Seasonal variability of PM2.5 and PM10 composition and sources in an urban background site in Southern Italy.

Comparison of fine and coarse fractions in terms of sources and dynamics is scarce in southeast Mediterranean countries; differences are relevant because of the importance of natural sources like sea spray and Saharan dust advection, because most of the monitoring networks are limited to PM10. In this work, the main seasonal variabilities of sources and processes involving fine and coarse PM (particulate matter) were studied at the Environmental-Climate Observatory of Lecce (Southern Italy). Simultaneous PM2.5 and PM10 samples were collected between July 2013 and July 2014 and chemically analysed to determine concentrations of several species: OC (organic carbon) and EC (elemental carbon) via thermo-optical analysis, 9 major ions via IC, and 23 metals via ICP-MS. Data was processed through mass closure analysis and Positive Matrix Factorization (PMF) receptor model characterizing seasonal variabilities of nine sources contributions. Organic and inorganic secondary aerosol accounts for 43% of PM2.5 and 12% of PM2.5-10 with small seasonal changes. SIA (secondary inorganic aerosol) seasonal pattern is opposite to that of SOC (secondary organic carbon). SOC is larger during the cold period, sulphate (the major contributor to SIA) is larger during summer. Two forms of nitrate were identified: NaNO3, correlated with chloride depletion and aging of sea-spray, mainly present in PM2.5-10; NH4NO3 more abundant in PM2.5. Biomass burning is a relevant source with larger contribution during autumn and winter because of the influence of domestic heating, however, is not negligible in spring and summer, because of the contributions of fires and agricultural practices. Mass closure analysis and PMF results identify two soil sources: crustal associated to long range transport and carbonates associated to local resuspended dust. Both sources contributes to the coarse fraction and have different dynamics with crustal source contributing mainly in high winds from SE conditions and carbonates during high winds from North direction.

Early-stage diffuse large B cell lymphoma of the head and neck: clinico-biological characterization and 18 year follow-up of 488 patients (IELSG 23 study).

It is known that extranodal head and neck diffuse large B cell lymphomas (eHN-DLBCL) can affect various anatomical structures what is not well-known, however, is whether they differ in terms of clinical presentation and outcome. Clinical data of the multi-institutional series, the largest of its kind as yet, has been analysed with the aim of answering these open questions and providing long-term follow-up information. Data from 488 patients affected by stage I/II eHN-DLBCL was collected: 300 of the Waldeyer's Ring (WR), 38 of the parotid and salivary glands (PSG), 48 of the thyroid gland (TG), 53 of the nasal cavity and paranasal sinuses (NPS), 24 of the palate and oral cavity (POC) and 25 with more than one involved site. Different eHN-DLBCL arising have distinct characteristics at presentation. The intermediate high risk-modified IPI was 67 % in TG, 44 % in WR, 38 % in PSG and POC and 20 % in MS. The worst 5-year survival rate had TG-DLBCL (61 %) due to the 61 % of patients with a mIPI >1. The addition of radiotherapy (cRT) to remitters did not translate into a survival advantage (5-year disease-free survival of 67 % in the cRT group vs. 70 % in the other). Three of four central nervous system recurrences occurred in NPS-DLBCL. Survival of HN-DLBCL was inferior to nodal DLBCL. This study showed that eHN-DLBCL remitters have an inferior survival when compared to nodal DLBCL, and that the addition of cRT does not provide a survival advantage. Since the standard of care nowadays is chemo-immunotherapy, survival of these patients might have been improved.

Monola oil versus canola oil as a fish oil replacer in rainbow trout feeds: effects on growth, fatty acid metabolism and final eating quality.

Monola oil, a high oleic acid canola cultivar, and canola oil were evaluated as replacers of fish oil at three levels of inclusion (60%, 75% and 90%) in rainbow trout diets. After a 27-week grow-out cycle, the diet-induced effects on growth, fatty acid metabolism and final eating quality were assessed. Overall, no effects were noted for growth, feed utilisation or fish biometry, and the fatty acid composition of fish fillets mirrored that of the diets. Dietary treatments affected fillet lipid oxidation (free malondialdehyde), pigmentation and flavour volatile compounds, but only minor effects on sensorial attributes were detected. Ultimately, both oils were demonstrated to possess, to differing extents, suitable qualities to adequately replace fish oil from the perspective of fish performance and final product quality. However, further research is required to alleviate on-going issues associated with the loss of health promoting attributes (n-3 long chain polyunsaturated fatty acids) of final farmed products.

