bluuebunny/crossref_metadata_2025 huggingface dataset:
Malignant Pheochromocytoma in Multiple Endocrine Neoplasia Type 2B Syndrome. Case Report and Review of the Literature
Authors: Scopsi Lucio , Castellani Maria Rita , Gullo Maria , Cusumano Fabio , Camerini Edgarda , Pasini Barbara , Orefice Sergio
Published: April 2018

A malignant behavior (i.e., distant metastatic spread) has been recorded in 3-4% of pheochromocytomas occurring in the context of multiple endocrine neoplasia type 2A syndrome, but has never been documented in patients with the type 2B form. In this report we describe a case of malignant pheochromocytoma arising in the latter syndrome setting. The patient, a white young male, had the full-blown syndrome, including multicentric, bilateral medullary thyroid carcinoma metastatic to regional lymph nodes, mucosal neuromas, digestive ganglioneuromatosis, marfanoid habitus, and bumpy lips. Three and a half years after surgical resection of an apparently benign adrenal pheochromocytoma he developed widespread osseous metastases. The presence of hypertensive crises and high urinary catecholamine excretion rates, coupled to moderate hypercalcitoninemia, normal circulating carcinoembryonic antigen levels, negative whole-body 99mTc-(V) dimercaptosuccinic acid scan, and absence of neck or mediastinal disease by magnetic resonance imaging, proved that the metastases were from his previous adrenal and not thyroid tumor. Furthermore, since the bone metastases strongly accumulated 131I-metaiodobenzylguanidine, several courses of the radiocompound were given, which resulted in an objective, though partial, tumor regression.
Extraosseous Aneurysmal Bone Cyst
Authors: Riccioni Luca , Foschini Maria P.
Published: April 2018

A 73-year-old man developed an enlarged cystic lesion located in the soft tissues surrounding the left hip. The lesion was surgically removed. The patient was well 1 year after surgery. The lesion was histologically identical to an aneurysmal bone cyst, therefore it was diagnosed as an extraosseous aneurysmal bone cyst. The differential diagnoses and a review of the literature are presented.
Meningeal Melanocytoma: A Rare Lesion of the Central Nervous System
Authors: Gardiman Marina , Altavilla Giuseppe , Marchioro Lorella , Boscolo Luisa , Alessio Luigi , Piazza Mario
Published: April 2018

Two cases of meningeal melanocytoma, both localized in the cerebellopontine angle, were studied. The patients underwent surgical excision, and in one case there was a recurrence. All the pathologic criteria of melanocytoma were fulfilled by the 2 reported cases. Immunohistochemical stainings were very important ancillary tools in the differential diagnosis with other pigmented meningeal tumors.
A Paratesticular Localization of Desmoplastic Small Cell Tumor. A Case Report
Authors: Bertoldin Roberto , Drei Nicola , D'Incà Giulio , Camuffo Maria Cristina , Guazzieri Stefano
Published: April 2018

We report a case of paratesticular desmoplastic small cell tumor. In accord with the literature, the patient was subjected to treatment with combined chemotherapy, but he developed progression of disease and died 13 months later.
Salivary Duct Carcinoma Metastasizing to the Small Bowel
Authors: Krušlin Božo , Ščukanec-Špoljar Mira , Šeparović Viktor , Manojlović Spomenka , Janković Dražn , Danilović Zarko
Published: April 2018

We report a case of salivary duct carcinoma in a 47-year-old woman. The patient presented with symptoms simulating acute appendicitis. Surgery revealed metastatic tumor in the wall of the small bowel. Two months later, a tumor of the right parotid gland was resected, and histologic analysis revealed a salivary duct carcinoma. To our knowledge, this is the first case of salivary duct carcinoma metastasizing to the small bowel with manifestations of metastatic disease as the prominent symptom.
5-Fluorouracil-Induced Severe but Reversible Cardiogenic Shock: A Case Report
Authors: Akhtar Shad S. , Wani Bashir A. , Bano Zareefa A. , Salim Khalida P. , Handoo Fayaz A.
Published: April 2018

5-fluorouracil cardiotoxicity is increasingly recognized with variable presentation. We report a patient who developed cardiogenic shock due to high-dose 5-fluorouracil infusion (1,000 mg/m2 every 24 hr for 96 hr). There was no evidence of myocardial necrosis. The patient recovered completely without any residual cardiac dysfunction. The exact cause of 5-fluorouracil toxicity remains to be determined. The case highlights the need for careful monitoring of patients who receive high-dose 5-fluorouracil for the development of cardiotoxicity.
Malignant Mesothelioma in Rome, Italy 1980-1995. A Retrospective Study of 79 Patients
Authors: Ascoli Valeria , Scalzo Caterina Carnovale , Facciolo Francesco , Martelli Massimo , Manente Liborio , Comba Pietro , Bruno Caterina , Nardi Francesco
Published: April 2018

Aim and background

To evaluate the characteristics of a case-series of 79 malignant mesothelioma patients collected from the main teaching hospital of Rome, Italy, and other local clinics of Latium Region and to assess the role of asbestos exposure, since previous studies on the occurrence of the disease in this area were lacking.

Methods

The study included cytohistologically diagnosed malignant mesothelioma (71 pleural, 7 peritoneal, and 1 testicular tunica vaginalis) detected or referred for consultation during the period 1980-1995. Information regarding occupational and/or nonoccupational exposures was derived from clinical records and interviews, when available.

