The role of different adjuvant therapies in locally advanced gastric adenocarcinoma

Complete surgical resection remains the only curative treatment option in locally advanced gastric cancer (GC). Several studies were conducted to prevent local recurrence and to increase the chance of cure. The aim of this study was to summarize our experience in locally advanced GC patients treated with adjuvant chemoradiotherapy (CRT) and to evaluate overall survival (OS), disease-free survival (DFS), toxicity rate and compliance to treatment

Il monitoraggio del consumo del suolo in Italia

La progressiva artificializzazione e cementificazione del territorio, legate sempre più spesso a un’espansione urbana incontrollata e non pianificata, sono responsabili del consumo del suolo, particolarmente degradato quando viene coperto in maniera permanente con materiali impermeabili come l’asfalto, con risvolti sia sul piano ambientale che su quello economico. Nel presente studio viene illustrata la metodologia di analisi del consumo di suolo sviluppata dall’ISPRA, che ricostruisce l’andamento del fenomeno in Italia dal 1950 ai giorni nostri, integrando dati campionari che derivano da un monitoraggio dettagliato di tipo puntuale con dati di osservazione della terra a livello europeo. Per i sei anni di rilevazione della serie storica disponibile (1956, 1989, 1996, 1998, 2006, 2010), sono stati prodotti indicatori per rilevanti ambiti amministrativi, che hanno evidenziato un consumo di suolo crescente nel tempo, dalla scala comunale a quella nazionale, passando dal 2,8% di superficie consumata totale nel 1956 al 6,9% nel 2010. In base ai risultati, l’aumento del consumo di suolo, che avviene soprattutto a discapito dei paesaggi peri-urbani, non è imputabile solo alla crescita demografica. Appare dunque necessaria una regolamentazione più stringente della crescita urbana che possa stimolare la rigenerazione dei centri esistenti, forme di insediamento più compatte, e la protezione delle aree naturali e agricole.The progressive land exploitation, increasingly related to exurban development and urban sprawl, produces the consumption of soil, particularly degraded when it is permanently covered with impervious materials as the asphalt, with environmental as well as economic implications. The present study illustrates a procedure developed by the Italian National Institute for Environmental Research and Protection, for assessing soil consumption in Italy. This procedure reconstructs the evolution of the phenomenon from 1956 to the present day, integrating data derived from a detailed monitoring of sample plots with earth observation data at European level. The indicators, produced for relevant administrative areas at six points in the investigated time (1956, 1989, 1996, 1998, 2006, 2010), showed an increasing sealed area over the years, both on local and national scale. Interestingly, on the basis of our results, soil consumption rose from 2.8% in 1956 to 6.9% in 2010 in Italy and this increase, occurring mainly at the expense of peri-urban landscapes, is not only due to population growth. Therefore, a more efficient regulation of the urban development is needed to stimulate the regeneration of city centres, more compact forms of settlement, and the protection of natural and agricultural areas

Revisiting "Southern" Sprawl : Urban Growth, Socio-Spatial Structure and the Influence of Local Economic Contexts

Given its unpredictable nature, urban sprawl in the Mediterranean region is considered an intriguing (and intricate) socioeconomic issue.Since the 1970s, urban dispersion advanced rapidly in southern Europe-irrespective of a city's size and morphology-withurbanization rates growing faster than population. A comparison between the metropolitan areas of Barcelona, Rome and Athens reveals how sprawl has occurred in different ways in the three cities, highlighting peculiar relationships between urbanization, land-use and economic structures. Sharing common drivers of change related to population dynamics, socio-spatial structure and deregulated urban expansion, sprawl has adapted to the local economic, cultural and environmental context. Barcelona shows a dispersion pattern towards a more spatially-balanced morphology, with expanding sub-centres distributed around the central city, Rome appears to be mostly scattered around the historical city with fragmentedGiven its unpredictable nature, urban sprawl in the Mediterranean region is considered an intriguing (and intricate) socioeconomic issue. Since the 1970s, urban dispersion advanced rapidly in southern Europe-irrespective of a city's size and morphology-with urbanization rates growing faster than population. A comparison between the metropolitan areas of Barcelona, Rome and Athens reveals how sprawl has occurred in different ways in the three cities, highlighting peculiar relationships between urbanization, land-use and economic structures. Sharing common drivers of change related to population dynamics, socio-spatial structure and deregulated urban expansion, sprawl has adapted to the local economic, cultural and environmental context. Barcelona shows a dispersion pattern towards a more spatially-balanced morphology, with expanding sub-centres distributed around the central city, Rome appears to be mostly scattered around the historical city with fragmente

