Nasopharyngeal carcinoma in a low incidence European area : A prospective observational analysis from the Head and Neck Study Group of the Italian Society of Radiation Oncology (AIRO).

PURPOSE: To evaluate the outcomes with respect to long-term survival and toxicity in patients with nasopharyngeal carcinoma (NPC) treated in a European country with low incidence. MATERIALS AND METHODS: A prospective observational study carried out by the AIRO Head and Neck group in 12 Italian institutions included 136 consecutive patients treated with radiotherapy (RT) ± chemotherapy (CHT) for NPC (without distant metastasis) between January 1, 2008 and December 31, 2010. RESULTS: The disease-specific survival (DSS), overall survival (OS), and disease-free survival (DFS) at 5 years were 92 (±2), 91 (±3), and 69 % (±5 %), respectively. Distant failure was the most frequent modality of relapse. The local, regional, and locoregional control at 5 years were 89 (±3), 93 (±3), and 84 % (±4 %), respectively. The incidence of acute and late toxicity and the correlations with different clinical/technical variables were analyzed. Neoadjuvant CHT prolongs radiotherapy overall treatment time (OTT) and decreases treatment adherence during concomitant chemoradiotherapy. An adequate minimum dose coverage to PTV(T) is a predictive variable well related to outcome. CONCLUSION: Our data do not substantially differ in terms of survival and toxicity outcomes from those reported in larger series of patients treated in countries with higher incidences of NPC. The T stage (TNM 2002 UICC classification) is predictive of DSS and OS. The GTV volume (T ± N) and an adequate minimum PTV(T) coverage dose (D95 %) were also identified as potential predictive variables. Sophisticated technologies of dose delivery (IMRT) with image-guided radiotherapy could help to obtain better minimum PTV(T) coverage dose with increased DFS; distant metastasis after treatment still remains an unresolved issue.

Blood pressure and progression of renal failure in the elderly.

There are a lack of studies about elderly patients with chronic renal failure (CRF). We studied 22 patients, aged 64 to 74 years, who were diagnosed with hypertensive nephropathy (HN), defined as a diastolic blood pressure (DBP) < 95 mm Hg and a basal creatinine clearance (CCr) of 52 +/- 6 ml/min/1.73 m2. During the minimum two-year follow-up, the progression of renal failure (RF) was analyzed by the plotted slope of CCr versus time. Patients were divided into two groups, each administered one of two different drugs, Ca antagonists (group I) and angiotensin converting enzyme (ACE) inhibitors (group II). The DBP in both groups was lowered by the end of the study. The mean arterial pressure (MAP) was less in group I (97.35 +/- 5.98 mm Hg) than in group II (108.3 +/- 9.95 mm Hg). The decline in renal function was a mean rate of -0.62 +/- 0.36 ml/min/month in group I and -1.03 +/- 0.17 ml/min/month in group II. In conclusion, we show that patients who were on ACE inhibitors exhibited a greater MAP and a greater decline in renal function compared with the patients who were on Ca antagonist therapy. We also found that patients who were younger than 70 years old had better control of their blood pressure rates and less of a rate of decline in renal function than their older counterparts.