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Franco P, Arcadipane F, Ragona R, Mistrangelo M, Cassoni P, Munoz F, Rondi N, Morino M, Racca P, Ricardi U. Volumetric modulated arc therapy (VMAT) in the combined modality treatment of anal cancer patients. Br J Radiol 2016; 89:20150832. [PMID: 26838953 DOI: 10.1259/bjr.20150832] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To report clinical and dosimetric outcomes of a consecutive series of patients with anal cancer treated with volumetric-modulated arc therapy (VMAT) concomitant to chemotherapy (CT). METHODS A cohort of 39 patients underwent VMAT employing a schedule consisting of 50.4 Gy/28 fractions to the gross tumour volume (GTV) and 42 Gy/28 fractions to the elective nodal volumes for patients with cT2N0 disease. Patients with cT3-T4/N0-N3 tumours were prescribed 54 Gy/30 fractions to the GTV and 50.4 Gy/30 fractions to the gross nodal volumes if sized ≤3 cm or 54 Gy/30 fractions if > 3 cm. Elective nodal regions were given 45 Gy/30 fractions. CT was administered concurrently following Nigro's regimen. The primary end point was acute toxicity. Secondary end points were colostomy-free survival (CFS), disease-free survival (DFS), cancer-specific survival (CSS) and overall survival (OS). Dosimetric data are also provided. RESULTS Median follow-up was 21 months. Maximum acute toxicities were: dermatologic-G3: 18%; gastrointestinal-G3: 5%; genitourinary-G3: 2%; anaemia-G2: 7%; leukopenia-G3: 28%; G4: 8%; neutropenia-G3: 13%; G4: 18%; thrombocytopenia-G3: 11%; and G4: 2%. The actuarial 2-year CFS was 77.9% [95% confidence interval (CI): 54-90.4%]. Actuarial 2-year OS and CSS were 85.2% (95% CI: 60.1-95.1%), while DFS was 75.1% (95% CI: 52.4.7-88.1%). CONCLUSION Our clinical results support the use of VMAT as a safe and effective intensity-modulated radiotherapy (IMRT) option in the combined modality treatment of anal cancer, with consistent dosimetry, mild toxicity and promising sphincter preservation and survival rates. ADVANCES IN KNOWLEDGE IMRT is a standard of care for patients with anal cancer, and VMAT is a robust technical solution in this setting.
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Affiliation(s)
| | | | - Riccardo Ragona
- 1 Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | | | - Paola Cassoni
- 3 Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fernando Munoz
- 4 Department of Medical Imaging and Radiotherapy, Radiation Oncology, AOU Città della Salute e della Scienza, Turin, Italy
| | - Nadia Rondi
- 4 Department of Medical Imaging and Radiotherapy, Radiation Oncology, AOU Città della Salute e della Scienza, Turin, Italy
| | - Mario Morino
- 2 Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Patrizia Racca
- 5 Oncological Centre for Gastrointestinal Neoplasm, Medical Oncology 1, AOU Città della Salute e della Scienza, Turin, Italy
| | - Umberto Ricardi
- 1 Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
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302
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Riva G, Boita M, Ravera M, Moretto F, Badellino S, Rampino M, Ricardi U, Pecorari G, Garzaro M. Nasal cytological changes as late effects of radiotherapy for nasopharyngeal cancer. Am J Rhinol Allergy 2016; 29:e41-5. [PMID: 25785741 DOI: 10.2500/ajra.2015.29.4156] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Radiation therapy is a cornerstone in nasopharyngeal cancer treatment. However, it can induce acute and long-term adverse effects, such as acute mucositis and late submucosal fibrosis. Late toxicities could not only affect submucosa but also mucosal cells, determining long-term cytological changes. OBJECTIVE Evaluation of delayed nasal cytological alterations in patients who underwent radiation therapy for nasopharyngeal carcinoma (NPC). METHODS In this case-control study, we analyzed 30 healthy subjects and 30 patients treated with chemotherapy and radiotherapy for NPC between 2003 and 2011, with a median follow-up of 59 months. All subjects underwent symptoms anamnestic evaluation (rhinorrea, nasal obstruction), endoscopic fiber optic nasal examination, skin-prick tests, and nasal scraping for cytological exam. RESULTS A higher percentage of rhinorrhea, nasal obstruction, mucosal hyperemia, and presence of nasopharyngeal secretions at fiber optic endoscopic exam was found in radiated subjects (p < 0.05). Nasal cytology analysis demonstrated a higher percentage of neutrophilic inflammation and squamous cell metaplasia and mucous cell metaplasia in treated patients (p < 0.05). No cytological atypia was seen. No statistically significant correlation between nasal cytological changes and objective findings, patients' age, tobacco smoking, and gastroesophageal reflux has been found in the radiotherapy group (p > 0.05). CONCLUSION Radiation therapy induces late nasal mucosal changes, which may be related to clinical consequences, such as abundant mucus production and its consequent endonasal stagnation. In the future, detailed knowledge of cytological changes in patients' nasal mucosa could represent a key prerequisite for the choice of effective interventions for late radiation-induced rhinitis.
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Affiliation(s)
- Giuseppe Riva
- 1st ENT Division, Surgical Sciences Department, University of Turin, Turin, Italy
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303
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Simontacchi G, Filippi AR, Ciammella P, Ricardi U. Interim PET After Two ABVD Cycles in Early-Stage Hodgkin Lymphoma: Outcomes Following the Continuation of Chemotherapy Plus Radiotherapy. In Reply to Adams and Kwee. Int J Radiat Oncol Biol Phys 2016; 93:725-6. [PMID: 26461018 DOI: 10.1016/j.ijrobp.2015.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 06/30/2015] [Accepted: 07/06/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Gabriele Simontacchi
- Radiotherapy Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | | | - Patrizia Ciammella
- Radiation Oncology Unit, Department of Advanced Technology, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
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304
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Niyazi M, Brada M, Chalmers AJ, Combs SE, Erridge SC, Fiorentino A, Grosu AL, Lagerwaard FJ, Minniti G, Mirimanoff RO, Ricardi U, Short SC, Weber DC, Belka C. ESTRO-ACROP guideline “target delineation of glioblastomas”. Radiother Oncol 2016; 118:35-42. [DOI: 10.1016/j.radonc.2015.12.003] [Citation(s) in RCA: 201] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 12/13/2015] [Indexed: 11/26/2022]
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305
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Ruella M, Filippi AR, Bruna R, Di Russo A, Magni M, Caracciolo D, Passera R, Matteucci P, Di Nicola M, Corradini P, Parvis G, Gini G, Olivieri A, Ladetto M, Ricardi U, Tarella C, Devizzi L. Addition of Rituximab to Involved-Field Radiation Therapy Prolongs Progression-free Survival in Stage I-II Follicular Lymphoma: Results of a Multicenter Study. Int J Radiat Oncol Biol Phys 2015; 94:783-91. [PMID: 26972651 DOI: 10.1016/j.ijrobp.2015.12.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/28/2015] [Accepted: 12/02/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE Rituximab (Rit) therapy added to involved-field radiation therapy (RT) has been proposed as an effective treatment for stage I-II follicular lymphoma (FL). The results of an observational multicenter study on the Rit-RT combination in limited-stage FL are here reported. METHODS AND MATERIALS Data have been collected from 2 consecutive cohorts of 94 patients with stage I-II FL treated between 1985 and 2011 at 5 Italian institutions. All patients had grade 1-3a FL, a median age of 54 years (range: 25-82). The first 51 patients received RT alone (control group), while the subsequent series of 43 patients received 4 rituximab courses (375 mg/m(2), days 1, 8, 15, 22) before RT (Rit-RT). Molecular disease was evaluated by nested bcl-2/IgH PCR or clonal IgH rearrangement was available in 33 Rit-RT patients. RESULTS At a median follow-up of 10.9 years (range: 1.8-22.9), the 10-year progression-free survival (PFS) and overall survival (OS) projections for the whole cohort were 57% and 87.5%, respectively. The 10-year PFS was significantly longer (P<.05) in the Rit-RT group (64.6%) compared to RT alone (50.7%), whereas the 10-year OS projections were not significantly different. On bivariate analysis controlling for stage, there was only a trend toward improved PFS for Rit-RT (HR, 0.55; P=.081). Follicular lymphoma international prognostic index and age were associated with OS but not with PFS on Cox regression analysis. Bone marrow molecular analysis showing PCR positivity at diagnosis was strongly associated with relapse risk upon univariate and multivariate analysis. CONCLUSIONS This multicenter observational study suggests a potential benefit of adding rituximab to radiation therapy for stage I-II FL. The results of the currently ongoing randomized studies are required to confirm these results. The study underlines the importance of molecular disease monitoring also for patient with limited-stage disease.
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Affiliation(s)
- Marco Ruella
- Division of Haematology and Cell Therapy, Mauriziano Hospital and University of Torino, Torino, Italy; Center for Cellular Immunotherapies, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Riccardo Bruna
- Division of Haematology and Cell Therapy, Mauriziano Hospital and University of Torino, Torino, Italy
| | - Anna Di Russo
- Radiation Oncology, Istituto Nazionale Tumori, Milano, Italy
| | - Michele Magni
- Division of Medical Oncology, Istituto Nazionale Tumori, and University of Milano, Milano, Italy
| | - Daniele Caracciolo
- Division of Haematology, San Giovanni Battista Hospital and University of Torino, Torino, Italy
| | - Roberto Passera
- Division of Nuclear Medicine, San Giovanni Battista Hospital and University of Torino, Torino, Italy
| | - Paola Matteucci
- Division of Medical Oncology, Istituto Nazionale Tumori, and University of Milano, Milano, Italy
| | - Massimo Di Nicola
- Division of Medical Oncology, Istituto Nazionale Tumori, and University of Milano, Milano, Italy
| | - Paolo Corradini
- Division of Haematology, Istituto Nazionale Tumori, and University of Milano, Milano, Italy
| | - Guido Parvis
- Division of Haematology, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy
| | - Guido Gini
- Division of Haematology, Ospedali Riuniti, Ancona, Italy
| | | | - Marco Ladetto
- Division of Haematology, San Giovanni Battista Hospital and University of Torino, Torino, Italy
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Torino, Torino, Italy
| | - Corrado Tarella
- Division of Haematology and Cell Therapy, Mauriziano Hospital and University of Torino, Torino, Italy; Hemato-Oncology Division, European Institute of Oncology, Milano, Italy.
| | - Liliana Devizzi
- Division of Medical Oncology, Istituto Nazionale Tumori, and University of Milano, Milano, Italy
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306
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Mantovani C, Filippi AR, Ricardi U. Which radiation therapy schedule in combination with chemotherapy for locally advanced NSCLC? Lung Cancer Manag 2015. [DOI: 10.2217/lmt.15.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Concurrent chemoradiotherapy is the standard of care in the management of locally advanced NSCLC, with disappointing results in terms of local tumor control and overall survival. Hystorically, it has been demonstrated a strict dose–response relationship in thoracic radiotherapy for lung cancer and, therefore, dose escalation was tested in many prospective trials. In this paper, we briefly review the most relevant publications focusing on dose management in terms of dose escalation with both conventional and altered fractionation schedules.
