Could machine learning improve the prediction of pelvic nodal status of prostate cancer patients? Preliminary results of a pilot study.

We tested and compared performances of Roach formula, Partin tables and of three Machine Learning (ML) based algorithms based on decision trees in identifying N+ prostate cancer (PC). 1,555 cN0 and 50 cN+ PC were analyzed. Results were also verified on an independent population of 204 operated cN0 patients, with a known pN status (187 pN0, 17 pN1 patients). ML performed better, also when tested on the surgical population, with accuracy, specificity, and sensitivity ranging between 48-86%, 35-91%, and 17-79%, respectively. ML potentially allows better prediction of the nodal status of PC, potentially allowing a better tailoring of pelvic irradiation.

Retrospective evaluation of occurrence of skin injuries in interventional cardiac procedures.

Interventional cardiology procedures can involve high doses to patients and, in particular, to patients' skin, the tissue at greatest risk of deterministic injuries. The evaluation of skin dose from interventional procedures is recommended, but difficult because of the amount of different X-ray fields and projections used in a procedure. For this reason, a retrospective follow-up study has been developed to identify skin injuries in patients submitted to one or more cardiac interventions in the Udine hospital between 1998 and 2002. Seventy-eight patients with a cumulative dose-area product >300 Gy cm2 were selected from 3332 patients, who underwent 5039 procedures. In this group the maximum skin dose was 6.7 Gy. The clinical follow-up, performed using the LENT-SOMA methodology, has not detected skin injuries and this result allows a frequency to be estimated for skin injuries in patients undergoing repeated cardiac procedures of <3 x 10(-4) in our centre.

Preoperative chemoradiotherapy in cancer of the thoracic esophagus.

Surgery with or without adjuvant radiotherapy (RT) is the standard treatment of esophageal cancer. Preoperative radio- and chemotherapy (CT) have been introduced to improve prognosis. We report a phase II prospective non-randomized trial of preoperative RT (42 Gy/25) plus CT (cisplatin 20 mg/mq/day plus 5-fluorouracil 600 mg/mq/day, 1-5 weeks) for the treatment of thoracic esophageal cancer. From 1993, 50 patients were enrolled (40 men and 10 women, mean age 57 years, range 30-75 years). Squamous cell carcinoma accounted for 90% of cases; 10% were adenocarcinoma. Downstaging of the disease was obtained in 77.3% of cases; there were 13 (29.5%) complete responses (CR) and 21 (47.7%) partial responses (PR). Median survival was 28 and 25 months, respectively, for CR and partial response (PR) plus stable disease (SD) and progressive disease (PD) (P = 0.05). Progressive-free median survival was 22 and 17 months, respectively, for CR and PR + SD + PD (P = 0.08). Multimodal treatment of esophageal cancer showed promising results, although not significant, in terms of survival and disease progression for patients achieving a complete pathologic response.

[Intraoperative radiotherapy in abdominal-pelvic cancer surgery]. / La radioterapia intraoperatoria nella chirurgia oncologica addomino-pelvica.

Intraoperative radiotherapy consists in the irradiation of the affected area, exposed using anesthesiological and laparotomic procedures, following the removal of a neoplasia using palliative or macroscopically radical surgical. This increases local tumour control and augments the selectivity of treatment between healthy and neoplastic tissues, thus obtaining a marked improvement in survival or palliation. The authors analyse the data reported in international literature regarding the possible use of intraoperative radiotherapy in patients undergoing abdomino-pelvic oncological surgery. The aim of the study was to evaluate this method for use in selected and combined treatment in which surgery represents an obligatory step. Studies were carried out in a few highly specialised centres given that special technical, logistic and professional skills were required. The populations studied were often very small with a marked prevalence of feasibility studies compared to random studies. In spite of this intraoperative radiotherapy is undoubtedly indicated in locally advanced gastric, rectal and vesical neoplasia, it represents a valid palliative solution in pancreatic neoplasia and in pelvic recidivation, and an effective alternative solution to mutilating surgery in the initial stages of vesical cancer. Positive results are obtained in prostate and uterine cancer, but they are reported by non-conclusive studies. Toxicity is acceptable and non-limiting within a given range of doses and irradiated volume. The "repercussion" in terms of knowledge, experience, scientific integration between oncological surgeons and radiotherapists is basic, with a marked improved in the management of cancer treatment.

