bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance of Fineneedle Aspiration Cytology of the Breast. Clinical Experience in Ravenna (Italy)
Authors: Bucchi Lauro , Schincaglia Patrizia , Melandri Giangiuseppe , Morini Nori , Naldoni Carlo , Serafini Monica , Buzzi Gianfranco
Published: April 2018

Aims and background

Fineneedle aspiration cytology (FNAC) is a routine test in the evaluation of breast lesions. We assessed the diagnostic accuracy of mammography (MG), physical examination (PE), ultrasonography (US) and FNAC in 1064 histologically confirmed breast lesions (638 malignant, 426 benign) observed consecutively at the Cancer Prevention Center of Ravenna (Italy).

Methods

The performance of each test and the additional contribution of FNAC were determined.

Results

FNAC was done in 69.6 % of cancers and 39.7 % of benign lesions (P = 0.00000), the frequency of aspiration being significantly associated with severity at MG, PE, and US. For FNAC, the true positive rate was 95.1 % and the true negative rate 67.4 %. Only one breast cancer case was detected by FNAC alone (additional true positive rate 0.2 %). The positive predictive value of FNAC in the absence of other abnormalities was 5 %. The negative predictive value of a benign report at MG, PE, US and FNAC was 100 %.

Conclusions

All breast lesions should be evaluated by all available techniques, especially FNAC, and open biopsy should be avoided for those reported as benign at all tests.
Epidermal Growth Factor Receptor and Estrogen and Progesterone Receptors in Breast Cancers of Premenopausal and Postmenopausal Patients
Authors: Skasko Elzbieta , Paszko Zygmunt , Bielińska Beata , Kluska Anna
Published: April 2018

Aims and backround

The purpose of our research was to investigate the relations between the levels of epidermal growth factor receptor and estrogen and progesterone receptors in breast cancers of premenopausal and postmenopausal Polish women.

Methods

Cell membrane levels of epidermal growth factor receptor (EGF-R), and cytosol (c) estrogen (ER) and progesterone (PR) receptors were determined in 221 specimens of primary breast cancers. ERc and PRc were assayed using the dextran-coated charcoal procedure, and EGF-R were assayed by the radioligand method of specific saturation of the crude membrane fraction with 125I-EGF

Results

A statistically significant inverse correlation was found in all tumors between the concentrations of EGF-R and ERc, whereas for PRc significance of this correlation was not fully confirmed. ERc concentrations in tumors were positively correlated with age of patients, whereas EGF-R and PRc were not. In all, in premenopausal, and in postmenopausal EGF-R-positive tumors (≥ 10 fmol/mg of membrane protein), mean concentrations of ERc did not differ significantly. These groups of tumors seem to be homogeneous with respect to ERc concentrations. In EGF-R-negative (< 10 fmol/mg of membrane protein) postmenopausal tumors, the mean ERc concentration was significantly higher than in premenopausal tumors, hence these groups of tumors appear to be heterogeneous with regard to ERc con tens:

Conclusions

The present findings may have significance in differentiation of postmenopausal breast cancer.
Prognostic Value of Early Postoperative Calcitonin Level in Medullary Thyroid Carcinoma
Authors: Girelli Maria Elisa , Dotto Silvia , Nacamulli Davide , Piccolo Michele , De Vido Daniele , Russo Tiziana , Bernante Paolo , Pelizzo Maria Rosa , Busnardo Benedetto
Published: April 2018

Aims

Serum calcitonin (CT) assay is commonly used in the diagnosis and follow-up of medullary thyroid carcinoma (MTC). The aim of this study was to ascertain whether serum CT levels, measured in the first few days after surgery, could be used to evaluate the efficacy of treatment.

Methods

A group of 33 patients was studied. In all patients the follow-up was more than 20 months.

Results

Preoperatively basal CT serum levels were high in all patients. Twenty-four hours after surgery CT serum levels dropped to within the normal range in 8 patients and 72 hours after operation in 7 others. In this group 1 patient was at stage I, 11 at stage II and 3 at stage III. Basal and pentagastrin stimulated CT levels continued to be in the normal range in these 15 patients 6 and 12 months after surgery and at the subsequent year by follow-up visits. No clinical or radiological evidence of disease was found during the follow-up in this group. In the other 18 patients CT was reduced but still high 72 hours after surgery; 6 months later basal serum CT levels continued to be elevated or responsive to pentagastrin stimulation. In this group restaging showed tumor relapse in the thyroid bed in 2 patients, cervical lymphadenopathy in 11, and distant metastases (bone, liver) in 3.

Conclusions

Immediate postoperative CT serum levels seem to be the most useful index to evaluate the efficacy of surgical treatment and the presence of residual neoplastic tissue.
Radiation Therapy in an Elderly African Population with Kaposi's Sarcoma
Authors: Stein Moshe , Kantor Angel , Spencer Dave , Lakier Roy , Ruff Paul , Dale Janet
Published: April 2018

There are no published studies on the efficacy of modern radiation therapy in elderly populations with the endemic African type of Kaposi's sarcoma (AKS). The present retrospective analysis of 20 elderly AKS patients treated by radiotherapy attempts to supply information relevant to the older age group. It demonstrates that excellent symptomatic relief with minimal side effects can be attained and suggests that the role of radiotherapy as the treatment of choice in this particular group should be emphasized.
Does Parenteral Nutrition Increase Tumor Growth? A Review
Authors: Cozzaglio Luca , Bozzetti Federico
Published: April 2018

