Publications (12)38.89 Total impact
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Article: Quality of life in elderly cancer patients.
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ABSTRACT: The incidence of most types of cancer is age-dependent and progressive ageing is rapidly increasing the number of elderly people who need treatment for cancer. Elderly patients (older than 70 years) present particular characteristics that make the choice of the correct treatment more difficult; for this reason, these patients are often undertreated and largely underrepresented in cancer trials making the experimental evidence on this topic even weaker. Only relatively recently has Health-Related Quality of Life (HRQoL) begun to be considered as one of the hard end-points for clinical cancer research in the elderly. Treatment of elderly cancer patients represents a typical situation where its assessment is particularly useful because of the expected toxicity of treatment and several unresolved methodological problems (higher frequency of illiteracy, worse compliance with the questionnaires, concomitant diseases, use of instruments not validated in the aged population). The aim of this review is to underline the importance detected by the too small number of studies on elderly QoL evaluation and the need in future trials either to improve QoL assessment in this subcategory of patients undergoing treatment for cancer or not, or find specific assessment tools to do it.European Journal of Cancer 08/2007; 43(10):1508-13. · 5.54 Impact Factor -
Article: Ifosfamide-related encephalopathy in elderly patients : report of five cases and review of the literature.
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ABSTRACT: Encephalopathy is a serious adverse reaction occurring in 15-30% of patients treated with the alkylating agent ifosfamide. Patients with this adverse effect may experience seizures, drowsiness, confusion and hallucinations of different grades of severity. In this article, we describe five cases of acute CNS toxicity in patients aged > or =65 years of age treated with ifosfamide and we review data on the management and outcome of this serious complication in elderly patients. All five patients experienced symptoms of encephalopathy soon after receiving combination chemotherapy including ifosfamide for different tumours. All of the patients had been assessed by means of a Comprehensive Geriatric Assessment for the presence of associated diseases, disability, cognitive status and depression, and scores were satisfactory in all patients, although case 5 was deemed frail because of cancer-related limitation in movement. In four patients, the antidote methylene blue (methylthioninium chloride) was administered intravenously, with successful recovery in three patients and a fatal outcome in the fourth patient. The fifth patient rapidly recovered after discontinuation of ifosfamide and did not receive methylene blue. The roles of older age, peak ifosfamide concentration, low albumin levels, increased serum creatinine and bulky abdominal disease as predisposing factors for ifosfamide-related encephalopathy in retrospective series are controversial.Although methylene blue has been frequently administered in patients with ifosfamide-related encephalopathy, its efficacy in this context has not been assessed objectively. Thus, careful baseline evaluation of elderly patients and constant clinical observation during infusion, especially during the first course of therapy, are recommended to reduce the risk of severe CNS toxicity from ifosfamide.Drugs & Aging 01/2007; 24(11):967-73. · 2.67 Impact Factor -
Article: The development of platinum compounds and their possible combination.
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ABSTRACT: Cisplatin plays a central role in cancer chemotherapy in spite of its toxicity. To circumvent this toxicity and to enhance its therapeutic index a lot of preclinical and clinical studies have been conducted and several thousand analogues have been synthesized. Much more analysis remains to be done, but nowadays, the absence of any definitive, biologically interpretable molecular predictor of activity is consistent with the idea that platinum compounds have multiple intracellular targets and that cells can have multiple mechanisms of resistance. This review analyses a part of these platinum compounds analyzed to date, their mechanism of action, resistance and the future trends in this sector.Critical Reviews in Oncology/Hematology 11/2006; 60(1):59-75. · 4.41 Impact Factor -
Article: Oxaliplatin-related neurotoxicity: how and why?
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ABSTRACT: In early clinical trials, oxaliplatin has demonstrated significant activity against colorectal cancer in combination with 5-fluorouracil (5-FU) and folinic acid (FA), both in metastatic as in radically resected disease. The drug differs from the other two most important platinum compounds (cisplatin and carboplatin) for the absence of nephrotoxicity or for the reduced drug-induced ototoxicity. During its administration, two different types of neurological symptoms can be experienced: the first one occurs during or immediately after the end of the infusion and it appears as a transient peripheral sensory neuropathy manifesting as paresthesias and dysesthesia in the extremities sometimes accompanied by muscular contractions of the extremities or the jaw (triggered or enhanced by exposure to cold). The second one occurs after long-term administration of oxaliplatin presenting with deep sensory loss, sensory ataxia and functional impairment (similar to those observed with cisplatin). This type of neurotoxicity is usually late-onset and correlated with the cumulative-dose of oxaliplatin. The aim of this review is to analyse the mechanism underlying induction of neurotoxicity and the possible treatments to prevent and to treat it.Critical Reviews in Oncology/Hematology 09/2006; 59(2):159-68. · 4.41 Impact Factor -
Article: Colorectal cancer adjuvant treatment in elderly patients.
