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8. Conservative treatment of early breast cancer: long-term results of 1232 cases treated with quadrantectomy, axillary dissection, and radiotherapy

Author

Veronesi, U., Salvadori, B., Luini, A., Banfi, A., Zucali, R., Del Vecchio, M., Sacozzi, R., Beretta, E., Boracchi, P., Farante, G., Galimberti, V., Mezzanotte, G., Sacchini, V., Tana, S., and Marubini, E.

Subjects
Breast, Breast cancer -- Radiotherapy, Health
Abstract

Today, approximately 40 percent of all treated cases of breast cancer involve small (less than 2 centimeters, or three-quarters of an inch) tumors. This is due to early detection, and has resulted in development of techniques designed to save as much of the breast tissue as possible. In 1981, results were reported using the QUART technique, which is conservative surgery involving excision of only that quadrant of the breast which contains the tumor, removal of the lymph nodes in the axilla, and radiation therapy. These results showed survival rates using the QUART technique that were comparable to those of patients who had undergone radical mastectomy (removal of the entire breast, underlying muscle, axillary lymph nodes and all adjacent fat, fascia and other tissue). Results are reported in this article of 1,232 women with cancerous tumors of less than 2 cm who were treated with QUART therapy. The overall survival rate at five years after surgery was 91 percent, and at 10 years, 78 percent. Probability of survival tended to decrease as the size of the tumor increased; the seven-year survival for patients with tumors 1.6 to 2 cm was 84 percent, compared with 94 percent for patients with tumors under 0.5 cm. Patients who had more than one lymph node involved in the cancer process showed a lower probability of survival (79 percent at seven years). There were 45 cases of cancer that developed in the opposite breast during the period of follow-up (averaging 72 months). The incidence of recurrence in the QUART-treated breast was 2.8 percent (35 patients), and the incidence of a new primary tumor in that breast was 1.6 percent (19 patients). These patients underwent a second operation; five died and 49 are still alive. The low rate of recurrence in the QUART-treated breast is remarkable. It appears that local recurrence after QUART does not have as great an affect on long-term survival as does local recurrence following more traditional surgery. The heavy irradiation of the breast does not appear to have increased the risk of new cancers within 10 years of treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Published
1990

11. Ten-year survival with chemotherapy and radiotherapy in patients with squamous cell carcinoma of the esophagus

Author

Bidoli, P, Bajetta, E, Stani, S, De, C, Santoro, A, Valente, M, Zucali, R, Valagussa, P, Ravasi, G, Bonadonna, G, Bidoli P, Bajetta E, Stani SC, De CD, Santoro A, Valente M, Zucali R, Valagussa P, Ravasi G, Bonadonna G., Bidoli, P, Bajetta, E, Stani, S, De, C, Santoro, A, Valente, M, Zucali, R, Valagussa, P, Ravasi, G, Bonadonna, G, Bidoli P, Bajetta E, Stani SC, De CD, Santoro A, Valente M, Zucali R, Valagussa P, Ravasi G, and Bonadonna G.

Abstract

Background. The effects of multimodality treatment on the survival of patients with esophageal carcinoma are unclear. The authors performed a prospective, Phase II study to assess the long-term results of chemotherapy plus radiotherapy (RT) on patients with esophageal squamous cell carcinoma. Methods. Of 106 consecutive patients who were recruited between 1985 and 1992, 101 patients were evaluable. Cisplatin (100 mg/m2 per day) on Day 1 and fluorouracil (1000 mg/m2 per day) on Days 1-4 were given for two cycles, with concomitant RT (30 grays [Gy] in 15 fractions) over 19 days. Patients with potentially resectable tumors were then assessed for curative surgery; the other patients received two more courses of chemotherapy and further RT (20 Gy in 10 fractions). Results. Of 40 patients who were candidates for surgery, 32 patients underwent surgery, and 24 patients had complete resection; 8 patients (25%) had no residual tumor in the specimen, and 12 patients (37%) had microscopic foci only. Surgical mortality was high (22%). Of 61 nonsurgical patients, 37 patients (61%) achieved complete clinical remission, and 14 patients (23%) achieved partial remission. The median survival for the entire series was 15 months (range, 1-136 months). The overall survival rate was 22% at 5 years and 12% at 10 years. At 10 years, freedom from disease progression was similar in the two groups (24%), whereas the median survival (22 months vs. 12 months) and the overall survival rates (17% vs. 9%) were better in nonsurgical patients compared with surgical patients, respectively, probably in relation to high surgical mortality. The larynx was preserved in 28% of 32 patients with cervical disease sites, with a 10-year disease free survival rate of 31%. Three deaths were attributed to nonsurgical treatments. Conclusions. Careful multidisciplinary pretreatment evaluation can identify patients who are ineligible for surgery without compromising long-term results. For patients with inoperable dis