Clinical benefit of adding oxaliplatin to standard neoadjuvant chemoradiotherapy in locally advanced rectal cancer: a meta-analysis : Oxaliplatin in neoadjuvant treatment for rectal cancer

Abstract. Background: To evaluate the treatment tolerance and clinical outcomes in patients aged 70 years and older with locally advanced oropharyngeal cancer treated by definitive intensity-modulated radiation therapy (IMRT). Patients and Methods: We retrospectively analyzed 15 consecutive elderly patients, with histologically-proven squamous cell carcinoma of the oropharynx, staged T3-4 with or without involved lymph nodes at diagnosis, who received definitive sequential IMRT (70 Gy; 2 Gy/fraction). Adult Comorbidity Evaluation-27 (ACE-27) score was calculated and its influence on treatment tolerance and clinical outcomes was analyzed. Results: A total of 15 patients were included with a median age of 77 years (range=70-88 years). At baseline, 8 patients (53.3%) had an ACE-27 score of 1, and the remainder (n=7, 46.7%) had a comorbidity index of 0. All patients completed programmed IMRT treatment, without any reduction of total dose. Oral pain and mucositis were the most common acute side-effects, classified as grade 3 in 6 patients (40%) only. Xerostomia was reported in 13 patients (86.7%), without severe manifestation. There was no hematological toxicity. ACE-27 score was not related to higher severe acute toxicity. No patients experienced grade 3 or more late toxicity. Five-year overall survival and disease-free survival rates were 63.6% (95% confidence interval=32.7-83.3%) and 55% (95% confidence interval=24.4-77.6%), respectively. Comorbidity score did not influence survival outcomes, both overall survival (p=0.46) and disease-free survival (p=0.55). Conclusion: Treatment tolerance, as well as survival outcomes were good in elderly oropharyngeal cancer patients treated with definitive sequential IMRT. Due to age and comorbidity, no dose or volume reduction for IMRT should be considered in this setting of patients. A prospective randomized trial with a large sample size should be conducted to confirm our result

Complexity in action: Untangling latent relationships between land quality, economic structures and socio-spatial patterns in Italy

Land quality, a key economic capital supporting local development, is affected by biophysical and anthropogenic factors. Taken as a relevant attribute of economic systems, land quality has shaped the territorial organization of any given region influencing localization of agriculture, industry and settlements. In regions with long-established human-landscape interactions, such as the Mediterranean basin, land quality has determined social disparities and polarization in the use of land, reflecting the action of geographical gradients based on elevation and population density. The present study investigates latent relationships within a large set of indicators profiling local communities and land quality on a fine-grained resolution scale in Italy with the aim to assess the potential impact of land quality on the regional socioeconomic structure. The importance of land quality gradients in the socioeconomic configuration of urban and rural regions was verified analyzing the distribution of 149 socioeconomic and environmental indicators organized in 5 themes and 17 research dimensions. Agriculture, income, education and labour market variables discriminate areas with high land quality from areas with low land quality. While differential land quality in peri-urban areas may reflect conflicts between competing actors, moderate (or low) quality of land in rural districts is associated with depopulation, land abandonment, subsidence agriculture, unemployment and low educational levels. We conclude that the socioeconomic profile of local communities has been influenced by land quality in a different way along urban-rural gradients. Policies integrating environmental and socioeconomic measures are required to consider land quality as a pivotal target for sustainable development. Regional planning will benefit from an in-depth understanding of place-specific relationships between local communities and the environment

Induction chemotherapy followed by neoadjuvant chemoradiotherapy and surgery in locally advanced rectal cancer: preliminary results of a phase II study

