Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy: practice and outcome analysis in a series of 2237 patients from 11 institutions

OBJECTIVE: Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure. METHODS: Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community and academic hospitals were treated with iodine-125 ((125)I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. (125)I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145 Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failure-free survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes. RESULTS: Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p < 0.0001) and V100 (p = 0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p = 0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT. CONCLUSION: This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer. ADVANCES IN KNOWLEDGE: Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome

FUNZIONI COGNITIVE FRONTALI E LIVELLI DI IMPULSIVITÀ: RISULTATI PRELIMINARI IN UN CAMPIONE DI PAZIENTI PSICHIATRICI AUTORI DI REATO

Frontal cognitive impairment is associated in psychiatric patients with a worse overall outcome and the risk of violent behavior. Thisstudy analyzes impulsivity levels and executive functions in a sample of 16 offender psychiatric patients. Patients with schizophreniaspectrum disorders presented worse attentional levels than patients with other diagnoses. Negative correlations between both total andattentional impulsivity and short-term memory emerged. Attentional performance was positively correlated with functioning whilepsychopathological severity negatively with short-term memory. Further research on larger samples is needed in order to adequatelycharacterize the cognitive profiles of psychiatric patients who commit crimes both for rehabilitation and preventive purposes on the riskof violence.La compromissione cognitiva frontale è associata nei pazienti psichiatrici a un peggiore outcome globale e al rischio di comportamentiviolenti. Questo studio analizza i livelli di impulsività e le funzioni esecutive in un campione di 16 pazienti psichiatrici autori di reato. Ipazienti con disturbo dello spettro schizofrenico hanno presentato livelli attentivi peggiori rispetto ai pazienti con altre diagnosi. Sonoemerse correlazioni negative tra impulsività sia totale che attentiva e memoria a breve termine. La performance attentiva è risultata correlatapositivamente con il funzionamento mentre la gravità psicopatologica negativamente con la memoria a breve termine. Ulteriori ricerchesu campioni più ampi appaiono necessarie al fine di caratterizzare adeguatamente i profili cognitivi dei pazienti psichiatrici autori di reatosia a fini riabilitativi che preventivi sul rischio di violenza

The role of vaginal brachytherapy in stage I endometrial serous cancer. a systematic review

Purpose: Serous adenocarcinoma (uterine serous carcinoma - USC) is a rare and aggressive histologic subtype of endometrial cancer, with a high-rate of recurrence and poor prognosis. The adjuvant treatment for stage I patients is unclear. The purpose of this study was to evaluate the outcomes of stage I USC treated exclusively with chemotherapy plus vaginal brachytherapy (VBT).Material and methods: A systematic research using PubMed, Scopus, and Cochrane library was conducted to identify full articles evaluating the efficacy of VBT in patients with stage I USC. A search in ClinicalTrials.gov was performed in order to detect ongoing or recently completed trials, and in PROSPERO for searching ongoing or recently completed systematic reviews.Results: All studies were retrospective and 364 of evaluated patients were found. The average local control was 97.5% (range, 91-100%), the disease free-survival was 88% (range, 82-94%), the overall survival was 93% (range, 72-100%), the specific cancer survival was 89.4% (range, 84.8-94%), and the G3-G4 toxicity was 0-8%.Conclusions: These data support the concept that in adequately selected patients, VBT alone may be a suitable radio- therapy technique in women with stage I USC who underwent surgical staging and received adjuvant chemotherapy