Roberto Orecchia

Vestibular apparatus disorders after external radiation therapy for head and neck cancers

External irradiation of different head and neck cancers may involve parts of the ear. The vestibular function of 25 patients in which the inner ear was comprised in the irradiated volume was investigated by electronystagmography (ENG). Doses administered to the vestibular system ranged between 2800 and 5120 cGy. Five patients suffered subjective vertigo or dizziness. Eleven patients (three out of five with vertigo) showed vestibular abnormalities to ENG (44% of the total). Altered responses to specific tests were as follow: six patients to the bithermal caloric stimulation, two to the pendular-sinusoidal test and the other three to both of them. Patients were evaluated 3 and 6 months after the ending of the radiation therapy course. At the first evaluation, abnormalities to caloric test were noted in three patients (12%) and to sinusoidal rotatory test in one patient (4%). At the second evaluation, rates of abnormal response increased to 36% and 20%, respectively. Vestibular disorders seemed to be scantly related to the total radiation dose. Data of literature are discussed in order to identify possible implications on treatment planning.

Hyperthermia alone in the treatment of recurrences of malignant tumors: Experience with 60 lesions

Localized hyperthermia alone has been used for the treatment of cancer recurrences in which previous conventional therapies have failed. Since 1983 and 1988, 57 patients with 60 lesions have been heated by means of a microwave and radiofrequency system. Treatment protocol provided 45 minutes of heating at the intratumor temperature of at least 42°C, twice a week, for a total number of six, eight, or ten heating sessions. Invasive intratumor thermometry was performed for all lesions. Complete response (CR) was obtained in ten cases (16.6%) and partial response (PR) in 14 (23.4%). Higher rates of CR were observed in the chest wall (38.5%) compared with the head and neck area (11.4%), trunk (10%), and limbs (none). Adenocarcinoma was the most responsive histologic type (40%). Squamous cells carcinoma had 7.7% CR. the only case of undifferentiated carcinoma showed CR; there were none on five sarcomas. Long‐term local control (24 months) was approximately 7%. the multivariate analysis showed the statistical significance of the histologic variety (adenocarcinoma versus others, P < 0.0001). Side effects and complications of the treatment were minimal.

Results of Chemotherapy Plus External Reirradiation in the Treatment of Locally Advanced Recurrences of Nasopharyngeal Carcinoma

Between 1982 and 1991, 16 patients with recurrent cancer of the nasopharynx were treated with chemotherapy (CT) and radiotherapy (RT). All patients had received prior RT (45-69, 30 Gy). According to rTNM there were three rT2, one rT3 and 12 rT4. 5 patients were N1. Reirradiation (12-46 Gy, mean: 28) started 3-4 weeks after CT (2-6 cycles of different combinations), but 2 cases involved concomitant therapy. Out of 16 patients 7 had complete response (CR) (43.7%), 7 partial response and 2 no response. Statistically significant prognostic factors for obtaining CR were time of relapse and response to initial CT. Median duration of CR was 22+ months (9-64+). Failures at primary site occurred in 3 patients, 2/2 of those receiving CT without platinum compounds and 1/5 of other ones, with statistically significant difference in local recurrence free-survival between the two groups. Two- and 3-year actuarial overall survival were 28% and 10%. Rates of disease-free survival were 17% and 8%, respectively. The acute toxicity was generally mild. No central nervous system damage or radiation-induced myelitis were observed in survivors.

Interstitial brachytherapy for carcinomas of the lower lip. Results of treatment

From 1973 to 1988 47 patients with previously untreated T1 and T2 squamous cell carcinomas of the lower lip received a definitive course of interstitial brachytherapy by iridium 192 wires. The disease stage was T1 in 21 cases (44.7 %) and T2 in 26, and NO in all cases except 2 of N1. Radiation therapy dose ranged between 6000 and 8000 cGy. Local control was obtained in 44 patients (93.6 %). Treatment failure in the neck was observed in 3 patients (6.7 %) The 5- and 10-year actuarial disease-free survival rates were 92% and 85%, respectively. A surgical salvage was attempted in 3 patients, with postoperative definitive control of the disease in 2. The 10-year actuarial overall survival was 95 %. The incidence of complications was acceptable (10.6% of mucosal necrosis). An excellent or good cosmetic result was obtained in 91.7% of patients.

