[Intraoperative electron radiotherapy (IOERT) in the QUART sequence: a phase I study]. / Radioterapia intraoperatoria con elettroni (IOERT) nella sequenza QUART: studio di fase I.

We evaluated the tolerance of a single dose of 800-1500 cGy, delivered with an electron beam from an IOERT-dedicated linear accelerator to the tumour bed in patients with breast cancer undergoing conservative treatment, instead of the traditional boost. We enrolled 27 patients (cT1-2, cN0). The first 6 received a dose of 800 cGy, 6 1000 cGy, 10 1200 cGy and 5 1500 cGy. External beam radiation therapy (EBRT) with a conventional schedule, 4000 cGy total dose, was performed after wound healing. The median gap between IOERT and EBRT was 8 weeks. Three patients with adverse prognostic factors undergoing chemotherapy, including doxorubicin or taxanes, received EBRT after completion of chemotherapy. One patient with a prosthesis implant had yielding of the surgical scar 8 months after IOERT (after 4 cycles of doxorubicin and 4 cycles of CMF complicated by frequent mastitis). Another patient with a large serum collection in the axilla manifested delayed scar formation. In the others no significant increase in healing time or surgery-related morbidity was observed. Another 4 patients developed mastitis. The cosmetic outcome was good in 26/27 patients. This treatment is well tolerated at all IOERT doses delivered. In the follow-up, to date, there have been no local relapses.

The value of ultrasound as a screening procedure for urological disorders in renal failure.

Renal ultrasound was evaluated as a screening procedure for urological conditions (hydronephrosis or space-occupying lesions) in 175 patients (316 kidneys) with renal failure. The final diagnosis of renal disease was based on excretory urography, ascending or translumbar pyelography, open surgical findings, clinical and laboratory test results or renal biopsies. Ultrasonic images suggestive of renal disease requiring surgery were obtained in 83 kidneys and subsequently confirmed in 67. There were 16 falsely positive and 2 falsely negative results. Assuming a 22 per cent prevalence of renal disease requiring surgery in the azotemic population, Bayes' theorem predicts that an abnormal ultrasonic test will increase the probability of surgery in a patient with renal failure from 0.22 to 0.81, while a negative test will reduce the probability from 0.22 to 0.013. Renal ultrasound is a highly effective method to screen for patients with renal failure who require contrast studies. With this means the risks and cost of contrast investigations can be reduced markedly.