Results

Patients were resident in Rome and other towns of Latium; a few were from other parts of central and southern Italy. Exposure to asbestos was assessed for 45.5% of patients, another 45.5% had unknown exposure, and for the remaining 9% such information was lacking. Occupational exposure occurred in 53% of men for whom information was available and nonoccupational exposure occurred in 20% of women. The study identified two clusters of cases from an asbestos-cement plant and a facility where asbestos was ubiquitous. Furthermore, most exposed subjects reported occupations in the construction industry, which is particularly active in the Latium Region; others were railroad workers, naval mechanics and navy personnel, bakers, explosive workers and car mechanics. A few patients reported indoor exposure to asbestos at home and/or in the workplace.

Conclusions

The study confirmed that mesothelioma risk is present in several job titles of the construction industry, and it is no longer confined to workers employed in the manufacture or application of asbestos products. The occurrence of malignant mesothelioma in patients with unexpected occupational and nonoccupational exposures indicates the need for further investigation on previously underestimated exposures.
Early Results of the Value of p53 in Predicting Survival in a Homogeneous Cohort of Patients with Invasive Bladder Cancer Treated with a Neoadjuvant Carboplatin-Based Regimen (M-CAVI)
Authors: Ribas Antoni , Bellmunt Joaquim , Albanell Joan , De Torres Inés , Bermejo Begoña , De Torres Jose A. , Morote Joan , Gallardo Enrique , Vera Ruth , Carulla Joan , Sole-Calvo Luis-Alfonso
Published: April 2018

Aims and Background

Several reports on prognostic factors for infiltrating bladder cancer have given controversial results. We assessed the prognostic value of p53 nuclear overexpression together with known prognostic factors for survival in patients with invasive T2-4 NO MO bladder cancer treated with neoadjuvant chemotherapy.

Study Design

Thirty-five paraffi-nized tumor samples from initial transurethral resection of patients with bladder cancer were analyzed immunohistochemi-cally to detect overexpression of p53 protein. Patients were treated with 3 to 4 cycles of neoadjuvant methotrexate, carboplatin, and vinblastine (M-CAVI) and then underwent radical cystectomy. Prechemotherapy, treatment, and postchemotherapy factors were analyzed for correlation with survival by univariate and multivariate analysis. Fifty-seven percent of tumors were positive for p53 protein, 71.5% had grade III-IV tumors, and 72% had organ-confined disease. The median follow-up was 20 months (range 5-71+).

Results

By univariate analysis, the significant pretreatment factors were initial tumor (T) stage ( P <0.0001) and the male sex ( P = 0.03). Five postchemotherapy variables were found significant: surgery performed according to protocol ( P = 0.003), overall clinical ( P = 0.004), and overall pathologic ( P = 0.02) response to therapy, postchemotherapy pathologic stage ( P = 0.0002), and tumor status after surgery ( P = 0.0006). By multivariate analysis, the initial prechemotherapy T stage was the only factor that demonstrated independent significance.

Conclusions

Although the median follow-up of the study is still too short, in this group of patients treated with a neoadjuvant carboplatin-based regimen, a classical variable (prechemotherapy T stage) rather than p53 nuclear overexpression was an independent prognostic factor for survival. Further follow-up will be required to assess the value of p53 overexpression as a prognostic factor in invasive bladder cancer patients treated with neoadjuvant carboplatin-based chemotherapy.
Do the Conventional Clinicopathologic Parameters Predict for Response and Survival in Head and Neck Cancer Patients Undergoing Neoadjuvant Chemotherapy?
Authors: Fonseca Emilio , Cruz J. Jesus , Dueñas Alfonso , Gómez Amalia , Sánchez Pedro , Martín Germán , Nieto Adelaida , Soria Pedro , Muñoz Angel , Gómez J. Luis , Pardal J. Luis
Published: April 2018

Aims and Background

Neoadjuvant chemotherapy for head and neck carcinoma is still an important treatment modality. The prognostic value of patient and tumor parameters has been extensively evaluated in several trials, yielding mixed results. We report the prognostic factors emerging from a group of patients undergoing neoadjuvant chemotherapy.

Patients and methods

From April 1986 to June 1992, 149 consecutive patients received cisplatin-5-fluorouracil-based neoadjuvant chemotherapy. After four courses of chemotherapy, patients underwent local-regional treatment with surgery, radiation or both. A variety of patient and tumor characteristics were evaluated as predictors for response to chemotherapy and survival.

Results

The complete response, partial response and no response rates to NAC were 52%, 33% and 15%, respectively. No parameters predicted response to chemotherapy. At a maximum follow-up of 87 months, overall survival was 39% and disease-free survival was 49%. Variables shown to be predictors of survival in univariate analyses were age, performance status, histology, site, T, N, stage, and response to chemotherapy. Using the Cox regression analysis, only complete response to induction chemotherapy ( P = 0.0006), performance status ( P = 0.03), stage ( P = 0.01), age ( P = 0.03) and primary tumor site ( P = 0.04) emerged as independent prognostic factors for survival.

