Extra-pleural pneumonectomy in the era of image-guided intensity-modulated radiotherapy.

PURPOSE: To assess the outcome of malignant pleural mesothelioma patients treated with extra-pleural pneumonectomy (EPP) and adjuvant radiotherapy (RT), using the most advanced radiotherapeutic techniques, namely image-guided intensity-modulated RT (IG-IMRT). METHODS AND MATERIALS: Fifty-four patients were analyzed. Minimum radiation dose was 50 Gy (2 Gy/fr). Planning target volume encompassed the entire hemithorax, including the ipsilateral mediastinum if interested by disease, the pericardium and diaphragm, and any drain sites. The study endpoints included loco-regional control (LRC), distant metastases free survival (DMFS), and overall survival (OS), as well as radiation-related toxicity. RESULTS: Major patients and treatment characteristics were the following: median age 62 years, epithelioid histology in 51 (94%) cases, locally advanced disease in 41 (90%) cases, and metastatic mediastinal lymph nodes in 27 patients (50%). Only 7 patients (13%) had gross residual disease after surgery. Chemotherapy was administered in 38 patients (70%). Median follow-up was 16 months (range 0-73 months). Median and 2-year OS were 21 months and was 43.8%, respectively. The predominant pattern of failure was distant: 34 patients (62.9%) developed some component of distant failure, and only 5 patients (9.2%) developed an isolated loco-regional recurrence. The estimates of LRC and DMFS at 2 years were 63.4% and 43.4%, respectively. Three fatal pneumonitis were documented. Other major toxicities included: Grade 2 and 3 pneumonitis in 1 and 2 cases, respectively, 1 case of bronchial fistula, pleural empyema, and Grade 3 esophagitis, respectively. CONCLUSIONS: Although executed in the era of high-technology radiotherapy (IG-IMRT), EPP should not be routinely performed.

Micrografting chronic lower extremity ulcers with mechanically disaggregated skin using a micrograft preparation system.

OBJECTIVE: The Rigenera system is a new standardised micrograft preparation system. It works by means of automated mechanical disaggregation of small tissue samples, extracting only the smallest cells (<50µm). The aim of this study was to retrospectively evaluate patients affected by chronic ulcers and who were treated with the micrograft preparation method. METHOD: Chronic ulcers have been included regardless of the cause. The specimen was collected with a 3mm diameter biopsy punch and immediately dissociated by means of the Rigenera System. The obtained suspension was placed on a scaffold of equine collagen. RESULTS: We included 15 patients (four males, 11 females) with a mean age of 72.2±8.41 (mean±standard deviation) years. In seven patients the ulcers were related to the complications of diabetes, post-traumatic in a further three diabetic patients, vasculitis in one patient, and four patients had venous leg ulcers (VLUs). The median main diameter was 5.0cm and the median estimated area was 43.96cm2. The ulcers were present from a mean of 4.50±2.30 months before inclusion in this study. At the second week the wounds were reduced by 37.33%±19.35%, at the week eight, nine patients (60.0%) were healed, and at week 16, 13 (86.7%) were healed. The quality of scars was good and did not deteriorate at the six month follow-up. CONCLUSION: The simplicity of the approach, the minimal invasiveness of the specimen collection, and the good quality of scarring of healed wounds, confirmed in the follow-up, makes this micrograft preparation method a useful tool to use on large or complex wounds.

Metaphors of adolescence during COVID-19 pandemic: a mixed-method analysis in relation to well-being and alexithymia.

Introduction: During the pandemic, young people experienced a general increase in stress levels in their home and school environments and in their relationships with peers and family, largely due to restrictions on freedom of movement and social isolation. The ability to identify sources of stress and respond positively to them, using both personal and environmental resources, seems to be key to maintaining an acceptable level of well-being. This study investigates the association between alexithymic traits, self-perceived well-being, and self-representations in adolescents as expressed via narrative metaphors during the COVID-19 epidemic. Methods: The sample comprised 229 Italian adolescents (51.1% females, mean age = 16.64). The research design was based on an exploratory, parallel, mixed-method approach. A semi-structured online interview was used as the major data gathering tool including both standardized quantitative questionnaire and open-ended questions. Data were analyzed by means of descriptive statistics, quantitative textual analysis and multidimensional co-word correspondence analysis. Results: Main findings reveal a general low level of perceived well-being associated with alexithymia, affecting adolescents' lexical choices for their metaphors. Alexithymia-related low levels of well-being correspond to metaphors in which confusion and overpowering emotions predominate. Vivid pictures indicating vitality and a bright view on the future is often correlated with high levels of well-being. Discussion: Overall, these novel findings appear to show an interactive effect of perceived well-being and alexithymia on adolescents' ability to identify and describe their own condition. Furthermore, metaphors emerge as powerful tools for investigating well-being in adolescents since closely related to inner states.

