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Introduction: Treatment of inoperable cutaneous squamous cell carcinoma (cSCC) of the head and neck region is still debated., Case Report: We report an original case of cure of cSCC of the head and neck region with weekly hypofractionated radiation therapy with megavoltage electrons prescribed for locally advanced inoperable disease., Results: Weekly hypofractionated radiotherapy assured complete regression and was well-tolerated., Conclusion: The real efficacy of this treatment in the therapeutic arsenal remains to be defined. A clinical trial is ongoing to test the use of 8 weekly fractions of 8 Gy hypofractionated RT regimens in non-resectable cSCC cases.

Purpose: To correlate dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters to tumor grading and to assess their reliability in predicting pathological complete response (pCR) before neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC)., Materials and Methods: Forty patients (24 male; mean age, 67.3 ± 8.1 years) with histologically proven LARC who had undergone 3-Tesla DCE-MRI before (MRI_1) and after CRT (MRI_2) between August 2015 and February 2016 were included in this retrospective study. DCE-MRI parameters at MRI_1 and MRI_2 were extracted by two board certified radiologists in consensus reading with Olea Sphere 2.3 software using the extended Tofts model. Based on DCE-MRI results, patients were divided in complete responders (CR) and non-complete responders (nCR) and the perfusion parameters were correlated to tumor grading and pCR., Results: Wash-out and K ep at MRI_1 showed significant correlation with LARC grading (P = 0.004 and 0.01, respectively). V e showed a significant increase between MRI_1 (0.47 ± 0.27) and MRI_2 (0.63 ± 0.23; P = 0.007). K trans measured at MRI_1 was significantly higher in CR (0.66 ± 0.48) compared to nCR (0.53 ± 0.34, P = 0.02)., Conclusion: Wash-out and K ep measured before CRT correlate with LARC grading. V e changes during CRT, while K trans measured before CRT may predict the response to therapy. Therefore, DCE-MRI parameters can predict tumor aggressiveness and CRT efficacy, playing a role as imaging biomarkers in patients with LARC.

The increasing growth of population with cardiac implantable electronic devices (CIEDs) such as Pacemaker (PM) and Implantable Cardiac Defibrillators (ICD), requires particular attention in management of patients needing radiation treatment. This paper updates and summarizes some recommendations from different international guidelines. Ionizing radiation and/or electromagnetic interferences could cause device failure. Current approaches to treatment in patients who have these devices vary among radiation oncology centres. We refer to the German Society of Radiation Oncology and Cardiology guidelines (ed. 2015); to the Society of Cardiology Australia and New Zealand Statement (ed. 2015); to the guidelines in force in the Netherlands (ed. 2012) and to the Italian Association of Radiation Oncology recommendations (ed. 2013) as reported in the guidelines for the treatment of breast cancer in patients with CIED. Although there is not a clear cut-off point, risk of device failure increases with increasing doses. Cumulative dose and pacing dependency have been combined to categorize patients into low-, medium- and high-risk groups. Measures to secure patient safety are described for each category. The use of energy ≤6MV is preferable and it's strongly recommended not to exceed a total dose of 2 Gy to the PM and 1 Gy for ICD. Given the dangers of device malfunction, radiation oncology departments should adopt all the measures designed to minimize the risk to patients. For this reason, a close collaboration between cardiologist, radiotherapist and physicist is necessary.

Introduction: Early stage breast cancer (pT-T2, N0, N+, M0) is generally treated with conservative surgery followed by radiation therapy, which procedures yield similar results to radical surgery. We studied the effects of irradiation on residual breast parenchyma in patients submitted to quadrantectomy and complementary irradiation., Material and Methods: 331 patients (Stage T1, T2, N0, M0) submitted to quadrantectomy and axillary dissection 1980-1993, were examined. The tumor was localized in external quadrants in 257 cases and in internal ones in 74 cases. Radiotherapy was given with 4-6 MV photon beams produced by a linear accelerator; the total dose to the breast was 50 Gy with a 10 Gy boost to tumor bed. All the patients were submitted to follow-up mammography at 6 months, one and two years after the end of radiotherapy. Parenchymal density was evaluated on an arbitrary scale from 0 to 3. We also considered the following other parameters: skin thickness, calcifications, cysts and possible signs of recurrence., Results: Trabecular patterns were unchanged in 41 patients (grade 0) and slightly changed in 67 (grade 1); 135 patients had grade 2 and 90 grade 3 changes. 254 patients had skin thickening. All the changes disappeared at 2-3 years' follow-up. The patients with bigger breasts had poorer cosmetic results., Conclusions: It is very important to assess irradiation-induced tissue changes to detect any early recurrence of breast carcinoma. All radiation-induced changes decrease over time, which confirms the good tolerance and the good cosmetic results of complementary irradiation for breast cancer

