapy or concomitant radiochemotherapy. In particular, with the latter, the rate of complete response (70%) is 30% higher as compared to radiotherapy alone or transurethral resection (TUR) of bladder and chemotherapy. In the treatment of intracapsular prostate cancer, radiotherapy is a valid alternative to prostatectomy with comparable results in terms of disease-free survival. In case of extraprostatic disease, results are clearly less satisfactory because of lower local control and blood-borne metastases. Conformal radiotherapy and neoadjuvant and adjuvant hormonotherapy are being studied to improve results.
Combined Modality Therapy↗
Local control assessment in clinical oncology.
The true significance of achieving local control has been a matter for debate among clinical oncologists for many years and still is for those tumors where distant metastases are the major cause of failure and mortality. The assessment of local control appears elusive as it may be conceived as the local eradication of neoplastic cells while this should be confirmed by no risk for recurrence. Tools and procedures are available to assess separately the local response after treatment and at long term. Direct methods are quite different according to the different clinical and pathologic conditions. Complete local responses may be followed by recurrence leading to a different approach: to wait for the appearance of recurrence rather than to pursue a complete response. The diagnostic clinical and instrumental methods while easy in superficial tumors, are complex, expensive and poorly reliable in deep-seated tumors. Thus, in general, any assessment of local control in terms of diagnostic work-up can frequently be difficult and misleading.
Breast Neoplasms↗