A mixed-method study on adolescents' well-being during the COVID-19 syndemic emergency.

In this study, we set out to investigate adolescents' levels of perceived well-being and to map how they went about caring for their well-being during the COVID-19 syndemic. Participants were 229 Italian adolescent high school students (48.9% males, mean age = 16.64). The research design was based on an exploratory, parallel, mixed-method approach. A multi-method, student-centered, computer-assisted, semi-structured online interview was used as the data gathering tool, including both a standardized quantitative questionnaire on perceived well-being and an open-ended question about how adolescents were taking charge of their well-being during the COVID-19 health emergency. Main findings reveal general low levels of perceived well-being during the syndemic, especially in girls and in older adolescents. Higher levels of well-being are associated with more affiliative strategies (we-ness/togetherness) whereas low levels of well-being are linked with more individualistic strategies (I-ness/separatedness) in facing the health emergency. These findings identify access to social support as a strategy for coping with situational stress and raise reflection on the importance of balancing the need for physical distancing to protect from infection, and the need for social closeness to maintain good mental health.

The role of teachers' socio-emotional competence in reducing burnout through increased work engagement.

Introduction: Research has highlighted the relevance of socio-emotional competence in buffering the harmful impacts of perceived stress on the psychological facets of the teaching profession. The purpose of this paper is to innovatively investigate the relationships between perceived stress, work engagement, and burnout in a single comprehensive model, when considering the potential role that socio-emotional competence plays in mitigating the adverse impact of perceived stress on burnout. Methods: A total of 276 Italian in-service teachers (mean age = 46.6 ± 9.9 years) completed quantitative self-report measures of perceived stress, socio-emotional competence, work engagement, and burnout. Data were analyzed by using a structural equation modeling (SEM) approach. Results: All fit indexes supported the model's full acceptance and suggested that teachers' socio-emotional competence reduced the effect of perceived stress on the risk of burnout by increasing their level of work engagement. Discussion: The implications of the findings are discussed in terms of promoting interventions that target not only stress reduction but also foster teachers' socio-emotional competence in order to maintain a good level of work engagement and reduce the effect of stress on burnout.

Full-Dose Intraoperative Electron Radiotherapy for Early Breast Cancer: Evidence from a Single Center's Experience.

To evaluate the clinical response rate and cosmetic outcome after full-dose intraoperative electron radiotherapy (IOERT) in early breast cancer (BC) treated with conserving surgery. Inclusion criteria were: >60 years old, clinical tumor size ≤2 cm, luminal A carcinoma, patological negative lymph nodes, excluded lobular carcinoma histology. IOERT was delivered with a dose of 21 Gy at 90% isodose. Clinical, cosmetic and/or instrumental follow-up were performed 45 days after IOERT, 6 months after the first check, and every 12 months thereafter. Acute and late toxicities were assessed with the CTCAE v.4.03 and EORTC-RTOG scales, respectively. Cosmetic outcome was evaluated using the Harvard/NSABO/RTOG Breast Cosmesis Grading Scale. Overall, 162 consecutive patients were included in this analysis (median follow-up: 54 months, range: 1-98 months). The overall response rate was 97.5% (CI 95%: 0.93-0.99%). Locoragional relapse occurred in 2.5% of patients. No patient showed distant metastases. No patient showed radiation-related acute complications, with 3.7% showing late G2-3 toxicity. Only 3.7% of patients showed poor cosmetic results. Our data confirmed that IOERT is a feasible and valid therapeutic option in low-risk BC patients treated with lumpectomy. A low local recurrence rate combined with good cosmetic results validates the settings of our operative method in routinely clinical practice.

Different methods of bone marrow harvesting influence cell characteristics and purity, affecting clinical outcomes.