Published
2002

14. Conservative treatment of early breast cancer. Long-term results of 1232 cases treated with quadrantectomy, axillary dissection, and radiotherapy

Author

Veronesi, U, Salvadori, B, Luini, A, Banfi, A, Zucali, R, Del Vecchio, M, Saccozzi, R, Beretta, E, Boracchi, P, and Farante, G

Subjects
Adult, Radiotherapy, High-Energy, Survival Rate, Axilla, Humans, Lymph Node Excision, Breast Neoplasms, Female, Middle Aged, Mastectomy, Segmental, Combined Modality Therapy, Research Article, Randomized Controlled Trials as Topic
Abstract

One thousand two hundred and thirty-two women with invasive breast cancer lesions measuring less than 2 cm in diameter, clinically assessed as T1N0-1M0, were treated from 1970 to 1983 at the National Cancer Institute of Milan with quadrantectomy, axillary dissection, and radiotherapy (QUART). Pathologic evidence of lymph-nodes metastases was found in 32% of the patients. Overall survival at 5 and 10 years from surgery was 91% and 78%, respectively. The cumulative probability of survival tends to decrease with increasing tumor size: the 7-year survival rate was 84% in cases in which lesions measured from 1.6 to 2.0 cm, and 94% in cases in which the lesions were less than 0.5 cm. Tumor site in the treated breast did not affect distant outcome. No difference was found between the patients without node metastases and patients with one node involved, whereas the patients with more than one node showed a lower probability of survival. The survival curves of 352 cases treated inside a randomized trial and that of 880 cases routinely treated appear to be superimposable. Local recurrences and new primary ipsilateral tumors were, respectively, 35 (2.8%) and 19 (1.6%); 56 women with local recurrences or second tumors underwent second surgery (total mastectomy, 43; wide resection, 11). Five of them died from distant spread of breast cancer, while 49 are alive and well. In the contralateral breasts 45 carcinomas were recorded during the follow-up time. The results of the present analysis of a large number of T1 cases reconfirm the safety of integrated radiosurgical conservative treatments.

Published
1990

15. Nutritional support in patients with cancer of the esophagus: impact on nutritional status, patient compliance to therapy, and survival

Author

Bozzetti, F, Cozzaglio, L, Gavazzi, C, Bidoli, P, Bonfanti, G, Montalto, F, Soto Parra, H, Valente, M, Zucali, R, Bozzetti, F, Cozzaglio, L, Gavazzi, C, Bidoli, P, Bonfanti, G, Montalto, F, Soto Parra, H, Valente, M, and Zucali, R

Abstract

Aims and background: The multimodal approach to patients with esophageal squamous cell carcinoma often includes polychemotherapy combined with radiation therapy. Cancer dysphagia and drug-related anorexia, mucositis and vomiting can all lead to malnutrition. The aim of this study was to analyze the impact of the administration of enteral nutrition (EN) on the patient's nutritional, tolerance of chemotherapy and radiotherapy, and that final oncological outcome. Methods: Fifty esophageal cancer patients who were to be submitted to chemotherapy (days 1-4 5-fluorouracil (FU) 1 g/m2/day and cisplatin (CDDP) 100 mg/m2/day 1) for two cycles plus radiotherapy (31 Gy) were referred to the Nutrition Support Unit prior to any therapy due to their malnourished status. Twenty-nine dysphagic patients received nutrition via tube (37 kcal/kg/day + 2.0 g proteins/kg/day for 34 days), while 21 others who were not dysphagic were given a standard oral diet (SD). The patients who received EN had a more severe weight loss than the SD patients (16.8% vs 12.8%, P < 0.02). Results: The dose of administered EN represented 86% of the planned support, and 70% of the nutritional therapy was administered in the home setting. Administration of EN support resulted in stable body weight and unchanged levels of visceral proteins, while SD patients had a decrease in body weight, total proteins and serum albumin (P < 0.01). There was no difference between the two groups in terms of tolerance and response to cancer therapy, suitability for radical resection and median survival (9.5 months). Conclusions: EN in patients with cancer of the esophagus undergoing chemotherapy and radiotherapy is well tolerated, feasible even in the home setting, prevents further nutritional deterioration and achieves the same oncological results in dysphagic patients as those achieved in non-dysphagic patients

Published
1998

16. Expression of p53, glutathione S-transferase-pi, and Bcl-2 proteins and benefit from adjuvant radiotherapy in breast cancer.

