[Factors affecting the contralateral dose for the non-treated breast in irradiation following quadrantectomy]. / Fattori che influenzano la dose alla mammella non trattata nell'irradiazione dopo quadrantectomia.

We evaluated, with a treatment planning system, the maximum and the mean contralateral breast doses, and, with thermoluminescent dosemeters LiF100; the skin dose during radiation therapy after conservative surgery. The doses were correlated with technical parameters through statistical analysis. Since 1995, 100 patients have been considered, all of them treated with two 60Co tangential beams after quadrantectomy. The mean dose to the contralateral breast exhibited a statistically significant correlation with the gantry angle of the lateral (Pearson, p < .02) and medial beams (p < .01); the maximum dose was correlated with the gantry angle of the lateral (p < .002) and the medial beams (p < .002). In the last 50 patients, the skin dose (measured with TLDs) was correlated with: distance from beam edge (Pearson, p < .02), breast thickness (p < .01), gantry angle of the lateral beam (p < .005), gantry angle of the medial beam (p < .002). Furthermore, only the gantry angle of the lateral (p < .02) and of the medial beams (p < .01) exhibited statistically significant Spearman's correlation with skin dose. Wilcoxon's signed rank sum test for paired data was performed to study wedge dependence. The average contralateral breast dose using two wedges was statistically reduced with respect to the dose without wedges (p < .02). These results suggest that the dose to the contralateral breast could be significantly decreased by careful attention to the treatment details, which implies that the procedures related to the technical aspects of the therapy should be submitted to careful quality control.

[Effects of immunomodulation on antineoplastic radiotherapy. A controlled clinical study]. / Effetti dell'immunomodulazione nella radioterapia antineoplastica. Studio clinico controllato.

It is well known that thymic hormones can counteract immunodepression due to radiation therapy, preventing and reducing the severity and the number of myelotoxic and hematologic reactions. We tried to confirm these findings in a controlled multicenter clinical study involving 1,060 patients undergoing radiation therapy (580 treated with thymopentin 50 mg s.c. every other day, after irradiation and for at least 6 cycles of 4 weeks each, and 480 control patients). Highly statistically significant results (to the ANOVA test) were obtained in the protection against radiation-induced leukopenia in the treated group; furthermore, the treated patients had a marked reduction (p = 0.003 chi 2 test) in the early delayed reactions to irradiation, namely in the upper aero-digestive tract. In general, we observed a better, but not statistically significant recovery of the blood parameters, lymphocyte subsets and skin tests in the treated group versus the control group. Both of the treated groups showed the same trend for Karnofsky performance status and body weight. The local and general protection provided by thymopentin against the reactions to irradiation could be advantageously used for the administration of higher doses of radiation therapy.

Evaluation of the esthetic results of conservative treatment of breast cancer.

AIMS AND BACKGROUND: This paper describes the evaluation of a personal series of 106 breast cancer patients, aged 28-75 years (average, 54), treated between 1988 and 1971, to determine the success of a conservative protocol proposed as a means of combining radicality with a better cosmetic result, less alteration of the body image and an improved quality of life. METHODS: All the patients were operated with quadrantectomy and excision of axillary lymph nodes, followed by radiotherapy: 50 Gy to the whole breast plus 10 Gy on the tumor bed (boost irradiation). Adjuvant hormone and/or chemotherapy was also administered in 71/106 cases. The mean follow-up was 22.3 months. Cosmetic assessment was subjective and objective (asymmetry, loss of volume, retraction). All patients were photographed. RESULTS: The subjective judgements were: excellent 79, satisfactory 25, and poor 2, compared with objective assessments of 72, 20 and 14, respectively. Patients with poor esthetic results were almost all either T2 or treated with chemotherapy. CONCLUSIONS: Conservative treatment of breast cancer using integrated irradiation and surgery can therefore attain the required objective of eradication of the cancer while maintaining a satisfactory esthetic and therefore good psychologic outcome.

[Determination++ of CA 15-3 in the control of primary and metastatic breast carcinoma]. / Dosaggio del CA 15-3 nel controllo del carcinoma mammario primitivo e metastatico.