Background: Bone marrow (BM)-derived stem cells were implanted to induce angiogenesis in patients with no-option critical limb-threatening ischemia. Considering the potential for this therapy, conflicting results related to BM harvesting methods have been reported that could affect stem cell concentrations and quality. Methods: A total of 75 patients with no-option critical limb-threatening ischemia were treated with BM implantation. For 58 patients, BM was harvested using a BM aspirate concentrate system (Harvest Technologies; group HT) with a standard aspiration needle, followed by an automated centrifugation process, to produce BM aspirate concentrate. For 17 patients, BM was harvested using the Marrow Cellution system (Aspire Medical Innovation; group MC). CD34+ cells/mL, CD117+ cells/mL, CD133+ cells/mL, CD309+ cells/mL, hematocrit, and BM purity were compared between the two BM preparations. Results: The retrospective analysis of a subset group after adjustment for age shows that the quality of BM obtained using the Marrow Cellution system is better, in terms of purity, than the classic harvesting method before centrifugation. Harvested BM before centrifugation is characterized by a higher percentage of CD133+ cells compared with BM after centrifugation. In contrast, the MC aspirate had a larger amount of very small embryonic-like cells, as indicated by the higher percentage of CD133+, CD34+, and CD45- cells. These differences translated into an increased occurrence of leg amputations in group HT than in group MC and an increase in transcutaneous oxygen pressure in patients treated with BM aspirated using MC. Conclusions: BM manipulation, such as centrifugation, affects the quality and number of stem cells, with detrimental consequences on clinical outcomes, as reflected by the different amputation rates between the two groups.

Feeling and thinking of others: affective and cognitive empathy and emotion comprehension in prosocial/hostile preschoolers.

This study aims at investigating the affective and cognitive components of empathy in relation to both emotion comprehension and prosocial/hostile behaviors in preschoolers. A total of 219 children (54% boys; aged between 3 and 6: mean age 4.10) and 20 teachers (two for each class: group A and group B) took part in this research. Pupils' empathy and hostile/prosocial roles were assessed by teacher reports [Belacchi and Farina, 2010] and children's emotion comprehension by a nonverbal test [Test of Emotion Comprehension: Pons and Harris, 2000; adapted by Albanese and Molina; 2008]. As expected, the results showed a significant influence of gender, with girls being more empathic than boys, according to all of the teachers' perception. Contrary to our expectations, no systematic age influence emerged. Regarding the relations of children's emotion comprehension with both empathy measures and their prosocial/hostile attitudes, we have found: (1) a low significant relation with the total empathy measure, according to all the teachers, but with the cognitive empathy only according to teachers B; (2) a robust negative relationship of both affective and cognitive empathy with Hostile roles and with Outsider role, contrary to a positive correlation of only affective empathy with Prosocial roles. No relationships emerged between empathy measures and Victim role.

Social Status and Emotional Competence in Bullying: A Longitudinal Study of the Transition From Kindergarten to Primary School.

Moving on to a higher level of schooling represents a crucial developmental challenge for children: studies have shown that transitioning to a new school context can increase the perceived importance of peer acceptance, popularity, and adaptation to the new social environment. The aim of this study was to investigate simultaneously the influence of interpersonal variables (social status indices) and personal variables (empathy and understanding of emotions) on role-taking in bullying episodes (hostile, prosocial, victim, and outsider roles) from a longitudinal perspective. These variables were assessed on 41 children in their last year of kindergarten (t1) and in their 1st year of primary school (t2). The main longitudinal results showed that prosocial behaviors are more stable than hostile, victim, and outsider behaviors. Moreover, social preference-together with affective empathy-at t1 had a clear negative predictive effect on hostile roles at t2, while social preference had a positive effect on prosocial roles at t2. Social impact at t1 negatively predicted being a victim at t2. On the other hand, social preference at t2 was negatively predicted only by the victim role at t1. Social impact at t1 had a significant and negative effect on being victimized at t2 while was negatively predicted at t2 by the outsider at t1. Our study-even if exploratory-seems to highlight the existence of a specific, differentiate effect of two distinct social status indices on the participant role-taking in bullying episodes in the transitional period from kindergarten to primary school.

Short course palliative radiotherapy in advanced solid tumors: a pooled analysis (the SHARON project).

