We report a case of a 30 years old male affected by synchronous bilateral germ cell tumor with a history of unilateral cryptorchidism; the patient underwent surgical treatment followed by adjuvant radiotherapy on paraaortic and iliac lymphnodes. Patients with synchronous tumors usually present with a higher stage disease in contrast to those with unilateral testicular carcinoma, yet the prognosis remains equally favorable.

Introduction: Aromatase inhibitors (AIs) are the adjuvant treatment of choice in postmenopausal women with early, hormone receptor-positive breast cancer (BC), because they produce improved disease-free survival rates compared with tamoxifen. Progressive bone loss and subsequent fractures are associated with adjuvant AIs, administered either alone or sequentially after tamoxifen in postmenopausal women with early BC. Recent findings of NSABP B-34 also suggest that bisphosphonates might have anticancer benefits for older postmenopausal women. We present the “BONADIUV” trial, a single-blind, randomized, placebo-controlled study designed to evaluate the impact of bisphosphonate treatment on bone mineral density (BMD) in women taking AIs. Methods: At this time, we enrolled 116 patients (of 190 planned patients) at Florence University (Radiotherapy Unit Department) treated with adjuvant AIs and affected by early BC and osteopenia. We assessed BMD every year and hematic and urinary calcemia, phosphoremia, parathormon, magnesemia, vitamin D, urinary pyridinoline and telopepitde-C every 6 months, until 2 years. Arm A consisted of AIs plus oral ibandronate (150 mg, monthly); Arm B consisted of AIs plus placebo. All patients were treated with calcium and vitamin D supplementation. Primary endpoint was evaluation of ibandronate efficacy in BMD reduction. Secondary endpoints were ibandronate patient's compliance, FRAX® index evaluation, ibandronate safety and bone turn-over markers. Results: At a median follow-up of 12 months (range 6-24), median age in Arm A was 60 (range 47-65) years (59 enrolled patients) and 60 (range 49-65) years in Arm B (57 enrolled patients). Basal Vitamin D was 21.1 ng/mL in Arm A and 37.0 ng/mL in Arm B; at 12 months basal Vitamin D was 25.2 ng/mL in Arm A and 26.3 ng/mL in Arm B. Compliance to ibandronate assumption was optimal. Concerning FRAX® index, at time of analyses we observed a significant improving in Arm A group (median ten years probability hip fracture reduction between 5 and 10%). Conclusions: Preliminary results of our single-blind, randomized, placebo-controlled study in women taking adjuvant AIs showed that the majority of patients had basal hypovitaminosis D. A good drug safety and an improvement of FRAX® index in the experimental Arm were shown; longer follow-up is needed. Disclosure: All authors have declared no conflicts of interest.

Purpose The aim of this study was to evaluate the rate of pathological response (PR), disease control and safety of neoadjuvant chemotherapy using oxaliplatin (OX) and 5-fluorouracil (5-FU) with concurrent radiotherapy for treating locally advanced rectal cancer. Materials and methods Between November 2002 and December 2010, 90 patients with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy (CRT) were retrospectively analysed. All patients underwent preoperative radiotherapy (45 Gy in 1.8-Gy fractions) with concurrent OX (80 mg/m2 i.v., day 1) and a 120-h continuous infusion of 5-FU (1,000 mg/m 2 per day). Surgery was performed within 6 weeks after completion of CRT treatment. Results Complete pathological response was obtained in six patients (6.7%), and 39 (43.3%) had their disease downstaged. The median follow-up period was 4.7 years (6 months to 9 years). Local recurrence occurred in two patients (2.2%), one of whom developed also liver metastases. Distant metastases not associated with local relapse occurred in 23 (25.6%) patients. Overall (OS) and disease-free (DFS) survival were 62.9% and 52.8%, respectively. CRT was well tolerated, with only one grade 3 (1.2%) haematological toxicity (neutropaenia). Conclusions Neoadjuvant systemic chemotherapy based on OX and 5-UC associated with radiotherapy is well tolerated, with good results in terms of pathological response, disease control and survival, in rectal cancer patients.

