Pattern of care and results of radiotherapy in patients 80 years old and over.

BACKGROUND AND AIMS: Cancer incidence increases with age and several cancer types are observed in older patients, so the need for radiotherapy (RT) in treatment of older patients with cancer is also on the rise. This study's aims to evaluate retrospectively the pattern of care and the feasibility of RT in elderly patients (80 years old and over) treated with different intents, and the impact of RT prescription on survival. MATERIALS AND METHODS: We reviewed 191 patient charts from the years 2005-2007, recording age, intent of treatment, site, and type of RT. Crude and actuarial survival were estimated. RESULTS: One hundred patients were males (M) and 91 females (F); 162 were seen on an outpatient basis, 29 as inpatients. A total of 138 patients were recruited for RT; 113 were treated, 112 completed RT. The ratio to all treated patients was 113/2125 (5.3%). Overall (treated and non-treated) cumulative survival probability was 71% for the first year, 45% for the second and 27% for the third. For treated patients, the cumulative survival probability was 67% for the first year, 43% for the second year and 23% for the third year, while for untreated patients it was 76% for the first year, 47% for the second year and 32% for the third year (Log-rank test: p = 0.23). CONCLUSIONS: RT did not decrease survival in elderly patients.

Adjuvant endocrine treatment in premenopausal early breast cancer.

The impact of endocrine therapies in the adjuvant treatment of premenopausal patients with early breast cancer is well established. However, the right combination and duration of endocrine manipulations currently available (luteinizing hormone-releasing hormone analogs and tamoxifen) remain unclear. Moreover, the role of chemotherapy in addition to endocrine therapies is not clearly defined. The most recent Early Breast Cancer Trialists' Collaborative Group overview has confirmed the efficacy of five years of tamoxifen in reducing the annual recurrence rate and the annual breast cancer death rate by 41 and 34%, respectively, in an estrogen receptor-positive population. These results are largely irrespective of age, use of chemotherapy or other tumor features. Moreover, the expert panel of the St. Gallen Conference accepted both tamoxifen or tamoxifen plus ovarian suppression as standard endocrine therapy for premenopausal breast cancer patients with endocrine-responsive disease. The use of ovarian suppression or ablation also significantly reduced the risk of breast cancer-related death, mainly in the absence of other systemic therapies. Chemotherapy is widely used in this population; however, its role in endocrine-positive premenopausal women with hormone-positive disease treated with optimal endocrine therapy remains unclear.

Esthesioneuroblastoma treated with external radiotherapy. Case report.

Esthesioneuroblastoma is a rare tumour arising from the olfactory epithelium of the nasal vault which frequently invades the cranial base and orbit. Esthesioneuroblastoma has a bimodal age distribution between 11 and 20 years and between 51 and 60 years. Esthesioneuroblastoma accounts for approximately 1-5% of intranasal cancers. The case is reported of a 79-year-old female patient with a Kadish stage C tumour with a one-year history of headache, nasal obstruction, anosmia, rhinorrhoea and epistaxis. Aim of this study is to analyse the natural history, treatment and prognosis of this tumour, based on a review of the literature.

[Multivariate analysis of prognostic factors and survival in patients with "glioblastoma multiforme"]. / Multivariate analysis of prognostic factors and survival inpatients with "glioblastoma multiforme".

PURPOSE: The aim of this study was to evaluate the survival of patients with "glioblastoma multiforme", to analyse the prognostic factors influencing the survival rate and to review recent results in the literature. MATERIALS AND METHODS: Seventy five patients underwent radiation treatment between May 1998 and April 2003. Among the factors under investigation we ascertained that sex, chemotherapy, conformal treatment, surgery, and the choice of the irradiation area (whole brain or only the involved field) did not influence the survival in a statistically significant manner. RESULTS: Whereas age and total dose were the 95% statistically significant variables. Hazard ratio of patients older than 58 years compared to younger patients was 1.69. The death risk was 69% in older than younger patients. A greater irradiation dose improved the survival with an increase of the median survival days. The total dose lower than 6000 cGy caused an increase of 81.8% in the death risk. The median survival from the diagnosis to the death was 14.7 months (446 days) and 1-, 2- and 3- year survival rate was 69.3%, 38.4%, and 14.7% respectively. CONCLUSIONS: The current medical literature and our experience attests that the use of temozolomide improves the survival of these patients.

Hallux valgus correction by the method of Bösch: a clinical evaluation.

Between December 1996 and February 1999, 197 operations for the correction of hallux valgus by the percutaneous technique of Bösch were performed in 156 patients (41 bilateral) at the Cardinal G. Panico Hospital (Tricase, Italy). Most operations were performed using local anesthesia. Unsupported weight bearing was nearly always allowed on the first postoperative day and a simple functional bandage was used for six weeks. One hundred forty three patients (39 bilateral) were available for follow-up evaluation (182 feet) at an average follow-up of 16.4 months. Clinical results and radiographic evaluation of these patients showed that 89% were fully satisfied with their result. Thus, it appears that the distal osteotomy of the first metatarsal using the technique of Bösch, combined, if necessary, with other procedures on the lateral metatarsals, is a satisfactory operation. Important features of this procedure include short operating time, low incidence of complications, and high patient compliance.

