Brain Stem Glioma Recurrence: Exploring the Therapeutic Frontiers.

Gliomas of the brainstem represent a small percentage of central nervous system gliomas in adults. Due to the proximity of the tumor to critical structures, radical surgery is highly challenging and limited to selected cases. In addition, postoperative treatments, which become exclusive to non-operable patients, do not guarantee satisfactory disease control, making the progression of the disease inevitable.

Electron FLASH radiotherapy in vivo studies. A systematic review.

FLASH-radiotherapy delivers a radiation beam a thousand times faster compared to conventional radiotherapy, reducing radiation damage in healthy tissues with an equivalent tumor response. Although not completely understood, this radiobiological phenomenon has been proved in several animal models with a spectrum of all kinds of particles currently used in contemporary radiotherapy, especially electrons. However, all the research teams have performed FLASH preclinical studies using industrial linear accelerator or LINAC commonly employed in conventional radiotherapy and modified for the delivery of ultra-high-dose-rate (UHDRs).

Glioblastoma and Internal Carotid Artery Calcium Score: A Possible Novel Prognostic Partnership?

Clinical evidence suggests an association between comorbidities and outcome in patients with glioblastoma (GBM). We hypothesised that the internal carotid artery (ICA) calcium score could represent a promising prognostic biomarker in a competing risk analysis in patients diagnosed with GBM. We validated the use of the ICA calcium score as a surrogate marker of the coronary calcium score in 32 patients with lung cancer.

New insights on clinical perspectives of FLASH radiotherapy: from low- to very high electron energy.

Radiotherapy (RT) is performed in approximately 75% of patients with cancer, and its efficacy is often hampered by the low tolerance of the surrounding normal tissues. Recent advancements have demonstrated the potential to widen the therapeutic window using "very short" radiation treatment delivery (from a conventional dose rate between 0.5 Gy/min and 2 Gy/min to more than 40 Gy/s) causing a significant increase of normal tissue tolerance without varying the tumor effect.

Cancer Stem Cells and Glioblastoma: Time for Innovative Biomarkers of Radio-Resistance?

Despite countless papers in the field of radioresistance, researchers are still far from clearly understanding the mechanisms triggered in glioblastoma. Cancer stem cells (CSC) are important to the growth and spread of cancer, according to many studies. In addition, more recently, it has been suggested that CSCs have an impact on glioblastoma patients' prognosis, tumor aggressiveness, and treatment outcomes.

A predictive model of polymetastatic disease from a multicenter large retrospectIve database on colorectal lung metastases treated with stereotactic ablative radiotherapy: The RED LaIT-SABR study.

Aim: Stereotactic ablative radiotherapy (SABR) showed increasing survival in oligometastatic patients. Few studies actually depicted oligometastatic disease (OMD) evolution and which patient will remain disease-free and which will rapidly develop a polymetastatic disease (PMD) after SABR. Therefore, apart from the number of active metastases, there are no clues on which proven factor should be considered for prescribing local treatment in OMD.

Impact of temporalis muscle thickness in elderly patients with newly diagnosed glioblastoma treated with radio or radio-chemotherapy.

Background: There is an unmet need for new biomarkers able to predict both the outcomes of up-front therapy and the compliance of elderly patients diagnosed with glioblastoma. For this purpose, temporal muscle thickness is a promising tool to be investigated.

Methods: Data from 52 glioblastoma patients older than 65 years, treated with post-operative radio or radio-chemotherapy and referred to Pisa University Hospital, were retrieved.

Old and New Systemic Immune-Inflammation Indexes Are Associated with Overall Survival of Glioblastoma Patients Treated with Radio-Chemotherapy.

. Systemic immunity and inflammation indexes (SI) derived from blood cells have gained increasing attention in clinical oncology as potential biomarkers that are associated with survival. .

Role of magnetic resonance imaging following postoperative radiotherapy in clinical decision-making of patients with high-grade glioma.

Objectives: The present study aims to investigate the role of the first magnetic resonances (MRI) following radio-chemotherapy (RT-CT) in patients diagnosed with high-grade glioma.

Methods: We retrospectively recorded radiological evaluations following RT-CT, symptoms related to disease progression (avoiding any sign due to radiotherapy or chemotherapy) and the change of therapeutic strategy.

Results: In March 2021, at data analysis, the data of 149 patients diagnosed with high-grade glioma and treated between May 2013 and July 2020 were retrieved for the present analysis.

A multicenter LArge retrospectIve daTabase on the personalization of stereotactic ABlative radiotherapy use in lung metastases from colon-rectal cancer: The LaIT-SABR study.

Introduction: Stereotactic ablative radiotherapy (SABR) has been shown to increase survival in oligometastatic disease, but local control of colorectal metastases remains poor. We aimed to identify potential predictive factors of SBRT response through a multicenter large retrospective database and to investigate the progression to the polymetastatic disease (PMD).

Material And Methods: The study involved 23 centers, and was approved by the Ethical Committee (Prot.

Adjuvant Radiotherapy in Patients With Pancreatic Adenocarcinoma. Is It Still Appealing in Clinical Trials? A Meta-analysis and Review of the Literature.

Aim: Pancreatic adenocarcinoma is a life-threatening disease with a rising frequency and the fourth leading cause of cancer death. This review aimed to assess the impact of postoperative radiotherapy through a meta-analysis of prospective randomized studies.

Materials And Methods: Six studies met the inclusion criteria and were analyzed to calculate the cumulative risk of death (hazard ratio) in patients affected by pancreatic cancer treated with or without radiotherapy.

Impact of recurrence pattern in patients undergoing a second surgery for recurrent glioblastoma.

