Biomedical subjects
P Gabriele
Publications and source records attributed to P Gabriele.
E- and H-field sensor system.
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[Postoperative radiotherapy of breast carcinoma].
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[Treatment of tumors by local hyperthermia in urology and gynecology (author's transl)].
An experimental study by the authors, on the effects of local-regional hyperthermia on bladder B.N.A. induced carcinoma of the dog has been going on since 1966. The authors have observed complete disappearance in the animals of the mucosa and sub-mucosa neoplasia, even after 6 years from the date of treatment. The sterilization of the neoplastic surface was checked by several histological sections observations on two excised bladders. As the results showed no negative secondary effects, the authors have started, since 1973, a clinical study of hyperthermia treatment of the bladder, vagina, female urethra and rectum stump carcinoma. Heat was obtained and introduced into the bladder by leans of an apparatus specifically designed for this purpose; the double-circuit terminal probe supplies a thermocouple controlled constant temperature. We are submitting the cases treated together with a discussion on results obtained and problems faced.
[Hysterosalpingography in uterine micropolyposis].
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Chemotherapy for recurrent salivary gland malignancies: experience of the ENT Department of Turin University.
Twenty-seven patients (17 males, 10 females; median age 59 years) with recurrent high-grade malignancies of major (22 cases) and minor (5 cases) salivary gland origin (10 adenoid cystic carcinomas, 9 adenocarcinomas, 4 poorly differentiated carcinomas, 1 mixed malignant tumor, 3 mucoepidermoid carcinomas) were treated by monochemotherapy--cisplatin (CDDP) in 8 cases, or adriamycin in 5 cases--or polychemotherapy--CDDP + epirubicin + 5-fluorouracil/cyclophosphamide in 9 cases or CDDP + 5-fluorouracil in 3 cases with mucoepidermoid carcinomas. In adenocarcinoma-like tumors, patients treated by polychemotherapy showed a better response (9.1% CR, 36.3% PR) than patients treated with monochemotherapy (no CR, 23% PR). Patients with local recurrence and adenocarcinoma exhibited a better response. Median response duration: 7.5 months after poly- and 4 after monochemotherapy. Median overall survival time was 8+ months (responders: 14+) in the polychemotherapy group and 5.5 (responders: 8) in the monochemotherapy group. In the 3 cases with mucoepidermoid carcinoma 1 patient achieved a PR (33.3%) and in 2 there was no change.
Concomitant chemoradiotherapy followed by adjuvant chemotherapy in parotid gland undifferentiated carcinoma.
AIMS AND BACKGROUND: Undifferentiated carcinoma of the parotid gland is a poor-prognosis lesion. Results in unresectable lesions, treated with radiotherapy alone, are very disappointing. METHODS: Six patients with T3-4 N0-1 inoperable lesions were treated with conventional radiotherapy (64-70 Gy, 2 Gy per fraction 5 times a week) and concomitant cisplatin (100 mg/m2, days 1, 22 and 43). Four weeks after radiotherapy, adjuvant chemotherapy (cisplatin, 80 mg/m2, day 1, + VP16, 100 mg/m2, days 1, 3 and 5, q = 3 weeks, for 3 cycles) was given. RESULTS: A median dose of 66 Gy (range, 64-70 Gy) was delivered, and all patients received 3 courses of cisplatin during radiotherapy. Five of 6 patients received all three chemotherapeutic adjuvant courses. Two months after the end of treatment, 3 CR (50%), 2 PR (33%) and 1 NC (16%) was observed. Median CR and PR duration was 26+ and 10 months, respectively. Median overall survival was 18 months. No severe acute or late toxicity was observed. CONCLUSIONS: Concomitant chemoradiotherapy followed by adjuvant chemotherapy in advanced unresectable undifferentiated parotid carcinoma is feasibile and well tolerated. The high percentage of long-lasting CR is encouraging.
Effective penumbra and scalloping effect: a dosimetric study in multifield radiotherapy with multileaf collimator for prostate cancer treatment.