From April 1987 to December 1990 490 women and 5 men suffering from primary or metastatic breast cancer underwent 1485 assays of the CA 15-3 marker using a radioimmunometric method supplied by Centocor based on two monoclonal antibodies: 115D8 and DF3. The dose-response curve constructed using 5 standards. Clinical and instrumental monitoring of patients continued for at least one year after the last assay. In line with the bibliographical data and the Author's extensive experience a cut-off 40 U/ml was selected. On this basis the percentages of sensitivity (58.2), specificity (96.0), accuracy (85.0), and positive (85.7) and negative (84.9) predictive value were calculated and were in overall terms better than those obtained using a threshold of 30 U/ml. A chart marking the trend of percentages for assays in patient with active metastasis showed that there was a rapid increase over 40 U/ml, reaching 100% over 90 U/ml. In asymptomatic patients, who were considered "ned" following clinical and instrumental controls, it was rare to find and assay level over 50 U/ml (13/1050). The authors underline the importance of serial controls in post-treatment follow-up at intervals of not less than one month and not more than 3 months for 1-2 years, and subsequently every six months. This marker has been found to offer considerable prognostic, but not diagnostic, reliability during the preoperative period and even more so during cancer control due to the possible early detection of metastasis in the viscera or skeleton, especially if this is conspicuous. On the other hand, the marker shows limited sensitivity to cutaneous or regional lymph node metastasis. In this pathology levels in excess of 200 U/ml have never been observed. CA 15-3 is particularly important in evaluating the efficacy of anti-tumour therapies or deciding whether they are worth continuing. In conclusion, a few general comments are made regarding the indications for doses and the value of the marker in controlling patients treated for breast cancer.

[Bone marrow scintigraphy with 99mTc nanocolloid. A complement to bone scintigraphy with 99mTc MDP in oncologic diagnosis]. / La scintigrafia del midollo osseo con 99mTc nanocolloide. Un completamento alla scintigrafia ossea con 99mTc MDP nella diagnosi oncologica.

We compared the results of bone marrow scintigraphy (SMO) with those of conventional bone scintigraphy (SO) obtained in patients suffering of malignant neoplasms. SMO was carried out using nanometer-sized particles (nanocolloid) labelled with 99mTc, known to target the phagocitic properties of the medullar reticulo-endothelial cells. The results of the two investigations carried out in 148 patients agreed with each other. Notwithstanding the lesser definition of SMO images compared to SO and the masking effect of the high hepatosplenic activity, the two diagnostic methods were found to agree in 81.1% of all cases. SMO is easy to perform, can be compared well with SO and was demonstrated to be complementary to the latter. The SMO/SO confrontation has been found to be useful for better defining the extension of neoplastic lesions, which in turn has led to better staging of the disease. The investigation provides information about the entire distribution of the central bone marrow and its possible pathologic peripheral expansion. A remarkably reduced nanocolloid uptake cannot only be found in the osseous structure subjected to radiotherapeutic doses in excess of 30 Gy, but also in the case of longer standing high-dosage cytostatic treatments. The latter finding does not have its correlate in SO, hence it could be of considerable interest in validating the continuation of antineoplastic therapies.

[The incidence of tumors of the nasal cavity and the paranasal sinuses in the district of Biella, 1970-1986]. / Incidenza dei tumori delle cavità nasali e dei seni paranasali nel comprensorio di Biella, 1970-1986.

The district of Biella in Piedmont (NW Italy) has one of the largest concentrations of the textile industry in Italy, traditionally manufacturing high quality wools. The present paper describes a survey of primitive cancers of the nasal fossae and paranasal sinuses diagnosed among residents of this area from 1970 to 1986. This study is a preliminary step in a case-control study aimed at investigating the association with occupational exposure in the textile industry. Seven cases were diagnosed in the 1970-75 period and 25 in the following ten years 1976-1986. The cut-off point corresponds to the year when the Hospital Admission and Discharge Registry became operative in Piedmont and Lombardy. The 1970-75 annual incidence rates (X 100,000, world standardized) were 0.5 both among males and females. Corresponding figures in 1976-86 were 1.2 and 0.2. Out of 32 cases, 16 were adenocarcinomas or adenoid-cystic carcinomas. Eleven cases are reported in the clinical record as wood or leather workers and seven as textile workers. Occupation was not reported for six cases. A case-control study is in progress.

Phase III randomized study of fluorouracil, epirubicin, and cyclophosphamide v fluorouracil, doxorubicin, and cyclophosphamide in advanced breast cancer: an Italian multicentre trial.

From February 1983 to January 1985, 497 patients with advanced breast cancer were randomly allocated to receive either epirubicin or doxorubicin in the following combination chemotherapy regimen: fluorouracil (5-FU) 500 mg/m2 intravenous (IV) on days 1 and 8; epirubicin or doxorubicin 50 mg/m2 IV on day 1; cyclophosphamide 500 mg/m2 IV on day 1 (FEC or FAC). Cycles were repeated every 21 days until progression or to cumulative doses of 700 mg/m2 for epirubicin and 550 mg/m2 for doxorubicin. Dose reductions were applied according to the standard criteria. Activity was evaluated in 443 patients (222 in the FEC arm and 221 in the FAC arm). The two experimental groups were comparable in age, performance status, menopausal status, histology, previous treatments, and site of the disease. The overall response rate (complete response and partial response [CR + PR]) was not significantly different: 53.6% for FEC and 56.5% for FAC. The median time to progression was 273 days for FEC and 314 days for FAC; the median survival time was 591 and 613 days, respectively. Leukopenia, anemia, nausea, and vomiting were significantly lower in patients treated with FEC. As for cardiotoxicity, four cases of congestive heart failure (CHF) were recorded among patients treated with FAC while only one was observed in the FEC group. These results indicate that epirubicin in a combination chemotherapy regimen is as active as doxorubicin and is significantly less toxic.