Gastric non-Hodgkin's lymphoma: analysis of 252 patients from a multicenter study.

AIMS AND BACKGROUND: The stomach is the most common site of primary extranodal non-Hodgkin's lymphoma (NHL) and no agreement has been reached so far on the best therapeutic approach. The main objects of this study were to report the long-term results and to evaluate the importance of some possible prognostic factors in a large series of patients. NHL was considered primary gastric if the main symptoms at presentation were those of gastric disease. METHODS AND STUDY DESIGN: We analyzed 252 consecutive patients treated between 1980 and 1993 in five hospitals in north-east Italy. According to the Working Formulation, 98 patients had low grade lymphoma, 59 intermediate grade (D to F), 81 G or high grade and 14 were not classified. The patients were divided into two groups: one including patients with limited disease (localized to the stomach or perigastric lymph nodes: 165 patients) and one including those with advanced disease (87 patients). The treatment consisted of surgery, chemotherapy, radiotherapy or combinations of these. Sixteen patients received only supportive therapy. RESULTS: The five-year overall survival was 65.4%: 80.3% for patients with limited disease and 36.7% for those with advanced disease (P < 0.0001). Among the limited disease patients the five-year survival was 84.4% for those treated with gastrectomy alone and 88.7% for those who received also adjuvant chemotherapy (P = 0.11). However, while chemotherapy did not improve survival in low grade NHL, it seemed to produce a better survival in the intermediate and high grade groups (P = 0.06). Twelve patients were treated with primary chemotherapy and the five-year survival was 71.2%. In multivariate regression analysis the most important variable for overall survival was surgery for the whole group of 252 patients (P < 0.0001), while it was age for the group with limited disease (P = 0.0008). CONCLUSIONS: Surgery alone can be curative for most patients with gastric lymphoma limited to the stomach or to the perigastric lymph nodes; surgery followed by chemotherapy seems to produce better results than surgery alone in intermediate and high grade lymphomas. Also a non-surgical approach with first-line chemotherapy is associated with a high rate of complete remissions and five-year survival. In advanced disease the five-year survival is similar to that of nodal NHL.

Stage-modified international prognostic index effectively predicts clinical outcome of localized primary gastric diffuse large B-cell lymphoma. International Extranodal Lymphoma Study Group (IELSG)

BACKGROUND: The definition of prognostic parameters in early stages of gastric lymphoma is still controversial. The aim of this retrospective analysis was to assess the value of the stage-modified international prognostic index (IPI) in predicting the outcome of a large, consecutive series of patients with PGL of diffuse large B-cell histology (DLCL). PATIENTS AND METHODS: Three hundred twelve consecutive, newly-diagnosed, patients with localized PGL (stages I-IIE according to the 'Lugano staging system for GI lymphomas') referred from April 1972 to December 1997 to eight Italian and one Swiss centers were reviewed and their outcomes updated to June 1998. One hundred three patients were treated with single-modality therapy, while two hundred four received combined-modality treatment, most of which included surgery and short-term chemotherapy. RESULTS: After a median follow-up of 66 months (range 0.6-300 months), 195 (64%) were alive in first continuous complete remission (CCR). The five-year estimates of overall survival (OS) and event-free survival (EFS) were 75% and 67%, respectively. OS and EFS varied according to IPI, from, respectively, 90% and 82% for patients with 0-1 risk factors, to 40% and 35% for patients with > or = 3 risk factors (P = 0.00001). Cox regression analysis showed that IPI was the strongest predictor of survival. CONCLUSIONS: This study shows that stage-modified IPI is an effective predictive model in patients with primary DLCL of the stomach, enabling identification of patients with significantly different outcomes.

[Radiotherapy of the tonsillar region. Analysis of prognostic factors]. / Radioterapia della regione tonsillare. Analisi dei fattori prognostici.

