Erectile dysfunction after prostate three-dimensional conformal radiation therapy. Correlation with the dose to the penile bulb.

PURPOSE: Erectile dysfunction is associated with all the common treatment options for prostate cancer. The aim of this research was to evaluate the relationship between erectile function and radiation dose to the penile bulb (PB) and other proximal penile structures in men receiving conformal radiotherapy (CRT) without hormonal therapy (HT) for prostate cancer, whose sexual function was known before treatment. PATIENTS AND METHODS: The study included 19 patients treated with 3D-CRT for localized prostate cancer at our department, who were self-reported to be potent before treatment, had not received HT, and had complete follow-up data available. Our evaluation was based on the International Index of Erectile Function (IIEF-5). Dose-volume histograms (DVHs) were used to evaluate the dose to the PB. Statistical analysis was performed with an unconditional logistic regression model. RESULTS: All patients reported change in potency after radiation. Eight patients (42%) remained potent but showed a decrease of 1 or 2 levels of potency, as defined by the IIEF-5 questionnaire (reduced potency group), while 11 patients (58%) reported a change of higher levels and revealed a severe erectile dysfunction after 2 years (impotence group). Multivariate analysis of morphological and dosimetric variables yielded significance for the mean dose (p = 0.05 with an odds ratio of 1.14 and 95% CI 1-1.30). Patients receiving a mean dose of less than 50 Gy to the PB appear to have a much greater likelihood of maintaining potency. CONCLUSION: Our data suggest a possible existence of a dose-volume correlation between the dose applied to the PB and radiation-induced impotence.

An afterloading technique suitable for carcinomas of the oral cavity.

The authors describe an afterloading brachytherapy to treat oral cavity carcinomas. Catheters for arterial/venous catheterization are inserted percutaneously in the target volume. The internal needles are then removed and replaced with iridium wires inside tubes to form wire loops. This technique has proven to be simple, quick and safe.

[Influence of radiotherapy on lymphocyte subpopulations]. / Influenza della terapia radiante sulla popolazione linfocitaria.

The authors investigated the effects of radiation therapy on the immune system by studying lymphocyte subsets and other parameters in 32 patients undergoing radiation therapy for solid cancer. With monoclonal antibody techniques, we studied both T- and B-lymphocytes; cell suspensions were analyzed by means of a Facs Spectrum III Ortho (Ortho-Diagnostic) unit. The first control was performed right after the beginning of radiotherapy, when the dose to the patients was 50 Gy or higher. The second control was performed at 40 Gy because all patients received this dose. 30% of the patients exhibited lymphopenia from the beginning of the study; at 40 Gy the number of T-lymphocytes was low and helper/suppressor ratio was altered. A variable response of B-cells was observed, although all patients exhibited restoration of normal values at 6 months. Four patients only suffered from side-effects: a patient with tongue cancer presented oral mycosis, and a woman--treated for breast cancer--presented vaginal mycosis. Two cases of cystitis were also observed, after 18 Gy, in patients with uterine carcinoma undergoing pelvic irradiation. Disease progression was observed in 2 patients with head and neck cancer, while 3 patients died from lung cancer progression. Another one, with head and neck cancer, died because of heart failure.

[Role of accelerated electrons in the therapy of advanced-stage skin epithelioma advanced stage: analysis of 31 cases]. / Ruolo degli elettroni accelerati nella terapia degli epiteliomi cutanei in stadio avanzato: analisi di 31 casi.

Electron beam therapy is the superior modality of treatment for advanced skin cancer or in specific anatomical situations. The authors report the results for the electron beam therapy of 31 patients with advanced skin carcinoma. There were 15 squamous cell carcinomas, 11 basal cell carcinomas and 5 mixed, basosquamous cell carcinomas. All lesions were 3 cm or greater in maximum diameter. With follow-up ranging from 1 to 6 years, 28 patients have not evidence of disease, 1 is dead with disease, 1 is alive with suspicious residual disease and 1 is alive with recurrence. Acute and late complications are acceptable; bone, cartilage and soft tissue necrosis are not reported. The treatment results are similar to those in the literature and show the advantages of the electron beam irradiation for advanced skin carcinomas.

[The treatment of cancer of the anal area with radiotherapy. An analysis of the authors' personal experience]. / Trattamento del cancro della regione anale con radioterapia. Analisi dell'esperienza personale.

The treatment of anal canal carcinoma is very difficult and great care must be taken in planning therapy because this type of cancer is potentially curable. From 1982 through 1989 we treated 16 patients with carcinoma of the anal canal. All patients were evaluable for toxicity and 14/16 for response after treatment. Of the 12 patients who underwent irradiation alone and were N0 M0, 8 are alive with no evidence of the disease, 4 had a recurrence which was treated with radical surgery, and 2 underwent palliative treatment alone. Therapy toxicity was not relevant in most cases and our results are in agreement with those reported in the literature.

[Oral bacteriotherapy with Bifidobacterium bifidum and Lactobacillus acidophilus in cirrhotic patients]. / Batterioterapia orale con Bifidobacterium bifidum e Lactobacillus acidophilus nel cirrotico.

Thirty-five patients with alcohol cirrhosis were treated for several months (average 4 months) with Infloran (6 capsules daily). Thirty cirrhotics were treated for the same length of time with lactulose and diuretics. Infloran-treated patients showed reduced ammonium levels, improvement of mental status and psychological performance. In addition, patients who required hospitalization had shorter in-patient periods thanks to a more rapid psychological and physical improvement. Infloran may be considered a valid alternative to conventional therapy for the out-patient management of subjects with alcoholic cirrhosis.

Effectiveness and toxicity of "BELD" polychemotherapy in advanced malignant melanoma.

From January 1985 to December 1987, 17 patients with advanced malignant melanoma were treated with the polychemotherapy regimen BELD (bleomycin, 15 mg subcutaneously on day 1 and 4, vindesine 3 mg/m2 intravenously on day 1 and 5, CCNU 80 mg/m2 orally on day 1 and DTIC 200 mg/m2 intravenously on day 1 through 5) proposed as effective (CR + PR 45%) and tolerable. All patients were evaluable for toxicity and 14/17 also for response after 2 BELD cycles (total n. of cycles was 54). Criteria for response were just the same as those used by Young et al. A complete remission and a partial remission (2/14) have been observed at lymph nodal level, the unique sites of the disease in these two patients. Remission lasted 6 and 4 months, respectively. Two other patients showed a minimal response of 2 and 3 months duration (lymphonodal and cutis, respectively); 9 patients had stabilized disease of 5 months median duration. One case of progression of disease was observed. However, toxicity was relevant because of 2 early deaths after the first cycle, most probably therapy related, nausea and vomiting (82%), leukopenia (17%) and muscle rigors (11%).