Conclusions

Complete response to chemotherapy was confirmed as the strongest prognostic factor influencing survival. However, conventional clinicopathologic factors did not predict response, hence, potential prognostic biologic and molecular factors for response must be sought. At present, much effort must be made for the improvement of the complete response rate, which seems to be a requisite to prolong survival.
Neoadjuvant Chemotherapy with Continuous Infusion of Cisplatin and Fluorouracil in Stage II-IV, M0 Squamous Cell Carcinoma of the Head and Neck
Authors: Boni Corrado , Moretti Gabriella , Savoldi Luisa , Armaroli Luciano , Barbieri Werter , Bisagni Giancarlo , Caroggio Angelo , lotti Cinzia , Pedroni Corrado , Manenti Anna Lucia , Rondini Ermanno , Sassi Maurizio , Zadro Alvise
Published: April 2018

Aims and Background

The aim of the study was to assess the activity and the toxicity of cisplatin (DDP) and fluorouracil (FU) administered by continuous infusion as neoadjuvant chemotherapy for patients with stage II-IV, MO squamous cell carcinoma of the head and neck.

Methods

Thirty previously untreated patients were submitted to chemotherapy with DDP (20 mg/m2) and FU (1000 mg/m2), both in continuous infusion for 5 days, repeated every 21 days, for a maximum of 5 cycles. Following completion of chemotherapy, the patients underwent radiotherapy; in some patients surgery was performed immediately after chemotherapy. All patients were monitored for response, time to failure, survival, treatment-related events and toxicity.

Results

All patients were evaluated for response; after chemotherapy the complete response rate was 27% and the partial response rate 33%. Twenty-four patients underwent radiotherapy: the overall response rate was 83% (complete response 79%). After a median follow-up of 34 months, the median survival time was 22 months with a median time to failure of 15 months. Acute vascular accidents were the main and unexpected adverse events, with 2 deaths for pulmonary embolism and 1 for stroke. The response rate to the regimen does not seem to be better than that obtained with the standard combination of cisplatin bolus and fluorouracil continuous infusion. The disadvantage of the regimen is that it causes more discomfort for the patient in that it requires hospitalization.

Conclusions

For this reason, we believe that there are no elements for recommending the schedule as neoadjuvant treatment of patients with squamous cell carcinoma of the head and neck or as an experimental arm in a randomized trial.
Phase II Study of Oral L-Leucovorin, 120-Hour Fluorouracil Infusion and Carboplatin in Advanced Pancreatic Cancer
Authors: Colleoni Marco , Nelli Patrizia , Vicario Giovanni , Pancheri Francesca , Sgarbossa Gigliola , Manente Paolo
Published: April 2018

Background

No effective chemotherapy has been developed for patients with metastatic pancreatic cancer. Encouraging results have been reported with the combination of cisplatin and fluorouracil infusion. The aim of the study was to test the activity of oral L-leucovorin, carboplatin and fluorouracil infusion in untreated pancreatic cancer patients.

Patients and Methods

Patients with advanced pancreatic carcinoma were treated with carboplatin (300 mg/m2 on day 1), L-leucovorin (5 mg/m2 twice a day on days 1-5), and fluorouracil (1,000 mg/m2 as a 120-hr infusion on days 1-5), cycles being repeated every 21 days.

Results

Nine patients were included and were assessable for response and side effects. All patients had measurable disease and an ECOG performance status of 0-2. No patient achieved partial remission, 3 had stable disease, and 6 progressive disease. Median time to progression was 2 months (range, 2-8), and median survival was 4 months (range, 3-12). Toxicity consisted of mucositis, diarrhea and neutropenia.

Conclusions

Patients with metastatic pancreatic carcinoma do not benefit from this treatment schedule.
Hemophagocytic Syndrome in a Case of Splenic Large B-Cell Lymphoma
Authors: Büchi Gualtiero , Termine Giuseppe , Orlassino Renzo , Pagliarino Mauro , Boero Roberto , Zappalà Cirino , Grosso Enzo
Published: April 2018

A case of splenic large B-cell lymphoma with hemophagocytic syndrome is reported. The difficulties of diagnosis are emphasized especially when peripheral lymph nodes or bone marrow lymphomatous infiltration are not present. Diagnostic criteria for hemophagocytic syndrome and their relationship with the pathogenesis of the disease are also stressed.
Breast Cancer Prevalence Measured by the Lombardy Cancer Registry
Authors: Micheli Andrea , Gatta Gemma , Sant Milena , Krogh Vittorio , Perone Concetta , Dell'Era Livio , Saltarelli Stefania , Berrino Franco
Published: April 2018

Aims and background

Breast cancer is the most important malignant neoplasm affecting women in Western countries. An increasing number of women undergo regular medical checkups, especially during the first years following the diagnosis. Therefore, from the health planning point of view, it is essential to have prevalence measures to furnish estimates for the demands that the health care system could possibly undergo.

Methods

By means of PREVAL, a computerized program, breast cancer prevalence has been measured in the Varese province using incidence and follow-up data from the Lombardy Cancer Registry (LCR).

Results

During the 1986–1988 period, breast cancer prevalence for patients alive within 10 years from diagnosis was about 625 per 100,000 resident women. Of these, 54% were over 60 years and 9% were under 45 years of age. Patients alive within 2 years from diagnosis were about 200 per 100,000 residents; considering the 1978–1980 period, patients alive within 2 years from diagnosis were just 140 per 100,000 residents. This dramatic increase in breast cancer prevalence is present also for long-term survivors (i.e. patients alive at 10–13 years from the diagnosis). Extrapolating breast cancer prevalence measured in the Varese province to the whole Lombardy region, the expected number of prevalent cases alive within 10 years of the diagnosis, presently living in Lombardy, would be 27,500. LCR's breast cancer prevalence figures were compatible with available data provided by the Finnish Cancer Registry.

