Management of radiation-induced oral mucositis in head and neck cancer patients: a real-life survey among 25 Italian radiation oncology centers

AIM

Radiation-induced oral mucositis (RIOM) is the most frequent side effect in head and neck cancer (HNC) patients treated with curative radiotherapy (RT). A standardized strategy for preventing and treating RIOM has not been defined. Aim of this study was to perform a real-life survey on RIOM management among Italian RT centers.

METHODS

A 40-question survey was administered to 25 radiation oncologists working in 25 different RT centers across Italy.

RESULTS

A total of 1554 HNC patients have been treated in the participating centers in 2021, the majority (median across the centers 91%) with curative intent. Median treatment time was 41 days, with a mean percentage of interruption due to toxicity of 14.5%. Eighty percent of responders provide written oral cavity hygiene recommendations. Regarding RIOM prevention, sodium bicarbonate mouthwashes, oral mucosa barrier agents, and hyaluronic acid-based mouthwashes were the most frequent topic agents used. Regarding RIOM treatment, 14 (56%) centers relied on literature evidence, while internal guidelines were available in 13 centers (44%). Grade (G)1 mucositis is mostly treated with sodium bicarbonate mouthwashes, oral mucosa barrier agents, and steroids, while hyaluronic acid-based agents, local anesthetics, and benzydamine were the most used in mucositis G2/G3. Steroids, painkillers, and anti-inflammatory drugs were the most frequent systemic agents used independently from the RIOM severity.

CONCLUSION

Great variety of strategies exist among Italian centers in RIOM management for HNC patients. Whether different strategies could impact patients' compliance and overall treatment time of the radiation course is still unclear and needs further investigation.

One-Year Seismic Survey of the Tectonic CO2-Rich Site of Mefite d'Ansanto (Southern Italy): Preliminary Insights in the Seismic Noise Wavefield

A passive seismic experiment is carried out at the non-volcanic highly degassing site of Mefite d'Ansanto located at the northern tip of the Irpinia region (southern Italy), where the 1980 M_S 6.9 destructive earthquake occurred. Between 2020 and 2021, background seismic noise was recorded by deploying a broadband seismic station and a seismic array composed of seven 1 Hz three-component sensors. Using two different array configurations, we were allowed to explore in detail the 1-20 Hz frequency band of the seismic noise wavefield as well as Rayleigh wave phase velocities in the 400-800 m/s range. Spectral analyses and array techniques were applied to one year of data showing that the frequency content of the signal is very stable in time. High frequency peaks are likely linked to the emission source, whereas at low frequencies seismic noise is clearly correlated to meteorological parameters. The results of this study show that small aperture seismic arrays probe the subsurface of tectonic CO₂-rich emission areas and contribute to the understanding of the link between fluid circulation and seismogenesis in seismically active regions.

Prognostic role of global work efficiency in patients undergoing transcatheter aortic valve implantation

Background

Non-invasive myocardial work (MW) quantification has emerged in the last years as an alternative echocardiographic tool for myocardial function assessment. Its role in patients with severe aortic stenosis (AS) after aortic valve implantation (TAVI) has not been adequately investigated.

Purpose

We aimed to evaluate MW indices as early echocardiographic markers of LV reverse remodeling within a month after TAVI and their prognostic value.

Methods and results

We conducted a single-centre prospective study, enrolling 88 consecutive patients (mean age 79.9±6.4 years, 35% males) with AS undergoing TAVI between April 2018 and 2021, selected from the EffecTAVI registry. Exclusion criteria were prior valve surgery, atrial fibrillation, left bundle branch block (LBBB) at baseline and and suboptimal quality of imaging. Echocardiographic assessment was performed before TAVI and at 30-day follow-up, including quantification of 2D global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). LV peak systolic pressure was estimated non-invasively from the sum of systolic blood pressure and trans-aortic mean gradient. One month after the procedure, there was a significant improvement of LV GLS (−18.4±4.2 vs −19.5±4.2%, before and after TAVI respectively, p=0.006), a significant reduction of GWI (2406±567 vs 1908±479 mmHg%, p<0.001), GCW (2783±616 vs 2202±463 mmHg%, p<0.001), and GWW (238±203 vs 173±127 mmHg%, p=0.002). Conversely, MWE did not change early after intervention (90.4±6.2 vs 91.4±5.1%, p=0.113). After TAVI, 32 patients (36.4%) developed LV dyssynchrony due to LBBB or pacemaker implantation. When the population was divided according to the presence or absence of LV dyssynchrony at 30-day follow-up, a significant reduction in GWW was found only in the those without dyssynchrony (241±229 vs 142±103 mmHg% before and after TAVI, p<0.001). Consistently, in this subgroup, MWE significantly improved after TAVI (90±7 vs 93±5%, p=0.001), while a trend of MWE reduction was observed in patients who developed dyssynchrony after TAVI (91±5 vs 89±5%, p=0.110). In the overall population, a 30-day value of MWE≤92% was associated with an increased rate of cardiovascular events (composite of all-cause death and rehospitalization for heart failure) at 1-year follow-up (29.5% vs 4.8%, long rank p=0.003). In multivariable Cox-regression analysis, adjusted for confounders, GWE after TAVI (HR: 0.892, CI: 0.817–0.974; p=0.011) was independently associated with events at 1-year follow-up.

Conclusions

In patients with severe AS undergoing TAVI a significant reduction of GWW and improvement of MWE can be detected only in those who do not develop LV dyssynchrony. In this setting, MWE≤92% early after TAVI is associated with poor outcome. Thus, MWE could represent an alternative tool for myocardial function assessment and prognostic evaluation in patients receiving TAVI.

Funding Acknowledgement

Type of funding sources: None.