AIMS AND BACKGROUND: The aim of the study was to test whether the multileaf collimator can be used to replace divergent alloy blocks for field shaping and to evaluate the dosimetric impact of the scalloping effect and the effective penumbra in multifield isocentric configurations routinely used at our department to treat early stage prostate tumor in supine patients. Deviations between measurements and treatment planning system calculations are also discussed in order to estimate the accuracy of effective penumbra calculations carried out by the software in the presence of blocks or a multileaf collimator. METHODS: The multileaf collimator installed on a dual energy (6 and 18 MV) linear accelerator Varian CLINAC 2100 C/D is an add-on component positioned below the standard jaws, with 40 computer-controlled opposed pairs of tungsten leaves. Transmission, effective penumbra and scalloping measurements were performed with films placed at different depths in a (30 x 30 x 20 cm3) acrylic phantom. A laser scanning photodensitometer was used to obtain the optical density and the relative dose profile. Effective penumbra and scalloping effect measured data were tested on a software phantom; the phantom, automatically performed with the treatment planning system, was a regular parallelepiped measuring 30 x 30 x 20 cm3 and the acrylic electronic density value. RESULTS: For one multileaf collimator-shaped field, the width of effective penumbra was about 2 mm wider than penumbra for cerrobend blocks, at a 45 degrees angle between leaf motion direction and the field edge. Collimator rotation, automatically performed by the treatment planning system, by minimizing the sum of over- and underblocked areas, reduces the differences between the multileaf collimator and blocks. The differences between measured and treatment planning system calculated data were within the treatment planning system dose calculation accuracy limits, as recommended in ICRU Report No. 42. CONCLUSIONS: Penumbra and, for the multileaf collimator, scalloping effect values seem to depend on the gantry angle, i.e., on the fields path of entry. The values for even fields are higher than the those for odd fields, because the dose gradient at the target edges is steeper for a single field than for two opposite fields, and the interplay of doses from the individual beams increases the distance between the isodose levels. Therefore, in order to reduce scalloping and effective penumbra values, it would be better to rotate the collimators, above all in even-number field techniques. In particular, the six-field technique, used mostly in prostate treatment, shows the same effective penumbra values with the multileaf collimator, with proper collimator rotation, and in blocked fields.
Implementation of an integrated "record and verify" system for data and images in radiotherapy.
In November 1999, new radiotherapy and medical physics departments began to operate in our institution. In the departments' project, considerable emphasis had been placed on the integration of the equipment through networking. In particular, a "record and verify" (R&V) system for data and images (Varian "Varis" and "Vision") has been employed in the daily routine since the beginning of treatments. After one year, more than 600 patients have been treated, and a first evaluation of the system can be carried out. In clinical practice, the software required no significant changes in the already-established radiotherapy workflow and has been successfully configured in an acceptable time. On the other hand, the way information is exchanged and shared has dramatically changed towards a nearly paperless and filmless way of working. A good application reliability has been experienced, and the client-server structure has been proven useful by avoiding loss of data in critical situations. The staff time spent for the application to run is now well balanced by the increased safety in daily practice, and digital archiving of all the radiotherapy activity has increased the effectiveness of routine tasks and statistical researches. The critical aspects we have experienced in the application are the proper user rights definition and a minor rounding error in the daily dose accumulation. Future developments in implementation of the system will be aimed to a better integration with the Hospital Information System and to a further exploitation of the RT-PACS features of the "Vision" application.
Head and neck metastases of renal cancer after nephrectomy: a report of 2 cases.
Two cases of metachronous metastases of renal cell adenocarcinoma are reported. One case presented a solitary metastasis of the ethmoid-orbit which was resected. The patient has remained well for the following 12 months. The second case presented with a secondary to the tongue and multiple metastases elsewhere. Electrodissection achieved a good palliative result.
Surgery or radiotherapy for early stages carcinomas of the glottic larynx.
AIMS AND BACKGROUND: The choice of treatment in limited squamous cell carcinoma of the glottic larynx often depends on individual and tumor factors. Data of the literature clearly show that surgery and radiotherapy tend to give identical results in terms of survival. We examined 196 cases of T1-T2/N0 cancers of the glottic larynx. We review the literature and discuss the indications and the efficacy of the various available treatments. METHODS AND STUDY DESIGN: 196 consecutive cases of T1-T2/N0 cancers of the glottic larynx were examined. In 54.5% the tumor was confined to the vocal cord; in 38.2% it extended to the anterior commissure, in 4.6% to the arytenoid cartilage and in 2.5% to the floor of the ventricle. We performed partial laryngeal surgery in 41.3% (81 cases). Radiotherapy alone was employed in 58.6% (115 cases). RESULTS: In T1a and T1b cases there was no statistically significant difference in 5-year disease-free survival. In T2 cases the NED survival of patients who underwent partial laryngectomies (90% of cases) was significantly better (P <0.05) than among patients given radiotherapy (73%). NED survival at 5 years in patients with the primary tumor on a vocal cord, ventricle or anterior commissure was 78%, 80% and 81%, respectively, with no statistically significant difference among the various sites. It is possible that involvement of the anterior commissure exposes patients to greater risk of recurrence when radiotherapy alone is used (5 out of 23 cases, 21.7%, compared to 3 out of 52 cases, 5.7%, among our surgically treated patients). CONCLUSIONS: When the tumor is confined to the vocal cord and mobility is not impaired (T1a), surgery and radiotherapy give comparable results, and the latter yields a better functional outcome. When the anterior commissure is involved, recurrences appear to be less likely after surgery. In T2 glottic carcinoma, surgery gives better results than radiotherapy alone. In any event, the choice of treatment should be patient-specific and based on a careful analysis of the factors involved in each case.
High prognostic impact of growth fraction parameters in advanced stage laryngeal squamous cell carcinoma.
