Breast cancer electron intraoperative radiotherapy: assessment of preoperative selection factors from a retrospective analysis of 758 patients and review of literature.

PURPOSE: To report our experience with full-dose 21 Gy IORT in early breast cancer patients after breast-conserving surgery to define most important selection factors. METHODS: Seven hundred and fifty eight patients, subjected to conserving surgery and IORT, were retrospectively analyzed evaluating most important clinical outcomes. RESULTS: Median follow up was 5.2 years. Results from Cox analyses defined 2 groups of patients, "suitable" (age > 50 years, non lobular histology, tumour size ≤ 2 cm, pN0 or pNmic, ki67 ≤ 20%, non triple negative receptor status and G1-G2) and "unsuitable" for IORT, with a higher rate of breast related events moving from "suitable" to "unsuitable" group. The 5 year rate of IBR is 1.8% in suitable group with significant differences versus unsuitable (1.8 vs. 11.6%, p < 0.005). Same differences between two groups were evidenced in true local relapse (0.6 vs. 6.9%, p < 0.005) and in new ipsilateral BC (1.1 vs. 4.7%, p < 0.015). CONCLUSIONS: In our current practice we consider the following preoperative factors to select patients suitable for IORT: age > 50 years, absence of lobular histology, tumor size ≤ 2 cm, pN0 or pNmic, according to APBI consensus statement, including also ki67 ≤ 20%, non triple negative receptor status and G1-G2.

A possible route for the release of fatty acid from fatty acid-binding protein.

A simulation of the release of fatty acid from intestinal fatty acid-binding protein was attempted, starting with the crystallographic model and using molecular-dynamic processes at different temperatures. The release of the ligand was observed only at high temperature, which perhaps makes the process unreliable in detail. Nevertheless, the overall behaviour of the protein, also confirmed by the simulation performed at room temperature, strongly supports the idea that the fatty acid leaves the protein through an opening formed by alpha-helix II and turns beta C-beta D and beta E-beta F. Additionally, it suggests a role for the lack of hydrogen bonds between the main chains of beta-strands D and E: this feature, observed in all the protein structures of this family which have currently been determined, seems to provide the structure with great flexibility, allowing the barrel to open and close without disruption of the hydrogen-bond network.

Radiotherapy versus surgery in the treatment of cervix stage Ib cancer.

In the years 1971-77 we have treated 250 Stage Ib patients with cancers of the cervix. One hundred twenty-three (49.2%) underwent a radical surgery, 37 had a classical Wertheim-Meigs operation, and 86 had a lymphadenectomy that was extended to the lumbar-aortic region. When feasible, all patients received postoperative radium therapy on the vaginal vault. The remaining 127 patients received a complete course of radiotherapy. This was not a randomized clinical trial. In fact surgery was preferred for patients who were younger (mean age: 49.6 years) and more physically fit, while radiotherapy was the treatment chosen for those who were older (mean age: 57.7) and generally less fit or obese. The 5 year NED survival was 89.3% in the surgical group and 90.9% in the radiotherapy group (P less than .05). Four fatal complications were observed in the surgical group (3.2%). Rate and causes of failures or complications are analyzed in detail.

[Comparison of radiotherapy and surgery in the management of cervical cancer in stages Ib and II]. / Confronto tra radioterapia e chirurgia nel trattamento degli stadi Ib e II del carcinoma della cervice.

In the years 1971-76 we have treated 243 stage Ib cancers of the cervix. 104 (45.9%) were submitted to a radical surgery in the form of a classical Wertheim-Meigs operation in 32 of them, whilst in the other 72 lymphadenectomy was extended to the lumbar-aortic chains. When feasible, all the operated cases were submitted to a postoperative radiumtherapy on the vaginal vault and to external irradiation if N+ at histological examination. 114 cases (46.9%) were submitted to a complete course of radiotherapy. The remaining 25 cases (10.3%) were submitted to a preoperative radiumtherapy plus radical surgery. The 5-year NED survival was 89.5% in the surgical group, 93.0% in the radiotherapy group and 91.1% for the patients submitted to a preoperative radiumtherapy. In the time interval considered the stage II cases were 89. 14 (15.7%) were operated upon, 66 (74.2%) were treated with a complete course of radiotherapy and 9 (10.1%) were submitted to a preoperative radiumtherapy plus radical surgery. The 5-year NED survival was respectively 83.8%, 67.1% (only for proximal-stage II cases) and 100.0%. Radiotherapy is equivalent to surgery for the treatment of the stage Ib cervical cancers. On the contrary several arguments claim a combined therapeutic approach in the treatment of the stage II cases.