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Affiliation(s)
- Cristina Mantovani
- Radiation Oncology Unit, Department of Oncology, University of Torino, Via Genova 3, 10126 Torino, Italy
| | - Andrea Riccardo Filippi
- Radiation Oncology Unit, Department of Oncology, University of Torino, Via Genova 3, 10126 Torino, Italy
| | - Umberto Ricardi
- Radiation Oncology Unit, Department of Oncology, University of Torino, Via Genova 3, 10126 Torino, Italy
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307
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Ricardi U, Badellino S, Filippi AR. Stereotactic body radiotherapy for early stage lung cancer: History and updated role. Lung Cancer 2015; 90:388-96. [DOI: 10.1016/j.lungcan.2015.10.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/12/2015] [Indexed: 12/21/2022]
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308
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Levra NG, Moretto F, Fiorentino A, Levis M, Fersino S, Pelle E, Ricchetti F, Mazzola R, Alongi F, Ricardi U. Whole-Brain Radiation Therapy and Simultaneous Integrated Boost in Patients With Brain Metastases: Preliminary Results of a Phase II Trials. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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309
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Franco P, Potenza I, Schena M, Riva G, Pecorari G, Garzino Demo P, Fasolis M, Moretto F, Garzaro M, Di Muzio J, Melano M, Airoldi M, Ragona R, Rampino M, Ricardi U. Induction Chemotherapy and Sequential Concomitant Chemo-radiation in Locally Advanced Head and Neck Cancers: How Induction-phase Intensity and Treatment Breaks May Impact on Clinical Outcomes. Anticancer Res 2015; 35:6247-6254. [PMID: 26504058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM The purpose of the study was to assess outcomes of locally advanced head and neck (LAHNC) treated with induction chemotherapy (ICT) and subsequent concurrent chemo-radiation. PATIENTS AND METHODS A total of 71 LAHNC patients were treated with 2-3 cycles of docetaxel, cisplatin and 5-fluorouracil as induction chemotherapy and subsequent concurrent chemoradiation with weekly cisplatin or carboplatin. Definitive radiotherapy was delivered with intensity-modulated radiation and a simultaneous integrated boost approach up to a total dose of 70 Gy in 35 fractions to the macroscopic primary and nodal disease. RESULTS Actuarial 2-year OS, CSS, DFS, MFS, LC were 55.3% (95%CI=39.3-68.6), 58.6% (95%CI=41.9-72), 60.5% (95%CI=47.3-71.4), 87.3% (95%CI=76.2-93.5) and 74.7% (95%CI=61.5-83.9), respectively. On multivariate analysis undergoing to 3 vs. 2 cycles of TPF (HR=22.31; 95%CI=2.68-185.66; p=0.004) and radiotherapy treatment break >4 days (HR=1.28; 95%CI=1.06-1.55; p=0.01) negatively affected cancer-specific survival (CSS) with statistical significance. Achieving complete remission after ICT had a statistically significant impact on CSS (HR=0.9; 95%CI=0.01-0.54; p=0.009). Patients undergoing ICT with 3 cycles had more frequently treatment breaks compared to those submitted to 2 cycles (HR=1.36; 95%CI=1.06-1.73; p=0.01), and had statistically significant longer treatment break time (5.9+1.8 vs. 3+0.36; p=0.02). CONCLUSION A shorter ICT phase may be a better option enhancing patients' tolerance during concurrent chemoradiation and affecting clinical outcomes.
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Affiliation(s)
| | - Ilenia Potenza
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - Marina Schena
- Department of Oncology, 1st Medical Oncology Division, AOU Città della Salute e della Scienza, Turin, Italy
| | - Giuseppe Riva
- Department of Surgical Sciences, 1st ENT Division, University of Turin, Turin, Italy
| | - Giancarlo Pecorari
- Department of Surgical Sciences, 1st ENT Division, University of Turin, Turin, Italy
| | - Paolo Garzino Demo
- Department of Surgical Sciences, Maxillofacial Surgery Division, University of Turin, Turin, Italy
| | - Massimo Fasolis
- Department of Surgical Sciences, Maxillofacial Surgery Division, University of Turin, Turin, Italy
| | - Francesco Moretto
- Department of Medical Imaging and Radiotherapy, AOU Città della Salute e della Scienza, Turin, Italy
| | - Massimiliano Garzaro
- Department of Surgical Sciences, 1st ENT Division, University of Turin, Turin, Italy
| | - Jacopo Di Muzio
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - Marco Melano
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - Mario Airoldi
- Department of Oncology, 2nd Medical Oncology Division, AOU Città della Salute e della Scienza, Turin, Italy
| | - Riccardo Ragona
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - Monica Rampino
- Department of Medical Imaging and Radiotherapy, AOU Città della Salute e della Scienza, Turin, Italy
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
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310
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Morgia G, Russo GI, Tubaro A, Bortolus R, Randone D, Gabriele P, Trippa F, Zattoni F, Porena M, Mirone V, Serni S, Del Nero A, Lay G, Ricardi U, Rocco F, Terrone C, Pagliarulo A, Ludovico G, Vespasiani G, Brausi M, Simeone C, Novella G, Carmignani G, Leonardi R, Pinnarò P, De Paula U, Corvò R, Tenaglia R, Siracusano S, Mantini G, Gontero P, Savoca G, Ficarra V. Patterns of prescription and adherence to European Association of Urology guidelines on androgen deprivation therapy in prostate cancer: an Italian multicentre cross-sectional analysis from the Choosing Treatment for Prostate Cancer (CHOICE) study. BJU Int 2015; 117:867-73. [PMID: 26332130 DOI: 10.1111/bju.13307] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate both the patterns of prescription of androgen deprivation therapy (ADT) in patients with prostate cancer (PCa) and the adherence to European Association of Urology (EAU) guidelines for ADT prescription. METHODS The Choosing Treatment for Prostate Cancer (CHOICE) study was an Italian multicentre cross-sectional study conducted between December 2010 and January 2012. A total of 1 386 patients, treated with ADT for PCa (first prescription or renewal of ADT), were selected. With regard to the EAU guidelines on ADT, the cohort was categorized into discordant ADT (Group A) and concordant ADT (Group B). RESULTS The final cohort included 1 075 patients with a geographical distribution including North Italy (n = 627, 58.3%), Central Italy (n = 233, 21.7%) and South Italy (n = 215, 20.0%). In the category of patients treated with primary ADT, a total of 125 patients (56.3%) were classified as low risk according to D'Amico classification. With regard to the EAU guidelines, 285 (26.51%) and 790 patients (73.49%) were classified as discordant (Group A) and concordant (Group B), respectively. In Group A, patients were more likely to receive primary ADT (57.5%, 164/285 patients) than radical prostatectomy (RP; 30.9%, 88/285 patients), radiation therapy (RT; 6.7%, 19/285 patients) or RP + RT (17.7%, 14/285 patients; P < 0.01). Multivariate logistic regression analysis, adjusted for clinical and pathological variables, showed that patients from Central Italy (odds ratio [OR] 2.86; P < 0.05) and South Italy (OR 2.65; P < 0.05) were more likely to receive discordant ADT. CONCLUSION EAU guideline adherence for ADT was low in Italy and was influenced by geographic area. Healthcare providers and urologists should consider these results in order to quantify the inadequate use of ADT and to set policy strategies to overcome this risk.
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Affiliation(s)
- Giuseppe Morgia
- Department of Urology, University of Catania, Catania, Italy
| | | | - Andrea Tubaro
- Department of Urology, Sant' Andrea Hospital, 'La Sapienza' University of Roma, Roma, Italy
| | | | | | | | | | | | - Massimo Porena
- Department of Urology, University of Perugia, Perugia, Italy
| | - Vincenzo Mirone
- Department of Urology, Università Federico II of Napoli, Napoli, Italy
| | - Sergio Serni
- Department of Urology, University of Firenze, Firenze, Italy
| | | | | | - Umberto Ricardi
- Radiotherapy, AOU University S. Giovanni Battista Molinette, Torino, Italy
| | | | - Carlo Terrone
- Urology, University Hospital 'Maggiore della Carità', Novara, Italy
| | | | - Giuseppe Ludovico
- Urology, Ospedale Generale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | | | | | - Claudio Simeone
- Department of Urology, University of Brescia, Brescia, Italy
| | - Giovanni Novella
- Department of Surgery, Urology Clinic, AOUI Verona, Verona, Italy
| | | | | | | | - Ugo De Paula
- Radiotherapy, AO S. Giovanni Addolorata, Roma, Italy
| | - Renzo Corvò
- Radiotherapy, Istituto Nazionale per la Ricerca, Genova, Italy
| | | | | | - Giovanna Mantini
- Radiotherapy, Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Paolo Gontero
- Department of Surgical Sciences, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Gianfranco Savoca
- Urology, Fondazione Istituto San Raffaele - G. Giglio di Cefalù, Cefalù, Italy
| | - Vincenzo Ficarra
- Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy
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Menegakis A, De Colle C, Yaromina A, Hennenlotter J, Stenzl A, Scharpf M, Fend F, Noell S, Tatagiba M, Brucker S, Wallwiener D, Boeke S, Ricardi U, Baumann M, Zips D. Residual γH2AX foci after ex vivo irradiation of patient samples with known tumour-type specific differences in radio-responsiveness. Radiother Oncol 2015; 116:480-5. [PMID: 26297183 DOI: 10.1016/j.radonc.2015.08.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/04/2015] [Accepted: 08/06/2015] [Indexed: 02/01/2023]
Abstract
PURPOSE To apply our previously published residual ex vivo γH2AX foci method to patient-derived tumour specimens covering a spectrum of tumour-types with known differences in radiation response. In addition, the data were used to simulate different experimental scenarios to simplify the method. MATERIALS AND METHODS Evaluation of residual γH2AX foci in well-oxygenated tumour areas of ex vivo irradiated patient-derived tumour specimens with graded single doses was performed. Immediately after surgical resection, the samples were cultivated for 24h in culture medium prior to irradiation and fixed 24h post-irradiation for γH2AX foci evaluation. Specimens from a total of 25 patients (including 7 previously published) with 10 different tumour types were included. RESULTS Linear dose response of residual γH2AX foci was observed in all specimens with highly variable slopes among different tumour types ranging from 0.69 (95% CI: 1.14-0.24) to 3.26 (95% CI: 4.13-2.62) for chondrosarcomas (radioresistant) and classical seminomas (radiosensitive) respectively. Simulations suggest that omitting dose levels might simplify the assay without compromising robustness. CONCLUSION Here we confirm clinical feasibility of the assay. The slopes of the residual foci number are well in line with the expected differences in radio-responsiveness of different tumour types implying that intrinsic radiation sensitivity contributes to tumour radiation response. Thus, this assay has a promising potential for individualized radiation therapy and prospective validation is warranted.