P-267 A continuous culture medium with a lower concentration of lactate has a pronounced effect on the percentage of usable blastocysts on day 5

Study question

Does Continuous Single Culture Medium NX, an embryo culture medium containing 1mM lactate, support increased blastocyst development over high lactate Vitrolife G1/G2 Series sequential culture?

Summary answer

There is a statistically significant increase in day 5 usable blastocysts in low lactate culture medium compared to the one with high lactate medium.

What is known already

Studies have shown that day 5 is the most desirable day to obtain blastocysts that are of an expansion, grade and quality to be utilized for transfer and/or vitrification procedures as those result in the highest success of clinical pregnancy,as compared to day 6/ 7 blastocysts, that do not meet criteria. Moreover, recent studies have indicated that there is an increase in chromosomal correctness of embryos cultured in a 1mM lactate environment as opposed to the higher 6-10mM lactate concentrations that have historically been believed necessary for successful blastocyst culture and resulting pregnancy.

Study design, size, duration

A prospective split sibling oocytes study was performed on 50 ICSI and IMSI cycles from October 2020 through April 2021. Oocytes were divided into the low lactate medium and high lactate gradient medium immediately following ICSI/IMSI and thereafter cultured in those medium until the final day of blastocyst culture. All patient ages were included in the sample population.

Participants/materials, setting, methods

This study was carried out in a private clinic. All patient stimulation protocol information and diagnosis’ were recorded; however, there was no restriction on participation. The endpoint was to analyse the resulting usable blastocyst rates on day 5 and day 6 in both arms of the study, using a denominator of normal 2PN fertilization. If a blastocyst was transferred or cryopreserved on day 5 or day 6, it was determined to be usable.

Main results and the role of chance

The resulting data was stratified not only by day 5 and day 6 usable blastocyst rates but also by patient age. It illustrates a statistically significant improvement in day 5 usable blastocysts for patients <35 in CSCM-NXC vs G1/G2 at 56% and 42%, respectively, a 14% increase (p < .05). The overall day 5 usable blastocyst rate was also statistically significant in CSCM-NXC (47%) as compared to G1/G2 (36%), (p < .05) with all ages considered. Additionally, on day 5, there was a higher percentage of usable blastocysts demonstrated in low lactate vs high in patients aged 35-37 (65% vs 42%, respectively) and 41-42 (41% vs 15%). Statistical significance was reversed in patients <35 on day 6, with G1/G2 having 24% usable blasts and CSCM-NXC 10% (p < .05). Interestingly, though not significant, G1/G2 had an increase in usable blastocyst percentage on day 5 in patients >42 (20% vs 11%), but overall, CSCM-NXC saw an increase in that same age group by 16%.

Limitations, reasons for caution

Though statistical significance was found in this study, a greater number will help to bolster the statistical power of the observations. Additionally, more studies are needed in order to ascertain if low lactate has an effect on the development prior to ICSI and resulting culture.

Wider implications of the findings

The mechanism of action that leads to the successful embryo development in low lactate embryo culture medium is vastly unknown, so further studies are required in order to understand the complexities and the impact of the observations provided.

Trial registration number

not applicable.

P-260 Study of kinetic parameters using KIDscoreTMDay5 version 3.0 in euploid, mosaic and aneuploid blastocysts

Study question

Do kinetic parameters change among euploid, mosaic and aneuploid blastocysts? Is the KIDscoreTMDay5 version 3.0 (KS-5.3) correlated to preimplantation genetic testing for aneuploidies (PGT-A) results?

Summary answer

The KS-5.3 differs in embryo ploidy classes. The analysis of the kinetic variables showed that the aneuploid embryos were significantly slower than euploid and mosaic.

What is known already

Chromosomal abnormalities affect more than 50% of embryos in women with >35 years of age and PGT-A is the best way to predict embryo’s ploidy status decreasing implantation failure and miscarriage. However, this procedure is not always possible due to social or moral issues. So, the use of the non-invasive time lapse monitoring could be helpful to determine the morphokinetic characteristics in the different ploidy classes. KS-5.3 (vitrolife,Sweden) is a scoring model based on morphokinetic data, developed to predict the pregnancy rate of day-5 blastocysts. Recent publications showed differences in kinetic parameters between euploid and aneuploid embryos.

Study design, size, duration

This retrospective study analyzed 728 blastocysts with PGT-A results obtained at Villa Mafalda Clinic from May 2020 to June 2021. Embryos were cultured in EmbryoScope+ time-lapse system (Vitrolife) at 37 °C, 6%CO2, and 5% O2. The PGT-A was performed using next-generation sequence (NGS) technology on the trophectoderm biopsy sample on day 5/6/7. Automatic annotations for division times and quality gradings were performed by senior embryologists and all kinetic values were reported in hours post microinjection.

Participants/materials, setting, methods

728 blastocysts were classified in: (E) euploid (n = 172), (M) mosaicism (n = 171) and (A) aneuploid (n = 385). In this study, they were considered KS-5.3 and the following kinetic variables: the time to reach 2 cells (t2), 3 cells (t3), 4 cells (t4), 5 cells (t5), and the blastocyst formation (TB). Continuous variables were reported as the median and interquartile range (IQR). For the statistical analysis, nonparametric tests were performed and p < 0.05 was considered statistically significant.

