Dermatologic radiotherapy in the treatment of extensive basal cell carcinomas: a retrospective study.

BACKGROUND: The increase of the number of new cases for year of basal cell carcinoma (BCC) has brought also an increase of BCC difficult to treat (extensive, locally advanced and high risk forms). OBJECTIVE: To evaluate retrospectively the results obtained with dermatologic radiotherapy (RT) for better defining the indications respect to new emerging treatments. METHODS: A series of extensive 115 BCC treated with RT from 1977 to 2014 were selected for the study, since endowed with histological diagnosis on the amount of 181 extensive BCC. RT was performed with conventional energies (50-160 kV) administering a total dose ranging from 47 to 85 Gy (median 55 Gy). The mean follow up was 40.66 months (median 21 months). A statistical evaluation was performed with chi-square test to analyse the possible correlations among therapeutic and cosmetic results and size, localisation and clinical type of the lesions. RESULTS: A complete remission (CR) was obtained in 70.43%, a partial remission (PR) in 20% of the lesions treated, while in 9.56% a no response (NR) or not evaluable response (NER) was registered. In 19% of the lesions a relapse was observed, with a five-year cure-rate of 55.13%. Cosmetic results were good in 28%, acceptable in 50% and not acceptable in 22% of the lesions in CR. In six lesions, localised at the trunk region, a chronic radiodermatitis developed. A statistically significative correlation was observed between therapeutic results and size, between cosmetic results and size and between therapeutic results and clinical type of BCC. CONCLUSION: The treatment of extensive BCC is still a challenge and radiotherapy is one of the possible choices, preferred in the elderly, in relapsing cases, after incomplete excision, and in difficult localisations of the face. Radiotherapy might be included in sequential schedules of treatment to improve final results.

Radiotherapy of morphea-type basal cell carcinoma: results in 127 cases.

BACKGROUND: The morphea-type basal cell carcinoma (MBCC) is a rare form of basal cell carcinoma (BCC) with lower response to treatments than other types of BCC.Objective To evaluate the role of radiotherapy (RT) in the therapeutic strategy of MBCC. METHODS: A retrospective study was performed on 127 patients affected with MBCC, who underwent RT in the period 1982-2013. RT was delivered with conventional energies ranging from 50 to 120 kV and the administration of a total dose ranging from 40 to 70 Gy (mean 56.17 Gy). The irradiated fields included a margin of 1.5 cm around the lesion. RESULTS: The median follow-up time was 29 months (range 1-324 months). Complete remission was observed in 122 patients (96.06%), partial remission in one (0.78%). Three cases were non-responsive (2.36%). In one case (0.78%), the lesion failed to heal after RT, since the onset of radiodermatitis histologically ascertained. The cure rate was 81.08% after 5 years and 78.02% after 10 years from the end of RT. Twelve cases relapsed (10.2%). CONCLUSION: Because of the frequent diagnostic delay and its ill-defined margins, MBCC is difficult to cure. Our results after 5 years from RT (cure rate 81.08%) are more satisfactory respect to the others reported in the literature (69% and 72.3%), but less good than those obtained in other forms of primary malignant neoplasms of the skin (92.43%). Nevertheless,we consider that RT plays an important role in the therapeutic strategy of MBCCs. In fact, it can be applied easily in elderly patients, and in peculiar localization of the disease (eyelid, nose and ear), without being invasive.

Radiotherapy of carcinomas of the skin overlying the cartilage of the nose: our experience in 671 lesions.

BACKGROUND: The skin overlying the nose cartilage is a particularly frequent localization of skin carcinoma (about 25% of all carcinomas occurring on the head and neck). It is therefore of great practical interest to identify the best therapy, able to combine effectiveness with a good cosmetic and functional result. OBJECTIVE: To verify both the therapeutic effectiveness of dermatologic radiotherapy and its 'toxicity' in the treatment of a large number of skin carcinomas overlying the cartilage of the nose. METHODS: A retrospective study was done on 671 basal and squamous cell carcinomas treated by kilovoltage radiotherapy in the period 1972-2007. RESULTS: The mean follow-up time was 38.016 months (range, 1-351 months). The 5-year cure rate was 88.09%. Cosmetic results were evaluated as 'good' or 'acceptable' in 96.84% of the treated lesions in complete remission. So far, no complication or sequelae to the radiologic treatment have been observed. CONCLUSION: Dermatologic radiotherapy showed to be a safe, effective and non-invasive method, superior, on the basis of the literature data, to any other available therapeutic modality in the management of basal and squamous cell skin carcinomas localized over the nasal cartilages.

