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A Azzarelli

Publications and source records attributed to A Azzarelli.

At least 55 records · Page 3Linked to original sources
PubMed1992

Intra-arterial induction chemotherapy for soft tissue sarcomas.

One hundred-one patients were treated in our institution with intra-arterial preoperative adriamycin (i.a. ADR) for large soft tissue sarcomas of the extremities, 45% recurrent at entry. Of the 78 high grade evaluable patients 38% had clinical and 45% had pathological responses to chemotherapy. Limb conservative surgery was performed in 80% of cases, with about 10% improvement made possible by the preoperative treatment. The local recurrence rate was 29%, and 50% five-year actuarial survival with a median follow-up of 68 months. These poor results are related to the severe selection of high risk cases. The clinical parameter of response was highly predictive of survival: 63% versus 36% (p = 0.01) 5-year survival in the group of responders and non-responders, respectively, whereas the pathological parameter of response was not so predictive. The improved effect of delivering the drug intra-arterially is theoretically expected but not proved in our experience. The major practical effect of this induction chemotherapy is the selection of patients with better prognosis and the possibility of perform, in some cases, easier limb salvage procedures. The last regimen combining i.a. ADR + i.v. Ifosfamide seems to provide little better but not yet significant results.

Adolescent↗
PubMed1991

The contribution of salvage surgery to the management of childhood osteosarcoma.

Between January 1970 and December 1988, 174 consecutive patients under the age of 20 years with curatively resected primary osteosarcoma were treated at our institute; 72 in the years of 1970 to 1981 and 102 in the years 1982 to 1988. In the latter period, adjuvant chemotherapy was replaced by neoadjuvant programs, and new criteria were adopted for the management of lung metastases, consisting in early bilateral surgical staging and lung resection through median sternotomy for all patients with purely intrathoracic relapse. Follow-up was updated in December 1989. During the last period, the overall 5-year survival improved significantly from 35% to 58% (P less than .001). The disease-free survival rose from 38% to 45% at 5 years, with median values of 15 months versus 33 months, while the frequency of isolated lung metastases dropped from 58% to the actuarial 48%. The proportion of patients who underwent complete resections of their pulmonary metastases rose from 17% (seven of 42) to 55% (27 of 49), without operative mortality. Due to such a high proportion of patients eligible for salvage surgery, the overall survival from detection of lung metastases improved from 0% to 28% at 5 years (P less than .001). Contralateral occult metastases were resected in three of 15 subjects with monolateral clinical lesions, and five patients underwent subsequent lung resections. These data indicate that systematic bilateral pulmonary resection plays an important role in improving the final cure rate of childhood osteosarcoma, beyond the benefit resulting from neoadjuvant chemotherapy.

Adolescent↗
PubMed1990

Median sternotomy and multiple lung resections for metastatic sarcomas.

In the attempt to apply salvage surgery to the majority of patients with pulmonary tumour relapse, we have adopted a new treatment plan consisting of early bilateral lung exploration and resection through median sternotomy in all cases of sarcoma with resectable lung metastases, including synchronous or previously resected ones. The present paper summarizes the early results achieved with this technique in 56 consecutive patients treated between 1985 and 1988. Perioperative mortality was zero, and morbidity negligible. Occult contralateral metastases were resected in about one third of subjects with monolateral clinical lesions. Overall actuarial survival from first pulmonary resection is 51% at 2 years and 35% at 3 years. A slightly more favourable trend is evident for solitary lesions but the difference is not statistically significant. No difference in survival is observed in relation to the initial disease-free interval or to the histological type. The majority of relapses occurred within 6 months of sternotomy (23/35) and were confined to the lungs (21/35). Ten of these 21 patients with pulmonary relapse have undergone further resection and 5 of them are alive, with a median survival of 28 months. Present results are encouraging as far as resectability and early recurrence rate are concerned. Median sternotomy appears a most valuable therapeutic approach to pulmonary metastases from sarcomas, being safe and effective in local control of disease, and compatible with further surgical management of pulmonary recurrences.