Total parenteral nutrition (TPN) is a supportive therapy commonly used in clinical oncology, in spite of its possible interference on tumor growth. In fact, studies performed on animals have demonstrated that TPN increases tumor growth and that load and quality of amino acids are probably the main factors involved. In contrast, some authors obtained a decrease in tumor growth using a special amino acids mixture or a TPN formula rich in lipids. However, data collected on animals are not transferable to humans owing to the large difference between tumor-host weight ratio and tumor doubling time. Analy sis of the studies on effect of TPN on tumor growth in humans has not demonstrated a bad effect, but the results reported in the literature are limited by the small number of patients, the lack of a sure and reproducible method to analyze tumor growth, and some methodologic defects. In conclusion, it is not evident that TPN is dangerous for cancer patients. However, it may be possible in the future to employ different formulas to improve the host nutritional status and inhibit tumor growth.
Radiation Therapy in Epidemic, Aids-Related Kaposi's Sarcoma in Southern Africa
Authors: Stein Moshe , Spencer Dave , Kantor Angelo , Lakier Roy , Lachter Jesse , Ben-Yosef Rami , Bezwoda Werner R.
Published: April 2018

Aims and background

Acquired Immunodeficiency Syndrome (AIDS) associated Kaposi's Sarcoma (EKS) is widely spread in the Southern African Region. No large studies concerning the role of radiation therapy in the Southern African variant of EKS have been reported to date.

Methods

Over a 10 year period (1982-1992) 25 patients with EKS (disseminated skin involvement) were treated primarily with radiation therapy at the Johannesburg General Hospital. Radiation fields were individually tailored to the extent of the disease. Total administered doses ranged between 8-12 Gy (single fraction) to 24-30 Gy fractionated over 2-3 weeks.

Results

Overall response and symptomatic relief rates were 72% and 80%, respectively. Toxicity was mild and manageable.

Conclusions

Our retrospective analysis supports the use of radiation therapy for the Southern African type of EKS.
Orchiectomy Alone for Clinical Stage I Nonseminomatous Germ Cell Tumors of the Testis (NSGCTT): A Minimum Follow-Up Period of 5 Years
Authors: Ondruš D. , Horňak M.
Published: April 2018

Aims and background

Surveillance after orchiectomy alone has gained great popularity in the management of stage I NSGCTT. Preliminary results were enthusiastic, but critical voices have been raised against general use of this option as routine management. In an effort to identify patients at high risk of relapse, there has been a search for adverse prognostic factors of stage I nonseminomatous germ cell testicular tumors (NSGCTT). The aim of the study was to identify those patients in whom a surveillance policy is less likely to be successful.

Methods

Eighty patients with stage I NSGCTT were followed for at least 5 years. They were assigned to their respective clinical stage on the basis of physical examination, chest X-ray, CT of the retroperitoneum and post-orchiectomy tumor markers. The criteria for inclusion in clinical stage I were normal results of these examinations. The policy of surveillance consisted of regular follow-up with tumor markers, chest X-ray and CT of the retroperitoneum. Patients who relapsed were treated with cisplatin-containing chemotherapy. In all patients, diagnostic delay, pre-orchiectomy tumor markers, T staging category, size, histopathology and vascular invasion in the primary tumor, and semen analysis were recorded.

Results

Follow-up revealed that 51 of the 80 patients (63.7%) were free of disease 61-110 months (mean, 83.1) after orchiectomy. Relapse was detected in 29 patients (36.3%) 3-58 months (mean, 13) after orchiectomy. The overall survival rate was 95%. The main risk factors of relapse were: vascular invasion, a major embryonal carcinoma and a minor teratoma component in the primary tumor, and low sperm count before orchiectomy.

Conclusions

The authors recommend the following risk-adapted treatment procedures: retroperitoneal lymph node dissection in patients with vascular invasion and a major teratoma component, adjuvant chemotherapy in patients with vascular invasion and a major embryonal carcinoma component, and surveillance policy in patients without vascular invasion.
Cisplatin and VP16 in Metastatic Breast Carcinoma as a Third-Line Chemotherapy: A Randomized Study Comparing Low versus High Doses of Cisplatin
Authors: Ceci Guido , Bisagni Giancarlo , Cocconi Giorgio , Rodinò Carmelina , Belsanti Virginio , Bertusi Maurizio , Buzzi Franco , Bacchi Marisa
Published: April 2018

Aims and background

The study was designed to define the activity of the combination of cisplatin and etoposide as third-line chemotherapy for advanced breast cancer and to investigate the role of the dosage of cisplatin on the effectiveness of the combination.

Methods

Ninety-five eligible patients with advanced breast cancer who had failed or relapsed on two previous lines of chemotherapy were randomized to receive cisplatin at a high dose (100 mg/m2 i.v. day 1, arm A) or a low dose (60 mg/m2 day 1, arm B), combined with etoposide (100 mg/m2 i.v. days 4, 6 and 8). Cycles were repeated every 3 weeks.

Results

Of the 78 patients evaluable for response (39 in arm A and 39 in arm B), 9 (12%) showed complete or partial response, 5 (13%) in the high-dose arm and 4 (10%) in the low-dose arm. One complete response was seen in the high-dose arm and none in the low-dose arm. The only 2 patients with brain involvement showed an objective response (one CR in arm A and one PR in arm B). Median time to progression was 14 weeks in arm A and 10 weeks in arm B, median duration of remission 28 and 34 weeks, and survival 36 and 35 weeks, respectively. The differences were not significant. As expected, the patients in the high-dose arm experienced more severe toxicity. One toxic death was observed in each arm due to sepsis in agranulocytosis. The difference was statistically significant regarding nausea and vomiting. Neurotoxicity and ototoxicity were not relevant problems in this patient setting.

