Scoccianti S.,Radiotherapy Unit |
Magrini S.M.,Instituto Del Radio |
Ricardi U.,University of Turin |
Detti B.,Radiotherapy Unit |
And 20 more authors.
Neuro-Oncology | Year: 2012
Although the evidence for the benefit of adding temozolomide (TMZ) to radiotherapy (RT) is limited to glioblastoma patients, there is currently a trend toward treating anaplastic astrocytomas (AAs) with combined RT TMZ. The aim of the present study was to describe the patterns of care of patients affected by AA and, particularly, to compare the outcome of patients treated exclusively with RT with those treated with RT TMZ. Data of 295 newly diagnosed AAs treated with postoperative RT TMZ in the period from 2002 to 2007 were reviewed. More than 75 of patients underwent a surgical removal. All the patients had postoperative RT; 86.1 of them were treated with 3D-conformal RT (3D-CRT). Sixty-seven percent of the entire group received postoperative chemotherapy with TMZ (n 198). One-hundred sixty-six patients received both concomitant and sequential TMZ. Prescription of postoperative TMZ increased in the most recent period (20052007). One-and 4-year survival rates were 70.2 and 28.6, respectively. No statistically significant improvement in survival was observed with the addition of TMZ to RT (P .59). Multivariate analysis showed the statistical significance of age, presence of seizures, Recursive Partitioning Analysis classes IIII, extent of surgical removal, and 3D-CRT. Changes in the care of AA over the past years are documented. Currently there is not evidence to justify the addition of TMZ to postoperative RT for patients with newly diagnosed AA outside a clinical trial. Results of prospective and randomized trials are needed. © 2012 The Author(s).
Scoccianti S.,University of Florence |
Magrini S.M.,University of Brescia |
Ricardi U.,University of Turin |
Detti B.,University of Florence |
And 21 more authors.
Neurosurgery | Year: 2010
OBJECTIVE: To investigate the pattern of care and outcomes for newly diagnosed glioblastoma in Italy and compare our results with the previous Italian Patterns of Care study to determine whether significant changes occurred in clinical practice during the past 10 years. METHODS: Clinical, pathological, therapeutic, and survival data regarding 1059 patients treated in 18 radiotherapy centers between 2002 and 2007 were collected and retrospectively reviewed. RESULTS: Most patients underwent both computed tomography and magnetic resonance imaging either preoperatively (62.7%) or postoperatively (35.5%). Only 123 patients (11.0%) underwent a biopsy. Radiochemotherapy with temozolomide was the most frequent adjuvant treatment (70.7%). Most patients (88.2%) received 3-dimensional conformal radiotherapy. Median survival was 9.5 months. Two- and 5-year survival rates were 24.8% and 3.9%, respectively. Multivariate analysis showed the statistical significance of age, postoperative Karnofsky Performance Status scale score, surgical extent, use of 3-dimensional conformal radiotherapy, and use of chemotherapy. Use of a more aggressive approach was associated with longer survival in elderly patients. Comparing our results with those of the subgroup of patients included in our previous study who were treated between 1997 and 2001, relevant differences were found: more frequent use of magnetic resonance imaging, surgical removal more common than biopsy, and widespread use of 3-dimensional conformal radiotherapy + temozolomide. Furthermore, a significant improvement in terms of survival was noted (P < .001). CONCLUSION: Changes in the care of glioblastoma over the past few years are documented. Prognosis of glioblastoma patients has slightly but significantly improved with a small but noteworthy number of relatively long-term survivors. Copyright © 2010 by the Congress of Neurological Surgeons.
Mencacci R.,Chirurgia Generale e Oncologica |
Mencacci R.,C O Unita Operativa Complessa Of Chirurgia Generale E Oncologica |
Alessandroni L.,Chirurgia Generale e Oncologica |
Arcangeli G.,Radioterapia Oncologica |
And 6 more authors.
Minerva Chirurgica | Year: 2010
Aim. Several randomized trials on conservative surgery compared with mastectomy in early-stage breast cancer have validated this technique in terms of local and distant relapse and survival of patients. Standard conservative approach includes surgical removal of the cancer with adequate cancer-free margins, axillary dissection, postoperative breast irradiation and adjuvant treatments when required. Methods. From 1987 to 2003, 500 early stage breast carcinoma were treated on 494 patients with conservative surgery and postoperative radiotherapy. Surgery consisted in a wide tumorectomy, with intraoperative control of RO margins. The total postoperative radiation dosage was 50 Gy on the whole breast, associated with a boost of 10 Gy on tumor bed (20 Gy in T2 neoplasms). Before 1997 node-positive patients were treated with axillary irradiation with 50 Gy. Postoperative chemotherapy and/or hormonal therapy were administered to patients according with node-involvement, age and menopausal status. AJCC-stage was TINO in 44%, T2N0 in 15%, T1N1 in 19% and T2N1 in 22% of the patients. Results. In a postoperative setting, we observed 9% of axillary seromas or hematomas and 7% of oedema of the arm. At a median follow-up of 150 months (range 48-248 months), actuarial local recurrence rates were 7% at 5 years and 14% at 10 years. The actuarial rates of distant metastases were 18% at 5 years and 33% at 10 years. Ten-year overall and disease-free survival rates were 81% and 60%, respectively. Cosmetic results were good/excellent in 80%, satisfactory in 10% and poor in 10% of patients. Conclusion. Recurrence and survival rates in breast-conserving surgery are consistent with indexed literature on conservative treatment of early breast cancer. Women eligible for conservative treatment should be offered the choice of either wide tumorectomy or quadrantectomy with axillary lymph nodes removal and postoperative radiotherapy, or modified radical mastectomy.
