Heterotopic hip ossification resection: monocentric experiences of associated factors, outcomes, and complications.

PURPOSE: The exponential increase in total hip arthroplasty (THA) has led to acute and chronic surgery-related complications. Common chronic and local complications are represented by hip ossification (HO). The aim of our study was to assess the clinical and radiological correlates of patients undergoing surgical removal of heterotopic ossifications after THA and the possible association between HO and prosthetic joint infection. METHODS: Data of 26 patients who underwent surgical removal of periprosthetic calcifications after THA from 2000 to 2022 were analyzed and compared with characteristics of 156 subjects without HO. RESULTS: The preoperative radiographs of patients showed a high-grade Brooker, 3 or 4, later reduced to 1 or 2 in the postoperative radiographs. Ten (38.5%) patients underwent radiotherapy prophylaxis, administered as a single dose 24 h before surgery. In 19 (73%) patients, pharmacological prophylaxis with indomethacin was added in the 30 postoperative days. Only one patient who underwent radiotherapy had a recurrence, while new ossifications were found in three patients without prophylaxis (11.5%). Intraoperative cultures were performed for suspected periprosthetic infection in 8 study group patients. In logistic regression, the presence of HO was significantly and inversely associated with the ASA score (OR = 0.27, 95% CI = 0.09-0.82; P = 0.021) after adjusting. CONCLUSION: Surgical HO removal in symptomatic patients with high-grade disease produces good clinical and radiographic results. Radiotherapy was a good perioperative and preventive strategy for recurrence, also associated with NSAIDs and COX-2 inhibitors.

Role of psa levels and pathological stadiation before radiation therapy in predicting mp-MRI results in patients with prostate cancer recurrence after radical prostatectomy.

OBJECTIVE: To evaluate PSA value in mp-MRI results prediction, analyzing patients with high (GS≥8, pT≥3, pN1) and low grade (GS<8, pT<3, pN0) Prostate Cancer (PCa). MATERIALS AND METHODS: One hundred eighty-eight patients underwent 1.5-Tmp-MRI after Radical Prostatectomy (RP) and before Radiotherapy (RT). They were divided into 2 groups: A and B, for patients with biochemical recurrence (BCR) and without BCR but with high local recurrence risk. Considering Gleason Score (GS), pT and pN as independent grouping variables, ROC analyses of PSA levels at primary PCa diagnosis and PSA before RT were performed in order to identify the optimal cut-off to predict mp-MRI result. RESULTS: Group A and B showed higher AUC for PSA before RT than PSA at PCa diagnosis, in low and high grade tumors. For low grade tumors the best AUC was 0.646 and 0.685 in group A and B; for high grade the best AUC was 0.705 and 1 in group A and B, respectively. For low grade tumors the best PSA cut-off was 0.565-0.58ng/mL in group A (sensitivity, specificity: 70.5%, 66%), and 0.11-0.13ng/mL in B (sensitivity, specificity: 62.5%, 84.6%). For high grade tumors, the best PSA cut-off obtained was 0.265-0.305ng/mL in group A (sensitivity, specificity: 95%, 42.1%), and 0.13-0.15ng/mL in B (sensitivity, specificity: 100%). CONCLUSION: Mp-MRI should be performed as added diagnostic tool always when a BCR is detected, especially in high grade PCa. In patients without BCR, mp-MRI results, although poorly related to pathological stadiation, still have a good diagnostic performance, mostly when PSA>0.1-0.15ng/mL.

MR imaging of rectal cancer before and after chemoradiation therapy.

PURPOSE: This study was done to determine the diagnostic accuracy of magnetic resonance (MR) imaging in patients with rectal carcinoma by comparing post-chemoradiation MR imaging with pathological specimens. MATERIALS AND METHODS: We enrolled 39 patients with locally advanced rectal cancer. All patients received chemoradiation therapy before surgery and neoadjuvant chemoradiation therapy followed by MR imaging. MR images were analysed by a team of two expert radiologists unaware of the clinical and histopathological findings. RESULTS: Following neoadjuvant chemoradiation therapy, the analysis of MR images showed 23 (59%) patients with a rectal disease staged ≤T2 and 16 (41%) with a disease staged >T2. Post-treatment histological staging (TNM) revealed 13 patients with a disease >T2 and 26 patients with a disease ≤T2. Cohen's kappa to measure concordance between post-chemoradiation MR staging and histological response showed 83.6% concordance for disease confined to the serosa (≤T3): concordance was 97.22% for disease ≤N1 and 33.33% for disease >N1. CONCLUSIONS: MR imaging is critical for discovering T3 disease; moreover, morphological MR imaging does not always provide the opportunity to discern small residual cancer cells hidden in fibrotic tissue that could cause involvement of circumferential resection margin (CRM) on histology.