Previous trials showed the tolerability and efficacy of a palliative radiotherapy (RT) regimen (SHARON) based on the 4 fractions delivered in 2 days in different oncological settings. In order to identify possible predictors of symptomatic response, the purpose of this study is to perform a pooled analysis of previous trials. We analyzed the impact on symptomatic response of the following parameters: tumor site, histological type, performance status (ECOG), dominant symptom, and RT dose using the Chi-square test and Fisher's exact test. One-hundred-eighty patients were analyzed. Median RT dose was 20 Gy (range: 14-20 Gy). The overall response rate was 88.8% (95% CI 83.3-92.7%) while pre- and post-treatment mean VAS was 5.3 (± 7.7) and 2.2 (± 2.2), respectively (p < 0.001). The overall response rate of pain, dyspnea, bleeding, dysphagia, and other symptoms was 86.2%, 90.9%, 100%, 87.5%, and 100%, respectively. Comparing the symptomatic effect based on the analyzed parameters no significant differences were recorded. However, patients with locally advanced disease showed a higher rate of symptomatic responses than metastatic ones (97.3% vs 83.0%; p = 0.021). Finally, the complete pain response rate was more than double in patients with mild to moderate (VAS: 4-7) compared to those with severe (VAS > 7) pain (36.0% vs 14.3%; p = 0.028). This pooled analysis showed high efficacy of the SHARON regimen in the relief of several cancer-related symptoms. The markedly and significantly higher complete pain response rate, in patients with mild-moderate pain, suggests early referral to palliative RT for patients with cancer-related pain.

Trait Emotional Intelligence and School Burnout Discriminate Between High and Low Alexithymic Profiles: A Study With Female Adolescents.

Alexithymic traits, which entail finding it difficult to recognize and describe one's own emotions, are linked with poor trait emotional intelligence (TEI) and difficulties in identifying and managing stressors. There is evidence that alexithymia may have detrimental consequences for wellbeing and health, beginning in adolescence. In this cross-sectional study, we investigated the prevalence and incidence of alexithymia in teenage girls, testing the statistical power of TEI and student burnout to discriminate between high- and low-alexithymic subjects. A sample of 884 female high school students (mean age 16.2 years, age range 14-19) attending three Italian academic-track high schools (social sciences and humanities curriculum) completed self-report measures of alexithymia, school burnout, and TEI. Main descriptive statistics and correlational analysis preceded the discriminant analysis. The mean alexithymia scores suggest a high prevalence of alexithymia in female adolescents; as expected, this trait was negatively correlated with TEI and positively associated with school burnout. Participants with high vs. low alexithymia profiles were discriminated by a combination of TEI and burnout scores. High scores for the emotionality and self-control dimensions of TEI were strongly associated with membership of the low alexithymia group; high scores for the emotional exhaustion dimension of school burnout were indicative of membership of the high alexithymia group. These findings suggest crucial focuses for educational intervention: efforts to reduce the risk of emotional exhaustion and school burnout should especially concentrate on enhancing emotional awareness and self-control skills, both strongly associated with low levels of alexithymia.

Advanced head and neck cancer in older adults: Results of a short course accelerated radiotherapy trial.

OBJECTIVES: To assess the feasibility and safety of a repeated SHort course Accelerated RadiatiON therapy (SHARON) regimen in the palliative setting of Head and Neck (H&N) cancer in older adults. MATERIAL AND METHODS: Patients with histological confirmed H&N cancers, age ≥ 80 years, expected survival >3 months, and Eastern Cooperative Oncology Group (ECOG) performance status of ≤3 were enrolled. Patients were treated in cohorts of six patients: a total dose of 20 Gy was delivered in 2 consecutive days with a twice-daily fractionation (5 Gy per fraction) and at least 8-h interval. If no Grade 3 toxicity was registered, a second enrollment started with another cohort of six patients to whom were administered two cycles (total dose of 40 Gy). The primary endpoint was to evaluate the feasibility of the two cycles of treatment. Secondary endpoints were evaluation of symptoms control rate, symptoms-free survival (SFS), and Quality of Life (QoL) scores. RESULTS: Seventeen consecutive patients (median age: 85 years) were treated. Nine patients were treated with one cycle and 8 patients with two cycles. No G3 toxicity was reported in either cohort. With a median follow-up time of 4 months, 3-month SFS in the first and second cohorts was 83.3%, and 87.5%, respectively. The overall palliative response rate was 88%. Among 13 patients reporting pain, 8 (61.5%) showed an improvement or resolution of their pain. CONCLUSION: Repeated short course accelerated radiotherapy in a palliative setting of H&N cancers is safe and well-tolerated in older adults.