One hundred and two cases of laryngeal squamous cell carcinoma, all treated in the same center with total or supraglottic laryngectomy, bilateral neck dissection and postoperative radiotherapy, were investigated with both Ki67 and MIB-1 monoclonal antibodies. The aim was to determine the prognostic impact of growth fraction markers in a homogeneous series of patients. All samples were stained with Ki67 monoclonal antibody on frozen sections, and with MIB-1 monoclonal antibody on paraffin sections, using the ABC immunoperoxidase method. The percentage of positive cells was compared in each case with the overall and disease-free survival, pathologic stage and histologic grading. The values obtained from Ki67 and MIB-1 counts were similar and highly correlated (r=0.90). Two groups of cases with low and high proliferation rate (59 and 43 respectively) were obtained by splitting up the whole series, on the basis of the median value; 84. 6% of the patients with high proliferation relapsed and/or died due to the tumor within two years from diagnosis whereas, at time of writing, 94% of the patients with low proliferation are alive and well (p<0.00001). No relation was found between growth fraction and histologic grading, pathologic stage (pT and pN) and site of the tumor. Only lymph node involvement was correlated with disease-free survival. Our results indicate that Ki67/MIB-1 index represents an independent variable to determine long-term prognosis in laryngeal squamous cell carcinomas. We recommend its use in diagnostic protocols, to distinguish high risk subsets of patients who might benefit from more aggressive treatments.
Paclitaxel and carboplatin for recurrent salivary gland malignancies.
BACKGROUND: The use of chemotherapy for recurrent salivary gland carcinomas is under investigation. PATIENTS AND METHODS: Fourteen patients (10 males, 4 females; median age 55 years, range 20-70) with recurrent carcinomas of major (9 patients) and minor (5 patients) salivary gland origin (histology: 1 adenocarcinoma, 10 adenoid cystic carcinoma, 2 undifferentiated carcinoma, 1 mucoepidermoid carcinoma) were treated with carboplatin AUC 5.5 + paclitaxel 175 mg/m2 (3-hour infusion) on day 1 (interval = 3 weeks). All patients had been previously treated with surgery + radiotherapy and 8 with a cisplatin combination. One patient had a local lesion, 7 locoregional recurrence and metastases and 6 patients had metastases only. RESULTS: Overall 65 courses were given (median 5; range 2-6). Responses were: PR in 2 patients (14%) lasting 5 and 12 months; 7 NC (50%) with a median duration of 8.5 months (5-12); and 5 PD (36%). The median survival time was 13.5 months for PR/NC patients, 6 months for non responders; median overall survival was 12.5 months (3-17+). CONCLUSION: This combination had a moderate activity; the treatment was well tolerated and toxicity was manageable.
[Modification of vestibular function after radiation therapy for head and neck tumors].
The effect of radiation on the vestibular apparatus of animals and man have not been widely investigate. Referred symptoms are disequilibrium and spontaneous nystagmus in animals while histological features are intralabyrinthic haemorrhage, edema of the endolymphatic spaces and alterations of sensory hair cells. A group of 20 patients with head and neck cancer located in different sites (nasal cavity, oropharynx, oral cavity, parotid gland) underwent to vestibular investigations before and 3-6 months after radiation therapy. Ten patients (50%) showed an alteration of the vestibular function of peripheral origin after radiation treatment. Complications appeared from a few weeks up to several months following termination of radiotherapy. The slow development of the lesion permitted central compensation. Few patients had symptoms and vestibular symptomatology was always of secondary importance with respect to the initial pathology.
[Hypothyroidism following combined treatment of pharyngolaryngeal carcinoma].
The onset of hypothyroidism following surgery and/or radiotherapy for head and neck cancer varies from 25 to 67% and it is fostered by some clinical conditions. However, these percentages increase when one takes into consideration the latent hypofunctioning brought about by high levels of T.S.H. The present case study involves 15 laryngeal or pharyngolaryngeal cancer patients: 3 had undergone surgery alone although most of them had received a combination of radiotherapy and surgery. For these patients both the clinical conditions of any hypothyroidism and the laboratory parameters for thyroid function were studied. Of these the most significant proved to be T.S.H. The patients were monitored at 4 month intervals over the course of a year. In three of the 15 pharyngolaryngeal cancer subjects who had undergone a combined treatment including surgery and radiotherapy comparison of the parameters studied proved statistically highly significant (with an increase in T.S.H.). The damage sustained does not so much depend on the total dose of radiation but rather on the number of fractions employed. It may, therefore, be suggested that making changes in surgery to the detriment of oncological radicality is not worth while. It would appear that a different scheme for distribution of radiotherapy doses should, rather, be devised.
[Taste variations after radiotherapy of neoplasms of the pharynx and oral cavity].
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[Results of radiotherapy alone or combined with surgery in the treatment of carcinoma of the hypopharynx].
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A computerized system for hyperthermic treatment of cancer. Clinical results regarding refractory or recurrent tumors.
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