Nicola Raffetto

Transrectal ultrasound color Doppler in the evaluation of recurrence of anal canal cancer

OBJECTIVE aim was to obtain elements for a differential diagnosis between post-radiation fibrosis and residual tumor or local relapse in anal canal cancer through detection of presence/absence of intralesional blood flow. Transrectal ultrasound and color Doppler were compared. METHODS 43 patients underwent transrectal ultrasound sonography and color Doppler before and after therapy to assess intralesional blood flow and flow pattern (spotty and linear signals). All diagnostic imaging results were compared to histological analysis. Specificity was submitted to statistical analysis using McNemar test. RESULTS before therapy 34 lesions (79%) showed color signal; no signal in 9 (21%), which were excluded from our analysis. Eighteen of the 34 patients considered, presented complete response to therapy, 14 partial response and two no response. After therapy, signal disappeared in 17 patients (94%); one false-positive (6%) presented spotty signals; 16 of 34 patients presented changed color signal. Color Doppler showed higher specificity than grey scale transrectal ultrasound in the differentiation of fibrosis from tumor. Response was confirmed by histological examination, considered gold standard. McNemar test demonstrated the significance of color Doppler (P < 0.0001). CONCLUSION color Doppler considerably increases transrectal ultrasound specificity in differentiating tumor relapse from fibrosis in anal canal cancer.

Chemoradiation as definitive treatment for primary squamous cell cancer of the rectum

In this report, we present a case of advanced squamous cell cancer located in the rectum of a 78-year-old woman treated with chemoradiation with curative intent. The patient showed a complete clinical response to chemoradiation; multiple biopsies were performed at the site of the previous mass 5 mo after the end of treatment and histological examination showed no residual tumour in the specimens. Surgical intervention was avoided and the patient was free of disease 12 mo after the diagnosis of cancer. Primary chemoradiation should be considered as the treatment of choice for this rare malignancy.

Irradiated fields spared Stevens-Johnson syndrome in a patient undergoing radiotherapy for bone metastases

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are two of the most severe, rare, and life-threatening adverse reactions to medications. Their incidence is approximately two patients per million population per year. Several cases have been reported in the literature in which SJS and TEN have occurred in patients with a neoplasm undergoing radiation therapy and who are taking an anticonvulsant. We report a case of SJS-TEN that developed in a 51-year-old woman with nonresectable non-small-cell lung cancer during treatment with phenobarbital plus radiation therapy for bone metastases but in whom the irradiated areas did not exhibit the SJS skin reaction. To our knowledge, no similar cases have been reported in the literature.

Number of mediastinal lymph nodes as a prognostic factor in PN2 non small cell lung cancer: a single centre experience and review of the literature.

Currently the most important prognostic factor in lung cancer is the stage. In the current lung TNM classification system, N category is defined exclusively by anatomic nodal location though, in other type of tumours, number of lymph nodes is confirmed to be a fundamental prognostic factor. Therefore we evaluated the number of mediastinal lymph nodes as a prognostic factor in locally advanced NSCLC after multimodality treatment, observing a significant effect of the number of lymph nodes in terms of OS (p<0.01) and DFS (p<0.001): patients with a low number of positive mediastinal nodes have a better prognosis.

Helical tomotherapy: an innovative radiotherapy technique for the treatment of locally advanced oropharynx and inoperable oral cavity carcinoma

BackgroundTo report our initial clinical experience of helical tomotherapy (HT) in the treatment of locally advanced oropharynx and inoperable oral cavity cancer.MethodsBetween February 2008 and January 2011, 24 consecutive patients, 15 with oropharyngeal cancer and 9 with oral cavity cancer were treated with exclusive radiotherapy or concomitant chemoradiotherapy. Simultaneous integrated boost (SIB) in 30 fractions scheme was prescribed to all patients, using Helical Tomotherapy. Doses administered to primary tumor, oropharynx/oral cavity and positive lymph-nodes and negative lymph-nodes were 66–67.5 Gy, 60–63 Gy and 54 Gy, respectively.ResultsComplete response rate for the oropharynx and the oral cavity group was 86.7% and 77.8%, respectively. The 1 and 2-year Overall Survival (OS) and Disease Free Survival (DFS) rate for the oropharynx group was 92.9%, 85.1%, 92.9% and 77.4% respectively. For the oral cavity group, 1 and 2-year OS and DFS rates were 55.6%, 55.6%, 75% and 75%, respectively. No patient developed grade ≥3 mucositis, dysphagia or dermatitis. The maximum late-toxicity grade observed was 2, for all the variables examined.ConclusionsHT appears to achieve encouraging clinical outcomes in terms of response, survival and toxicity rates.

Comparison between intensified neoadjuvant treatment and standard preoperative chemoradiation for rectal cancer.

Objectives The aim of the current study was to compare a neoadjuvant regimen containing oxaliplatin with standard preoperative treatment for rectal cancer. Methods From December 2006 to December 2007, 20 patients with rectal cancer were treated at our Institution with the weekly addition of oxaliplatin (50 mg/m2) to radiotherapy (50.4–54.0 Gy in 28–30 daily fractions) and continuous infusion of 5-fluorouracil (200 mg/m2). The results of the regimen were compared with a historical control group including 21 consecutive patients previously treated with standard 5-fluorouracil treatment from December 2004 to October 2006. Results Both the rate of sphincter preservation in low rectal cancer (91.7% vs 36.4%, P = 0.009) and the rate of downstaging (84.2% vs 47.6%, P = 0.023) were higher in the oxaliplatin group than in the control group. Pathological complete response was achieved in 8 patients (42.1%) in the oxaliplatin group and in 4 patients (19.0%) in the control group (P = 0.172). When ypT0-pT1 stages were analyzed together, the P value was 0.051. Acute toxicity was increased in the oxaliplatin group, with a higher incidence of G3 diarrhea and pelvic pain than in the control group (30.0% vs 14.3%, P = NS). Conclusions Our data seem to correlate the addition of oxaliplatin to the standard treatment for rectal cancer with higher rates of sphincter preservation, down-staging and complete response. Toxicity is increased and requires careful monitoring. However, our results refer to a retrospective comparison of a small series of patients and need to be validated by the large, phase III randomized trial currently ongoing.

Pre-operative Radio-Chemotherapy of Rectal Cancer: Toxicity and Preliminary Results with the Addition of Weekly Oxaliplatin

The standard pre-operative treatment of rectal cancer consists of radiotherapy combined with continuous infusion of fluorouracil (FU) at a dose of 200 mg/m2/day. Platinum compounds can increase the anti-tumour activity of radiotherapy and are suitable agents to be combined with FU. We report our experience with the addition of oxaliplatin to radiotherapy and FU in the pre-operative treatment of patients with rectal cancer.