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Vinante L, Avanzo M, Furlan C, Fiorica F, Perin T, Militello L, Spazzapan S, Berretta M, Jena R, Stancanello J, Piccoli E, Mileto M, Micheli E, Roncadin M, Massarut S, Trovò M. Ten daily fractions for partial breast irradiation. Long-term results of a prospective phase II trial. Breast J 2019; 25:243-249. [PMID: 30714257 DOI: 10.1111/tbj.13195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/14/2018] [Accepted: 03/16/2018] [Indexed: 11/30/2022]
Abstract
Partial breast irradiation (PBI) is an effective adjuvant treatment after breast conservative surgery for selected early-stage breast cancer patients. However, the best fractionation scheme is not well defined. Hereby, we report the 5-year clinical outcome and toxicity of a phase II prospective study of a novel regimen to deliver PBI, which consists in 40 Gy delivered in 10 daily fractions. Patients with early-stage (pT1-pT2, pN0-pN1a, M0) invasive breast cancer were enrolled after conservative surgery. The minimum age at diagnosis was 60 years old. PBI was delivered with 3D-conformal radiotherapy technique with a total dose of 40 Gy, fractionated in 10 daily fractions (4 Gy/fraction). Eighty patients were enrolled. The median follow-up was 67 months. Five-year local control (LC), disease-free survival (DFS), and overall survival (OS) were 95%, 91%, and 96%, respectively. Grade I and II subcutaneous fibrosis were documented in 23% and 5% of cases. No grade III late toxicity was observed. PBI delivered in 40 Gy in 10 daily fractions provided good clinical results and was a valid radiotherapy option for early-stage breast cancer patients.
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Affiliation(s)
- Lorenzo Vinante
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Michele Avanzo
- Division of Medical Physics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Carlo Furlan
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy.,Department of Radiation Oncology, Belluno General Hospital, Belluno, Italy
| | - Francesco Fiorica
- Department of Radiation Oncology, University Hospital S. Anna, Ferrara, Italy
| | - Tiziana Perin
- Department of Pathology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Loredana Militello
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Simon Spazzapan
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Massimiliano Berretta
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Rajesh Jena
- Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Erica Piccoli
- Breast Surgery Unit, Department of Oncology and Surgery, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Mario Mileto
- Breast Surgery Unit, Department of Oncology and Surgery, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Elvia Micheli
- Department of General Surgery, Pordenone General Hospital, Pordenone, Italy
| | - Mario Roncadin
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Samuele Massarut
- Breast Surgery Unit, Department of Oncology and Surgery, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Marco Trovò
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy.,Department of Radiation Oncology, Udine General Hospital, Udine, Italy
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Boz G, De Paoli A, Innocente R, Del Pup L, Talamini R, Scarabelli C, Scozzari G, Roncadin M, Franchin G, Trovò MG. Endometrial Stage I Carcinoma Treated with Surgery and Adjuvant Irradiation: A Retrospective Analysis. Tumori 2018; 81:256-60. [PMID: 8540122 DOI: 10.1177/030089169508100408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Data from the literature show that the incidence of pelvic recurrences in poor prognosis endometrial carcinoma is significantly reduced by combined surgery and radiotherapy compared to surgery alone. Methods In this paper we analyze the results of the combined treatment surgery and adjuvant irradiation in patients with endometrial carcinoma with regard to survival, site of progression, and toxicity. The surgical treatment consisted of total abdominal hysterectomy and bilateral salpingo-oophorectomy in 40 patients. Pelvic and para-aortic node dissection was performed in 19 patients and lymph node sampling in 5. Results Overall 5-year survival was 85%. One patient had local failure, and 5 patients with local control of disease had distant metastases. Toxicity was mild and transient. Conclusions Our experience confirms the data of the literature. Postoperative irradiation is a safe and well-tolerated treatment that can achieve a good local control in high risk, stage I, endometrial carcinoma. The control of distant metastases remains an open question.
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Affiliation(s)
- G Boz
- Radiotherapy Division, General Hospital Pordenone, Italy
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Franchin G, De Paoli A, Gobitti C, Boz G, Minatel E, Roncadin M, Arcicasa M, Bortolus R, Innocente R, Trovò GM. Postoperative Radiotherapy in Locally Advanced Head and Neck Cancer. Tumori 2018; 75:47-52. [PMID: 2711474 DOI: 10.1177/030089168907500113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This retrospective study was conducted on 255 consecutive patients with locally advanced squamous-cell carcinoma of the oral cavity, oropharynx, larynx or hypopharynx, treated at the Radiotherapy Department of Pordenone General Hospital between January 1975 and December 1985. All patients underwent radical surgery followed, after an interval ranging from 10 days to 2.9 months, by radiotherapy given either through a 6 MeV linear accelerator or a cobalt-60 unit. Field extension and dose delivered were comparable in relation to stage and involvement of the surgical resection margins. The aims of the study were to evaluate the survival rate and to analyze the clinical parameters which can influence the disease-free survival. The adjusted overall 5-year survival rate was 71%; stage, performance status at diagnosis, and site of the primary tumor were significant factors in determining patient prognosis, whereas Infiltration of resection margins was not significant in determining locoregional control of disease. Seventy-five patients relapsed and 67 died of cancer-related diseases whereas death in 52 patients was not related to the head and neck cancer. The combined modality treatment consisting of surgery followed by radiotherapy was well tolerated and proved to be effective in the treatment of locally advanced head and neck tumors.
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Affiliation(s)
- G Franchin
- Department of Radiotherapy, General Hospital, Pordenone, Italy
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Amichetti M, Caffo O, Richetti A, Zini G, Rigon A, Antonello M, Roncadin M, Coghetto F, Valdagni R, Fasan S, Maluta S, Di Marco A, Neri S, Vidali C, Panizzoni G, Aristei C. Subclinical Ductal Carcinoma in Situ of the Breast: Treatment with Conservative Surgery and Radiotherapy. Tumori 2018; 85:488-93. [PMID: 10774571 DOI: 10.1177/030089169908500612] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and Background In spite of the fact that ductal carcinoma in situ (DCIS) of the breast is a frequently encountered clinical problem, there is no consensus about the optimal treatment of clinically occult (i.e., mammographic presentation only) DCIS. Interest in breast conservation therapy has recently increased. Few data are available in Italy on the conservative treatment with surgery and adjuvant postoperative radiotherapy. Methods A retrospective multi-institutional study was performed in 15 Radiation Oncology Departments in northern Italy involving 112 women with subclinical DCIS of the breast treated between 1982 and 1993. Age of the patients ranged between 32 and 72 years (median, 50 years). All of them underwent conservative surgery: quadrantectomy in 89, tumorectomy in 11, and wide excision in 12 cases. The most common histologic subtype was comedocarcinoma (37%). The median pathologic size was 10 mm (range 1 to 55 mm). Axillary dissection was performed in 83 cases: all the patients were node negative. All the patients received adjunctive radiation therapy with 60Co units (77%) or 6 MV linear accelerators (23%) for a median total dose to the entire breast of 50 Gy (mean, 49.48 Gy; range, 45-60 Gy). Seventy-six cases (68%) received a boost to the tumor bed at a dose of 8-20 Gy (median 10 Gy) for a minimum tumor dose of 58 Gy. Results At a median follow-up of 66 months, 8 local recurrences were observed, 4 intraductal and 4 invasive. All recurrent patients had a salvage mastectomy and are alive and free of disease at this writing. The 10-year actuarial overall, cause-specific, and recurrence-free survival was of 98.8%, 100%, and 91%, respectively. Conclusions The retrospective multicentric study, with a local control rate of more than 90% at 10 years with 100% cause-specific survival, showed that conservative surgery and adjuvant radiation therapy is a safe and efficacious treatment for patients with occult, non-palpable DCIS.
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Affiliation(s)
- M Amichetti
- Radiation Oncology Department, Santa Chiara Hospital, Trento, Italy
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Boz G, De Paoli A, Roncadin M, Franchin G, Galligioni E, Arcicasa M, Bortolus R, Gobitti C, Minatel E, Innocente R. Radiation Therapy Combined with Chemotherapy for Inoperable Pancreatic Carcinoma. Tumori 2018; 77:61-4. [PMID: 1708178 DOI: 10.1177/030089169107700115] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
From March 1985 to July 1989, 22 patients with unresectable pancreatic adenocarcinoma entered the study to receive external beam irradiation with chemotherapy. Radiation therapy consisted of 60 Gy in 3 courses (20 Gy each course) delivered over a period of 2 weeks, with a 2-week rest between the courses. Chemotherapy consisted of 5 fluorouracil, 500 mg/m2, plus cisplatinum, 20 mg/m2, administered on days 1,2 and 3 of each radiation therapy course. Of the 22 evaluable patients, 10 were males and 12 females; their median age was 63 years (range, 32-77), and their median performance status was 80 (range, 60-90). After treatment, 12 partial remissions and 6 no changes were reported. In 4 cases, abdominal progression of disease during treatment required interruption of the therapy program. At the start of treatment, abdominal pain was the most important symptom in 17 patients; improvement of abdominal pain was observed in 10 cases (76%) after treatment and lasted for a median of 5 months. Median survival time was 7.5 months, and time to progression was 6.2 months. Median follow-up was 7 months (range, 14 days -38). In 2 cases, persistent hematologic toxicity did not permit completion of therapy, and in another 3 cases grade II hematologic toxicity required a 2-week rest period over the normal split-course program. In another 4 cases, grade I hematologic toxicity did not require any delay in the therapy program. Our results are comparable with those achieved in other major studies and are acceptable in terms of survival time, palliation of symptoms and toxicity. In our experience, the combination of radiotherapy plus 5-fluoro-uracil and cisplatinum does not seem to offer any advantage over the combination of radiation therapy and 5-fluorouracil.
