Non-Hodgkin lymphomas presenting with spinal epidural involvement.

Spinal cord compression was the presenting symptom in 9 out of 299 previously undiagnosed non-Hodgkin lymphomas observed between 1972 and 1987. All patients had unfavourable histologic diagnosis and 4 had stage I E, 2 stage II E and 2 were staged as IV; one patient did not undergo a staging procedure. All patients were treated with surgery and radiotherapy, whereas chemotherapy was employed in 3 cases only. Only 2 patients are still alive and disease-free after 3 and 8 years respectively; the remaining 7 died with progression of disease, even if in 2 cases a complete clinical remission was obtained. The recent literature has been reviewed. Non-Hodgkin lymphoma with spinal epidural presentation is usually an aggressive disease. An intensive treatment combining surgery, radiotherapy and chemotherapy is finally suggested to achieve better local and long-term results. Surgery can as a rule be limited to laminectomy plus biopsy.

Postoperative management of primary spinal cord ependymomas.

Treatment and final outcome of 11 patients with primary spinal cord ependymomas admitted between 1967 and 1983 have been reviewed. All patients had undergone surgery once or twice before radiation treatment. Six of them are alive and disease-free 78 months to more than 180 months after radiation therapy. A short analysis of the recent literature is presented with special emphasis on the most frequent treatment techniques, extension of radiation fields and doses. The value of postoperative radiation therapy and the complications of both surgery and radiotherapy are analyzed. Some guidelines for treatment are finally discussed and proposed.

Postoperative irradiation of brain ependymomas. Analysis of 33 cases.

Treatment and final outcome of 33 patients with brain ependymoma were reviewed. All patients had been operated, but the surgical removal was incomplete in the great majority of cases. Radiation therapy was subsequently performed using one of the following techniques; a) partial brain irradiation against the primary involved areas in 17 cases, b) whole brain irradiation plus boost against primary involved sites in 6 cases and c) total craniospinal irradiation in 7 cases. Three patients were not eligible for the present study because of underdosage. Five- and 10-year survival rates were 48 and 38% respectively. A short survey of recent literature is presented. The possible causes of failure and the methods for postoperative irradiation are discussed against the background of literature and our own cases.

Dose evaluation to patients irradiated by 60Co beams, by means of direct measurement on the incident and on the exit surfaces.

A method for direct dose measurements on a patient treated with 60Co beams, is described. A home-made multi-probe dosimeter with silicon diodes as detectors is described. Measurements were performed on the entrance as well as on the exit fields, and a correlation was established with the mid-line dose. The influence of field size, SSD, patient thickness, and inhomogeneities was investigated.

Pharmacological data and technical feasibility of intraperitoneal 5-fluorouracil administration.

Via a surgically implanted Tenckhoff catheter, 5-fluorouracil was intraperitoneally administered to patients with malignant disease confined to abdominal space. Treatment was well tolerated without local complications. Peritoneal and plasmatic drug levels were measured, showing that: 1) peritoneal drug levels declined as a first order function; 2) plasmatic levels were very close to those reported for continuous i.v. administration, but peritoneal concentrations were much higher (log 1 to 3); 3) concentration x time product had a peritoneum: plasma ratio ranging from 120 to 1350. The hypothesized role of intraperitoneal 5-fluorouracil administration and the questions still to be answered are summarized.

[Approach to the problem of economic costs of the medical therapy of tumors]. / Approccio al problema dei costi economici della terapia medica dei tumori.

The use of antitumoral drugs is increasing constantly. The economic cost pro capite of the commonest oncotherapeutic treatments has been analysed. The calculation is carried out on the basis of out-patient as well as in-patient treatment. The costs were identical in the hospital where the study was carried out due to the application of the recent regional health legislation. A number of considerations are made regarding the implications of unqualified use of the medical treatment of cancer.

A new CMF regimen.

In CMF regimen, gastric disturbances secondary to oral administration of cyclophosphamide (CTX) frequently induce many patients to take the drug erratically, to lower the daily dose, or to divide it in many administrations. These alterations act as a source of uncertainty in the evaluation of treatment results and may decrease the chemotherapy effectiveness. An i.v. CTX administration is proposed, and the rationale of such a proposal in examined. Data on the mild toxicity of the new schedule are reported.