[Use of fast neutrons in the treatment of tumors of the salivary glands: rationale, review of the literature and experience in Orleans]. / Utilisation des neutrons rapides dans le traitement des tumeurs des glandes salivaires: rationnel, revue de la littérature et expérience d'Orléans.

If low LET radiation therapy (photons, electrons), following radical microscopically and complete surgery can improve results in term of local control from 34 to 74% for salivary gland tumors, local control is more difficult to achieve in advanced tumors and only palliative treatment is usually attempted. In this survey, all the patient series treated worldwide were reviewed. They show an overall control rate of 31% with photon vs 64% with neutron therapy. A prospective randomised trial sponsored by the RTOG and the MRC published in 1988 and reviewed in 1993 showed an overall locoregional complete tumor clearance of 67% for neutrons and 17% for photons (P < 0.005), with 68% and 25% survival at two years for neutrons and photons respectively. This study was closed for ethical reasons. In Orleans, since 1987, 59 patients have been treated. At five years the persistent local control probability was 69.5%, the five-year crude survival probability 66% and the five-year tumor free survival probability was 64.5%. This review provides evidence that surgical treatment for salivary gland tumors should be limited to patients presenting a high likelihood of negative surgical margin and a small risk of facial nerve damage. Others patients should receive neutron radiation therapy alone as definitive treatment.

Quality of life in patients with ductal carcinoma in situ of the breast treated with conservative surgery and postoperative irradiation.

AIM OF THE STUDY: To evaluate the quality of life (QL) in patients with ductal carcinoma in situ of the breast treated with conservative surgery and postoperative irradiation. MATERIAL AND METHODS: A self-completed questionnaire covering many disease-, symptom-, and treatment-specific issues was administered to 106 conservatively treated patients affected by non-infiltrating breast cancer. The questionnaire was based on a series of 34 items assessing five main fields of post-treatment adjustment: physical well being, sexual adaptation, aesthetic outcome, emotional/psychological well being, relational behaviour. Furthermore, the patients were requested to evaluate the degree of information provided by the medical staff concerning surgical procedures and radiation therapy, and to evaluate the effects of the treatment on their social and overall life. RESULTS: The questionnaire was completed by 83 patients (78%), who had a median follow-up of 54.5 months. This final sample had a median age of 50 years (range 29-88) at the time of treatment and 54 years (range 32-94) at the time of study. The patients claimed to be in good physical condition. Data relating to sexual life were provided by 93% of the sample. Some limitations in sexuality, some interference with sexual desire, and some modifications during intercourse were reported by 5, 6, and 5 patients, respectively. The subjective evaluations of the cosmetic results of the therapies were generally good. Only 13 patients (16%) reported the perception of a worsened body image. Forty-six percent of the sample (38 patients) declared that they felt tense, 48% (39 patients) nervous, 29% (38 patients) lonely, 59% (41 patients) anxious, and 41% (34 patients) depressed. Only seven patients (8%) declared that the treatment had had a bad effect on their social life, and 15 (18%) thought that their current life had been affected by the treatment. The amount of information received concerning the disease and treatment (surgery and radiotherapy) was considered sufficient by 79%, 75%, and 79% of the sample, respectively. CONCLUSIONS: This study revealed a good QL in patients treated with breast conservation and postoperative irradiation, with a preserved favourable body image and a lack of negative impact on sexuality. Radiation therapy did not lead to any significant additional problems capable of affecting the QL.

Neoadjuvant chemotherapy with continuous infusion of cisplatin and fluorouracil in stage II-IV, M0 squamous cell carcinoma of the head and neck.

AIMS AND BACKGROUND: The aim of the study was to assess the activity and the toxicity of cisplatin (DDP) and fluorouracil (FU) administered by continuous infusion as neoadjuvant chemotherapy for patients with stage II-IV, M0 squamous cell carcinoma of the head and neck. METHODS: Thirty previously untreated patients were submitted to chemotherapy with DDP (20 mg/m2) and FU (1000 mg/m2), both in continuous infusion for 5 days, repeated every 21 days, for a maximum of 5 cycles. Following completion of chemotherapy, the patients underwent radiotherapy; in some patients surgery was performed immediately after chemotherapy. All patients were monitored for response, time to failure, survival, treatment-related events and toxicity. RESULTS: All patients were evaluated for response; after chemotherapy the complete response rate was 27% and the partial response rate 33%. Twenty-four patients underwent radiotherapy: the overall response rate was 83% (complete response 79%). After a median follow-up of 34 months, the median survival time was 22 months with a median time to failure of 15 months. Acute vascular accidents were the main and unexpected adverse events, with 2 deaths for pulmonary embolism and 1 for stroke. The response rate to the regimen does not seem to be better than that obtained with the standard combination of cisplatin bolus and fluorouracil continuous infusion. The disadvantage of the regimen is that it causes more discomfort for the patient in that it requires hospitalization. CONCLUSIONS: For this reason, we believe that there are no elements for recommending the schedule as neoadjuvant treatment of patients with squamous cell carcinoma of the head and neck or as an experimental arm in a randomized trial.