Conclusions

Considering the very poor prognostic factors presented by these patients, the combination showed a certain activity, and further evaluation in earlier stages of disease is warranted. A particular responsiveness on brain metastases is suggested. The dose of cisplatin was not proven to be of significant importance.
Follicular Thyroid Carcinoma with a Predominant Insular Component in a Child: A Case Report
Authors: Kotiloḡlu Esin , Kale Gülsev , Senocak Mehmet Emin
Published: April 2018

Thyroid carcinoma is rare in children and differs from its adult counterpart in many aspects, including that childhood thyroid carcinomas are all well differentiated. Here we present a 14-year-old female from a goitrous area with follicular thyroid carcinoma with a predominant insular component. The child was well without recurrence or metastases after 5 years of follow-up.
Acute Myeloblastic Leukemia Associated with Mediastinal Nonseminomatous Germ Cell Tumors. Report on two Cases
Authors: Berruti Alfredo , Pazè Enrica , Fara Enrica , Gorzegno Gabriella , Dogliotti Luigi
Published: April 2018

The demonstrated association with hematologic neoplasms may partially account for the poor survival of patients with mediastinal nonseminomatous germ cell tumors (MNSGCT) compared to patients with testicular and retroperitoneal counterparts. It has been shown that the median interval from the diagnosis of MNSGCT to the diagnosis of the hematologic disorders is 6 months, which contrasts sharply with the average time of 2 to 3 years for the development of therapy-related leukemias. The 2 cases herein described, 1 male and 1 female, developed acute M2 leukemia 4 and 2 years after the diagnosis of MNSGCT. In the second patient (the first female ever described), we cannot exclude a pathogenetic role of the PEB regimen (platinum, etoposide, bleomicin), even though the total dose of etoposide administred has been demonstrated to have a mild leukemogenic potential. This is not the case of the first patient, who did not receive adjuvant chemotherapy after the radical resection of primary MNGSCT and developed the hematologic disorder a few months after local recurrence. In conclusion, the time elapsed from chemotherapy administration does not discriminate the hematologic neoplasms associated to MNGSCT from those related to therapy.
Antioxidant Agents and Colorectal Carcinogenesis: Role of β-Carotene, Vitamin E and Vitamin C
Authors: Pappalardo Giuseppe , Guadalaxara Antonio , Maiani Giuseppe , Illomei Giovanni , Trifero Mauro , Frattaroli Fabrizio Maria , Mobarhan Sohrab
Published: April 2018

In consideration of findings reported in the literature and of our study, we examined the correlation between antioxidants (β-carotene, vitamin C, vitamin E) and colorectal carcinogenesis. Although diagnostic progress has been made in the last decades, no significant improvements in death rates have been achieved in the western world. Exogenous factors might be responsible for a complex alteration process of normal colonic mucosa into adenoma and carcinoma. Free radicals and reactive oxygen metabolites, due to increased production or to reduced inactivation, following a decrease in the antioxidant burden in the mucosa, might cause damage to DNA, thereby resulting in genetic alterations. This might represent the cause of the transformation process: normal mucosa→ adenoma→ carcinoma. In a prospective study, we observed a reduction of β-carotene levels in normal colonic mucosa in patients with polyps and colorectal cancer. We also showed that β-carotene supplementation raises levels of this micronutrient in the colonic mucosa of these patients. Findings from the literature and our trials show a significant decrease in the antioxidant capacity of colorectal mucosa in patients affected by colorectal cancer, although there is a significant interindividual variability. Such results suggest a possible chemopreventive role of antioxidant agents in colorectal cancer.
Surgery Followed by Intracavitary plus Systemic Chemotherapy in Malignant Pleural Mesothelioma
Authors: Colleoni Marco , Sartori Francesco , Calabrò Francesco , Nelli Patrizia , Vicario Giovanni , Sgarbossa Gigliola , Gaion Fernando , Bortolotti Luigi , Tomolo Lamberto , Manente Paolo
Published: April 2018

Aims and background

Malignant mesothelioma is associated with a median survival of 4 to 12 months. Data from the literature indicate that single modality treatment (surgery or intrapleural and/or systemic chemotherapy) does not significantly affect survival.

Methods

We therefore evaluated a combined approach consisting of surgery (pleurectomy + diaphragmatic or pericardial resection), intrapleural chemotherapy with cisplatin (100 mg/m2) and cytarabine (1,000 mg/m2) for 4 h immediately after pleurectomy, and systemic chemotherapy consisting of epirubicin (60 mg/m2) and mitomycin-C (10 mg/m2) day 1 every 4 weeks for 4 cycles.

Results

Twenty patients were enrolled in the study and were evaluable. Thirteen cases had residual gross disease after pleurectomy and 7 patients only minimal disease. Median time to disease progression was 7.4 months, and median survival was 11.5 months (range, 2-25+). No treatment-related death have been observed. Side effects after intracavitary chemotherapy included renal toxicity, anaemia and pain. Myelosuppression and alopecia were recorded during systemic chemotherapy.