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Affiliation(s)
- G Boz
- Radiotherapy Dept., Centro di Riferimento Oncologico (C.R.O.), Aviano-Pordenone, Italy
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Tirelli U, Frustaci S, Galligioni E, Veronesi A, Trovò MG, Magri DM, Crivellari D, Roncadin M, Tumolo S, Grigoletto E. Medical Treatment of Metastatic Renal Cell Carcinoma. Tumori 2018; 66:235-40. [PMID: 7445105 DOI: 10.1177/030089168006600212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Thirty five patients with metastatic RCC were observed over a 57 months period in our Division of Radiotherapy and Medical Oncology, and 30 are evaluable for this analysis. MPA was selected as primary treatment agent in 23 patients, VLB singly, in combination with MPA or in combination with CCNU was used in 1.4 and 2 patients. With MPA the TR rate was 3/23 (1 CR and 2 PR). Duration of response for the patient with CR was 6 months whereas for the patients with PR was 21 and 14 months respectively. 4 additional patients showed NC. With VLB-MPA the TR rate was 1/4 (1 PR). Duration of PR was 3 months. The median duration of survival for the 11 patients with CR, PR and NC was 14 months whereas for the 19 patients with NR was 7 months (p < 0.01). TES and TAM showed no or minimal activity as second treatment agents.
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Tirelli U, Veronesi A, Galligioni E, Trovò MG, Magri D, Frustaci S, Crivellari D, Roncadin M, Tumolo S, Grigoletto E. Clinical and Immunological Evaluation of 5 Cases of Mycosis Fungoides in Advanced Stages. Tumori 2018; 65:447-53. [PMID: 315125 DOI: 10.1177/030089167906500404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Five patients with mycosis fungoides, hospitalized in the Division of Radiotherapy and Medical Oncology of the Ospedale Civile, Pordenone, from January 1975 to December 1978, were studied and treated as non-Hodgkin lymphomas. All patients had evidence of disseminated disease: 3 with bone marrow infiltration, 1 with splenic involvement and 1 with lymph node involvement. Three patients were treated with CVP, resulting in 2 complete remissions that lasted 18 months and 1 PR > 50% maintained for 7 months. One patient was treated with ABVD with a PR > 50% maintained for 10 months. The last patient was treated with prednisone and then with CV, but expired from pulmonary embolism after 1 cycle. Lymphocyte function, using E and EAC rosette and PHA, was evaluated before therapy in all patients: in the 2 patients who obtained a CR, an improvement in T-lymphocyte function was noted after therapy. The chromosome pattern of peripheral blood lymphocytes was altered before therapy in only one patient. Even if the follow-up period is still relatively brief, the duration of the 2 complete remissions must be stressed. In addition, a strict correlation between T-lymphocyte function and response to therapy was revealed in our study.
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Gobitti C, Borsatti E, Arcicasa M, Roncadin M, Franchin G, Minatel E, Skrap M, Zanotti B, Tuniz F, Cimitan M, Capra E, Drigo A, Trovò MG. Treatment of recurrent high-grade gliomas with GliaSite brachytherapy: A prospective mono-institutional Italian experience. Tumori 2018; 97:614-9. [DOI: 10.1177/030089161109700513] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background The present study evaluated toxicity, local control, and survival in patients with relapsed high-grade glioma after surgery and external beam radiation therapy and treated with re-operation and GliaSite brachytherapy. Methods Between 2006 and 2008, 15 patients with recurrent high-grade glioma underwent re-operation and GliaSite brachytherapy. Ten patients were males and 5 females. Median age was 40 years (range, 20–71). Karnofsky performance status was ≥70. All patients but one received GliaSite irradiation of the surgical cavity wall at the dose of 4500 cGy at a depth of 1 cm. Results No severe acute side effects were observed during GliaSite brachytherapy. Pathologically documented, symptomatic late radiation necrosis was observed in 3 patients (20%); 2 subsequently died of further complications. Two patients were alive at a median follow-up 13 months (range, 1–30). Median overall survival after GliaSite brachytherapy was 13 months. Conclusions Patients with recurrent high-grade glioma can be treated with additional surgery and GliaSite brachytherapy, delivering 4500 cGy at 1 cm depth without significant acute side effects but with a significant rate (20%) of late radiation necrosis, resulting in 13% of treatment-related deaths. Compared with the literature, survival results in our study appear to be satisfactory, but they may be related to patient selection criteria. Re-intervention followed by GliaSite brachytherapy should not be offered as a standard treatment for recurrent high-grade glioma, because of the high rate of late complications, treatment-related deaths, and high treatment costs.
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Affiliation(s)
- Carlo Gobitti
- Radiation Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano
| | - Eugenio Borsatti
- Nuclear Medicine, Centro di Riferimento Oncologico, National Cancer Institute, Aviano
| | - Mauro Arcicasa
- Radiation Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano
| | - Mario Roncadin
- Radiation Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano
| | - Giovanni Franchin
- Radiation Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano
| | - Emilio Minatel
- Radiation Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano
| | - Miran Skrap
- Neurosurgery Department, University Hospital, Udine, Italy
| | - Bruno Zanotti
- Neurosurgery Department, University Hospital, Udine, Italy
| | | | - Marino Cimitan
- Nuclear Medicine, Centro di Riferimento Oncologico, National Cancer Institute, Aviano
| | - Elvira Capra
- Medical Physics Divisions, Centro di Riferimento Oncologico, National Cancer Institute, Aviano
| | - Annalisa Drigo
- Medical Physics Divisions, Centro di Riferimento Oncologico, National Cancer Institute, Aviano
| | - Mauro G Trovò
- Radiation Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano
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Mileto M, Perin T, Trovo' M, Roncadin M, Capra E, Avanzo M, Massarut S. Intraoperative radiotherapy during breast-conserving surgery: 10-year of our experience. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Truccolo I, Cipolat Mis C, Cervo S, Dal Maso L, Bongiovanni M, Bearz A, Sartor I, Baldo P, Ferrarin E, Fratino L, Mascarin M, Roncadin M, Annunziata MA, Muzzatti B, De Paoli P. Patient-Centered Cancer Care Programs in Italy: Benchmarking Global Patient Education Initiatives. J Cancer Educ 2016; 31:405-412. [PMID: 25773134 PMCID: PMC4831987 DOI: 10.1007/s13187-015-0805-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In Italy, educational programs for cancer patients are currently provided by the national government, scientific societies, and patient advocate organizations. Several gaps limit their effectiveness, including the lack of coordinated efforts, poor involvement of patient feedback in the planning of programs, as well as a lack of resources on innovative cancer-related topics. This process is parallel to a strong shift in the attitude of patients towards health in general and taking charge of their own health conditions in particular. The National Cancer Institute in the USA and the Organization of European Cancer Institutes encourage comprehensive cancer centers in providing educational programs conceived to overcome these gaps. The goal of this paper is to identify and describe the key elements necessary to develop a global patient education program and provide recommendations for strategies with practical examples for implementation in the daily activities of cancer institutes. A multidisciplinary committee was established for patient education, including patient representatives as equal partners, to define, implement, verify, and evaluate the fundamental steps for establishing a comprehensive education program. Six essential topics were identified for the program: appropriate communication of cancer epidemiology, clinical trial information, new therapeutic technologies, support in the use of medicines, psycho-oncological interventions, age-personalized approaches, and training programs for healthcare providers. Integration of these topics along with patient feedback is the key to a successful model for educational programs. An integrated educational program can transform a comprehensive cancer center to an institution that provides research and care for and with patients.
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Affiliation(s)
- Ivana Truccolo
- Scientific Directorate, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Chiara Cipolat Mis
- Scientific Directorate, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Silvia Cervo
- CRO-Biobank, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy.
- Clinical Cancer Pathology, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy.
| | - Luigino Dal Maso
- Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Marilena Bongiovanni
- Associazione Nazionale Guariti Lungoviventi Oncologici (ANGOLO), CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Alessandra Bearz
- Medical Oncology, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Ivana Sartor
- Scientific Directorate, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Paolo Baldo
- Pharmacy, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Emanuela Ferrarin
- Pharmacy, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Lucia Fratino
- Medical Oncology, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Maurizio Mascarin
- Radiotherapy, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Mario Roncadin
- Radiotherapy, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | | | - Barbara Muzzatti
- Psychooncology, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Paolo De Paoli
- Scientific Directorate, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
- CRO-Biobank, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
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Trovo M, Piccoli E, Micheli E, Mileto M, Favaro A, Perin T, Spazzapan S, Massarut S, Roncadin M. Five Year Results With 3-D Conformal Radiation Therapy to Deliver Partial-Breast Irradiation Consisting of 40 Gy in 10 Daily Fractions. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Avanzo M, Trovo M, Stancanello J, Jena R, Roncadin M, Toffoli G, Zuiani C, Capra E. Hypofractionation of partial breast irradiation using radiobiological models. Phys Med 2015; 31:1022-1028. [PMID: 26508014 DOI: 10.1016/j.ejmp.2015.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/10/2015] [Accepted: 08/03/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To reduce the fraction number in Partial Breast Irradiation (PBI) with initial prescription of 40 Gy in 10 fractions using radiobiological models with specific focus on risk of moderate/severe radiation-induced fibrosis (RIF) and report clinical results. METHODS AND MATERIALS 68 patients (patient group A) were treated with 40 Gy in 10 fractions delivered by field-in-field, forward-planned IMRT. Isotoxic regimens with decreasing number of fractions were calculated using Biological Effective Dose (BED) to the breast. Risk for RIF in hypofractionated treatment was predicted by calculating NTCP from DVHs of group A rescaled to fractions and dose of novel regimens. Moderate/severe RIF was prospectively scored during follow-up. Various NTCP models, with and without incomplete repair correction, were assessed from difference to observed incidence of RIF. In order to verify the value for α/β of 3 Gy assumed for breast, we fitted α/β to observed incidences of moderate/severe RIF. RESULTS Treatments with 35 Gy/7f and 28 Gy/4f were selected for the fraction reduction protocol. 75 patients (group B) were treated in 35 Gy/7f. Incidence of moderate/severe RIF was 5.9% in group A, 5.3% in group B. The NTCP model with correction for incomplete repair had lowest difference from observed RIF. The α/β obtained from fitting was 2.8 (95%CIs 1.1-10.7) Gy. CONCLUSIONS The hypofractionated regimen was well tolerated. The model for NTCP corrected for incomplete repair was the most accurate and an assumed α/β value of 3 Gy is consistent with our patient data. The hypofractionation protocol is continuing with patients treated with 28 Gy/4f.