[Radiotherapy of the breast: changes in the volume of the lung covered in the treatment fields and resulting changes in dose distribution]. / Radioterapia della mammella: variazioni del volume del polmone compreso nei campi del trattamento e conseguenti modificazioni della distribuzione della dose.

In breast cancer adjuvant therapy, respiratory movements continuously modify the irradiated volumes and the anatomical shape of this body region. Fifteen patients were submitted to 3 Computed Tomography (CT) sequences for treatment planning: the first one without any indications to the patient (the standard sequence) and the second and the third one with spontaneous stopped inspiration and expiration, respectively; the patient was always in the same position. The treatment was planned on standard CT images and then applied to the other sequences, maintaining all parameters unvaried, including isocenter position and treatment time. The lung volumes within the fields (and those included in the 95%, 100%, 105% isodoses referred to the prescribed dose) were evaluated with dose/volume histograms. The average irradiated lung was 69 cm3 (DS 28) in standard sequences, 136 cm3 (DS 67) in inspiration and 41 cm3 (DS 25) in expiration. The pulmonary volume within the above isodoses exhibited similar changes. In other words, the lung volume actually irradiated during the whole treatment is smaller than the one which can be calculated on standard CT sequences and it corresponds to expiration volume. The remaining part falls into a wide "twilight zone" relative to dose. Therefore, the true risk of lung toxicity can be similarly lower than the calculable one on standard CT images. Thus, the complication risk (based on dose/volume histograms and normal tissue control probability parameters) could be assessed in new prospective studies, introducing a corrective factor for the irradiated lung volume, because the latter is smaller than that shown by standard CT.

Postradiation sarcoma of head and neck: report of two cases.

AIMS AND BACKGROUND: Post-irradiation sarcoma (PIS) a rare, late side effect of radiotherapy and, consequently, its natural history is not well known. For this reason, two cases treated between 1975 and 1990 are described. CASE REPORTS: The Authors describe one case of malignant fibrous histiocytoma grown in the larynx 111 months after conservative surgery and postoperative radiotherapy, and one case of soft tissue sarcoma developed in the oral cavity 72 months after radical interstitial low dose rate brachytherapy. Both patients had chronic distress of the soft tissues after the primary treatment. The patients are alive and well respectively at 94 and 18 months from salvage surgery. DISCUSSION: The PIS of the head and neck region is a rare event, usually with a bad prognosis. An improvement in results could be possible with early diagnosis, followed by a timely excision, when anatomically possible. As the chronic suffering of the irradiated tissues may increase the risk of PIS, a longer and more frequent follow-up is advisable in these cases.

[Adjuvant radiotherapy in rectal neoplasms. Survival analysis,local control, prognostic factors and toxicity]. / Radioterapia adiuvante nelle neoplasie del retto. Analisi di sopravvivenza, controllo locale, fattori prognostici e tossicità.

January 1985 to June 1991, seventy-five patients affected with surgically treated rectal cancer received adjuvant postoperative irradiation at the Radiation Therapy Department of the Ospedale S. Maria Nuova, Reggio Emilia, Italy. Forty-seven patients had Astler-Coller B2-B3 lesions and 28 had stage C2-C3 disease. The patients underwent postoperative irradiation (range: 44-60 Gy, median: 48.5 Gy) with a 60 Co unit, most of them with conventional fractionation; no patient received adjuvant chemotherapy. A local boost was used in 19 cases (5.4-14 Gy); actuarial 5-year overall and disease-free survival rates were 55.2 +/- 10.5% and 53.4 +/- 10%, respectively; actuarial 5-year local control was 78.7 +/- 10.5%. In 11 cases (14.5%) chronic sequelae were observed; 6 cases required surgical intervention. In 42% of cases the disease relapsed, locally in 12 patients (16%). In conclusion, our results are in agreement with literature data; adequate and innovative techniques are required to decrease treatment-related toxicity.

[Effects of immunomodulation on antineoplastic radiotherapy. A controlled clinical study]. / Effetti dell'immunomodulazione nella radioterapia antineoplastica. Studio clinico controllato.

