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Biomedical subjects

R Orecchia

Publications and source records attributed to R Orecchia.

At least 73 records · Page 4Linked to original sources
PubMed1991

Interstitial brachytherapy for carcinomas of the lower lip. Results of treatment.

From 1973 to 1988 47 patients with previously untreated T1 and T2 squamous cell carcinomas of the lower lip received a definitive course of interstitial brachytherapy by iridium 192 wires. The disease stage was T1 in 21 cases (44.7%) and T2 in 26, and N0 in all cases except 2 of N1. Radiation therapy dose ranged between 6000 and 8000 cGy. Local control was obtained in 44 patients (93.6%). Treatment failure in the neck was observed in 3 patients (6.7%). The 5- and 10-year actuarial disease-free survival rates were 92% and 85%, respectively. A surgical salvage was attempted in 3 patients, with postoperative definitive control of the disease in 2. The 10-year actuarial overall survival was 95%. The incidence of complications was acceptable (10.6% of mucosal necrosis). An excellent or good cosmetic result was obtained in 91.7% of patients.

Adult↗
PubMed1991

[Recurrences of epithelial tumors of the head and neck: review of the literature and a critical analysis of the problem].

Recurrence is a tumor renewal in a previously treated field or surgical wound after a disease-free period. The present work investigates loco-regional recurrences. In the first part of the work the most frequent recurrence sites, types and their characteristics (i.e. infiltrating, exophytic, ulcerating) are studied along with the problems in clinical and pathological diagnosis, new diagnostic imaging (CT and MR) and the UICC classification system. The second part of the work is dedicated to examining classical treatments (surgery, radiotherapy, chemotherapy and radiochemotherapy associations) as well new therapies (i.e. cryosurgery, hyperthermia, immunotherapy, photodynamic therapy). A review of the literature is made for indications, results and complications. An extensive study of the cases of the Head and Neck Group of the University of Turin during the 1983-1990 period is also reported. This experience is based on 312 cases: 68 (oropharynx and larynx) treated by surgery, 51 (neck nodes and stomal recurrences) treated by radiotherapy and hyperthermia, 35 (neck nodes) by hyperthermia alone, 168 (all sites) by chemotherapy and 20 by immunotherapy. In the third part of this work supportive therapies and practical problems are reported. In conclusion a therapeutic approach is proposed in relation to the site of the recurrence and previous treatments.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

[Radiotherapy of laryngeal carcinoma (T1a/b excluding glottic cancer). Critical review of the literature and personal experience].

The authors reviewed the literature on definitive radiation therapy of supraglottic and glottic cancers (T1 a/b glottic excluded). The results are here presented, in terms of local control and survival, of radiotherapy alone and combined with surgery. Voice quality and complications are discussed, as related to results and therapeutic choice. Methods to improve local control (radio-chemotherapy combinations, chemical modifiers, hyperthermia, multiple day fractionation) are analyzed. Prognostic factors and their influence on treatment choice are discussed. The authors report their results with definitive radiotherapy in patients primarily excluded from surgery (18 T2-3 glottic carcinomas and 119 T1-2-3-4 N0-1-2-3 supraglottic carcinomas). Local control was 61% and 38%, respectively; NED survival at 5 years is 45% and 35%. Complication rate is low (5.8%). In conclusion, the authors try to evaluate the comparative adequacy of surgery (especially conservative) and radiation therapy according to the risk/benefit ratio of disease control.

Combined Modality Therapy↗
PubMed1990

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. Invasive intratumor thermometry was performed for all lesions. Complete response (CR) was obtained in ten cases (16.6%) and partial response (PR) in 14 (23.4%). Higher rates of CR were observed in the chest wall (38.5%) compared with the head and neck area (11.4%), trunk (10%), and limbs (none). Adenocarcinoma was the most responsive histologic type (40%). Squamous cells carcinoma had 7.7% CR. The only case of undifferentiated carcinoma showed CR; there were none on five sarcomas. Long-term local control (24 months) was approximately 7%. The multivariate analysis showed the statistical significance of the histologic variety (adenocarcinoma versus others, P less than 0.0001). Side effects and complications of the treatment were minimal.

Adult↗
PubMed1990

[Thermal dose and fractionation in clinical hyperthermia].

