Multidisciplinary Management of Elderly Cancer Patients:The Radiation Oncologist's Point of View

The complexity of oncological treatments for elderly patients starts from the very beginning, since the definition of "geriatric patient" is not univocal. From the point of view of public health, the problem is of the outmost importance

Bevacizumab for the Treatment of Radiation-Induced Cerebral Necrosis: A Systematic Review of the Literature

Radiation necrosis (RN) of brain tissue is a serious late complication of brain irradiation and recently bevacizumab has been suggested as treatment option of RN. There is a lack of data in the literature regarding the effectiveness of bevacizumab for the treatment of RN. The purpose of this review was to perform a comprehensive analysis of all reported cases using bevacizumab for the treatment of brain RN. In September 2016, we performed a comprehensive literature search of the following electronic databases: PubMed, Web of Science, Scopus and Cochrane Library. The research for the review was conducted using a combination of the keywords “radiation necrosis”, “radiotherapy” and “bevacizumab” alongside the fields comprising article title, abstract and keywords. Randomized trials, non-randomized trials, prospective studies, retrospective studies and single case reports were included in the review. Our research generated 21 studies and 125 cases where bevacizumab had been used for the treatment of RN. The median follow-up was 8 months and the most frequent bevacizumab dose used was 7.5 mg/kg for 2 weeks with a median of four cycles. Low-dose bevacizumab resulted in effectiveness with improvement in both clinical and radiographic response. The median decrease in T1 contrast enhancement and in T2/FLAIR signal abnormality was 64% and 60%, respectively. A reduction in steroidal therapy was observed in majority of patients treated. Based on the data of our review, bevacizumab appears to be a promising agent for the treatment of brain RN. Future prospective studies are required to evaluate the role of bevacizumab in RN and to define the optimal scheduling, dosage and duration of therapy

The Relevance of Assessing Subjective Experiences of Skin Toxicity During Adjuvant Radiotherapy for Breast Cancer

Purpose: Radiodermatitis is likely to be an inevitable side effect of radiotherapy (RT) but experiencing pain relief during RT might contribute making treatment more acceptable and less impairing. The current study aimed to assess the subjective perceptions and experiences of skin toxicity in a sample of women undergoing adjuvant RT for breast cancer. Methods: Eighty patients were randomly assigned to one out of two groups: treatment (i.e., a newly developed topical product) and control (i.e., standard-of-care). Patients underwent adjuvant RT for 3 weeks. Clinical assessment of radiodermatitis and self-reported levels of pain, relief, and perceptions of treatment response were collected at the initiation of RT (T1), during RT (T2 and T3), and 2 weeks after treatment completion (T4). To assess changes in skin-related QoL, a subgroup of patients completed the Padua Skin-Related QoL questionnaire at T0 (before the initiation of RT) and at T4. Results: A comparable timing of onset and severity of radiodermatitis during treatment was observed in both groups. The treatment group reported lower levels of pain and higher levels of relief compared to the control group when skin toxicity was at its highest levels (T2 and T3). Independent of the group, levels of perceived improvements in clinical status increased over time, whereas skin-related QoL worsened from T0 to T4. Conclusion: Current findings outline the relevance of integrating clinical evaluations of radiodermatitis with patients\u2019 subjective experiences of skin toxicity in interventional studies. Moreover, they provide preliminary evidence about the soothing effect of a newly developed topical product, thus supporting its usefulness of as a supportive care

The role of clinicopathologic and molecular prognostic factors in the post-mastectomy radiotherapy (PMRT): a retrospective analysis of 912 patients