INTRODUCTION: We report our personal experience with the treatment of tonsillar cancers at the Otorhinolaryngology-Radiotherapy Department of Umberto I Hospital, Mestre, Italy. The results were analyzed by tumor site and stage, lymph node involvement, treatment type and patient age. MATERIAL AND METHODS: January, 1987, through December, 1995, we treated a hundred and 25 patients with carcinoma of the tonsil and tonsillar region. Most patients were men (M:F = 4:1), with a mean age of 61.9 years (range: 38-87). The lesions were staged at physical examination, chest radiography, bone scintigraphy. US of the liver and neck, CT and/or MRI of the tonsillar region and neck. Eleven patients were in stage I (8.8%), 26 in stage II (20.8%), 31 in stage III (24.8%) and 57 in stage IV (45.6%). Forty-one patients were submitted to tonsillectomy and more/less massive neck dissection: surgery was not radical-in 14 of them. All patients received gamma-photon radiotherapy with a cobalt unit: the minimum dose was 50 Gy after radical surgery and 60 Gy for exclusive irradiation and after nonradical surgery. The hemiblock field technique was always used with the conventional fractionation (2 Gy/day. 1 fraction/day, 5 fractions/week); the treatment was planned with the Theraplan V05-B method on CT scans. When the tolerance dose was reached, the spinal cord was shielded and the dose compensated with 9 MeV electrons. The treatment was discontinued only when needed, and never for more than 7-10 days. RESULTS: The overall 5-year survival and the 5-year disease-free survival rates were 28% and 45%, respectively; the overall 5-year cause-specific survival rate was 39%. Disease-free survival was 81% in stage I, 52.7% in stage II, 44.2% in stage III and 35.8% in stage IV (p = .005). The 5-year disease-free survival for the patients receiving surgery and irradiation was 62.1%, versus 38.3% for irradiation alone; the rate was 37.6% when neck nodes were involved (N+). One hundred and two patients achieved complete remission (CR), while the other 23 had partial remission (PR). Twenty-eight CR patients recurred; the most common cause of death was failure in primary tumor local control. There were no complications during or after treatment. Secondary lesions were found in 13 patients (10.1%). CONCLUSIONS: Irradiation alone yields fairly good results in early tonsil carcinoma, while the surgery-irradiation combination should be preferred in large tumors. Better results are expected from kinetic and conformal irradiation techniques with 3D calculations on CT and MR images, which should permit to deliver high doses to strictly targeted areas and to reduce side-effects. Other improvements are expected from new combination therapies.

[Epistaxis in Rendu-Weber-Osler disease. The role of brachytherapy]. / L'epistassi nel morbo di Rendu-Weber-Osler. Ruolo della brachiterapia.

Rendu-Weber-Osler disease is a rare autosomic disorder. Its most common symptom is epistaxis with transitory periods of remission and of ingravescent exacerbation compromising normal daily activities and forcing the patient to give up his normal life-style for prolonged periods of time. Often it proves difficult to control the recurrent epistaxis and the treatments available today are not always totally satisfactory. The authors present the results obtained using endonasal brachytherapy in 8 patients (13 treatments) epistaxis stemming from previously diagnosed Rendu-Weber-Osler disease. Brachytherapy employs thin plastic tubes, positioned in the nostril with the heaviest epistaxis. These tubes are then filled with Iridum192. The total dose, prescribed against the reference isodose, strictly adjacent to the nasal fossae mucosa, was 30 Gy over a period ranging from two to four days (average 2.5 days). Four patients required a second treatment to the controlateral nostril as the symptoms returned after a period ranging from 36 to 60 months (average 47.1 months). Only one patient required a second treatment in the same nostril 9 years later. The episodes of epistaxis were scored by symptom severity on a scale from 0 to 5. Of the 13 treatments administered (mono and bilateral treatments), 12 can be considered satisfactory as the epistaxis was reduced from the initial pre-treatment score of 4-5 to 2 or less (5 were reduced to 0, 3 to 1 and 4 to 2). In only 1 case was the score 3. Remission of symptoms lasted for a period ranging from 11 to 108 months with an average of 51.6 months. No complications arose from the use of brachytherapy. Only one patient required embolization 3 years after the endonasal brachytherapy treatment.