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Affiliation(s)
- Michele Avanzo
- Medical Physics Department, CRO Aviano, 33081 Aviano, Italy.
| | - Marco Trovo
- Radiation Oncology Department, CRO Aviano, 33081 Aviano, Italy
| | | | - Rajesh Jena
- Department of Oncology, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Mario Roncadin
- Radiation Oncology Department, CRO Aviano, 33081 Aviano, Italy
| | - Giulia Toffoli
- Institute of Diagnostic Radiology, Department of Medical and Biological Sciences, University of Udine, 33100 Udine, Italy
| | - Chiara Zuiani
- Institute of Diagnostic Radiology, Department of Medical and Biological Sciences, University of Udine, 33100 Udine, Italy
| | - Elvira Capra
- Medical Physics Department, CRO Aviano, 33081 Aviano, Italy
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Trovò MG, Veronesi A, Bortolus R, Roncadin M, De Paoli A, Franchin G, Grigoletto E, Minatel E. Is chemotherapy necessary in the management of unresectable nonmetastatic nonsmall-cell lung cancer? Antibiot Chemother (1971) 2015; 41:126-30. [PMID: 2854431 DOI: 10.1159/000416192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- M G Trovò
- Radiotherapy Department, Centro Riferimento Oncologico, Aviano (Pordenone), Italy
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Vaidya JS, Wenz F, Bulsara M, Tobias JS, Joseph DJ, Keshtgar M, Flyger HL, Massarut S, Alvarado M, Saunders C, Eiermann W, Metaxas M, Sperk E, Sütterlin M, Brown D, Esserman L, Roncadin M, Thompson A, Dewar JA, Holtveg HMR, Pigorsch S, Falzon M, Harris E, Matthews A, Brew-Graves C, Potyka I, Corica T, Williams NR, Baum M. Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. Lancet 2014; 383:603-13. [PMID: 24224997 DOI: 10.1016/s0140-6736(13)61950-9] [Citation(s) in RCA: 581] [Impact Index Per Article: 58.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The TARGIT-A trial compared risk-adapted radiotherapy using single-dose targeted intraoperative radiotherapy (TARGIT) versus fractionated external beam radiotherapy (EBRT) for breast cancer. We report 5-year results for local recurrence and the first analysis of overall survival. METHODS TARGIT-A was a randomised, non-inferiority trial. Women aged 45 years and older with invasive ductal carcinoma were enrolled and randomly assigned in a 1:1 ratio to receive TARGIT or whole-breast EBRT, with blocks stratified by centre and by timing of delivery of targeted intraoperative radiotherapy: randomisation occurred either before lumpectomy (prepathology stratum, TARGIT concurrent with lumpectomy) or after lumpectomy (postpathology stratum, TARGIT given subsequently by reopening the wound). Patients in the TARGIT group received supplemental EBRT (excluding a boost) if unforeseen adverse features were detected on final pathology, thus radiotherapy was risk-adapted. The primary outcome was absolute difference in local recurrence in the conserved breast, with a prespecified non-inferiority margin of 2·5% at 5 years; prespecified analyses included outcomes as per timing of randomisation in relation to lumpectomy. Secondary outcomes included complications and mortality. This study is registered with ClinicalTrials.gov, number NCT00983684. FINDINGS Patients were enrolled at 33 centres in 11 countries, between March 24, 2000, and June 25, 2012. 1721 patients were randomised to TARGIT and 1730 to EBRT. Supplemental EBRT after TARGIT was necessary in 15·2% [239 of 1571] of patients who received TARGIT (21·6% prepathology, 3·6% postpathology). 3451 patients had a median follow-up of 2 years and 5 months (IQR 12-52 months), 2020 of 4 years, and 1222 of 5 years. The 5-year risk for local recurrence in the conserved breast was 3·3% (95% CI 2·1-5·1) for TARGIT versus 1·3% (0·7-2·5) for EBRT (p=0·042). TARGIT concurrently with lumpectomy (prepathology, n=2298) had much the same results as EBRT: 2·1% (1·1-4·2) versus 1·1% (0·5-2·5; p=0·31). With delayed TARGIT (postpathology, n=1153) the between-group difference was larger than 2·5% (TARGIT 5·4% [3·0-9·7] vs EBRT 1·7% [0·6-4·9]; p=0·069). Overall, breast cancer mortality was much the same between groups (2·6% [1·5-4·3] for TARGIT vs 1·9% [1·1-3·2] for EBRT; p=0·56) but there were significantly fewer non-breast-cancer deaths with TARGIT (1·4% [0·8-2·5] vs 3·5% [2·3-5·2]; p=0·0086), attributable to fewer deaths from cardiovascular causes and other cancers. Overall mortality was 3·9% (2·7-5·8) for TARGIT versus 5·3% (3·9-7·3) for EBRT (p=0·099). Wound-related complications were much the same between groups but grade 3 or 4 skin complications were significantly reduced with TARGIT (four of 1720 vs 13 of 1731, p=0·029). INTERPRETATION TARGIT concurrent with lumpectomy within a risk-adapted approach should be considered as an option for eligible patients with breast cancer carefully selected as per the TARGIT-A trial protocol, as an alternative to postoperative EBRT. FUNDING University College London Hospitals (UCLH)/UCL Comprehensive Biomedical Research Centre, UCLH Charities, National Institute for Health Research Health Technology Assessment programme, Ninewells Cancer Campaign, National Health and Medical Research Council, and German Federal Ministry of Education and Research.
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MESH Headings
- Aged
- Breast Neoplasms/mortality
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Female
- Humans
- Intraoperative Care/methods
- Intraoperative Care/mortality
- Kaplan-Meier Estimate
- Mastectomy, Segmental/methods
- Mastectomy, Segmental/mortality
- Middle Aged
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/prevention & control
- Radiotherapy/methods
- Radiotherapy/mortality
- Treatment Outcome
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Affiliation(s)
- Jayant S Vaidya
- Clinical Trials Group, Division of Surgery and Interventional Science, University College London, London, UK; Department of Surgery, Royal Free Hospital, London, UK; Department of Surgery, Whittington Hopsital, London, UK.
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Max Bulsara
- Department of Biostatistics, University of Notre Dame, Fremantle, WA, Australia
| | - Jeffrey S Tobias
- Department of Clinical Oncology, University College London Hospitals, London, UK
| | - David J Joseph
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Mohammed Keshtgar
- Department of Surgery, Royal Free Hospital, London, UK; Department of Surgery, Whittington Hopsital, London, UK
| | - Henrik L Flyger
- Department of Breast Surgery, University of Copenhagen, Copenhagen, Denmark
| | - Samuele Massarut
- Department of Surgery, Centro di Riferimento Oncologia, Aviano, Italy
| | - Michael Alvarado
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Christobel Saunders
- Department of Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia; School of Surgery, University of Western Australia, Perth, WA, Australia
| | - Wolfgang Eiermann
- Department of Gynecology and Obstetrics, Red Cross Hospital, Munich, Germany
| | - Marinos Metaxas
- Clinical Trials Group, Division of Surgery and Interventional Science, University College London, London, UK
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Marc Sütterlin
- Department of Gynecology and Obstetrics, University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Douglas Brown
- Department of Surgery, Ninewells Hospital, Dundee, UK
| | - Laura Esserman
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Mario Roncadin
- Department of Radiation Oncology, Centro di Riferimento Oncologia, Aviano, Italy
| | | | - John A Dewar
- Department of Radiation Oncology, Ninewells Hospital, Dundee, UK
| | - Helle M R Holtveg
- Department of Breast Surgery, University of Copenhagen, Copenhagen, Denmark
| | - Steffi Pigorsch
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany
| | - Mary Falzon
- Department of Pathology, University College London Hospitals, London, UK
| | - Eleanor Harris
- Department of Radiation Oncology, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - April Matthews
- Psychosocial Oncology Clinical Studies Group, National Cancer Research Institute, London, UK; Independent Cancer Patients' Voice, London, UK
| | - Chris Brew-Graves
- Clinical Trials Group, Division of Surgery and Interventional Science, University College London, London, UK
| | - Ingrid Potyka
- Clinical Trials Group, Division of Surgery and Interventional Science, University College London, London, UK
| | - Tammy Corica
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Norman R Williams
- Clinical Trials Group, Division of Surgery and Interventional Science, University College London, London, UK
| | - Michael Baum
- Clinical Trials Group, Division of Surgery and Interventional Science, University College London, London, UK
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Trovo M, Durofil E, Polesel J, Roncadin M, Giovanna S, Perin T, Mileto M, Massarut S, Carbone A, Trovo M. Delivering Adjuvant Radiation Therapy Beyond 6 Months After Breast-Conserving Surgery Does Not Jeopardize the Locoregional Control in Early-Stage Breast Cancer Patients. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Trovo M, Polesel J, Biasutti C, Sartor G, Roncadin M, Trovo GM. Fiducial markers for image-guided partial breast irradiation. Radiol Med 2013; 118:1212-9. [PMID: 23892956 DOI: 10.1007/s11547-013-0967-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 09/12/2012] [Indexed: 10/26/2022]
Abstract
PURPOSE This study was undertaken to study the role of fiducial markers for image-guided partial breast irradiation (IG-PBI), and to compare the shifts based on bony anatomy and fiducial markers. MATERIALS AND METHODS Fifteen patients underwent IGPBI. Three fiducial markers were placed in the tumour bed at the time of surgery. Daily orthogonal anterior/ posterior and lateral kV-images were taken before each fraction and compared with the digitally-reconstructed radiographs, both using bony landmarks and fiducial markers as reference. The Student's t test was used to detect a meaningful difference of 3 mm in between the two methods. RESULTS A total of 105 image-guided radiation therapy (IGRT) sessions were obtained. The mean superior/inferior, right/left, and anterior/posterior shifts obtained using the bony landmarks vs. the fiducial markers were 2 mm [standard deviation (SD) 10 mm] vs. 0 mm (SD 7 mm), 0 mm (SD 7 mm) vs. 1 mm (SD 4 mm), and 1 mm (SD 7 mm) vs. 0 mm (SD 5 mm), respectively. The mean shift differences in absolute value between the two methods, along the superior/inferior, right/left and anterior/posterior directions were 5 mm (p=0.001), 3 mm [p=not significant (ns)], and 3 mm (p=ns), respectively. CONCLUSIONS Fiducial markers for IG-PBI increase set-up accuracy compared to the bony landmarks, in particular along the superior/inferior direction.
