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Adenoid cystic carcinoma (ACC) of the tracheo-bronchial tree is an uncommon tumor. ACC is generally diagnosed as a lesion involving the trachea; endobronchial involvement is extremely rare. At present, surgical resection and reconstruction followed or not by post-operative irradiation is considered as the therapy of choice for definitive cure. Endoscopic treatment of these tumors is uncommonly reported in the literature. We report two cases of ACC of the tracheo-bronchial tree successfully treated by laser and post-operative irradiation.

Aims and background Endometrial carcinoma is a rare cause of brain metastases, accounting for less than 1% of all metastatic lesions to the brain. This report aims to review our experience in the treatment of patients with brain metastases from endometrial carcinoma in order to establish the characteristics of these patients and evaluate the results and efficacy of whole-brain radiation therapy as a palliative measure. Methods Three cases of brain metastases from endometrial carcinoma treated with radiotherapy were identified in the files of the Division of Radiotherapy at the A. Businco Regional Oncological Hospital of Cagliari between 1999 and 2005. Results All patients had brain metastases as the only sign of systemic disease (a single lesion in 2 patients and 2 lesions in 1 patient). Two patients were classified as RTOG RPA class I and 1 patient as class III. Radiotherapy to the brain was delivered after surgical resection in the first 2 patients and as the only method of palliation in the third patient. The delivered radiation dose was 3000 cGy in 10 fractions over 2 weeks in the postoperative setting and 2000 cGy in 5 fractions over 1 week to the patient treated with irradiation alone. The 2 surgically treated patients are alive and well after 16 and 64 months, respectively. The patient treated with palliative intent died 2 months after irradiation. Conclusions The combination of surgery and postoperative whole-brain irradiation in selected patients with solitary brain metastases from endometrial carcinoma is an effective method of palliation.

Aims and background Carcinoma of the colon-rectum is an infrequent cause of brain metastases, constituting 1-5% of all metastatic lesions to the brain. We reviewed our experience in the treatment of brain metastases from colorectal cancer to define the efficacy of whole brain radiation therapy as a palliative measure in this setting of patients. Methods Twenty-three consecutive cases of brain metastasis from colorectal cancer treated between 1999 and 2004 were identified in the files of the Division of Radiotherapy of the A Businco Regional Oncological Hospital, Cagliari. Their records were reviewed for patient and tumor characteristics and categorized according to the RTOG RPA classes. Results Fifteen patients (65%) had multiple metastases. Twenty-one patients (91%) showed extracranial metastases. Fourteen patients were classified as RTOG RPA class II and 9 class III. The median radiation dose delivered was 2000 cGy in 5 fractions in one week (range, 20-36 Gy). In 14 of 20 assessable patients (70%), symptomatic improvement was observed. The median follow-up and survival time for all the patients, 12 females and 11 males, was 3 months. In 3 patients only the cause of death was the brain metastasis. Conclusions Despite the disappointing survival time, external radiation therapy to the whole brain proved to be an efficacious palliative treatment for patients with multiple or inoperable brain metastasis from colorectal cancer.