[The use of a single anterior oblique field in the treatment of T1aN0 vocal cord neoplasms. Results and comparison with other technics]. / Impiego di un campo unico obliquo anteriore nel trattamento delle neoplasie delle corde vocali T1aN0. Risultati e confronto con altre tecniche.

From 1985 through 1993, 113 patients affected with T1N0 glottic cancer were treated with irradiation alone at the Radiotherapy Department of Umberto I Hospital in Mestre, Italy. An anterior oblique beam of 12 MV X-rays (LINAC) or gamma-rays of a Cobalt unit were used. Dose distribution was always studied on CT scans and with a Theraplan V05-B, Theratronics. Patients age ranged 40-92 years (mean: 64.7 years) and they were mostly males. The dose was always 60 Gy/30 fractions referred to the 90% isodose. The dose to the target volume ranged 90-105%, with a mean of 99%. The follow-up ranged 26 to 98 months; the median and the mean are 38 and 40 months, respectively. Six patients had local relapses and were all operated on: cordectomy was performed in 3 of them and laryngectomy in the other 3. Radiation therapy yielded 94.7% disease control; the lesion was ultimately controlled in 100% of patients after surgical salvage. Fifteen patients died, all of them of non-neoplastic disease. The authors compared this technique with those most frequently used, i.e., wedged opposed lateral fields and wedged anterior oblique beams, and observed that it allows minimal volumes to be irradiated with maximal doses and yields results. Wedged beams are not necessary with this technique. The authors consider irradiation the treatment of choice for early glottic cancer and believe that surgery, with the conservative approach if feasible, should be limited to relapses.

[The polycentric multiple arc complanar technic, or telebrachytherapy. A 4-year experience (an innovative way for the local control of solid neoplasms)]. / La tecnica complanare "policentrica ad archi multipli", ovvero la telebrachiterapia. Quattro anni di esperienza (una via innovativa per il controllo locale delle neoplasie solide).

The coplanar polycentric multiple 180 degrees single arc and narrow beams technique (PMA) allows high radiation doses to be delivered to the target, with similar dose distribution to that of brachytherapy. Since 1990, more than 100 patients have been treated: 80 had NSCLC, 12 had epidermoid head and neck (oral cavity and oropharynx) cancers, 8 brain tumors, 4 esophageal cancers and, sporadically, other patients had many other kinds of tumors, e.g., Hodgkin's and non-Hodgkin's lymphomas and sarcomas. X photons of a 12-MV Linac have always been used. NSCLC patients are assessable for local control, toxicity and survival, while the other patients only for local control and/or toxicity. As for 31 stage I-II lung cancer patients, CR has been observed in 82.8% of them and PR in 13.8%; the response was always assessed with chest radiography, CT, FBS, cytology and/or histology. The overall actuarial survival rate is 71% at 40 months, the disease-free survival rate is 75% and the local progression-free survival rate is 94%. As for 49 stage-III patients, CR has been observed in 40% of them and PR in 56%. The overall disease-free survival is 10% at 28 months (median survival: 14.37 +/- 0.6 months). The disease-free survival rate is 23%. The local progression-free survival rate is similar to the overall survival rate, which seems to prove the very high metastatic spread of this disease in advanced stages. Twelve head and neck cancer patients have been treated, 5 of them in stage II and 7 in stage IV. CR has been observed in all the patients in lower stages (100%), in 4/7 patients in stage IV (57%) and in 4/5 patients (80%) in the T4N0 subgroup. The response of brain tumors treated with the PMA technique is difficult to assess because radiographic, CT and MR images are difficult to correlate with patients clinical status. The patients in our series are still alive, with a medium follow-up of 7 months (range: 2-16 months). A longer follow-up is necessary before any other considerations on the effectiveness of this method can be made. This technique was used on the patients who were not eligible for the other techniques with high doses delivered to the tumor, because of its volume and/or shape. Four esophageal cancers were treated with palliative intent, because of absolute dysphagia, in alternative to HDR brachytherapy. All these patients have obtained symptom remission.(ABSTRACT TRUNCATED AT 400 WORDS)

[Brachytherapy of epistaxis in Rendu-Osler disease. Indications, technic, results]. / La brachiterapia dell'epistassi nel morbo di Rendu-Osler. Indicazioni, tecnica, risultati.