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Affiliation(s)
- Apostolos Menegakis
- Department of Radiation Oncology, Medical Faculty and University Hospital, Eberhard Karls University Tübingen, Germany; German Cancer Research Center (DKFZ), Heidelberg and German Consortium for Translational Cancer Research (DKTK) Partner Sites Tübingen, Germany.
| | - Chiara De Colle
- Department of Oncology, Radiation Oncology, University of Turin, Italy
| | - Ala Yaromina
- Department of Radiation Oncology (Maastro), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands
| | - Joerg Hennenlotter
- Department of Urology, Medical Faculty and University Hospital, Eberhard Karls University Tübingen, Germany
| | - Arnulf Stenzl
- Department of Urology, Medical Faculty and University Hospital, Eberhard Karls University Tübingen, Germany
| | - Marcus Scharpf
- Department of Pathology, Medical Faculty and University Hospital, Eberhard Karls University Tübingen, Germany
| | - Falko Fend
- Department of Pathology, Medical Faculty and University Hospital, Eberhard Karls University Tübingen, Germany
| | - Susan Noell
- Department of Neurosurgery, Medical Faculty and University Hospital, Eberhard Karls University Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, Medical Faculty and University Hospital, Eberhard Karls University Tübingen, Germany
| | - Sara Brucker
- Department of and Research Institute for Women's Health, Medical Faculty and University Hospital, Eberhard Karls University Tübingen, Germany
| | - Diethelm Wallwiener
- Department of and Research Institute for Women's Health, Medical Faculty and University Hospital, Eberhard Karls University Tübingen, Germany
| | - Simon Boeke
- Department of Radiation Oncology, Medical Faculty and University Hospital, Eberhard Karls University Tübingen, Germany; German Cancer Research Center (DKFZ), Heidelberg and German Consortium for Translational Cancer Research (DKTK) Partner Sites Tübingen, Germany
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, Italy
| | - Michael Baumann
- German Cancer Research Center (DKFZ), Heidelberg and German Consortium for Translational Cancer Research (DKTK) Partner Sites Dresden, Germany; Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Germany
| | - Daniel Zips
- Department of Radiation Oncology, Medical Faculty and University Hospital, Eberhard Karls University Tübingen, Germany; German Cancer Research Center (DKFZ), Heidelberg and German Consortium for Translational Cancer Research (DKTK) Partner Sites Tübingen, Germany
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Simontacchi G, Filippi AR, Ciammella P, Buglione M, Saieva C, Magrini SM, Livi L, Iotti C, Botto B, Vaggelli L, Re A, Merli F, Ricardi U. Interim PET After Two ABVD Cycles in Early-Stage Hodgkin Lymphoma: Outcomes Following the Continuation of Chemotherapy Plus Radiotherapy. Int J Radiat Oncol Biol Phys 2015; 92:1077-1083. [DOI: 10.1016/j.ijrobp.2015.04.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/27/2015] [Accepted: 04/10/2015] [Indexed: 10/23/2022]
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313
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Rovea P, Fozza A, Franco P, De Colle C, Cannizzaro A, Di Dio A, De Monte F, Rosmino C, Filippi AR, Ragona R, Ricardi U. Once-Weekly Hypofractionated Whole-Breast Radiotherapy After Breast-Conserving Surgery in Older Patients: A Potential Alternative Treatment Schedule to Daily 3-Week Hypofractionation. Clin Breast Cancer 2015; 15:270-6. [DOI: 10.1016/j.clbc.2014.12.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 12/30/2014] [Accepted: 12/31/2014] [Indexed: 01/02/2023]
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314
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Potenza I, Franco P, Moretto F, Badellino S, Balcet V, Rossi G, Landolfo V, Riva G, Pecorari G, Ragona R, Rampino M, Ricardi U. Exclusive Radiotherapy for Early-stage Glottic Cancer: A Single-institution Retrospective Analysis with a Focus on Voice Quality. Anticancer Res 2015; 35:4155-4160. [PMID: 26124371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM To report on clinical outcomes of patients with early-stage glottic cancer treated with exclusive radiotherapy with specific analysis of voice quality. PATIENTS AND METHODS A consecutive cohort of 55 patients with early glottic cancer was retrospectively analyzed. Patients were treated with exclusive radiation up to a conventionally fractionated total dose of 66-70 Gy with a 3-dimensional conformal technique. Oncological outcomes and toxicity profiles were investigated. A sub-sample of this cohort was also analyzed in terms of voice quality employing subjective and objective tools such as the Voice Handicap Index-10 (VHI-10) and the Multidimensional Voice Program (MDVP™) software and was compared to a group of similar patients treated with CO2 laser cordectomy. RESULTS after a median observation time of 74.5 months, 5- and 10-year local control was 89% [95% confidence interval (CI)=70.7-93.1%] and 86% (95% CI=68.7-89.6%), respectively. Larynx-preservation rate was 91.8% (95% CI=82.4%-94.9%) at 10 years. Five- and 10-year actuarial overall survival was 72% (95% CI=50.4-79.2%) and 56% (95% CI=48.7-64.3%). Maximum detected acute toxicity included G3 dermatitis (5.4%) and G4 dyspnea (1.8%). Late toxicity profile was mild. VHI-10 scores showed a mild voice disability in both groups, with no statistically significant difference (p=0.12), even when investigating different domains. Patients treated with radiation had a lower deterioration rate in all parameters excluding low voice, interruptions of sound and diplophony. CONCLUSION Exclusive radiation proved an effective treatment for patients with early glottic cancer in terms of both oncological outcome and voice quality.
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Affiliation(s)
- Ilenia Potenza
- Department of Oncology-Radiation Oncology, University of Turin School of Medicine, Turin, Italy
| | - Pierfrancesco Franco
- Department of Oncology-Radiation Oncology, University of Turin School of Medicine, Turin, Italy
| | - Francesco Moretto
- Department of Oncology-Radiation Oncology, University of Turin School of Medicine, Turin, Italy
| | - Serena Badellino
- Department of Oncology-Radiation Oncology, University of Turin School of Medicine, Turin, Italy
| | - Vittoria Balcet
- Department of Oncology-Radiation Oncology, University of Turin School of Medicine, Turin, Italy
| | - Giuseppe Rossi
- Radiotherapy Department, AOU City of Health and Science, Turin, Italy
| | - Vincenzo Landolfo
- Department of Surgical Sciences-First ENT Division, University of Turin School of Medicine, Turin, Italy
| | - Giuseppe Riva
- Department of Surgical Sciences-First ENT Division, University of Turin School of Medicine, Turin, Italy
| | - Giancarlo Pecorari
- Department of Surgical Sciences-First ENT Division, University of Turin School of Medicine, Turin, Italy
| | - Riccardo Ragona
- Department of Oncology-Radiation Oncology, University of Turin School of Medicine, Turin, Italy
| | - Monica Rampino
- Radiotherapy Department, AOU City of Health and Science, Turin, Italy
| | - Umberto Ricardi
- Department of Oncology-Radiation Oncology, University of Turin School of Medicine, Turin, Italy
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315
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Girelli G, Franco P, Sciacero P, Cante D, Borca VC, Pasquino M, Annoscia S, Tofani S, La Porta MR, Ricardi U. Image-guided Intensity-modulated Radiotherapy for Prostate Cancer Employing Hypofractionation and Simultaneous Integrated Boost: Results of a Consecutive Case Series with Focus on Erectile Function. Anticancer Res 2015; 35:4177-4182. [PMID: 26124375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM To report on clinical outcomes of prostate cancer patients treated with hypofractionated radiotherapy employing a simultaneous integrated boost strategy. PATIENTS AND METHODS A consecutive series of 104 patients affected with prostate cancer was treated with intensity-modulated radiotherapy using a hypofractionated schedule and a simultaneous integrated boost consisting of 70 Gy (2.5 Gy daily) to the prostate gland, 63 Gy to the seminal vesicles (2.25 Gy daily) and 53.2 Gy to the pelvic nodes (1.9 Gy daily) when needed, delivered in 28 fractions. All patients underwent image-guided radiotherapy procedure consisting of daily cone-beam computed tomography. RESULTS After a median observation time of 26 (range=15-48) months, the 3-year biochemical failure-free survival was 96.5% [95% confidence interval (CI)=89%-98%], 3-year cancer-specific survival was 98.5% (95% CI=91%-99%) and 3-year overall survival was 96.5% (95% CI=89%-98%). The gastrointestinal and genitourinary toxicity profiles were mild with fewer than 2% of grade 3 events. Erectile function was partially affected by radiation in men potent at baseline. CONCLUSION Hypofractionation delivered with intensity-modulated radiotherapy and a simultaneous integrated boost approach proved to be a safe and effective treatment option for patients with prostate cancer. Patients with a preserved baseline erectile function experience a decrease in functionality correlated with the mean dose received by penile bulb.