Author

Silvestrini R, Veneroni S, Benini E, Daidone MG, Luisi A, Leutner M, Maucione A, Kenda R, Zucali R, Veronesi U, Silvestrini, R, Veneroni, S, Benini, E, Daidone, M G, Luisi, A, Leutner, M, Maucione, A, Kenda, R, Zucali, R, and Veronesi, U

Abstract

Background: In clinical breast cancer research, the utility of certain biomarkers as predictors of response to surgery, chemotherapy, or hormonal therapy has been studied intensively. Much less research has been done on the relevance of biologic predictors of response to radiotherapy, which represents an effective local-regional treatment for breast cancer.Purpose: The utility of biomarkers involved in DNA damage repair (p53 protein), control of programmed cell death (p53 and Bcl-2 proteins), and cellular detoxification (glutathione S-transferase-pi [GST-pi] enzyme) in predicting local breast cancer recurrence was analyzed retrospectively in two cohorts of breast cancer patients. These patients had had no detectable metastases in the axillary lymph nodes (i.e., node-negative) or in distant sites and had had similar distributions of clinicopathologic and biologic prognostic features. They had been treated by conservative surgery alone (139 case patients) or by conservative surgery followed by adjuvant radiotherapy (496 case patients) during the period from 1984 through 1990.Methods: The expression of the p53, GST-pi, and Bcl-2 proteins in the specimens of primary breast tumor obtained from these patients was determined by use of immunohistochemistry; cell proliferation activity and levels of steroid receptors were determined by use of a [3H]thymidine-labeling index assay and the dextran-coated charcoal technique, respectively. The median time of follow-up of patients was 6 years. In the analyses of patient outcomes, only local failures that presented as first events were considered.Results: After surgery alone, the risk of local recurrence at 6 years was higher for patients with tumors exhibiting elevated levels of p53 and GST-pi protein expression than for patients with low levels (hazard ratio [HR] = 3.1, 95% confidence interval [CI] = 1.3-7.7, two-sided P = .012; HR = 2.7, 95% CI = 1.1-6.4, two-sided P = .026, respectively). Weak or no observable expression of Bcl-2 protein was only suggestive of a higher frequency of local failures. Adjustment for patient age, tumor size, cell proliferation, and estrogen receptor status did not change these findings. Conversely, in the series of patients given conservative surgery followed by radiotherapy, there was no difference in local tumor recurrence between patients with tumors expressing or not expressing each of the three markers.Conclusions: Our study provides indirect evidence of a benefit from radiation therapy in preventing local breast cancer relapse, particularly among node-negative patients with tumors that express elevated levels of the p53 or GST-pi proteins or that express little or no Bcl-2 protein. [ABSTRACT FROM AUTHOR]

Published
1997
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18. Combined radiation and chemotherapy in esophageal cancer

Author

Zucali, R, Bidoli, P, Salvini, P, Santoro, A, Spinazzè, S, Bonadonna, G, Valente, M, Alloisio, M, Ravasi, G, Salvini, PM, Zucali, R, Bidoli, P, Salvini, P, Santoro, A, Spinazzè, S, Bonadonna, G, Valente, M, Alloisio, M, Ravasi, G, and Salvini, PM

Published
1993

23. Standards of reference in early breast cancer post-operative irradiation: The Italian association for radiation oncology (AIRO) document

Author

Valdagni, R., primary, Amichetti, M., additional, Bignardi, M., additional, Cazzaniga, L.F., additional, Ciocca, M., additional, Cosention, D., additional, Gatti, G.M., additional, Guenzi, M., additional, Lozza, L., additional, Maiorana, A., additional, Orecchia, R., additional, Pacini, P., additional, and Zucali, R., additional

Published
1997
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24. Efficacy, toxicity, and applicability of high-dose sequential chemotherapy as adjuvant treatment in operable breast cancer with 10 or more involved axillary nodes: five-year results.

Author

Gianni, A M, primary, Siena, S, additional, Bregni, M, additional, Di Nicola, M, additional, Orefice, S, additional, Cusumano, F, additional, Salvadori, B, additional, Luini, A, additional, Greco, M, additional, Zucali, R, additional, Rilke, F, additional, Zambetti, M, additional, Valagussa, P, additional, and Bonadonna, G, additional

Published
1997
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35. Primary Chemotherapy To Avoid Mastectomy in Tumors With Diameters of Three Centimeters or More

Author

Bonadonna, G., primary, Veronesi, U., additional, Brambilla, C., additional, Ferrari, L., additional, Luini, A., additional, Greco, M., additional, Bartoli, C., additional, Yoldi, G. C. d., additional, Zucali, R., additional, Rilke, F., additional, Andreola, S., additional, Silvestrini, R., additional, Fronzo, G. D., additional, and Valagussa, P., additional

Published
1990
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37. Combined chemotherapy-radiotherapy approach in locally advanced (T3b-T4) breast cancer.