Conclusions

The results of the study indicate that the schedule is feasible, with encouraging results in terms of survival for patients with minimal residual disease after surgery.
Malignant Rhabdoid Tumor of the Vulva: A Case Report and Review of the Literature
Authors: Lupi Giovanni , Jin Rui , Clemente Claudio
Published: April 2018

Malignant rhabdoid tumor (MRT) is an uncommon aggressive neoplasm which usually occurs in the kidney of children, but it has also been found in extrarenal sites. MRT arising in the vulva is extremely rare. Only four cases of MRT of the vulva have been reported in the English literature. We herein present another case. The diagnosis and management of vulva MRT are reviewed.
Incidence, Mortality and Prevalence of Stomach Cancer in Italian Regions
Authors: De Angelis Roberta , Valente Fulvia , Frova Luisa , Capocaccia Riccardo , Micheli Andrea , Chessa Eqidio , Sant Milena
Published: April 2018

The basic descriptive epidemiologic data on stomach cancer occurrence in Italian regions are presented and discussed. Incidence and prevalence were estimated from official mortality and survival data provided by four population-based Italian cancer registries. Age-adjusted mortality, incidence, and prevalence rates are presented by region for the year 1990. Time trends of incidence and their projection for the year 2000 are also presented by region and three broad age classes. Althrough the occurence of stomach cancer has been decreasing in Italy and most western countries over the last decades, a substantial slowing down of this decrease was evidenced in Italy, especially for women under 65 and for the regions of southern Italy. A marked tendency towards a reduction of geographic heterogeneity in stomach cancer occurrence was also shown. Such a phenomenon is consistent with the observed changes of dietary habits in Italian regions. The regions of Umbria and The Marches seem to emerge as new areas at relatively high risk of stomach cancer incidence and mortality. About 45,000 prevalent cases were estimated in Italy by 1990, half of which have been diagnosed before 1984.
Continuous Subcutaneous Infusion of Ketorolac in Cancer Neuropathic Pain Unresponsive to Opioid and Adjuvant Drugs. A Case Report
Authors: Ripamonti Carla , Ticozzi Chiara , Zecca Ernesto , Rodriguez Carlos H. , De Conno Franco
Published: April 2018

Ketorolac is a new non-steroidal anti-inflammatory drug (NSAID) having a potent nonopioid analgesic activity. Administered by continuous subcutaneous infusion (CSI), its analgesic efficacy has been documented in the treatment of somatic and visceral cancer pain whilst it has been shown to be ineffective in the treatment of neuropathic pain. Here is a description of a cancer patient with neuropathic pain unresponsive to anticonvulsant or antidepressant drugs administered in association or not with oral opioids but who was successfully treated with ketorolac alone via CSI. Furthermore, the analgesia lasted over 75 days of treatment without any significant renal and gastric side effects.
A Pilot Safety Study of Capecitabine, A New Oral Fluoropyrimidine, in Patients with Advanced Neoplastic Disease
Authors: Bajetta Emilio , Carnaghi Carlo , Somma Luisa , Stampino Corrado Gallo
Published: April 2018

5-fluorouracil (5-FU) is still one of the most prescribed cytostatic drugs, but gastrointestinal toxicity limits its use. Capecitabine, an orally administered prodrug of 5-FU, is activated by a cascade of three enzymes, resulting in the preferential release of 5-FU at the tumor site; it was developed in an attempt to avoid the problem of gastrointestinal toxicity of fluoropyrimidines. The aim of the present study was to investigate the safety profile of capecitabine at the daily oral dose of 502 mg/m2, given in two divided doses 12 hr apart for at least 10 days of treatment. In conformity with Italian law, 11 patients (8 females and 3 males) with advanced or metastatic pretreated solid tumors (4 colon-rectum, 3 breast, 2 stomach, 1 ovary, 1 lung) were enrolled. Treatment duration ranged from 1.5 to 14 days. Ten of the 11 patients received the planned 10 days of treatment. One patient was discontinued on the second treatment day when he presented with symptoms of intracranial hypertension with multiple brain metastases documented by CT scan. Toxicity consisted of 1 case of mild edema; no adverse events characteristic of fluoropyrimidines were recorded. No abnormalities in hematologic, renal, hepatic or electrolyte values were seen. In conclusion, capecitabine, given at this dose and for a relatively short period, proved to be well tolerated. Further investigation is recommended to define the promising antitumor efficacy documented in many human xenograft models in mice.
How Thick Should CT/MR Slices be to Plan Conformal Radiotherapy? A Study on the Accuracy of Three-Dimensional Volume Reconstruction
Authors: Somigliana Anna , Zonca Giancarlo , Loi Gianfranco , Sichirollo Adele Emilia
Published: April 2018

Aim and background

The aim of this experimental study was to correlate the thickness of acquired CT slices (2, 4 and 8 mm) or MR slices (4 and 7 mm) with the accuracy of three-dimensional volume reconstruction as performed by a commercially available radiation therapy planning system.

Methods

We used a cylindrical phantom, with a 15-cm diameter and 20-cm height, containing 5 spheres (12.7-31.8 mm diameter) of solid Plexiglas sunk in a 3% agar jelly solution. The phantom was scanned by the CT scan with 3 different slice thicknesses (2, 4 and 8 mm and a distance of 0 mm between the slices). Two different acquisition techniques (slice thickness of 4 and 7 mm with 0.8 and 1.4 mm slice distance, respectively) were compared in the MR study. The volume values calculated from measurements were compared with the known true volume values of the spheres.

Results

The average percentage volume difference between calculated and true values for the smaller spheres reconstructed with CT images 2 and 4 mm thick was generally less than 8%, whereas the error for volumes reconstructed with 8-mm-thick CT slices was more than 20%. For the larger spheres, the error was generally less than 5%. The data produced by MR acquisition agreed with those obtained using CT sections.