The authors report a series of patients with osteosarcoma or Ewing's sarcoma irradiated 1968-1988 at the Institute of Radiology of "La Sapienza" University, Rome. Twelve of 17 osteosarcoma patients (71%) died and 5 are alive, with a median survival of 13 months. Seven of 12 Ewing's sarcoma patients (58%) died and 5 are alive (42%), with a median survival of 67 months. These results are similar to those of most contemporary series in the literature; the long follow-up of our series allowed us to calculate actuarial survival rates at 5, 10 and 15 years of 41%, 34% and 17%, respectively, in osteosarcoma patients and 75%, 45% and 34% for those with Ewing's sarcoma. The review of the literature on the management of bone tumors high-lights the importance of new developments and technologies to improve the life expectancy of these patients. The authors discuss the role of modern imaging techniques in defining tumor margins and predicting treatment-induced tumor regression and the research into new therapeutic approaches. Multimodality combinations and new schedules appear promising tools to improve prognosis and to reduce side-effects, thus stressing the need of combined efforts of surgeons, radiotherapists and chemotherapists. State-of-the-art radiotherapy can further increase local control with higher total doses to the lesion and selectively sparing adjacent normal tissues, thanks to 3D treatment planning of hadron beam equipment.

January, 1972, through December, 1982, ninety-four patients with Hodgkin's disease in stages I and IIA were treated in the Dept. of Radiation Oncology of the University "La Sapienza", Rome. All patients had a minimum follow-up of 10 years. After careful clinical and surgical examinations comprehensive of laparosplenectomy, all patients were submitted to extended field radiation treatment. Ninety-one of 94 patients (97%) obtained complete remission. Overall survival at 10 years was 91% and independent of stage (94% in stage I and 87% in stage II), while relapse-free survival at 10 years did depend on stage (83% in stage I and 49% in stage II); the difference was statistically significant (p < 0.01). Thirty-one of 94 patients relapsed, but fortunately 94% of them obtained a second complete remission after salvage chemotherapy. Our experience confirms the low tumorigenic potential of exclusive radiation therapy; only one of 4 secondary neoplasms (acute non-lymphatic leukemia) observed in this series had been treated with radiotherapy. The results of this study confirm the efficacy of exclusive irradiation in stage I patients, while treatment approach remains debated in stage II patients. The combination of short-time chemotherapy with curative irradiation is probably the best option to reduce both the incidence of recurrences and treatment-induced complications.

Pulmonary fungal infections have been increasingly reported in the patients with hematologic malignancies treated with aggressive chemotherapy and therefore presenting chemotherapy-induced leukopenia. The diagnosis of fungal infections in these severely immunocompromised hosts is of great importance, enabling the administration of an antifungal treatment to prevent potentially fatal fungal dissemination. This retrospective study was carried out to assess the most valuable conventional radiologic and CT features in the diagnosis of sinusal and cerebral mycosis infections. The authors reviewed their personal series of 71 patients with malignant hematologic diseases who developed a fungal lesion: twenty-eight cases were selected, 10 of them with an autoptic diagnosis of cerebral fungal lesions and 18 with a bioptic diagnosis of paranasal fungal lesions. In 10 patients with encephalic lesions, CT enabled four main types of tomodensitometric alterations with fungine etiology to be singled out--i.e., ischemic lesions, brain abscesses, granulomatoses and meningitis with possible brain parenchyma involvement. In 18 patients with fungal sinusitis, radiography and CT showed three main types of alterations: sinus opacities, pseudocystic images within the sinus and bone erosions. We conclude that in sinusal and cerebral fungal lesions no "specific criteria" can be established for the radiologic differential diagnosis between different fungine species and between fungine lesions with different etiologic agents.

The authors report on 14 cases of fungal parenchymal infections of the abdomen detected with CT and/or US in immunodepressed patients. Image patterns and the capabilities of the two diagnostic techniques are analyzed in the early detection of fungal lesions. CT was the first-choice examination, followed by US, in 9 patients; laboratory tests followed in 3 cases; US was performed first (and CT second) in 1 patient; finally, US alone was performed in 1 patient. The information yielded by CT and that given by US overlapped in 8/9 cases: in the extant patient, US demonstrated multiple fungal microabscesses of liver, while CT was negative, probably due to low liver density. CT patterns were multiple, small and round nonenhanced areas. Since the indiscriminate administration of intravenous contrast medium is unsuitable, CT cannot be performed first. On the other hand, in several patients liver CT with no contrast medium gave the same results for venous and fungal lesions. Compared with CT, US is a safer technique which is easier to perform and to evaluate. Therefore, US should be the exam of choice in immunodepressed patients with suspected fungal lesions. US is likely to demonstrate, in most cases, a pathologic condition (fungal microabscesses) as well as vascular and biliary anatomy.

