Could machine learning improve the prediction of pelvic nodal status of prostate cancer patients? Preliminary results of a pilot study.

We tested and compared performances of Roach formula, Partin tables and of three Machine Learning (ML) based algorithms based on decision trees in identifying N+ prostate cancer (PC). 1,555 cN0 and 50 cN+ PC were analyzed. Results were also verified on an independent population of 204 operated cN0 patients, with a known pN status (187 pN0, 17 pN1 patients). ML performed better, also when tested on the surgical population, with accuracy, specificity, and sensitivity ranging between 48-86%, 35-91%, and 17-79%, respectively. ML potentially allows better prediction of the nodal status of PC, potentially allowing a better tailoring of pelvic irradiation.

[High-dose-rate brachytherapy in esophageal carcinoma: the Italian experience]. / Brachiterapia con alto rateo di dose del carcinoma esofageo: esperienza italiana.

The results are reported of HDR intracavitary brachytherapy in 134 esophageal carcinoma patients (110 men and 24 women) treated in 10 Italian centers. Forty-one patients received radical treatment and brachytherapy was often combined with external irradiation and/or chemotherapy. Clinical response rates follow: 56% complete remissions, 34% partial remissions, 10% no response/disease progression and not assessed. Ninety-three patients underwent palliative treatment: dysphagia was reduced in 80% of them and pain was reduced in 71% of them. Treatment-induced esophageal damage consisted in G3-G4 esophagitis (5% of patients), strictures (10%) and fistulas (3%). Complication rates were correlated with fraction dose (9.5% complications for fraction doses < 500 cGy, 20% with doses ranging 500-800 cGy and 38% with fraction doses > 800 cGy). Moreover, the esophagus was more severely injured when small tubes were used (24% with tubes phi < 2 mm, 19% with tubes phi 2-6 mm and 5% with tubes phi > 6 mm). When external irradiation was combined with brachytherapy, dysphagia was more relieved than with brachytherapy alone (89% vs. 71%), with no increase in complication rates. Also the chemotherapy-brachytherapy combination improved swallowing more than brachytherapy alone (88% vs. 79%) and once again complication rates did not increase. To conclude, in the radical treatment of esophageal carcinoma, HDR brachytherapy permits higher radiation doses to be delivered, with fair complication rates. As for palliative treatment, HDR brachytherapy is safe, has low morbidity and provides adequate relief of dysphagia in 80% of patients. We suggest the use of tubes phi > 6 mm and fraction doses ranging 5-6 Gy.

[Conservative treatment of stage I-II breast carcinoma. Side-effects and esthetic results]. / Trattamento conservativo del carcinoma mammario negli stadi I-II. Effetti collaterali e risultato estetico.

A good cosmetic result is one of the main goals in conservative breast cancer treatment (quadrantectomy plus radiotherapy and, sometimes, adjuvant chemotherapy). In a retrospective study on 302 patients treated at Cremona Hospital Radiotherapy Department, a group of 68 patients was selected because of its homogeneity: all these patients had been operated by the same surgeon and irradiated according to the same technical rules. Acute reactions, late side-effects and cosmetic results are analyzed in this group. Acute postoperative complications were seen in 15% of the cases and late or persistent changes in 54%. Radiotherapy caused acute reactions in 73.5% of the cases and late side-effects in 47%. An acceptable cosmetic result was obtained in 95.5% of the patients: an excellent result in 31%, a good result in 41% and a sufficient one in 23.5%. The dose to whole breast, the dose to the quadrant and the kind of boost have no influence on the cosmetic results, while concomitant chemotherapy (p = 0.028) and high inhomogeneity in dose distribution (p = 0.04) caused a worse outcoming. The authors believe that better results may be obtained by improving treatment planning (to reduce inhomogeneity) and by optimizing chemotherapy and radiotherapy combination.