Prospective phase II trial of cetuximab plus VMAT-SIB in locally advanced head and neck squamous cell carcinoma. Feasibility and tolerability in elderly and chemotherapy-ineligible patients.

INTRODUCTION: Cetuximab plus radiotherapy (RT) may be an effective alternative to chemoradiation in locally advanced head and neck squamous cell carcinoma (LASCCHN) patients. We analyzed a group of patients treated at our institute with cetuximab plus volumetric modulation arc therapy (VMAT) with the RapidArc technique in a simultaneous integrated boost (SIB) regime. The primary end point was the assessment of acute toxicity and the feasibility of the combined approach. MATERIALS AND METHODS: Between December 2008 and March 2010, 22 patients were submitted to IMRT-SIB plus cetuximab for radical intent in case of LASCCHN. None of the patients was suitable for chemotherapy because of important comorbidities (the majority suffered of heart chronic diseases). All patients underwent planning CT (additional image modalities were acquired for contouring purposes in the same treatment position: MRI in 12 and FDG-PET in 4 out of 22 patients). VMAT, by means of RapidArc, and SIB with two dose levels of 54.45 Gy and 69.96 Gy in 33 fractions were adopted. All patients included in the analysis were concomitantly treated with cetuximab: administration of the drug was initiated 1 week before RT at a loading dose of 400 mg/m(2) body surface area over a period of 120 min, follow by a weekly 60 min infusion of 250 mg/m(2) for the duration of RT. Patients were assessed for toxicities according to the Radiation Therapy Oncology Group (RTOG) criteria. RESULTS: All but 2 patients completed treatment and achieved the minimum follow-up of 12 months after the end of the treatment. Of the 22 patients, 18% (4 patients) showed grade 1, 36% (8 patients) grade 2, and 36% (8 patients) showed grade 3 dermatitis, while 9% (2 patients) had grade 1, 36% (8 patients) grade 2, and 45% (10 patients) had grade 3 mucositis/stomatitis. No grade 4 toxicities were recorded. Considering blood parameters, 3 cases of grade 1 anemia and 1 case of grade 2 thrombocytopenia were observed. Nobody required feeding tube placement during treatment. CONCLUSION: The here reported toxicity data are promising and encouraging in regard to the adoption of moderate hypofractionation with VMAT-SIB techniques, when cetuximab is concomitantly administered.

Sinonasal inverted papilloma: 84 patients treated by endoscopy and proposal for a new classification.

AIM: To suggest a new classification system for sinonasal papilloma based on a critical analysis of surgical indications and results obtained. METHODS: We analysed surgical data from 84 cases of sinonasal papilloma treated endoscopically. RESULTS: In 58 males and 26 females, between 25 and 85 years, the ethmoid sinus (63 cases), the maxillary sinus (43), and the nasal fossa (22) were mostly involved. No case of endocranial extension or carcinoma was reported. Complications were reported in 15.4% of patients, as well as 5 recurrences (5.9%). Median follow up was 39,5 months. To categorise the tumour for the most appropriate surgical treatment, we propose a classification based on 6 main categories that depend on the location, origin and extension of the tumour. CONCLUSION: The classification that we propose presents advantages for prognosis and surgical indication in comparison with other classifications.

[A rare case of isolated aspergilloma of the sphenoid sinus]. / Su un raro caso di aspergilloma isolato del seno sfenoidale.

The authors report an interesting case of an isolated pathology of the sphenoid sinus (more precisely, in this case a mycotic infection of this paranasal sinus), up to a few years ago an extremely rare disease and still today an exceptional entity in the clinical practice of an otolaryngologist. The investigations carried out indicated that the infection was caused by Aspergillus candidus, a fungus which only rarely becomes pathogenic in man. The paper reports the main anamnestic data as well as the clinical and instrumental assessment of the disease. It furthermore describes the surgical procedure employed, the relative reports obtained and supplies data concerning the microbiological tests carried out on the material removed and the histological pattern observed. The surgery had an excellent outcome: the patient was cured and showed no sign of recurrence of the disease. The discussion briefly presents the clinical picture created in man by Aspergillus and stresses the rarity of the disease, noting that, including the case in question, only 23 reports, documented with histological and microscopic data, have been made in literature. The AA affirm that to their knowledge this particular case of sphenoid sinusitis caused by Aspergillus candidus [correction of Candida] is the first ever to be reported and in conclusion underline the extreme care necessary in dealing with this pathology and in making a "quoad vitam" prognosis.

[Pneumocystosis]. / Pneumocistosi.

On the basis of personal experience, the microbiological, epidemiological, clinical and therapeutic features of Pneumocystis carinii pneumonia are analysed.