Hyperthermia is one of the most promising methods for cancer treatment. Two important problems are nonetheless to be solved to define the actual role of this technique: the first one is how to express the thermal dose, and the second one is to assess the optimal sequence for the administration of heat and radiation. The authors critically reviewed the literature on the subject, pointing out those questions which have not yet been solved. Their work was then integrated with their own clinical experience on 191 lesions treated by hyperthermia alone or combined with radiotherapy. The impact is also analyzed of such prognostic factors as minimum intratumor temperature and total number of heating session on the final results.

Breast Neoplasms↗
PubMed1990

[Radiotherapy of carcinoma of the nasopharynx. Results and analysis of prognostic factors].

Radiation therapy of the patients with nasopharyngeal carcinoma results in permanent loco-regional control in 55-100% of cases according to stage of disease. Five-year overall survival rates range 30-55% and 5-year disease-free survival 30-40%. Factors affecting survival are: sex, age, overall patient conditions, Epstein-Barr associated antibodies, histology, T and N stages, cranial nerve and neck nodes involvement, staging method, dose and fractionation of radiation therapy, and adjuvant treatment. Our results in 94 patients can be summarized as follows: 78.4% local control, 89.8% control of lymph nodes clinically palpable at diagnosis, 40% overall 5-year survival, and 38% 5-year disease-free survival. Significant prognostic factors in our series of patients were T and N stages and histology.

Adult↗
PubMed1989

Results of hyperthermia, alone or combined with irradiation, in chest wall recurrences of breast cancer.

In the period between September 1983 and July 1987, 28 locoregional recurrences (about 86% in the chest wall) of breast cancer in 19 patients were treated with external microwave hyperthermia. Of these, 11 lesions were treated with hyperthermia alone and 17 with the combination of heat and external irradiation. Hyperthermia was induced in most cases with 915 MHz microwave (at least 42 degrees C for 30-45 min, for 6-10 sessions). Radiation was administered using photon or electron beams with total doses varying from 2000 to 5000 cGy. Complete and partial response rates on the whole series of patients were 53.6% and 42.9%, respectively. Of 17 lesions treated with combined treatment, 10 had a complete (58.8%) and 7 a partial response; of 11 lesions treated with hyperthermia alone, 5 had a complete (45.5%), 5 a partial (45.5%), and 1 no response. Complete responses were long lasting in all but 3 cases, which recurred after 4 months (2 cases) and 1 year, respectively.

Adult↗
PubMed1989

Clinical hyperthermia, alone or with radiation therapy: results of a preliminary study on recurrences of cancers.

Authors present results obtained by hyperthermic treatment (alone or associated with radiation therapy) on 50 patients (with a total of 66 sites) treated between September 1983 and August 1986. All patients had recurrent or metastatic lesions of pretreated malignant tumors. Among these there were 19 breast adenocarcinomas, 33 squamous cell carcinomas of head and neck, 9 melanomas and 5 subcutaneous metastases of adenocarcinoma of the cervix, rectum and colon. The clinical protocol was: hyperthermia alone (43 degrees -45 degrees C for 30 minutes, bi-weekly, for 4-5 weeks) or hyperthermia plus radiation therapy (4 Gy/fraction) for a total of 8-10 seances, in accordance with previous given doses of irradiation. In summary, complete response rates were 21.2% for head and neck tumors, and 51.5% for cutaneous or subcutaneous lesions. Results have also been analysed according to different prognostic variables related to tumor and treatment characteristics. These data are discussed.

Adenocarcinoma↗
PubMed1989

Three new applicators for hyperthermia.

A computerized system with automatic treatment parameters control for radiological hyperthermia, called Sapic SV03, is presented. The system has been planned and built by the "Sezione Avionica ed Equipaggiamenti" of the Aeritalia in cooperation with the Radiotherapy Department of the University of Turin. The device is supplied with a multifrequency generator system (915, 433, 2-30 MHz) connected with many kinds of applicators, with a fiber optic system for temperature control and a previsional thermometry system. In this paper the authors presented three new applicators. The first one is a concave parallel microstrip applicator at 433 MHz, with a size 16 x 9 cm; the heating pattern is homogenous until 4 cm of depth. This antenna can be used for the treatment of chest wall recurrences of breast cancer. The second is a 27 MHz inductive ring and the third applicator is a pyramidal antenna ("TEM line") that operates at a frequency around 27 MHz.

