[The use of cisplatin as radiosensitizing agent in advanced tumors of the head and neck. Randomized study]. / Utilizzazione del cisplatino come radiosensibilizzante nei tumori avanzati della regione testa-collo. Studio randomizzato.

This study was aimed at assessing whether c-DDP administration immediately before radiotherapy could increase frequency and duration of objective responses, as well as survival, in patients affected with locally advanced stages of squamous carcinomas of the head and neck. All patients had already undergone two induction cycles according to the CABO schedule. Ninety-six of 108 treated patients could be evaluated. Treatment schedule consisted in: 1) randomized distribution of patients into two groups before induction chemotherapy; 2) two cycles of induction chemotherapy according to the CABO schedule in all patients; 3) radiation therapy: the patients in group A were given 5 mg/mq of i.v. cisplatin, 30-60 minutes before each session. The results from the two groups were compared and no significant differences were observed regarding objective response (82.5% in group A vs. 86% in group B), response duration and overall survival rates. Even though toxicity was higher in the patients in group A, therapeutic protocol never needed be modified.

[The role of radiotherapy in the treatment of vulvar tumors]. / II ruolo della radioterapia nel trattamento del tumore della vulva.

Carcinoma of the vulva is relatively rare, making up 3% to 4% of all primary genital cancer. It is a disease of the elderly. The Authors treated from 1976 to 1987 twenty-one patients with locally advanced squamous vulvar cancer (6 T2; 12 T3; 3 T4). Nine of these patients were submitted to radiotherapy alone; the others were treated with a combination of surgery and postoperative radiation. Two and five years disease-free survival rate was 33% and 19%. The rate of radiotherapy sequelae has been low, because the patients were treated with the concentional 200 cGy per day or similar fractionation schemes. Disease-free survival rate was better in the subgroup of patients who underwent to combined surgery and post-operative radiation therapy. These results are discussed in comparison with others series in literature.

Hyperthermia alone in the treatment of recurrences of malignant tumors. Experience with 60 lesions.

Localized hyperthermia alone has been used for the treatment of cancer recurrences in which previous conventional therapies have failed. Since 1983 and 1988, 57 patients with 60 lesions have been heated by means of a microwave and radiofrequency system. Treatment protocol provided 45 minutes of heating at the intratumor temperature of at least 42 degrees C, twice a week, for a total number of six, eight, or ten heating sessions. Invasive intratumor thermometry was performed for all lesions. Complete response (CR) was obtained in ten cases (16.6%) and partial response (PR) in 14 (23.4%). Higher rates of CR were observed in the chest wall (38.5%) compared with the head and neck area (11.4%), trunk (10%), and limbs (none). Adenocarcinoma was the most responsive histologic type (40%). Squamous cells carcinoma had 7.7% CR. The only case of undifferentiated carcinoma showed CR; there were none on five sarcomas. Long-term local control (24 months) was approximately 7%. The multivariate analysis showed the statistical significance of the histologic variety (adenocarcinoma versus others, P less than 0.0001). Side effects and complications of the treatment were minimal.

[The use of electrons in oncologic radiotherapy: our experience]. / L'uso degli elettroni nella radioterapia oncologica: nostra esperienza.

The authors describe the interaction of electrons with tissues, the characteristics of depth isodose curves with sharp dose fall-off. These characteristics reduce the utilization of electron therapy only for tumors situated some 5 cm depth below the skin surface and with regular surface. The authors report their experience from 1978 in the treatment of vulvar carcinoma, chest-wall recurrences from breast carcinoma, and cutaneous lymphomas. All these neoplastic diseases were treated with electron beam of adequate energy. Initially betatron was used, successively a linear accelerator (Siemens) about for two years. Results obtained in the treatment of vulvar carcinoma are reported. Two and five years disease free survival rates was respectively 33% and 19% (it is remarked the importance of prophylactic treatment on inguinal lymphnodes). Local control observed in 44 patients with cutaneous lymphomas was 85% until three years; a greater number of recurrences was observed in centrocytic-centroblastic lymphomas. Moreover, local control of breast recurrences was 65% with 5 years survival rate of 22% (34% in patients with only one skin recurrence). Only 22% of the further local failures appear within the treatment field while 78% appear out of field.

Serum thyroid hormone changes in head and neck cancer patients treated with microwave hyperthermia on lymph node metastasis.

