Therapeutic options for breast cancer treatment in patients previously irradiated for Hodgkin's disease: radical mastectomy or conservative surgery followed by reirradiation?

Patients undergoing radiotherapy for the treatment of Hodgkin' disease (HD) occurred at young age present a higher risk to develop second cancer compared to general population. Among the possible second tumours, breast cancer is the most frequent and the age at presentation is younger than the "classic" form. Patients at risk for second cancer undergo a strict follow-up permitting often to diagnose breast cancer at early stages (I-II).The aim of this work is to review the various therapeutic options for the treatment of breast cancer in patients previously irradiated for HD, with particular attention to the possibility of reirradiation of mammary tissue thanks to the new radiotherapy techniques developed in the last years.

Prognostic features and treatment outcome in patients with nasopharyngeal carcinoma: an experience of 20 years.

BACKGROUND: The best treatment of Nasopharyngeal Carcinoma (NPC) is still an open question. The purpose of this retrospective study was to determine risk factors that affect locoregional control and treatment outcome of NPC patients after radiotherapy, with or without chemotherapy. METHODS: Between January 1976 and December 1996, 66 consecutive patients (stage I = 0; stage II = 13; stage III = 32; stage IV = 21) were given definitive radiotherapy at a single Institution. Concurrent or adjuvant chemotherapy was also given to 14 of them (21%). Multivariate analysis was performed to evaluate age, T stage, N stage, radiotherapy dose, histology, chemotherapy bone of skull erosions or cranial nerve palsies and base of skull involvement as prognostic factors of locoregional control and overall survival. RESULTS: By the end of January 2000, after a median follow-up of 66 months and a minimal follow-up of 36 months, the event-free overall survival rate of 5 years was 48% and the overall survival 54%. Risk factor analysis revealed that radiotherapy dose, age and stage were the most important factors for overall survival of these patients. The 5 year overall survival was 89% for stage II and 49% for stage III-IV (p = 0.004), 62% for dose higher than 60 Gy and 20% for dose below 60 Gy (p = 0.007), 62% for age below 65 years and 36% for age higher than 65 years (p = 0.027). The concurrent or adjuvant chemotherapy did not have prognostic significance. CONCLUSIONS: We confirm the need to determine the risk factors in patients with NPC. The choice of treatment, whether radiotherapy alone, at dose > 60 Gy, or radiotherapy plus chemotherapy, should be made after identification of patients with high risk disease, suitable for the combined modality.

[Exclusive radiotherapy in stage III esophageal cancer]. / Radioterapia esclusiva nel cancro dell'esofago stadio III.

BACKGROUND: The purpose of the report is to evaluate the role of radiotherapy in the treatment of stage III esophageal carcinoma and to analyze the influence of site, extension, grade of dysphagia and histology on local control and survival. METHODS: Twenty males and 6 females were submitted to external beam therapy with 4-6 MV X-rays and received 60-70 Gy in fractions of 180 cGY to 200 cGy per day, 5 days a week. Radiation therapy technique was two posterior oblique portals and a single anterior field at 100 cm SAD. After 4500 cGy portals were coned down, holding the spinal cord dose below 4500 cGy. RESULTS: Global response to therapy was 73.1%. Median survival was 11 months. The 2-year survival rate was 12.5% in patients with lesions smaller than 5 cm and 5.5% for those with lesions greater than 5 cm. Patients with grade 2 dysphagia had a median survival of 16 months, those with grade 1, 11 months and 2 patients with grade 0, 4 and 9 months. In all patients mild to moderate esophagitis was observed. Two patients developed esophagotracheal fistula. CONCLUSIONS: Exclusively radiotherapy cannot be considered the treatment of choice in III stage patients. Primary chemoradiotherapy may emerge as the treatment of choice for cancer of the esophagus.

Radiotherapy alone in elderly patients with medically inoperable stage IIIA and IIIB non-small cell lung cancer.

BACKGROUND: We have analysed our experience with medically inoperable IIIA and IIIB elderly patients (aged > or = 70 years), treated with radiotherapy alone, to better define the potential benefit of this approach. MATERIALS AND METHODS: From 1992 to 1995, 41 patients with NSCLC (Non Small Cell Lunc Cancer), stage III, aged > or = 70 years were irradiated with curative intent. RESULTS: Median follow-up was 20 months (range 9-53). The 2 year OS (Overall Survival) and DFS (Disease Free Survival) were respectively 27% and 14.6% for all patients. Patients presenting weight loss > 10% experienced 14% OS at 24 months compared to 58% for those without weight loss (p = 0.0027). A 64% OS at 24 months was seen in patients with tumor size less than 4 cm compared to 7% of patients with tumor size > 4 cm (p = 0.0009). CONCLUSION: Radiotherapy is a good management for locally advanced NSCLC in the elderly patients assuring good quality of life, high rates of relief of symptoms and OS and DFS similar to those obtained with chemotherapy and chemotherapy plus radiotherapy.

