Simultaneous Integrated Boost in Once-weekly Hypofractionated Radiotherapy for Breast Cancer in the Elderly: Preliminary Evidence

Aim: To evaluate once-weekly hypofractionated radiotherapy in elderly patients affected by early breast cancer, reporting acute and late toxicity profiles, and treatment feasibility. Patients and Methods: Fifty patients were treated with a hypofractionated regimen: 28.5\ub12.5 Gy in five fractions at one fraction weekly. Simultaneous integrated boost (SIB) to the tumor bed in high-risk cases. Inclusion criteria: patients over 70 years old, pT1-2, N0-1a. Acute and late toxicities were assessed based on Radiation Therapy Oncology Group. Results: The median follow-up was 20 months and the median patient age was 79 years. SIB was added for 22 patients (44%). Grade 3-4 acute cutaneous toxicities were not observed; grade 2 toxicity occurred only in four patients (8%). Late subcutaneous tissue toxicity consisted of grade 2 fibrosis in two patients (4%), grade 1 in five (10%) and grade 0 in 41(85%). Conclusion: Limiting fraction numbers with a safer profile may improve the management of breast cancer for the elderly

La sindrome “Hikikomori”: prevalenza nella popolazione generale e psichiatrica. Una systematic review con meta-analisi [The “hikikomori” syndrome: Prevalence in the general and the psychiatric population. A systematic review and meta-analysis]

“Hikikomori” Syndrome is a condition observed in Japanese adolescents in the last decade, characterized by complete and prolonged social withdrawal and repetitive activities, such as the use of the computer at home, associated with loss of interest in school or work. It is not clear to what extent this phenomenon exists in other cultural contexts. In the international literature, there is no systematic review with meta-analysis, which summarizes its prevalence.The present work describes the first systematic review with meta-analysis on the prevalence of the syndrome in the general and the psychiatric population.A systematic search was conducted by using the electronic databases PubMed and Scopus. Nine studies (n = 8598) were included, 7 out of which were conducted in Asian countries. In the general population studies, a significant mean effect size of 0.015 was observed (p <0.001), showing 1.5% prevalence.A significant mean effect size of 0.26 (p <0.05) was observed in the psychiatric population, showing 26% prevalence. In the studies where the mean age was lower (B =-0.06, p <0.001) or with higher percentage of males (B = 0.18, p <0.001), prevalence was significantly higher. Prevalence was comparable to that of the other severe psychiatric disorders, such as personality disorders. It is possible that gender differences, associated with social support and help-seeking behaviours, mediate the role of the male gender. Further studies are requested in Western countries, particularly in Italy

La sindrome “Hikikomori”: prevalenza nella popolazione generale e psichiatrica. Una systematic review con meta-analisi

La Sindrome Hikikomori è una condizione, osservata nel corso dell’ultimo decennio in adolescenti giapponesi, caratterizzata da completo e prolungato ritiro sociale e permanenza in ambiente domestico in attività ripetitive quali l’utilizzo del PC, associato a perdita di interesse nei confronti di scuola o lavoro. Non è chiaro in che misura il fenomeno esista in altri contesti culturali. Nella letteratura internazionale è assente una revisione sistematica con meta-analisi, che ne sintetizzi la prevalenza. Il presente lavoro descrive il primo studio di systematic review con meta-analisi sulla prevalenza della Sindrome Hikikomori nella popolazione generale e quella psichiatrica. È stata condotta una ricerca sistematica con l’utilizzo dei database elettronici PubMed e Scopus. Sono stati inclusi 9 studi (n = 8598), 7 dei quali condotti in Paesi asiatici. Negli studi sulla popolazione generale è stato osservato un effect size medio significativo di 0.015 (p < 0.001), che indica una prevalenza di 1.5%. Nella popolazione psichiatrica è stato osservato un effect size medio significativo di 0.26 (p < 0.05), che indica una prevalenza di 26%. Negli studi in cui l’età media era più bassa (B= -0.06, p <0.001) o la percentuale di maschi più alta (B= 0.18, p <0.001), la prevalenza è stata significativamente maggiore. La prevalenza è risultata paragonabile a quella di altri disturbi psichiatrici gravi, come i disturbi di personalità. È possibile che differenze di genere, associate all’utilizzo del supporto sociale e dei comportamenti di richiesta di aiuto come strategia di coping, medino il ruolo del genere maschile. Si rendono necessari ulteriori studi sul fenomeno nei Paesi occidentali, in particolare in Italia

Clinical Study Image Guided Hypofractionated Radiotherapy by Helical Tomotherapy for Prostate Carcinoma: Toxicity and Impact on Nadir PSA

Aim. To evaluate the toxicity of a hypofractionated schedule for primary radiotherapy (RT) of prostate cancer as well as the value of the nadir PSA (nPSA) and time to nadir PSA (tnPSA) as surrogate efficacy of treatment. Material and Methods. Eighty patients underwent hypofractionated schedule by Helical Tomotherapy (HT). A dose of 70.2 Gy was administered in 27 daily fractions of 2.6 Gy. Acute and late toxicities were graded on the RTOG/EORTC scales. The nPSA and the tnPSA for patients treated with exclusive RT were compared to an equal cohort of 20 patients treated with conventional fractionation and standard conformal radiotherapy. Results. Most of patients (83%) did not develop acute gastrointestinal (GI) toxicity and 50% did not present genitourinary (GU) toxicity. After a median follow-up of 36 months only grade 1 of GU and GI was reported in 6 and 3 patients as late toxicity. Average tnPSA was 30 months. The median value of nPSA after exclusive RT with HT was 0.28 ng/mL and was significantly lower than the median nPSA (0.67 ng/mL) of the conventionally treated cohort ( = 0.02). Conclusions. Hypofractionated RT schedule with HT for prostate cancer treatment reports very low toxicity and reaches a low level of nPSA that might correlate with good outcomes