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Affiliation(s)
- Giuseppe Girelli
- Department of Radiotherapy, Ivrea Community Hospital, Ivrea, Italy
| | | | - Piera Sciacero
- Department of Radiotherapy, Ivrea Community Hospital, Ivrea, Italy
| | - Domenico Cante
- Department of Radiotherapy, Ivrea Community Hospital, Ivrea, Italy
| | | | - Massimo Pasquino
- Department of Medical Physics, Ivrea Community Hospital, Ivrea, Italy
| | - Scipio Annoscia
- Department of Urology, Ivrea Community Hospital, Ivrea, Italy
| | - Santi Tofani
- Department of Medical Physics, Ivrea Community Hospital, Ivrea, Italy
| | | | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Torino, Turin, Italy
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316
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Ricardi U, Badellino S, Filippi AR. Stereotactic radiotherapy for early stage non-small cell lung cancer. Radiat Oncol J 2015; 33:57-65. [PMID: 26157674 PMCID: PMC4493429 DOI: 10.3857/roj.2015.33.2.57] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 06/16/2015] [Accepted: 06/17/2015] [Indexed: 12/11/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) represents a consolidated treatment option for patients with medically inoperable early stage non-small cell lung cancer (NSCLC). The clinical evidence accumulated in the past decade supports its use as an alternative to surgery with comparable survival outcomes. Due to its limited toxicity, SBRT is also applicable to elderly patients with very poor baseline pulmonary function or other severe comorbidities. Recent comparative studies in operable patients raised the issue of the possible use of SBRT also for this subgroup, with quite promising results that still should be fully confirmed by prospective trials with long-term follow-up. Aim of this review is to summarize and discuss the major studies conducted over the years on SBRT and to provide data on the efficacy and toxicity of this radiotherapy technique for stage I NSCLC. Technical aspects and quality of life related issues are also discussed, with the goal to provide information on the current role and limitations of SBRT in clinical practice.
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Affiliation(s)
- Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Torino, Torino, Italy
| | - Serena Badellino
- Department of Oncology, Radiation Oncology, University of Torino, Torino, Italy
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317
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Ferrero C, Badellino S, Filippi AR, Focaraccio L, Giaj Levra M, Levis M, Moretto F, Torchio R, Ricardi U, Novello S. Pulmonary function and quality of life after VMAT-based stereotactic ablative radiotherapy for early stage inoperable NSCLC: a prospective study. Lung Cancer 2015; 89:350-6. [PMID: 26164208 DOI: 10.1016/j.lungcan.2015.06.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/16/2015] [Accepted: 06/22/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To analyze changes in pulmonary function and quality of life (QoL) at different time points after Stereotactic Ablative Radiotherapy (SABR) for early stage inoperable lung cancer, and potential correlations between radiation dose-volume parameters and pulmonary toxicity or changes in pulmonary function tests (PFT) and QoL. MATERIALS AND METHODS From July 2012 to October 2013, 30 patients were enrolled in this prospective observational study. Complete PFT were performed and Lung Cancer Symptoms Scale (LCSS) questionnaire administered prior to SABR; all patients then underwent Computed Tomography (CT) scan and PFT at 45, 135, 225 and 315 days after SABR, together with LCSS questionnaire. Clinical lung toxicity and radiological toxicity (acute and late) were prospectively recorded by using the Radiation Therapy Oncology Group (RTOG) scoring system. RESULTS A decline in Slow Vital Capacity (SVC), Forced Expiratory Volume in 1s (FEV1), Single-breath lung diffusing capacity (DLCO) and blood partial pressure of oxygen (PaO2) was seen at 135 days post-SABR. PaO2 values rescued to normal levels at 315 days. None of the baseline PFT parameters resulted to be associated with the occurrence of pulmonary toxicity or with late radiological changes. Mean V5, V10, and V20 and MLD2Gy were higher in patients who developed radiation pneumonitis, even if not significantly associated at Cox regression analysis. LCSS QoL showed a significant worsening of the single item fatigue at 135 days after SABR. CONCLUSIONS A small (mean 10%) but significant decline in lung volumes and DLCO was recorded after SABR, with clinical impact of such change difficult to estimate in individual patients. Global QoL was not significantly impaired. Dose-volume parameters did not emerge as significantly predictive of any clinical, radiological or functional toxicity.
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Affiliation(s)
- Cinzia Ferrero
- Respiratory Function and Sleep Laboratory, S. Luigi Hospital, Orbassano, Italy
| | | | | | | | | | - Mario Levis
- Department of Oncology, University of Torino, Torino, Italy
| | | | - Roberto Torchio
- Respiratory Function and Sleep Laboratory, S. Luigi Hospital, Orbassano, Italy
| | | | - Silvia Novello
- Department of Oncology, University of Torino, Torino, Italy
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318
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Filippi AR, Ragona R, Piva C, Scafa D, Fiandra C, Fusella M, Giglioli FR, Lohr F, Ricardi U. Optimized volumetric modulated arc therapy versus 3D-CRT for early stage mediastinal Hodgkin lymphoma without axillary involvement: a comparison of second cancers and heart disease risk. Int J Radiat Oncol Biol Phys 2015; 92:161-8. [PMID: 25863763 DOI: 10.1016/j.ijrobp.2015.02.030] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/08/2015] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the risks of second cancers and cardiovascular diseases associated with an optimized volumetric modulated arc therapy (VMAT) planning solution in a selected cohort of stage I/II Hodgkin lymphoma (HL) patients treated with either involved-node or involved-site radiation therapy in comparison with 3-dimensional conformal radiation therapy (3D-CRT). METHODS AND MATERIALS Thirty-eight patients (13 males and 25 females) were included. Disease extent was mediastinum alone (n=8, 21.1%); mediastinum plus unilateral neck (n=19, 50%); mediastinum plus bilateral neck (n=11, 29.9%). Prescription dose was 30 Gy in 2-Gy fractions. Only 5 patients had mediastinal bulky disease at diagnosis (13.1%). Anteroposterior 3D-CRT was compared with a multiarc optimized VMAT solution. Lung, breast, and thyroid cancer risks were estimated by calculating a lifetime attributable risk (LAR), with a LAR ratio (LAR(VMAT)-to-LAR(3D-CRT)) as a comparative measure. Cardiac toxicity risks were estimated by calculating absolute excess risk (AER). RESULTS The LAR ratio favored 3D-CRT for lung cancer induction risk in mediastinal alone (P=.004) and mediastinal plus unilateral neck (P=.02) presentations. LAR ratio for breast cancer was lower for VMAT in mediastinal plus bilateral neck presentations (P=.02), without differences for other sites. For thyroid cancer, no significant differences were observed, regardless of anatomical presentation. A significantly lower AER of cardiac (P=.038) and valvular diseases (P<.0001) was observed for VMAT regardless of disease extent. CONCLUSIONS In a cohort of patients with favorable characteristics in terms of disease extent at diagnosis (large prevalence of nonbulky presentations without axillary involvement), optimized VMAT reduced heart disease risk with comparable risks of thyroid and breast cancer, with an increase in lung cancer induction probability. The results are however strongly influenced by the different anatomical presentations, supporting an individualized approach.
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Affiliation(s)
| | - Riccardo Ragona
- Department of Oncology, Radiation Oncology, University of Torino, Torino, Italy
| | - Cristina Piva
- Department of Oncology, Radiation Oncology, University of Torino, Torino, Italy
| | - Davide Scafa
- Department of Oncology, Radiation Oncology, University of Torino, Torino, Italy
| | - Christian Fiandra
- Department of Oncology, Radiation Oncology, University of Torino, Torino, Italy
| | - Marco Fusella
- Medical Physics, AOU Città della Salute e della Scienza Hospital, Torino, Italy
| | | | - Frank Lohr
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Torino, Torino, Italy
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319
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Arezzo A, Arolfo S, Allaix ME, Munoz F, Cassoni P, Monagheddu C, Ricardi U, Ciccone G, Morino M. Results of Neoadjuvant Short-Course Radiation Therapy Followed by Transanal Endoscopic Microsurgery for T1-T2 N0 Extraperitoneal Rectal Cancer. Int J Radiat Oncol Biol Phys 2015; 92:299-306. [DOI: 10.1016/j.ijrobp.2015.01.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 01/07/2015] [Accepted: 01/20/2015] [Indexed: 10/23/2022]
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320
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Giunta F, Zotta M, Menga M, Balma M, Bellò M, Passera R, Filippi AR, Chiappella A, Ladetto M, Ricardi U, Vitolo U, Bisi G. Using PET-CT in the restaging of primitive mediastinal B-cell lymphoma (PMBCL) after chemotherapy: which criteria should we use? Q J Nucl Med Mol Imaging 2015; 59:214-219. [PMID: 25669764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Primitive mediastinal B-cell lymphoma (PMBCL) is a relatively rare form of non-Hodgkin lymphoma (NHL), typically concerning the youngster, with an aggressive course and poor prognosis. The therapy generally consists of high dose chemotherapy followed by radiotherapy. PET-CT is used at staging, restaging after chemotherapy and after radiotherapy, or when relapse is suspected. Aim of the study was to compare different criteria in the evaluation of response to chemotherapy in this setting. METHODS Thirty-eight patients with PMBCL (15 M, 23 F, median age 33 yrs [range 18-79]), all treated with chemo-immunotherapy and radiotherapy, who had undergone baseline (b-PET) and end of chemotherapy (f-CHT-PET) 18F-FDG-PET-CT scans at our institution between July 2004 and September 2014 were retrospectively re-evaluated; the median follow-up was 42 months (range 4-109), at which 4/38 (11%) had died, 5/38 (13%) were in partial response (PR) and 29/38 (76%) were in complete response (CR). The primary endpoint was progression-free survival (PFS), while the secondary one was overall survival (OS), according to the Cheson criteria. SUV max of the mediastinal disease mass at staging, of the residual mass at CT after chemo-immunotherapy, SUV max of the liver and of the mediastinal blood pool (MBP) were calculated for all patients. RESULTS In our population, we observed that: 1) visual criteria performs better when positivity-negativity threshold is set at point 3 of the 5-point scale (5-PS); 2) semiquantitative approach by use of Δ SUV max performs better when the threshold is set at 66% decrease: in fact, at Δ SUV max analysis with 66% decrease, 9 patients resulted positive at the test (Δ SUV max ≤66%), 29 negative (Δ SUV max >66%). CONCLUSION In our population Δ SUV max could be working well in these patients because the baseline values are very high and very homogeneous. Our data, though limited in numerosity of patients and events, suggests that in this particular setting the use of the 5-PS reporting system could not be the best tool available; on the other hand, Δ SUV max could prove to be reliable in the evaluation of response to chemotherapy.