Computer Systems↗
PubMed1988

[Radiotherapy in the treatment of carcinoma of the major salivary glands].

The authors conducted a retrospective study on 99 patients with malignant tumors of the major salivary glands, who had been treated by radiotherapy between 1976 and 1986: 86 cases of parotid tumors and 13 cases of submandibular gland tumors. Only 28 tumors (28%) were T1-T2, N0-N1. Local control, 3-5 and 8-year survival rates, and complications were considered. Radiation therapy alone was performed on 19 patients (19%), while combined surgical and radiation therapy was performed on 80 patients (80%). The results of radiation therapy alone and combined with surgery are discussed. Loco-regional disease control was obtained in 9 out of 19 patients (47%) by irradiation alone, and by combined irradiation and surgery in 60 out of 80 cases (75%). Distant metastases developed in 23 out of 99 patients (23%). Loco-regional metastases were the most frequent cause of death (20 out of 55 cases: 36%). Severe complications were extremely rare. The results demonstrate not only the advantages of combined treatment but also the value of radiotherapy alone in the treatment of tumors of the major salivary glands.

Adolescent↗
PubMed1988

[Radiotherapy in the treatment of carcinomas of the base of the tongue. Analysis of the literature and personal experience].

Carcinoma of the base of the tongue is usually treated with radiation therapy. After a review of the literature, the findings are reported of 129 patients with squamous cell carcinoma of the base of the tongue treated in 1979-1983, with a minimum of a 3-year follow-up: 8 T1, 40 T2, 60 T3 and 21 T4 were found; only 48 cases were N0. Advanced stages (stage III and stage IV) were 83% of the total. External photon irradiation (Cobalt-60) was used in all cases; 33 patients underwent chemotherapy or surgery as additional treatment. The overall local control rate was 45.7%. Local control decreased as T stage advanced: T1 62.5%, T2 55%, T3 41.7% and T4 33.3%. The overall regional control rate for lymph nodes clinically palpable was 51.8%. The overall actuarial 5-year survival rate was 29.1%. The 5-year survival rate according to the N-staging varied from 37% for N0-stage to 17.4% for N3-stage. The majority of failures (92.8%) occurred within 2 years since the end of the therapy. Treatment complications, secondary carcinomas and causes of death are also discussed. Radiation therapy has proven to be effective for early-stage carcinoma of the base of the tongue; in more extensive lesions results are poor. Improved results could be obtained by optimal application of radiotherapeutic techniques. Knowledge of the various prognostic factors is essential to administer the therapeutic regimen for a given patient by the characteristics of his particular tumor.

Adult↗
PubMed1987

Comparison of methotrexate and sequential methotrexate-5-fluorouracil for patients with recurrent squamous cell carcinoma of the oral cavity.

Forty-eight fully assessable previously treated patients with biopsy-proven recurrent squamous cell carcinoma of the oral cavity were randomized to receive either methotrexate (MTX), 40 mg/m2 iv push weekly, or sequential MTX and 5-fluorouracil (5-FU) (MTX 150 mg/m2 iv for 1 h; 1 h after the end of MTX, 5-FU 600 mg/m2 iv for 2 h; 24 h later, leucovorin rescue 10 mg/m2 iv and the same dose was given orally every 6 h 4 times; the treatment was repeated every 10 days). There were 1 complete response (CR) and 5 partial responses (PR) in the MTX group; median remission duration = 84 days. There were 3 CR and 11 PR in the MTX-5-FU group (overall response 14/24, 58.3%--p less than 0.05); median remission duration = 125 days. Median survival was 6.2 months in the MTX group and 8.1 months in the MTX-5-FU group. There was no difference in mucositis between the two groups, and a prevalence of leukopenia and moderate gastro-intestinal toxicity in the MTX-5-FU group.

Adult↗
PubMed1987

[Results of radiotherapy in the treatment of 218 carcinomas of the tonsillar area].