Aims and background In 75% of the patients with bone metastases (BM) pain is the dominant symptom. Radiotherapy (XRT) plays a major role in the palliation of pain in patients with BM. Several schedules of short and long fractionation XRT are used in clinical practice, with hypofractionated treatments being even more attractive for practical reasons. A considerable body of evidence supports the clinical use of short schedules and single-dose XRT. We retrospectively evaluated the efficacy of two short fractionated schedules of 8 Gy as a single dose and 20 Gy in 5 fractions in relieving pain in patients with multiple uncomplicated BM. Method From January to December 2001, 130 patients with 146 painful BM were treated with palliative localized XRT. There were 42 males and 88 females with a median age of 58 years (range 28–84). The commonest sites of treatment were the spine (59.6%) and pelvis (14.4%). The primary endpoint was clinically significant pain relief in the first six months of follow-up evaluated with the IAEA (International Atomic Energy Agency) pain measurement score measuring pain severity and pain frequency. Analgesic use was also recorded before and after treatment as drug frequency and drug severity. Patients with painful BM from any primary tumor site were irradiated. Treatment schedules consisted of a course of XRT with 4 Gy/fraction/day (total dose: 20 Gy/5 fractions) (group A, 59 lesions) or with a single dose of 8 Gy (group B, 87 lesions). Results There was no significant difference in complete response (CR) rates between treatment schedules: complete pain relief was achieved in 17/59 lesions (29%) in the fractionated group and in 29/87 lesions (33%) in the single-dose group. Also the overall response (complete + partial) was similar: 35/59 lesions (60%) in group A and 60/87 (69%) in group B. The minimum, maximum and median follow-up was 3, 23, and 9 months, respectively, for group A and 3, 20, and 11 months for group B. The actuarial median duration of pain relief was similar: 4.5 months in group A and 4 months in group B. No particular side effects were recorded in either group. Conclusions There were no differences between the two fractionation schedules used in our study with regard to pain relief and use of analgesics. Palliation of pain was obtained in approximately two thirds of patients with both schedules, providing further evidence of the similar efficacy between single and multiple fractions. With regard to pain response these data justify a recommendation for the use of a more simple and convenient 8 Gy single fraction for the palliation of uncomplicated BM.

S S11 Exclusive I.O.R.T. for early stage breast cancer: Results after 93 cases using GEC-ESTRO criteria G. Gambula*, M. Dessena, B. Demontis, L.P. Grosso, S. Porru, M. Dess i, M. Fiorbelli, G. Lay, G. Murenu 1 Oncology Hospital UOC Experimental Surgery, Cagliari, Italy Oncology Hospital UOC Health Physics, Cagliari, Italy Oncology Hospital UOC Oncologic Radiotherapy, Cagliari, Italy * Corresponding author: Giuseppe Gambula, Oncology Hospital UOC Experimental Surgery, Cagliari, Italy. E-mail address: gambul75@yahoo.it (G. Gambula) Study objectives: To evaluate feasibility, tolerability, cosmetic outcome and local control of intra-operative radiation therapy (IORT) as an exclusive treatment of early stage breast cancer in patients selected according to GEC-ESTRO criteria (good candidates). Materials and methods: From October 2008 to December 2013, 93 patients underwent wide breast cancer excision or quadrantectomy followed by IORT on tumor bed with accelerated electrons (Novac 7 NRT) at the dose of 21Gy. Patients were aging at least 50 years with unicentric, unifocal, pT1-2 ( 5) associated to occurrence of major morbidity after the first-step were predictive factors of second-step failure. Major hepatectomy with the need of transfusion in pts who received more than 8 cycles of (bio)chemotherapy were associated to significant postoperative morbidity. The overall mortality rate after liver resection was 9%. The overall 3eyear survival rate in pts who underwent complete radical liver surgery were 65% versus 0% for those who could not undergo radical surgery. Conclusion: The results suggest that in highly selected pts with initially not easily resectable LM from CRC, radical (one or two-step) hepatectomy can increase the 3-year survival rate after down-sizing biochemotherapy with consequent mortality. http://dx.doi.org/10.1016/j.ejso.2014.10.031 Long-term follow up in patients with IPMN-branch duct type (BDT) not submitted to surgery S. Molfino*, G.L. Baiocchi, N. Portolani, M. Bartoli, D. Lomiento, G. Merigo, S.M. Giulini Surgical Clinic, University of Brescia, Brescia, Italy * Corresponding author: Sarah Molfino, Brescia, Italy. E-mail address: sarahmolfino@gmail.com (S. Molfino) Study objective: Even if International Guidelines contemplate surgery for IPMN-BDT larger than 3 cm of diameter, with wall-thickness >3 mm, with parietal nodules, however some data suggest that a lot of these tumors could only be followed-up. The aim of this article is to analyze the implications of long-term follow-up in patients with IPMN-BDT not submitted to surgery, with particular attention on clinical and morphological evolution. Material and methods: During the period 2006e2011, two-hundred and thirty-four patients with IPMN have been observed. Surgery was directed to patients with IPMN MDT and BDT + MDT (92 patients) and to other 13 patients with IPMN-BDT with a strong suspect of malignancy (by cytology with EUS and/or 18FDG-PET), independently from Sendai Criteria.