Adolescent↗
PubMed1990

Results of salvage surgery for metastatic sarcomas.

Between January 1970 and December 1988, 105 consecutive patients underwent complete resection for lung metastases from sarcoma, 33 of them in the years from 1970 to 1983 and 72 between 1984 and 1988. In the latter period, new criteria consisting of early bilateral surgical staging and lung resection through median sternotomy were adopted for the management of lung metastases, in all patients with purely intrathoracic relapse. There was no operative mortality, follow-up was updated in August 1989, and actuarial survivals were calculated by the logrank method at 36 months from the time of first lung resection. During the second period, the overall actuarial survival at three years improved significantly (24% vs. 50%, P less than 0.02), notwithstanding the higher incidence of patients with unfavourable prognostic factors. The three-year survival was also significantly better in the subset of patients with a disease-free interval less than or equal to 12 mos. and/or multiple pathological lesions (9% vs. 45%, P less than 0.05). Contralateral occult metastases were resected in 10 of 29 subjects who underwent sternotomy for monolateral clinical lesions. Of 26 patients with further intrapulmonary recurrence, 16 (62%) were amenable to re-operation and eventual surgical rescue. These data suggest that median sternotomy and early management of occult contralateral disease may contribute to an improvement in the long-term survival of patients with metastatic sarcomas. On the other hand, it is possible that the effectiveness of salvage surgery is related to the higher activity and wider application of adjuvant and salvage chemotherapy.

Adolescent↗
PubMed1989

Lung resection for metastatic sarcomas: total survival from primary treatment.

The results of surgical management of 63 cases of pulmonary metastases from bone and soft tissue sarcomas, admitted at the Istituto Nazionale Tumori of Milan, between 1970 and 1987, are reviewed in this paper. To estimate the relative impact of metastasectomy on the overall performance of treatment, survival curves were calculated from the time of first thoracotomy, as well as from the initial treatment of primary sarcoma. In the present series, total actuarial survival at 10 years was 37% for osteosarcoma, 27% for soft tissue sarcomas, and 24% for the other bone sarcomas, with a median survival of 48, 56, and 36 months, respectively. Five-year survival from the first pulmonary resection was influenced by the number of metastases and the length of the first disease-free interval only in osteosarcoma, while in soft tissue sarcomas a major untoward factor was represented by local recurrence at the site of the primary tumor. These data support the concept of pulmonary metastasectomy as effective salvage therapy for radically treated sarcomas; this management can rescue a significant proportion of all relapsed patients.

Adolescent↗
PubMed1988

Sacral chordoma and rehabilitative treatment of urinary disorders.

Sacral chordoma is one of the rarest tumors of the central nervous system (less than 1% of the entire group). Mictional disorders are among the most frequent symptoms and are caused by the extrinsic compression brought to bear on the cauda equina and by surgical demolition of the sacrum. Seven patients who had undergone sacral resection for chordoma, starting from S2, were followed for at least one year. It was observed that mictional disorders were often early symptoms signalling the presence of chordoma. Several patients were affected by a complete bladder denervation (infrasacral lesion) after surgery. Early rehabilitative treatment given after surgery for one year restored normal bladder functions in all the patients whose bladder denervation seemed to be not total (negative Lapides' test). Even when a complete infrasacral lesion of the bladder has been ascertained, early rehabilitative treatment may well prevent serious renal damage.

Chordoma↗
PubMed1988

Lung resection as salvage treatment for metastatic osteosarcoma.

Resection of pulmonary metastases has achieved a central role in the overall management of osteosarcoma, since a number of studies have demonstrated that salvage surgery is able to cure 20 to 40% of all relapsing patients. This paper presents the results of surgical management of 27 consecutive cases of pulmonary metastases from osteosarcoma, who underwent complete resection at the Istituto Nazionale Tumori of Milan between 1975 and 1986. In the present series, overall actuarial survival at 3 years from the first thoracotomy was 47%, with a median survival of 28 months and no operative mortality. Better results were observed in patients with single lesions (68% survival) or when the interval to lung metastases exceeded 12 months (60% survival). These data support the concept of pulmonary metastasectomy as effective salvage therapy for metastatic osteosarcomas whose distant spread is confined in the lungs.