Rendu-Osler disease is a clinical form characterized by skin, mucous and bowel teleangiectasias causing repeated bleeding, especially in the nasal region. Repeated epistaxis is controlled, however transiently, with electrocoagulation, laser therapy, embolization, mucous transplants and external radiotherapy or, more frequently, brachytherapy. The authors report on a Curietherapy technique based on the use of 192Iridium wires. The wires, which cannot be placed in parallel lines, must be positioned in three places after a fan-wise pattern: the first one on the floor, the second one along the anterior wall and the third one in between. The three wires are inserted into plastic tubes during fluoroscopy. The length of the wires is differentiated for greater dose distribution homogeneity. The dose given to the reference isodose--which is probably in contact with the mucosa--is 30 Gy. We performed 9 maneuvers in 6 patients and three of them were also treated in the contralateral nostril. Complete remission was seen in 4 patients. In 2 patients the response has lasted 18 and 32 months and 2 others have a shorter follow-up. In 5 patients we obtained a good response (mean: 58 months). Our results are in agreement with those in brachytherapy literature. Few trials are reported of external irradiation but in our personal experience, its results are poor. Brachytherapy effect is limited in time but yields major clinical benefits to the patient. Brachytherapy cannot replace other treatment methods and must therefore be considered as a palliative treatment which can improve patient's quality of life in time.

CA 15-3 value and neoplastic disease predictivity in the follow-up for breast cancer.

The role of CA 15-3 in breast cancer has been widely studied by several authors. This study was designed to describe the predictivity of CA 15-3 determinations for the metastasis or second primary tumor in patients subjected to follow-up for breast cancer. All the 1,123 determinations of CA 15-3 carried out during 1991 in a hospital laboratory were analyzed. By cross-matching anagraphic items of patients with clinical data from different hospital databases, it was possible to reconstruct the clinical history. At the cutoff point of 40 U/ml, the positive predictive value of the CA 15-3 was 99.4%. This study shows the very close association between CA 15-3 > or = 40.0 U/ml and disease, suggesting a careful restaging when the marker increases without clinical evidence of metastases. Hormonal treatment should also be considered.

[Brachytherapy in choroid tumors]. / Brachiterapia dei tumori coroidei.

Even though brachytherapy has been used for many years to treat choroidal tumors, it is not a widespread technique because it requires much organization and operators skills. The most common methods use 60Cobalt and 106Rutenium plaques, or custom-made plaques with 125Iodine loaded seeds. Another, less common, technique uses 192Iridium wires loaded on custom-made plaques. The technique we used to treat 4 retinoblastomas and 2 choroidal melanomas uses 192Iridium wires loaded on custom-made plaques. The applicator is made of a quick drying paste poured over a sphere the same size as the eye-ball: plastic tubes are inserted, according to preliminary dosimetric measurements, to house the Iridium wires. The applicator is positioned on the eye-ball corresponding to tumor site by surgery. The Iridium sources are inserted into the plastic tubes at the end of surgical placement: this afterloading technique guarantees maximal staff protection. 192Iridium (320 keV gamma emitter) allows the dose to be transmitted deeper than with 125Iodine (30 keV gamma-emitter) and 106Rutenium (3540 keV beta-emitter). Therefore, with Iridium, the dose delivered is lower on the eye-ball surface for the same tumor dose. On the other hand, the use of 60Cobalt (1250 keV gamma-emitter) gives the healthy surrounding tissues higher doses. To conclude, this method allows us to customize the application to every single case, to reach posterior sites, to ensure radioactive protection to staff thanks to afterloading and to obtain a good depth to surface dose ratio.

[Carcinoma in situ of the breast: which treatment?]. / Carcinoma in situ della mammella: quale trattamento?

