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Caravatta L.,San Francesco Hospital | Ramella S.,Biomedical University of Rome | Melano A.,Radiotherapy Unit | Trippa F.,Radiation Oncology Center | And 4 more authors.
Tumori | Year: 2015

Aims: To assess the contribution of radiation oncologists in Italy in current management of breakthrough pain (BtP). Methods: In 2012, the Palliative and Supportive Care Study Group of the Italian Association of Radiation Oncology (AIRO) proposed a survey. All Italian radiation oncologists were individually invited to complete an online questionnaire regarding their management of BtP in patients undergoing radiotherapy treatment. Results: A total of 303 Italian radiation oncologists (of 330 who had access to the Web site) completed the questionnaire over an 8-month period. Some important differences were shown in pain intensity assessment by validated measurement scales, as well as in setting and prescribing analgesic therapy to prevent procedural pain. These differences were also reviewed and discussed related to international guidelines and data available from the literature. Conclusions: Compared to other medical professionals, the involvement of radiation oncologists in cancer pain management remains marginal, at least in Italy. More than 70% of radiation oncologists directly optimized the analgesic therapy during the treatment course and more than 50% implemented specific treatment for BtP. However, the ability of the radiation oncologist to manage BtP could be improved. In order to increase the consciousness of systematic symptom measurement and to spread the knowledge of the best type of analgesic drugs to be used, training events promoted by national associations, such as AIRO, and a collaborative multidisciplinary approach of the management of cancer pain will be promoted. © 2015 INTM, Italy.

Pontoriero A.,Messina University | Conti A.,Messina University | Iati G.,Operative Unit of Radiation Oncology | Mondello S.,Messina University | And 7 more authors.
Neurosurgical Review | Year: 2016

In this retrospective study, we evaluated the overall survival (OS) and local control (LC) of brain metastases (BM) in patients treated with stereotactic radiosurgery (SRS). The scope was to identify host, tumor, and treatment factors predictive of LC and survival and define implications for clinical decisions. A total of 223 patients with 360 BM from various histologies treated with SRS alone or associated with whole brain radiotherapy (WBRT) in our institution between July 1, 2008 and August 31, 2013 were retrospectively reviewed. Among other prognostic factors, we had also evaluated retrospectively Karnofsky performance status scores (KPS) and graded prognostic assessment (GPA). Overall survival (OS) and local control (LC) were the primary endpoints. Kaplan-Meier and Cox proportional hazards models were used to estimate OS and LC and identify factors predictive of survival and local control. The median duration of follow-up time was 9 months (range 0.4–51 months). Median overall survival of all patients was 11 months. The median local control was 38 months. No statistical difference in terms of survival or LC between patients treated with SRS alone or associated with WBRT was found. On multivariate analysis, KPS was the only statistically significant predictor of OS (hazard ratio [HR] 2.53, p = 0.006). On univariate analysis, KPS and GPA were significantly prognostic for survival. None of the host, tumor, or treatment factors analyzed in the univariate model factors were significantly associated with local failure. © 2016, Springer-Verlag Berlin Heidelberg.

Pontoriero A.,Messina University | Iati G.,Operative Unit of Radiation Oncology | Pergolizzi S.,Messina University
Radiation Oncology Journal | Year: 2015

External beam radiotherapy can be used to treat cutaneous squamous cell carcinomas (SCC). Acute skin toxicity is the most common adverse event. In this case study we report on an elderly patient with nasal root cutaneous SCC treated with stereotactic technique using a dedicated linear accelerator (CyberKnife system). Grade 3 skin toxicity was observed but it was resolved after 6 weeks. The use of stereotactic radiotherapy permitted a clinical remission of SCC with good cosmetic results. © 2015. The Korean Society for Radiation Oncology.

Pergolizzi S.,Messina University | Santacaterina A.,Operative Unit of Radiation Oncology | Adamo B.,Messina University | Franchina T.,Messina University | And 5 more authors.
Radiation Oncology | Year: 2011

Background: to evaluate activity and toxicity of a sequential treatment in advanced, non metastatic, mostly unresectable, head and neck squamous cell carcinoma.Methods: Patients with loco-regionally advanced or unresectable, head and neck cancer, were prospectively treated with 3 courses of induction chemotherapy followed by concurrent chemoradiation. Induction chemotherapy consisted of paclitaxel 175 mg/m2 day 1 and cisplatin 75 mg/m2 day 2, given every 3 weeks, to a total of three courses. Curative radiotherapy started 4 weeks after the last cycle of chemotherapy with the goal of delivering a total dose ≥ 66 Gy. During RT weekly paclitaxel (40 mg/m2) was administered.Results: The trial accrued 43 patients from January 1999 to December 2002. All patients received 3 courses of induction chemotherapy and the planned dose of radiotherapy. Thirty-eight patients were able to tolerate weekly paclitaxel during irradiation at least for 4 courses. After induction therapy there were 32 overall responses, 74.4% (23 partial and 9 complete); at completion of concomitant treatment overall responses were 42, 97.7% (20 partial and 22 complete). Median time to treatment failure was 20 months and the disease progression rate at 3 and 5 years was 33% and 23%, respectively. The median overall survival time was 24 months and 3 and 5 years overall survival rates were 37% and 26%, respectively. The major toxicity was mucositis.Conclusions: This combined treatment was found to be feasible and active in advanced or unresectable, head and neck squamous cell carcinoma patients. Long-term results observed in this trial encourage to consider this approach in further investigation using newer radiation delivering technique and new molecularly agents. © 2011 Pergolizzi et al; licensee BioMed Central Ltd.

Iati G.,Operative Unit of Radiation Oncology | Pontoriero A.,Messina University | Mondello S.,Messina University | Brogna A.,Operative Unit of Medical Physics | And 6 more authors.
Brachytherapy | Year: 2014

Purpose: Aim of this study was to evaluate dose distribution within organs at risk (OARs) and planning target volume (PTV) based on three-dimensional treatment planning according to two different setup positions in endometrial carcinoma patients submitted to postoperative brachy-radiotherapy on vaginal vault. Methods and Materials: Patients with endometrial cancer necessitating of adjuvant brachytherapy on vaginal vault were enrolled. Pelvic computed tomography studies were prospectively obtained in two different setup positions: extend legs (A position) and gynecological (B position). Contoured OARs were bladder, rectum, and small bowel. The PTV was identified as applicator's surface with an isotropic 5-mm margin expansion. Radiation dose delivered in 1cc (D1cc) and 2cc (D2cc) of OAR were calculated. Results: Coverage of PTV and values of D1cc and D2cc obtained for bladder and small bowel were similar in the two positions. For rectum, both D1cc and D2cc had statistically significant lower values in A with respect to B position. Conclusions: Both in A and B positions, radiation doses delivered do not exceed the dose constraints. However, A setup seems to significantly reduce doses to rectum while obtaining the same PTV coverage. The findings from our study provide evidence supporting the use of A position setup for delivering vaginal vault brachytherapy. © 2014 American Brachytherapy Society.

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