Daniele Scartoni

A Case of Focal Haematopoietic Hyperplasia of a Vertebral Body and Review of the Modern Literature

We report on a case of focal haematopoietic hyperplasia occurring in the haematopoietic marrow in a lumbar vertebral body, of a young man. The PET scan performed showed high uptake of the radiotracer in the vertebral body of L3 and a MRI of the lumbar spine confirmed the vertebral lesion. A biopsy of the L3 vertebral body lesion was performed and the histological result was of chronic myeloproliferative disease but the analysis performed consequently excluded the diagnosis of chronic myeloproliferative disorder, according to the WHO criteria. Focal benign hyperplasia is regarded a late reactive process after trauma, as well as the case reported

Radiotherapy timing in the treatment of limited-stage small cell lung cancer: the impact of thoracic and brain irradiation on survival

Aims and Background Small cell lung cancer is an aggressive histologic subtype of lung cancer in which the role of chemotherapy and radiotherapy has been well established in limited-stage disease. We retrospectively reviewed a series of limited-stage small cell lung cancers treated with chemotherapy and thoracic and brain radiotherapy. Methods and Study Design A total of 124 patients affected by limited-stage small cell lung cancer has been treated over 10 years in our Institute. Fifty-three patients (42.8%) had concomitant radio-chemotherapy treatment and 71 patients (57.2%) a sequential treatment. Eighty-eight patients (70.9%) underwent an association of a platinum-derived drug (cisplatinum or carboplatinum) and etoposide. Prophylactic cranial irradiation was planned in all patients with histologically proven complete response to primary radio-chemotherapy. Results With a mean follow-up of 2.2 years, complete response was obtained in 50.8% of cases. We found a significant difference between different radio-chemotherapy association approaches (P = 0.007): percentages of overall survival were respectively 10.0%, 12.9% and 5.6% in early, late concomitant and sequential radiochemotherapy timing. Cranial prophylaxis did not seem to influence overall survival (P = 0.21) or disease-free survival for local relapse (P = 0.34). Conclusions Concomitant radio-chemotherapy is the best approach according to our experience. Our results show a benefit of prophylactic cranial irradiation in distant metastasis-free survival.

Does lymphocyte-to-monocyte ratio before, during, or after definitive chemoradiation for locally advanced pancreatic cancer predict for clinical outcomes?

BACKGROUND Elevated pre-treatment lymphocyte (L) to monocyte (M) ratio (LMR) in peripheral blood has been suggested to correlate with improved survival in some malignancies, but data in the context of pancreatic cancer (PC) is limited. The aim of this study was to evaluate the prognostic significance of LMR before, during and after definitive chemoradiotherapy (CRT) for locally advanced pancreatic cancer (LAPC). METHODS We retrospectively reviewed 57 patients with LAPC treated with definitive CRT at a single institution from 2005 to 2013. Complete blood counts were obtained before (TP1), during the third week (TP2) and at the end of CRT (TP3). Univariate analysis (UVA) included gender, age, body mass index, pre-treatment CA19-9, T stage, N stage, induction chemotherapy (ICT), absolute L count (TP1, TP2, TP3), absolute M count (TP1, TP2, TP3), LMR (TP1, TP2, TP3), and relative LMR changes (TP2 ÷ TP1, TP3 ÷ TP1, TP3 ÷ TP2). RESULTS Median follow-up was 14 months. Twelve patients received ICT. Median LMR was 2.7 (range, 0.8-5.25), 1.4 (range, 0.3-5) and 0.98 (range, 0.3-3.4) at TP1, TP2 and TP3, respectively. Superior PFS was significantly associated with an absolute M count during CRT <0.1 (P=0.04) while pre-CRT L count ≥1.1 trended towards significance (P=0.09). Superior OS was significantly associated with change in LMR (TP3 ÷ TP2) > 0.32 (P<0.0001) while pre-CRT LMR ≥2.6 trended towards significance (P=0.06). CONCLUSIONS Factors significantly associated with overall survival (OS) and progression-free survival (PFS) were change in LMR at the end of CRT and absolute M count during CRT. This analysis suggests treatment-time-specific immune system parameters may affect clinical outcomes and warrant continued investigation.