The role of multiparametric mri in the diagnosis of local recurrence after radical prostatectomy and before salvage radiotherapy.

PURPOSE: Assess multiparametric-MRI (mp-MRI) diagnostic accuracy in the detection of local recurrence of Prostate Cancer (PCa) after Radical Prostatectomy (PR) and before Radiation Therapy (RT). MATERIALS AND METHODS: A total of 188 patients underwent 1.5-T mp-MRI after RP before RT. Patients were divided into two groups: with biochemical recurrence (group A) and without but with high risk of local recurrence (group B). Continuous variables were compared between two groups using T-Student; categoric variables were analyzed using Pearson chi-square. ROC analysis was performed considering PSA before RT, ISUP, pT and pN as grouping variables. RESULTS: PCa recurrence (reduction of PSA levels after RT) was 89.8% in the group A and 80.3% in the group B. Comparing patients with and without PCa recurrence, there was a significant difference in PSA values before RT for group A and for PSA values before RT and after RT for group B. In group A, there was a significant correlation between PSA before RT and diameter of recurrence and between PSA before RT and time spent before recurrence. The mp-MRI diagnostic accuracy in detecting PCa local recurrence after RP is of 62.2% in group A and 38% in group B. DWI is the most specific MRI-sequence and DCE the most sensitive. For PSA = 0.5 ng/ml, the AUC decreases while sensitivity and accuracy increase for each MRI-sequence. For PSA = 0.9 ng/ml, DCE-AUC increases significantly. CONCLUSION: mp-MRI should always be performed before RT when a recurrence is suspected. New scenarios can be opened considering the role of DWI for PSA ≤ 0.5 ng/ml.

A multicenter LArge retrospectIve daTabase on the personalization of stereotactic ABlative radiotherapy use in lung metastases from colon-rectal cancer: The LaIT-SABR study.

INTRODUCTION: Stereotactic ablative radiotherapy (SABR) has been shown to increase survival in oligometastatic disease, but local control of colorectal metastases remains poor. We aimed to identify potential predictive factors of SBRT response through a multicenter large retrospective database and to investigate the progression to the polymetastatic disease (PMD). MATERIAL AND METHODS: The study involved 23 centers, and was approved by the Ethical Committee (Prot. Negrar 2019-ZT). 1033 lung metastases were reported. Clinical and biological parameters were evaluated as predictive for freedom from local progression-free survival (FLP). Secondary end-point was the time to the polymetastatic conversion (tPMC). RESULTS: Two-year FLP was 75.4%. Two-year FLP for lesions treated with a BED < 00 Gy, 100-124 Gy, and ≥125 Gy was 76.1%, 70.6%, and 94% (p = 0.000). Two-year FLP for lesion measuring ≤10 mm, 10-20 mm, and >20 mm was 79.7%, 77.1%, and 66.6% (p = 0.027). At the multivariate analysis a BED ≥125 Gy significantly reduced the risk of local progression (HR 0.24, 95%CI 0.11-0.51; p = 0.000). Median tPMC was 26.8 months. Lesions treated with BED ≥125 Gy reported a significantly longer tPMC as compared to lower BED. The median tPMC for patients treated to 1, 2-3 or 4-5 simultaneous oligometastases was 28.5, 25.4, and 9.8 months (p = 0.035). CONCLUSION: The present is the largest series of lung colorectal metastases treated with SABR. The results support the use of SBRT in lung oligometastatic colorectal cancer patients as it might delay the transition to PMD or offer relatively long disease-free period in selected cases. Predictive factors were identified for treatment personalization.

Diagnosis and treatment of early and locally advanced non-small-cell lung cancer: The 2019 AIOM (Italian Association of Medical Oncology) clinical practice guidelines.

The Italian Association of Medical Oncology (AIOM) has developed clinical practice guidelines for the diagnosis and treatment of patients with early and locally advanced non-small cell lung cancer. In the current paper a panel of AIOM experts in the field of thoracic malignancies discussed these topics, analyzing available scientific evidences, with the final aim of providing a summary of clinical recommendations, which may guide physicians in their current practice.