It is well known that thymic hormones can counteract immunodepression due to radiation therapy, preventing and reducing the severity and the number of myelotoxic and hematologic reactions. We tried to confirm these findings in a controlled multicenter clinical study involving 1,060 patients undergoing radiation therapy (580 treated with thymopentin 50 mg s.c. every other day, after irradiation and for at least 6 cycles of 4 weeks each, and 480 control patients). Highly statistically significant results (to the ANOVA test) were obtained in the protection against radiation-induced leukopenia in the treated group; furthermore, the treated patients had a marked reduction (p = 0.003 chi 2 test) in the early delayed reactions to irradiation, namely in the upper aero-digestive tract. In general, we observed a better, but not statistically significant recovery of the blood parameters, lymphocyte subsets and skin tests in the treated group versus the control group. Both of the treated groups showed the same trend for Karnofsky performance status and body weight. The local and general protection provided by thymopentin against the reactions to irradiation could be advantageously used for the administration of higher doses of radiation therapy.

Treatment of metastatic colorectal cancer by means of specific monoclonal antibodies conjugated with iodine-131: a phase II study.

Eighteen consecutive patients with advanced and/or metastatic colorectal carcinoma have been treated with intraperitoneal administration of radiolabelled (iodine-131) monoclonal antibodies raised against different antigens associated to these kinds of tumours: anti-CEA FO23C5, anti-CEA BW494/32, anti-TAG B72.3, AUA1. The doses of isotope ranged between 21 and 150 mCi (777-5550 MBq) which delivered a radiation dose to the target tumour from 768 to 4628 cGy. Thirteen patients were previously treated with conventional regimens which consisted of chemotherapy (5-fluoracil with or without other anti-neoplastic drugs) both in adjuvant or palliative setting. Three patients are considered non-evaluable owing to concomitant chemotherapy in 2 and lack of objective parameters in 1. Out of 15 evaluable patients 2 achieved complete remission and 2 partial remission with a response rate of 26.6%. Three stable and 8 with progressive disease have also been registered. The toxicity was negligible consisting of hematologic WHO grade 1 in 7 patients, grade 2 in 1 patient and grade 3 in 1 patient, as well as hepatic WHO grade 1 in 8 and grade 2 in 2 patients. The authors conclude that this innovative way of treatment for advanced colorectal carcinoma seems to offer promising therapy; from these data, therefore, a new trial is justified employing radiolabelled MoAbs in well selected patients with metastatic or locally advanced colorectal carcinoma.

[En-bloc treatment of tumors of the hypopharyngeal-laryngeal-tracheal tract with a new isocentric multipendular technic]. / Trattamento in blocco dei tumori del tratto ipofaringo-laringo-tracheale con una nuova tecnica multipendolare isocentrica.

The authors propose a new technique for the treatment of hypopharyngeal-laryngeal-tracheal tract tumors using cobalt-60 irradiation. This technique allows the simultaneous irradiation of both primary tumor and cervical lymph nodes. Therapeutically effective doses can be administered without affecting the spinal cord. The above-mentioned technique consists of 3 isocentric rotations, the widest one carried out by interposing a small lead bar shielding in the middle of the field. Dose distributions obtained in an Alderson-Rando phantom and in a patient are reported.

[Analysis of prognostic factors in 106 cases of carcinoma of the rhinopharynx treated with cobalt teletherapy]. / Analisi dei fattori prognostici in 106 casi di carcinoma della rinofaringe trattati con telecobaltoterapia.

A series of 106 patients affected with nasopharyngeal carcinomas and treated by definitive external irradiation from January 1975 to December 1986 was retrospectively reviewed. The median follow-up, from the end of the treatment, was 43 months (range 24-90). The nasopharynx received not less than 60 Gy to the midplane: the clinically negative neck (N0) was treated with a total dose of 50 Gy and the patients who had N1-3 disease received not less than 60 Gy. Thirty-eight patients had a recurrence in the irradiated areas (31 in the nasopharynx, and 7 in the neck); 17 patients developed distant metastases. Disease-free survival at 60 months was 42%. The most significant prognostic factor (p less than 0.05) was the presence of advanced neck involvement (N2-3), since most of the lymphatic and distant recurrences were observed in this group of patients. The overall results did not reveal but slight differences in the survival according to histology, even though patients with undifferentiated carcinomas had a local recurrence rate significantly lower than those with squamous cell carcinomas. Our findings suggest that patients with N2-3 neck diseases or with locally advanced involvement (T3-4) be treated by adjuvant chemotherapy in order to decrease the risk of local and distant relapses.