Adult↗
PubMed1988

Chordoma: natural history and treatment results in 33 cases.

Thirty-three chordomas were observed at the Istituto Nazionale Tumori of Milan from 1933 to 1983: 27 sacrococcygeal, 3 spheno-occipital, and 3 vertebral. The male:female ratio was 2.7, and the median age was 63 yr for patients with sacrococcygeal and 35.2 yr for those with nonsacral chordomas. After pathologic reassessment, distinct cytologic patterns were found: physaliphorous, syncytial, and mixed subtypes, with variable degrees of cytologic atypia. However, no evident difference in survival was documented in relation to these cytohistologic features. Four cases had a prior traumatic fracture, and the pathogenetic role of trauma is stressed. Eight cases were operated with adequate surgery and only three recurred, whereas of 11 inadequate operations, 10 developed local relapse. However, follow-up for recent adequate operations is short. Radiation therapy seemed to be effective with adjuvant or palliative aims. No chemotherapeutic regimen achieved any result; one case had a short complete remission after cis-dichlorodiammineplatinum + vinblastine + bleomycin (PVB). This analysis confirms the possibility of achieving radicality with high resection of the sacrum for lesions confined below the second sacral vertebra. Nonsacral chordomas were all unresectable. The best treatment for unresectable lesions seems to be palliative surgery plus radiotherapy.

Adolescent↗
PubMed1988

Kaposi's sarcoma: malignant tumor or proliferative disorder?

UNLABELLED: In order to provide information on the response to treatments and clinico-pathological pattern, the clinical course of 41 patients with classic Kaposi's sarcoma (KS) was reconsidered. Twenty-six cases presented a single nodular lesion, and 15 multiple, pluricentric lesions. Surgery was the first treatment for patients with single lesions, 14 of 26 (54%) patients had recurrences: the disease-free interval ranged from a few months to 11 years. Five cases had disseminated disease, three of these were preceded by local recurrence. Cases with multiple lesions were treated by a combination of surgery, chemo- and radiation therapy (RT). In three cases spontaneous regression of disease was observed and two of these are presently disease-free. After chemotherapy and RT, many patients had complete remission of disseminated disease for up to 40 months. The drugs of first choice were vinblastine and bleomycin. Over all, only one patient died of KS, 10 years after diagnosis, nevertheless the cure rate was very poor and the final overall disease-free rate was around 30%. Proper treatment for nodular or disseminated lesions provides a fair disease-free period. FINAL CONSIDERATIONS: mortality of disease is exceptional despite the 80% risk of recurrence or dissemination. Data from our series do not provide proof that adequate control of the primary single lesion could screen against recurrence: the interval between treatment of the first lesion and recurrence is sometimes exceptionally long, up to more than 10 years, and for that it is not easy to state when disease is really cured. These considerations and other analogies between KS and lymphoproliferative disorders in immunodepressed people strongly suggests the possibility of a non-malignant or even non-tumoral pattern to this disease, with implications for therapeutic strategies.

Adult↗
PubMed1987

Long-term evaluation of surgery followed by adjuvant adriamycin in osteogenic sarcoma.

From 1974 to 1978 29 consecutive patients with operable osteogenic sarcoma entered 2 successive clinical trials of adjuvant chemotherapy with adriamycin (ADM) alone. Following radical surgery the first group of 14 patients received ADM 75 mg/sqm q 4 weeks for a total of 8 doses, the second group received ADM 30 mg/sqm daily for 3 days every 4 weeks for a total of 6 cycles. All patients belonging to the first group underwent amputation or exarticulation, while in 4 of 15 of the second group a limb-sparing surgery was performed. Lung tomograms as well as bone scans were not mandatory in the initial work-up. Follow-up ranged from 7 to more than 11 years. Thirteen patients (45%) remain continuously relapse-free survivors: 4 of 14 (28.5%) in the first group and 9 of 15 (60%) in the second group. This difference is not statistically significant. The longest free interval in the 16 patients relapsed was 32 months. Severe toxicity from ADM was observed in only 1 patient and consisted of reversible cardiomyopathy. ADM alone as postoperative adjuvant chemotherapy for osteogenic sarcoma achieved results comparable to those obtained by other contemporary more complex regimens of combination chemotherapy.