From January 1984 to December 1992, twenty-eight patients affected with breast carcinoma in situ were treated with surgery (8 with radical mastectomy, 20 with quadrantectomy) at Umberto I Hospital in Mestre, Italy. The patients with multicentric lesions and treated with quadrantectomy received also radiation therapy. The dose was 50 Gy/25 fractions with 60Co and a boost of 10 Gy to the tumor bed. The mean age of our patients was 55 years (range: 34-74 years). Histology diagnosed lobular carcinoma in situ in 7 cases, intraductal carcinoma in 19 cases and comedocarcinoma in 2 cases. The median and the mean follow-up are 37 and 42 months (range: 24-128), respectively. The eight-year local control and the cause-specific survival rates are 100%. No local relapses have been observed. One patient died, of another neoplastic disease, free from breast disease. We believe that the conservative approach in breast carcinoma in situ, according to literature results and to our personal experience, should be more frequently preferred to radical surgery even in the patients with multicentric lesions.

[Palliative bronchial deobstruction with kinetic radiotherapy in non-small cell lung cancer]. / Disostruzione bronchiale palliativa con radioterapia cinetica nel cancro polmonare non a piccole cellule.

The palliative treatment of lung atelectasis can significantly improve the quality of life in the patients who are unsuitable for cure. The authors present a new transcutaneous radiotherapy technique for treating this complication of lung cancer. After conventional and CT localization, a treatment is scheduled featuring a small (3-5 cm wide and 4-6 cm long) single 180 degrees arc beam giving 14 Gy to the 90% isodose line in two daily fractions. The treatment is repeated 3 weeks later (dosage: 28 Gy). The mean dosage to the ICRU reference point was 34 Gy; the min., max. and mean dosages to the planning target volume were 31, and 35 Gy, respectively, in 4 fractions over a 3-week period. Lesions were localized best by positioning the distal end of a fiberoscope close to the tumor and by checking its position under fluoroscopic guidance, on two orthogonal projections, immediately after every treatment session. Nine patients with histologically-proven non-small cell lung cancer were treated. They relapsed after surgery and/or full-course radiotherapy. Lung reventilation, demonstrated with fiberbronchoscopy and on chest films, was observed in 8/9 patients, in 1 of them lasting for about 40 days. In the extant 7/8 cases, it lasted longer (range: 60-180 days). Of the latter patients, 5 are alive and 2 died 60 and 86 days after treatment, with no atelectasis. The treatment was very well tolerated and severe symptoms were relieved with no complications.

[Results of conservative treatment of stage I-II carcinoma of the breast. Analysis of 311 patients]. / Risultati del trattamento conservativo del carcinoma della mammella nel I-II stadio. Analisi di 311 pazienti.

From January 1984 through December 1990, 311 patients affected with breast cancer were treated with quadrantectomy plus lymphadenectomy and radiation therapy (QUART) at the Umberto I Hospital in Mestre, Italy. The patients with positive nodes (N+) were treated with adjuvant chemotherapy (CMF) or hormonotherapy (Tamoxifen) according to pausal status. Most patients were in the 5th, 6th and 7th decades of life; 60.5% of them were over 50. Staging was always performed according to TNM classification (UICC criteria) and demonstrated mostly stage-I lesions (66.9%). Overall and disease-free (NED) survival rates were 95%; mean survival rates were 7.47 (+/- 0.138) and 7.22 (+/- 0.164) years, respectively. Ten patients died (5 from breast cancer); 6 local relapses were observed and 8 metastases. Metastases were seen mostly in patients with breast cancer in the internal quadrants (QI) N0, with no statistically significant differences relative to the other groups. This is probably due to the existence of an axillary pN0 and parasternal N+ group of patients, who receive insufficient treatment.

[The prognostic factors for the radiation treatment of the cerebral metastases from breast carcinoma]. / Fattori prognostici per il trattamento radiante delle metastasi cerebrali da carcinoma mammario.

