ABSTRACT
AIM: Generally speaking, the negative side of radiation treatment of the pelvic district is the toxicity that may compromise the patient's quality of life and lead to temporary suspension of treatment with possible negative effects on its effectiveness. In neoadjuvant radiochemotherapy for locally advanced rectal cancer (LARC), the toxicity that is most frequently observed is proctitis, usually treated with topical corticosteroids or mesalazine. Hyaluronic acid's function is to restore the regular trophism and elasticity of the connective tissues leading to faster repair of the damage, and this could represent a viable option for the control of actinic proctitis. METHODS: Since March 2012, a neoadjuvant radiochemotherapy protocol has been active at the Pisa Universitary Hospital for patients with LARC; 23 patients have been enrolled up to the present. Treatment involves an induction chemotherapy phase according to the FOLFOXIRI + Bevacizumab regimen for 6 cycles, followed by chemotherapy (capecitabina + Bevacizumab) concomitant with radiotherapy (5040 cGy in 28 fractions). Surgery is scheduled 6-8 weeks after the end of RTCT. During the course of associated treatment (RTCT), 12/23 patients received topical therapy with hyaluronic acid (Proktis-M suppositories) for the prevention of proctitis. RESULTS: All 23 patients enrolled in the study completed the induction chemotherapy phase. In the first 11 enrolled patients who did not receive prior Proktis-M suppositories, intense rectal toxicity was observed. Proctalgia of grade G1-2 and G3-4 presented respectively in 64% and 36% of cases, with consequent interruption of treatment which, in 45% of patients, lasted longer than 10 days. In the remaining 12 patients who underwent prior treatment with Proktis-M suppositories, the percentage of rectal toxicity was lower. In those cases where it did present, onset was later and its intensity and duration lower. 25% of patients did not develop proctalgia, 33% developed proctalgia of grade G1 and 42% proctalgia of grade G2. In none of these was it found necessary to interrupt radiochemotherapy. CONCLUSION: Prior topical treatment with Proktis-M suppositories in patients undergoing preoperative RTCT for LARC, enabled us to carry out radiochemotherapy at scheduled times, so protecting the treatment's effectiveness on the down-staging of the disease and preserving the patient's quality of life.
Subject(s)
Adenocarcinoma/therapy , Adjuvants, Immunologic/therapeutic use , Hyaluronic Acid/therapeutic use , Proctitis/prevention & control , Rectal Neoplasms/therapy , Chemoradiotherapy , Humans , Neoadjuvant Therapy , SuppositoriesABSTRACT
The Horne and Hostberg questionnaire to differentiate "morning" and "evening" types was adopted to study the morningness-eveningness in I44 medical students. Furthermore the reliability of the proposed typology was assessed by using the cluster analysis, which partially confirmed the categories of Horne and Ostberg, since the clusters were characterized by the presence of subjects belonging to different types. No difference by sex was observed by either method. By means of the cluster analysis it was possible to identify 20% of evening and 40% of morning types.
Subject(s)
Circadian Rhythm , Individuality , Somatotypes , Adult , Female , Humans , Male , Surveys and QuestionnairesSubject(s)
Circadian Rhythm , Individuality , Somatotypes , Biometry , Humans , Surveys and QuestionnairesABSTRACT
A questionnaire modified in regard to that previously suggested by Horne and Ostberg has been utilized to distinguish the "morning" from the "evening" types. In 144 medical students it was found that almost 22% were evening type and 53% were morning type. By means of the new questionnaire there was an increment, percentagewise, of both groups from the 62% to 75%, indicating the usefulness of the method. The study of biological as well as psychological parameters should be pursued in order to control the validity of these results.