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Biomedical subjects

F Lombardi

Publications and source records attributed to F Lombardi.

227 records · Page 13Linked to original sources
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The evolving role of radiation therapy in the optimal multimodality treatment of childhood cancer.

Childhood cancer is rare, representing only 1% of the total cancer problem. Of children diagnosed with cancer today, more than 70% are predicted to be long-term survivors. Essentially all pediatric cancers are treated by interdigitating radiation with surgical resection and systemic chemotherapy. The use of irradiation, important to achieve high rates of disease local control, must be always balanced against late effects specifically related to this treatment modality, principally growth retardation and second tumors induction. Using neuroblastoma, Wilms' tumor and rhabdomyosarcoma as examples, the advances in the optimal multimodality treatment of childhood cancer and the evolution of the role of radiation therapy are discussed.

Child↗
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Prognostic value of clinicopathologic characteristics including neuroectodermal differentiation in osseous Ewing's sarcoma family of tumors in children.

AIMS AND BACKGROUND: The aim of the present study was to determine the relationship between clinico-pathologic parameters, including neuroectodermal differentiation, and their impact on survival in a series of pediatric patients with osseous tumors of the Ewing's sarcoma family admitted to the Pediatric Department of the Istituto Nazionale Tumori of Milan. METHODS: Seventy-three patients were enrolled. The variables analyzed were sex, age, site of primary tumor, serum lactate dehydrogenase (LDH) level at diagnosis, involvement of periosseous soft tissues by primary tumor, presence of metastatic disease, status of disease after the treatment plan, as well as the presence of mitoses, morphologic and immunocytochemical neural markers, and neuroendocrine markers in the primary tumor. RESULTS: Neural and neuroendocrine markers were not significantly associated with any of the other parameters. In the univariate analysis, significant risk factors related to unfavorable outcome were elevated LDH, metastatic disease, lack of complete remission after treatment, presence of mitoses and of morphological neural markers; immunocytochemical neural and neuroendocrine markers lacked prognostic value. In the multivariate analysis, only LDH levels and the status of disease following the treatment were retained. CONCLUSIONS: LDH level at diagnosis might be a useful marker to identify different risk levels; neuroectodermal differentiation might have no clear-cut impact on the clinical management of osseous Ewing's sarcoma family of tumors.

Adolescent↗
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Malignant peripheral nerve sheath tumors in children: a single-institution twenty-year experience.

A retrospective series of pediatric patients with localized malignant peripheral nerve sheath tumors (MPNST) treated during a 20-year period at one institution is reported. Between 1976 and 1996, 24 consecutive children were treated by a multimodality approach. Conservative surgery was the treatment of choice: primary radical surgery was performed in 10. Postoperative radiotherapy was administered in 12 and adjuvant chemotherapy in 19. Eight patients were alive without evidence of disease, six in first complete remission and two in second complete remission, after a median follow-up of 230 months. The 10-year event-free survival (EFS) and survival were 29% and 41%, respectively. Survival was 80% for the patients who underwent radical surgery, and 14% for the others; 71% for patients with tumors smaller than 5 cm, and 29% for those with tumors 5 cm or larger. Local recurrence was the major cause for treatment failure (13 of 17; 76%); the rate of local relapse was 33% v 75% in patients who either received or did not receive radiotherapy. Complete surgical excision remains the most effective treatment for MPNST and represents the main prognostic factor along with tumor size. Radiotherapy seems to play a role in achieving local control, whereas the role of chemotherapy is uncertain.

Adolescent↗
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[Not Available].

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Historiography↗
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Treatment of single brain metastases.

Brain metastases (BrM) occur in 30% to 50% of patients with malignant tumours and represent a relevant cause of morbidity and mortality. As documented by the extensive clinical use of magnetic resonance imaging with contrast enhancement, 25% to 35% of patients with BrM have a single localisation to the brain. Conventional therapeutic options for single BrM consist of either neurosurgery, or whole brain irradiation, or a combination of both. Treatment finality for the majority of the patients is palliation and life expectancy is in the order of a few months. In the last decade, the development of radiosurgery has represented an important advancement in the treatment of patients with BrM. This radiotherapeutic technique represents a possible non-invasive alternative to surgical exeresis for patients with lesions <3 cm, without a cystic component or obstructive hydrocephalus. Randomised clinical trials are warranted to define the appropriate indications and combinations of radiosurgery, neurosurgery, whole brain irradiation, and systemic treatment as well as the impact of different treatment modalities on amelioration of survival and quality of life.

Brain Neoplasms↗
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Neurovegetative regulation and cardiovascular diseases.

