Late gastrointestinal tissue effects after hypofractionated radiation therapy of the pancreas

Background To consolidate literature reports of serious late gastrointestinal toxicities after hypofractionated radiation treatment of pancreatic cancer and attempt to derive normal tissue complication probability (NTCP) parameters using the Lyman-Kutcher-Burman model. Methods Published reports of late grade 3 or greater gastrointestinal toxicity after hypofractionated treatment of pancreatic cancer were reviewed. The biologically equivalent dose in 1.8 Gy fractions was calculated using the EQD model. NTCP parameters were calculated using the LKB model assuming 1–5 % of the normal tissue volume was exposed to the prescription dose with α/β ratios of 3 or 4. Results A total of 16 human studies were examined encompassing a total of 1160 patients. Toxicities consisted of ulcers, hemorrhages, obstructions, strictures, and perforations. Non-hemorrhagic and non-perforated ulcers occurred at a rate of 9.1 % and were the most commonly reported toxicity. Derived NTCP parameter ranges were as follows: n = 0.38–0.63, m = 0.48–0.49, and TD50 = 35–95 Gy. Regression analysis showed that among various study characteristics, dose was the only significant predictor of toxicity. Conclusions Published gastrointestinal toxicity reports after hypofractionated radiotherapy for pancreatic cancer were compiled. Median dose was predictive of late grade ≥ 3 gastrointestinal toxicity. Preliminary NTCP parameters were derived for multiple volume constraints

I tumori della mammella

Il cancro della mammella \ue8 una malattia purtroppo sempre di attualit\ue0, che colpisce ogni anno in Italia quasi 18.000 donne ed \ue8 responsabile direttamente o indirettamente di circa 11.000 decessi. L\u2019incidenza cumulativa di rischio da 0 a 75 anni \ue8 in lenta ma continua ascesa, a causa del progressivo \u201cinvecchiamento\u201d della popolazione; attualmente nel nostro Paese \ue8 valutabile attorno al 5-7%, a seconda delle aree geografiche considerate, essendo pi\uf9 elevata nelle Regioni settentrionali. Trattandosi della neoplasia pi\uf9 frequente del sesso femminile, la sua gestione pone problemi non solo di ordine strettamente sanitario, ma anche sociale, familiare e psicologico, impegnando forse pi\uf9 di altre patologie tutti gli Operatori del settore ed in particolare il Medico di famiglia. L\u2019immensa quantit\ue0 di lavori scientifici che ogni anno vengono pubblicati sull\u2019argomento e le molte opinioni contrastanti che riguardano i diversi aspetti della malattia, creano non poche difficolt\ue0 a chi desidera un aggiornamento qualificato ma non ha la possibilit\ue0 di soddisfare in tempi brevi tale esigenza. Su suggerimento di alcuni Colleghi che lavorano come Medici di Medicina Generale nell\u2019area del Triveneto, con i quali collaboriamo spesso nell\u2019ambito di questa e di altre patologie, abbiamo pensato di preparare un testo breve e compatto ma al tempo stesso aggiornato, sui tumori della mammella, che speriamo possa essere di facile comprensione e piacevole lettura. Alla fine di ogni capitolo una selezione di voci bibliografiche consente, a chi volesse, di approfondire ciascun argomento

Percutaneous cholecystostomy for severe (Tokyo 2013 stage III) acute cholecystitis

PURPOSES: To evaluate the impact of percutaneous cholecystostomy (PC) on severe acute cholecystitis (AC). METHODS: According to the ICD-9 classification, we retrospectively retrieved medical records of patients discharged with a diagnosis of AC from January 2007 to December 2016 at our hospital. Patients were then stratified according to the Tokyo 2013 (TG 13) AC severity criteria. Grade III AC was diagnosed according to the TG 13 criteria. Indications for PC were failure of optimal medical treatment within 48 h, worsening of clinical condition within early medical treatment, patients unfit for upfront surgery and patient's preference. Ascites was considered a contraindication to PC while coagulopathy was considered a minor contraindication. Primary end points were: clinical improvement, morbidity and related mortality. Secondary endpoints were AC recurrences and elective laparoscopic cholecystectomies (LS). Response was evaluated by clinical and blood test improvement. Morbidity was evaluated according to the Dindo-Clavien scale. RESULTS: A total of 117 eligible patients were diagnosed as grade III AC. Of these, 29 (24.7%) underwent PC. The procedure was completed in all cases. Overall morbidity rate was 20.6%. Main complication was the drainage dislodgement due to involuntary patient's movement. Overall mortality was 17.2% but no causes of death were dependent upon the procedure. Clinical improvement was reported in 95.5% of surviving patients. CONCLUSION: This study confirms that PC is a valuable tool in the treatment of severe AC. Randomized trials are needed to clarify the criteria for patient selection and to optimize the timing for both cholecystostomy and cholecystectomy