13 research outputs found
INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE for MACULAR HOLE SURGERY WITHOUT EXTRA MANIPULATION of the FLAP
No full textPurpose: To determine whether surgical manipulation steps of the internal limiting membrane (ILM) flap, such as ILM trimmed, ILM tuck inside the hole, ILM massage, are mandatory to obtain satisfactory outcomes for the repair of large stage IV idiopathic macular hole using the inverted ILM flap technique. Methods: In this interventional comparative prospective single-masked study, 81 eyes were randomized into 2 treatments groups. In Group 1 (41 eyes), the classic inverted ILM flap technique was performed. In Group 2 (40 eyes), a modified procedure was used: after ILM peeling, no extra flap manipulation was performed. The macular hole was covered by the inverted ILM flap because of the air pressure at the time of the fluid-air exchange. Results: At 12 months, macular hole closure was observed in 40 eyes (97.6%) in Group 1 and in 39 eyes in Group 2 (97.5%). U-shape closure rate, ellipsoid zone defects, and external limiting membrane defects were similar in both groups. The results indicate no statistical difference in anatomical and functional success between both groups. Conclusion: The macular hole closure rate, improved visual acuity, and no extra complications indicate noninferiority of the modified inverted ILM technique. Internal limiting membrane finishing, tucking, and massage may not be required to obtain surgical success
Cancer Stem Cells and Glioblastoma: Time for Innovative Biomarkers of Radio-Resistance?
No full textDespite countless papers in the field of radioresistance, researchers are still far from clearly understanding the mechanisms triggered in glioblastoma. Cancer stem cells (CSC) are important to the growth and spread of cancer, according to many studies. In addition, more recently, it has been suggested that CSCs have an impact on glioblastoma patients’ prognosis, tumor aggressiveness, and treatment outcomes. In reviewing this new area of biology, we will provide a summary of the most recent research on CSCs and their role in the response to radio-chemotherapy in GB. In this review, we will examine the radiosensitivity of stem cells. Moreover, we summarize the current knowledge of the biomarkers of stemness and evaluate their potential function in the study of radiosensitivity
CHIRURGIA DEL FORO MACULARE A TUTTO SPESSORE. RISULTATI ANATOMICI E FUNZIONALI DEL PEELING DELLA MEMBRANA LIMITANTE INTERNA CON LA TECNICA DEL FLAP INVERSO CON E SENZA LA MANIPOLAZIONE DEL FLAP POST PEELING.
No full textScopo dello studio: Determinare l’importanza della manipolazione post peeling del flap nella tecnica del flap inverso della Membrana Limitante Interna (ILM), nel trattamento del foro maculare a tutto spessore.
Metodi: In questo studio prospettico comparativo randomizzato sono stati inclusi 78 pazienti (81 occhi), l’età media era di 74 anni (range 46-91 anni), trattati per la chiusura chirurgica del foro maculare a tutto spessore con diametro minore di dimensioni maggiori di 400µm. I pazienti sono stati divisi in due gruppi: il Gruppo 1 è rappresentato dai pazienti sottoposti a vitrectomia via pars plana, seguendo la tecnica originale del flap inverso della ILM, comprendente 41 occhi (39 pazienti); il Gruppo 2 è rappresentato dai pazienti nei quali è stata realizzata la tecnica modificata del flap inverso della ILM per la chiusura del foro maculare, comprendente 40 occhi (39 pazienti). Nella tecnica modificata non è stata realizzata la manipolazione post peeling del flap.
È stato valutato l’esito funzionale e anatomico dopo l’intervento. I parametri valutati prima e dopo l’intervento sono stati: l’acuità visiva, il tono oculare, il profilo foveale tramite Tomografia a Coerenza Ottica (OCT) e/o OCT Spectral-Domain (SD-OCT).
Risultati. È stato riscontrato il successo anatomico nel 97.6% nel Gruppo 1 e nel 97.5% del Gruppo 2. In entrambi i gruppi, i fori non chiusi sono stati direttamente correlati a fattori quali: lunga durata (>20mesi), diametro minimo maggiore di 500µm e diametro massimo maggiore di 1000µm.
I diffetti dei fotorecettori e della Membrana Limitante Esterna (ELM) riscontrati nei primi controlli sono diminuiti in entrambi i gruppi.
