A sequential chemo-radiotherapeutic treatment for patients with malignant gliomas: a phase II pilot study.

BACKGROUND: The purpose of our study was to evaluate the activity and toxicity of a sequential chemo-radiotherapeutic treatment on the basis of an earlier report by The Johns Hopkins Oncology Center. MATERIALS AND METHODS: Eighteen patients with histologically diagnosed malignant gliomas entered the study. Fifteen patients had glioblastoma multiforme (83%). BCNU (40 mg/sqm/die) and Cisplatin (40 mg/sqm/die) were administered concurrently for 3 days every 3-4 weeks. Radiotherapy consisted of 45 Gy whole cranial irradiation plus a 15 Gy boost on the preoperative volume. RESULTS: Thirteen patients had measurable disease and were evaluable for response. After chemotherapy we obtained 3 CRs (complete remission) and 4 PRs (partial remission) (RR (response rate 54%). Three PRs were converted to CRs after radiotherapy, for a complete remission rate of 46% (6/13). The median duration of response was 10 months. The median survival of the entire patients population was 9 months with 33% survival rates at 1 year. Hematological toxicity grade 4 in one patient and grade 3 in two patients were the major complications due to chemotherapy. CONCLUSIONS: Our sequential chemo-radiotherapeutic regimen appears to have significant activity in adults with newly diagnosed high-grade gliomas.

[Preoperative and immediate postoperative respiratory therapy in patients with pulmonary resection]. / La fisiokinesiterapia respiratoria nella preparazione all'intervento e nel trattamento postoperatorio immediato dei pazienti sottoposti a resezione polmonare.

Twenty patients with a resectable lung cancer and with a low respiratory function were included in this study. During the preoperative period all patients underwent a physiokinesic preparation in view of some improvement of their ventilation performances. Methodology as well as results are reported good response to the program, better post-operative functional recovery and absence of complications were observed in this group of patients.

[Radiotherapy in the treatment of Merkel cell tumors]. / La radioterapia nel trattamento dei merkelomi.

Merkel cell carcinomas are very rare (80 cases up to 1986) and very malignant; they have been known for 20 years only as "trabecular carcinomas". They do not rise from neural crests, and therefore are not apudomas, but from a staminal cell of the skin with neuroendocrine evolution. Merkel cell carcinomas must be distinguished from undifferentiated carcinomas of the skin, lymphomas, and oat cell carcinomas. Eight patients (46 to 86 years old) are presented, 4 males and 4 females, with 1 gluteal (the younger female patient), 3 head and 4 limb localizations of Merkel cell carcinoma. Radiotherapy was carried out after surgery in 7 patients and after biopsy in 1; local recurrences were already present in 3 cases, and lymph node metastases in 5; tumor doses were 36-65 Gy, administered with different techniques, i.e. roentgen therapy, telecobalt therapy, 192Ir curietherapy. Chemotherapy was used in 2 metastatic patients only. Four patients are alive and free of disease and 4 are dead; 3 of the living patients have been followed 3-26 months. The high risk of radiation damage (1 necrosis, 2 giant edemas, 1 severe fibrosis) recommends that large fields and high single and/or total radiation doses be avoided. In conclusion, surgery is diagnostic but not curative on account of the high risk of recurrence; radiotherapy is important because Merkel cell carcinomas are very radiosensitive. Due to easy lymphatic spread of this type of cancer, radiotherapy must include the regional lymph nodes (dose: 40-50 Gy). The role of chemotherapy is still to be assessed but many antiblastic drugs are effective.