Prosocial/hostile roles and emotion comprehension in preschoolers.

Bullying occurs at approximately the same rate in kindergarten as in elementary school, but few studies inquired into preschool years [Alsaker and Nägele, 2008; Stassen Berger, 2007]. This study aimed at: (1) verifying the presence in preschoolers of two additional participant roles (Consoler and Mediator), besides the six traditional roles detected by Salmivalli et al. [1996], grouped in four latent macroroles, by means of teacher report version of the Eight Participant Roles Questionnaire (PRQ) [Belacchi, 2008]; (2) linking prosocial and hostile behaviors to age and gender; and (3) investigating the relationship between roles and emotion understanding. Two hundred and nineteen children (54% boys; aged 3-6 years: mean age 4;10) were administered the Italian version of the Test of Emotion Comprehension [Albanese and Molina, 2008]; 20 teachers (2 for each class) filled in the questionnaire, attributing frequency scores on 24 items (3 for each role) to each pupil. A confirmatory analysis supported the fit of the hetero-report version of the Eight PRQ, revealing four macroroles: Hostile Roles (Bully, Reinforcer and Assistant), Prosocial Roles (Defender, Consoler, and Mediator), Victim, and Outsider. Satisfactory interteachers agreement not only confirms the macroroles hypothized, but also their expected distribution for gender and age. Moreover, the Prosocial roles presented a significant positive correlation with all subdimensions of emotion comprehension (External, Mental, and Reflective). The Victim and Outsider roles negatively correlated only with the External subdimension. The implications of these results for prevention and intervention purposes are discussed.

High School Student Burnout: Is Empathy a Protective or Risk Factor?

Students' school burnout has been extensively investigated in relation to interpersonal factors such as peer relations and social adjustment. However, few studies have examined the role of individual traits such as empathic skills. Our aim in this study was to test, within a single comprehensive model, how students' empathic skills affect their levels of school burnout, both directly and indirectly via satisfaction with school relationships. A sample of 998 high school students (aged 14 to 19 years) took part in this cross-sectional study. Participants completed quantitative self-report measures of school burnout, empathic skills (both cognitive and affective), and satisfaction with school relationships (peers and teachers). Using structural equation modeling, we tested a conceptual model in which emphatic skills were hierarchically associated with satisfaction about school relationships and school burnout, while also controlling for age. The structural equation model offered an excellent fit for the empirical data. Analysis of the total, direct, and indirect effects showed that empathic skills were associated with both satisfaction about school relationships and school burnout. Satisfaction with school relationships appeared to mediate the relationship between empathy and school burnout. Students' age was also found to have statistically significant effects. The negative effect of high school students' empathic skills on their risk of school burnout may be prevented or at least reduced by helping them to develop positive and satisfying relationships with both teachers and peers.

Short-Course 2-Dimensional Radiation Therapy in the Palliative Treatment of Esophageal Cancer in a Developing Country: A Phase II Study (Sharon Project).

PURPOSE: Patients with locally advanced and metastatic esophageal cancer are usually affected by cancer-related symptoms, which worsen their performance status and quality of life. The aim of this study was to determine the efficacy of short-course accelerated radiation therapy for symptomatic palliation in a low resourced setting where only a 2-dimensional radiation therapy (RT) technique was available. METHODS AND MATERIALS: A phase II trial based on Simon's 2-stage design was planned. A total dose of 12 Gy in 4 fractions, twice per day, over 2 days, ≥8 hours apart, using a 2-dimensional conventional RT technique was delivered with a Cobalt 60 unit (Equinox, Best Theratronics, Ottawa, Ontario). Symptoms were graded using the International Atomic Energy Agency scoring system. RESULTS: A total of 17 patients were treated (male/female = 10/7; median age, 50.0 years; range, 27-78 years; histology: 6 adenocarcinomas and 11 squamous cell carcinomas; tumor site: 4 gastresophageal junction and 13 esophagus). The most frequent baseline symptoms were dysphagia or regurgitation (100%), odynophagia (76%), and chest or back pain (53%). At 1 month after RT, all patients were alive with palliative response rates (complete plus partial) for dysphagia, regurgitation, odynophagia, and chest or back pain of 76%, 82%, 69%, and 56%, respectively. No patients presented acute ≥G3 toxicity. CONCLUSIONS: Short-course accelerated radiation therapy treatment, planned and delivered using a conventional 2-dimensional RT technique, was effective and well tolerated for the symptomatic palliation of locally advanced or metastatic esophageal cancer. This schedule may be useful for RT centers in developing countries to reduce treatment times, costs, and patient waiting times before treatment.