In entrambi gruppi è stato riscontrato un miglioramento visivo significativo, migliorando da 0.78 LogMAR nei due gruppi a 0.18 LogMAR nel Gruppo 1 e 0.25LogMAR nel Gruppo 2. Inoltre non è stata rilevata nessuna differenza statisticamente significativa nella acuità visiva iniziale e finale tra i due gruppi.
Conclusioni. I risultati del nostro studio hanno dimostrano l’efficacia e sicurezza della tecnica senza manipolazione post peeling del flap nella tecnica del flap inverso della ILM, nel trattamento chirurgico del foro maculare di dimensioni maggiori di 400µm. Questa tecnica ha riportato risultati positivi funzionali ed anatomici, riducendo il rischio del danno all’Epitelio Pigmento Retinico (RPE), che può avvenire occasionalmente durante la manipolazione del flap, diminuendo inoltre i tempi chirurgici
PLAQUE BRACHYTHERAPY FOR THE TREATMENT OF UVEAL MELANOMA: OUR STRATEGIES AND RESULTS
No full textAbstract
AIM: To evaluate our community-based institutional experience of the treatment of uveal melanoma (UM), with plaque brachytherapy using ruthenium-106 and iodine-125 plaques, with a focus on local control rates, factors impacting disease progression, metastasis and enucleation.
Material and Methods: A retrospective study of patients affected by UM from January 2010 to November 2020, using ruthenium-106 and iodine-152 plaques at the University Hospital of Pisa. UM was diagnosticated with A-scan and B-scan standardized echography, fluorescein angiography, indocyanine green–angiography, optical coherence tomography and/or magnetic resonance. Primary outcomes measures were local control, overall survival, progression disease, globe preservation and metastases. Secondary outcome measures were acute and late radiation adverse effects.
Results: A total of 155 patients with UM located in the choroid (75.5%), ciliary body (20%) and the iris (4.5%). Their mean age at the diagnosis was 66 years. The median follow up was 73.5 months (range 12-130 months). The mean thickness at tumor apex was 4.2 mm (SD 2.6), with a mean basal diameter of 9.1 mm (SD 3.4). 86 (55.5%) of the 155 tumors were T-category 1 or 2 according with the American Joint Committee on Cancer (AJCC) classification and 69 (44.5%) were T-size category 3, no T-size categoty 4 were included in this study. 116 patients (74.8%) were treated with 106Ru plaque with a prescription dose of 110 Gy at the tumor apex, the remaining 39 tumors (25.2%) were treated with 125I plaque with a prescription dose of 85 Gy to the tumor apex.
The 5 yea rate of LC, PFS, OS, EFS and MFS were 92.9%, 89%, 96.7%, 96.1% and 94.2% respectively.
The most frequent common terminology criteria for late events grade 1 toxicity was vitreous hemorrhage (8.4%), grade 2 was retinal vascular disorders (9.7%), grade 3 was cataract (25.2%), and grade 4 was glaucoma (1.3%).
Conclusions:
Plaque BT offers an effective and safe approach for selected cases of uveal melanoma, due to the reported satisfactory results in terms of local control, eye conservation and survival
Lymph-vascular Space Involvement and/or p53 Overexpression Correlated With the Clinical Outcome of Early-stage Endometrial Cancer Patients Treated With Adjuvant Vaginal Brachytherapy
No full textBackground/Aim: The majority of patients with endometrial cancer (EC) are diagnosed at an early stage and undergo primary surgery, followed by observation or adjuvant therapy according to risk factors on surgical samples. The objective of this study was to assess the correlation between a risk profile represented by the presence of substantial lymph -vascular space involvement (LVSI) and/or p53 overexpression and the clinical outcome of patients with early-stage endometrial cancer (EC) who received adjuvant vaginal brachytherapy (BT). Patients and Methods: This investigation assessed 79 patients who underwent hysterectomy, bilateral salpingo-oophorectomy, and pelvic and/o aortic lymphadenectomy or sentinel lymph node biopsy followed by hypofractionated (HDR)-vaginal BT, using 192Ir source, for stage I-II endometrioid (n=70) or non-endometrioid (n=9) EC. Thirty-four patients (43.0%) were considered to have an unfavorable risk profile defined by the presence of substantial LVSI and /or p53 overexpression. Results: Five-year disease-free survival (DFS) and five-year overall survival (OS) were 93.7% and 95%, respectively. There was a significant correlation between unfavorable risk-profile and pelvic recurrence rate (p=0.002) and distant recurrence rate (p=0.017). Patients with abnormal p53 had a higher risk of local relapse (p=0.041). Substantial LVSI was strongly associated with pelvic recurrence (p=0.001) and distant metastasis (p<0.001). Conclusion: The presence of substantial LVSI and/or p53 overexpression strictly correlated with poor outcome of patients with early-stage EC and should be taken into consideration for better planning adjuvant treatment in this clinical setting