[Scintigraphy of the bone marrow for the evaluation of injuries caused by antiblastic agents]. / Scintigrafia del midollo osseo per la valutazione del danno da farmaci antiblastici.

For various reasons the well-known myelopoietic damage caused by cancer chemotherapy is not easy to quantify by means of usual diagnostic procedures. The bone marrow scan with a Tc 99m-nanocolloid rapidly cleared by the phagocytic action of the RES, which has a topographic extension similar to red marrow, has been used for many years to evaluate the inflammatory and neoplastic diseases, both localized and diffuse. Such examination was thus performed in patients undergoing cytostatic therapy, either to follow-up metastatic lesions or to evaluate a tissue damage due to different drugs. The BMS is easily performed and has no side-effects. It consists of a dynamic and a static part. Moreover, it helped pointing out important diagnostic data, such as the reduction of the sacroiliac uptake index below the normal values (3.7) in 33 out of 57 cases, and an abnormal distribution of nanocolloid in the skeleton (Munz's classification, 1983) in 37 out of 69 cases, higher in more myelotoxic cytostatics, which could be detected even after a few months.

[Scintigraphy of bone marrow for the evaluation of injuries caused by antiblastic radiotherapy]. / La scintigrafia del midollo osseo per la valutazione del danno da radioterapia antiblastica.

A nanocolloid marked with 99mTc was used to perform 100 bone marrow scintiscans in 72 patients given radiotherapy for tumours. The compound is taken up by the cells of the phagomonocytic system whose distribution in the bones is similar to that of the erythropoietic marrow. With doses over 30 Gy a more or less marked reduction in captation by the marrow involved in radiation was always noted. The damage remains even for years after radiation, though recovery is possible especially in young patients given moderate doses of up to 40-45 Gy. Bone marrow scintigraphy using a nanocolloid is noninvasive and inexpensive, involves only tiny radiation doses and appears to be useful in the study of cancer patients subjected to radiation treatment either alone or in combination with chemotherapy.

[Course of the serum determination of 4 tumor markers in viral hepatitis]. / Andamento del dosaggio sierico di quattro markers tumorali in corso di epatite virale.

The radioimmunological method was used to measure the serum levels of 4 tumour markers--CEA, TPA, Ca 19-9 and Ferritin--in 20 hepatitis patients. Blood levels of bilirubin and transaminase were assayed at the same time. Patients with high levels of bilirubin and transaminase also revealed pathological levels of all 4 markers, especially TPA and ferritin which fell towards normal levels once the acute attack was over.

[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.

[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.

[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.

[Lymphoscintigraphy. Comparison of 2 microcolloids labeled with Tc99m]. / Linfoscintigrafia. Confronto di due microcolloidi marcati con 99mTc.

The physical and chemical properties of two colloids labelled with 99mTc used for lymphoscintigraphic investigations for some time are reviewed. The advantages of human albumin nanocolloids over sulphated microcolloids are described and discussed. These mainly consist of more rapid, larger-sale endolymphatic transport.

The usefulness of sequential isotopic angiography of the scrotum for study of the varicocele.

132 patients were examined by Sequential Isotopic Scrotal Angiography (SISA) to determine whether or not they had primary varicoceles. The results with SISA were more reliable than those of clinical examination and scrotal telethermography. It is a rapid, simple and essentially harmless procedure that also provides pictures that can clearly present the situation to the patient. The principal indications for the examination are to confirm the presence of small varicoceles and to look for clinically non-detectable (subclinical) varicoceles.

[Lung cancers synchronous and metachronous with primary malignant neoplasms in other sites]. / Carcinomi del polmone sincroni e metacroni a neoplasie maligne primitive in altre sedi.

A series of 19 cases are reported in which, with the exception of one case, two primary malignant tumours developed at different times, one of which in the lung. Some details of this occurrence are discussed in relation to similar findings in the international literature. The average interval between the two tumours was found to be 7.5 years. In eight cases, all male, the lung tumour arose in subjects who had already been subjected to radical treatment for a laryngeal tumour. A lung carcinoma appeared in four women who had been subjected to radiation therapy following mastectomy. This sequence of events was considered a coincidence and not radioinduced in view of the fact that a total of 1061 similarly treated patients were observed over the same period. Finally it is suggested that certain histobiochemical factors induced by the lung tumour may somehow become pathogenically transformed to simulate a new primary malignant tumour.