Conclusion

Owing to aging of the population, the improvement in survival and the increasing incidence, the number of prevalent cases will increase. This phenomenon has and will have great importance for the health planning.
Concurrent Carboplatin/5Fu and Radiotherapy Compared to Radiotherapy Alone in Locally Advanced Cervical Carcinoma: A Case-Control Study
Authors: Colombo Alessandro , Landoni Fabio , Cormio Gennaro , Barni Sandro , Maneo Andrea , Nava Simonetta , Pellegrino Antonio , Placa Franco , Mangioni Costantino
Published: April 2018

Aims and background

Despite the introduction of innovative techniques in radiotherapy (RT) delivery, no significant improvement in survival has been achieved in the last decades. Concurrent chemoradiation therapy (CRT) is one of the several avenues being explored to improve the results.

Methods and study design

Twenty-eight women with locally advanced squamous cell carcinoma of the uterine cervix were treated with CRT comprising a combination of external and intracavitary RT, along with 3 cycles of 5-fluorouracil (5-FU) and carboplatin. Toxicity, pelvic control rate and disease-free survival achieved in this group of patients were compared in a case-control study with those of a group of 28 patients with similar clinicopathologic characteristics treated with radical RT alone at our institution.

Results

CRT was well tolerated, with 97% of the patients completing the protocol as planned. Acute toxicity, primarily hematologic, was significantly (P=0.05) higher in the cases than in the controls (25% vs 3%). One treatment-related death occurred in a stage III patient in the CRT group. The median follow-up was 55 months (range, 20–156) in the RT group and 20 months (range, 14–46) in the CRT group. Pelvic control rate, disease-free survival and overall survival were not significantly different in the two groups. Estimated 5-year survival rate was 70% and 66% respectively for the RT and CRT group.

Conclusions

Concomitant carboplatin/5-FU and radiotherapy is a safe and tolerable means of treatment for locally advanced cervical cancer. In our study, however, concurrent CRT did not result in a significant improvement in pelvic control rate or survival compared to standard conventional radiotherapy.
The use of Granulocyte Colony-Stimulating Factors following Peripheral Blood Progenitor Cell Rescue after High-Dose Chemotherapy for Advanced Breast Cancer: A Prospective Study
Authors: Dazzi Claudio , Albertazzi Livia , Rosti Giovanni , Maestri Antonio , Fiorentini Giammaria , Leoni Maurizio , Tienghi Amelia , Turci Daniele , Ferrante Patrizia , Vertogen Bernadette , Cariello Anna , Latino Walter , Zumaglini Federica , Marangolo Maurizio
Published: April 2018

The use of high-dose chemotherapy followed by hematopoietic rescue is increasing worldwide for solid tumors. Several studies have suggested that the period of absolute neutrophil count (ANC, <500/ml) may be shortened in patients who receive peripheral blood progenitor cells (PBPC). To estimate the clinical value of granulocyte-colony-stimulating factor, we examined a cohort of 26 consecutive patients with advanced breast cancer who received one or two cycles of high-dose chemotherapy with PBPC rescue with or without filgrastim. Thirty-five courses of high-dose ICE (ifosfamide, carboplatin, etoposide) chemotherapy were administered and evaluated. All patients received PBPC rescue. Sixteen patients (21 courses) received subcutaneous filgrastim (5 mg/kg) following PBPC infusion. Recovery to ≥ 500 ANC occurred at a median time of 7 days post PBPC infusion among patients who received filgrastim versus 10 days among patients who received standard support care only (P<0.01). The administration of filgrastim was not associated with a reduction in the duration of hospitalization, in the total number of days on nonprophylactic antibiotics, number of red blood cell transfusions, time to platelet engraftment, or number of febrile days. This could be the consequence of the high hematopoietic cell dose administered in the study. Therefore, any effect of filgrastim was probably masked by the use of a large number of PBPC. Larger prospective randomized studies, specifically focused on the utility of the administration of growth factors following high-dose chemotherapy and PBPC rescue, may be warranted to know whether the administration of filgrastim after PBPC transplantation is really necessary.
Impact of Distal Clearance Margin on Oncologic Outcome after Restorative Resection of the Rectum
Authors: Bozzetti Federico , Mariani Luigi , Miceli Rosalba , Montalto Fabrizio , Baratti Dario , Andreola Salvatore
Published: April 2018

There is considerable controversy about the distal clearance margin that needs to be maintained beyond the extent of a rectal tumor in order to reduce the risk of local recurrence. We investigated the rate of local recurrence, distant metastases and survival in 87 patients who had undergone radical restorative resection of the rectum for cancer and had been followed up for a median period of over 6 years, and we analyzed the statistical relation (log-rank test for trend) with the length of the distal margin. The distal margin length was divided into three categories: 1 cm, 2 cm, and ≥3 cm.