Main results and the role of chance

KS5.3 was significantly different between groups [E = 6.6(4.6-7.9) vs M = 5.3(2.9-7.2) vs A = 4.0(2.5-6.6), p < 0.0001]. It was significantly higher in euploid than in mosaic and aneuploid (EvsM p = 0.0007, EvsA p  <0.0001, MvsA p = 0.0077). A significant delay in t2,t3,t4 and tb was showed in aneuploid embryos compared to euploid and mosaic, whereas there was no significant difference between euploid and mosaic: [t2: E = 25.80 (24.56-28.09), M = 25.99 (24.49-28.91), A = 27.02 (25.30-29.47), EvsA p  <0.0001, AvsM p = 0.03, EvsM p = 0.32]; [t3: E = 37.08 (34.74-39.34), M = 36.69 (34.55-40.02), E = 38.45 (35.93-41.14), EvsA p = 0.0003, MvsA p = 0.002, EvsM p >0.99]; [t4: E = 38.28 (35.63-41.19), M = 38.49 (35.47-42.13), A 39.72 (37.25-43.31), EvsA p = 0.0001, MvsA p = 0.02, EvsM p = 0.65]; [tb: E = 107.70 (102.20-114.30), M = 110.10 (103.60-116.80), A = 113.7 (106.80-122.70), EvsA p  <0.0001, MvsA p  <0.0001, EvsM p = 0.42]. As for t5, there were no differences among the groups. Longer cell cycles in aneuploid embryos could be associated with activated DNA repair mechanism or during chromosome segregation. Instead, regarding the mosaics, there was a significant difference with euploid embryos only in KS5.3. The age was similar between euploid and mosaic [E = 36.29 (33.42-39.00) vs M = 36.71 (34.00-39.33) p = 0.99], whereas that was significantly higher in aneuploid embryos [A = 39.11(36.01-42.27), EvsA/EvsM p  <0.0001].

Limitations, reasons for caution

All these findings have to be validated in a larger sample size. Furthermore, for the retrospective nature of this study, there were some confounding factors, such as protocol of stimulation, female age, and malefactor. This research did not consider the importance of every single kinetic parameter.

Wider implications of the findings

A further study is needed to verify if there is a correlation between morphology and ploidy status. This could clarify the difference in KS-5.3 between euploid and mosaic. In order to decrease age bias, we should enlarge the sample size to analyze a subgroup of patients with higher maternal age.

Trial registration number

not applicable

Management of Metastatic Disease in Campania (MAMETIC): An Observational Multicenter Retrospective and Prospective Trial on Palliative Radiotherapy in an Italian Region. Study Protocol

Background

Methods

Conclusion

Emergencies in oncology: an overview and practical suggestions

Oncologic emergencies are clinical situations that can lead to death in a short time (24-48 hours) if not quickly faced. In the clinical practice of the medical oncologist, such situations do not infrequently occur. The onset of oncologic emergencies may depend on the presence of cancer itself, the therapies carried out to counteract cancer, or the patient’s predisposition to develop such events. Mediastinal syndrome, spinal cord compression, endocranial hypertension, pancytopenia, metabolic syndromes, deep vein thrombosis, pulmonary thromboembolism, disseminated intravascular coagulation and the massive pericardial effusion are the main medical emergencies in oncology occurring in clinical practice. It is essential to recognize the aforementioned situations early in order to treat them promptly, thus avoiding serious consequences. This paper is aimed at presenting an overview on the topic, offering practical suggestions useful in daily clinical practice.

Translational Research: A Future Strategy for Managing Squamous Cell Carcinoma of the Head and Neck?

BACKGROUND

Squamous Cell Carcinoma of the Head and Neck (SCCHN) are neoplasms arising from the epithelium of the first aero-digestive tract. They are very heterogeneous both clinically and biologically. Classic and well acknowledged risk factors are alcohol and tobacco consumption and other forms of smokeless tobacco assumption, although lately the incidence of Human Papilloma Virus (HPV)-related SCCHN is rapidly increasing. HPV-related tumors are very different from their alcohol and tobacco-associated counterpart, as they show strong chemo and radio sensitivity and thus can often be treated with conservative treatment strategies. Moreover, peculiar biologic features characterize HPV-related tumors, such as wild type TP53, low expression of Epidermal Growth Factor Receptor (EGFR), wild type CCND1 and high expression of P16. In contrast, alcohol and tobacco related SCCHN show opposite features, together with higher number of chromosomal and genetic abnormalities, conferring them chemo and radio resistance.

METHODS

We have performed a narrative review of the PubMed database with the aim to study the mutational landscape of SCCHN.

RESULTS

Several lines of evidence support the existence of at least two genetically different types of SCCHN, one virus-related and the other alcohol and/or tobacco-related, characterized by both clinical and biological opposite features. Virus related SCCHN are very chemo and radiosensitive, so suitable for organ preserving strategy, which in the near future may be induction chemotherapy followed by association of chemotherapy and underpowered radiotherapy. Alcohol and tobacco related SCCHN are themselves strongly heterogeneous and can be divided in different entities on the basis of the "Driver" genetic aberration, responsible for carcinogenesis. The most frequently mutated genes in alcohol and tobacco-related SCCHN are TP53, NOTCH1, CCND1, CDKN2A, EGFR and PI3KCA.

CONCLUSIONS

Virus-related SCCHN can be managed with chemo-radiotherapy. Alcohol and tobacco-related tumors should be further characterized on the basis of their "Driver Mutations" in order to select effective targeted therapies.

Prevention of Cutaneous Damages Induced by Radiotherapy in Breast Cancer: An Institutional Experience

Background and Aims

A minimal part of patients treated with radiotherapy on the entire breast may present an acute, subacute or chronic cutaneous damage of the healthy tissues involved in the radiation fields. The aim of this retrospective study was to evaluate the most efficient topical hydrating treatment in the prevention of cutaneous radio-induced acute effects in breast cancer.

