Servizio Nazionale Informativo sul Cancro. Procedure di qualità del Punto Informazione e Accoglienza

This procedure is a draft work produced by the multidisciplinary Italian team of the project "Riduzione delle disparità nell’accesso dei pazienti ai mezzi diagnostici e alle terapie" granted by the Italian Ministry of Health through the cancer network "Alleanza Contro il Cancro (ACC)" 2006. Its purpose is to draw some practical recommendations in order to establish and manage a service information point for patients within the oncological Units Institutes with the collaboration of voluntary associations personnel (AIMaC, FAVO). It is inspired to the international literature about cancer patients information' topic

Multicenter randomized trial of dacarbazine alone or in combination with two different doses and schedules of interferon alfa-2a in the treatment of advanced melanoma

Purpose: Some phase II studies have suggested that the combination of interferons (IFNs) with dacarbazine (DTIC) in the treatment of malignant melanoma (MM) increases the antitumor activity of DTIC alone. In an attempt to confirm this hypothesis, a randomized study was performed with the further intent of observing whether low doses of recombinant interferon alfa-2a (rIFNα2a) could be as effective as intermediate doses. Patients and Methods: Two hundred sixty-six patients were randomized onto three different treatment arms: DTIC 800 mg/m 2 intravenously (IV) days 1 and 21; DTIC plus rIFNα2a 9 mIU intramuscularly (IM) daily; and DTIC plus rIFNα2a 3 mIU IM three times per week. Major prognostic factors were well balanced among the three arms. Chemotherapy was administered for a maximum of eight cycles. After 6 months of therapy, rIFNα2a was continued until disease progression at 3 mIU three times per week in responding patients who had received the combined treatment. Results: The percentage of objective responses did not differ among the three groups (20%, 28%, and 23%, respectively), although a significant prolongation of response duration was observed when rIFNα2a was added to DTIC (2.6 v 8.4 v 5.5 months, respectively). However, this improvement in response duration did not translate into an amelioration of overall survival. The addition of rIFNα2a led to the onset of flu-like syndrome, but in no case was it necessary to withdraw the treatment program and no toxic deaths or life-threatening toxicities were reported. Conclusion: In this study, rIFNα2a significantly prolonged response duration, whereas no effects on response rate and survival were observed; rIFNα2a 3 mIU appeared to be equally effective and better tolerated than 9 mIU.info:eu-repo/semantics/publishe

Thin Stage I Primary Cutaneous Malignant Melanoma

Although wide surgical excision is the accepted treatment for thin malignant melanomas, there is reason to believe that narrower margins may be adequate. We conducted a randomized prospective study to assess the efficacy of narrow excision (excision with 1-cm margins) for primary melanomas no thicker than 2 mm. Narrow excision was performed in 305 patients, and wide excision (margins of 3 cm or more) was performed in 307 patients. The major prognostic criteria were well balanced in the two groups. The mean thickness of melanomas was 0.99 mm in the narrow-excision group and 1.02 mm in the wide-excision group. The subsequent development of metastatic disease involving regional nodes and distant organs was not different in the two groups (4.6 and 2.3 percent, respectively, in the narrow-excision group, as compared with 6.5 and 2.6 percent in the wide-excision group). Disease-free survival rates and overall survival rates (mean follow-up period, 55 months) were also similar in the two groups. Only three patients had a local recurrence as a first relapse. All had undergone narrow excision, and each had a primary melanoma with a thickness of 1 mm or more. The absence of local recurrence in the group of patients with a primary melanoma thinner than 1 mm and the very low rate of local recurrences indicate that narrow excision is a safe and effective procedure for such patients. (N Engl J Med 1988; 318:1159–62.) THE question of how much surrounding normal skin should be removed during the excision of primary melanomas of the skin has never been properly answered. For decades, wide excision (with margins of 3 to 5 cm) has been universally accepted as the treatment of choice. In 1977, however, Breslow and Macht1 reported that narrow resection margins may be satisfactory in the treatment of very thin melanomas. Subsequent reports2 3 4 5 6 7 8 9 10 11 have also supported the conservative surgical approach to local control of the primary tumor. Nevertheless, there are several points of disagreement, including how thick a primary melanoma can be and still be. © 1988, Massachusetts Medical Society. All rights reserved.SCOPUS: ar.jinfo:eu-repo/semantics/publishe