The impact of different patterns of glioblastoma (GBM) recurrence has not yet been fully established in patients suitable for a second surgery. Through the present observational study carried out at Pisa University Hospital, we aimed to investigate how different patterns of GBM failure influence second surgery outcomes. Overall survival (OS) and post-recurrence survival (PRS) were assessed according to clinical characteristics, including pattern of recurrence, in a prospective cohort of recurrent GBM patients.

Association of XRCC3 rs1799794 polymorphism with survival of glioblastoma multiforme patients treated with combined radio-chemotherapy.

This study reports the results of a monocentric prospective analysis conducted with the aim of evaluating the impact of XRCC1 rs25487, XRCC3 rs861539, XRCC3 rs1799794, RAD51 rs1801320 and GSTP-1 rs1695 single nucleotide polymorphisms (SNP) on patients with high-grade glioma treated with concomitant radio-chemotherapy. From October 2010 to August 2019, a total of 75 patients aged ≥18 years, with histological diagnosis of high-grade glioma, isocitrate dehydrogenase (IDH) 1/2 wild type and treated with radio-chemotherapy and sequential chemotherapy with temozolomide (TMZ) were prospectively recruited. The local ethic committee approved this study (Comitato Etico di Area Vasta Nord Ovest [CEAVNO]; protocol 3304/2011).

Vascular endothelial growth factor (VEGF) and other common tissue prognostic indicators in breast cancer: a case-control study.

VEGF is a specific mitogen and survival factor for endothelial cells and a key promoter of angiogenesis in physiological and pathological conditions. Nevertheless, VEGF tissue evaluation in cancer patients as a prognostic factor compared to the conventional histological and biological parameters is still controversial. In this case-control study, tissue VEGF was retrospectively determined by immunohistochemistry and related to T, N, ER, PgR, c-erbB-2, p53, MIB-1 and cyclin D1 in 129 breast cancer patients.

[The conservative treatment of infected vascular prostheses in surgery to revascularize the lower limbs].

Infected vascular grafts are associated with very high rates of limb loss and mortality. "Classic" treatment has invariably included graft excision. Recent reports have suggested that a more conservative approach may be indicated in selected cases, leaving the graft in place and using an aggressive local treatment associated with appropriate intravenous antibiotics.

[Crural hernia after inguinal hernia repair. A technical note].

A case of femoral hernia following repair of an inguinal hernia with the Shouldice method is presented. The authors discuss the pathogenesis, suggest the use of ultrasound for a precise preoperative diagnosis, and propose the "plug" technique of Lichtenstein as the method of choice for the repair. This method offers a minimally invasive approach, without disturbing the previous inguinal repair and it is very simple to perform.

[Infected pseudoaneurysms of the upper limb. A case re-evaluation].

The authors report a case of infected pseudoaneurysm of the brachial artery in a drug addict, treated with aneurysm excision and brachio-brachial bypass with inverted saphenous vein. They review the literature on the subject and management options.

[The Knight-Griffen technique in colorectal surgery].

The use of stapling devices has changed the practice of colorectal surgery. The authors report their experience with the "double stapling" technique introduced by Knight and Griffen in 1980 for the performance of low colorectal anastomosis. They treated 42 patients, with a mean age of 63.

[Rectal foreign bodies. Principles of therapy].

The authors report their experience with the treatment of endorectal foreign bodies (EFB). They review the literature on the subject and examine the various therapeutic options. Considering the possible complications of leaving an EFG in place for prolonged period of times in the hope of spontaneous delivery, they suggest that immediate removal is always indicated.

[Subacute Budd-Chiari syndrome treated with rTPA. Considerations on a case].

The authors report on a case of hepatic vein thrombosis or Budd-Chiari syndrome (BCS) successfully treated with recombinant Tissue Plasminogen Activator (rTPA). They briefly outline the etiology and symptomatology of this disease as well as the various surgical procedures used for treatment. Medical therapy has been so far poorly effective in treatment BCS, but recently various reports seem to indicate that rTPA may have a role.

[Calculosis of the cystic duct].

The authors report on three cases of cystic duct syndrome, a fairly uncommon complication of cholelithiasis, consisting in migration of a large gallstone from the gallbladder to the common bile duct, resulting in the formation of a common cavity between cystic, hepatic and common bile ducts. They review the pathogenesis of this entity, as well as the diagnostic modalities best suited to a precise diagnosis. They stress that surgical therapy must be chosen on a case by case basis, trying to restore a functional extrahepatic biliary tree.

[Caroli's disease associated with cholangiocarcinoma. A case of our own observation].

The authors report a case of Caroli's disease associated with cholangiocarcinoma. The patient presented with pain and jaundice and ultrasonography disclosed multiple common bile duct stones, cystic dilatation of the extrahepatic biliary tree and a mass in the right lobe of the liver. At operation, after a frozen section demonstrated cholangiocarcinoma, a common bile duct exploration, right hepatic lobectomy and hepato-jejunostomy were performed.

[Acute intestinal infarction. Diagnostic and therapeutic problems].

The authors report their experience in thirteen cases of mesenteric infarction. They emphasize the difficulty in diagnosing and treating this entity, considering also the impossibility in most centers of performing emergency selective angiography of the superior mesenteric artery (SMA) When feasible, mesenteric rivascularization should always be attempted, followed 24 hours later by a "second look" procedure.

[Surgical treatment of toxic megacolon].

After an introduction on the various aetiological factors involved in toxic megacolon, its onset, medical treatment and indications to surgery, the paper describes personal experience with seven cases. The report highlights the importance of medical treatment which is recommended as the appropriate initial therapeutic approach. Then after a review of evolving surgical techniques, it is suggested , again on the basis of personal experience, that the surgical approach should be neither excessively aggressive (total proctocolectomy with permanent ileostomy) nor excessively conservative (multistoma decompression).