PURPOSE: To report preliminary results of induction chemotherapy (IC) followed by neoadjuvant chemoradiotherapy (CRT) and surgery in locally advanced rectal cancer (LARC) patients.MATERIALS AND METHODS: This is the preliminary evaluation of a phase II study. Patients with histologically proven rectal adenocarcinoma, stage II-III disease, who met the inclusion criteria, received induction FOLFOXIRI (5-FU, leucovorin, oxaliplatin and irinotecan) regimen in combination with targeted agents followed by CRT and surgery. Analysis of the first 8 patients was required to confirm the treatment feasibility before the accrual of 20 additional patients. RESULTS: The first 8 patients were evaluated. The median follow-up time was 23 months. There were no treatment-related deaths. Trimodality strategy was well tolerated with high compliance and a good level of toxicity. There were no evidence of febrile neutropenia and any grade 4 adverse events were recorded. Three patients had pathologic complete response (pCR) and 1 patient had a nearly pCR (ypT1 ypN0). CONCLUSION: Preliminary results are encouraging. FOLFOXIRI regimen plus targeted agents followed by CRT and surgery seems a safe approach. Longer follow-up and higher number of patients are mandatory to confirm such findings

The effect of postmastectomy radiation therapy on breast implants. Material analysis on silicone and polyurethane prosthesis

The pathogenic mechanism underlying capsular contracture is still unknown. It is certainly a multifactorial process, resulting from human body reaction, biofilm activation, bacteremic seeding, or silicone exposure. The scope of the present article is to investigate the effect of hypofractionated radiotherapy protocol (2.66 Gy × 16 sessions) both on silicone and polyurethane breast implants.Silicone implants and polyurethane underwent irradiation according to a hypofractionated radiotherapy protocol for the treatment of breast cancer. After irradiation implant shells underwent mechanical, chemical, and microstructural evaluation by means of tensile testing, infrared spectra in attenuated total reflectance mode, nuclear magnetic resonance, and field emission scanning electron microscopy.At superficial analysis, irradiated silicone samples show several visible secondary and tertiary blebs. Polyurethane implants showed an open cell structure, which closely resembles a sponge. Morphological observation of struts from treated polyurethane sample shows a more compact structure, with significantly shorter and thicker struts compared with untreated sample. The infrared spectra in attenuated total reflectance mode spectra of irradiated and control samples were compared either for silicon and polyurethane samples. In the case of silicone-based membranes, treated and control specimens showed similar bands, with little differences in the treated one. Nuclear magnetic resonance spectra on the fraction soluble in CDCl3 support these observations. Tensile tests on silicone samples showed a softer behavior of the treated ones. Tensile tests on Polyurethane samples showed no significant differences.Polyurethane implants seem to be more resistant to radiotherapy damage, whereas silicone prosthesis showed more structural, mechanical, and chemical modifications

High-resolution anoscopy predictive modeling of anal canal cancer response after definitive chemoradiotherapy in COVID19 era

Purpose: To develop a predictive index model, integrating both clinical and high-resolution anoscopy (HRA) features to further personalize the decision making process in anal canal carcinoma in COVID19 era.Methods and materials: We assess HRA parameters after definitive chemoradiotherapy in patients with anal canal malignant lesions.Results: HRA features could be important to assess the effect of CRT and a risk stratification system should be introduced in clinical practice to better allocate therapeutic interventions.Conclusion: To our knowledge this is the first proposal for HRA findings in anal canal cancer after definitive CRT. We believe that a risk score can be useful to estimate the risk of treatment failure (in term of persistence disease and/or recurrence) and its clinical relevance should not to be underestimated

Il consumo di suolo in Italia - Edizione 2015

Nel nostro Paese si continua a consumare suolo e la seconda edizione del Rapporto ISPRA fornisce un quadro completo sull’avanzata della copertura artificiale del nostro territorio. Il Rapporto sul consumo di suolo in Italia 2015 integra nuove informazioni, aggiorna le precedenti stime sulla base di dati a maggiore risoluzione e completa il quadro nazionale con specifici indicatori per regioni, province e comuni. Sono, inoltre, approfonditi alcuni aspetti che caratterizzano le dinamiche di espansione urbana e di trasformazione del paesaggio a scala nazionale e locale con riferimento alla fascia costiera, alle aree montane, ai corpi idrici, alle aree protette, alle aree a pericolosità idraulica, all’uso del suolo, alle forme e alle densità di urbanizzazione, ai fenomeni dello sprawl urbano, della frammentazione, della dispersione e della diffusione insediativa