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ABSTRACT: Colorectal adenocarcinoma ranks second as a cause of death due to cancer in the Western world. In Europe, 40% of patients with this disease is over 70 years old and only 52% of them with positive nodes usually receive an adjuvant chemotherapy. Despite early reports to the contrary, these patients tolerate cancer treatment and surgical resections as well as their younger counterparts but as a result of exclusion criteria, those receiving an adjuvant therapy are very few. This paper examines the factors pertinent to the small number of clinical trials designed for adjuvant colorectal cancer in the elderly.Critical Reviews in Oncology/Hematology 10/2005; 55(3):201-6. · 4.41 Impact Factor -
Article: Treatment of stage IV colorectal carcinoma in elderly patients.
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ABSTRACT: Colorectal adenocarcinoma ranks second as a cause of death due to cancer in the Western world. In Europe, 40% of patients with colorectal cancer are over 70 years old and the incidence increased through the 1980's. Without any treatment the median survival after the detection of liver metastases is approximately 9 months, depending on the extent of disease at the time of diagnosis but not on the patients age. In the elderly there are only few data apt to define the standard regimen in the advanced disease, but results seem similar to those observed in younger patients. As a result of exclusion criteria and screening, elderly patients entering clinical trials are usually a select group, with good performance status, access to transportation, and limiting numbers of coexisting conditions. This paper examines the factors pertinent to the small number of clinical trials designed for metastatic colorectal cancer in this group of persons.Critical Reviews in Oncology/Hematology 06/2005; 54(2):145-55. · 4.41 Impact Factor -
Article: Neoadjuvant treatment for locally advanced rectal carcinoma.
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ABSTRACT: Rectal cancer is one of the most common neoplasms of Western Countries. Overall mortality at 5 years is about 40%. This cancer is commonly diagnosed at a precocious stage, but because of local relapse and/or metastatic disease, only half of radically resected patients can be considered disease free. The value of adding radiotherapy to surgery in the treatment of patients with resectable rectal cancer has been assessed in trials using either preoperative or postoperative irradiation. Preoperative irradiation is more "dose-effective" than postoperative radiotherapy; that is, a higher dose is needed postoperatively to reduce rates of local recurrence to the same extent as preoperative radiation. Nevertheless, preoperative treatment has not been routinely recommended, mainly because it has not been shown to improve overall survival and because in some trials it has been associated with increased postoperative mortality. This paper critically reviews clinical trials of chemoradiotherapy on whether an optimal combination exists for locally advanced rectal cancer. Even if in the latest years, recent advances in surgery have improved the local control of disease, the next steps in rectal cancer care should aim at the improvement of local cure rates and the enhancement of systemic control. New approaches to CT treatment are necessary. Patient enrollment into rigorous and well-conducted clinical trials will generate new information regarding investigational therapies and it will offer improved therapies for patients with this disease.Critical Reviews in Oncology/Hematology 11/2004; 52(1):61-71. · 4.41 Impact Factor -
Article: Common management of primary rectal carcinoma in patients with stage IV disease at the diagnosis.
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ABSTRACT: Rectal cancer is one of the more common neoplasms of Western countries. It is commonly diagnosed at a precocious stage but, because of local relapse and/or metastatic disease, only half of radically resected patients can be considered free of disease. In patients presenting at diagnosis with stage IV disease the best treatment is still unknown. If the patient is a candidate for surgical resection, the primary tumor should be treated as in a patient without metastatic disease. If metastases are unresectable, the treatment of the primary lesion is palliative and, according to the patients' symptoms, it is usually represented by a chemotherapy approach. It is still unclear whether to reserve radiotherapy only for the symptomatic cases. This paper examines the factors pertinent to clinical trials designed for stage IV rectal cancer with resectable and unresectable metastases and reviews the existing data supporting palliative therapy for symptomatic and asymptomatic primary tumors.Anticancer research 23(6D):4999-5004. · 1.73 Impact Factor -
Article: FOLFOX versus FOLFIRI: a comparison of regimens in the treatment of colorectal cancer metastases.