No significant correlation was found between the length of the distal clearance margin and the oncologic outcome. Taken together, our data suggest that if the resection line distally falls on healthy tissue, there is no need to resect additional rectum in order to achieve a better outcome.
Antineuronal Antibodies in Patients with Neuroblastoma: Relationships with Clinical Features
Authors: Salmaggi Andrea , Luksch Roberto , Forno Maria Grazia , Pozzi Annalisa , Silvani Antonio , Boiardi Amerigo , Gasparini Marco , Nemni Raffaello
Published: April 2018

We evaluated the frequency of serum antineuronal antibodies in a cohort of 39 neuroblastoma patients and related their presence to clinical features. Twelve patients displayed antineuronal antibodies at immunocytochemistry. Only one of these 12 patients suffered from a clinically overt paraneoplastic syndrome. No significant differences emerged between autoantibody-positive and autoantibody-negative patients in terms of progression-free and overall survival, although when only patients evolving to disease progression were considered, the time interval between diagnosis and progression was slightly longer in autoantibody-positive patients.
Synchronous and Metachronous Diagnosis of Multiple Primary Cancers
Authors: Crocetti Emanuele , Arniani Stefania , Buiatti Eva
Published: April 2018

Aims

In the time period near to the diagnosis of a new cancer, other tumors (synchronous cancers), especially slow-growing tumors, may be detected because several diagnostic examinations are performed. The frequency of synchronous in comparison with metachronous carcinomas has been evaluated in a population-based series of multiple primary cancers.

Methods

The case series of multiple primary cancers of the Tuscany Tumor Registry, incident during the period 1985-1991 was analyzed. For each site of a second independent tumor, the proportions of synchronous (diagnosed within 2 months of the first primary) and metachronous cancers were compared with the mean distribution (all sites except the specific one).

Results

During 1985-1991, 1095 patients had two independent tumors diagnosed; 216 were synchronous. The proportion of synchronous compared to metachronous cancers was significantly higher for bladder, prostate and renal cell carcinomas; it was significantly lower for lung cancer. When cancers following skin epitheliomas were evaluated, only the proportion of synchronous skin cancers was significantly increased.

Conclusions

Silent slow-growing tumors are suspected to be more frequent in patients with prostate, bladder or renal cell carcinomas. In fact, they were most frequently diagnosed during ascertainment for another cancer. When few examinations were performed, as after the diagnosis of a skin epithelioma, no difference between metachronous and synchronous cancers was evident, except for skin.
Risk of Endometrial Cancer in Breast Cancer Patients under Long-Term Adjuvant Treatment with Tamoxifen
Authors: Cecchini Silvia , Ciatto Stefano , Bonardi Rita , Mazzotta Antonia , Pacini Paolo , Muraca Maria Grazia , Zappa Marco
Published: April 2018

Aims

To evaluate the relative risk of endometrial cancer with respect to the expected underlying incidence in breast cancer patients undergoing long-term adjuvant tamoxifen therapy.

Methods

A total of 1010 postmenopausal breast cancer patients receiving adjuvant tamoxifen and with a first negative endometrial ultrasonography (cutoff for abnormal endometrial thickness >5 mm) were followed by annual transvaginal ultrasonography. Abnormal endometrial thickness prompted an outpatient endometrial biopsy or curettage under anesthesia in the case of cervical stenosis and increasing endometrial thickness. The standardized incidence ratio (SIR) with respect to underlying incidence was determined.

Results

A total of 1,010 eligible subjects who had been receiving tamoxifen for an average of 51 months were enrolled and followed for a total of 2,361 patient-years between January 1993 and December 1996. Five cases of endometrial cancer were observed in the study period: 1 was detected at screening, and 4 were diagnosed for vaginal bleeding in the interval between screening examinations. SIR was 4.0 (95% confidence interval, 1.39.4) and increased to 4.8 (CI, 1.6-10.5) when the single cancer detected at first screening was considered as incident.

Conclusions

This study adds evidence to the hypothesis that long-term tamoxifen treatment may be responsible for a relevant increase in the risk of developing endometrial cancer. Surveillance based on endometrial ultrasonography was poorly sensitive, but the favorable stage at diagnosis of screen-detected or interval endometrial cancers does not support a more aggressive screening approach.
Image Analysis in the RGB and HS Colour Planes for a Computer-Assisted Diagnosis of Cutaneous Pigmented Lesions
Authors: Tomatis Stefano , Bono Aldo , Bartoli Cesare , Tragni Gabrina , Farina Bruno , Marchesini Renato
Published: April 2018

Aims and background

A study was carried out to evaluate the effectiveness of image analysis performed by the two color representation models when a computer-assisted diagnosis of melanoma is involved.

Methods

Color images of 40 skin pigmented lesions, which included 12 melanomas, were acquired by a standard color RGB video camera and stored in a PC for off-line processing. Image analysis was performed in the red green and blue color representation model and using hue and saturation color components. To describe shape and color characteristics of each lesion, including area, roundness and color variegation, 16 parameters were derived from red, green, blue, hue and saturation color planes and tested as possible variables useful to differentiate melanomas from benign nevi.

Results

The test gave a result of significance for six of the 16 derived image descriptors. The general trend of our data was in agreement with clinical observations according to which melanoma is usually darker, more variegated and less round than a benign nevus, whereas lesion dimension of melanomas and benign lesions was not significantly different.