Conclusions

For targets less than 1.5 cm in diameter on our system it is reasonable to acquire CT images with the smallest thickness available. For targets between 1.5 and 3 cm, it seems sufficient to acquire the localization images with a slice thickness of 4 mm. For targets more than 4 cm in diameter, considering that with our radiation therapy planning system the time spent for manual contouring and for isodose calculation highly increased with the number of acquired images, we suggest that the acquisition of CT-MR slices 8-10-mm thick is totally adequate even for Conformal radiotherapy treatments.
Cancer Mortality in Italy, 1992
Authors: Decarli Adriano , La Vecchia Carlo
Published: April 2018

Background

Data and statistics are presented on cancer death certification in Italy, updating previous publications covering the period 1955-1991.

Methods

Data for 1992 subdivided into 30 cancer sites are presented in 8 tables, including age- and sex-specific absolute and percentage frequencies of cancer deaths, and crude, age-specific and age-standardized rates, at all ages and truncated for the 35-64 year age group. Male to female ratios have also been tabulated, and trends in age-standardized rates for major cancer sites plotted from 1955 to 1992.

Results

Age-adjusted death certification rates (on the world standard population) for all neoplasms declined from 193.4 in 1991 to 189.8/100,000 males in 1992, and from 100.1 to 99.5/100,000 females. The favorable trends were even more marked in middle and younger age, but not in children below age 15, whose overall age-standardized cancer mortality rates were higher in 1992 than in 1989. Lung cancer was by far the leading site of cancer mortality, with over 30,700 deaths. For the fourth subsequent year, its rates in males declined, to reach 57.0/100,000, but continued to rise in females, to reach 8.0/100,000. Rates for other major cancer sites (intestines, stomach, female breast, prostate, pancreas) were stable or moderately favorable, but some increase was apparent also in 1992 for non-Hodgkin's lymphoma death rates.

Conclusions

Italian cancer mortality rates in 1992 were moderately favorable, with the major exception of the persistent spread of the tobacco-related lung cancer epidemic in females.
In Situ and Very thin Melanomas (< 0.75 mm) are Similarly and Commonly Recognizable
Authors: Bono Aldo , Bartoli Cesare , Tessandri Laura , Del Prato Ivan , Tragni Gabrina , Bucci Alessandra , Moglia Daniele , Cascinelli Natale
Published: April 2018

Aims and Background

Recent data have suggested that cutaneous melanoma in situ can be clinically recognized in most cases by its features, which resemble those of early invasive melanoma. The aim of the study was to verify whether the diagnostic sensitivity of melanoma in situ is actually equivalent to that of early invasive melanoma.

Methods

We retrospectively reviewed the clinical diagnosis of 274 consecutive cutaneous melanoma <0.75 mm thick. The series consisted of 84 in situ and 190 invasive lesions.

Results

The clinical diagnosis of melanoma was performed in 62% (52/84) of cases of in situ melanoma and in 68% (130/190) of the cases of invasive melanoma. The differences were not statistically significant.

Conclusions

Our results show that cutaneous melanoma can be clinically diagnosed at a very early stage. In situ and very thin melanomas (< 0.75 mm) are similarly recognizable.
Steroid Hormone Receptors Related to Parameters Characterizing the Biology of Human Breast Cancer
Authors: Görlich Max , Jandrig Burkhard
Published: April 2018

Steroid hormone receptors are important parameters to characterize breast tumors. Thus, it is important to evaluate their relationships with factors such as histological type and size of the tumor, axillary lymph node invasion and distant spread, age and menopausal status of the patients, and parameters of tumor differentiation.

The receptor levels observed vary within wide ranges. Therefore, statistically significant differences between different groups of parameters are seldom found. A significant dependence on receptor levels has been observed only for patient age and menopausal status. The parameters clinical stage, tumor size, tumor histology, metastatic involvement and histopathologic grading showed no statistically significant relation with receptor levels. Nevertheless, a relationship exists between all parameters mentioned and the frequency of a positive receptor status. Consequently, receptor status can contribute to define the biological behavior of the disease in specific groups of patients. In individual cases other parameters than the biochemical evidence of steroid receptor binding seem to be more important. We found that data derived from DNA flow cytometric measurements allowed a better recognition of tumor aggressiveness than ER status. In axillary lymph node metastases we usually observed higher receptor levels than in primary tumors, but we did not find an age dependency of ER levels in these metastases.
Preliminary Experience with High-Dose Cisplatin, Reduced Glutathione and Natural Interferon-α in Dacarbazine-Resistant Malignant Melanoma
Authors: Bajetta Emilio , Rimassa Lorenza , Carnaghi Carlo , Del Vecchio Michele , Celio Luigi , Cassata Antonio
Published: April 2018

Aims and background

The incidence of malignant melanoma is rapidly increasing in many countries, and when this disease has reached advanced stages, standard therapies have little impact. Dacarbazine (DTIC) is the most effective chemotherapeutic agent with an overall response rate of 20-25%, but durable responses are uncommon. Interesting results with the use of cisplatin (CDDP) have been reported in DTIC-resistant melanoma. Moreover, malignant melanoma is an immunogenic tumor and a potential target for biological response modifier (BRM) therapies. The aim of the present study was to evaluate the efficacy and tolerability of a chemo-immunotherapeutic regimen including high-dose CDDP combined with glutathione (GSH) to limit platinum-related toxicity, and natural interferon-α (IFN-α) in patients with DTIC-resistant metastatic melanoma.

