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

Radioterapia intraoperatoria (IORT) nel carcinoma mammario in stadio iniziale. Risultati preliminari in 77 pazienti

Purpose: To verify feasibility and effectiveness of IORT (intraoperative radiotherapy) in patients with early stage breast cancer, especially in regard to prevention of recurrence and treatment toxicity. Methods: From october 2000 to november 2006 we operated on 77 patients with stage I breast cancer. We have selected these patients on the basis of a preestablished experimental IORT protocol, participing in a national research project. All these patients underwent a surgical procedure including quadrantectomy of the breast and IORT (average dose 23 Gy). Results: The median follow-up is 69 months (range 18-94 months). We didn’t detected local relapses in any patient. One patients developed further cancer in the other breast. Two patients developed metastasis (one dead). The wound-healing average time was 8 days. We evalueted the treatment late toxicity at 36 months in 64 patients: we detected circumscribed fibrosis (grade 2) in 19 patients; fibrosis with skin retraction (grade 3) in 2 patients; symptomless fat-necrosis in 39 patients (mammographic finding). Conclusions: In our experience, concerning conservative treatment of early breast cancer, IORT proved to be a feasible procedure, causing poor morbidity. However, in spite of valuable preliminary results, a longer follow-up is required to establish the impact of IORT on relapse control and final cosmetic result

Conservative treatment of breast ductal carcinoma in situ: results of an Italian multi-institutional retrospective study

<p>Abstract</p> <p>Background</p> <p>The incidence of ductal carcinoma in situ (DCIS) has increased markedly in recent decades. In the past, mastectomy was the primary treatment for patients with DCIS, but as with invasive cancer, breast-conserving surgery followed by radiation therapy (RT) has become the standard approach. We present the final results of a multi-institutional retrospective study of an Italian Radiation Oncology Group for the study of conservative treatment of DCIS, characterized by a very long period of accrual, from February 1985 to March 2000, and a median follow-up longer than 11 years.</p> <p>Methods</p> <p>A collaborative multi-institutional study was conducted in Italy in 10 Radiation Oncology Departments. A consecutive series of 586 women with DCIS histologically confirmed, treated between February 1985 and March 2000, was retrospectively evaluated. Median age at diagnosis was 55 years (range: 29–84); 32 patients were 40 years old or younger. All women underwent conservative surgery followed by whole breast RT. Irradiation was delivered to the entire breast, for a median total dose of 50 Gy; the tumour bed was boosted in 295 cases (50%) at a median dose of 10 Gy.</p> <p>Results</p> <p>After a median follow-up of 136 months (range: 16–292 months), 59/586 patients (10%) experienced a local recurrence: invasive in 37 cases, intraductal in 20 and not specified in two. Salvage mastectomy was the treatment of choice in 46 recurrent patients; conservative surgery in 10 and it was unknown in three patients. The incidence of local recurrence was significantly higher in women younger than 40 years (31.3%) (p= 0.0009). Five patients developed distant metastases. Furthermore 40 patients developed a contralateral breast cancer and 31 a second primary tumour in a different site. The 10-year actuarial overall survival (OS) was 95.5% and the 10-year actuarial disease-specific survival (DSS) was 99%.</p> <p>Conclusions</p> <p>Our results are consistent with those reported in the literature. In particular it has been defined the importance of young age (40 years or less) as a relevant risk factor for local recurrence. This retrospective multi-institutional Italian study confirms the long term efficacy of breast conserving surgery with RT in women with DCIS.</p

Public Italian universities towards accrual accounting and management control

The paper analyzes the accounting, financial reporting and management control systems of the Italian public universities, according to the new legislation (Law 240/2010, Decree 18/2012). This reform includes two important changes: the adoption of accrual accounting and the introduction of a management control system, both mandatory from 1st January 2014. The paper provides a description of the current situation of Italian universities, which allows to understand the reality in which the reform will be implemented and to evaluate whether universities are ready to realize these important changes. For this purpose, an empirical analysis has been conducted, based on the results of a semi-structured questionnaire that was applied to the 67 public universities during the first half of 2013. Survey results indicate that not many universities possess budgeting and accounting reporting systems aligned with the new legislation; however, most of them have executed different types of efforts for the transition process