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Affiliation(s)
- F Giunta
- Division of Nuclear Medicine, Azienda Ospedaliera Universitaria, Città della Salute e della Scienza, Turin, Italy -
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321
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Franco P, Cante D, Sciacero P, Girelli G, La Porta MR, Ricardi U. Tumor Bed Boost Integration during Whole Breast Radiotherapy: A Review of the Current Evidence. Breast Care (Basel) 2015; 10:44-9. [PMID: 25960725 DOI: 10.1159/000369845] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Radiation therapy delivered with hypofractionation, which involves the delivery of a higher dose per fraction in fewer fractions (generally with a lower total nominal dose) over a shorter overall treatment time, is an established therapeutic option at least for a selected group of early breast cancer patients after breast-conserving surgery. Optimal delivery of the tumor bed boost dose in terms of timing, fractionation, and total dose whenever a hypofractionated schedule is employed has yet to be established. We herein present a review of the current evidence on the role of boost integration in whole breast radiotherapy.
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Affiliation(s)
| | - Domenico Cante
- Radiation Oncology Department, Ivrea Community Hospital, ASLTO4, Ivrea, Italy
| | - Piera Sciacero
- Radiation Oncology Department, Ivrea Community Hospital, ASLTO4, Ivrea, Italy
| | - Giuseppe Girelli
- Radiation Oncology Department, Ivrea Community Hospital, ASLTO4, Ivrea, Italy
| | - Maria Rosa La Porta
- Radiation Oncology Department, Ivrea Community Hospital, ASLTO4, Ivrea, Italy
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Torino, Turin, Italy
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322
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De Bari B, Vallati M, Gatta R, Simeone C, Girelli G, Ricardi U, Meattini I, Gabriele P, Bellavita R, Krengli M, Cafaro I, Cagna E, Bunkheila F, Borghesi S, Signor M, Di Marco A, Bertoni F, Stefanacci M, Pasinetti N, Buglione M, Magrini SM. Could machine learning improve the prediction of pelvic nodal status of prostate cancer patients? Preliminary results of a pilot study. Cancer Invest 2015; 33:232-40. [PMID: 25950849 DOI: 10.3109/07357907.2015.1024317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We tested and compared performances of Roach formula, Partin tables and of three Machine Learning (ML) based algorithms based on decision trees in identifying N+ prostate cancer (PC). 1,555 cN0 and 50 cN+ PC were analyzed. Results were also verified on an independent population of 204 operated cN0 patients, with a known pN status (187 pN0, 17 pN1 patients). ML performed better, also when tested on the surgical population, with accuracy, specificity, and sensitivity ranging between 48-86%, 35-91%, and 17-79%, respectively. ML potentially allows better prediction of the nodal status of PC, potentially allowing a better tailoring of pelvic irradiation.
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Affiliation(s)
- B De Bari
- 1Istituto del Radio "O. Alberti", Radiotherapy Department, Spedali Civili di Brescia and University of Brescia, Brescia, Italy
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323
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Franco P, Mistrangelo M, Arcadipane F, Munoz F, Sciacero P, Spadi R, Migliaccio F, Angelini V, Bombaci S, Rondi N, Numico G, Ragona R, Cassoni P, Morino M, Racca P, Ricardi U. Intensity-modulated radiation therapy with simultaneous integrated boost combined with concurrent chemotherapy for the treatment of anal cancer patients: 4-year results of a consecutive case series. Cancer Invest 2015; 33:259-66. [PMID: 25950188 DOI: 10.3109/07357907.2015.1028586] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To report the 4-year outcomes of a consecutive series of anal cancer patients treated with concurrent chemo-radiation delivered with intensity-modulated radiotherapy (IMRT), employing a simultaneous integrated boost (SIB) approach. METHODS A consecutive series of 54 patients was enrolled between 2007 and 2013. Treatment schedule consisted of 50.4 Gy/28 fractions (1.8 Gy daily) to the gross tumor volume, while the elective nodal volumes were prescribed 42 Gy/28 fractions (1.5 Gy/daily) for patients having a cT2N0 disease. Patients with cT3-T4/N0-N3 tumors were prescribed 54 (T3) or 60 (T4) Gy/30 fractions (1.8-2 Gy daily) to the gross tumor volume; gross nodal volumes were prescribed 50.4 Gy/30 fr (1.68 Gy daily) if sized ≤ 3 cm or 54 Gy/30 fr (1.8 Gy daily) if > 3 cm; elective nodal regions were given 45 Gy/30 fractions (1.5 Gy daily). Chemotherapy was administered concurrently according to the Nigro's regimen. Primary endpoint was colostomy-free survival (CFS). Secondary endpoints were local control (LC), disease-free survival (DFS), cancer-specific survival (CSS), overall survival (OS), and toxicity profile. RESULTS Median follow up was 32.6 months (range 12-84). The actuarial probability of being alive at 4 years without a colostomy (CFS) was 68.9% (95% CI: 50.3%-84.7%). Actuarial 4-year OS, CSS, DFS, and LC were 77.7% (95% CI: 60.7-88.1%), 81.5% (95% CI: 64%-91%), 65.5% (95% CI: 47.7%-78.5%), and 84.6% (95% CI: 71.6%-92%). Actuarial 4-year metastasis-free survival was 74.4% (95% CI: 55.5%-86.2%). Maximum detected acute toxicities were as follows: dermatologic -G3: 13%; GI-G3: 8%; GU-G3: 2%; anemia-G3: 2%; neutropenia-G3:11%; G4: 2%; thrombocytopenia- G3:2%. Four-year G2 chronic toxicity rates were 2.5% (95% CI: 3.6-16.4) for GU, 14.4% (95% CI: 7.1-28) for GI, 3.9% (95% CI: 1%-14.5%) for skin, and 4.2% (95% CI: 1.1-15.9) for genitalia. CONCLUSIONS Our study shows the feasibility of IMRT in the combined modality treatment of anal cancer, with comparable results to the literature with respect to LC, sphincter preservation and survival. Acute toxicity is lower if compared to series employing standard techniques. Our results support the use of IMRT on a routine basis for the treatment of anal cancer.
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324
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Senetta R, Duregon E, Sonetto C, Spadi R, Mistrangelo M, Racca P, Chiusa L, Munoz FH, Ricardi U, Arezzo A, Cassenti A, Castellano I, Papotti M, Morino M, Risio M, Cassoni P. YKL-40/c-Met expression in rectal cancer biopsies predicts tumor regression following neoadjuvant chemoradiotherapy: a multi-institutional study. PLoS One 2015; 10:e0123759. [PMID: 25875173 PMCID: PMC4398550 DOI: 10.1371/journal.pone.0123759] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 01/21/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Neoadjuvant chemo-radiotherapy (CRT) followed by surgical resection is the standard treatment for locally advanced rectal cancer, although complete tumor pathological regression is achieved in only up to 30% of cases. A clinicopathological and molecular predictive stratification of patients with advanced rectal cancer is still lacking. Here, c-Met and YKL-40 have been studied as putative predictors of CRT response in rectal cancer, due to their reported involvement in chemoradioresistance in various solid tumors. MATERIAL AND METHODS A multicentric study was designed to assess the role of c-Met and YKL-40 expression in predicting chemoradioresistance and to correlate clinical and pathological features with CRT response. Immunohistochemistry and fluorescent in situ hybridization for c-Met were performed on 81 rectal cancer biopsies from patients with locally advanced rectal adenocarcinoma. All patients underwent standard (50.4 gy in 28 fractions + concurrent capecitabine 825 mg/m2) neoadjuvant CRT or the XELOXART protocol. CRT response was documented on surgical resection specimens and recorded as tumor regression grade (TRG) according to the Mandard criteria. RESULTS A significant correlation between c-Met and YKL-40 expression was observed (R = 0.43). The expressions of c-Met and YKL-40 were both significantly associated with a lack of complete response (86% and 87% of c-Met and YKL-40 positive cases, p< 0.01 and p = 0.006, respectively). Thirty of the 32 biopsies co-expressing both markers had partial or absent tumor response (TRG 2-5), strengthening their positive predictive value (94%). The exclusive predictive role of YKL-40 and c-Met was confirmed using a multivariate analysis (p = 0.004 and p = 0.007 for YKL-40 and c-Met, respectively). TRG was the sole morphological parameter associated with poor outcome. CONCLUSION c-Met and YKL-40 expression is a reliable predictor of partial/absent response to neoadjuvant CRT in rectal cancer. Targeted therapy protocols could take advantage of prior evaluations of c-MET and YKL-40 expression levels to increase therapeutic efficacy.