Material and Methods

From February 2009 to March 2010, 100 patients affected by breast cancer have been recruited, all of the female sex and with an average age of 47 years. The following topical treatments were compared: Pure vitamin E (Vea lipogel®), Omega-3,6,9 (Quinovit®), Betaglucan, sodium hyaluronate (Neoviderm®), Vitis vinifera A.s-I-M.t-O.dij, (Ixoderm®), natural triglycerides-fitosterols (Xderit®). All enrolled patients were subjected to breast conservative treatment (quadrantectomy with or without homolateral axillary dissection) and without prosthesis positioning, in combination or not with hormonal treatment. Evaluation of the cutaneous acute toxicity was defined according to the RTOG scale either during radiotherapy and during follow-up (3 months after radiation treatment).

Results

All patients completed the radiotherapy; 62% of patients presented G0-G1 cutaneous toxicity, 28% have developed G2 cutaneous toxicity, 10% have developed G3 toxicity; no patient presented G4 toxicity. Analysis of the data revealed a correlation between the topical treatment used and the incidence of cutaneous toxicity.

Conclusions

Of the patients who used the cutaneous hydrating creams – betaglucan, sodium hyaluronate (Neoviderm®) and Vitis vinifera A.s-I-M.t-O.dij (Ixoderm®) – during the radiation treatment, 80% developed G0-G1 toxicity and 20% G2 toxicity. The patients who used the other hydrating creams tested in the study manifested not only G1-G2 toxicity but also some G3 toxicity. Chemotherapeutic treatment with taxanes and/or anthracyclines did not result in an increased breast cutaneous toxicity induced by radiotherapy. The hormone therapy given to patients undergoing radiotherapy did not result in increased breast cutaneous toxicity. Further analysis on a larger number of patients is necessary for definitive results.

Outcomes of Radiation Therapy for T1 Glottic Carcinoma from an Italian Regional Series with Doses Ranging from 60 to 66 Gy

Aims and background

Radiotherapy has remarkable success rates for the cure of patients affected by glottic carcinoma; local control rates are similar to surgery with lower morbidity and better functional results. Our aim was to determine local-regional control rates, overall survival, second cancer incidence, acute-late toxicity and prognostic factors in our series of T1 glottic cancer patients with radiation doses of 60 to 66 Gy. Functional results were not sufficient for statistical analysis.

Methods and study design

A retrospective study was carried out of all T1N0 glottic carcinomas treated with radiation therapy between 1996 and 2006. To be eligible, patients had to have newly diagnosed cancer and had to be treated with a curative intent by radiation therapy alone. Ninety-eight patients satisfied the eligibility requirements: 85 patients had T1a disease; 13 patients were staged as T1b. Treatment was performed for all cases with a 6 megavoltage linear accelerator. The total dose prescribed varied from 60 to 66 Gy: 2 Gy/fraction, 1 fraction/day, 5 fractions/week. During treatment, a weekly clinical evaluation was performed; endoscopic examination was performed once every two weeks. After the treatment, a clinical, endoscopic and radiological follow-up was performed every three months for the first two years, every 6 months till the fifth year, and then once a year.

Results

With a median follow-up of 41.5 months (range, 10-132; mean, 56.8), we registered 12 cases of local failures; 8 of them were successfully treated with salvage surgery (median time to relapse, 3–48 months). The local relapse rate was 12.2%, and disease-specific survival, taking into account salvage surgery, was 6%. Thirty-four deaths were registered: 2 for local progression, 2 for distant metastasis, 4 for a new primary cancer, and 26 for non-neoplastic causes. Five- and 10-year overall survival were respectively 85.8% and 69.4%. Four cases of lung cancer were detected in the upper aerodigestive tract in our series. In terms of acute-late toxicity, no grade 3-4 dermatitis, dysphagia or hoarseness occurred. Mild dermatitis and arythenoid edema were the most common causes of toxicity. Only one patient did not complete the treatment (60 Gy instead of the planned 66 Gy).

Conclusions

Our series confirmed the primary role of radiation therapy for the cure of T1N0 glottic cancer. Outcomes were good in terms of local-regional control as well as overall toxicity. Radiation therapy can be offered to T1 glottic cancer patients as a valid alternative to surgery, with high rates of functional preservation.

Patterns of Postoperative Radiotherapy for Head and Neck Cancer in Italy: A Prospective, Observational Study by the Head and Neck Group of the Italian Association for Radiation Oncology (AIRO)

Aims and background

Our previous survey showed that the patterns of postoperative radiotherapy (PORT) for head and neck cancer (HNC) in Italy might be suboptimal. A prospective observational study was therefore designed to evaluate this issue in greater detail.

Methods

All radiotherapy centers involved in the HNC Working Group of the Italian Radiation Oncology Association were asked to enter into the study all patients treated with PORT during a 6-month period.

Results

A total of 200 patients were accrued by 24 centers from December 2008 to May 2009. Larynx (38%) and oral cavity (34%) were the most common primary sites. The median time between surgery and the start of radiotherapy was 69 days (range, 25–215 days). Seventy-nine percent of cases with no evidence of risk factors for local recurrence were treated with high-dose radiotherapy to the primary site. In about 75% of cases the pN0 neck was included in the target volume. Concomitant chemotherapy was delivered to about 60% of patients with major risk factors and 21% of patients with no risk factors.

Conclusions

Three issues emerged from our study as potential targets for future investigations: the impact on clinical outcome of the interval between surgery and the start of PORT; factors driving radiation oncologists to overtreat volumes at low risk of recurrence; and problems associated with the delivery of concomitant chemotherapy.

