Nasopharyngeal carcinoma in a low incidence European area : A prospective observational analysis from the Head and Neck Study Group of the Italian Society of Radiation Oncology (AIRO).

PURPOSE: To evaluate the outcomes with respect to long-term survival and toxicity in patients with nasopharyngeal carcinoma (NPC) treated in a European country with low incidence. MATERIALS AND METHODS: A prospective observational study carried out by the AIRO Head and Neck group in 12 Italian institutions included 136 consecutive patients treated with radiotherapy (RT) ± chemotherapy (CHT) for NPC (without distant metastasis) between January 1, 2008 and December 31, 2010. RESULTS: The disease-specific survival (DSS), overall survival (OS), and disease-free survival (DFS) at 5 years were 92 (±2), 91 (±3), and 69 % (±5 %), respectively. Distant failure was the most frequent modality of relapse. The local, regional, and locoregional control at 5 years were 89 (±3), 93 (±3), and 84 % (±4 %), respectively. The incidence of acute and late toxicity and the correlations with different clinical/technical variables were analyzed. Neoadjuvant CHT prolongs radiotherapy overall treatment time (OTT) and decreases treatment adherence during concomitant chemoradiotherapy. An adequate minimum dose coverage to PTV(T) is a predictive variable well related to outcome. CONCLUSION: Our data do not substantially differ in terms of survival and toxicity outcomes from those reported in larger series of patients treated in countries with higher incidences of NPC. The T stage (TNM 2002 UICC classification) is predictive of DSS and OS. The GTV volume (T ± N) and an adequate minimum PTV(T) coverage dose (D95 %) were also identified as potential predictive variables. Sophisticated technologies of dose delivery (IMRT) with image-guided radiotherapy could help to obtain better minimum PTV(T) coverage dose with increased DFS; distant metastasis after treatment still remains an unresolved issue.

Rapid palliative radiotherapy unit: multidisciplinary management of bone metastases.

PURPOSE: The aim of this study was to highlight the advantages of rapid access to a palliative radiotherapy unit adopting a multidisciplinary approach to symptom management to relieve pain and improve quality of life in patients with bone metastases. MATERIALS AND METHODS: From January 2007 to December 2008, 142 oncological patients were treated with linear accelerator radiotherapy (RT) administered in a single 8-Gy fraction. The European Organization for Research and Treatment Quality of Life Questionnaire (EORTC QLQ-C30) was administered to each patient at admission and at subsequent intervals. A traditional simulator was used to define the correct patient setup, and all treatment plans were performed with a two-dimensional technique.. RESULTS: Ninety-six patients agreed to fill in the EORTC QLQ-C30 questionnaire; 80 actually completed it. Twelve weeks after RT, a reduction in pain level compared with baseline (T0) was recorded, which was classified as 1 in 36 patients (45%) and 2 in 44 patients (55%). Pain interference with daily activities was also recorded, with significantly reduced scores with respect to T0: 1 in eight patients (10%), 2 in 28 patients (35%) and 3 in 44 patients (55%); quality of life scores also improved with respect to T0: 2 in 28 patients (35%), 3 in 23 patients (29%), 4 in 22 patients (27%) and 5 in seven patients (9%). CONCLUSIONS: The proposal for treating patients with painful bone metastases with a single 8-Gy fraction of RT, with all the procedures being performed on the same day, offers many advantages in terms of pain relief, quality of life and clinical management.

Topical issues in the treatment of rectal cancer: economic and organizational aspects of concomitant radiochemotherapy.

Concomitant radiochemotherapy in patients with locally advanced rectal carcinoma has been shown to be useful in improving local control and survival in operated patients and in favoring sphincter preservation when administered before surgery. Together with the search for less toxic combinations, cost-analysis of radiochemotherapy has become topical also in consideration of new generation drugs. In this study the analysis was carried out by comparing the costs for 4 different combined modalities in the dual perspective of the payer (the National Health Service) and the provider (the Hospital). Based on their characteristic of treatment and innovative aspects, the following combinations were examined: external beam radiotherapy (ERT) 50.4 Gy + 5FU bolus; ERT 50.4 Gy + 5FU protracted infusion; ERT 50.4 Gy + 5FU continuous infusion, week 1 and 5; ERT 50.4 Gy+ Tomudex bolus. Costs were evaluated based on the frequency and type of specific services provided in therapeutic protocols: the positioning of central venous catheter, time of stay in day-hospital or hospital ward and the cost of drugs. Calculations were carried out based on an "ideal" patient of 1.7 sqm body surface. Costs were based on out patient rates, DRGs and the official drug list valid to September 1999. As for day-hospital costs afforded by the payer it is observed that the most expensive combinations are bolus and continuous infusion followed by protracted infusion; Tomudex, is the most economic. As for hospital costs afforded by the provider, it is observed that the most expensive combination is continuous infusion followed by protracted infusion, bolus administration and Tomudex. In conclusion, doctors are increasingly involved in the economic and organizational aspects of therapeutic decisions; however, the patient's needs should be kept in mind; apart from the therapeutic benefits, lower toxicity and ready use of treatments are amongst the patient's needs. The analysis of the patient's satisfaction is still lacking suitable means of evaluation, however it should be defined and carefully studied for an exhaustive evaluation of the impact of combined modality therapy.

The surgical treatment of Kienböck's disease.

A long term follow up of thirty two patients operated on for Kienböck's disease of the semilunar bone at the Istituto Ortopedico Toscano in the last twenty eight years has been carried out. Three types of operation were performed; excision of the semilunar, lengthening of the ulna, and shortening of the radius. The best results were obtained from shortening the radius. Good results were also obtained in cases in which there was no preoperative relative shortening of the ulna at the inferior radio-ulnar joint.