Complex mechanisms of various nature, not only physical, can influence the patterns of metastases. We compared the patients with recurrences to the brain as the only metastatic site from breast cancer with the patients relapsing in the brain and other organs. All cases were staged and treated following professional protocols. When brain metastases were diagnosed, the patients were accurately restaged before being submitted to radiation therapy; the whole brain was irradiated with various total doses and the same fractionation. The patients underwent clinical examination before and after irradiation. Survival analysis was carried out using the product-limit method considering the following periods: total survival, relapse-free survival, elapsed time till the appearance of brain metastases, and survival after radiation therapy. The cases were grouped and compared using Mantel-Cox and Breslow methods according to the following prognostic factors: brain as the first site of recurrence, pausal state, total radiation dose, stage (TNM), T and N. No significant difference in survival was observed between the cases with brain as the first metastasized organ and the others. The patients were grouped according to the extant prognostic factors: longer total and postirradiation survival rates were observed in patients in premenopausal state (Breslow: p = 0.025 and 0.005) and in the cases treated with total radiation doses greater than 40 Gy (Breslow: p = 0.023 and 0.005). T levels seemed to significantly affect all the examined periods--which influences the stage effect. Conversely, N levels seemed to be of no significant value. The menopausal factor may reflect the effects of age, from which it cannot be separated. These results can be useful for treatment planning.

ADL: an integrated database for filing and study of malignant lymphoma patients.

The filing of clinical data must comply with purposes of logical organization for comparisons and evaluations. ADL (Archives of Data on Lymphomas) is an application program of dBASE III plus (Ashton-Tate) for personal computers, especially suitable for filing and studying patients afflicted with malignant lymphoma. It is subdivided into four data files: general data (private data, stage, therapy); disease data (sites of disease by tests and body area); immunological data (lymphocyte subpopulations, globulin and immunoglobulin dosage, delayed hypersensitivity skin tests); lost patients (register of patients not seen for at least 1 year). It has many utilities (descriptive statistics, clinical report, export service). Congruence checks and verification of names and dates input are included. This program stands as a valuable alternative to more traditional filing systems.

[Changes in lymphocyte subsets after radiotherapy]. / Variazione dei subset linfocitari dopo radioterapia.

Radiation therapy seems to induce depletion of lymphocytes, which are very important cells for immunity response. The lymphocyte phenotype was studied in 41 non-pretreated patients with normal immunological parameters who received postoperative radiation therapy for breast, mediastinal or pelvic cancer with at least 50 Gy/25 fractions. The functional immunological assessment was analyzed by Multiskin test (Merieux) too. The lymphocyte phenotype was determined on whole-blood lysate employing an Ortho double-fluorescence cytofluorimeter. All patients, after radiation treatment, exhibited decrement in absolute and percent lymphocyte subpopulations; the Multiskin test demonstrated simultaneous change in skin-test response. The results are highly significant (p 2-tailed area less than 0.0001) for absolute cells count and skin-delayed response test, but percent variations are not significant when verified by t-test.

[Postoperative radiotherapy in the treatment of breast tumors. Evaluation of a 5-year case series]. / La radioterapia post-chirurgica nel trattamento dei tumori della mammella. Valutazione di una casistica di 5 anni.

Between January 1981 and December 1985, 364 female patients underwent surgical treatment for breast cancer in Mestre General Hospital. The pathological stage of the disease was stage I in 60 patients, stage II in 215 patients, stage III A in 30 patients, stage III B in 44 patients and stage IV in 15 patients. The patients with T1-T2 N0 lesions located in the outer quadrants received no additional treatment after surgery, while the others received adjuvant therapy. The patients with stage-IV disease (M+) were treated with chemo and/or hormonotherapy. All patients were followed for an average of 33 months up to December 1986 (range 1-71 months). Local-regional relapses developed in 17 patients, 15 on the chest wall and 2 in the drainage lymph nodes (only 7 within the previously-treated area). A 5-year actuarial survival rate was observed of about 78%, and 66% of relapse-free survival, in the whole group of patients (100% and 92% in stage I; 92.5% and 76% in stage II; 51% and 33% in stage III A; 32% and 19% in stage III B; 31% in stage IV, respectively). As far as our series of patients is concerned, the massive involvement of axillary lymph nodes seems to be the most adverse prognostic factor in survival rates. Even though the short follow-up does not allow definitive conclusions to be drawn, the authors believe such loco-regional treatments as surgery and radiation therapy to be extremely important in the local control of breast cancers, as well as in the patients' survival in the long run.