Concomitant chemotherapy and external radiotherapy plus brachytherapy for locally advanced esophageal cancer: results of a retrospective multicenter study.

Aims And Background: In October 1995, the Piedmont AIRO (Italian Society of Radiation Oncology) Group started a multi-institutional study of radiochemotherapy on locally advanced esophageal cancer, characterized by external radiotherapy followed by an intraluminal high dose-rate brachytherapy boost. Most patients were re-evaluated for surgery at the end of the program. The primary aim of the study was to assess efficacy of curative radiochemotherapy regarding overall survival and local control rates.

Multimodal management of stages III-IVa malignant thymoma.

Purpose: The optimal therapy for locally advanced malignant thymoma is controversial. We review our experience with a multimodal approach in 63 consecutive cases.

Patients And Methods: Forty-three patients had stage III and 20 stage IVa disease.

Hypoxia and tumor response to irradiation.

In radiobiology, the hypoxic cells have been shown to be more resistant to irradiation as compared to cells irradiated in conditions of normal oxygenation. Moreover, most solid tumors contain foci of clonogenic cells able to cause the failure of radiotherapy and the development of more aggressive phenotypes. To-date, numerous techniques allow the detection and quantitation of tumor hypoxia in many tumors and to correlate it with the clinical course.

CT-MRI image fusion for delineation of volumes in three-dimensional conformal radiation therapy in the treatment of localized prostate cancer.

The objective of this study was to assess the utility of CT-MRI image fusion software and compare both prostate volume and localization with CT and MRI studies. We evaluated the differences in clinical volumes in patients undergoing three-dimensional conformal radiation therapy for localized prostate cancer. After several tests performed to ensure the quality of image fusion software, eight patients suffering from prostate adenocarcinoma were submitted to CT and MRI studies in the treatment position within an immobilization device before the start of radiotherapy.

Timing of radiotherapy in breast cancer conserving treatment.

The optimal timing and sequencing of adjuvant radiotherapy and chemotherapy after breast-conserving surgery for early invasive breast cancer is controversial. Several studies demonstrated that postoperative radiation therapy significantly reduces the incidence of breast recurrences. For patients who do not need systemic treatment, the interval between surgery and the start of radiotherapy should not exceed eight weeks.

Total skin electron beam therapy in mycosis fungoides. Our experience from 1985 to 1999.

Purpose: The specific goal of this retrospective study is to evaluate the role of total skin electron beam therapy (TSEBT) in the treatment of Mycosis Fungoides (MF) and to assess the most significant prognostic factors in univariate and multivariate analyses.

Material And Methods: From January 1985 to December 1999, 92 TSEBT (Stanford Standing technique) were performed on a total of 86 patients (63 with Mycosis Fungoides, 6 with Sezary Syndrome and 17 with Cutaneous Lymphomas). This study considers only the Mycosis Fungoides group, which consisted of 60 cases evaluable for response, survival and toxicity.

Basic and clinical research for the new radiotherapy.

Basic research has allowed the full knowledge of the underlying mechanisms of the use of radiotherapy in cancer treatment. However, in spite of the crop of radiobiological studies, the impact on clinical research in last years has been relatively little. Within the recent research in man, studies on altered dose fractionations, combined radiation and chemotherapy together with the development of sophisticated technology have allowed the use of new methods of radiotherapy while those existing have been optimized.

Results of hypofractionated stereotactic re-irradiation on 13 locally recurrent nasopharyngeal carcinomas.

Thirteen patients with locally recurrent, previously-irradiated nasopharyngeal carcinoma were treated with linac-based hypofractionated stereotactic radiotherapy (24 Gy in two or four fractions). One- and 3-year overall survival were 54 and 31%. Three patients were free of disease at 30, 34 and 65 months.

Topical role of brachytherapy: economic and organizational aspects.

Brachytherapy for the recent technological advances, represents a fundamental "therapeutic step" in a multidisciplinary approach based on surgery, external beam radiotherapy and chemotherapy, if necessary. The various professionals involved, each within their personal skills, participate in the formulation of a correct therapeutic program. The widespread use of high dose rate brachytherapy leads to consider that the machines should be supplied to major radiotherapy centers only, because the procedure requires the combination with external beam radiotherapy.

Brachytherapy and local control.

Locoregional control of primary tumor is fundamental to cure since only in one third of patients the onset of distant metastases is the major cause of therapeutic failure. Thus recently, all therapeutic approaches aimed at the enhancement of locoregional control have been considered with growing interest. More particularly, brachytherapy alone or in combined modality therapy as an important option in the local treatment of various malignant tumors, has been widely used; this being related to the now available information on dose-rate, remote after-loading procedures, the new, safe and handy radionuclides and computerized dosimetry systems which allow a more accurate and rapid dose calculation.

Combined modality therapy for laryngeal and hypopharyngeal cancer.

In recent years, the improvement in results in terms of survival in the treatment of laryngeal and hypopharyngeal cancer at the same stage has been rather poor. Therefore, oncologists have tried to improve the quality of life through a decrease in morbidity while not decreasing the treatment efficacy. In particular, the objective was to preserve with noninvasive procedures the anatomy and function of the larynx and hypopharynx while not affecting the possible cure.

Biological predictors of response to radiotherapy in cervical carcinomas.