Author

De Lena, M, Zucali, R, Viganotti, G, Valagussa, P, and Bonadonna, G

Abstract

Combined treatment modality was applied in 110 consecutive women with primary inoperable (T3b-T4) Breast cancer. Treatment was started with four cycles of adriamycin plus vincristine (AV). This was followed in responders by high-energy radiotherapy (RT). At the end of combined therapy, patients in complete remission (CR) were randomized to either no further treatment or six more cycles of chemotherapy. AV induced objective response in 89% of patients (complete 15.5%, partial 54.5%, improvement 19%). At the end of RT, 81% of 98 (82.7%) patients responding to AV were classified in CR. The median duration of CR was 15 months. The median free interval was statistically prolonged by additional chemotherapy. The three-year survival was 52.8%. Altogether, present findings indicate that combined treatment modality has improved the three-year survival compared to the previous series treated with radiotherapy alone. However, to achieve a satisfactory control of T3b-T4 breast cancer a more aggressive and prolonged treatment is required. [ABSTRACT FROM AUTHOR]

Published
1978

42. Abdominal Dosimetry for Supradiaphragmatic Irradiation of Hodgkin's Disease in Pregnancy. Experimental Data and Clinical Considerations

Author

De Palo G, Marchesini R, and Zucali R

Subjects
Risk, Cancer Research, medicine.medical_specialty, Linear particle accelerator, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Fetus, 0302 clinical medicine, Pregnancy, medicine, Humans, Scattering, Radiation, Dosimetry, Cobalt Radioisotopes, Pelvis, Dosimeter, business.industry, Mediastinum, Radiotherapy Dosage, General Medicine, Hodgkin Disease, Pregnancy Complications, medicine.anatomical_structure, Oncology, 030220 oncology & carcinogenesis, Radiological weapon, Abdomen, Female, Thermoluminescent dosimeter, Radiology, Nuclear medicine, business
Abstract

An experimental dosimetry by an Alderson Phantom was carried out at the Istituto Nazionale Tumori of Milan to evaluate the scattered radiation in the abdomen for a radiotherapeutic treatment of some lymph node supradiaphragmatic regions. This information is very important when a radiological treatment of stage I and IIA Hodgkin's disease must be set up after the 3rd month of pregnancy. A dose of 3000 rad (30 Gy) was given to left supraclavicular and mediastinum as if involved by a lymphoma. A cobalt 60 unit and a 6 MeV linear accelerator were sequentially tested. Scattered radiation was measured by TLD dosimeters in multiple abdominal sections from diaphragm to pubis every 5 cm. Scattered radiation was lower with the linear accelerator than with cobalt. Doses to the pelvis ranged from 3.5 rad to 6.3 rad for the linear accelerator. These values are not negligible but acceptable, because the risks of fetal malformation are very low after the third month of pregnancy.

Published
1981
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44. T3b-T4breast cancer: factors affecting results in combined modality treatments

Author

Valagussa, P., Zambetti, M., Bignami, P., Lena, M., Varini, M., Zucali, R., Rovini, D., and Bonadonna, G.

Abstract

Two hundred and seventy-seven consecutive patients with T3b-T4breast cancer referred to the Milan Cancer Institute between 1973 and 1980 were treated with a combined modality approach. Chemotherapy (CT) consisted of AV, i.e. adriamycin (60–75 mg/m2day 1) and vincristine (1·2 mg/m2days 1 and 8) and was given for three to four cycles prior to local regional modality. Local-regional treatment consisted of either radiotherapy (RT) in 198 patients or surgery (S) in 79 women. Additional chemotherapy was then administered to a total of 205 patients. In the absence of distant metastases, frequency of good local control was significantly inferior in patients given CT + RT (63·9 per cent) compared to those treated with CT + RT + CT (75·4 per cent) and CT + S + CT (82·3 per cent, P=0·033). Also freedom from progression (FFP) and overall survival (SURV) were significantly superior in the groups receiving more prolonged chemotherapy treatment compared to patients treated with CT + RT (FFP: P·0001; SURV: P=0·002). None of the variables examined was able to affect the response rate, while axillary nodal status and tumor size played a major role in the duration of FFP and SURV. Our findings indicate that a more aggressive treatment is needed to improve current results in this stage of disease. To overcome the problem of local-regional recurrence, treatment should probably begin with cytoreductive surgery followed by postoperative radiotherapy in all patients with the exception of those having inflammatory carcinoma. Systemic treatment should then be delivered to control distant micrometastases.

Published
1983
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45. Combined radiation and chemotherapy in esophageal cancer

Author

Zucali, R., Bidoli, P., Salvini, P. M., Santoro, A., Spinazze, S., Bonadonna, G., Valente, M., marco alloisio, Ravasi, G., Zucali, R, Bidoli, P, Salvini, P, Santoro, A, Spinazzè, S, Bonadonna, G, Valente, M, Alloisio, M, and Ravasi, G

Subjects
Esophageal Neoplasms, Humans, esophageal cancer, Combined Modality Therapy

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