Trait Emotional Intelligence and School Burnout: The Mediating Role of Resilience and Academic Anxiety in High School.

The main aim of the current study was to investigate the role of trait emotional intelligence (TEI) in preventing students' school burnout directly and indirectly via anxiety and academic resilience. The data were derived from a sample of 1235 high school students (962 females and 273 males), ranging in age between 13 and 17 years (mean = 15.46; stand deviation = 1.22). Structural equation modelling revealed a strong indirect effect of TEI on school burnout, mediated via anxiety and resilience. Overall, students with high TEI were less likely to experience school anxiety and more likely to exhibit resilience which, in turn, reduced school burnout risk. Findings are discussed with reference to the wider role of TEI in educational contexts and highlight the need and potential for scientifically driven interventions to enhance emotional adjustment at school and in life, more generally.

Accelerated Middle Half Body Radiotherapy in Bone Metastases from Prostate Cancer: A Phase I Study (SHARON Project).

BACKGROUND/AIM: The primary endpoint of this phase I study was the maximum tolerated dose (MTD) of middle half body (MHB) accelerated radiotherapy (RT) in multiple bone metastatic (BM) prostate cancer (PCa) patients. PATIENTS AND METHODS: Three step dose escalation [13 Gy (3.25 Gy/fraction), 14 Gy (3.5 Gy/fraction), and 15 Gy (3.75 Gy/fraction)] in three consecutive patient cohorts were planned. RT was delivered in two consecutive days and two daily fractions. Six patients were enrolled in the first two cohorts and 12 in the third cohort. Grade ≥3 toxicity was considered as a dose-limiting toxicity (DLT). RESULTS: Twenty-five patients (median age=71 years, median follow-up=7.4 months) were enrolled. Defined MTD dose was 15 Gy. Overall pain response rate was 76%: 9 patients (36%) showed complete and 10 patients (40%) reported partial response of pain. CONCLUSION: MHB accelerated RT (total dose: 15 Gy) delivered in two consecutive days and two daily fractions is well tolerated.

CGF Treatment of Leg Ulcers: a Randomized Controlled Trial.

BACKGROUND: Concentrated Growth Factors (CGF) is a concentration of second generation autologous growth factors compared to platelet rich plasma (PRP) and represents a multifactorial stimulation system that can be used for the management and treatment of chronic skin ulcers. AIM: The aim of this work is to evaluate the additional benefits of the CGF compared to the standard of dressing and its effects on the dynamics of the healing process. METHODS: Autologous CGFs were obtained from 100 patients with chronic mixed ulcers (venous ulcers in patients with II stage claudication) of the lower limbs in a multicentric controlled randomized study. RESULTS: The results showed a significant advantage in the use of CGF in association with cleansing and selective compression in the healing time and stabilization of mixed ulcers of the lower extremities. CONCLUSIONS: These results support the CGF's clinical use for improving clinical outcomes in mixed ulcers of the legs.

Palliative Short-course Radiotherapy in Advanced Pelvic Cancer: A Phase II Study (SHARON Project).

AIM: To define safety and efficacy of a palliative, short-course accelerated radiation therapy for symptomatic locally advanced primary pelvic cancer. MATERIALS AND METHODS: A phase II trial was planned based on the minimax Simon's two-stage design. A total of 18 Gy in 4.5 Gy/fraction administered twice a day was delivered (SHARON). Pain and quality of life were recorded according to the Visual Analogue self-assessment and the cancer linear analog scales (CLAS), respectively. RESULTS: Twenty-five patients were enrolled in the study. The most frequent baseline symptoms were pain (48%), bleeding (40%), bleeding/pain (8%), and intestinal sub-occlusion (4%). The overall palliative response rate was 96.0%, with a median palliative duration of 6 months. An improvement of quality-of-life indices (well-being, fatigue, and ability to perform daily activities) was noted in 64.0%, 36.0%, and 48.0% of patients, respectively. CONCLUSION: The SHARON regimen was well tolerated and effective in the palliative treatment of patients with locally advanced pelvic cancer. Based on these results, a multicentric prospective phase III trial is ongoing to compare this regimen with traditional 2-week radiotherapy treatment.