Vulvar cancer (VC) is a rare disease of which recurrence poses management problems due to patients’ advanced age and comorbidities, and to the localization of the disease. Palliative treatments, allowing local disease control in patients previously treated with multimodal therapies or with comorbidities, are lacking. In this study we tested electrochemotherapy (ECT) on recurrent VC refractory to standard therapies to assess the tumor response and to define the selection criteria for patient’s candidate to ECT. This is a multicenter observational study carried out in five Italian centers. Data about patients and tumor characteristics, treatment, toxicity, and clinical response were recorded. In all procedures, intravenous bleomycin was administered according to European Standard Operative Procedure ECT (ESOPE) guidelines. Sixty-one patients, with a median age 79 years (range: 39–85) and mainly affected by squamous cellular carcinoma (91.8%), were treated with ECT. No serious adverse events were reported. Patients were discharged after three days (median, range: 0–8 days). Two months after ECT, the clinical response rate was 83.6% and was not related to age, body mass index, International Federation of Gynecology and Obstetrics (FIGO) stage, number of treated nodules, or previous treatments. ECT is a safe procedure with a favorable cost-effectiveness ratio and should be considered as a treatment option for local disease control in patients unsuitable for standard therapies.

The aim of this study is to provide a more accurate representation of COVID-19's case fatality rate (CFR) by performing meta-analyses by continents and income, and by comparing the result with pooled estimates. We used multiple | ABOU GHAYDA ET AL.

AimThis article discusses the current use of volumetric modulated arc therapy (VMAT) techniques in clinical practice and reviews the available data from clinical outcome studies in different clinical settings. An overview of available literature about clinical outcomes with VMAT stereotactic/radiosurgical treatment is also reported.Materials and methodsAll published manuscripts reporting the use of VMAT in a clinical setting from 2009 to November 2016 were identified. The search was carried out in December 2016 using the National Library of Medicine (PubMed/Medline). The following words were searched: “volumetric arc therapy”[All Fields] OR “vmat”[All Fields] OR “rapidarc”[All Fields], AND “radiotherapy”[All Fields] AND “Clinical Trial”[All Fields].ResultsOverall, 37 studies (21 prospective and 16 retrospective) fulfilling inclusion criteria and thus included in the review evaluated 2,029 patients treated with VMAT; of these patients, ~30.8% had genitourinary (GU) tumors (81% prostate, 19% endometrial), 26.2% head-and-neck cancer (H&NC), 13.9% oligometastases, 11.2% had anorectal cancer, 10.6% thoracic neoplasms (81% breast, 19% lung), and 7.0% brain metastases (BMs). Six different clinical scenarios for VMAT use were identified: 1) BMs, 2) H&NC, 3) thoracic neoplasms, 4) GU cancer, 5) anorectal tumor, and 6) stereotactic body radiation therapy (SBRT) performed by VMAT technique in the oligometastatic patient setting.ConclusionThe literature addressing the clinical appropriateness of VMAT is scarce. Current literature suggests that VMAT, especially when used as simultaneous integrated boost or SBRT strategy, is an effective safe modality for all cancer types.

We found that T SUVmax, stage, and para-aortic lymph node status assessed by FDG-PET were independent prognostic factors of DFS, whereas only T SUVmax correlated with OS.

Methods PatientsThe busulfan cohort was made up of 185 consecutive patients (Table 1) who were transplanted at the Institute of Hematology "L. and A. Seràgnoli", University of Bologna, Italy, between 2005 and 2009, using busulfan as conditioning. Myeloablative conditioning (0.8 mg/kg intravenous busulfan, 2-h infusions, four times a day, four consecutive days plus cyclophosphamide, 120 mg/kg) was administered to 167 patients. Lower (6 patients) or standard busulfan doses plus fludarabine 160 mg/m 2 (12 patients) were also used. Ideal body weight (IBW) was calculated as 0.91 x (height in cm -152) +50 (for men) or +45 (for women). IBW was used when lower than the actual weight and when body mass index (BMI) was lower/equal to 27. When BMI was greater than 27, IBW was adjusted as IBW+ 0.25 x (actual weight -IBW).A total of 146 consecutive patients (comparator cohort, Table 1) transplanted at the same Institution were also studied. In this cohort, the myeloablative conditioning was cyclophosphamide (120 mg/kg) plus unfractionated total body irradiation (8 Gy).Graft-versus-host disease prophylaxis was cyclosporin-A and short-term methotrexate plus rabbit anti-thymocyte globulin (3-5 mg/kg/die, Fresenius, Bad-Homburg, Germany), from Day -6 to Day -2. Patients with acute leukemia in first complete remission or with chronic myeloid leukemia in first chronic phase were classified as being in early phase at transplant; the remaining patients were classified as being in advanced phase. Written informed consent for the study was obtained from all patients. The study was approved by the Ethics Committee