Conclusions

Our preliminary results suggested that image analysis performed on hue and saturation-derived and red green and blue-derived data could better discriminate melanoma from nevi than separately using the two color representation models.
Bone Lesion in a Patient with Transplanted Liver for a Metastatic Carcinoid. The Role of Somatostatin Receptor Scintigraphy
Authors: Savelli Giordano , Chiti Arturo , Spinelli Antonella , Regalia Enrico , Mazzaferro Vincenzo , Castellani Maria Rita , Balzarini Luca , Musumeci Renato , Bombardieri Emilio
Published: April 2018

A patient who had previously undergone ileal resection and liver transplantation for a gastroenteropancreatic (GEP) tumor was evaluated with somatostatin receptor scintigraphy (SRS) using 111In-DTPA-D-Phe1-pentetreotide. Eighteen months after surgery, during follow-up procedures, conventional imaging techniques (ultrasound, computed tomography, magnetic resonance imaging) only showed a relapse in the gastropancre-atic lymph nodes, while SRS demonstrated skeletal spread. This case report emphasizes the clinical impact of SRS on the management of patients affected by neuroendocrine gastroenteropancreatic tumors.
Immobilization Devices between Routine and Quality Assurance
Authors: Polico Cesare , Pavanato Giovanni , Capirci Carlo , Mandoliti Giovanni
Published: April 2018

Aims and background

To evaluate the impact of immobilization devices in reducing treatment errors and delivering high doses to limited target volumes. The clear advantages are matched with quality control necessity.

Methods

The Authors examine two fundamental aspects of the topic:1) the immobilization of head and neck and the relative implications in reducing the skin-sparing at the build-up region; 2) the rationale and management of quality assurance procedures in the immobilization devices utilization, with a particular reference to pelvic radiation treatment.

Conclusions

The immobilization devices utilization certainly leads to an optimization in the execution of radiation treatments. Nevertheless, in the choice for their routine use, the Authors suggest to follow some “conceptual rules” with the aim of successfully matching each of the discussed aspects connected with their utilization.
Supportive Care in Radiotherapy: A Review
Authors: Ausili-Cèfaro Giampiero , Marmiroli Luca
Published: April 2018

The normal tissue tolerance and the related early side effects represent the main constraint on the total radiation dose which can be administered to the target volume. The most common disorders during radiotherapy or chemo-radiotherapy are summarized in this review. Since in the recent years great advances have been made towards the improvement of acute tolerance, practically every adverse symptoms can be controlled or lowered with an adequate treatment. Some suggestions are reported in order to prevent or lower the degree and the incidence of major complications, specifically mucositis-related symptoms like stomatitis, diarrhea, cystitis. Possibly, a multicenter effort is to be made in order to optimize the quality of supportive care for irradiated patients in all radiation therapy centers.
Two Quality Control Procedures on Radiotherapy Beam Calibration and Treatment Planning System Implementation
Authors: Piermattei Angelo , Azario Luigi , Canne Stefania delle , Fidanzio Andrea , Palazzoni Giovanni
Published: April 2018

New challenging dosimetric approaches, such as narrow beams and 3D algorithms, are being used in radiotherapy. In this paper two quality control (QC) procedures are reported. The first one concerns the QC of the dosimetry of small x-ray beams, generally carried out by using silicon detectors. The comparison of dose values obtained by a silicon diode, a diamond detector, and radiochromic films shows that for x-ray beams of high energy, the silicon diode can give an overestimation of the output factors in phantom, up to 4%. This is due to the higher than unit density silicon diode and the surrounding envelope that restore the lateral electron equilibrium. About the 3D algorithms for breast treatment planning, a quality control test has been adopted to verify the accuracy of the computed dosimetry when “loss of scatter” occurs. The results show a sensible agreement (within 1.5%) between computed and experimental data.
Randomized Trials on Altered Fractionation in Head and Neck Cancer Radiotherapy with Conventional Fractionation as Control Arm: Another Lap to Go
Authors: Olmi Patrizia , Fallai Carlo
Published: April 2018

The Authors present a review of randomized trials on non conventional fractionation in head and neck cancer radiotherapy with conventional fractionation as control arm. Hyperfractionation was studied in 5 trials, accelerated hyperfractionation in 4 trials and accelerated fractionation in 3 trials. Furthermore, the reviews of eminent Authors dealing with the above mentioned trials are summarized. In spite of improved local control rate reported with hyperfractionation, non conventional radiotherapy schedules are not yet recommended as routine clinical practice, but all the radiation oncologists are invited to join trials on this subject.
Altered Fractionation Radiotherapy in Lung Cancer
Authors: Palazzi Mauro , Cerrotta Annamaria , Villa Sergio
Published: April 2018

Clinical trials on altered fractionation radiotherapy (RT) regimens currently play a significant role in lung cancer, due to the importance of local control and to the disappointing therapeutic results in this disease. In non-small-cell lung cancer (NSCLC) two strategies are being actively investigated: hyperfractionation with a “curative” aim, and hypofractionation with a palliative aim; in small-cell lung cancer (SCLC) altered fractionation seems to play a minor role at this moment. In this review paper the results of reported randomised trials are summarised and discussed. Conclusions may indicate that through hyperfractionation, particularly if accelerated, clinical outcome of non-metastatic NSCLC patients can be improved; data are however not sufficiently mature to advise its use outside controlled clinical trials. In the palliative setting, hypofractionation should be considered standard treatment.
Clinical Results of Unconventional Fractionation Radiotherapy in Central Nervous System Tumors
Authors: Botturi Marco , Fariselli Laura
Published: April 2018