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Affiliation(s)
- Marco Trovo
- Department of Radiation Oncology, Centro di Riferimento Oncologico, CRO, Via F. Gallini 2, 33081, Aviano (PN), Italy,
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Trovo M, Roncadin M, Polesel J, Piccoli E, Mileto M, Micheli E, Perin T, Carbone A, Massarut S, Trovo MG. Toxicity and cosmesis following partial breast irradiation consisting of 40 Gy in 10 daily fractions. Breast 2013; 22:744-7. [PMID: 23352319 DOI: 10.1016/j.breast.2012.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 10/09/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To assess the toxicity and cosmetic results in breast cancer patients undergoing adjuvant partial breast irradiation (PBI) to a total dose of 40 Gy in 10 daily fractions (4 Gy/fraction). METHODS AND MATERIALS Patients affected by early-stage breast cancer were enrolled in this phase II trial. Patients had to be 60 years old and treated with breast conservative surgery for early stage (pT1-T2 pN0-N1a) invasive ductal carcinoma. RESULTS 77 patients were enrolled. Median follow-up was 18 months. The proposed schedule was well tolerated. One patient reported Grade 3 pain at the site of irradiation. Four (5%) patients experience Grade 2 erythema. Late Grade 2 and 1 fibrosis was observed in 3 (4%) and 14 (18%) patients, respectively. Cosmesis was judged "good/excellent" and "poor" in 75 (97%) and in 2 (3%) patients, respectively. CONCLUSIONS 40 Gy in 10 daily fractions, 4 Gy/fraction, is a well tolerated regimen to deliver PBI.
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Affiliation(s)
- Marco Trovo
- Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, via F. Gallini 2, 33081 Aviano (PN), Italy.
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Avanzo M, Stancanello J, Trovò M, Jena R, Roncadin M, Trovò MG, Capra E. Complication probability model for subcutaneous fibrosis based on published data of partial and whole breast irradiation. Phys Med 2012; 28:296-306. [DOI: 10.1016/j.ejmp.2011.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 10/24/2011] [Accepted: 11/06/2011] [Indexed: 11/16/2022] Open
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Avanzo M, Rink A, Dassie A, Massarut S, Roncadin M, Borsatti E, Capra E. In vivodosimetry with radiochromic films in low-voltage intraoperative radiotherapy of the breast. Med Phys 2012; 39:2359-68. [DOI: 10.1118/1.3700175] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Gobitti C, Borsatti E, Arcicasa M, Roncadin M, Franchin G, Minatel E, Skrap M, Zanotti B, Tuniz F, Cimitan M, Capra E, Drigo A, Trovò MG. Treatment of recurrent high-grade gliomas with GliaSite brachytherapy: a prospective mono-institutional Italian experience. Tumori 2012. [PMID: 22158493 DOI: 10.1700/989.10721] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND BACKGROUND The present study evaluated toxicity, local control, and survival in patients with relapsed high-grade glioma after surgery and external beam radiation therapy and treated with re-operation and GliaSite brachytherapy. METHODS Between 2006 and 2008, 15 patients with recurrent high-grade glioma underwent re-operation and GliaSite brachytherapy. Ten patients were males and 5 females. Median age was 40 years (range, 20-71). Karnofsky performance status was ≥70. All patients but one received GliaSite irradiation of the surgical cavity wall at the dose of 4500 cGy at a depth of 1 cm. RESULTS No severe acute side effects were observed during GliaSite brachytherapy. Pathologically documented, symptomatic late radiation necrosis was observed in 3 patients (20%); 2 subsequently died of further complications. Two patients were alive at a median follow-up 13 months (range, 1-30). Median overall survival after GliaSite brachytherapy was 13 months. CONCLUSIONS Patients with recurrent high-grade glioma can be treated with additional surgery and GliaSite brachytherapy, delivering 4500 cGy at 1 cm depth without significant acute side effects but with a significant rate (20%) of late radiation necrosis, resulting in 13% of treatment-related deaths. Compared with the literature, survival results in our study appear to be satisfactory, but they may be related to patient selection criteria. Re-intervention followed by GliaSite brachytherapy should not be offered as a standard treatment for recurrent high-grade glioma, because of the high rate of late complications, treatment-related deaths, and high treatment costs.
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Affiliation(s)
- Carlo Gobitti
- Radiation Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy.
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Trovo M, Durofil E, Polesel J, Roncadin M, Perin T, Mileto M, Piccoli E, Quitadamo D, Massarut S, Carbone A, Trovo MG. Locoregional failure in early-stage breast cancer patients treated with radical mastectomy and adjuvant systemic therapy: which patients benefit from postmastectomy irradiation? Int J Radiat Oncol Biol Phys 2012; 83:e153-7. [PMID: 22386375 DOI: 10.1016/j.ijrobp.2011.12.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 10/25/2011] [Accepted: 12/12/2011] [Indexed: 10/28/2022]
Abstract
PURPOSE To assess the locoregional failure in patients with Stage I-II breast cancer treated with radical mastectomy and to evaluate whether a subset of these patients might be at sufficiently high risk of locoregional recurrence (LRR) to benefit from postmastectomy irradiation (PMRT). METHODS AND MATERIALS Stage I-II breast cancer patients (n = 150) treated with radical mastectomy without adjuvant irradiation between 1999 and 2005 were analyzed. The pattern of LRR was reported. Kaplan-Meier analysis was used to calculate rates of LRR, and Cox proportional hazards methods were used to evaluate potential risk factors. RESULTS Median follow-up was 75 months. Mean patient age was 56 years. One-hundred forty-three (95%) patients received adjuvant systemic therapy: 85 (57%) hormonal therapy alone, 14 (9%) chemotherapy alone, and 44 (29%) both chemotherapy and hormonal therapy. Statistically significant factors associated with increased risk of LRR were premenopausal status (p = 0.004), estrogen receptor negative cancer (p = 0.02), pathologic grade 3 (p = 0.02), and lymphovascular invasion (p = 0.001). T and N stage were not associated with increased risk of regional recurrence. The 5-year LRR rate for patients with zero or one, two, three, and four risk factors was 1%, 10.3%, 24.2%, and 75%, respectively. CONCLUSIONS A subset of patients with early-stage breast cancer is at high risk of LRR, and therefore PMRT might be beneficial.
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Affiliation(s)
- Marco Trovo
- Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano, Italy.
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Trovo M, Durofil E, Polesel J, Roncadin M, Perina T, Massarut S, Carbone A, Trovo M. Loco-regional Failure in Early-stage Breast Cancer Patients Treated with Radical Mastectomy and Adjuvant Systemic Therapy: Which Patients Benefit from Post-mastectomy Irradiation? Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Belletti B, Massarut S, D'Andrea S, Martinuzzo D, Roncadin M, Perin T, Sartor G, Trovò M, Calin G, Baldassarre G. P259 TARGIT modulates miRNAs expression to control growth factors production in breast tissue. Breast 2011. [DOI: 10.1016/s0960-9776(11)70203-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Vaidya JS, Joseph DJ, Tobias JS, Bulsara M, Wenz F, Saunders C, Alvarado M, Flyger HL, Massarut S, Eiermann W, Keshtgar M, Dewar J, Kraus-Tiefenbacher U, Sütterlin M, Esserman L, Holtveg HMR, Roncadin M, Pigorsch S, Metaxas M, Falzon M, Matthews A, Corica T, Williams NR, Baum M. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet 2010; 376:91-102. [PMID: 20570343 DOI: 10.1016/s0140-6736(10)60837-9] [Citation(s) in RCA: 514] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND After breast-conserving surgery, 90% of local recurrences occur within the index quadrant despite the presence of multicentric cancers elsewhere in the breast. Thus, restriction of radiation therapy to the tumour bed during surgery might be adequate for selected patients. We compared targeted intraoperative radiotherapy with the conventional policy of whole breast external beam radiotherapy. METHODS Having safely piloted the new technique of single-dose targeted intraoperative radiotherapy with Intrabeam, we launched the TARGIT-A trial on March 24, 2000. In this prospective, randomised, non-inferiority trial, women aged 45 years or older with invasive ductal breast carcinoma undergoing breast-conserving surgery were enrolled from 28 centres in nine countries. Patients were randomly assigned in a 1:1 ratio to receive targeted intraoperative radiotherapy or whole breast external beam radiotherapy, with blocks stratified by centre and by timing of delivery of targeted intraoperative radiotherapy. Neither patients nor investigators or their teams were masked to treatment assignment. Postoperative discovery of predefined factors (eg, lobular carcinoma) could trigger addition of external beam radiotherapy to targeted intraoperative radiotherapy (in an expected 15% of patients). The primary outcome was local recurrence in the conserved breast. The predefined non-inferiority margin was an absolute difference of 2.5% in the primary endpoint. All randomised patients were included in the intention-to-treat analysis. This trial is registered with ClinicalTrials.gov, number NCT00983684. FINDINGS 1113 patients were randomly allocated to targeted intraoperative radiotherapy and 1119 were allocated to external beam radiotherapy. Of 996 patients who received the allocated treatment in the targeted intraoperative radiotherapy group, 854 (86%) received targeted intraoperative radiotherapy only and 142 (14%) received targeted intraoperative radiotherapy plus external beam radiotherapy. 1025 (92%) patients in the external beam radiotherapy group received the allocated treatment. At 4 years, there were six local recurrences in the intraoperative radiotherapy group and five in the external beam radiotherapy group. The Kaplan-Meier estimate of local recurrence in the conserved breast at 4 years was 1.20% (95% CI 0.53-2.71) in the targeted intraoperative radiotherapy and 0.95% (0.39-2.31) in the external beam radiotherapy group (difference between groups 0.25%, -1.04 to 1.54; p=0.41). The frequency of any complications and major toxicity was similar in the two groups (for major toxicity, targeted intraoperative radiotherapy, 37 [3.3%] of 1113 vs external beam radiotherapy, 44 [3.9%] of 1119; p=0.44). Radiotherapy toxicity (Radiation Therapy Oncology Group grade 3) was lower in the targeted intraoperative radiotherapy group (six patients [0.5%]) than in the external beam radiotherapy group (23 patients [2.1%]; p=0.002). INTERPRETATION For selected patients with early breast cancer, a single dose of radiotherapy delivered at the time of surgery by use of targeted intraoperative radiotherapy should be considered as an alternative to external beam radiotherapy delivered over several weeks. FUNDING University College London Hospitals (UCLH)/UCL Comprehensive Biomedical Research Centre, UCLH Charities, National Institute for Health Research Health Technology Assessment programme, Ninewells Cancer Campaign, National Health and Medical Research Council, and German Federal Ministry of Education and Research (BMBF).