Methods

The treatment schedule included GSH 1,500 mg/m2 i.v. and CDDP 40 mg/m2 i.v. for 4 consecutive days every 3 weeks, with a maximum of 6 courses, and IFN-α 3 MIU i.m. 3 times a week, continuative for a maximum of 12 months.

Results

Twelve patients were enrolled in this phase II trial. Accrual was stopped due to treatment-related toxicity. Ten patients were evaluable for response; there were 2 partial responses, lasting 5+ and 9+ months, respectively, and 2 cases of stable disease, lasting 3+ and 8+ months. None of these patients completed the therapeutic program due to treatment-related side effects.

Conclusions

This regimen seems to be only partially active in DTIC-resistant metastatic melanoma. Hematologic and non-hema-tologic (nausea and vomiting, peripheral neurotoxicity, and asthenia) side effects are significant and GSH is not effective in limiting CDDP-related neurotoxicity in pretreated patients. Therefore, there is no indication to employ this regimen as second-line treatment in metastatic melanoma and these disappointing results highlight the urgent need for new therapeutic approaches.
Long-Term Survival in Cerebral Glioblastoma. Case Report and Critical Review of the Literature
Authors: Puzzilli Fabrizio , Ruggeri Andrea , Mastronardi Luciano , Di Stefano Domenica , Lunardi Pierpaolo
Published: April 2018

Glioblastoma multiforme is the most malignant tumor of the glial series. The average survival of patients with this tumor ranges from 6 to 12 months. The case of a patient who survived for more than 11 years after diagnosis of a temporal-occipital glioblastoma which was treated with surgery, radiotherapy and chemotherapy is described. The authors deduce that among patients with glioblastoma multiforme (GM), those with a long disease-free interval after initial diagnosis who undergo multimodal therapy, including aggressive tumor removal, are the most likely long-term survivors (LS). Other factors which appeared to be related to longer survival were younger age and high Karnofsky scores.
Metastatic Adenocarcinoma Presenting with Central Diabetes Insipidus
Authors: Marinella Mark A.
Published: April 2018

The case of a previously healthy 63-year-old female with metastatic adenocarcinoma to the hypothalamus presenting with central diabetes insipidus is presented. The patient was found to have metastatic disease isolated to her hypothalamus on brain magnetic resonance imaging as well as a water deprivation test consistent with central diabetes insipidus. The patient had a decrease in symptoms of polyuria and polydypsia as well as a decrease in urine volumes after treatment with intranasal vasopressin. Even though a rare occurrence, physicians should consider metastatic adenocarcinoma in patients with recent-onset polyuria and polydypsia.
Advances in Treatment with Intensity-Modulated Conformal Radiotherapy
Authors: Webb Steve
Published: April 2018

The modern practice of radiotherapy centres on the development of conformai radiotherapy, techniques to ensure the high-dose volume is tightly wrapped around the diseased tissue and excluded as far as possible from adjacent normal structures. The development of conformai radiotherapy is a chain of processes involving treatment planning, development of new methods to deliver radiation, verification of the accuracy of radiation delivery and improvement of biological outcome. This is an enormous field of activity. This invited review paper summarises some of the main elements of progress towards implementing intensity-modulated conformai radiotherapy. This is the newest and most exciting development and, when achieved clinically, will lead to a quantum leap in tumour control probability with a fixed level of normal tissue damage.
Radiotherapy Treatment Verification
Authors: Novario Raffaele , Stucchi Paola , Perna Lucia , Conte Leopoldo
Published: April 2018

During a radiotherapy treatment, a dosimetric verification or a geometric localization can be done, in order to assess the quality of the treatment. The dosimetric verification is generally performed measuring the dose at some points inside (natural cavities) or outside the patient, and comparing it to the dose at the same points calculated and predicted by the treatment planning system. This can be done either with thermoluminescent or diodes dosimeters or with ionization chambers. The geometric localization can be done acquiring a portal image of the patient. Portal imaging can be performed either with films placed between metallic screens, or with an electronic portal imaging device such as fluoroscopic systems, solid state devices or matrix ionization chamber systems. In order to assess possible field placement errors, the portal images have to be compared with images obtained with the simulator in the same geometric conditions and/or with the digitally reconstructed radiograph (DRR) obtained with the treatment planning system. In particular, when using matrix ionization chamber systems, the portal images contain also information regarding the exit dose. This means that this kind of imaging device can be used both for geometric localization and for dosimetric verification. In this case, the exit dose measured by the portal image can be compared with the exit dose calculated and predicted by the treatment planning system. Some “in-vivo” applications of this methodology are presented.
Non Conventional Fractionation in Radiotherapy of the Musculo-Skeletal Sarcomas
Authors: Barbieri Enza , Frezza Giovanni , Martelli Ombretta , Neri Stefano , Mercuri Mario , Gherlinzoni Franco , Bacci Gaetano , Mancini Antonia , Putti Carlo , Babini Lucio
Published: April 2018

In 1989 we started an accelerated hyperfractionated schedule of radiotherapy (two 1.6 Gy daily fractions) in standard risk localized Ewing's sarcoma of bone, with the aim at reducing late effects in young patients and at improving disease control through a better integration of treatment modalities. From 1991, the same schedule was used in preoperative radiotherapy of adult soft tissue sarcomas of the extremities: the main purpose was to reduce the time to surgery and to evaluate surgical complications in comparison with a previous experience of hypofractionated radiotherapy (one 3 Gy daily fraction). From 1991 to 1997, 76 patients with Ewing's sarcoma and 24 patients with soft tissue sarcoma were treated at our Institution. Results and complication rates are analyzed in comparison with historical data. In Ewing's sarcoma, a correct evaluation of improvement in local control was difficult because of changing treatment policy (bulky disease was not included in the present series). Late effects, as evaluated in patients with a minimum follow-up of 3 years, occurred with similar incidence, but at higher total dose levels in patients treated with accelerated hyperfractionation. In patients with soft tissue sarcomas, incidence of surgical complications is reduced as compared to historical experience. Major problems of wound healing were seen in association with intraoperative brachitherapy boost.
Biological and Clinical Implications for Multimodality Treatment in Patients Affected by Squamous Cell Carcinoma of the Head and Neck
Authors: Corvò Renzo , Sanguineti Giuseppe , Benasso Marco
Published: April 2018