Eleven patients with head and neck cancer (ten men, one woman; mean age, 65 years) (larynx, six; oropharynx, two; tongue, one; skin, one; thyroid, one) with regional lymph node enlargements either in contiguity or firmly adherent to the vascular structures of the neck have been treated by means of external microwaves (915, 434 MHz) applicators. All patients were treated by hyperthermia (42-45 degrees C) alone (ten sessions, twice a week, each lasting 30 minutes). Thyroid hormones (T4, T3, FT4, FT3, rT3, thyroid stimulating hormone less than obTSH]) were evaluated during sessions 1, 2, 3, and 8, just before the session (time [t] = 0) and at 10-minute intervals during the heating (t = 10, t = 20, t = 30). Blood was also taken 10 (t = 40) and 30 minutes (t = 60) after the end of each session. T4 showed a decreasing trend; T3 decreased significantly from t = 10 and reached the lowest values at t = 40 and t = 60; FT4 decreased at t = 40 and t = 60 at all sessions; FT3 and rT3 showed no change; TSH decreased at t = 10 until t = 40.

Results of hyperthermia, alone or combined with irradiation, in chest wall recurrences of breast cancer.

In the period between September 1983 and July 1987, 28 locoregional recurrences (about 86% in the chest wall) of breast cancer in 19 patients were treated with external microwave hyperthermia. Of these, 11 lesions were treated with hyperthermia alone and 17 with the combination of heat and external irradiation. Hyperthermia was induced in most cases with 915 MHz microwave (at least 42 degrees C for 30-45 min, for 6-10 sessions). Radiation was administered using photon or electron beams with total doses varying from 2000 to 5000 cGy. Complete and partial response rates on the whole series of patients were 53.6% and 42.9%, respectively. Of 17 lesions treated with combined treatment, 10 had a complete (58.8%) and 7 a partial response; of 11 lesions treated with hyperthermia alone, 5 had a complete (45.5%), 5 a partial (45.5%), and 1 no response. Complete responses were long lasting in all but 3 cases, which recurred after 4 months (2 cases) and 1 year, respectively.

Three new applicators for hyperthermia.

A computerized system with automatic treatment parameters control for radiological hyperthermia, called Sapic SV03, is presented. The system has been planned and built by the "Sezione Avionica ed Equipaggiamenti" of the Aeritalia in cooperation with the Radiotherapy Department of the University of Turin. The device is supplied with a multifrequency generator system (915, 433, 2-30 MHz) connected with many kinds of applicators, with a fiber optic system for temperature control and a previsional thermometry system. In this paper the authors presented three new applicators. The first one is a concave parallel microstrip applicator at 433 MHz, with a size 16 x 9 cm; the heating pattern is homogenous until 4 cm of depth. This antenna can be used for the treatment of chest wall recurrences of breast cancer. The second is a 27 MHz inductive ring and the third applicator is a pyramidal antenna ("TEM line") that operates at a frequency around 27 MHz.

Clinical hyperthermia, alone or with radiation therapy: results of a preliminary study on recurrences of cancers.

Authors present results obtained by hyperthermic treatment (alone or associated with radiation therapy) on 50 patients (with a total of 66 sites) treated between September 1983 and August 1986. All patients had recurrent or metastatic lesions of pretreated malignant tumors. Among these there were 19 breast adenocarcinomas, 33 squamous cell carcinomas of head and neck, 9 melanomas and 5 subcutaneous metastases of adenocarcinoma of the cervix, rectum and colon. The clinical protocol was: hyperthermia alone (43 degrees -45 degrees C for 30 minutes, bi-weekly, for 4-5 weeks) or hyperthermia plus radiation therapy (4 Gy/fraction) for a total of 8-10 seances, in accordance with previous given doses of irradiation. In summary, complete response rates were 21.2% for head and neck tumors, and 51.5% for cutaneous or subcutaneous lesions. Results have also been analysed according to different prognostic variables related to tumor and treatment characteristics. These data are discussed.

[Clinical and therapeutic considerations on a case of hemangiopericytoma of the cheek]. / Considerazioni cliniche e terapeutiche su di un caso di emangiopericitoma della guancia.

The paper reports on a case of recurrent hemangiopericytoma of the cheek, discusses the results of hyperthermia combined with intra-arterial chemotherapy after the postoperative recurrence and draws significant conclusions about the therapeutic approach to this type of tumour.