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Affiliation(s)
- Jayant S Vaidya
- Research Department of Surgery, Division of Surgery and Interventional Science, University College London, London, UK.
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Karlsson P, Cole B, Colleoni M, Roncadin M, Chua B, Gruber G. 0110 Timing of radiotherapy and outcome in patients receiving adjuvant endocrine therapy. Breast 2009. [DOI: 10.1016/s0960-9776(09)70151-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Belletti B, Vaidya JS, D'Andrea S, Entschladen F, Roncadin M, Lovat F, Berton S, Perin T, Candiani E, Reccanello S, Veronesi A, Canzonieri V, Trovò MG, Zaenker KS, Colombatti A, Baldassarre G, Massarut S. Targeted intraoperative radiotherapy impairs the stimulation of breast cancer cell proliferation and invasion caused by surgical wounding. Clin Cancer Res 2008; 14:1325-32. [PMID: 18316551 DOI: 10.1158/1078-0432.ccr-07-4453] [Citation(s) in RCA: 150] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE After apparently successful excision of breast cancer, risk of local recurrence remains high mainly in the area surrounding the original tumor, indicating that wound healing processes may be implicated. The proportional reduction of this risk by radiotherapy does not depend on the extent of surgery, suggesting that radiotherapy, in addition to killing tumor cells, may influence the tumor microenvironment. EXPERIMENTAL DESIGN We studied how normal and mammary carcinoma cell growth and motility are affected by surgical wound fluids (WF), collected over 24 h following breast-conserving surgery in 45 patients, 20 of whom had received additional TARGeted Intraoperative radioTherapy (TARGIT), immediately after the surgical excision. The proteomic profile of the WF and their effects on the activation of intracellular signal transduction pathways of breast cancer cells were also analyzed. RESULTS WF stimulated proliferation, migration, and invasion of breast cancer cell lines. The stimulatory effect was almost completely abrogated when fluids from TARGIT-treated patients were used. These fluids displayed altered expression of several cytokines and failed to properly stimulate the activation of some intracellular signal transduction pathways, when compared with fluids harvested from untreated patients. CONCLUSIONS Delivery of TARGIT to the tumor bed alters the molecular composition and biological activity of surgical WF. This novel antitumoral effect could, at least partially, explain the very low recurrence rates found in a large pilot study using TARGIT. It also opens a novel avenue for identifying new molecular targets and testing novel therapeutic agents.
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Affiliation(s)
- Barbara Belletti
- Experimental Oncology, Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
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Vaidya JS, Baum M, Tobias JS, Massarut S, Wenz FK, Hilaris B, Corica T, Kraus-Tiefenbacher U, Roncadin M, Keshtgar M, Saunders C, Joseph D. Efficacy of targeted intraoperative radiotherapy (Targit) boost after breast-conserving surgery: Updated results. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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28
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Baldassarre G, Belletti B, Vaidya JS, D'Andrea S, Roncadin M, Perin T, Trova MG, Candiani E, Veronesi A, Colombatti A, Massarut S. Intraoperative radiotherapy (IORT) impairs surgical wound-stimulated breast cancer cell invasion. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.21139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
21139 Background: Risk of local recurrence after complete excision of breast cancer is higher in the area around the original tumor, suggesting that wound healing may be implicated. Methods: We collected blood samples (BS) before surgery and wound fluid (WF) in the 24 hours after breast conserving surgery from 50 patients. Twenty five of these patients were also treated with TARGeted Intraoperative radioTherapy (TARGIT, 20Gy to tumor bed surface in one session), immediately after the surgical excision. The ability of the BS and WF to stimulate growth and motility of a panel of normal and mammary carcinoma cells was studied. A proteomic approach was used to analyze the expression pattern of WF and BS. Results: We assayed five cell lines in a transwell based assay using individual patient BS and wound fluids WF as potential chemo-attractants. WF strongly attracted cells from all 5 types of breast cancer cell lines that we tested including MDA- MB 231, MCF-7, MDA-MB 453, T47D and SKBR-3. The WF attracted the cells better than both the respective BS. Importantly, in all tested cell lines TARGIT significantly impaired the ability of WF to attract cancer cells (p=0.03 MDA-MB 231 and MCF-7. p=0.01 for MDA-MB 453, and SKBR-3). Moreover, while BS did not stimulate 3D motility over the control WF strongly stimulated 3D movement of MDA-MB 231 and MDA-MB- 453 cells. This stimulatory effect was abrogated in the WF taken from patients who had received TARGIT (p=0.01 for MDA-MB 231 and p<0.0001 for MDA-MB 453). Similar results were obtained when cell proliferation was evaluated using the same cell lines and BS or WF samples. Finally, proteomics analyses demonstrated that TARGIT modifies the expression levels of several key proteins involved in tumor cell growth and dissemination. Conclusion: TARGIT delivered to the tumor bed alters the cytokines and growth factors expression patterns in the surgical wound and abrogates its stimulatory effect on cancer cell growth and motility. This novel mechanism of action of radiotherapy could partly explain the very low recurrence rates found in large pilot studies of this technique and open new avenues for peri-operative therapies. No significant financial relationships to disclose.
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Affiliation(s)
- G. Baldassarre
- Centro di Riferimento Oncologico, Aviano, Italy; University of Dundee, Dundee, United Kingdom
| | - B. Belletti
- Centro di Riferimento Oncologico, Aviano, Italy; University of Dundee, Dundee, United Kingdom
| | - J. S. Vaidya
- Centro di Riferimento Oncologico, Aviano, Italy; University of Dundee, Dundee, United Kingdom
| | - S. D'Andrea
- Centro di Riferimento Oncologico, Aviano, Italy; University of Dundee, Dundee, United Kingdom
| | - M. Roncadin
- Centro di Riferimento Oncologico, Aviano, Italy; University of Dundee, Dundee, United Kingdom
| | - T. Perin
- Centro di Riferimento Oncologico, Aviano, Italy; University of Dundee, Dundee, United Kingdom
| | - M. G. Trova
- Centro di Riferimento Oncologico, Aviano, Italy; University of Dundee, Dundee, United Kingdom
| | - E. Candiani
- Centro di Riferimento Oncologico, Aviano, Italy; University of Dundee, Dundee, United Kingdom
| | - A. Veronesi
- Centro di Riferimento Oncologico, Aviano, Italy; University of Dundee, Dundee, United Kingdom
| | - A. Colombatti
- Centro di Riferimento Oncologico, Aviano, Italy; University of Dundee, Dundee, United Kingdom
| | - S. Massarut
- Centro di Riferimento Oncologico, Aviano, Italy; University of Dundee, Dundee, United Kingdom
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Vaidya JS, Baum M, Tobias JS, Massarut S, Wenz F, Murphy O, Hilaris B, Houghton J, Saunders C, Corica T, Roncadin M, Kraus-Tiefenbacher U, Melchaert F, Keshtgar M, Sainsbury R, Douek M, Harrison E, Thompson A, Joseph D. Targeted intraoperative radiotherapy (TARGIT) yields very low recurrence rates when given as a boost. Int J Radiat Oncol Biol Phys 2006; 66:1335-8. [PMID: 17084562 DOI: 10.1016/j.ijrobp.2006.07.1378] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Revised: 07/21/2006] [Accepted: 07/27/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE Patients undergoing breast-conserving surgery were offered boost radiotherapy with targeted intraoperative radiotherapy (TARGIT) using the Intrabeam system to test the feasibility, safety, and efficacy of the new approach. METHODS AND MATERIALS We treated 302 cancers in 301 unselected patients. This was not a low-risk group. One-third of patients (98/301) were younger than 51 years of age. More than half of the tumors (172, 57%) were between 1 cm and 2 cm, and one-fifth (62, 21%) were >2 cm; 29% (86) had a Grade 3 tumor and, in 29% (87), axillary lymph nodes contained metastasis. After primary surgery, 20 Gy was delivered intraoperatively to the surface of the tumor bed, followed by external-beam radiotherapy (EBRT), but excluding the usual boost. RESULTS The treatment was well tolerated. The follow-up ranged from 3 to 80 months (164 and 90 patients completed 2 and 3 years follow-up, respectively). Four patients (1.3%) had local recurrence. The Kaplan-Meier estimate of local recurrence is 2.6% (SE = 1.7) at 5 years. This compares favorably with the 4.3% recurrence rate in boosted patients from the EORTC boost study, in which only 8.1% patients were node-positive, as opposed to 29% in our series. CONCLUSION Targeted intraoperative radiotherapy combined with EBRT results in a low local recurrence rate. This could be attributed to both accurate targeting and timeliness of the treatment. These data support the need for a randomized trial to test whether the TARGIT boost is superior to conventional external boost, especially in high-risk women.