Treatment of advanced non-small-cell lung cancer: The 2019 AIOM (Italian Association of Medical Oncology) clinical practice guidelines.

The Italian Association of Medical Oncology (AIOM) has developed clinical practice guidelines for the treatment of patients with advanced non-small cell lung cancer (NSCLC). In the current paper a panel of AIOM experts in the field of thoracic malignancies discussed the available scientific evidences, with the final aim of providing a summary of clinical recommendations, which may guide physicians in their current practice.

Treatment of brain metastases in small cell lung cancer: Decision-making amongst a multidisciplinary panel of European experts.

BACKGROUND: Brain metastases (BM) are common in patients with small cell lung cancer (SCLC). In recent years, the role of whole brain radiotherapy (WBRT) for brain metastases in lung cancer is being reevaluated, especially in the context of new systemic treatments available for SCLC. With this analysis, we investigate decision-making in SCLC patients with BM among European experts in medical oncology and radiation oncology. METHODS: We analyzed decision-making from 13 medical oncologists (selected by IASLC) and 13 radiation oncologists (selected by ESTRO) specialized in SCLC. Management strategies of individual experts were converted into decision trees and analyzed for consensus. RESULTS AND CONCLUSION: In asymptomatic patients, chemotherapy alone is the most commonly recommended first line treatment. In asymptomatic patients with limited volume of brain metastases, a higher preference for chemotherapy without WBRT among medical oncologists compared to radiation oncologists was observed. For symptomatic patients, WBRT followed by chemotherapy was recommended most commonly. For limited extent of BM in symptomatic patients, some experts chose stereotactic radiotherapy as an alternative to WBRT. Significant variation in clinical decision-making was observed among European SCLC experts for the first line treatment of patients with SCLC and BM.

Chemo-radiotherapy in non-small cell lung cancer: the role of gemcitabine.

Gemcitabine (2'-2'-difluorodeoxycytidine) is a well-known cytotoxic drug and a potent radio-enhancer. We herein report the in vitro evidence of its activity, and the clinical experiences when this drug is administered concurrently with radiation. The phase I-II trials are analyzed, focusing on the recent ability to deliver irradiation with low incidence of side effects.

Induction cisplatin-gemcitabine-paclitaxel plus concurrent radiotherapy and gemcitabine in the multimodality treatment of unresectable stage IIIB non-small cell lung cancer.

BACKGROUND: To evaluate feasibility and safety of induction three-drugs combination chemotherapy and concurrent radio-chemotherapy in stage IIIB NSCLC. PATIENTS AND METHODS: Patients with stage IIIB NSCLC were treated with three courses of induction chemotherapy, cisplatin 50 mg/m(2), paclitaxel 125 mg/m(2) and gemcitabine 1000 mg/m(2) on days 1,8 of every 21 day cycle. Patients without distant progressive disease were then treated with radiotherapy and concurrent weekly gemcitabine (250 mg/m(2)). Toxicity and response of radio-chemotherapy treatment have been assessed. RESULTS: Between Jan 01 and Nov 02, 46 patients were enrolled. Grade 3+ hematological and non-hematological toxicity during the induction phase were 41.3% and 13.1%, respectively. In 38 patients a Clinical Response or Stable Disease was recorded and these patients underwent to concurrent radio-chemotherapy. Grade 3+ hematological and non-hematological toxicities were 8.2% in this group. Further response was observed in 66% of patients. Overall median survival time was 17.8 months, with a 3-year survival rates of 23%. CONCLUSION: Three-drugs induction chemotherapy and concurrent radio-chemotherapy with weekly gemcitabine in locally advanced stage IIIB NSCLC is feasible and safe.

Ten years experience with breast reconstruction after salvage mastectomy in previously irradiated patients: analysis of outcomes, satisfaction and well-being.