Malignant brain tumors (primary and metastatic) are apparently resistant to most therapeutic efforts. Several randomized trials have provided evidence supporting the efficacy of radiation therapy. Attempts at improving the results of external beam radiotherapy include altered fractionation, radiation sensitizers and concomitant chemotherapy. In low-grade gliomas, all clinical studies with radiotherapy have employed conventional dose fractionation regimens. In high-grade gliomas, hypofractionation schedules represent effective palliative regimens in poor prognosis subsets of patients; short-term survival in these patients has not allowed to evaluate late toxicity. In tumors arising within the central nervous system, hyperfractionated irradiation exploits the differences in repair capacity between tumour and late responding normal tissues. It may allow for higher total dose and may result in increased tumor cell kill. Accelerated radiotherapy may reduce the repopulation of tumor cells between fractions. It may potentially improve tumor control for a given dose level, provided that there is no increase in late normal tissue injury. In supratentorial malignant gliomas, superiority of accelerated hyperfractionated over conventionally fractionated schedules was observed in a randomized trial; however, the gain in survival was less than 6 months. At present no other randomized trial supports the preferential choice for altered fractionation irradiation. Also in pediatric brainstem tumors there are no data to confirm the routine use of hyperfractionated irradiation, and significant late sequelae have been reported in the few long-term survivors. Shorter treatment courses with accelerated hyperfractionated radiotherapy may represent a useful alternative to conventional irradiation for the palliation of brain metastases. Different considerations have been proposed to explain this gap between theory and clinical data. Patients included in dose/effect studies are not stratified by prognostic factors and other treatment-related parameters. This observation precludes any definite conclusion about the relative role of conventional and of altered fractionation. New approaches are currently in progress. More prolonged radiation treatments, up to higher total doses, could delay time to tumor progression and improve survival in good prognosis subsets of patients; altered fractionation may be an effective therapeutic tool to achieve this goal.
Radiotherapy with Heavy Ions: Radiobiology, Clinical Indications and Experience at GSI, Darmstadt
Authors: Kraft Gerhard
Published: April 2018

In the history of external beam radiotherapy, the trend for a better conformation as well as for a higher biological efficiency has been the driving force for the improvement of clinical results. However, these two goals had to be followed with separate types of radiation, i.e. photons and neutrons, and could not be combined. For the first time being, beams of heavy ions like carbon offer the possibility to combine both advantageous properties: better targeting and higher biological efficiency. Particle beams have an inverse depth dose profile, with a maximum dose in the deep seated tumor, a finite range, small lateral scattering, and a drastically increased biological efficiency in the tumor. These properties maximize the deletion effects on tumor cells. In addition, particle beams can be directed precisely in the limit of one or two millimeters, and can be monitored using positron emission tomography (PET) with the same precision. In the following paper the conditions are given that are necessary to translate these properties into clinical routine.
Number of Potential Patients to be Treated with Proton Therapy in Italy
Authors: Orecchia Roberto , Krengli Marco
Published: April 2018

In radiotherapy, the use of proton beams is one of the most promising approaches in order to reduce the treatment volume and, consenquently, increase the total dose avoiding severe complications to the normal tissues surrounding the target. Among the new hospital-based facilities that are planned for the next future, the italian project is in an advanced stage of study. Because of the complexity and high cost of the italian centre, one of the most important information in order to establish the cost/benefit balance, is represented by the number of potential patients to be treated for the various pathologies. For this reason it is useful to define a priority scale of clinical indications and, on this basis, to estimate the yearly patient afflux to the center, taking into account the incidence and the expected new cases to be treated with protons. Indications have been divided into two categories, according to decreasing priority. Category A includes all the tumors in which the use of proton therapy has clearly demonstrated to be advantageous, being the only way to give a curative dose to the target. In Italy, the extimated number of this category of patients is 825 each year. Category B comprises a great variety of tumors characterized mainly by a local evolution, with a limited likelihood of distant spread, and therefore potentially cured if the local control can be obtained. The total number of potential patients in this category is more than 10,000.
Clinical Application of Integrated Treatments in Breast Cancer
Authors: Cosentino Dorian , Valli Maria Carla
Published: April 2018