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Affiliation(s)
- Rebecca Senetta
- Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Cristina Sonetto
- SSCVD Colorectal Cancer Unit, City of Health and Science Hospital of Turin, Turin, Italy
| | - Rossella Spadi
- SSCVD Colorectal Cancer Unit, City of Health and Science Hospital of Turin, Turin, Italy
| | - Massimiliano Mistrangelo
- Digestive and Colorectal Surgery, Centre of Minimal Invasive Surgery, University of Turin, Turin, Italy
| | - Patrizia Racca
- SSCVD Colorectal Cancer Unit, City of Health and Science Hospital of Turin, Turin, Italy
| | - Luigi Chiusa
- Department of Medical Sciences, University of Turin, Turin, Italy
| | | | | | - Alberto Arezzo
- Digestive and Colorectal Surgery, Centre of Minimal Invasive Surgery, University of Turin, Turin, Italy
| | - Adele Cassenti
- Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Mauro Papotti
- Department of Oncology, University of Turin, Turin, Italy
| | - Mario Morino
- Digestive and Colorectal Surgery, Centre of Minimal Invasive Surgery, University of Turin, Turin, Italy
| | - Mauro Risio
- Candiolo Cancer Institute—FPO (Fondazione del Piemonte per l'0ncologia), IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Candiolo, Turin, Italy
| | - Paola Cassoni
- Department of Medical Sciences, University of Turin, Turin, Italy
- * E-mail:
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325
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Boschetti A, Fusella M, Fiandra C, Giglioli F, Ragona R, Ricardi U. PO-1120 4D-CBCT in lung SBRT: characterization and validation using 6D motion platform and antropomorphic phantom. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41112-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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326
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Filippi A, Guerrera F, Badellino S, Ceccarelli M, Castiglione A, Guarneri A, Spadi R, Racca P, Ciccone G, Ricardi U, Ruffini E. PO-0770: Stereotactic radiotherapy versus surgery: comparison of survival in lung metastases from colo-rectal cancer. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40762-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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327
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Ricardi U. SP-0312: Is SBRT a best tool in the treatment of oligometastatic disease? Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40310-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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328
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Franco P, Arcadipane F, Segantin M, Munoz F, Migliaccio F, Sciacero P, Mistrangelo M, Angelini V, Racca P, Morino M, Cassoni P, Ricardi U. EP-1217: SIB-IMRT combined with concurrent chemotherapy for anal cancer: 4-year results of a consecutive case series. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41209-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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329
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Riva G, Raimondo L, Ravera M, Moretto F, Boita M, Potenza I, Rampino M, Ricardi U, Garzaro M. Late sensorial alterations in different radiotherapy techniques for nasopharyngeal cancer. Chem Senses 2015; 40:285-92. [PMID: 25800268 DOI: 10.1093/chemse/bjv011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Intensity-modulated radiation therapy (IMRT) for nasopharyngeal cancer (NPC) allowed a better distribution of the dose to the tumor volume, sparing surrounding structures. Aim of the study is the objective evaluation of olfactory and gustatory impairments in patients who underwent chemo-radiotherapy for NPC. Correlation between smell and taste alterations, xerostomy, and radiation technique was investigated. Thirty healthy subjects and 30 patients treated with chemo-radiation therapy for NPC, with at least a 2-years follow-up period, were evaluated. All subjects underwent symptoms evaluation, endoscopic fiber optic nasal examination, taste strips, Sniffin' sticks tests, Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer late radiation morbidity scoring system. Patients were divided in 2 groups: 2-dimensional radiotherapy/conformal 3-dimensional radiotherapy and IMRT. A higher percentage of rhinorrhea, nasal obstruction, xerostomy, hyposmia, hypogeusia, mucosal hyperemia, and presence of nasopharyngeal secretions was found in irradiated subjects (P < 0.05). Concerning olfactory and gustatory scores, we demonstrated a statistically significant difference between healthy subjects and irradiated patients (P < 0.05), with lower gustatory total score in IMRT group (P < 0.01). In conclusion, chemo-radiotherapy for NPC induces long-term smell and taste impairments, which can compromise quality of life. Although based on small samples, it is also important to consider that IMRT can induce higher taste dysfunction compared with traditional techniques.
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Affiliation(s)
- Giuseppe Riva
- 1st ENT Division, Department of Surgical Sciences, University of Turin, Turin 10126, Italy,
| | - Luca Raimondo
- 1st ENT Division, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Mattia Ravera
- 1st ENT Division, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Francesco Moretto
- Radiation Oncology Unit, Department of Oncology, University of Turin, Turin 10126, Italy, and
| | - Monica Boita
- Allergology and Clinical Immunology, Department of Medical Science, University of Turin, Turin 10126, Italy
| | - Ilenia Potenza
- Radiation Oncology Unit, Department of Oncology, University of Turin, Turin 10126, Italy, and
| | - Monica Rampino
- Radiation Oncology Unit, Department of Oncology, University of Turin, Turin 10126, Italy, and
| | - Umberto Ricardi
- Radiation Oncology Unit, Department of Oncology, University of Turin, Turin 10126, Italy, and
| | - Massimiliano Garzaro
- 1st ENT Division, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
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330
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Garrido P, Engel-Riedel W, Serke M, Giraud P, Ricardi U, Vallejo C, Visseren-Grul C, Ameryckx S, Soldatenkova V, Chouaki N, Novello S. Final results from a Phase II study of pemetrexed and cisplatin with concurrent thoracic radiation after Pem-Cis induction in patients with unresectable locally advanced non-squamous non-small cell lung cancer (NSCLC). Lung Cancer 2015; 88:160-6. [PMID: 25758556 DOI: 10.1016/j.lungcan.2015.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/06/2015] [Accepted: 02/16/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This single-arm multicenter Phase II study investigated the efficacy and safety of pemetrexed (Pem) and cisplatin (Cis) induction chemotherapy (CT) followed by full-dose Pem-Cis plus concurrent radiotherapy (RT) in patients with locally advanced non-squamous NSCLC. MATERIALS AND METHODS Patients with unresectable Stage III non-squamous NSCLC received two 21-day cycles of Pem 500 mg/m(2) (vitamin/folic acid supplementation and dexamethasone prophylaxis per Pem-label)+Cis 75 mg/m(2) on Day 1. Eligible patients who had not progressed continued with 2 further cycles of full-dose Pem-Cis plus concurrent RT (2 Gy/fraction, 5 days/week, 66 Gy total). Primary endpoint was the 1-year progression-free survival (PFS) rate. RESULTS Of 90 patients enrolled (all treated; median age 61 years, male/female 57%/43%, ECOG performance status 0/1 66%/34%, adenocarcinoma 90%, Stage III 36%/62%), 75 (83%) completed induction CT and started concurrent CT+RT. 64 (71%) patients received all 4 CT cycles and an RT dose ≥60 Gy. The 1-year PFS rate was 51.3% (95%CI: 42.0, 60.5). Median PFS was 10.6 months (95%CI: 8.6, 17.3), median OS was 26.2 months (95%CI: 16.7, not estimable). One patient died from enteritis (treatment-related) during Cycle 4. Four patients discontinued due to treatment-related adverse events, 1 on induction CT (renal failure), 3 on concurrent CT+RT (1 hypoacusis, 2 acute esophagitis). During induction CT, 18.9% of patients reported Grade 3/4 CTCAEs, only neutropenia (2.2%) and syncope (2.2%) were reported by >1 patient. During concurrent CT+RT, 41.3% of patients reported G3/4 CTCAEs, mainly esophagitis (12.0%), neutropenia (10.7%), and leukopenia (9.3%). CONCLUSION In this study of Pem-Cis induction CT followed by full-dose Pem-Cis with concurrent RT, median PFS was 10.6 months and toxicity was manageable, in line with previous data on Pem-Cis plus RT.
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Affiliation(s)
- Pilar Garrido
- Medical Oncology Department, University Hospital Ramon y Cajal, Madrid, Spain.
| | | | - Monika Serke
- Thoracic Oncology Department, Hemer Lung Clinic, Hemer, Germany
| | - Philippe Giraud
- Department of Oncology Radiotherapy, Paris Descartes University, Georges Pompidou European Hospital, Paris, France
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, Italy
| | - Carmen Vallejo
- Department of Oncology Radiotherapy, University Hospital Ramon y Cajal, Madrid, Spain
| | | | - Sophie Ameryckx
- Clinical Trial Management, Oncology, Lilly S.A. Eli Lilly Benelux N.V., Brussels, Belgium
| | | | - Nadia Chouaki
- Medical Oncology Department, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - Silvia Novello
- Department of Oncology, University of Turin, S. Luigi Hospital, Orbassano (TO), Italy
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331
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Maraldo MV, Dabaja BS, Filippi AR, Illidge T, Tsang R, Ricardi U, Petersen PM, Schut DA, Garcia J, Headley J, Parent A, Guibord B, Ragona R, Specht L. Radiation therapy planning for early-stage Hodgkin lymphoma: experience of the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys 2015; 92:144-52. [PMID: 25670544 DOI: 10.1016/j.ijrobp.2014.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 11/26/2014] [Accepted: 12/04/2014] [Indexed: 12/25/2022]
Abstract
PURPOSE Early-stage Hodgkin lymphoma (HL) is a rare disease, and the location of lymphoma varies considerably between patients. Here, we evaluate the variability of radiation therapy (RT) plans among 5 International Lymphoma Radiation Oncology Group (ILROG) centers with regard to beam arrangements, planning parameters, and estimated doses to the critical organs at risk (OARs). METHODS Ten patients with stage I-II classic HL with masses of different sizes and locations were selected. On the basis of the clinical information, 5 ILROG centers were asked to create RT plans to a prescribed dose of 30.6 Gy. A postchemotherapy computed tomography scan with precontoured clinical target volume (CTV) and OARs was provided for each patient. The treatment technique and planning methods were chosen according to each center's best practice in 2013. RESULTS Seven patients had mediastinal disease, 2 had axillary disease, and 1 had disease in the neck only. The median age at diagnosis was 34 years (range, 21-74 years), and 5 patients were male. Of the resulting 50 treatment plans, 15 were planned with volumetric modulated arc therapy (1-4 arcs), 16 with intensity modulated RT (3-9 fields), and 19 with 3-dimensional conformal RT (2-4 fields). The variations in CTV-to-planning target volume margins (5-15 mm), maximum tolerated dose (31.4-40 Gy), and plan conformity (conformity index 0-3.6) were significant. However, estimated doses to OARs were comparable between centers for each patient. CONCLUSIONS RT planning for HL is challenging because of the heterogeneity in size and location of disease and, additionally, to the variation in choice of treatment techniques and field arrangements. Adopting ILROG guidelines and implementing universal dose objectives could further standardize treatment techniques and contribute to lowering the dose to the surrounding OARs.