Ravera E.,Struttura Complessa di Anestesia e Terapia del Dolore |
Di Santo S.,Struttura Complessa di Anestesia e Terapia del Dolore |
Bosco R.,Struttura Complessa di Anestesia e Terapia del Dolore |
Arboscello C.,Radioterapia Oncologica |
Chiarlone R.,Radioterapia Oncologica
Aging Clinical and Experimental Research | Year: 2011
Background and aims: Several publications and guidelines stress the efficacy and safety of opioid-based therapy for cancer and non-cancer pain management. The first point of the World Health Organization (WHO) guidelines recommends that, if possible, analgesics should be given by mouth. This advice fully matches the European Society for Medical Oncology (ESMO) guidelines, which advise that opioids should be titrated to take effect as rapidly as possible. The European Association for Palliative Care (EAPC) guidelines specify that transdermal fentanyl should be administered only in patients with stable analgesic requirements. The aim of this study was to assess the efficacy and influence on the quality of life of controlled-release (CR) oxycodone in patients who had obtained no or only partial pain relief after transdermal (TTD)-based opioid therapy. Methods: Forty-one consecutive patients experiencing persistent cancer and non-cancer related pain and in treatment with transdermal-based opioid therapy for at least 5 days were enrolled in this open-label, multicenter observational study. All patients were switched from transdermal to oral opioid therapy with oxycodone CR for 21 days. Pain intensity was rated on a numeric rating scale (NRS) from 0 to 10 (0=no pain, 10=maximum severity). Patients were asked to rate their perceptions on efficacy and pain interference on the quality of life on an NRS from 0 to 10 (0=no interference, 10=maximum interference). Results: After 3 days with oxycodone CR, pain intensity decreased by 38.83% (p<0.001) and maintained a significant decrease throughout the period (T0-T7: -59.71%, p<0.001; T0-T21: -65.75%>, p<0.001). The average daily dose of oxycodone CR increased from 68.75 mg at baseline to 72.39 mg after 7 days and was maintained stable until the study ended. At T0, 56.10% of patients suffered from severe pain (NRS 7-10); this percentage had decreased to 2.56% at the end of the study. About 7% of patients considered transdermal therapy effective at baseline; after 21 days, 72.22% and 19.44% of patients considered it effective and very effective, respectively. Quality of life improved significantly during the 21 days with the oral treatment (p<0.001). Conclusions: Switching from transdermal opioid to oxycodone CR treatment is effective and leads to patients' improved satisfaction and quality of life. ©2011, Editrice Kurtis.
Terlizzi A.,Fisica Sanitaria |
Mola D.,Fisica Sanitaria |
Perna N.,Fisica Sanitaria |
Laterza G.,Fisica Sanitaria |
And 4 more authors.
Nuovo Cimento della Societa Italiana di Fisica B | Year: 2010
With this study we investigated the α/β ratio of prostate cancer by analyzing the Freedom From Biochemical Failure (FFBF) and by comparing the FFBFs of our study with the results from hypofractionated trials reported in the literature. Our sample was the outcome for 169 men with T1-T4, N0, M0 prostate cancer who received definitive conformal radiotherapy at Taranto Hospital Radiotherapy Department. Biochemical failure was defined as 3 consecutive rising prostate-specific antigen (PSA) levels after reaching a nadir, i.e. absolute lowest PSA level achieved after any treatment. The log-rank test was used to compare the groups. Radiotherapy was delivered to a planning target volume with a 5-7 fields conformal technique to a mean dose of 74 Gy in 37 daily fractions. When patients were grouped into good, intermediate, or poor prognostic groups, the 5-year FFBF was, respectively, 90.9%, 78.1%, and 75.7%. When the biochemical control rates were plotted versus equivalent dose from different studies (for intermediate-risk prostate cancer), the ratio of 1.5 Gy clearly produced the closest fit to the curve. The α/β ratio was 1.27 Gy, after the addition of External Beam Radiotherapy (EBRT) data from hypofractionation trials reported in the literature. These preliminary data appear to be consistent with a low α/β ratio. © Società Italiana di Fisica.