[Evaluation of the treatment with thymopentin associated with radiotherapy in head and neck tumors]. / Valutazione del trattamento con timopentina associato alla radioterapia nei tumori della testa e del collo.

The aims of the study has been the analysis of the optimal conditions for the use of thymopentin in reducing the incidence and severity of early and late complications following radiotherapy of patients with head and neck cancers submitted to radiotherapy by means of cobalt or linear accelerator. 168 patients of 10 Center have been examined. Analysis of the results demonstrated that the tymopentin reduce the incidence and severe reactions (p < 0.05) in statistically significant manner in cases of irradiation of the hypopharynx, oropharynx in oral cavity. The complications were more frequent during cobalt beam therapy (p < 0.01) and the beneficial effect of the immunomodulating treatment were greater for females than the males (p < 0.05).

[Loco-regional intra-arterial chemotherapy combined with radiotherapy in cervical carcinoma]. / La chemioterapia intra-arteriosa loco-regionale associata alla radioterapia nel cervicocarcinoma.

Fifteen patients with squamous cell carcinoma of the uterine cervix--7 in stage II, 6 in stage III and 2 in stage IV--were considered not to respond at the end of radiotherapy. Therefore, the whole patient population underwent bilateral intraarterial chemotherapy with Mitomycin-C (3 cycles, 3-4 weeks' intervals). Patients' responses were evaluated with clinical and CT examinations following irradiation and after completing chemotherapy. Pelvic irradiation was administered by external beams (6 Mv), for a 50-Gy dosage (200 cGy/day for 5 weeks); in 4 cases treatment was completed by means of brachytherapy (192 Ir), with 20-25 Gy dosage. Intraarterial infusion was carried out after positioning the catheters in both uterine arteries; in 5 cases, the internal iliac artery alone was cannulated. At the end of the combined treatment, 2 patients (13%) responded completely, 9 (60%) partially and 4 (27%) not at all. Mean survival was 24 months. No hematologic complication was so severe that treatment had to be discontinued. In 4 patients chemotherapy caused a partially ulcerated skin erythema in the buttocks, which was completely cured in all cases.

[Role of CT in radiotherapy radiation planning for tumors of the rhinopharynx]. / Il ruolo della TC nell'impostazione del piano di trattamento radiante dei tumori della rinofaringe.

The authors compare the results obtained by CT with clinics and conventional radiography in the staging of nasopharyngeal tumors. The accurate evaluation of tumor size, localization, and spread, helps optimize treatment planning and fit radiation boosts on small fields. Twenty-six patients underwent clinical examination, radiography of the skull and neck, lateral stratigraphy of epipharynx, and CT of head and neck. We compared the results obtained in the study of: nasopharyngeal walls, parapharyngeal space, paranasal sinuses, nasal cavity, bone erosion of the base of skull, and continuous invasion without bone erosions. Our results point to conventional radiology as the examination of choice for the study of upper nasopharyngeal wall, while CT allows a better evaluation of the lateral wall, and is clearly superior in demonstrating parapharyngeal space, contiguous intracranial invasion, and neck nodes involvement.

Pretreatment scalene node biopsy in cervical carcinoma.

To evaluate incidence of scalene node metastases from carcinoma of the cervix, 20 patients had scalene fat-pad node biopsy. All cases were staged according to FIGO criteria and abdominal lymph nodes were studied by CT and lymphangiography. Scalene node metastases were found in 2 patients with clinically suspicious node and pelvic and paraaortic nodes involvement. Seven patients had sinus histiocytosis in scalene node biopsy and this seems related to a more favourable prognosis. From this study it appears that scalene node biopsy is not a routine procedure and should be performed in all patients with palpable supraclavicular masses or when paraortic nodes are involved.

[Evaluation of the process of lumbo-aortic metastasis in carcinoma of the cervix uteri]. / Valutazione delle modalità di metastatizzazione lomboaortica nel carcinoma della cervice uterina.

Paraaortic lymph nodes involvement in patients with cervical carcinoma, even in less advanced stages, found in 100 cases examined, besides the data reported in literature, has driven the authors to locate, through the examination of lymphangiograms, the routes by which paraaortic metastases can occur. Authors pointed out different ways of invasion, besides the more common subsequent involvement going from pelvic to paraaortic nodes or from posterior channels that can lead to paraaortic spread without lesions in common iliac nodes. In detail lymphatic pathways have been opacified connecting distant nodal chains and finally external routes from external iliac lymph nodes directly to paraaortic chain.