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Affiliation(s)
- Jayant S Vaidya
- Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
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Massarut S, Baldassarre G, Belletti B, Colombatti A, D'Andrea S, Candiani E, Perin T, Reccanello S, Roncadin M, Vaidya JS. Intraoperative radiotherapy impairs breast cancer cell motility induced by surgical wound fluid. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.10611] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10611 Background: Most recurrences after breast conserving surgery for cancer occur in the tissues around the original tumour. Wound-fluid has been shown to induce proliferation of breast carcinoma cells. We investigated whether intraoperative radiotherapy (IORT) using the targeted intraoperative radiotherapy (Targit) technique changes the effect of surgical wound fluid on the behaviour of breast cancer cells. Methods: Preoperative peripheral blood serums (A) and wound fluid (B) (first 24 hours’s drainage) from 30 unselected patients undergoing breast conserving surgery with (14) or without (16) IORT using the Targit technique was collected, processed and stored at −80°C. The breast carcinoma cell lines (MDA-MB231, MDA-MB-45 and SKBR-3) were used to evaluate the activity of A and B on cell proliferation (MTT-FACS analysis) and motility (chemotaxis) and invasion (Matrigel). Results: Wound fluid stimulated cell proliferation, cell motility and cell invasion significantly more than the preoperative serum from the same patient. Targit did not influence the effect of wound fluid on cell proliferation. However, Targit abrogated the effect wound fluid on cell motility and cell invasion. Conclusions: This work demonstrates that wound fluid after surgery for breast cancer stimulates cancer cell growth and motility. Targit appears to significantly abrogate the effect on cancer cell migration and invasion. This outcome may confer more benefits than could be expected from the tumoricidal activity of radiotherapy, and may stimulate the development of novel peri-operative treatments directed at compensating the possible harmful effects of surgery. No significant financial relationships to disclose.
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Amichetti M, Caffo O, Minatel E, Roncadin M, Valli MC, Lozza L, Panizzoni G. Ocular metastases from breast carcinoma: A multicentric retrospective study. Oncol Rep 2000; 7:761-5. [PMID: 10854540 DOI: 10.3892/or.7.4.761] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Breast cancer may affect the eye and orbit by metastatic neoplastic infiltration, uvea being the most common site of presentation. Management of these cases with radiotherapy is usually gratifying with reported response rate of approximately 75%. A retrospective evaluation of cases treated in five Institutions participating in a collaborative radiation therapy group of north-Italy is reported. Fifty-four cases of metastases to the eye or orbit were referred for radiation therapy to the Departments participating in the survey in the period 1977-1995. There were 49 female patients aged between 28 and 75 years (median, 44 years) at presentation of orbital metastasis. Thirty-eight lesions (70%) were metastases to the choroid, 9 involved other parts of the eye, and 7 patients had orbital metastases. Five of the 49 patients had bilateral choroidal metastases. Radiotherapy was employed with megavoltage equipment. The median total dose delivered was 40 Gy (range, 16-60 Gy). All the patients were treated 5 times per week with fraction sizes ranging from 1.8 to 3.0 Gy (median, 2.0 Gy). Of the 43 evaluable eyes, 34 (79%) showed a definite improvement after radiotherapy. There was a stabilization of the process in 4 patients. The rest (11 lesions) were lost to detailed follow-up of the response of the eye metastases. Twelve patients experienced acute transient cheratoconjunctivitis and in a case a subconjunctival haemorrhage was observed; as late side effects, two cases of chataract were observed during a period of observation of 37 and 117 months. A median survival time of 17 months was observed. The goal of irradiation was to improve vision or at least prevent blindness and enucleation. The palliative effect of irradiation was confirmed with a response rate consistent with the data of the literature on this subject.
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Affiliation(s)
- M Amichetti
- U.O. Radioterapia Oncologica, Ospedale S. Chiara, Largo Medaglie d'Oro, 38100 Trento, Italy
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Coghetto F, Amichetti M, Lozza L, Roncadin M, Lora O, Vidali C, Bonetta A, Falchi A, Bordin A. Post-irradiation sarcoma (PIS) in patients treated for breast cancer: a retrospective study of the BCNIRTOG-Italy. Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)81729-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Trovò MG, Gigante M, Roncadin M, Arcicasa M, Bortolus R. [Timing of radiotherapy in the treatment of breast carcinoma. Review of the literature]. Ann Ital Chir 1999; 70:371-6. [PMID: 10466240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Combined modality treatments are indicated for most patients with breast cancer. The definition of a proper treatment schedule and of the timing of each modality is a relevant issue that affects the feasibility and the clinical outcome of the treatment. A review of the literature was done on the timing of radiation therapy (RT) in the post-operative treatment of breast cancer. Retrospective studies and randomized clinical trials addressing the issue were considered and grouped according to the combined modality treatments performed. With regard to breast conserving surgery and adjuvant RT, it was verified that a delay up to 8 weeks between breast surgery and start of RT is not associated with an increased risk of local failure if compared with RT started within 4 weeks. Concerning breast conserving surgery followed by adjuvant RT and chemotherapy, the choice of the best schedule is still a complex unresolved issue. More results on sequential schedule of adjuvant RT and chemotherapy from recently published randomized studies are available. The reconstruction of the breast after conservative surgery is rarely necessary and is usually performed immediately after surgical treatment. With regard to mastectomy followed by adjuvant RT and breast reconstruction, it appears from some retrospective studies that autologous tissue transfer offers better results over implants. Concerning the transverse rectus abdominis muscle (TRAM) procedure, either immediate reconstruction before RT or delayed reconstruction after RT was feasible without significative differences in complication rates. Further randomized clinical studies are required to address the unresolved issues linked to the timing of RT. At present the treatment plan should be based on the patient's individual circumstances with regard to risk of metastasis and local failure.
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Affiliation(s)
- M G Trovò
- Divisione di Oncologia Radioterapica, Centro di Riferimento Oncologico, Aviano, PN, Italia
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Arcicasa M, Roncadin M, Bidoli E, Dedkov A, Gigante M, Trovò MG. Reirradiation and lomustine in patients with relapsed high-grade gliomas. Int J Radiat Oncol Biol Phys 1999; 43:789-93. [PMID: 10098434 DOI: 10.1016/s0360-3016(98)00457-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to evaluate the toxicity, response, and survival of patients with relapsed high-grade gliomas after radiation therapy (RT) combined with lomustine (CCNU). METHODS AND MATERIALS Thirty-one patients with relapsed gliomas at least 6 months after completion of RT were reirradiated. Twenty-four patients had a pathological diagnosis of high-grade gliomas, whereas 7 had a radiological diagnosis of relapsed malignant gliomas. The study focused on patients with high-grade relapsed gliomas. A total dose of 34.5 Gy was delivered in 23 fractions over 4.5 weeks. Oral administration of CCNU (130 mg/m2) was begun at the same time as RT, and was repeated every 6 weeks until disease progression, or up to 12 courses. RESULTS Twelve of 24 patients had surgery before RT plus CCNU treatment. Median interval between RT courses was 14 months (range 6-73). All patients received a complete course of RT, and 22 of 24 patients received at least one course of CCNU. Objective responses were seen in 14 evaluable patients: 3 with partial response, 5 with stable disease, and 6 with progressive disease. Duration of partial response was 20, 9, and 8 months. Median time to progression and overall survival from the onset of retreatment were 8.4 months (range 1-22) and 13.7 months (range 1-63+), respectively. One case of G4 thrombocytopenia was observed. Five patients had G1 or G2 leucopenia and 3 patients had G3 leucopenia. Moderate nausea and vomiting were reported in 4 patients. One patient, after one course of CCNU, refused further chemotherapy. No significant difference in survival from relapse was found between patients who underwent surgery before RT plus CCNU and those who received only RT plus CCNU (p = 0.74). CONCLUSION Overall, the acute toxicity was moderate, and patient compliance was good. Reirradiation of high-grade glioma was associated with modest subjective and objective response rates. It is remarkable that median overall survival from relapse was 13.7 months.
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Affiliation(s)
- M Arcicasa
- Divisione Oncologia Radioterapica, Centro di Riferimento Oncologico, Aviano, Italy.