Adolescent↗
PubMed1987

A posterior approach for the excision of sacral chordoma.

We report eight cases of sacrococcygeal chordoma treated by high sacral resection through S2 by a posterior approach, with the intention of achieving radical removal. The technique we describe is easier than the combined abdominosacral approach, and there have been no serious intra-operative or postoperative complications. The major technical problems were the margins of excision in the sacrum itself (one recurred) and in the perirectal soft tissues (four recurred), and the preservation of sacral nerve roots. When both S2 roots were preserved, sphincter problems were mild and reversible. One patient died from recurrence 32 months after operation and one was lost to follow-up at eight months. Six patients are alive with a median survival of three years; three of them are free of disease after 22, 36 and 80 months respectively. These results indicate the possibility of surgical cure of this malignant tumour.

Adult↗
PubMed1986

Chondrosarcoma--55 unreported cases: epidemiology, surgical treatment and prognostic factors.

Fifty-five cases of chondrosarcoma, seen at the Istituto Nazionale Tumori of Milan, were reviewed to collect epidemiological data in order to verify therapeutic effects and the validity of possible prognostic factors. Epidemiological data according to sex and age distribution and skeletal location were in accordance with the literature (male:female ratio, 1.8; mean age, 37 years, 62% of lesions located in the pelvic or scapular girdle). Of 52 cases operated on with the intent of radicality, 5 were intralesional operations, 20 marginal and 27 radical. The local recurrence rate was dependent upon the degree of surgical radicality (60%, 35% and 11% respectively for intralesional, marginal and radical surgery). Age, site, type of first symptom and pathological grading were significant as prognostic factors. The type of the first symptom was directly correlated to the site of the tumour. Sex, tumour size and degree of surgical radicality were not relevant.

Adolescent↗
PubMed1983

Fine-needle aspiration biopsy in parotid masses.

Seventy-nine cases of parotid masses were punctured by fine needle for cytologic examination and subsequently operated on. Of the material obtained, conventional smears, as well as formalin-fixed, paraffin-embedded histologic sections were prepared. The two procedures detected 16 malignant tumors and 63 nonmalignant lesions, with a high sensitivity (86%) and absolute specificity (100%). These data confirm the validity of this combined method and favor the complementary use of the two procedures, which improves the accuracy (80%) of preoperative diagnosis and histologic typing of parotid tumors.

Biopsy, Needle↗
PubMed1983

Accuracy of breast cancer diagnosis by physical, radiologic and cytologic combined examinations.

Physical examination, mammography and fine-needle aspiration cytology were performed in 1498 consecutive cases with a solitary solid lump of the female breast. The intent was to verify the validity of this diagnostic triplet in the accuracy of the preoperative diagnosis of breast cancer. Clinically sure cancers were excluded from the study. The collected data were evaluated in terms of sensitivity, specificity and predictivity of any procedure alone or in combination. In 1138 cases confirmed by histology (514 carcinomas and 669 benign or non-neoplastic lesions), the physical examination and mammography were very sensitive (respectively 96% and 84%) but with a high rate of false-positive reports (respectively 20% and 18%). The cytologic diagnosis was less sensitive (65%), mostly due to many inadequate smears, but highly specific (93%) and predictive for malignancy (99%) when the cytologic report was frankly positive. Any single procedure improved the overall sensitivity, and taken together this triplet appears to be the most effective noninvasive diagnostic combination that provides in a short time with minimal cost and discomfort, a diagnosis of certain malignancy in about 50% of carcinomas with a predictivity close to 100%, when cytology detected malignancy.

Adult↗