OBJECTIVE: To assess the association of clinicopathologic and molecular features with loco-regional recurrence (LRR) in post-mastectomy breast cancer patients with or without adjuvant radiotherapy (PMRT). PATIENTS AND METHODS: We retrospectively reviewed data of patients undergone to mastectomy followed or not by PMRT between January 2004 and June 2013. The patients were divided according to clinicopathologic and molecular sub-classification features. LRR and Cancer Specific Survival (CSS) were calculated using the Kaplan-Meier method; the prognostic factors were compared using long-rank tests and Cox regression model. RESULTS: A total of 912 patients underwent to mastectomy of whom 269 (29.5%) followed by PMRT and 643 (70.5%) not; among the PMRT group, 77 underwent to the chest wall (CW) and 202 to the chest wall and lymphatic drainage (CWLD) irradiation. The median follow-up was 54 months (range, 3-118). No significant difference in terms of LRR and CSS was found between non-PMRT and PMRT group (p=0.175; and p=0.628). The multivariate analysis of LRR for patients who did not undergo PMRT showed a significant correlation with the presence of extracapsular extension (ECE) (p=0.049), Ki-67>30% (p=0.048) and triple negative status (p=0.001). In the PMRT group, triple negative status resulted as the only variable significantly correlated to LRR (p=0.006) at the multivariate analysis and T-stage also showed a trend to significance (p=0.073). Finally, no difference in LRR control was shown between CW and CWLD-PMRT (p=0.078). CONCLUSIONS: After mastectomy ECE, a cut off of Ki-67>30% and triple negative status werestrictly correlated with LRR regardless of clinicopathologic stage. PMRT has a positive impact in decreasing LRR in patients with this molecular profile. Besides, CW might represent a valid option for patients with one to three positive nodes

Iperglicemia a digiuno e mortalita' ospedaliera nel paziente anziano non diabetico:studio multicentrico.

Studio multicentrico in 2 nazioni su pazienti anziani ammessi per eventi patologici acuti e ricoverati in corsie di Medicina Generale o Geriatri

RUOLO DELLA RISONANZA MAGNETICA (RM) NEL CHIARIRE RISULTATI EQUIVOCI ALLA RIVALUTAZIONE CON TOMOGRAFIA A EMISSIONE DI POSITRONI (PET/TC) DI PAZIENTI AFFETTI DA CARCINOMA A CELLULE SQUAMOSE DELL’OROFARINGE TRATTATI CON CHEMIORADIOTERAPIA E STRATIFICATI PER POSITIVITA’ ALL’HPV: STUDIO RETROSPETTIVO.

SCOPI DEL LAVORO. Descrivere la risposta alla Tomografia ad Emissione di Positroni con 18-FDG associata a Tomografia Computerizzata (PET/TC) in pazienti con carcinoma orofaringeo a cellule squamose (Oropharyngeal Squamous Cell Carcinoma, OPSCC) trattati con radiochemioterapia, ed esaminare il ruolo della RM nel rivalutare i risultati PET/TC positivi o equivoci. MATERIALI E METODI. Studio retrospettivo su 170 pazienti con OPSCC trattati con radiochemioterapia e rivalutati mediante PET/TC 12 settimane dopo il trattamento. La risposta è stata categorizzata come completa (CR), equivoca (ER) o positiva (PD). Sono state valutate separatamente le risposte a livello della neoplasia primitiva e dei linfonodi laterocervicali, stratificando i pazienti in base all’espressione della p16. È stata descritta la variazione delle ER e PD alla PET/TC dopo rivalutazione RM. RISULTATI. Su 170 pazienti, 130 (76,5%) sono p16+, 35 (20,6%) p16- e per 5 (2,9%) non è stato possibile definire lo status p16. Alla PET nei p16+, le CR a livello del T e dell’N sono state il 61%, nei p16- sono state il 65,7%. Rivalutando con RM i pazienti p16+ con ER o PD a livello del T, la percentuale di CR è salita dal 61% al 72,3%; per i pazienti p16- l’aumento di CR è salito dal 65,7% al 68,6%. DISCUSSIONE\CONCLUSIONE. I dati confermano l’efficacia della radiochemioterapia nel trattamento dell’OPSCC e la validità della PET/TC nella valutazione della risposta. Tuttavia il suo valore predittivo positivo resta insoddisfacente, data la subottimale distinzione tra risposte positive e condizioni non maligne. La RM potrebbe contribuire a chiarire alcuni dei risultati equivoci alla PET/T