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Affiliation(s)
- Maja V Maraldo
- Departments of Clinical Oncology and Hematology, Rigshospitalet, University of Copenhagen, Denmark.
| | | | - Andrea R Filippi
- Department of Oncology, University of Torino School of Medicine, Torino, Italy
| | - Tim Illidge
- Department of Oncology, Christie Hospital, Manchester, United Kingdom
| | - Richard Tsang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Umberto Ricardi
- Department of Oncology, University of Torino School of Medicine, Torino, Italy
| | - Peter M Petersen
- Departments of Clinical Oncology and Hematology, Rigshospitalet, University of Copenhagen, Denmark
| | - Deborah A Schut
- Departments of Clinical Oncology and Hematology, Rigshospitalet, University of Copenhagen, Denmark
| | - John Garcia
- Department of Radiation Oncology, MD Anderson Cancer Center, Texas
| | - Jayne Headley
- Department of Oncology, Christie Hospital, Manchester, United Kingdom
| | - Amy Parent
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Benoit Guibord
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Riccardo Ragona
- Department of Oncology, University of Torino School of Medicine, Torino, Italy
| | - Lena Specht
- Departments of Clinical Oncology and Hematology, Rigshospitalet, University of Copenhagen, Denmark
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332
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Brignardello E, Felicetti F, Castiglione A, Fortunati N, Matarazzo P, Biasin E, Sacerdote C, Ricardi U, Fagioli F, Corrias A, Arvat E. GH replacement therapy and second neoplasms in adult survivors of childhood cancer: a retrospective study from a single institution. J Endocrinol Invest 2015; 38:171-6. [PMID: 25344310 DOI: 10.1007/s40618-014-0179-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 09/16/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Growth hormone deficiency (GHD) is the most common endocrine late effect observed in childhood cancer survivors (CCS) previously submitted to cranial irradiation. Radiation therapy can also increase the risk of second neoplasms (SNs). Since in previous studies GH replacement therapy was associated with increased incidence of neoplasia, we explored the association between SNs and GH replacement therapy in a cohort of CCS with GHD. METHODS Within the clinical cohort of CCS referred to the Transition Unit for Childhood Cancer Survivors of Turin between November 2001 and December 2012, we considered all patients who developed GHD as a consequence of cancer therapies. GHD was always diagnosed in childhood. To evaluate the quality of data, our cohort was linked to the Childhood Cancer Registry of Piedmont. RESULTS GHD was diagnosed in 49 out of 310 CCS included in our clinical cohort. At least one SN was diagnosed in 14 patients, meningioma and basal cell carcinoma being the most common SNs. The cumulative incidence of SNs was similar in GH-treated and -untreated patients (8 SNs out of 26 GH-treated and 6 out of 23 GH-untreated patients; p = 0.331). Age, sex and paediatric cancer type had no impact on SNs development. CONCLUSIONS In our CCS, GH replacement therapy does not seem to increase the risk of SNs. Anyway, independently from replacement therapy, in these patients we observed an elevated risk of SNs, possibly related to previous radiation therapy, which suggests the need of a close long-term follow-up.
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Affiliation(s)
- E Brignardello
- Transition Unit for Childhood Cancer Survivors, Department of Oncology, AOU Città della Salute e della Scienza Hospital, Via Cherasco, 15, 10126, Turin, Italy.
| | - F Felicetti
- Transition Unit for Childhood Cancer Survivors, Department of Oncology, AOU Città della Salute e della Scienza Hospital, Via Cherasco, 15, 10126, Turin, Italy
- Oncological Endocrinology Unit, Department of Oncology, University of Torino, Turin, Italy
| | - A Castiglione
- Unit of Clinical Epidemiology, University of Torino and Centre for Cancer Epidemiology and Prevention (CPO Piemonte), Turin, Italy
| | - N Fortunati
- Transition Unit for Childhood Cancer Survivors, Department of Oncology, AOU Città della Salute e della Scienza Hospital, Via Cherasco, 15, 10126, Turin, Italy
- Oncological Endocrinology Unit, Department of Oncology, University of Torino, Turin, Italy
| | - P Matarazzo
- Paediatric Endocrinology Unit, Department of Paediatric Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
| | - E Biasin
- Paediatric Hematology/Oncology Unit, Department of Paediatric Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
| | - C Sacerdote
- Unit of Clinical Epidemiology, University of Torino and Centre for Cancer Epidemiology and Prevention (CPO Piemonte), Turin, Italy
| | - U Ricardi
- Radiation Oncology Unit, Department of Oncology, University of Torino, Turin, Italy
| | - F Fagioli
- Paediatric Hematology/Oncology Unit, Department of Paediatric Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
| | - A Corrias
- Paediatric Endocrinology Unit, Department of Paediatric Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
| | - E Arvat
- Oncological Endocrinology Unit, Department of Oncology, University of Torino, Turin, Italy
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333
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Franco P, Potenza I, Moretto F, Segantin M, Grosso M, Lombardo A, Taricco D, Vallario P, Filippi AR, Rampino M, Ricardi U. Hypericum perforatum and neem oil for the management of acute skin toxicity in head and neck cancer patients undergoing radiation or chemo-radiation: a single-arm prospective observational study. Radiat Oncol 2014; 9:297. [PMID: 25544371 PMCID: PMC4300176 DOI: 10.1186/s13014-014-0297-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 12/11/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Radiation dermatitis is common in patients treated with combined radiotherapy and chemotherapy for head and neck malignancies. Its timely and adequate management is of uttermost importance for both oncological outcomes and global quality of life. We prospectively evaluated the role of hypericum perforatum and neem oil (Holoil®; RIMOS srl, Mirandola, Italy) in the treatment of acute skin toxicity for patients undergoing radiotherapy or chemo-radiotherapy for head and neck cancer. METHODS A consecutive series of 28 head and neck cancer patients submitted to radiotherapy (RT) was enrolled onto this mono-institutional single-arm prospective observational study. Patients undergoing both definitive or post-operative radiotherapy were allowed, either as exclusive modality or combined with (concomitant or induction) chemotherapy. We started Holoil treatment whenever bright erythema, moderate oedema or patchy moist desquamation were observed. Holoil® was used during all RT course and during follow up time, until acute skin toxicity recovery. RESULTS The maximum detected acute skin toxicity was Grade 1 in 7% of patients, Grade 2 in 68%, Grade 3 in 25%, while at the end of RT was Grade 0 in 3.5%, Grade 1 in 32%, Grade 2 in 61%, Grade 3 in 3.5%. For patients having G2 acute skin toxicity, it mainly started at weeks 4-5; for those having G3, it began during weeks 5-6. Median times spent with G2 or G3 toxicity were 17.5 and 11 days. Patients having G2 acute skin toxicity had a dermatitis worsening in 27% of case (median occurrence time: 7 days). G3 events were reconverted to a G2 profile in all patients (median time: 7 days). Those experiencing a G2 skin event were converted to a G1 score in 23% of cases (median time: 14 days). Time between maximum acute skin toxicity and complete skin recovery after RT was 27 days. CONCLUSIONS Holoil® proved to be a safe and active option in the management of acute skin toxicity in head and neck cancer patients submitted to RT or chemo-radiotherapy. A prophylactic effect in the prevention of moist desquamation may be hypothesized for hypericum and neem oil and need to be tested within a prospective controlled study.
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Affiliation(s)
- Pierfrancesco Franco
- Department of Oncology, Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy.
| | - Ilenia Potenza
- Department of Oncology, Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy.
| | - Francesco Moretto
- Radiotherapy Department, AOU Città della Salute e della Scienza, Turin, Italy.
| | - Mattia Segantin
- Department of Oncology, Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy.
| | - Mario Grosso
- Radiotherapy Department, AOU Città della Salute e della Scienza, Turin, Italy.
| | - Antonello Lombardo
- ENT Surgery Department, AOU Città della Salute e della Scienza, Turin, Italy.
| | - Daniela Taricco
- Radiotherapy Department, AOU Città della Salute e della Scienza, Turin, Italy.
| | - Patrizia Vallario
- Radiotherapy Department, AOU Città della Salute e della Scienza, Turin, Italy.
| | - Andrea Riccardo Filippi
- Department of Oncology, Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy.
| | - Monica Rampino
- Radiotherapy Department, AOU Città della Salute e della Scienza, Turin, Italy.
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy.
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334
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Filippi AR, Badellino S, Ceccarelli M, Guarneri A, Franco P, Monagheddu C, Spadi R, Ragona R, Racca P, Ricardi U. Stereotactic ablative radiation therapy as first local therapy for lung oligometastases from colorectal cancer: a single-institution cohort study. Int J Radiat Oncol Biol Phys 2014; 91:524-9. [PMID: 25542308 DOI: 10.1016/j.ijrobp.2014.10.046] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/07/2014] [Accepted: 10/24/2014] [Indexed: 12/18/2022]
Abstract
PURPOSE To estimate stereotactic ablative radiation therapy (SABR) efficacy and its potential role as an alternative to surgery for the treatment of lung metastases from colorectal cancer. METHODS AND MATERIALS Forty consecutive patients who received SABR as first local therapy at the time of lung progression were included, from 2004 to 2014. The primary study endpoint was overall survival. Secondary endpoints were progression-free survival and safety. RESULTS A single nodule was treated in 26 patients (65%), 2 nodules in 10 patients (25%), 3 in 3 patients (7.5%), and 4 in 1 patient (2.5%), for a total of 59 lesions. The median delivered biological effective dose was 96 Gy, in 1 to 8 daily fractions. Median follow-up time was 20 months (range, 3-72 months). Overall survival rates at 1, 2, and 5 years were, respectively, 84%, 73%, and 39%, with 14 patients (35%) dead. Median overall survival was 46 months. Progression occurred in 25 patients (62.5%), at a median interval of 8 months; failure at SABR site was observed in 3 patients (7.5%). Progression-free survival rates were 49% and 27% at 1 and 2 years, respectively. DISCUSSION The results of this retrospective exploratory analysis suggest safety and efficacy of SABR in patients affected with colorectal cancer lung oligometastases and urge inclusion of SABR in prospective clinical trials.