Modeling birds on wires

In this paper we introduce a mathematical model to study the group dynamics of birds resting on wires. The model is agent-based and postulates attraction-repulsion forces between the interacting birds: the interactions are "topological", in the sense that they involve a given number of neighbors irrespective of their distance. The model is first mathematically analyzed and then simulated to study its main properties: we observe that the model predicts birds to be more widely spaced near the borders of each group. We compare the results from the model with experimental data, derived from the analysis of pictures of pigeons and starlings taken in New Jersey: two different image elaboration protocols allow us to establish a good agreement with the model and to quantify its main parameters. We also discuss the potential handedness of the birds, by analyzing the group organization features and the group dynamics at the arrival of new birds. Finally, we propose a more refined mathematical model that describes landing and departing birds by suitable stochastic processes.

Validation of DWI in assessment of radiotreated bone metastases in elderly patients

Bone metastases are commonly observed in oncologic patients with advanced disease. These metastases are considered the main cause of neoplastic pain, with more than half of oncologic patients experiencing neoplastic pain during the course of the disease due to bone involvement. Lung, breast, and prostate cancers are the primary causes of bone metastases. Magnetic resonance imaging (MRI), especially diffusion weighted imaging (DWI) sequences, is the focus of our research, as it has been proven to be an optimal predictive index to assess the radiation treatment in many patients. We included patients treated with standard fractioning of radiation therapy. First, we examined the irradiated lesions with the MRI-DWI technique, before treatment and 30 and 60 days after its completion. Then we combined the MRI results and clinical parameters in a table with a predictive score for the quality of life in patients with bone metastases. This was a significant predictor of the efficacy of radiation treatment, from both clinical and psychological points of view, as it can allow an early assessment of the response to RT and therefore better scheduling of the next therapeutic steps to be performed. The table of the score we proposed helped guide patient monitoring, enabling us to undertake, where possible, follow-up with therapeutic strategies tailored to each patient's needs.

Technical guidelines for head and neck cancer IMRT on behalf of the Italian association of radiation oncology - head and neck working group

Performing intensity-modulated radiotherapy (IMRT) on head and neck cancer patients (HNCPs) requires robust training and experience. Thus, in 2011, the Head and Neck Cancer Working Group (HNCWG) of the Italian Association of Radiation Oncology (AIRO) organized a study group with the aim to run a literature review to outline clinical practice recommendations, to suggest technical solutions and to advise target volumes and doses selection for head and neck cancer IMRT. The main purpose was therefore to standardize the technical approach of radiation oncologists in this context. The following paper describes the results of this working group. Volumes, techniques/strategies and dosage were summarized for each head-and-neck site and subsite according to international guidelines or after reaching a consensus in case of weak literature evidence.

Preventing the acute skin side effects in patients treated with radiotherapy for breast cancer: the use of corneometry in order to evaluate the protective effect of moisturizing creams

BACKGROUND AND PURPOSE

The purpose of this study was to add, to the objective evaluation, an instrumental assessment of the skin damage induced by radiation therapy.

MATERIALS AND METHODS

A group of 100 patients affected by breast cancer was recruited in the study over one year. Patients were divided into five groups of 20 patients. For each group it was prescribed a different topical treatment. The following products were used: Betaglucan, sodium hyaluronate (Neoviderm®), Vitis vinifera A. s-I-M.t-O.dij (Ixoderm®), Alga Atlantica plus Ethylbisiminomethylguaicolo and Manganese Cloruro (Radioskin1®) and Metal Esculetina plus Ginko Biloba and Aloe vera (Radioskin 2®); Natural triglycerides-fitosterols (Xderit®); Selectiose plus thermal water of Avene (Trixera+®). All hydrating creams were applied twice a day starting 15 days before and one month after treatment with radiations. Before and during treatment patients underwent weekly skin assessments and corneometry to evaluate the symptoms related to skin toxicity and state of hydration. Evaluation of acute cutaneous toxicity was defined according to the RTOG scale.

RESULTS

All patients completed radiotherapy; 72% of patients presented a G1 cutaneous toxicity, 18% developed a G2 cutaneous toxicity, 10% developed a G3 toxicity, no one presented G4 toxicity. The corneometry study confirmed the protective role of effective creams used in radiation therapy of breast cancer and showed its usefulness to identify radiation-induced dermatitis in a very early stage.

CONCLUSIONS

The preventive use of topic products reduces the incidence of skin side effects in patients treated with radiotherapy for breast cancer. An instrumental evaluation of skin hydration can help the radiation oncologist to use strategies that prevent the onset of toxicity of high degree. All moisturizing creams used in this study were equally valid in the treatment of skin damage induced by radiotherapy.

Solitary plasmacytoma of the larynx treated with radiotherapy: a case report

AIMS AND BACKGROUND

Solitary plasmacytomas are rare tumors accounting for less than 10% of plasma cell neoplasms. On initial presentation they must be differentiated from multiple myeloma. This can be difficult because a high percentage of these tumors may be associated with subsequent development of multiple myeloma. We present a case of plasmacytoma of the larynx treated with surgery and radiotherapy.

CASE REPORT

A 56-year-old man presented a solitary plasmacytoma of the larynx. The diagnosis was made by biopsy and the presence of a mass on the right side of the larynx was confirmed by computed tomography and whole-body positron-emission tomography. Soon after the biopsy the patient underwent a CO2 laser cordectomy. After the definitive histological confirmation, the patient was referred to our department for three-dimensional conformal radiotherapy (3DCRT) to the involved site with curative intent. The prescribed dose was 50 Gy.

RESULTS

Five months after the 3DRTE treatment there was no CT or PET evidence of tumor, and examination by the otorhinolaryngologist confirmed the success of laser cordectomy and 3DRTE treatment. There were no long-term side effects of the treatment.

CONCLUSION

Radiation therapy following CO2 laser cordectomy can achieve excellent locoregional control of solitary plasmacytoma of the larynx.