Aims and background

Several strategies combining radiotherapy and chemotherapy have been developed for the cure of squamous cell carcinoma of the head and neck (SCC-HN) in an attempt to improve loco-regional control and survival. This overview aims to summarize clinical results of reported randomized trials and to discuss the biological mechanisms underlying the interactive and non-interactive processes promoted when chemotherapy is added to radiotherapy.

Methods

The clinical goals of combined modality therapy and exploitable associations of chemotherapy and radiotherapy that may lead to a therapeutic gain in comparison with radiotherapy alone are reported and reviewed. Clinical applications of the four main ways of combining chemotherapy with radiotherapy (neoadjuvant, concomitant, alternating and adjuvant) are briefly re-analyzed and discussed.

Results and Conclusions

Published evidence suggests that induction chemotherapy (neo-adjuvant) should not be routinely recommended; however, induction chemotherapy increases the likelihood of larynx preservation in patients with laryngeal and hypopharyngeal cancer and should be offered as a treatment option as an alternative to surgery. Positive results of several randomized studies and a recent meta-analysis show that concomitant use of chemotherapy and radiotherapy in unresectable SCCHN is beneficial and should be considered as a potential standard treatment. A complementary biological staging of SCCHN, by evaluating new predictive factors of tumor response, is presently under investigation to better interpretate clinical randomized trials exploring chemo-radiotherapy.
Combined Modality Treatment of Locally Advanced Lung Cancer
Authors: Trovò Mauro G. , Gigante Marco , Minatel Emilio , Gobitti Carlo , Franchin Giovanni
Published: April 2018

This paper describes the mechanisms of action of ionizing radiations combined with antineoplastic drugs. Some relevant drugs for the combined modality treatments of locally advanced lung cancer are reported. The meta-analyses including randomized trials comparing single agent (radiotherapy or chemotherapy) versus combined chemoterapy and radiotherapy in patients with unresectable non small cell lung cancer and limited small cell lung cancer are then reviewed. The clinical outcome in relation to different schedules of chemoradiotherapy (sequential, alternating and concurrent) is also focussed.
Pharmacological Treatment of Cancer Pain: Alternative Routes of Opioid Administration
Authors: Ripamonti Carla , Zecca Ernesto , De Conno Franco
Published: April 2018

Cancer-related pain is present in 51% of patients at various stages of the disease, and the incidence increases up to 74% in advanced and terminal stages. The World Health Organization proposed and issued very simple guidelines for the pharmacologic treatment of cancer-related pain. According to the guidelines, opioid analgesics are the mainstay of analgesic therapy, and the first choice for drug administration is considered to be the oral route. However, in some clinical situations, the oral route is not feasible, and analgesic drugs consequently have to be administered via an alternative route. For example, this is the case when the patient presents vomiting, bowel obstruction, severe dysphagia, mental confusion and when the opioid dose has to be increased drastically in order to achieve adequate pain control. This review of the literature is aimed at describing the indications, the limits and the main aspects of the pharmacokinetics and pharmacodynamics relative to the alternative routes of administration of opioids most commonly used in clinical practice. Sublingual, rectal, subcutaneous, intravenous, transdermal and spinal administration routes are examined.
Evaluation of Clinical Efficacy of New Medical Treatments in Advanced Colorectal Cancer. Results of a Workshop Organized by the Eortc Gitccg
Authors: Wils Jacques , Sahmoud Tarek , Sobrero Alberto , Bleiberg Harry , Ahmedzai Sam , Blazeby Jane , Blijham Geert , Conroy Thierry , Cunningham David , Curran Desmond , Díaz-Rubio Eduardo , Ducreux Michel , Evans Jeff , Glimelius Bengt , Hutchinson Gillian , Kerr David , Kiebert Gwendoline , Köhne Hennig , Labianca Roberto , Langendijk Rina , Nitti Donato , Nordlinger Bernard , Rougier Philippe , Scheithauer Werner , Schmoll Hans-Joachim , Van Cutsem Eric , Wagener Theo , Wilke Jochen , Marinus Ann , Therasse Patrick
Published: April 2018

During the last few years several factors have contributed to an increasing change in the medical treatment of advanced colorectal cancer. Among them are the more general acceptance of the impact of chemotherapy on quality of life and survival in first as well as in second-line treatment, the introduction of new drugs and the definition of novel endpoints which can roughly be defined as “patient benefit”. For this reason the European Organization for Research and Treatment of Cancer (EORTC) Gastrointestinal Tract Cancer Cooperative Group (GITCCG) felt it was appropriate to organize a workshop with experts from different countries and national groups to discuss in depth several aspects concerning the treatment of patients with advanced colorectal cancer.
Promoting Participation in a Population Screening Program for Breast and Cervical Cancer: A Randomized Trial of Different Invitation Strategies
Authors: Segnan Nereo , Seriore Carlo , Giordano Livia , Ponti Antonio , Ronco Guglielmo
Published: April 2018

Aims and background

Attendance level has been identified as a major determinant of cost-effectiveness of organized screening programs. We tested the effectiveness of 4 different invitation systems in the context of an organized population screening program for cervical and breast cancer.