Adjuvant Radiotherapy in Patients With Pancreatic Adenocarcinoma. Is It Still Appealing in Clinical Trials? A Meta-analysis and Review of the Literature
No full textAim. Pancreatic adenocarcinoma is a lifethreatening disease with a rising frequency and the fourth leading cause of cancer death. This review aimed to assess the impact of postoperative radiotherapy through a meta-analysis of prospective randomized studies. Materials and Methods: Six studies met the inclusion criteria and were analyzed to calculate the cumulative risk of death (hazard ratio) in patients affected by pancreatic cancer treated with or without radiotherapy. Higgins' index was used to determine heterogeneity in betweenstudy variability and, subsequently, the random-effects model was applied according to DerSimonian and Laird. Results: Eight hundred and thirty-seven patients were analyzed (418 in the control arm and 419 in the treatment one), the hazard ratio for death after randomization was 0.92 (p=0.560, 95% confidence interval=0.70-1.22). When scrutinizing these studies, only one out of six showed a statistically significant benefit due to the addition of radiotherapy in the postoperative setting. Conclusion: We conclude that the use of adjuvant radiotherapy is not beneficial in treating all patients affected by pancreatic cancer but only for a subset of cases with potential residual local disease
Early Versus Late Postoperative Radiotherapy in Patients With Prostate Cancer: Results of a Single-centre Retrospective Study
No full textBackground/Aim: A much-debated topic relating to patients at risk of local prostate cancer recurrence, but with post-operative leveIs of prostate-specific antigen (PSA) lower than 0.2 ng/ml, concerns the best timing of postoperative radiotherapy (RT), adjuvant or salvage? The present monocentric, retrospective study aimed to investigate the best PSA value at which to plan salvage RT for patients with recurrent prostate cancer. Patients and Methods: From January 2011 to December 2019, 158 patients were treated with adjuvant RT at Pisa University Hospital, whilst 91 patients underwent salvage RT. We grouped the patients treated with salvage RT using their PSA values at the time of salvage RT: PSA >0.5 ng/ml, PSA between 0 and 0.5 ng/ml, and PSA . 0.2 ng/ml. The median follow-up was 63 measured from surgery was the primary endpoint. Results: considering the whole cohort of patients, with a hazard ratio of 3.195 (95% confidence interval=1.534-6.655, p=0.002). However, analysing only the group of patients with PSA . 0.2 ng/ml at the time of salvage RT, salvage RT led to BFS similar to that achieved with adjuvant RT (p=0.35). Conclusion: Our results suggest that when scheduled for patients with a PSA . 0.2 ng/ml, salvage RT results in equivalent biochemical control to that with adjuvant RT
Electron FLASH radiotherapy in vivo studies. A systematic review
No full textFLASH-radiotherapy delivers a radiation beam a thousand times faster compared to conventional radiotherapy, reducing radiation damage in healthy tissues with an equivalent tumor response. Although not completely understood, this radiobiological phenomenon has been proved in several animal models with a spectrum of all kinds of particles currently used in contemporary radiotherapy, especially electrons. However, all the research teams have performed FLASH preclinical studies using industrial linear accelerator or LINAC commonly employed in conventional radiotherapy and modified for the delivery of ultra-high-dose-rate (UHDRs). Unfortunately, the delivering and measuring of UHDR beams have been proved not to be completely reliable with such devices. Concerns arise regarding the accuracy of beam monitoring and dosimetry systems. Additionally, this LINAC totally lacks an integrated and dedicated Treatment Planning System (TPS) able to evaluate the internal dose distribution in the case of in vivo experiments. Finally, these devices cannot modify dose-time parameters of the beam relevant to the flash effect, such as average dose rate; dose per pulse; and instantaneous dose rate. This aspect also precludes the exploration of the quantitative relationship with biological phenomena. The dependence on these parameters need to be further investigated. A promising advancement is represented by a new generation of electron LINAC that has successfully overcome some of these technological challenges. In this review, we aim to provide a comprehensive summary of the existing literature on in vivo experiments using electron FLASH radiotherapy and explore the promising clinical perspectives associated with this technology
High-dose-rate brachytherapy for non-melanoma skin cancer using tailored custom moulds – a single-centre experience
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