After a brief review of the literature, the results of the treatment by radiation therapy in 218 patients with tonsillar region carcinoma are reported. The patients were treated at the Turin University Radiotherapy Department (131 cases) and at the Radiotherapy Department of the Ospedale Maggiore, Novara (87 cases) from 1976 through 1984. The series included 29 T1, 88 T2, 64 T3 and 37 T4; 86 patients (40%) were N0. Only 49 patients were stages I and II (1/4 of the total). The local control (T) rate at the end of therapy was 63.5% for the overall series (139/218) ranging from 100% in T1, 72.6% T2, 54.6% T3 to 30% T4; the regional control (N) for patients with cervical lymphadenopathy was 66% (88/132). The overall 5-year survival was 38%; the 5-year disease-free survival was 35%. The 5-year survival according to T-stage was 52% for limited cases (T1-T2) in comparison to 22% for advanced ones (T3-T4). The 5-year survival for N0 stage was 55%; when neck nodes were present (N # 0) the survival was 29% after 5 years. Complications included 6 cases of trismus and 2 osteonecroses of the mandible. Second primary malignant diseases were seen in 17 cases (7.8%). The most common cause of death was failure in primary tumour control (80% of cases). In this series the results of radiotherapy of early stage tonsillar carcinomas are quite good; patients with large tumour masses fare less satisfactorily. Better results should be obtained in the future by identifying prognostic factors, monitoring potential causes of treatment failure and optimizing the radiotherapeutic treatment plan and technique.

Adult↗
PubMed1986

[Carcinoma of the paranasal sinuses. Results with radiotherapy alone or with a radio-surgical combination].

The authors evaluate 117 patients affected by paranasal sinuses carcinoma treated by radiation therapy alone or by post-operative irradiation, from 1976 to 1984. Among these: 4 T1, 21 T2, 48 T3 and 44 T4; 66 cases were squamous cell carcinomas, 23 adenocarcinomas, 16 undifferentiated carcinomas and 12 adenoid cystic carcinomas. The overall 3 and 5 years actuarial survival rates were, respectively, 46% and 27%. The survival rates for stages T1 and T2 were 82 and 48% at 3 and 5 years; for stages T3 and T4 were 36% and 21%. According to the hystological type the survival rate varied from 50% for adenoid cystic carcinomas to 0% for undifferentiated carcinomas at 5 years. The survival rate for the group of patients treated with post-operative irradiation was 37% at 5 years, versus 10% for the group treated by radiotherapy alone. Complications have been minimal. Causes of failure are discussed. In conclusion, the authors consider a multicentric study as necessary to determine the efficacy of various schedules of treatment.

Adult↗
PubMedDate not supplied

Small cell carcinoma of the esophagus: a case report and review of the literature.

We present a case of small cell esophageal carcinoma (SCEC) treated with alternated chemotherapy (including cisplatin, etoposide, vincristine, cyclophosphamide and doxorubicin) and irradiation (36 Gy) followed by surgery. Despite a pathological complete response, the patient died of regional disease recurrence 29 months after the diagnosis. We reviewed the available literature on SCEC with regard to the incidence, clinical symptoms, radiological signs, diagnostic workup, therapeutic modalities and prognosis of this malignancy.

Carcinoma, Small Cell↗
PubMedDate not supplied

Radiotherapy-related fatigue: how to assess and how to treat the symptom. A commentary.

Acute and chronic radiotherapy-related fatigue occurs in up to 80% and 30%, respectively, of patients undergoing irradiation for cancer. Frequently, the symptom is not expected by the patients and is underestimated by medical and nursing staff. Fatigue can affect global quality of life more than pain, sexual dysfunction and other cancer- or treatment-related symptoms. Its etiology and correlates are not clear. Published reports are mainly descriptive, and in many of them numerous methodological biases are present. One of the limitations is lack of a standard method of assessment that could simplify the comparison between different series. In the last decade, modern instruments have been designed to measure fatigue. They include uni- and multidimensional tools. Use of these specific instruments is highly recommended for research on radiation-related fatigue. In daily practice when time is limited, simple assessment is necessary. For example, systemic use of plain and easily understandable questions about fatigue, its level and impact on daily life could be sufficient and reliable. Therapeutic strategies for radiotherapy-induced fatigue have not yet been clearly defined, but a few randomized studies have been recently published. Physical exercise, group psychotherapy and relaxation therapy have been demonstrated to be effective. Moreover, pharmacological treatment of concomitant disturbances (anemia, pain, insomnia, depression, dehydration, infection, malnutrition) and other radiotherapy side effects (diarrhea, hormonal insufficiency etc.) should be considered. Further methodologically correct studies are warranted to better define the causes, optimal prevention, assessment and management of this symptom.

Acute Disease↗