From 1965 through 1988, 113 patients affected with testicular seminoma were treated at the Dept. of Radiotherapy, University "La Sapienza", Rome, Italy. Mean age of the patients was 38 years; in 70 cases tumor developed in the right testis and in 43 in the left one. In 9 patients underlying cryptorchidism was observed. All cases underwent radical orchiectomy. Histology diagnosed anaplastic seminoma in 5 cases and pure seminoma in all the other patients. Structures were involved in 7 cases. Eighty-four patients were in stage I, 20 in stage IIA, 4 in IIB, 4 in IIIA, and 1 in stage IIIB. All patients staged as I and IIA were treated with exclusive radiotherapy on paraaortic lymph nodes and inguinal and iliac lymph nodes of the involved sites (total doses: 28-35 Gy in stage I and 34-40 Gy in stage IIA). Before 1970 these patients underwent prophylactic irradiation of mediastinum and of left supraclavicular lymph nodes (total dose: 25-28 Gy). Patients in stage IIB were administered subdiaphragmatic lymph nodes irradiation with inverted-Y field (total dose: 36-45 Gy). Two cases were irradiated also on mediastinum and left supraclavicular lymph nodes, and 2 received two cycles of polychemotherapy (PVB) before irradiation. Patients in stage IIIA underwent sub-/supra-diaphragmatic irradiation (total dose: 40-45 Gy, and 40-42 Gy). The case in stage IIIB underwent palliation chemotherapy and local irradiation. All cases in stages I, IIA and IIB obtained complete remission. Three cases of the 4 in stage IIIA obtained complete remission (75%), while 1 (25%) progressed and died 8 months after diagnosis; the only case in stage IIIB progressed and died after 7 months of follow-up. Two cases in stage I recurred (2.4%), 1 in the mediastinum and 1 in the left supraclavicular lymph nodes. Both were cured with salvage radiation therapy. Toxicity related to treatment was low. Two cases in stage I developed secondary malignant neoplasms, at 4 and 34 months of follow-up, respectively.

From 1983 through 1989, 141 untreated patients with Hodgkin's disease underwent CT of the abdomen. They subsequently underwent staging laparotomy plus splenectomy and multiple biopsies of liver and lymph nodes, at the Institute of Radiology and Hematology, University "La Sapienza", Rome. CT results were compared with surgical findings to evaluate CT sensitivity, specificity, and overall accuracy. The cases from this series were divided into two groups depending on the characteristics of the CT scanners employed. From 1983 to 1985, 78 patients were examined with 2nd-generation CT units; from 1986 to 1989, 63 patients underwent CT performed with 3rd-generation scanners. The results from the two groups were analyzed according to these parameters. A total number of 622 biopsies were performed, of spleen, liver, and lymph nodes. CT sensitivity, specificity, and overall accuracy were: 22.9% (group I) vs 43.7% (group II), 83.1% vs 92%, and 68.4% vs 81.2% for lymph nodes; 28.1% vs 36.3%, 93.5% vs 98%, and 66.7% vs 87.3% for the spleen, and 12.5% vs 42.8%, 97.1% vs 98.2%, and 88.5% vs 92.1% for the liver. Our results demonstrate an obvious increase in reliability with newer units, even though a high percentage of false-negatives were still observed in our series, which caused understaging in 19.4% of cases vs 24.4% in group I.

The staging, therapy and course of 91 patients with extranodal NHL of the head and neck treated between 1970 and 1985, were analyzed. The sites involved were: Waldeyer's ring 71 patients, tonsil 59, nasopharynx 12 and extralymphatic sites 20 patients (larynx 6, paranasal sinus 5, orbit 5, oral cavity 3, salivary gland 1). Sixty-three patients had unfavourable histology with 22 patients in stage I; 33 in II; 21 in III; 15 in IV. Chemotherapy plus radiotherapy was used in 43 patients and 34 obtained Complete Remission (CR). Chemotherapy alone was used in 30 patients and in 11 CR was achieved, radiotherapy alone in 18 patients and 11 obtained CR. The actuarial survival rate was 55% and recurrence-free survival, evaluated only in those patients who achieved complete remission, was 80%. Results, as survival and freedom from recurrence, are analyzed in relation to main prognostic factors and therapy, and patterns of recurrence are reported. The present study confirmed the view that radiotherapy combined with chemotherapy represents the best treatment for NHL of the head and neck.