PO-0695: Lobectomy vs Stereotactic Ablative Radiotherapy in NSCLC:a multicentric series in four centers

S325 ________________________________________________________________________________ Patients were treated consecutively in the University Hospitals of Leuven between 2005 and 2014 and their data were retrospectively retrieved. PORT MPM patients were treated with RT doses up to 64 Gy in 2-Gy fractions. PORT NSCLC were treated with RT doses up to 60 Gy in 2-Gy fractions. Non-surgical patients were treated with RT doses up to 66 Gy in 2.75 Gy sequentially with chemotherapy or up to 70 Gy in 2 Gy fractions concurrently with chemotherapy. Dyspnea scores (CTCAE 4.03) before and after RT were retrieved and delta dyspnea was calculated as the difference between the dyspnea after RT (worse at any time point) and before RT. For every patient, 2 CT scans were retrieved: 1) CT0: a free breathing planning CT scan; 2) CT3M: deep inspiration breath-hold diagnostic follow up CT scan 3-6 months after the end of RT. CT0 and CT3M were non-rigidly co-registered in MIM. Differences in Hounsfield Unit (delta HU=HU3M-HU0) were represented as the slope of the dosedependent delta HU between 0 and 20 Gy (expressed in delta HU/Gy). Primary endpoint was delta dyspnea >= 2. Univariate and multivariate logistic regression analysis were performed in order to identify significant predictors of delta dyspnea >= 2. A p-value of < 0.05 was considered statistically significant.

Complete response in metastatic renal cell carcinoma after radiotherapy and everolimus: a clinical case and review of the literature

We report the case of a man affected by renal cell carcinoma with vertebral metastases, who presented a radiological complete response after systemic treatment with everolimus.

Oral Lapacho-Based Medication: An Easy, Safe, and Feasible Support to Prevent and/or Reduce Oral Mucositis During Radiotherapy for Head and Neck Cancer.

The aim of our Phase II study is to demonstrate the benefits, safety, and tolerance of Orasol Plus, an easy and feasible Lapacho-based medication. Orasol Plus is a nutritional, swallowable solution, useful to support the defenses of the oropharyngeal mucosa. Between January and June 2014, 40 consecutive adult patients affected by head and neck cancer were enrolled. Orasol Plus was administered 3 times a day from the first day till the end of radiotherapy. Primary endpoint was to evaluate tolerance and safety of Orasol Plus; secondary endpoint was to evaluate the effect of Orasol Plus on the incidence of treatment discontinuation. Nearly all patients used Orasol Plus easily till the end of radiotherapy without interruptions. Only 11 (27.5%) patients developed oral mucositis (OM) Grade 2 and only 4 (10%) patients OM Grade 3, no patient developed OM Grade 4. No patient discontinued radiotherapy because of OM. Orasol Plus was well tolerated and the compliance of patients was optimal, mainly due to the fact that it can be swallowed. Data from our study are encouraging and they need to be confirmed by a Phase III study.

Multiple Cutaneous Angiosarcomas after Breast Conserving Surgery and Bilateral Adjuvant Radiotherapy: An Unusual Case and Review of the Literature

Breast angiosarcomas (BAs) are rare but serious events that may arise after radiation exposure. Disease outcome is poor, with high risk of local and distant failure. Recurrences are frequent also after resection with negative margins. The spectrum of vascular proliferations associated with radiotherapy in the setting of breast cancer has expanded, including radiation-associated atypical vascular lesions (AVLs) of the breast skin as a rare, but well-recognized, entity. Although pursuing a benign behavior, AVLs have been regarded as possible precursors of postradiation BAs. We report an unusual case of a 71-year-old woman affected by well-differentiated bilateral cutaneous BA, diagnosed 1.9 years after adjuvant RT for synchronous bilateral breast cancer. Whole-life clinical followup is of crucial importance in breast cancer patients.