On 21 patients with T1b-T3b tumours subjected to external radiotherapy and brachytherapy, the expression of P53 and glutathione S-transferase pi [GST-pi], immunohistochemically detected, the S-phase cells fraction (H-3-thymidine labeling index, TLI) and DNA content evaluated by image analysis were determined on biopsies before and after the first 10 Gy. P53 accumulation was reduced in 60% of P53-overexpressing tumours and not induced in P53-negative tumours, GST-pi was induced in about 40% of pretreatment GST-pi-negative cases, TLI was reduced in 70% of the cases regardless of pretreatment values, and DNA profiles remained unchanged in two-thirds of the cases. P53 accumulation was a predictor of 3-year relapse-free survival after radiotherapy, followed by GST-pi expression, whereas TLI did not influence prognosis.

Quality control in radiotherapy.

Results achieved in radiotherapy have progressively improved in the course of years for the steady technological advances which allowed to exploit at best the available equipment and to create new devices, as well as for the better radiobiological knowledge. However, the need is felt for recommendations defining a set of principles to ensure the minimum acceptable standards. In Italy, a quality assurance system in radiotherapy should be applicable to the over 90 centers now operating with about 170 high energy units, 600 radiotherapists, 200 physicists and 600 technicians who treat over 100,000 patients per year.

Results of a low aggressivity chemotherapy regimen (CVP/CEB) in elderly Hodgkin's disease patients.

Background: Hodgkin's disease (HD) after the age of 65 years is uncommon and there are no published data on chemotherapy regimens devised for elderly HD patients.

Patients And Methods: From 1990 to 1993, 25 elderly HD patients were treated with the CVP/CEB regimen: chlorambucil 6 mg/sqm p.o.

[High-dose-rate brachytherapy. The indications, technic and preliminary results].

The authors report their experience of high dose brachytherapy technique (HDR), relative to the first period of work, especially regarding treatment indications and preliminary clinical results. Twenty eight patients were examined, 12 of them with esophageal carcinoma, 7 biliary tract carcinoma, 6 skin of the face and 3 head and neck carcinoma. HDR brachytherapy was the first treatment in 20 cases; the other 8 cases were recurrences after previous irradiation.

The cost of hyperthermia: nine years experience at the Radiation Therapy Department of the Turin University.

Background: In this paper the authors try to quantify the expenditure for the equipment, staff, treatment per patient and research, sustained at the Radiation Therapy Department of the University of Turin for the treatment of cancer with hyperthermia,

Methods: Two hyperthermic computerized devices are available: the SAPIC SVO3 multifrequencies system (915, 434 and 2-30 MHz) for external hyperthermia, and the SACEM system. working only with the frequency of 915 MHz, for interstitial and intracavitary heating. From September 1983 to December 1991, 408 patients have been treated with hyperthermia, for a total number of treated sites of 483; 2960 heating sessions were performed, with a average of six sessions per patient.

Probability of cure in elderly Hodgkin's disease patients.

Background: Elderly Hodgkin's disease patients have a poor prognosis. The question arises whether these patients need aggressive treatment or a palliative strategy. So far, as a consequence of the scarcity of trials designed for them, useful information can be obtained only by retrospective analyses.

Concomitant radiotherapy and daily low-dose carboplatin in locally advanced, unresectable head and neck cancer. Definitive results of a phase I-II study.

The combination of daily low-dose carboplatin and radiotherapy was studied in 55 patients with inoperable head and neck cancer. All patients were planned to receive 70 Gy plus carboplatin i.v.

Vestibular apparatus disorders after external radiation therapy for head and neck cancers.

External irradiation of different head and neck cancers may involve parts of the ear. The vestibular function of 25 patients in which the inner ear was comprised in the irradiated volume was investigated by electronystagmography (ENG). Doses administered to the vestibular system ranged between 2800 and 5120 cGy.

Aggressive treatment of intrathoracic recurrences of thymoma.

Between 1974 and 1988, 21 patients with intrathoracic recurrences of thymoma received radiotherapy with radical intent; surgery was always attempted when considered feasible: 11 patients were partially (6 cases) or totally (5 cases) resected before irradiation, while in the other 10 radiotherapy was the only treatment. In 7 cases the recurrence was confined to the anterior mediastinum, 9 had pleural nodules without mediastinal lesions and 5 had both mediastinal and pleural lesions. Mediastinal recurrences were treated by opposed parallel mediastinal fields with 2/3 of the dose delivered through the anterior port: doses ranged between 38 and 44 Gy; a boost of 10-16 Gy was given in patients not radically resected.

Daily low-dose carboplatin and standard radiotherapy in unresectable head and neck and lung cancers: a pilot study.

A total of 14 patients with locally advanced and unresectable head and neck (SCCHN) or non small cell lung cancer were treated with a definitive course of radiation therapy with conventional fractionation and 30 mg/m2 carboplatin (CBDCA) given daily as an i.v. infusion during the 1st, 3rd, 5th and 7th weeks of the combined treatment.

Hyperthermia alone in the treatment of recurrences of malignant tumors. Experience with 60 lesions.

Localized hyperthermia alone has been used for the treatment of cancer recurrences in which previous conventional therapies have failed. Since 1983 and 1988, 57 patients with 60 lesions have been heated by means of a microwave and radiofrequency system. Treatment protocol provided 45 minutes of heating at the intratumor temperature of at least 42 degrees C, twice a week, for a total number of six, eight, or ten heating sessions.