Methods

Women eligible for invitation - 8385 for cervical and 8069 for breast cancer screening - listed in the rosters of 43 and 105 general practitioners (GP), respectively, who had accepted to collaborate in the program, were randomized to 4 invitation groups: Group A - letter signed by the GP, with a prefixed appointment; Group B - open-ended invitation, signed by the GP, prompting women to contact the screening center to arrange an appointment; Group C - letter (same as for group A), signed by the program coordinator, with a prefixed appointment; Group D - extended letter (highlighting the benefits of early cancer detection) signed by the GP, with a prefixed appointment. Assignment to the interventions was based on a randomized block design (block=GP).

Results

Assuming Group A as the reference, the overall compliance with cervical cancer screening was reduced by 39% in Group B (RR=0.61; 95% CI, 0.56-0.68) and by 14% in Group C (RR=0.86; 95% CI, 0.78-0.93); no difference was observed for Group D (RR=1.03; 95% CI, 0.95-1.1). The response pattern was similar for breast screening (Group B: RR=0.71; 95% CI, 0.65-0.76; Group C: RR=0.87; 95% CI, 0.81-0.94; Group D: RR=1.01; 95% CI, 0.94-1.08).

Conclusions

Personal invitation letters signed by the woman's GP, with preallocated appointments, induce a significant increase in compliance with screening. Efficiency can be ensured through the adoption of overbooking, provided that attendance levels are regularly monitored.
La Ricerca Sugli Antiemetici: Un Modello Italiano Di Successo
Authors: Roila Fausto
Published: April 2018

At the beginning of the 80's the Italian Group for Clinical Research (G.O.I.R.C.) identified chemotherapy-induced nausea and vomiting as one of the most distressing adverse events, and decided to plan and execute clinical trials on antiemetics in order to reduce this negative impact on patients.

Therefore, some consecutive double-blind randomized trials were conducted on cisplatin-treated patients. The first was a dose-finding study on four different high-doses of domperidone, followed by a study comparing two different high-doses of metoclopramide, and a study comparing the addition of a corticosteroid to high-dose metoclopramide with respect to metoclopramide alone. Finally, a study demonstrating that a combination of a higher dose of metoclopramide (3 mg/kg x2) plus dexamethasone and diphenhydramine was significantly superior with respect to a lower dose of metoclopramide (1 mg/kg x 4) combined with methylprednisolone was carried out.

With the introduction of the 5-HT3 receptor antagonists the interest for antiemetic therapy increased and other Italian gynecological and medical oncology centres became involved in the antiemetic research. The Italian Group for Antiemetic Research was formed in 90's and its first study demonstrated the superiority of a combination of a 5-HT3 receptor antagonist plus dexamethasone with respect to the standard three drug combination of high doses of metoclopramide in the prevention of cisplatin-induced acute emesis.

In the following years, the Group contributed to the identification of the best antiemetic prophylaxis for acute emesis induced by moderately emetogenic chemotherapy, and for delayed emesis induced by cisplatin. Also a drug utilization review on antiemetics in clinical practice has recently been carried out.

Today, the interest of the Group is concentrated in studying the optimal antiemetic prophylaxis for delayed emesis induced by moderately emetogenic chemotherapy.

The rules always followed by the Italian Group for Antiemetic Research are: - complete independence of judgement on the efficacy and the tolerability of antiemetic drugs from the pharmaceutical companies; - priority of ethical problems in designing clinical trials; - strict adherence to the methodological problems of antiemetic research and - complete autonomy concerning the study planned, the data computerization and the data elaboration.

In the last twelve years approximately 70 Italian centres have enrolled their patients into the studies of the Italian Group for Antiemetic Research.
EPOETINA ALFA NEI TUMORI DEL POLMONE
Authors: Ardizzoni Andrea , Cafferata Mara Argenide , Rosso Riccardo
Published: April 2018

There is a high frequency of hematopoietic abnormalities in patients with neoplastic disorders, anemia being one of the most common and important, especially in lung cancer patients undergoing chemotherapy. A number of factors are able to affect the incidence and severity of chemotherapy-induced anemia: the type of chemotherapy, chemotherapy dose-intensity, chemotherapy duration, prior treatment, baseline Hb value and entity of Hb decrease during chemotherapy. An impaired erythroid marrow response to erythropoietin (EPO) and reduced EPO levels in response to anemia may contribute to the development of this form of anemia in lung cancer patients. Recombinant human EPO has been successfully used in the treatment of anemia. EPO increases the red cells mass and eliminates by approximately 50% the need for blood transfusions in patients with chronic anemia of cancer. EPO is also effective in the prevention of anemia of cancer patients. Besides increasing the levels of hemoglobin, EPO is also able to significantly improve the quality of life and performance status of anemic patients with cancer. EPO is well tolerated and the only drawbacks are represented by its cost and the need for a prolonged parenteral treatment. The use of EPO can be optimized by taking into consideration some predicting factors, by modulating the dose and by using iron support. In patients with lung cancer, the objective of EPO treatment may vary from palliation to survival improvement according to stage, type of antineoplastic treatment and prognosis. To take maximum advantage from its efficacy, EPO treatment in lung cancer patients needs to be individualized by identifying for each patient the risk of severe anemia and the objective of treatment.