OBJECTIVE: Reconstruction following mastectomy offers women an opportunity to mollify some of the emotional and aesthetic effects of this devastating disease. PATIENTS AND METHODS: The authors reviewed the files of 83 patients who underwent immediate postmastectomy reconstruction with tissue expander between January of 2003 and June of 2012 at our hospital. The patients were divided into two groups: Group A (study group) included 30 patients with previous quadrantectomy and radiotherapy who underwent salvage mastectomy after local recurrence; Group B (control group) included 53 patients submitted to primary radical mastectomy. We submitted Breast-Q reconstruction post-operative module to all of our patients. RESULTS: The median follow-up time for the whole group was 36 months (range = 12-144 months). Between group A and group B, there were no significant differences. In the group A, the median time from RT to reconstruction was 24 months (range = 9-192 months). The overall rate of complications was not similar between the two groups (66.6% vs. 58.5%; p = NS). However, the  major complications occurred mostly in the irradiated group, showing a trend of statistical significance (53.3% vs. 32.0%; p = 0.07). In this group, the occurrence of major complications was not different according to time from RT to reconstruction (p = 0.313). In particularly, patients from the irradiated group (group A) had a significantly higher risk of grade III-IV capsular contracture (relative risk 3.75, p = 0.02) and autologous salvage reconstruction (relative risk 10.4, p = 0.02). CONCLUSIONS: The results of this study prove that heterologous reconstruction is still possible following salvage mastectomy in previously irradiated patients.

Radioguided surgery of breast cancer: radiation protection survey.

The aim of this study was to estimate the radioactive risk for surgical staff performing radioguided sentinel lymph node (SN) biopsy and to calculate the contamination level in the operating room for assessment of the possible need for specific radiation protection procedures. We studied 20 patients who were selected for quadrantectomy and SN biopsy. The day before surgery a volume of 0.15 mL of 99mTc-nanocoll was injected: the activity was 3.11 +/- 0.85 MBq in group A (15 pts) and 11.6 +/- 0.6 MBq in group B (5 pts). External radiation to staff was evaluated by measuring the exposure rate in air one hour after radiopharmaceutical administration. The air KERMA rate during surgery was estimated considering the physical decay of 99mTc. Contamination of disposable materials and surgical instruments in the operating room was measured using a contamination monitor, whereas the residual activity in the SN and the injection site was measured with a gamma probe. The exposure rate at 20 cm from the injection site was 0.75 microSv/h when the most radioactive patients (group B) were treated. Contamination in the operating room proved to be negligible. Considering the number of radioguided treatments carried out by a surgeon in one year, an equivalent effective dose of 0.075 mSv was estimated; the recommended dose limit according to the relevant Italian law, DL 230/95, is 1 mSv/yr. Surgical staff therefore do not require a classification of "exposed workers" and there is no need to supply the operating room with special containers for radioactive waste.

[Computerized processing of static scintigraphic gamma camera images. Experimental results and clinical applications]. / Elaborazione computerizzata delle immagini scintigrafiche statiche da gammacamera. Risultati sperimentali ed applicazioni cliniche.

Two different phantoms were used to carry out several scintigraphic experiments with a gamma camera linked to a computer. Each image was subjected to several types of electronic processing. The contrast was assessed in certain pre-established areas in order to obtain an indication of the efficacity of the various techniques. The experimental results were transferred to scintigraphic application methodology with the formulation of treatment schedules consisting of a variable sequence of successive processings designed to improve the quality of the information required for more accurate diagnosis.

[Index of splenohepatic uptake of 99mTc-MMA in the diagnosis of diffuse hepatopathy]. / Indice di captazione spleno-epatica del 99mTc-MMA nella diagnosi di epatopatia diffusa.

A sequential scintigraphic technique for the evaluation of liver and spleen granulopexic function is described. The spleno-hepatic uptake index revealed by computerised scintiscanning proved a reliable indicator of moderate and especially severe diffuse hepatopathy. The test is quickly and easily performed and is also practical since it uses the same radioactive bolus injected for static scintigraphy.

[Evaluation of thallium-201 distribution in myocardial scintigraphies performed after exertion]. / Valutazione della distribuzione del 201Tallio nelle scintigrafie miocardiche effettuate dopo sforzo.

Various techniques are described for the electronic processing of myocardial scintigraphic images using 201Thallium taken at various intervals after muscular exertion. The techniques serve to improve image definition and contrast, making them more representative of the physiopathological reality. The advantages and limitations of certain computer techniques for the measurement of radioactive distribution in the left ventricular myocardium are also discussed. Using such techniques it is possible to obtain an objective and comparative assessment of successive images.

[Advantages and limitations of combined assays of 4 serum markers in various types of malignant neoplasms]. / Vantaggi e limiti del dosaggio combinato di quattro markers sierici in diversi tipi di neoplasie maligne.