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ABSTRACT: Colorectal adenocarcinoma ranks second as a cause of death due to cancer in the Western world. Already at the time of the primary tumor, 15-25% of the patients present with liver metastases while another 20% will develop metastasis following treatment of the colorectal primary. Without any treatment the median survival after the detection of metastases is approximately 9 months, depending on the extent of the disease at the time of diagnosis. Clinical trials with the "FOLFOX and FOLFIRI families" of drugs, designed for the treatment of metastatic colorectal cancer, their results and the costs of each therapy are examined. For each drug, the cost/mg, the cost/mg/m2 and the cost/therapy (according to its duration) are evaluated according to the prices reported in the Italian Directory of Medicines and Manufacturers, 63rd Edition, November 2003.Anticancer research 25(1B):563-76. · 1.73 Impact Factor -
Article: Stable disease in advanced colorectal cancer: therapeutic implications.
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ABSTRACT: Colorectal cancer is one of the most common neoplasms in Western Countries and ranks second as a cause of death due to cancer. The overall mortality at 5 years is about 40%. Patients with resectable metastatic disease can be cured, but for those who cannot, treatment is purely palliative, and overall survival (OS) is from approximately 7 to 24 months. Infusional regimen with modulated 5Fluorouracil (5FU) gives an objective response rate (RR) of up to 30-40%. The addition of CPT11 or oxaliplatin to 5FU improves RR, time to progression (TTP) and OS with a stabilization of disease (SD) in 40-70% of cases and 20-40%, respectively. The concurrent utilization of selective biological agents as growth factor receptors acting at a molecular level and influencing the processes of tumor formation and growth, increases tumor cell apoptosis and inhibits tumor growth; as a result, the tumor regresses or is inhibited, with consequently prolonged OS and TTP. This paper examines the problem related to the treatment of metastatic colorectal cancer with SD. Current doubts regarding the continuation of one treatment until disease progression (PD) with a risk of toxicity, whether or not to use a less toxic "maintenance" therapy after a fairly aggressive "induction" therapy in "stabilized" responders, or whether to stop the treatment in the presence of a SD confirmed after at least two consecutive evaluations, are present.Anticancer research 26(1B):511-22. · 1.73 Impact Factor -
Article: Liver metastases of colorectal cancer: medical treatments.
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ABSTRACT: Colorectal adenocarcinoma ranks second as a cause of death due to cancer in the Western world. Liver metastases form the main cause of death in patients with colorectal cancer. Already at the time of the primary tumor, 15-25% of the patients present with liver metastases, while another 20% will develop these metastases following treatment of the colorectal primary. Without any treatment the median survival after the detection of liver metastases is approximately 9 months, depending on the extent of the disease at the time of diagnosis. This paper examines the factors pertinent to clinical trial designed for metastic colorectal cancer and reviews the existing data supporting adjuvant and neoadjuvant therapy for potentially resectable disease and chemotherapy in the inoperable disease.Anticancer research 23(5b):4245-56. · 1.73 Impact Factor -
Article: Role of neoadjuvant treatment in cT3N0M0 rectal cancer.
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ABSTRACT: The aim of the study was to evaluate the pathological response (pTNM), local relapse and overall survival (OS) in clinical T3N0M0 (cT3N0M0) rectal cancer after a neoadjuvant chemoradiotherapy (CHT-RT) with 5-fluorouracil (5-FU) continuous infusion (c.i.) (+/- oxaliplatin) or bolus or capecitabine (an oral fluorpyrimidine). A secondary endpoint was to identify the local relapse rate and OS in those patients also receiving an adjuvant chemotherapy. From January 2000 to January 2006, 48 consecutive cT3N0M0 rectal cancer cases neoadjuvantly treated were retrospectively examined. Variables considered were age, gender, modality of 5-FU administration and tumour site. Median age was 64 years (range, 22-84 years) and the male:female ratio was 28:20. All the patients received the full course of CHT-RT. Twenty-eight patients received c.i. 5-FU neoadjuvant chemotherapy, 17 received bolus 5-FU administration and 3 patients received capecitabine-based therapy. The mean number of chemotherapy weeks was 4.9 (range, 2-6). A total of 85.4% of patients were operated on without relevant postoperative complications but another 4 are awaiting surgery. Twenty-one patients had a lower (< or = 5 cm from the anal verge) and 27 had a middle rectal lesion (from 6 to 10 cm). In those patients with the lower site of lesion, a sphincter-saving (SS) procedure was achieved in 88.9%. Downstaging was reported in 66.7%. Ninety percent of cases are still free from progression after a median follow-up of 22.1 months; 7.5% are dead. The down-staging, the good level of SS and the disease-free survival (DFS) obtained here suggests that a neoadjuvant therapy may also be useful for stage II rectal cancer at diagnosis. The use of a postoperative chemotherapy should probably be outlined better.Anticancer research 28(6B):4129-35. · 1.73 Impact Factor
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Institutions
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2007
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Istituto Oncologico Veneto
Padova, Veneto, Italy
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