Prevention of cutaneous damages induced by radiotherapy in breast cancer: an institutional experience

BACKGROUND AND AIMS

A minimal part of patients treated with radiotherapy on the entire breast may present an acute, subacute or chronic cutaneous damage of the healthy tissues involved in the radiation fields. The aim of this retrospective study was to evaluate the most efficient topical hydrating treatment in the prevention of cutaneous radio-induced acute effects in breast cancer.

MATERIAL AND METHODS

From February 2009 to March 2010, 100 patients affected by breast cancer have been recruited, all of the female sex and with an average age of 47 years. The following topical treatments were compared: Pure vitamin E (Vea lipogel®), Omega-3,6,9 (Quinovit®), Betaglucan, sodium hyaluronate (Neoviderm®), Vitis vinifera A.s-I-M.t-O.dij, (Ixoderm®), natural triglycerides-fitosterols (Xderit®). All enrolled patients were subjected to breast conservative treatment (quadrantectomy with or without homolateral axillary dissection) and without prosthesis positioning, in combination or not with hormonal treatment. Evaluation of the cutaneous acute toxicity was defined according to the RTOG scale either during radiotherapy and during follow-up (3 months after radiation treatment).

RESULTS

All patients completed the radiotherapy; 62% of patients presented G0-G1 cutaneous toxicity, 28% have developed G2 cutaneous toxicity, 10% have developed G3 toxicity; no patient presented G4 toxicity. Analysis of the data revealed a correlation between the topical treatment used and the incidence of cutaneous toxicity.

CONCLUSIONS

Of the patients who used the cutaneous hydrating creams--betaglucan, sodium hyaluronate (Neoviderm®) and Vitis vinifera A.s-I-M.t-O.dij (Ixoderm®)--during the radiation treatment, 80% developed G0-G1 toxicity and 20% G2 toxicity. The patients who used the other hydrating creams tested in the study manifested not only G1-G2 toxicity but also some G3 toxicity. Chemotherapeutic treatment with taxanes and/or anthracyclines did not result in an increased breast cutaneous toxicity induced by radiotherapy. The hormone therapy given to patients undergoing radiotherapy did not result in increased breast cutaneous toxicity. Further analysis on a larger number of patients is necessary for definitive results.

Solitary Plasmacytoma of the Larynx Treated with Radiotherapy: A Case Report

Aims and background.

Solitary plasmacytomas are rare tumors accounting for less than 10% of plasma cell neoplasms. On initial presentation they must be differentiated from multiple myeloma. This can be difficult because a high percentage of these tumors may be associated with subsequent development of multiple myeloma. We present a case of plasmacytoma of the larynx treated with surgery and radiotherapy.

Case report.

A 56-year-old man presented a solitary plasmacytoma of the larynx. The diagnosis was made by biopsy and the presence of a mass on the right side of the larynx was confirmed by computed tomography and whole-body positron-emission tomography. Soon after the biopsy the patient underwent a CO2 laser cordectomy. After the definitive histological confirmation, the patient was referred to our department for three-dimensional conformal radiotherapy (3DCRT) to the involved site with curative intent. The prescribed dose was 50 Gy.

Results.

Five months after the 3DRTE treatment there was no CT or PET evidence of tumor, and examination by the otorhinolaryngologist confirmed the success of laser cordectomy and 3DRTE treatment. There were no long-term side effects of the treatment.

Conclusion.

Radiation therapy following CO2 laser cordectomy can achieve excellent locoregional control of solitary plasmacytoma of the larynx.

Skin toxicity from external beam radiation therapy in breast cancer patients: protective effects of Resveratrol, Lycopene, Vitamin C and anthocianin (Ixor®)

Introduction

This is an observational study and the aim is to evaluate the effect of dietary supplements based on Resveratrol, Lycopene, Vitamin C and Anthocyanins (Ixor^®) in reducing skin toxicity due to external beam radiotherapy in patients affected by breast cancer.

Materials and methods

71 patients were enrolled and they were divided in two different groups: a control group (CG) of 41 patients treated with prophylactic topical therapy based on hyaluronic acid and topical steroid therapy in case of occurrence of radiodermatitis, and a Ixor-Group (IG) of 30 patients treated also with an oral therapy based on Resveratrol, Lycopene, Vitamin C and Anthocyanin (Ixor^®) at a dose of 2 tablets/day, starting from 10 days before the radiation treatment until 10 days after the end of treatment. Skin toxicity has been related to PTV, to breast volume that received a radiation dose equal or lower than 107%, included between 107% and 110%, or greater than 110% of the prescribed dose. Moreover it's been studied the relationship between skin toxicity and the chemotherapy schedule used before treatment. We calculated in both groups the percentage of patients who had a skin toxicity of grade 2 or 3 (according to RTOG scale). Absolute risk reduction (ARR), relative risk (RR) and odds ratio (OR) have been calculated for each relationship.

Results

Control Group (CG) patients with a PTV > 500 ml presented skin toxicity G2 + G3 in 30% of cases, versus 25% of Ixor-Group (IG) [OR 0.77]. In patients with a PTV < 500 ml G2 + G3 toxicity was 0% in the IG compared to 18% in CG (OR 0.23). When Dmax was less than or equal to 107% of the prescribed dose skin toxicity was G2 + G3 in 12.5% in CG, versus 0% in IG (OR 0.73), instead when Dmax was included between 107 and 110% of the prescribed dose, G2 + G3 skin toxicity was 35% in CG and 21% in IG (OR 0.50). In patients undergoing chemotherapy with anthracyclines and taxanes, G2 + G3 toxicity was 27% in CG, against 20% in IG (OR 0.68).