We conducted a retrospective analysis to evaluate the management and outcome of invasive male breast cancer treated in a single-institution over a period of 40 years.

Abstract Aim: nodal metastatic involvement is the most important prognostic indicator in breast cancer. Sentinel node biopsy led to an increase in the detection of micrometastases. The aim of our analysis was to identify predictive factors of micrometastases and macrometastases of sentinel node. Materials and Methods: between January 2000 and December 2006, 675 patients were treated with breast surgery and sentinel node evaluation at University of Florence (Florence, Italy). Estrogen receptor status, progesterone receptor status, and Ki-67 labeling index determined with the MIB1 monoclonal antibody were assessed. HER2 immunohistochemistry (IHC) expression was scored as follows: 0, no staining or faint membrane staining; 1+, faint membrane staining in >10% of tumor cells, incomplete membrane staining; 2+, weak to moderate membrane staining in >10% of tumor cells; and 3+, intense circumferential membrane staining in >10% of tumor cells. HER2 scores of 0 and 1+ were considered negative. HER2 IHC 3+ and fluorescent in situ hybridization (FISH) – amplified tumors were considered positive. All IHC 2+ tumors and indeterminate tumors were tested for gene amplification by FISH. The sentinel node was examined by hematoxylin and eosin. The patients were divided into three groups based on AJCC TNM staging: sentinel node negative (n = 601); micrometastases if tumor deposit more than 0.2 mm but <2 mm (n = 20), and macrometastases if tumor deposit more than 2 mm (n = 53). Results: at the logistic regression with polytomous analyses (outcome micrometastases or macrometastases), age (p = 0.048), menopausal state (p = 0.013), breast quadrant (p = 0.005), lymph vascular invasion (p = 0.0001), post-surgical T stage (p = 0.0001), histotypes (p = 0.023), HER2 status (p = 0.02), Ki-67 proliferative index (p = 0.001) and nuclear grade (p = 0.024) were significantly correlated with sentinel node macrometastases. Sentinel node biopsy technique (cytological aspiration versus histological biopsy) was not associated with micrometastases (p = 0.89) or macrometastases (p = 0.48) occurrence. The only feature significantly associated with micrometastases in sentinel node was the lymph vascular invasion (p = 0.0001). Conclusion: the presence of micrometastases remained fairly constant over time if compared to macrometastases. In our experience the only feature significantly associated with micrometastases in sentinel node is the lymph vascular invasion. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-01-25.

S4802nd ESTRO Forum 2013 intraoperative US was done, there was one uterine perforation (14%) and six proper applications (86%).There was no statistical difference (Fisher's test = 1).Conclusions: Real-time US guiding for cervical cancer brachytherapy decreased proportion of uterine perforation.A larger study would be needed to bring out a statistical difference.For our daily practice, we now use systematically US imaging during cervical cancer brachytherapy procedure.

Background: The use of adjuvant radiotherapy in ductal carcinoma in situ is accepted by most radiation oncologists worldwide; the role of a boost on the tumor bed is however more controversial.Materials and methods: We reviewed our Institute experience in DCIS treatment, focusing on main prognostic factors and impact of radiation boost on local relapse. A total of 389 patients treated between 1990 and 2007 were retrospectively analyzed. All patients received adjuvant radiotherapy after breast-conserving surgery for a median dose of 50 Gy; 190 patients (48.8%) received and additional radiation boost on the tumor bed.Results: At a mean follow up of 7.7 years, we recorded 26 local recurrence (6.7%). Concerning local relapse-free survival, at Cox regression univariate analyses <1 mm surgical margins (p < 0.0001) and young age (p = 0.01) emerged as significant unfavorable prognostic factors.At multivariate analysis Cox regression model, surgical margins (p < 0.001) and radiation boost (p = 0.014) resulted as the significant independent predictors of recurrence.Conclusions: Our experience showed the negative prognostic impact of surgical margins <1 mm and the protective role of radiation boost on LR rate. Anyway, results from ongoing prospective Phase III studies are strongly necessary to better identify high-risk DCIS patients. (C) 2013 Elsevier Ltd. All rights reserved.