Biomedical subjects

S Luzi

Publications and source records attributed to S Luzi.

41 records · Page 3Linked to original sources

PubMedDate not supplied

Quality assurance in radiotherapy of prostatic cancer.

External beam radiotherapy is a widely experimented treatment modality in prostatic cancer. Recently published studies have documented a close dependence of clinical results, in terms of local control and toxicity in particular, on radiation therapy quality. Efforts to improve results of conventional radiotherapy were directed towards the identification of new therapeutic modalities (conformal therapy, fast neutron radiotherapy, neoadjuvant hormonotherapy) as well as towards the optimization of treatment accuracy. In this respect, the following procedures have been particularly effective: 1. the systematic use of CT and retrograde urethrography in PTV definition; 2. immobilization systems which allow a significant reduction in positioning errors; 3. checks before and during treatment by "portal imaging" which allow the identification and correction of a relevant percentage of inaccuracies. The general evolution in treatment planning occurred in recent years has introduced into prostatic cancer radiotherapy new methods and calculation algorithms. While at present the use of new and at the same time complex techniques makes the need for quality assurance of radiation treatments increasingly critical, it is in any case a daily requirement even in most conventional routine treatments.

Humans↗

PubMedDate not supplied

Organ preservation in carcinoma of the anal canal.

Over a 9-year period, 52 patients with anal carcinoma were observed: there were 18 males and 34 females (ratio: 1:1.9); mean age was 62 years. In 37 patients (71%) the neoplasm origin was in the anal canal, in the margin in 14 (27%) and a coaclogenic form was located in the lower rectum in one. 39 patients (75%) showed an epidermoid carcinoma and 13 (25%) an adenocarcinoma. Treatment consisted in two cycles of 5FU (1000 mg/m2/24 h, day 1-4), mitomycin C (10 mg/m2 bolus, day 1) plus radiotherapy (23.4 Gy, split course with 4- week rest). At 6-8 weeks, brachytherapy was performed for epidermoid lesions of the anal canal and margin while adenocarcinomas were referred to surgery. Sphincter preservation at 5 years was 64%. In epidermoid carcinomas sphincter preservation was 69% vs 45% in adenocarcinomas (p = 0.17). In patients treated with a curative intent and presenting with epidermoid carcinoma of the anal canal, sphincter preservation was 77% vs no patient with adenocarcinoma of the anal canal. In 53% of patients with epidermoid carcinoma of the anal margin there was sphincter preservation. Overall 5-year survival was 62%, better for epidermoid carcinoma (69% vs 36%; p = 0.02) but similar as for the site (anal canal:62%; anal margin:60%).

Adenocarcinoma↗

PubMedDate not supplied

Organ preservation in the management of prostatic cancer.

Thirty-two patients with cT2 prostatic adenocarcinoma underwent a protocol of combined treatment based on: neoadjuvant hormonotherapy (LH-RH analogues + antiandrogens) and concomitant external radiotherapy (ERT), two months before ERT until the end of it; ERT to the entire pelvis (45 Gy) with a boost dose to the prostatic volume (+20 Gy). All patients completed the planned treatment. Acute toxicity was moderate (Gr 1-2 RTOG). At a median follow-up of 22 months (range: 6-68) one patient (3.1%) showed bone metastases while none had local disease progression. Overall 5 year survival and disease-free survival were 100% and 97% respectively. Late toxicity was mild (Gr 1 RTOG: intestinal: 3.1%; urological: 21.9%). The protocol was shown to be feasible with no relevant toxicity. Even if the follow-up was short, results achieved in this group of potentially resectable prostatic cancer patients seem to confirm the possibility of achieving results comparable to those of surgery with no relevant impairment of urinary and intestinal function, thus with an acceptable quality of life.

Actuarial Analysis↗

PubMedDate not supplied

Radiation, hormonotherapy, survival and local control in prostatic carcinoma.

The combination of concomitant external beam radiotherapy (ERT) and neoadjuvant hormonotherapy was shown to be able to significantly improve local control and disease-free survival in locally advanced prostatic carcinoma. (RTOG study 8610). Aim of this analysis was to assess the clinical results observed in a population of patients undergoing this combined treatment and, more particularly, to examine the prognostic impact of local control. 84 patients (T2: 47%, T3: 49.4%, T4: 3.6%) underwent concomitant ERT (dose to pelvic volume: 45 Gy; mean dose to prostatic volume: 65 Gy) and neoadjuvant hormonotherapy (flutamide: 250 mg three times/daily for 30 days; LH-RH analogue: 1 oral dose every 28 days starting 2 months prior to radiotherapy and for its whole duration). With a median follow-up of 36 months, 3.6% of patients were deceased; hematogenous metastases and local disease progression were recorded in 16.7% and 4.8% of patients, respectively. Local disease progression was shown to be significantly correlated with the incidence of metastases. In fact, the actuarial incidence of metastases at 5 years was 100% and 27% in patients with and without local recurrence (p = 0.0043) respectively. Overall, metastases-free local and biochemical recurrence-free survival was 89.2%, 66.5%, 85.0% and 41.9% respectively. At univariate analysis (logrank) the clinical stage (T) was shown to be significantly correlated with the incidence of metastases (p = .0004) and local progression (p < .0001). In conclusion, this study has confirmed the low rate of local progression with the combination of hormonotherapy and radiotherapy and the significant correlation of local control with the incidence of hematogenous metastases.

Adenocarcinoma↗

PubMedDate not supplied

Cancer of the anal canal and local control.

Concomitant radiochemotherapy is the standard treatment of squamous cell carcinoma of the anal canal. It can afford a high local control rate though the same impact has not been observed on survival. A few reports have concerned the impact of local control on distant metastases and survival. From 1988 to 1998 at the "Divisione di Radioterapia" of the "Università Cattolica del S. Cuore" of Rome 30 patients with squamous cell carcinoma of the anal canal were treated for cure. Treatment consisted of two cycles of radiotherapy (23.4 Gy) with a 4-5 week split in each cycle. 5FU (100 mg/sqm/24 h) was administered in continuous infusion for the first 4 days of therapy; mitomycin C (10 mg/sqm bolus) was administered on day 1, 4-6 weeks after the end of cycle 2 of concomitant radiochemotherapy, patients received a boost of interstitial brachytherapy. Local control on T of all patients was 84% at 5 years. Six patients showed locoregional recurrence: 3 recurrences on T and 4 disease progressions in locoregional lymph nodes. 3 of 6 patients underwent salvage surgery. The initial extent of the disease, the patient's age and brachytherapy boost did not have a statistically significant influence on local control. Two of the 30 patients showed liver metastases, and at their appearance, one patient was free of local disease while the other showed locoregional progression after Miles' operation for salvage. The metastasis-free interval was not significantly influenced by local control, although at 5 years, 96% of patients with local control of T were free of metastases vs 75% of those with recurrence on T (p = 0.22). Overall actuarial survival at 5 years was 75%. The behavior of survival in our experience seemed to be significantly influenced by local control: in the group with local control, 5-year survival was 85% vs 40% of patients with local recurrence (p = 0.01).

Adult↗