Conclusions

The protective effect of Resveratrol, Lycopene, Vitamin C and Anthocyanin (Ixor^®) is more detected in patients with PTV < 500 ml, when Dmax reaches values lower or equal to 107%, but not exceeding 110% of the prescribed dose, and in patients undergoing adjuvant chemotherapy with anthracyclines and taxanes.

Patterns of postoperative radiotherapy for head and neck cancer in Italy: a prospective, observational study by the head and neck group of the Italian Association for Radiation Oncology (AIRO)

AIMS AND BACKGROUND

Our previous survey showed that the patterns of postoperative radiotherapy (PORT) for head and neck cancer (HNC) in Italy might be suboptimal. A prospective observational study was therefore designed to evaluate this issue in greater detail.

METHODS

All radiotherapy centers involved in the HNC Working Group of the Italian Radiation Oncology Association were asked to enter into the study all patients treated with PORT during a 6-month period.

RESULTS

A total of 200 patients were accrued by 24 centers from December 2008 to May 2009. Larynx (38%) and oral cavity (34%) were the most common primary sites. The median time between surgery and the start of radiotherapy was 69 days (range, 25-215 days). Seventy-nine percent of cases with no evidence of risk factors for local recurrence were treated with high-dose radiotherapy to the primary site. In about 75% of cases the pN0 neck was included in the target volume. Concomitant chemotherapy was delivered to about 60% of patients with major risk factors and 21% of patients with no risk factors.

CONCLUSIONS

Three issues emerged from our study as potential targets for future investigations: the impact on clinical outcome of the interval between surgery and the start of PORT; factors driving radiation oncologists to overtreat volumes at low risk of recurrence; and problems associated with the delivery of concomitant chemotherapy.

Optimization versus randomness for car traffic regulation

We focus on the differences among the analytical optimization of traffic flow on a road network, modeled by a fluid-dynamic approach, and a dynamic random one. In particular, two real urban networks are analyzed: Re di Roma Square, in Rome, and Via Parmenide crossing, in Salerno. With such two examples, it is possible to show that dynamic random algorithms are not the right choice for the improvement of traffic conditions.

Effect of ascorbic acid based amphiphiles on human erythrocytes membrane

6-O-alkyl ascorbic acid esters (ASCn) are amphiphilic molecules that behave as surfactants in aqueous solution. These compounds show physico-chemical and aggregation properties that depend on the alkyl chain length, pH and temperature. It must consider that ASCn have shown some physical and rheological properties that suggest a potential utility as drug carriers. The present paper aims to evaluate the effects of these surfactants on human erythrocyte membranes. The membrane properties studied were: osmotic resistance in hypotonic media, shape transformation, and vesicle release at lytic concentration. According to our results, all properties depended on the length of the hydrophobic chain and they did not evolve monotonically. Finally, the study of ASCn interaction with erythrocyte membrane allowed us to postulate the crucial influence that the molecular structure exerts upon the manner in which amphiphiles interact with biological membranes and the effects involved in them.

Conception rates and serum progesterone concentration in dairy cattle administered gonadotropin releasing hormone 5 days after artificial insemination

The objectives of this study were to determine the effect of administration of exogenous GnRH 5days after artificial insemination (AI) on ovarian structures, serum progesterone concentration, and conception rates in lactating dairy cows. In experiment 1, 23 Holstein cows were synchronized using the Ovsynch protocol. Five days after AI (day 0) cows were assigned randomly to receive either saline (saline; n=11) or 100microg GnRH (GnRH; n=12). To examine ovarian structures, ultrasonography was performed on day 1 and every other day beginning on day 5 until day 13. On days 5 and 13 blood samples were obtained to measure serum progesterone concentrations. All cows in the GnRH-treated group developed an accessory corpus luteum (CL), whereas cows in the saline group did not. Mean serum progesterone concentrations did not differ between GnRH and saline groups on day 5 (1.64+/-0.46ng/ml versus 2.04+/-0.48ng/ml). On day 13 serum progesterone concentrations were greater (P<0.05) in the GnRH group compared with saline (5.22+/-0.46ng/ml versus 3.36+/-0.48ng/ml). In experiment 2, 542 lactating cows, at two different commercial dairies, were used to test the effect of administering GnRH 5 days after AI on conception rates. Cows were synchronized and detected for estrus according to tail chalk removal. Cows detected in estrus received AI within 1h after detection of estrus. Five days after AI, cows were assigned randomly to receive either GnRH (n=266) or saline (n=276). Pregnancy status was determined by palpation per rectum of uterine contents approximately 40 days after AI. There was no effect of farm on conception rate. There was no effect of treatment as conception rates did not differ between GnRH and saline groups (26.7% GnRH versus 24.3% saline). Regardless of treatment, days in milk, parity, milk yield, and number of services had no effect on the odds ratio of pregnancy. In summary, the results of this study indicated that GnRH administered 5 days after AI increased serum progesterone by developing an accessory CL but did not improve conception rates in dairy cattle.