[The doses absorbed by the patients and the exposure of the operators in dental radiodiagnosis]. / Dosi assorbite dai pazienti ed esposizione degli operatori nella radiodiagnostica odontoiatrica.

The present paper reports an updated dosimetry of dental radiology since it presents the data relative to 7 radiological techniques. The doses to 9 organs were measured on a Randoman phantom using TLD (4 in each chosen cavity) for lenses, tongue, cervical vertebrae (C2), thyroid, ovaries, uterus and testes. The examinations were subsequently repeated after applying X-ray shields to the phantom. The main conclusions follow: a) local doses are never negligible but can be really high, especially for tongue (1.880 mGy), thyroid (1.011 mGy), and C2 (0.699 mGy); b) X-ray shields for lenses, ovaries, uterus and testes have proven to be unnecessary; in a more general context, X-ray shields should be evaluated by the Health Physics Dept., especially relative to radiation leaks from the X-ray tube. As for the thyroid, X-ray shields have proven very useful but can result in repeated acquisitions because of possible interference with the radiological image; c) technicians' risk, in the present experimental conditions, does not exceed the threshold values recommended by Italian laws. At any rate, the use of fixed or mobile shieldings should always be evaluated while keeping in mind the specific working conditions in radiology departments.

[Sources of ionizing radiation in dwellings]. / Fonti di radiazioni ionizzanti nelle abitazioni.

According to recent surveys made by the International Commission on Radiological Protection (ICRP) and the World Health Organization (WHO), it has been estimated that in temperate regions people spend only 20% of their time outdoors and spend the remaining 80% indoors (homes, schools, other buildings). It is therefore important to establish whether radiation sources exist inside buildings in order to assess risk for the population. The 238U and 232Th radioactive chains are of particular importance because of Radon and Radon daughter production and 40K as component of building materials. It has been estimated that about 4.5% of lung cancers observed in the population are associated with exposure to Radon daughters. In order to comply with international regulations it is estimated that 1.5% of the existing dwellings in temperate regions need to be improved.

[NIOBI-X filter: reduction of patient exposure and effect on image quality]. / Filtro NIOBI-X: riduzione dell'esposizione del paziente ed effetto sulla qualità dell'immagine.

Patient protection against ionizing radiation has become more and more important and the subject has been included in all the latest ICRP publications. Recently a 50 microns Niobium filter (NIOBI-X) has come out, which, installed on tungsten anode X-ray apparatuses, allows patient dose reduction by absorbing the radiation which does not contribute to the image. In order to verify the NIOBI-X actual effect on image quality and on patient dose reduction, image resolution, image contrast and patient exposure (air-Kerma) were measured using a bone-equivalent stepped wedge. The NIOBI-X, added to the total filtration of the X-ray apparatus, allows an air-Kerma reduction of about 50% from 60 to 130 kV. In the case of bone-equivalent material exposure the filter causes a slight contrast loss and does not affect, or even improves, image resolution. Before choosing the NIOBI-X filter for all the X-ray apparatuses a cost-benefit analysis should of course be made by evaluating results and cost related to other kinds of filter. With particular regard to Aluminium filters, whose prices are far lower than Niobium ones, it has to be pointed out that: 1) in order to have the same air-Kerma reduction the Aluminium filter thickness must be quite heavy (2.8 mm) which causes practical problems of use; 2) the Aluminium filter causes image quality loss especially at lower kVs.

[Phototherapy of psoriasis of the scalp. Results in 21 patients treated with a special portable ultraviolet rays lamp]. / Fototerapia della psoriasi del cuoio capelluto. Risultati in 21 pazienti trattati con una apposita lampada portatile a raggi ultravioletti.

The presence of hair hampers the performance of photo- and photochemotherapy and blocks the efficacy of exposure to sunlight in patients affected by scalp psoriasis. A portable source of ultra-violet rays was tested on 21 patients: the device is equipped with a special comb which, by separating the hair, partially overcomes the protective shield formed by the latter. The light source's physical parameters were experimentally evaluated and it is worth noting the high concentration of UVB in the emission spectrum. No topical or systemic drugs were used during treatment. A complete remission of dermatosis was achieved in 6 cases, a marked improvement in 11 (50-95%), and a slight improvement in 4 (20-30%). The source used was found to be efficacious especially in those forms of slight to medium psoriasis of the capillitium; it was handy and easy to use making it suitable for home use.