Assessing Novel Drugs and Radiation Technology in the Chemoradiation of Oropharyngeal Cancer

Integrating immunotherapy, proton therapy and biological dose escalation into the definitive chemoradiation of oropharyngeal cancer poses several challenges. Reliable and reproducible data must be obtained in a timely fashion. However, despite recent international radiotherapy contouring guidelines, controversy persists as to the applicability of such guidelines to all cases. Similarly, a lack of consensus exists concerning both the definition of the organ at risk for oral mucositis and the most appropriate endpoint to measure for this critical toxicity. Finally, the correlation between early markers of efficacy such as complete response on PET CT following treatment and subsequent survival needs elucidation for biological subsets of oropharyngeal cancer

Squamous cell carcinoma (SCC) of the Pyriform sinus with multiple metachronous brain metastases, a case report

Distant Metastases from Head and Neck Squamous cell carcinomas are uncommon (9-11%) and they are usually found in the lung and less frequently in the liver, kidney and adrenals. Central nervous system (CNS) metastases are extremely rare (2-8%), and they are described mainly in patients who already have extracranial metastases. So there's scarcity of data about their optimal management

Radiation-induced nausea and vomiting in head and neck cancer: Is it something worth considering in the intensity modulated radiotherapy era? "A narrative review"

Radiation therapy is one of the cornerstones in the treatment of head and neck squamous cell carcinomas (HNSCC), alone or in combination with chemotherapy or surgery. Technological advances which occurred over the last few decades have increased the efficacy of radiotherapy (RT), particularly, intensity-modulated RT (IMRT). IMRT can deliver treatments on complex tumoral targets with dose escalation while sparing organs at risk; anyway IMRT deposits dose in unpredictable patterns outside of the target volume with the purpose of improving conformality. Radiation-induced nausea and vomiting (RINV) is a frequent albeit neglected side effect of RT that can lead to delays in treatment with serious consequences on cure rates. According to several guidelines (MASCC 2016, NCCN 2018), RT for HNSCC has traditionally been regarded as a low emetic risk treatment. Nevertheless, several works suggest that IMRT could increase RINV. Further studies are needed to define the exact incidence and the detailed pathophysiology of RINV in patients with HNSCC treated with state of art IMRT techniques, with and without concurrent chemotherapy

Ein Vergleich von Schluckst\uf6rungen nach dreidimensionaler konformaler und intensit\ue4tsmodulierter Strahlentherapie: Ein systematischer Review der \u201cItalian Head and Neck Radiotherapy Study Group\u201d

Purpose Dysphagia is one of the most important treatmentrelated side effects in head and neck cancer (HNC), as it can lead to severe life-threating complications such as aspiration pneumonia and malnutrition. Intensity-modulated radiotherapy (IMRT) could reduce swallowing dysfunction by producing a concave dose distribution and reducing doses to the swallowing-related organs at risk (SWOARs). The aim of this study was to review the current literature in order to compare swallowing outcomes between IMRT and three-dimensional conformal radiotherapy (3DCRT). Methods A search was conducted in the PubMed and Embase databases to identify studies on swallowing outcomes, both clinically and/or instrumentally assessed, after 3DCRT and IMRT. Dysphagia-specific quality of life and objective instrumental data are summarized and discussed. Results A total of 262 papers were retrieved from the searched databases. An additional 23 papers were retrieved by hand-searching the reference lists. Ultimately, 22 papers were identified which discussed swallowing outcomes after 3DCRT and IMRT for HNC. No outcomes from randomized trials were identified. Conclusion Despite several methodological limitations, reports from the current literature seem to suggest better swallowing outcomes with IMRT compared to 3DCRT. Further improvements are likely to result from the increased use of IMRT plans optimized for SWOAR sparing