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35
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Amichetti M, Caffo O, Arcicasa M, Roncadin M, Lora O, Rigon A, Zini G, Armaroli L, Coghetto F, Zorat P, Neri S, Teodorani N. Quality of life in patients with ductal carcinoma in situ of the breast treated with conservative surgery and postoperative irradiation. Breast Cancer Res Treat 1999; 54:109-15. [PMID: 10424401 DOI: 10.1023/a:1006125602353] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM OF THE STUDY To evaluate the quality of life (QL) in patients with ductal carcinoma in situ of the breast treated with conservative surgery and postoperative irradiation. MATERIAL AND METHODS A self-completed questionnaire covering many disease-, symptom-, and treatment-specific issues was administered to 106 conservatively treated patients affected by non-infiltrating breast cancer. The questionnaire was based on a series of 34 items assessing five main fields of post-treatment adjustment: physical well being, sexual adaptation, aesthetic outcome, emotional/psychological well being, relational behaviour. Furthermore, the patients were requested to evaluate the degree of information provided by the medical staff concerning surgical procedures and radiation therapy, and to evaluate the effects of the treatment on their social and overall life. RESULTS The questionnaire was completed by 83 patients (78%), who had a median follow-up of 54.5 months. This final sample had a median age of 50 years (range 29-88) at the time of treatment and 54 years (range 32-94) at the time of study. The patients claimed to be in good physical condition. Data relating to sexual life were provided by 93% of the sample. Some limitations in sexuality, some interference with sexual desire, and some modifications during intercourse were reported by 5, 6, and 5 patients, respectively. The subjective evaluations of the cosmetic results of the therapies were generally good. Only 13 patients (16%) reported the perception of a worsened body image. Forty-six percent of the sample (38 patients) declared that they felt tense, 48% (39 patients) nervous, 29% (38 patients) lonely, 59% (41 patients) anxious, and 41% (34 patients) depressed. Only seven patients (8%) declared that the treatment had had a bad effect on their social life, and 15 (18%) thought that their current life had been affected by the treatment. The amount of information received concerning the disease and treatment (surgery and radiotherapy) was considered sufficient by 79%, 75%, and 79% of the sample, respectively. CONCLUSIONS This study revealed a good QL in patients treated with breast conservation and postoperative irradiation, with a preserved favourable body image and a lack of negative impact on sexuality. Radiation therapy did not lead to any significant additional problems capable of affecting the QL.
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Affiliation(s)
- M Amichetti
- Department of Radiation Oncology of Trento, St. Chiara Hospital, Italy
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Amichetti M, Caffo O, Minatel E, Roncadin M, Panizzoni G, Balli M, Valli M, Lozza L, Zucali R. Intraocular metastases from breast cancer: A retrospective Study of the Breast Cancer North Italian Radiation Therapy Oncology Group. Eur J Cancer 1998. [DOI: 10.1016/s0959-8049(98)80245-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Roncadin M, Massarut S, Perin T, Arcicasa M, Canzonieri V, Rossi C, Carbone A. Breast angiosarcoma after conservative surgery, radiotherapy and prosthesis implant. Acta Oncol 1998; 37:209-11. [PMID: 9636019 DOI: 10.1080/028418698429801] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- M Roncadin
- Department of Radiotherapy, Centro di Riferimento Oncologico, Aviano (PN), Italy.
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Bortolus R, Arcicasa M, Roncadin M, Bidoli E, Dedkov A, Gigante M, Trovò MG. Reirradiation and lomustine in patients with relapsed high grade gliomas. Int J Radiat Oncol Biol Phys 1998. [DOI: 10.1016/s0360-3016(98)80390-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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40
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Crivellari D, Buonadonna A, Sacco C, Bidoli E, Candiani E, Massarut S, Roncadin M, Rossi C, Galligioni E. High-Dose Epirubicin in Locally Advanced Operable Noninflammatory Breast Cancer: A Feasibility Trial. Tumori 1997; 83:656-60. [PMID: 9267483 DOI: 10.1177/030089169708300306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background Anthracyclines are among the most active agents for the treatment of patients with locally advanced breast cancer. The aim of our study was to evaluate the feasibility and activity of a relatively high-dose regimen with 4-epirubicin plus normal doses of cyclophosphamide over a short period of time without the use of hematologic growth factors as adjuvant in resected locally advanced breast cancer. Methods. Between January 1990 and June 1992, 43 consecutive patients, premenopausal or postmenopausal «60 yrs, were surgically resected and then treated with epirubicin plus cyclophosphamide for at least 4 cycles (maximum 6). Electron beam (6–10 MeV energy) radiotherapy was delivered on the chest wall in patients with pathological skin infiltration (pT4b). Results Median age was 46 years (range, 27–59); 37 were premenopausal and 6 postmenopausal. The total number of administered cycles was 202 (6 in 15 patients and 4 in 28 patients); 195/202 (96.5%) were administered at full dose, and 7 (3.5%) were reduced to 75% of the planned dosage. The three-year disease-free survival was 67% for stage IlIa and 61% for stage IIIb patients. The three-year overall survival was 88% and 79%, respectively. Local relapse only was reported in one patient (2%), distant relapse in 11 patients (25%), and local and distant relapse in four patients (9%). Toxicity was acceptable and mainly hematologic. Conclusions. Our trial showed that the regimen is feasible without the use of hematologic growth factors. In this era of cost containment, the use of this short-term, high-dose induction course instead of repetitive courses of conventional dose regimens merits further evaluation, possibly in a large randomized trial.
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Affiliation(s)
- D Crivellari
- Division of Medical Oncology, Centro di Riferimento Oncologico, Aviano, Italy
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Wallgren A, Bernier J, Gelber RD, Goldhirsch A, Roncadin M, Joseph D, Castiglione-Gertsch M. Timing of radiotherapy and chemotherapy following breast-conserving surgery for patients with node-positive breast cancer. International Breast Cancer Study Group. Int J Radiat Oncol Biol Phys 1996; 35:649-59. [PMID: 8690630 DOI: 10.1016/0360-3016(96)00186-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE A controversy exists regarding whether it is safe to delay radiation therapy until the completion of chemotherapy following breast-conserving surgery for patients with node-positive breast cancer. Within the context of two concurrent randomized clinical trials we had the opportunity to evaluate outcomes for patients who received breast irradiation after completing different durations of chemotherapy. METHODS AND MATERIALS From July 1986 to April 1993 the International Breast Cancer Study Group (IBCSG) Trial VI randomly assigned 1554 pre/perimenopausal node-positive breast cancer patients to receive cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) for either three consecutive courses on months 1-3, or six consecutive courses on months 1-6, both with or without reintroduction CMF. IBCSG Trial VII randomly assigned 1266 postmenopausal node-positive breast cancer patients to receive tamoxifen for 5 years, or tamoxifen for 5 years with three early cycles of CMF, both with or without three courses of delayed CMF. Both trials allowed a choice of mastectomy, or breast-conserving surgery plus radiation therapy, and both were stratified by type of surgery. Radiotherapy was delayed until the initial block of CMF was completed; 4 or 7 months after surgery for pre/perimenopausal patients, and 2 or 4 months after surgery for postmenopausal patients. Over both trials, 718 eligible patients elected to receive breast-conserving surgery plus radiation therapy: 433 on Trial VI, and 285 on Trial VII. Four-year actuarial total failure rates (failure at any site), risks of developing distant metastases (DM at any time during observation), and overall survival (OS) were estimated using the Kaplan-Meier method. To avoid potential bias due to competing causes of failure, only patients who could be followed for at least 4 years (enrolled prior to July 1, 1990) were used to evaluate the patterns of first relapse site. Crude percents of local failure with or without other sites (LF), distant metastases including regional nodal failure (DM/RNF), or other first events (second primaries/death without recurrence) were estimated for each treatment group. For this report, an intent to treat analysis was performed at a median follow-up of 48 months. RESULTS No differences were found in the 4-year actuarial total failure rates, risk of developing distant metastases, and overall survival among the two radiotherapy groups of each study. The cumulative incidence of types of first failure and the 4-year crude rates showed no treatment differences in the patterns of site of first event. Estimates for the 4-year crude percent of local failures were 8 and 9% for pre/perimenopausal patients who had radiation therapy at 4 or 7 months after surgery, and 3 and 6% for postmenopausal patients who had radiation therapy at 2 months or 4 months after surgery. CONCLUSIONS For node positive patients receiving breast-conserving surgery followed by radiation therapy, the incidence of breast recurrence in the conserved ipsilateral breast within 4 years was between 8 and 9% for pre/perimenopausal patients and between 3 and 6% for postmenopausal patients. After 48 months of median follow-up, administering radiation therapy after three or six cycles of CMF for pre/perimenopausal women, or after no cycles or three cycles of CMF for postmenopausal women does not influence overall efficacy or local control in this series.
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Affiliation(s)
- A Wallgren
- Department of General Oncology, Salgrenska University Hospital, Gothenborg, Sweden
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Perin T, Canzonieri V, Massarut S, Bidoli E, Rossi C, Roncadin M, Carbone A. Immunohistochemical evaluation of multiple biological markers in ductal carcinoma in situ of the breast. Eur J Cancer 1996; 32A:1148-55. [PMID: 8758245 DOI: 10.1016/0959-8049(96)00037-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In order to obtain prognostic clinicopathological information, 49 cases of pure ductal carcinoma in situ of the breast (DCIS), were evaluated for the immunohistochemical expression of potential predictor markers including c-erbB-2 oncogene product, p53 protein, oestrogen (ER) and progesterone (PR) receptors, oestrogen-regulated proteins pS2 and cathepsin-D (cath-D), CD44 protein and 67-kDa laminin receptor (MLuC5). Immunohistochemical findings were compared with conventional pathological parameters, clinical findings, and the clinical outcome of the patients. When markers were matched to each other, statistical analyses provided a significant positive correlation between c-erbB-2 overexpression and p53 positivity (P < 0.01) and between ER and PR (P < 0.01), ER, PR and pS2 (P < 0.01), pS2 and MLuC5 (P < 0.05). Significant negative correlations between c-erbB-2 overexpression and ER (P < 0.05), PR (P < 0.01) and pS2 (P < 0.01) positivity was also observed. Data on the relationship between marker status and pathological findings revealed a significant positive trend between c-erbB-2, p53, and increased grade values (P < 0.05) and opposite results with PR receptor expression (P < 0.01). c-erbB-2 overexpression was further significantly associated with comedotype carcinoma (P < 0.05) and distribution of disease in confluent neoplastic ducts (P < 0.01). Although no statistically significant correlation among biological markers expression, clinical findings and outcome was demonstrated, overall this study indicates that tumour cells from a subset of DCIS, which includes comedotype carcinoma, express significantly unfavourable prognostic factors.