Time and Incidence of Ovulation and Conception Rates After Incorporating Estradiol Cypionate into a Timed Artificial Insemination Protocol

Two experiments were conducted to determine the effect of estradiol cypionate (ECP), when incorporated into a conventional GnRH-PGF(2alpha)-GnRH timed artificial insemination protocol (Ovsynch), on systemic estradiol (E(2)), time and incidence of ovulation, luteal development, and conception rate in Holstein cows. Our objective was to determine if administration of 0.25 mg of ECP at the time of the second GnRH injection would effectively synchronize ovulation and increase conception rate. In Experiment 1, lactating Holstein cows (n = 23; 58.7 +/- 1.2 d in milk) were synchronized with PGF(2alpha) (at d -10). Ten days later, Ovsynch was initiated with the administration of 100 mug of GnRH (d 0) followed by PGF(2alpha) on d 7. On d 9, cows were assigned randomly to be treated with either GnRH + 0.25 mg of ECP (OVS-ECP; n = 11) or GnRH and 1 mL of cottonseed oil (OVS-C; n = 12). Ovarian activity was monitored by ultrasonography on d 0, 7, and 9. To determine the time of ovulation, ultrasound examinations were conducted at 12 and 20 h posttreatment and then at least every 3 h until either 36 h posttreatment or ovulation was observed. Blood samples were collected on d 0, 7, 9, and 16 for progesterone analysis. Blood samples also were collected at the time of treatment (d 9, 0 h) and at 6, 12, 20, and 28 h for E(2) analysis. Incidence of ovulation did not differ between treatments. Mean ovulation time relative to the second GnRH administration was similar between treatments. Serum progesterone concentration did not differ between treatments at any time. Serum E(2) concentration was not different at the time of treatment (0 h); however, mean E(2) concentration was greater for the OVS-ECP group at 6 and 12 h after treatment compared with OVS-C. In Experiment 2, lactating dairy cows (n = 333) in 3 commercial herds were randomly assigned to OVS-ECP (n = 169) or OVS-C (n = 164). Cows were inseminated 22 to 24 h posttreatment. Conception rates did not differ between treatments. Estradiol cypionate treatment was successful in increasing serum E(2) when administered at the time of the second dose of GnRH in the Ovsynch protocol. Conception rates, however, were not affected by treatment.

Short Communication: Conception Rates Following Detection of Estrus and Timed AI in Dairy Cows Synchronized Using GnRH and PGF2

The objective of this study was to compare conception rates of cows exhibiting spontaneous estrus and receiving artificial insemination (AI) before completion of a timed AI protocol with cows that did not display estrus spontaneously, but were inseminated after 1 of 3 GnRH-PGF2alpha protocols. Cows (n = 432) in 2 herds were administered GnRH on d -7 and were tail-chalked daily. Cows detected in estrus before d 0 were inseminated immediately. Cows not detected in estrus by d 0 were administered PGF2alpha and were tail-chalked daily until 48 h after PGF2alpha. Cows detected in estrus from d -7 to 48 h after PGF2alpha were inseminated and designated as treatment A (n = 46). Cows not detected in estrus and not inseminated by 48 h after PGF2alpha were assigned randomly to receive either GnRH 48 h after PGF2alpha and timed AI 16 h later (treatment B; n = 132), or GnRH and timed AI 64 h after PGF2alpha (treatment C; n = 127), or timed AI 64 h after PGF2alpha (treatment D; n = 127). Pregnancy was diagnosed 38 to 45 d after AI by palpation per rectum of uterine contents. Nearly 11% of all cattle exhibited spontaneous estrus and received immediate AI. Herd did not influence the percentage of cows detected in estrus and inseminated. Conception rates did not differ among treatments. Conception rates differed between herds, but no interaction of herd x treatment was detected. No differences were detected between herds for days in milk, milk production, AI service number, or parity.

Radiologist evaluation of a multispectral image compression algorithm for magnetic resonance images

With the advent of teleradiology and picture archiving and communication systems (PACS), the expense and time required for image transmission and long term image archiving become important. The use of validated image compression algorithms can greatly reduce these costs. A lossy, multispectral image compression scheme at compression ratios (CR) of 25:1 and 32:1 was used for a set of 26 different patient MR exams. The original and compressed/decompressed (CD) images sets were evaluated in a blinded fashion by four radiologists in two phases. The main objective was to determine whether radiologic interpretation would vary between the two types of CD image sets and the corresponding originals. In general, the compression algorithm caused a slight decrease in image quality; however, the interpretation of pathology did not change between the original and CD image sets. In only one case at the maximum CR = 32 did one of four radiologists change the interpretation of pathology after CD. In this study, lossy multispectral image compression of MR images at CR = 25 maintained diagnostic integrity. This could play a significant role in image storage and communications.

A canine model of acute hydrocephalus with MR correlation

Within 3 hours of induction of acute hydrocephalus in a canine model, lateral ventricular CSF pressure increased from an initial average of 14.6 +/- 2.8 cm H2O to 40.2 +/- 5.7 cm H2O. Ventricular volumes, as measured from MR images, increased 1.45 +/- 0.94 cm3, 1.92 +/- 0.82 cm3, and 2.24 +/- 0.60 cm3 after 6, 24, and 48 hours, of hydrocephalus, respectively. This canine model was reliable and consistent with clinical conditions.

[Proteiform syndrome (Proteus syndrome). Skin manifestations in a recently observed case]

The case of a 4-year-old female affected by partial gigantism of the feet, syndactyly and polydactyly, partial right hemihypertrophy of buttock and lower limb, warty hyperpigmented nevus and vulvar lipoma is described. The Authors discuss about the Proteus syndrome, pointing out its rarity, the polymorphism and the problems of differential diagnosis with the Klippel-Trenaunay-Weber syndrome and with other congenital hamartomatous disorders.

Localized cell death in Drosophila imaginal wing disc epithelium caused by the mutation apterous-blot

Drosophila melanogaster carrying the mutation apterous-blot have blistered wings. Trypan blue stains a patch of dead cells localized to the wing pouch of imaginal discs and the same area shows acid phosphatase (AcPase) activity suggesting that the cell death is lysosomal. Autophagic vacuoles and other secondary lysosomes show AcPase activity within the disc epithelium and enzyme activity is found in fragments of dead cells which have been extruded basally. The cell death, although extensive and confined to the presumptive wing region, does not result in loss of adult structures.