Results of hyperthermia, alone or combined with irradiation, in chest wall recurrences of breast cancer

In the period between September 1983 and July 1987, 28 loco-regional recurrences (about 86% in the chest wall) of breast cancer in 19 patients were treated with external microwave hyperthermia. Of these, 11 lesions were treated with hyperthermia alone and 17 with the combination of heat and external irradiation. Hyperthermia was induced in most cases with 915 MHz microwave (at least 42 °C for 30–45 min, for 6–10 sessions). Radiation was administered using photon or electron beams with total doses varying from 2000 to 5000 cGy. Complete and partial response rates on the whole series of patients were 53.6% and 42.9%, respectively. Of 17 lesions treated with combined treatment, 10 had a complete (58.8%) and 7 a partial response; of 11 lesions treated with hyperthermia alone, 5 had a complete (45.5%), 5 a partial (45.5%), and 1 no response. Complete responses were long lasting in all but 3 cases, which recurred after 4 months (2 cases) and 1 year, respectively.

Concomitant Radiotherapy and Daily Low-Dose Carboplatin in Locally Advanced, Unresectable Head and Neck Cancer Definitive results of a phase I-II study

The combination of daily low-dose carboplatin and radiotherapy was studied in 55 patients with inoperable head and neck cancer. All patients were planned to receive 70 Gy plus carboplatin i.v. daily, 45-60 min before radiotherapy. A starting schedule of 30 mg/m2 on days 1 through 5, weeks 1, 3, 5 and 7 was administered to 17 patients; an escalating daily dose, up to 55 mg/m2, was given to 38 additional patients. Up to a daily dose of 45 mg/m2, only 4.4% of the patients developed grade 3 leukopenia; on the contrary, grade 3 and 4 leukopenia was seen in 62.5% of patients receiving 50 mg/m2 or more. Mucositis was the major nonhaematologic toxicity and seemed to be dose-dependent. At the end of the loco-regional treatment there were 33 (61.1%) CR and 17 PR; the most effective total carboplatin dose seemed to be 40-45 mg/m2. After surgical salvage the number of CRs increased to 37 (68.5%). One- and 2-year loco-regional control rates were 64% and 53% respectively. One- and 2-year actuarial survival rates were 71% and 53% respectively; the corresponding rates of disease-free survival were 60% and 43%. There was a strong correlation nodal status and both survival and disease-free survival.

Daily low-dose carboplatin and standard radiotherapy in unresectable head and neck and lung cancers: a pilot study.

A total of 14 patients with locally advanced and unresectable head and neck (SCCHN) or non small cell lung cancer were treated with a definitive course of radiation therapy with conventional fractionation and 30 mg/m2 carboplatin (CBDCA) given daily as an i.v. infusion during the 1st, 3rd, 5th and 7th weeks of the combined treatment. The planned tumor dose of at least 7000 cGy was reached in all SCCHN patients except 1 (6600 cGy). The 2 NSCLC patients received 6320 and 5980 cGy, respectively. The planned total CBDCA-dose of 600 mg/m2 was administered in all patients. No treatment delays were required in 10 patients. Interruptions for severe mucositis or myelosuppression occurred in 4 patients (28.6 %), but in no case did the delay exceed 1 week. Complete response was obtained in 8 patients (57.1 %); 7 of the 12 with SCCHN and 1 of the 2 with NSCLC. The other 6 patients achieved a partial response. Granulocytopenia of WHO grade 3 occurred in 1 patient; apart from vomiting and mucositis, toxicities above grade 2 were not observed.

The cost of hyperthermia: nine years experience at the Radiation Therapy Department of the Turin University.

Background In this paper the authors try to quantify the expenditure for the equipment, staff, treatment per patient and research, sustained at the Radiation Therapy Department of the University of Turin for the treatment of cancer with hyperthermia Methods Two hyperthermic computerized devices are available: the SAPIC SV03 multifrequencies system (915, 434 and 2-30 MHz) for external hyperthermia, and the SACEM system. working only with the frequency of 915 MHz, for interstitial and intracavitary heating. From September 1983 to December 1991, 408 patients have been treated with hyperthermia, for a total number of treated sites of 483; 2960 heating sessions were performed, with a average of six sessions per patient. Results The overall cost of our “hyperthermia project” was about 2,000,000,000 Italian liras; the equipment cost was estimated at 1,258,650,000 Liras (839,100 US

Small cell carcinoma of the esophagus.

), and the cost per treatment and per heat session at about 3,985,200 (2676 US

Radiotherapy results in the treatment of malignant tumors of the nasal fossa and vestibule

) and 664,200 liras (443 US