[Interstitial brachytherapy in carcinoma of the lip. Case histories and results]. / Brachiterapia interstiziale nel carcinoma del labbro. Casistica e risultati.

Squamous cell carcinomas of the lip can be treated by surgery or radiation therapy. Since local control rates exceed 90% with both treatment modalities, therapy is chosen according to functional and cosmetic results, to the patient's wishes and to the physician's medical policy. This study was aimed at retrospectively reviewing our local control results and patterns of failure relative to survival as well as evaluating the results according to technical surgical variables. From 1982 to 1991, sixty-nine patients with squamous cell carcinoma of the lip received a course of interstitial brachytherapy with 192Ir. The disease stage was T1 in 36 cases, T2 in 12 cases and T3 in 2 cases and 19 recurrences; 3 patients only had clinically detectable lymph nodes at diagnosis. Interstitial brachytherapy was used as postoperative treatment, at a dose of 60 Gy, in 47 cases. As an exclusive curative approach brachytherapy was given at a reference dose of 65 Gy, with a medium dose rate of 62.88 cGy; a single plane was used in 55 cases, a triangular plane in 11 and a double plane in 3 cases. In one patient only the disease persisted and no local failures were observed. Overall actuarial survival at 5 years is 76.81% (91.3% when corrected for disease). In fact, 6 patients died of disease progression: 3 with lung metastases, 1 with bone metastases and 3 with lymph node metastases. Five patients died of cancer in other sites--i.e., ovary, lung, prostate, hypopharynx, stomach--and 4 of non-neoplastic diseases. Tolerance rates were excellent, with only one mucosal necrosis which resolved spontaneously; no sequelae were observed in gums, teeth and jaws. The cosmetic result was also excellent in most of the cases with a worsening trend for multiplanar disposition. In conclusion, interstitial brachytherapy can be considered the treatment of choice for early lip cancer.

Cancer chemotherapy does not enhance MDR-associated 170 kd glycoprotein expression in normal blood mononuclear cells.

BACKGROUND: The multidrug resistance (MDR) associated 170kd glycoprotein (P170) is expressed at a low level in normal and malignant cells, but in the latter it becomes frequently overexpressed after chemotherapy. This study evaluated P170 expression in normal blood mononuclear cells after and during cancer chemotherapy. METHODS: P170 was detected by immunocytochemistry with two monoclonal antibodies (MRK-16 and JSB-1). RESULTS: P170 expression was low in all samples before, during and after chemotherapy. CONCLUSIONS: Cancer chemotherapy did not enhance P170 expression in normal peripheral blood mononuclear cells. The mechanisms enhancing P170 expression are likely to be more operative in tumor cells than in normal cells.

Evaluation of the circulating glycoprotein CA549 in mammary cancer and other malignancies.

A prospective study was carried out on a recent marker for breast cancer, CA549, a mucine-like acid glycoprotein present in the fat membranes of human milk. Fifty healthy control subjects and 91 with benign conditions, 103 mammary cancer patients and 256 patients with other types of malignancy were studied. For comparison, CEA and CA15-3 were also investigated. The CA549 cutoff was 11 U/ml. In breast cancer the marker was below the cutoff in 9 cases (92.8%); in malignancies other than breast cancer it was above the cutoff in 5 to 50% of patients. In breast cancer it was raised in 83.3% of cases (CA15-3 showed 82.9% and CEA 50%). In breast cancer after radical surgery, CA549 was normal in patients who were in TNM stage I but above the cutoff in 57.1% of those at more advanced stages. The follow-up study is ongoing among these patients. In all the study conditions, CA549 favorably compared to CA15-3 values, with sensitivity and specificity greater than CEA.