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Affiliation(s)
- T Perin
- Division of Pathology, Istituto Nazionale di Ricovero e Cura a Carattere Scientifico, Italy
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Caffo O, Amichetti M, Arcicasa M, Roncadin M, Rigon A, Lora O, Zini G, Coghetto F, Zorat P. PP-10-2 Evaluation of quality of life after conservative treatment for intraductal carcinoma of the breast. Eur J Cancer 1996. [DOI: 10.1016/0959-8049(96)84289-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Arcicasa M, Roncadin M, Bortolus R, Bassignano G, Boz G, Franchin G, De Paoli A, Trovó MG. Results of three consecutive combined treatments for malignant gliomas. Ten-year experience at a single institution. Am J Clin Oncol 1994; 17:437-43. [PMID: 8092118 DOI: 10.1097/00000421-199410000-00017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Between 1978 and 1988, 108 consecutive patients with malignant gliomas were treated. The patients were divided into 3 groups as follows: Group I, surgery if possible, otherwise biopsy followed by whole-brain irradiation to a total dose of 34 Gy in 4 fractions, VCR (2 mg i.v.), and BCNU (80 mg/m2 i.v.) repeated every 6 weeks; Group II received irradiation as Group I plus VP16 (75 mg/m2) every 3 weeks and BCNU (50 mg/m2 i.v.) every 6 weeks; Group III received 60 Gy in 30 fractions to the tumor bed plus VCR (2 mg i.v.), BCNU (50 mg/m2 i.v.), and CDDP (15 mg/m2 i.v.) every 6 weeks. In group I, 28 patients had stable disease (SD) and 2 patients showed disease progression (PRO). Median survival time was 9 months (range 1-18). In Group II 22 SD's were observed. Median survival time was 6 months (2-16). In the third group of patients 29 SDs and 14 partial remissions (PR) were recorded. Median survival time in this group was 13 months (range: 3-59+ months). In general, the group of patients treated with radical or subtotal surgery and the group of patients included in neurologic classes I-II and with performance status (PS) > or = 70 had a longer survival. In our experience, patients with grade III and IV astrocytoma receiving treatments similar to those described above showed no difference in survival and response. Regardless of treatment, none of the patients experienced severe toxicity.
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Affiliation(s)
- M Arcicasa
- Radiotherapy Department, Centro di Riferimento Oncologico, Aviano-Pordenone, Italy
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Roncadin M, Arcicasa M, Zagonel V, Bortolus R, Valeri P, Pinto A, De Paoli A, Franchin G, Carbone A, Trovò MG. Total body irradiation and prednimustine in chronic lymphocytic leukemia and low grade non-Hodgkin's lymphomas. A 9-year experience at a single institution. Cancer 1994; 74:978-84. [PMID: 8039128 DOI: 10.1002/1097-0142(19940801)74:3<978::aid-cncr2820740330>3.0.co;2-b] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The efficacy and toxicity of total body irradiation (TBI) in patients with chronic lymphocytic leukemia (CLL) and low grade non-Hodgkin's lymphomas (NHL) were evaluated. METHODS Between January 1984 and September 1992, 81 consecutive patients, 40 affected with CLL and 41 with low grade NHL, with symptomatic Stage III and IV disease, were treated with TBI followed by prednimustine. TBI was given with a 6 MV linear accelerator, applying two opposite alternating fields, including total body, with two fractions of 15 cGy given per week (3-day interval). A total dose of 150 cGy was given over 5 weeks. Six to nine courses of prednimustine (100 mg/m2 orally for 5 consecutive days every 4 weeks) was administered 2 months after TBI treatment as consolidation therapy. RESULTS Of 40 patients with CLL, 18 (Group I; median age 58.5 years) were younger than 65 years and 22 (Group II; median age 73 years) were older. The overall response rates were 78% in Group I and 91% in Group II, with a median response time of 16.5 and 16 months, respectively. Hematologic toxicity was 72% in Group I and 73% in Group II. It was reversible in all but one heavily pretreated patient who died of progressive anemia and thrombocytopenia after TBI alone. In the 40 patients with CLL, the response rate was 85%; there were 5 complete responses (CRs) (12.5%) and 29 partial responses (PRs) (72.5%). Of the 41 patients with NHL, 29 (Group I; median age 55 years) were younger than 65 years and 12 (Group II; median age 71.5) were older. The overall response rate in both groups was 83%, with median response times of 18.5+ and 14.5+ months for Groups I and II, respectively. Hematologic toxicity was 59% in Group I, whereas it was 50% in Group II. It was reversible in all patients. Overall, in the 41 patients with symptomatic Stage III and IV low grade NHL, the response rate was 82.8%; there were 10 CRs (24.3%) and 24 PRs (58.5%). The prednimustine regimen was generally well tolerated. CONCLUSIONS In our experience, TBI given in a dose of 150 cGy in 10 fractions twice a week, followed by prednimustine, is an effective treatment for patients with CLL and patients with low grade NHL. This treatment also is effective in patients older than 65 years. The toxicity is acceptable, particularly when TBI and prednimustine are given as initial treatment. Pretreated patients should be monitored strictly.
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Affiliation(s)
- M Roncadin
- Radiotherapy Division, Centro di Riferimento Oncologico, Aviano, Italy
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Candiani E, Roncadin M, Massarut S, Arcicasa M, Bortolus R, Perin T, Morassut S, Carbone A, Rossi C, Trovò M. Conservative treatment for in situ ductal carcinoma. Eur J Cancer 1994. [DOI: 10.1016/0959-8049(94)90734-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Minatel E, Trovò MG, Forner L, Franchin G, de Paoli A, Roncadin M, Gobitti C, Bassignano G. The efficacy of radiotherapy in the treatment of intraocular metastases. Br J Radiol 1993; 66:699-702. [PMID: 7536608 DOI: 10.1259/0007-1285-66-788-699] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
From January 1980 to May 1991, 28 patients with intraocular metastases were seen at our Institute. Three presented with bilateral metastases and two developed contralateral involvement. Out of the 33 ocular metastases 27 were managed by radiotherapy. The most common primary tumour sites were breast (18/28 patients) and lung (3/28). 22 patients were treated with an 8 MV linear accelerator, using a 4 x 4 cm anterior direct field. The median dose was 40 Gy/20 fractions (range 28 Gy/14 fractions to 50 Gy/25 fractions). Of the 27 treatments reported, 16 resulted in a complete response (59%), six in a partial response (22%) and five resulted in no change (19%). Complete and partial responses lasted for a median time of 13 months (range of 3-89+ months). The median survival time from the start of ocular treatment was 13 months. The aim of radiation treatment is either to prevent or to postpone the visual loss caused by intraocular metastases.
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Affiliation(s)
- E Minatel
- Radiotherapy Division, Centro di Riferimento Oncologico, Aviano (PN), Italy
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Bortolus R, Roncadin M, Arcicasa M, Boz G, Franchin G, De Paoli A, Falchi AM, Trovó MG. [Unknown primary bone metastasis: therapeutic and diagnostic strategies]. Radiol Med 1993; 85:406-10. [PMID: 8516467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The primary site remains unknown in 0.5-15% of patients with multiple metastases. In 5-20% of these patients bone metastases are the first sign of disease. Survival after diagnosis ranges 2 to 6 months and 1-year survival is less than 25%. First of all, this paper reviews the current diagnostic and therapeutic approaches to patients with bone metastases from an unknown primary site and then reports the 10-year experience with radiotherapy at the Radiotherapy Division of the Centro di Riferimento Oncologico (Aviano) and of the Pordenone General Hospital in this patient population. Seventy-nine patients with bone metastases were evaluated. In 33 patients histology confirmed the original diagnosis and in 46 patients diagnosis was based on radiological and clinical findings. With respect to pain relief, differences in irradiated areas and in the ages of the patients were not significant. The patient's sex, however, did make a difference both to the degree of pain relief achieved and to survival (more favorable in women). To conclude, this paper suggests the diagnostic procedures necessary for the correct follow-up of patients with bone metastases from an unknown primary site.
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Affiliation(s)
- R Bortolus
- Divisione Oncologia Radioterapica, C.R.O. Aviano Pordenone
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Roncadin M, Candiani E, Arcicasa M, Bortolus R, Del Pup L, Gobitti C, Rossi C, Carbone A, Trovò MG. Quadrantectomy followed by radiotherapy (RT) in T1 – T2 breast cancer. Eur J Cancer 1993. [DOI: 10.1016/0959-8049(93)90987-q] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Arcicasa M, Franchin G, Bassignano G, Sartor G, Drigo A, Bortolus R, Roncadin M, De Paoli A, Trovò MG. Hyperthermia in Clinical Practice: Preliminary Results and Current Problems in the Treatment of 21 Patients. Tumori 1992; 78:262-5. [PMID: 1466083 DOI: 10.1177/030089169207800410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
From February 1988 through February 1991, 21 patients were managed by superficial hyperthermia and radiotherapy. Nineteen patients had received previous treatment; the most common histology was breast carcinoma. Twenty-six cycles of combined hyperthermia and radiotherapy were delivered: 4 complete responses (15.4 %), 17 partial responses (65.4 %), 1 minimal partial response (3.8 %), 3 stable diseases (11.6 %) and 1 disease progression (3.8 %) were obtained. The median duration of response was 7 months (range 1-16) for responding and 4 months (range 2.5-4) for non-responding patients. The toxicity encountered (confined mostly to epithelitis –- 7/21 patients) was completely reversible. In our experience, hyperthermia combined with radiotherapy proved to be an effective treatment. However, some problem that emerged during treatment planning and delivery showed the need for further development and research into hyperthermic devices and thermometry systems.
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Affiliation(s)
- M Arcicasa
- Radiotherapy Division, General Hospital, Pordenone, Italy
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