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Aristei C.,University of Perugia | Palumbo I.,University of Perugia | Perrucci E.,Radiation Oncology Section
Current Drug Therapy | Year: 2010

Postoperative treatment of early-stage breast cancer often includes radio-and chemo-therapy and, more recently, trastuzumab. Optimal timing, i.e. sequential or concomitant, of radiotherapy and systemic therapies to maximize efficacy and cosmetic outcome and minimize toxicity, is still controversial. This review analyzes the effects of different sequences after surgery as reported in phase III randomized studies and the most significant retrospective studies. Few randomized clinical trials investigated the optimal therapeutic sequence as most were designed to evaluate the efficacy of different chemotherapy schemes and schedules. Since end-points did not usually include the optimal timing of the two modalities, single participant centers were often free to decide whether radiotherapy should be administered or not, and what fields and schedules to use. Concomitant or sequential chemo-and radio-therapy were not associated with major differences in outcome. Concurrent administration is reserved for patients treated with CMF; it is not recommended when antracycline or taxanes are used, because of the increased risk of cutaneous, esophageal, cardiac and pulmonary toxicity. Although concurrent trastuzumab and radiotherapy seem feasible, trastuzumab induces cardiac damage. Even though it seems reversible, follow-ups in diverse studies were too short to assess the late side effects of concomitant trastuzumab and radiotherapy. © 2010 Bentham Science Publishers Ltd. Source


Frakulli R.,University of Bologna | Galuppi A.,University of Bologna | Cammelli S.,University of Bologna | Macchia G.,Catholic University of the Sacred Heart | And 9 more authors.
Journal of Contemporary Brachytherapy | Year: 2015

Purpose: Non melanoma skin cancers (NMSC) of eyelid are uncommon. Many treatments approach are available with surgery being considered as the gold standard. Radiotherapy is an effective alternative in patients unfit for surgery. Brachytherapy (BT) might be a better therapeutic option due high radiation dose concentration to the tumor and rapid dose fall-off resulting in normal tissues sparing. The aim of this review is to evaluate local control, toxicity, and functional cosmetic outcome of BT in NMSC of eyelid. Material and methods: A systematic search of the bibliographic databases PubMed, Scopus, and Cochrane Library from the earliest possible date through October 2015 was performed. Only studies published in English were included. Results: Six articles fulfilled the selection criteria and were included in our review. Due to high risk of bias, all studies were classified to provide a low level of evidence (according to Scottish Intercollegiate Guidelines Network Classification). No randomized controlled trials or case control studies were founded. Brachytherapy was well tolerated with acceptable toxicity and high local control rates (median: 95.2%). Functional and cosmetic outcome were reported in five study as acceptable good functional-cosmetic outcome (median: 100%). Conclusions: To date, few evidences are available on the role of BT in eyelid NMSC, and they show satisfactory results in terms of local control and functional cosmetic outcome. Therefore, prospective controlled trials are justified. Source


Lupattelli M.,Radiation Oncology Section | Falcinelli L.,Radiation Oncology Section
Current Drug Therapy | Year: 2010

Significant advances have been made in the treatment of rectal cancer. Multidisciplinary management is the preferred approach and offers the best clinical outcome. In locally advanced disease, surgery with total mesorectal excision remains the leading option, but adjuvant treatments are necessary due to local and systemic failure. Even if the preoperative approach is the treatment of choice, chemoradiotherapy may be considered both in preoperative or post-operative setting as it significantly improves local control with lower toxicity rates. Nevertheless, additional drugs are to be incorporated in the combined treatment programs mainly aiming to reduce metastases at distant sites. © 2010 Bentham Science Publishers Ltd. Source


Aristei C.,Radiation Oncology Section | Falcinelli L.,Radiation Oncology Section | Palumbo B.,Nuclear Medicine Section | Tarducci R.,Medical Physics Unit
Expert Review of Anticancer Therapy | Year: 2010

This review analyzes PET images in radiotherapy treatment planning for lung cancer patients and discusses the most controversial current issues. Computed tomography images are commonly used to assess location and extension of target volumes and organs at risk in radiotherapy treatment planning. Although PET is more sensitive and specific, contouring on PET images is difficult because tumor margins are indistinct, due to heterogeneous 18fluorodeoxyglucose uptake distribution and limited spatial resolution. The best target delineation criteria have not yet been established. In non-small-cell lung cancer, PET appears to improve sparing of organs at risk and reduce the risk of toxicity; prescribed doses can be increased. Data are scarce on small-cell lung cancer. © 2010 Expert Reviews Ltd. Source


Perrucci E.,Radiation Oncology Section | Lancellotta V.,University of Perugia | Bini V.,University of Perugia | Falcinelli L.,Radiation Oncology Section | And 5 more authors.
Tumori | Year: 2015

Aim and Background: Conservative surgery and radiotherapy for early breast cancer offers a better quality of life than mastectomy. As 80-85% of breast relapses develop close to the tumour bed, partial breast irradiation was developed to overcome drawbacks with standard radiotherapy. This study compares quality of life and cosmesis after partial breast multi-catheter high-dose rate interstitial brachytherapy or standard radiotherapy. Methods: A questionnaire, exploring body image, fear of recurrence, satisfaction with treatment and cosmesis, was administered to 39 partial and 78 whole breast patients at a median of 20 and 80 months after radiotherapy. Patients' and physicians' cosmetic assessments were compared. Results: Groups were well-matched, except for: a higher percentage of chemotherapy-treated patients in the whole breast group and a older median age and a higher percentage of infiltrating ductal carcinoma G1 in partial breast group. At first and second analysis no significant inter-group difference emerged on body image and fear of recurrence, while partial breast patients were more satisfied with cosmetic outcome and at first analysis with treatment. Comparing results from first and second analysis into each treatment group, body image was significantly better at the first analysis in both groups. Fear of recurrence was unchanged. No differences were found in cosmesis as assessed by patients. At first and second analyses physicians' assessment of cosmesis was significantly better in the partial breast group. Conclusions: Even at longer follow-up, quality of life is similar after partial or whole breast irradiation. Cosmesis is better after partial breast irradiation. © 2015 INTM, Italy. Source

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