In this paper we analyse the problems related to the “state of the art” in the treatment of stage I and II breast cancer which has become, in Italy too, an increasingly prominent problem: it is the most frequently diagnosed female cancer, accounting for about 45,000 new cases/year (150/100,000 women). In the last decade the approach to this disease has greatly evolved because of new surgical techniques, advances in adjuvant medical therapies, innovations in the field of radiotherapy, and wider use of biological parameters. We emphasize the emerging problem of ductal and lobular carcinoma in situ, because their biological patterns will be better indentified and the related treatment extensively practiced in the next future. The innovations in surgery, which has now a less demolishing role, are reviewed focusing on the “sentinel axillary node” and the actual need for axillary dissection. In relation to chemotherapy (CT), we evaluate the role of adjuvant treatment also in node negative patients, and the impact of neoadjuvant schedules on survival and toxicity. Radiotherapy (RT) is complementary to conservative surgery, and its important role in preventing local relapse and in increasing OS (overall survival) has been established; recent and more sophisticated techniques have reduced its acute and late toxicity. We are however waiting for answers concerning the usefulness of a booster dose, the impact of RT on local relapse in DCIS, and the impact of RT to the breast regional lymph nodes on OS and disease-free survival (DFS). The optimal sequencing and timing of postoperative RT and CT are unknown, both concerning each other and surgery. Some possibilities include giving all planned CT before RT, all CT after RT, giving both concurrently, or giving a portion of CT before RT and then completing CT afterwards (sandwich technique): we analyse the advantages and the problems of these different therapeutic schedules in relation to the OS, the DFS and cosmesis. In conclusion, there are very few certainties to guide us in the clinical practice: the general feeling is that we need to collect more data on homogeneous groups of patients to better understand which are the prognostic factors we can rely on, in order to choose the best treatment strategy, and which are the optimal schedules of adjuvant treatments (CT and RT), with the aim of improving OS, DFS and cosmesis.
Radio-Chemotherapy of Anal Cancer
Authors: Zucali Roberto , Doci Roberto , Kenda Rado , Lozza Laura , Tana Silvia , Valvo Francesca
Published: April 2018

Conventional treatment of anal cancer has been the demolitive Miles operation for decades. Radiotherapy has been utilized in a limited number of centers for early cancers only. Radio-chemotherapy has become the treatment of choice for all stages of anal cancer after the first experiences by the group of Detroit and after the confirmation of successful results by many other centers. Infusional chemotherapy (5-FU and Mitomycin C or CDDP) and concurrent irradiation are able to achieve local control in more than 80% of patients. Surgery currently represents a rescue treatment for partial responders or in relapsing patients. A brief review of the literature and the experience at the Istituto Tumori in Milano are presented.
Combined Modality Treatment for Esophageal Cancer
Authors: Tordiglione Michele , Kalli Maurizio , Vavassori Vittorio , Luraghi Roberto
Published: April 2018

We have performed a review of recent literature about combined modality therapy in esophageal cancer. Radiobiological principles and radio-chemotherapy interactions modalities in clinical experiences have been considered. Therapeutic schedules, modalities of implementation, and the most relevant clinical results obtained by the major clinical research groups have been emphasized. We also comment on the current role of surgery and on the clinical questions arising in combined radio-chemotherapy treatment.
Prevention of Radiotherapy-Induced Emesis
Authors: Roila Fausto , Ciccarese Giovanni , Palladino Maria Angela , De Angelis Verena
Published: April 2018

The severity of nausea and vomiting in patients undergoing radiotherapy is lower than that associated with chemotherapy regimens, but its duration may be considerably longer. Total body irradiation and irradiation of the upper part of the abdomen or whole abdomen are considered the most emetogenic regimens in radiotherapy. Instead, the emetogenic potential is considered moderate in radiotherapy of the thorax, pelvis and lower half-body irradiation, and low in radiotherapy of head and neck, extremities, brain and skin. In contrast to the very extensive literature on the prevention of chemotherapy-induced emesis, relatively few studies have been published on patients submitted to radiotherapy. Metoclopramide, prochlorperazine and cannabinoids offer only limited symptom control in patients undergoing radiotherapy of moderate to severe emetogenic potential. Double-blind randomized studies showed the superior antiemetic efficacy of the 5-HT3 antagonists with respect to placebo and to the older antiemetic drugs in patients submitted to single dose or fractionated doses of radiotherapy to the upper abdomen, to lower hemibody radiotherapy and to total body irradiation. In all these cases the 5-HT3 antagonists should be considered the antiemetic treatment of choice and should be administered as prophylactic agents. The optimal duration of antiemetic therapy with the 5-HT3 antagonists is unknown. Whether corticosteroids added to the 5-HT3 antagonists will increase their antiemetic efficacy, as in chemotherapy-treated patients, remains to be demonstrated in double-blind controlled trials. Patients submitted to radiotherapy of low emetogenic risk do not require any antiemetic prophylaxis. In this case a rescue antiemetic treatment can be administered if patients present vomiting or moderate to severe nausea.
New Trends in the Surgical Treatment of Colorectal Cancer Liver Metastases
Authors: Curley Steven A. , Vecchio Rosario
Published: April 2018

Colorectal cancer is one of the most common solid tumors affecting people around the world. A significant proportion of patients with colorectal cancer will develop or will present with liver metastases. In some of these patients, the liver is the only site of metastatic disease. Thus, surgical treatment approaches are an appropriate and important treatment option in patients with liver-only colorectal cancer metastases. Resection of colorectal cancer liver metastases can produce long-term survival in selected patients, but the efficacy of liver resection as a solitary treatment is limited by two factors. First, a minority of patients with liver metastases have resectable disease. Second, the majority of patients who undergo successful liver resection for colorectal cancer metastases develop recurrent disease in the liver, extrahepatic sites, or both. In this paper, in addition to the results of liver resection for colorectal cancer metastases, we will review the results of cryoablation, heat ablation, and hepatic arterial chemotherapy using a surgically implanted pump. Each of these surgical treatment modalities can produce long-term survival in a subset of patients with liver-only colorectal cancer metastases, whereas systemic chemotherapy used alone rarely results in long-term survival in these patients. While surgical treatments provide the best chance for long-term survival or, in some cases, the best palliation in patients with colorectal cancer liver metastases, it is clear that further improvements in patient outcome will require multimodality therapy regimens.