Heart period and arterial pressure short term variabilities contain rhythmic oscillations which might provide information on neural mechanisms regulating cardiovascular function. Continuous electrocardiographic and/or arterial pressure signals, after appropriate analogue to digital conversion, furnish the time series which constitute the basis for spectral analysis of their variabilities. Under stationary conditions, this methodology can be utilized to assess both total variability and the power and center frequency of each rhythmic component. Human physiological and animal studies support the hypothesis that the low frequency (LF) component, around 0.1 Hz, is a marker of sympathetic modulation of both R-R and arterial pressure variabilities, while the high frequency (HF) component, around 0.25 Hz, is a marker of vagal modulation of R-R variability. LF/HF ratio of R-R variability is a marker of sympatho-vagal balance. Spectral components when assessed for a 24-hour period evidence marked circadian rhythmicity with sympathetic predominance during the day and vagal predominance at night. Various pathophysiological conditions including arterial hypertension, ischemic heart disease, cardiac transplantation, congestive heart failure, Chagas' disease and diabetic neuropathy have been explored with this methodology, and a new quantitative evaluation of the alterations in sympatho-vagal balance which seem to characterize these abnormal states has been obtained. The study of cardiovascular rhythmicity, i.e. an analysis performed in the frequency domain, although based on indirect spectral markers, seems to offer a new clinical tool for the exploration of cardiovascular neural control in health and disease.

Cardiovascular Diseases↗
PubMedDate not supplied

A cooperative study of epirubicin with cyclophosphamide, vincristine and prednisone (CEOP) in non-Hodgkin's lymphoma.

BACKGROUND: The purpose of our cooperative trial was to investigate whether epirubicin (EPI) at 90 mg/m2 in a CHOP-like combination (called CEOP) could increase complete response (CR) and survival rates in non-Hodgkin lymphoma (NHL) patients while maintaining a tolerable degree of toxicity. METHODS: Between September 1986 and July 1992, 218 patients from 12 Centers in Lombardy entered this study. The inclusion criteria were: a histological diagnosis of intermediate or diffuse large cell (DLC) NHL and no previous radio-chemotherapy. The patients in stages IA and IIA (both intermediate and DLC) received four CEOP courses followed by local/regional radiotherapy; those with intermediate NHL in stages IB, IIB, III A and B and IV A and B received six CEOP courses and, if they achieved CR, three further courses as consolidation. RESULTS: Among the 160 evaluable patients, CR was observed in 90% of the subjects with DLC-NHL (stages IA and IIA) and in 59% of those with intermediate-grade NHL (all clinical stages). If the clinical stages are considered separately, the CR rates were 92% for stages IA, IIA and 53% for stages IB, IIB, III A and B, IV A and B. Relapses occurred in 20% of the patients treated with four CEOP courses plus radiotherapy and in 31% of those who received nine CEOP courses because of the advanced stage of their disease. As of May 1994, the median follow-up was 42 months. If all of the patients are considered together, the 7-year overall survival (OS) probability was 64% and the 7-year disease-free survival (DFS) probability 67%. In comparison with stages III/IV, the patients in stages I-II had better DFS (7-year chance 77% vs 56%, p < 0.03). Hematological toxicity was acceptable, and a delay in the administration of CEOP chemotherapy was required in only three patients. No life-threatening infections were recorded. CONCLUSIONS: Our cooperative study of the use of the CEOP combination in NHL patients shows that response rates and the length of DFS are equal to the best results obtained with CHOP and more intensive programs, although further confirmation must be provided by means of a longer follow-up and a more careful analysis of prognostic factors according to the recently proposed international index. In our experience, an EPI dose of 90 mg/m2 has negligible toxicity (particularly on bone marrow), even in elderly patients. These findings are interesting since it is well known that myelotoxicity is the principal limiting factor for the majority of anthracycline-containing regimens used in the treatment of potentially curable NHL.

Adult↗
PubMedDate not supplied

[Long-term hematopoietic reconstitution after myeloablative antitumor therapy and circulating hematopoietic stem cell transplantation].

BACKGROUND: It remains unknown if hematopoiesis reconstituted by autografting with the sole peripheral blood hematopoietic progenitors (CPCs) after myeloablative high dose radiotherapy and/or chemotherapy is durable and capable of coping with increased demand due to boost radiotherapy, surgery, or infection. PATIENTS AND METHODS: Durability of hematopoiesis was evaluated in 34 consecutive cancer patients treated with myeloablative total body irradiation (n = 17, median follow-up 3 years, range 3-49 months) and/or alkylating agent chemotherapy (n = 17, median follow-up 8 months, range 6-41 months) and autografted with CPCs because bone marrow autografting was contraindicated. CPCs (> or = 8 x 10(8) CD34+ cells/kg) had been collected during mobilization into the circulation in response to previous anticancer therapy and hematopoietic growth factor(s). RESULTS: Following brief temporary pancytopenia, all patients achieved normal and durable hematopoiesis. The newly reconstituted hematopoietic system was capable of reacting favorably to stressful and noxious events such as surgery, radiotherapy, or varicella-zoster infection. No secondary irreversible failure of blood cell production occurred. CONCLUSIONS: The documentation of the durability of normal hematopoiesis following myeloablative cancer therapy and autografting with mobilized CPCs implies that the latter procedure, rather than solely an alternative to bone marrow autografting, represents an advantageous tool of choice permitting substantial amelioration of the therapeutic index of high-dose cancer therapy.

Cryopreservation↗