[Case series of mesotheliomas from hospital archives as contribution to preventive intervention]. / Casistica di mesoteliomi tratta da archivi di reparti ospedalieri come contributo all'attività di prevenzione.

The clinical charts of 18 patients in the departments of radiotherapy and oncology of the hospital "Casa Sollievo della Sofferenza" (San Giovanni Rotondo, Italy) from 1993 to August 1998, were reviewed. Each case was assigned to first (fine needle aspiration, cytologic exam), second (multiple biopsies during thoracoscopy or laparoscopy) or third (operation) diagnostic level and asbestos exposure was analysed. The age-group was between 21 and 76 years (median 57 years). Three patients were less than 30 years old. The ratio M:F was 17:1. Malignant mesotheliomas were histologically confirmed in 16 cases: 1 patient was classified as malignant pleural tumor (cytology and CT scan), 1 patient as suspicious malignant pleural tumor (only radiological diagnosis) and both were excluded for analysis. We observed 1 case in 1993, 2 in 1994, 3 in 1995, 3 in 1996, 5 in 1997, 2 up to August 1998. Second level diagnosis was assigned to 9 patients and third level to 7 patients. In 9 out 16 cases (56%) the exposure was occupational: 5 ascertained, 2 probable, 2 possible.

Micronuclei in cytokinesis-blocked lymphocytes may predict patient response to radiotherapy.

We have applied the cytokinesis-block micronucleus assay to peripheral blood lymphocytes of patients undergoing radiotherapy in pelvic and pulmonary sites, in order to evaluate the individual cytogenetic response. Our cytogenetic data correlated with the equivalent whole-body dose are homogeneous and compare well with the data presented by other authors. We have used an exponential mathematical formula to calculate the attenuation of the cytogenetic effect with time. The k coefficient (cytogenetic recovery factor) in the formula expresses the degree of attenuation. In lymphocytes from patients after radiotherapy, the trend of the micronucleus frequency observed after 2 Gy of in vitro X-irradiation demonstrates that the cytogenetic effect obtained in vitro is added to that obtained in vivo. The k coefficient is inversely proportional to the micronucleus frequency observed after 2 Gy in vitro. The micronucleus assay and the cytogenetic recovery factor are proposed as suitable diagnostic tools for application in the field of radiotherapy.

[An in-vivo dosimetric study of the scattered radiation during the treatment of breast carcinoma]. / Studio dosimetrico in vivo della radiazione diffusa durante il trattamento del carcinoma mammario.

In the last decade, radiation therapy has been increasingly used to treat breast cancer conservatively and some authors showed their concern about the radiogenic effects of irradiation outside the treated area. Our aim was to measure the scattered dose to the contralateral breast, thyroid and gonads during radiation therapy after conservative breast surgery. Thermoluminescent dosimeters, LiF Mn Ti (3 x 3 x 0.9 mm3), were used to measure scattered radiations outside the treated area. They were positioned on the skin of the patients in small (2 cm in diameter and 1 cm thick) perspex holders. Each measurement was performed once per treatment and six dosimeters were used--two on the contralateral breast, one on the midpoint of the medial side and one on the midpoint of the lateral side; two on thyroid lobes and two on the pelvis. The minimum dose to the contralateral breast (p < 0.002) and the maximum dose to the gonads (p < 0.003) were significantly higher in the 60Co group than in the LINAC6 group. The mean values of the minimum doses to the contralateral breast were significantly different (p < 0.007) in the whole series when beam area values were lower or higher than the median value (176 cm2). In the whole series the beam area and the minimum dose to the contralateral breast were correlated (Pearson, p < 0.001); the beam area and the minimum dose to the contralateral breast (p < 0.005), the gantry angle for the lateral beam and the minimum dose to the contralateral breast (Spearman, p < 0.001) exhibited statistically significant correlations. Of 30 patients, 16 were irradiated with 60Co (group A) and 14 with LINAC6 (group B). In group A the average scattered dose to the contralateral breast ranged 0.53-2.15 Gy, 0.66-1.91 Gy in the thyroid, 0.14-0.19 Gy in the gonads. In group B the average scattered dose to the contralateral breast ranged 0.36-2.07 Gy, 0.53-0.98 Gy in the thyroid and 0.08-0.12 Gy in the gonads. In the LINAC6 group the beam area and the minimum dose to the thyroid exhibited a statistically significant correlation (p < 0.009), as well as the beam area and the maximum dose to the gonads (p < 0.006), the beam area and the minimum dose to the gonads (p < 0.02), the gantry angle of the lateral beam and the minimum dose to the contralateral breast (p < 0.02). In the 60Co group no correlation was statistically significant, except for the correlation between the beam area and the minimum dose to the gonads (p < 0.001). Our experience confirms the scattered dose to depend on head treatment, beam area, gantry angle and wedge angle. Finally, the literature on this subject is reviewed.

[High dose brachytherapy in gynecologic neoplasms. Review of the literature]. / Brachiterapia ad alto dose rate nelle neoplasie ginecologiche. Revisione della letteratura.

The paper reports the historical origins of remote afterloading systems in intracavitary radiotherapy, together with the results and complications of high dose rate brachytherapy in gynecological tumours. High dose rate therapy achieves the same results as low dose rate therapy but has the advantage of making treatment more comfortable for patients.