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Affiliation(s)
| | - Serena Badellino
- Department of Oncology, Radiation Oncology, University of Torino, Torino, Italy
| | - Manuela Ceccarelli
- Cancer Epidemiology and CPO Piemonte, Città della Salute e della Scienza, Torino, Italy
| | - Alessia Guarneri
- Radiation Oncology, Città della Salute e della Scienza, Torino, Italy
| | | | - Chiara Monagheddu
- Cancer Epidemiology and CPO Piemonte, Città della Salute e della Scienza, Torino, Italy
| | - Rosella Spadi
- Medical Oncology, Colorectal Cancer Unit, Città della Salute e della Scienza, Torino, Italy
| | - Riccardo Ragona
- Department of Oncology, Radiation Oncology, University of Torino, Torino, Italy
| | - Patrizia Racca
- Medical Oncology, Colorectal Cancer Unit, Città della Salute e della Scienza, Torino, Italy
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Torino, Torino, Italy
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335
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Ricardi U, Franco P, Munoz F, Levis M, Fiandra C, Guarneri A, Moretto F, Bartoncini S, Arcadipane F, Badellino S, Piva C, Trino E, Ruggieri A, Filippi AR, Ragona R. Three-Dimensional Ultrasound-Based Image-Guided Hypofractionated Radiotherapy for Intermediate-Risk Prostate Cancer: Results of a Consecutive Case Series. Cancer Invest 2014; 33:23-8. [DOI: 10.3109/07357907.2014.988343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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336
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Sciacero P, Girelli GF, Cante D, Franco P, Casanova Borca V, Grosso P, Marra A, Bombaci S, Tofani S, La Porta MR, Ricardi U. Cerebellar glioblastoma multiforme in an adult woman. Tumori 2014; 100:e74-8. [PMID: 25076255 DOI: 10.1700/1578.17236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND BACKGROUND Glioblastoma multiforme (GBM) is the most frequent primary central nervous system malignancy in adults, accounting for 50% of all primary intracranial malignancies. GBM mostly arises within the cerebral hemispheres and frequently affects patients in the fifth and sixth decades of life. Conversely, primary cerebellar GBM is a rather infrequent occurrence in the adult population, accounting for 1%-2.2% of all GBMs. Here we report a case of cerebellar GBM in an adult woman and provide an extensive review of the literature. METHODS A 42-year-old woman was referred to our hospital for occipital constrictive headache, dizziness and gait disturbance. Multimodality imaging including computed tomography and magnetic resonance imaging (MRI) showed a right cerebellar mass. Gross total resection was performed. Histological examination showed grade IV GBM according to the World Health Organization classification, with a synchronous component of low-grade glioma. Immunohistochemistry showed positivity for p53 and negativity for epidermal growth factor receptor (EGFR). After surgical tumor excision, the patient underwent adjuvant radiation to the posterior fossa with an intensity-modulated approach for a total dose of 60 Gy in 30 fractions. In addition, she received concurrent and adjuvant chemotherapy with temozolomide. RESULTS Treatment was well tolerated, with mild acute toxicity. There was no evidence of recurrence on brain and spinal gadolinium-enhanced MRI scans 4, 8 and 12 months after primary surgery. No late side effects were recorded. CONCLUSION Our patient had several immunohistochemical characteristics of secondary glioblastoma such as p53 positivity, EGFR negativity and the presence of a low-grade glioma component. Intensity-modulated radiation therapy allowed us to safely deliver full-dose radiation with sparing of critical structures.
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337
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Brignardello E, Palestini N, Felicetti F, Castiglione A, Piovesan A, Gallo M, Freddi M, Ricardi U, Gasparri G, Ciccone G, Arvat E, Boccuzzi G. Early surgery and survival of patients with anaplastic thyroid carcinoma: analysis of a case series referred to a single institution between 1999 and 2012. Thyroid 2014; 24:1600-6. [PMID: 25110922 DOI: 10.1089/thy.2014.0004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Extensive resection of the tumor has been associated with better survival of anaplastic thyroid carcinoma (ATC) patients. However, surgery is not the rule for ATC patients with distant metastases at the time of diagnosis (stage IV-C), regardless of tumor resectability. The aim of this work was to explore the potential role of surgery in ATC patients, including those in stage IV-C. METHODS We considered all the consecutive ATC patients referred to our institution from June 1999 to July 2012. Patients with stage IV-A incidentally discovered ATC were excluded because of their better prognosis. All patients eligible for surgery at the time of diagnosis were first operated with the intent to obtain a macroscopically complete resection (R0, R1), or a R2 resection with minimal macroscopical residual tumor. These operations were defined as "maximal debulking," whereas operations that did not achieve this goal were defined as "partial debulking." After surgery, almost all patients received adjuvant chemotherapy, associated to radiotherapy in more than 50% of patients. RESULTS There were 55 eligible patients (34 women; median age 73.15 years). Thirty-one patients had distant metastases (stage IV-C). The median overall survival was 5.55 months [CI 4.94-6.60], with no difference according to stage. "Maximal debulking" was obtained in 70.73% of operated patients as a first modality and resulted associated with better survival than "partial debulking" (6.57 months [CI 5.52-12.09] vs. 3.25 months [CI 0.66-4.80]), without any difference between stage IV-B and IV-C patients. Furthermore, 21% of patients submitted to "maximal debulking" died secondary to local progression of the tumor, whereas this was the case for 69% of patients treated with "partial debulking" or not operated at all. CONCLUSIONS Early "maximal debulking," followed by adjuvant therapy, can improve the survival and ameliorate the quality of residual life preventing the risk of suffocation. This effect is also observed in patients with distant metastasis at diagnosis and treated with this approach: they have an outcome similar to that observed in stage IV-B patients. We thus suggest that surgery may be considered in the management of all ATC patients, and should not be restricted a priori to stages IV-A and IV-B.
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Affiliation(s)
- Enrico Brignardello
- 1 Department of Oncology, AOU Città della Salute e della Scienza di Torino , Turin, Italy
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Franco P, Migliaccio F, Angelini V, Cante D, Sciacero P, Peruzzo Cornetto A, Casanova Borca V, Zeverino M, Torielli P, Arrichiello C, Girelli G, La Porta MR, Tofani S, Numico G, Ricardi U. Palliative radiotherapy for painful bone metastases from solid tumors delivered with static ports of tomotherapy (TomoDirect): feasibility and clinical results. Cancer Invest 2014; 32:458-63. [PMID: 25259607 DOI: 10.3109/07357907.2014.958495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the feasibility and response to palliative radiotherapy delivered with static ports of tomotherapy--TomoDirect (TD) in patients affected with painful bone metastases from solid tumors. METHODS A prospective cohort of 130 patients (185 osseous lesions) was treated between 2010 and 2013 with TD. Three fractionation schedules were employed according to clinical decision-making (3 Gy × 10; 4 Gy × 5; 8 Gy × 1). Pain response was investigated at 2 weeks and 2 months (for evaluable patients). The Numeric Rating Scale (NRS-11) was used to assess pain. Response rates to radiotherapy were calculated following the criteria of the International Bone Metastases Consensus Group (IBMCG), accounting for the use of concomitant analgesics (response: complete or partial; non-response: stable pain, pain progression or "other"). Analgesic consumption was recalculated into the daily oral morphine-equivalent dose (OMED). RESULTS Most of the patients had 1-2 bone metastases (91); those with multiple lesions mostly had a metachronous presentation (60%). Synchronous lesions were mainly approached with multiple plans (63%). Most treatments employed 3-4 fields (77%). Treatment times ranged from 255 to 939 s depending on fractionation, fields, and target lesions number. At 2 weeks, the median self-reported worst pain decreased significantly as median oral morphine-equivalent dose regardless of fractionation used. The response rate according to the IBMCG-based response categories ranged from 45 to 55%. Pain relief duration seems (response at 2 months) slightly inferior with the single fraction approach, with a higher re-treatment rate. At 2 weeks, the median self-reported worst pain and OMED significantly decreased regardless of fractionation (response rate: 49-55%). Pain relief decreased at 2 months, especially for single fraction (higher re-treatment rate). CONCLUSION TD is a valid option to deliver palliative radiotherapy for painful bone metastases from solid tumors.
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Lohr F, Georg D, Cozzi L, Eich HT, Weber DC, Koeck J, Knäusl B, Dieckmann K, Abo-Madyan Y, Fiandra C, Mueller RP, Engert A, Ricardi U. Novel radiotherapy techniques for involved-field and involved-node treatment of mediastinal Hodgkin lymphoma: when should they be considered and which questions remain open? Strahlenther Onkol 2014; 190:864-6, 868-71. [PMID: 25209551 DOI: 10.1007/s00066-014-0719-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 07/01/2014] [Indexed: 01/10/2023]
Abstract
PURPOSE Hodgkin lymphoma (HL) is a highly curable disease. Reducing late complications and second malignancies has become increasingly important. Radiotherapy target paradigms are currently changing and radiotherapy techniques are evolving rapidly. DESIGN This overview reports to what extent target volume reduction in involved-node (IN) and advanced radiotherapy techniques, such as intensity-modulated radiotherapy (IMRT) and proton therapy-compared with involved-field (IF) and 3D radiotherapy (3D-RT)- can reduce high doses to organs at risk (OAR) and examines the issues that still remain open. RESULTS Although no comparison of all available techniques on identical patient datasets exists, clear patterns emerge. Advanced dose-calculation algorithms (e.g., convolution-superposition/Monte Carlo) should be used in mediastinal HL. INRT consistently reduces treated volumes when compared with IFRT with the exact amount depending on the INRT definition. The number of patients that might significantly benefit from highly conformal techniques such as IMRT over 3D-RT regarding high-dose exposure to organs at risk (OAR) is smaller with INRT. The impact of larger volumes treated with low doses in advanced techniques is unclear. The type of IMRT used (static/rotational) is of minor importance. All advanced photon techniques result in similar potential benefits and disadvantages, therefore only the degree-of-modulation should be chosen based on individual treatment goals. Treatment in deep inspiration breath hold is being evaluated. Protons theoretically provide both excellent high-dose conformality and reduced integral dose. CONCLUSION Further reduction of treated volumes most effectively reduces OAR dose, most likely without disadvantages if the excellent control rates achieved currently are maintained. For both IFRT and INRT, the benefits of advanced radiotherapy techniques depend on the individual patient/target geometry. Their use should therefore be decided case by case with comparative treatment planning.
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Affiliation(s)
- Frank Lohr
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany,
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Lo S, Redmond K, Poon I, Foote M, Dagan R, Lohr F, Ricardi U, Sahgal A. A Multi-National Report on Technical Factors of Stereotactic Body Radiation Therapy for Oligometastases. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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341
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Dabaja B, Tsang R, Qi S, Allen P, Hodgson D, Ricardi U, Hoppe R, Ng A, Mauch P, Specht L, Li Y, Terezakis S, Wirth A, Reinartz G, Eich H, Aleman B, Constine L, Yahalom J. Favorable Outcome in Stage I-II Mantle Cell Lymphoma: A Report of 160 Patients From the International Lymphoma Radiation Oncology Group (ILROG). Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ashworth A, Senan S, Palma D, Riquet M, Ahn Y, Ricardi U, Congedo M, Gomez D, Wright G, Melloni G, Milano M, Sole C, De Pas T, Carter D, Warner A, