Adjuvant radiochemotherapy for gastric cancer. Should we use prognostic factors to select patients?

Radiotherapy has a not well-established role in the pre-operative and in the post-operative setting in gastric cancer (GC) patients. Randomized trials report controversial outcomes and impact on survival. In the D2 loco-regional node resection era, after a well-performed radical surgery, local treatment using radiotherapy combined to chemotherapy should be considered for locally advanced GC. Prognostic factors could help the better selection of subgroups that present high risk of loco-regional recurrence. Then, the addition of radiotherapy could improve the disease-free survival and also quality of life. There are no large prospective studies that have assessed specific factors predicting for recurrence or survival, but only retrospective series, some of them including high number of patients with homogeneous characteristics. In locally advanced GC adding radiotherapy to the post-operative chemotherapy seems to improve outcomes and quality of life. Prognostic factors such as T-stage, N-status, nodal ratio, and other histological factors should be considered to submit patients to post-operative combined treatment. Larger prospective series are necessary to investigate the role of combined chemoradiation after radical D2-resection, especially in locally advanced GC. Further prospective investigations are needed to suggest prognostic factors that have significant impact on survival and recurrence, improving the management and outcomes, particularly in locally advanced GC patients

Aveiro, Campus e città Disegno urbano per la connessione delle parti

I canali, i “moliceiros”, la produzione di ceramica, i villaggi dei pescatori, il “salgado de Aveiro”. Elementi che producono l’immagine della città a livello nazionale e internazionale. Un’immagine profondamente relazionata con la “Ria” e le saline, che sono stati nel tempo i principali fautori dello sviluppo della città e che ne definiscono una propria e chiara identità. Il sistema naturale e l’edificato che, influenzandosi a vicenda, hanno permesso lo sviluppo del primo insediamento e determinato le forme della città, risaltano oggi, però, come due corpi estranei, seppur adiacenti. Una città che si è evoluta, inoltre, per parti, nella quale le successive espansioni del tessuto urbano non hanno seguito una logica di insieme, evidenziando le differenze tra una zona e l’altra nonostante i numerosi tentativi di pianificazione del territorio, e generando organismi indipendenti separati dal contesto: le città nella città. Attraverso lo studio del luogo, della sua storia, della struttura urbana e dei diversi piani urbanistici che hanno conferito alla città l’immagine attuale, si è cercato di realizzare un progetto di riqualificazione urbana, con l’obbiettivo di completare e di legare due zone della città che sono state oggetto di profonde trasformazioni e di progettazioni protratte nel tempo: il “Campus da Universidade” ed il “Bairro de Santiago”. Un intervento che non vuole porsi con la stessa rigidità dei piani adottati in precedenza, ma che si configura come diffuso lungo un’ampia zona della città, instaurando nuovi rapporti e connessioni già tentati ma mai realmente presenti

Shwachman Diamond Syndrome: an emergency challenge

Shwachman Diamond Syndrome is a rare congenital disorder characterized by pancreatic insufficiency, bone marrow dysfunction and skeletal abnormalities. No specific test is available for a definitive diagnosis for SDS. In the presence of clinical features of SDS, pancreatic insufficiency should be tested for or lipomatosis radiologically demonstrated. New directions might be found in genetic analysis. Sometimes, a life-threatening event may be the first clinical manifestation of the syndrome

Stereotactic radiotherapy and radiosurgery for non-functioning and secreting pituitary adenomas

Radiotherapy (RT) is frequently employed in patients with residual or recurrent pituitary adenoma with excellent rates of tumor control and remission of hormonal hypersecretion. Advances in RT have improved with the use of stereotactic techniques either as fractionated stereotactic radiotherapy (FSRT) or stereotactic radiosurgery (SRS), all aiming to improve the dose distribution to the tumor while reducing the amount of normal brain receiving significant doses of radiation. We provide an overview of the recent published literature on the long-term efficacy and adverse effects of stereotactic irradiation in nonfunctioning and secreting pituitary adenomas. Both techniques are associated with excellent clinical outcomes; however, advantages and drawbacks of each of these techniques in terms of local control, hormonal excess normalization, and radiation-induced toxicity remain a matter of debate. In clinical practice, single-fraction SRS may represent a convenient approach to patients with small and medium-sized pituitary adenoma away at least 2[[ce:hsp sp="0.25"/]]mm from the optic chiasm, whereas FSRT is preferred over SRS for lesions >2.5–3[[ce:hsp sp="0.25"/]]cm in size and/or involving the anterior optic pathway

Severe and prolonged myelosuppression during concomitant temozolomide and radiotherapy treatment in a patient with glioblastoma multiforme

Aims: We describe the case of a patient with glioblastoma (GBM) who developed severe and prolonged myelosuppression during concomitant daily temozolomide (TMZ) and radiotherapy (RT) treatment. Analysis of polymorphisms in genes correlated with TMZ-induced myelotoxicity was also performed. Presentation of the Case: A 67–year-old man with diagnosis of GBM undergoing concomitant RT-TMZ treatment developed severe and prolonged pancytopenia that led to discontinuation of TMZ and required frequent platelet and red cells transfusions. Analysis of single nucleotide polymorphisms (SNPs) in the genes NAD(P)H dehydrogenase, quinone 1 (NQO1) and glutathione S-transferase pi 1 (GSTP1) was carried out. Both SNPs were found to be wild-type. Discussion: TMZ is an oral alkylating agent used for the treatment of glioblastoma. TMZ is usually considered well tolerated and safe, with nausea and mild myelosuppression being the most common side effects. However, severe haematologic adverse events have been also reported. Recently, there has been growing interest in gene polymorphisms that might be associated with an increased risk of hematologic toxicity. Conclusion: Myelosuppression is a side effect that can occur relatively early during concomitant TMZ treatment and can negatively impact on patient’s quality of life. Further studies are warranted to find out a correlation between genetic factors and the occurrence of severe hematologic toxicity

Fractionated stereotactic conformal radiotherapy for large benign skull base meningiomas

<p>Abstract</p> <p>Purpose</p> <p>to assess the safety and efficacy of fractionated stereotactic radiotherapy (FSRT) for large skull base meningiomas.</p> <p>Methods and Materials</p> <p>Fifty-two patients with large skull base meningiomas aged 34-74 years (median age 56 years) were treated with FSRT between June 2004 and August 2009. All patients received FSRT for residual or progressive meningiomas more than 4 centimeters in greatest dimension. The median GTV was 35.4 cm³(range 24.1-94.9 cm³), and the median PTV was 47.6 cm³(range 33.5-142.7 cm³). Treatment volumes were achieved with 5-8 noncoplanar beams shaped using a micromultileaf collimator (MLC). Treatment was delivered in 30 daily fractions over 6 weeks to a total dose of 50 Gy using 6 MV photons. Outcome was assessed prospectively.</p> <p>Results</p> <p>At a median follow-up of 42 months (range 9-72 months) the 3-year and 5-year progression-free survival (PFS) rates were 96% and 93%, respectively, and survival was 100%. Three patients required further debulking surgery for progressive disease. Hypopituitarism was the most commonly reported late complication, with a new hormone pituitary deficit occurring in 10 (19%) of patients. Clinically significant late neurological toxicity was observed in 3 (5.5%) patients consisting of worsening of pre-existing cranial deficits.</p> <p>Conclusion</p> <p>FSRT as a high-precision technique of localized RT is suitable for the treatment of large skull base meningiomas. The local control is comparable to that reported following conventional external beam RT. Longer follow-up is required to assess long term efficacy and toxicity, particularly in terms of potential reduction of treatment-related late toxicity.</p

Hemophagocytic lymphohistiocytosis and visceral leishmaniasis in children: case report and systematic review of literature

Hemophagocytic lymphohistiocytosis is a potentially fatal disorder resulting from excessive activation and non-malignant proliferation of T lymphocytes and macrophages. Neoplasms, autoimmune disorders and systemic infections can cause secondary hemophagocytic syndrome. The association of hemophagocytic syndrome and visceral leishmaniasis is rarely found in childhood. We report a case of an infant affected by hemophagocytic lymphohistiocytosis secondary to visceral leishamniasis and describe all cases of hemophagocytic syndrome associated with visceral leishamniasis in childhood reported in literature, focusing on clinical manifestation, diagnosis and treatment