CEA, TPA, GICA and Ferritin were assayed in 700 cancer patients (230 assays in 181 breast cancers, 75 in 57 lung cancers, 114 in 70 cervico-facial neoplasms, 131 in 95 uterovaginal tumours, 444 in 225 colorectal tumours, 106 in 72 gastric cancers). Groups were divided into stages and the results of all possible associations were assessed. Only the most significant are reported. Among combinations of 2 markers the combined assay of CEA and TPA offers the best response as diagnostic potential (expressed as percentage positivity) in all neoplasm groups as well as a good correlation with the evolution of the disease.

[Value and limitations of the gastric secretion function test with 99mTc-pertechnetate]. / Valori e limiti del test di funzionalità secretiva gastrica mediante 99mTc-pertecnetato.

The technique and results of the gastric secretion test using 99mTc-pertechnetate to investigate functional organic gastropathies are described. The test is fairly simple, well tolerated and an alternative to gastric probing. If performed with a computerised gamma chamber it can indicate the volume of the secretion. A rapid scintigraphy will also provide information on intestinal morphology and is useful if such information it not otherwise obtainable. However the real value of the test is in checking the results of pharmacological or surgical treatment.

[Evaluation of vesico-ureteral reflux in children with computerized isotopic cystography in association with urodynamic tests]. / Valutazione del reflusso vescico ureterale in età pediatrica con cistografia isotopica computerizzata in associazione ad esame urodinamico.

Method and results are presented for the cystoscintigraphic detection with 99mTc-DTPA, associated with urodynamic examination for the evaluation of the vesicoureteral reflux, involving a relatively simple execution. The use of this method is advised in Pediatrics because of its low gonadal dose, thorough examination and least aggressiveness.

[Scintigraphy in the study of varicocele]. / L'indagine scintigrafica nello studio del varicocele.

Varicocele which is relatively common after puberty may cause even severe alterations to fertility. Sequential Isotopic Scrotal Angiography (SISA) was used for the diagnosis of this condition in both the recognition and confirmation phase. This dynamic and static survey based on the use of 99mTc-pyrophosphate proved able to discriminate between the various degrees of varicocele. No statement can as yet be made on the specificity and sensitivity of the examination since so few cases have so far been checked with other techniques (Doppler-Telethermography-Phlebography) and an insufficient number of postsurgical controls came to our observation.

Estimating the value of surgical clips for target volume delineation in external beam partial breast radiotherapy.

AIMS: To investigate the role of surgical clips in defining the clinical target volume (CTV) for three-dimensional conformal external beam radiotherapy-partial breast irradiation (3D-CRT-PBI) using preoperative computed tomography scans. MATERIALS AND METHODS: A group of patients with early breast cancer underwent conservative surgery with placement of surgical titanium clips (at least three clips required). All patients had a treatment planning computed tomography simulation before (CT1) and after surgery (CT2). The two sets of images were co-registered with a match point registration. The relationship between the clips-based CTV for PBI delineated on CT2 and the initial tumour location on CT1 was studied, evaluating the percentage of intersection volume. RESULTS: Twenty-eight patients participated in this study. In total, 13 patients (46.4%) had an intersection volume ≥ 50% and 10 patients (35.7%) had complete intersection (intersection volume = 100%). An increased median intersection volume was observed in patients with more than six clips (P = 0.007) and in patients with a larger portion of breast volume covered by the PBI-CTV (CTV/BV; P = 0.010). Intersection volume increased with the number of clips, after adjustment for CTV/BV (linear coefficient = 5.1693; P = 0.043). Also, a maximum distance from the chest wall ≤0.7 cm and CTV/BV > 9.5% were found to be predictors of an intersection volume ≥50% (area under the curve 0.841; confidence interval 0.649-0.952; P < 0.0001; area under the curve 0.800; confidence interval 0.607-0.926; P = 0.0004) and of an intersection volume of 100% (area under the curve 0.776, confidence interval 0.573-0.916, P = 0.046; area under the curve 0.752, confidence interval 0.536-0.935; P = 0.032). CONCLUSIONS: Titanium clips are essential and six or more increase the accuracy of tumour bed delineation for PBI; also the primary tumour location as well as the percentage of volume of breast covered by PBI-CTV may influence the correct delineation of PBI-CTV.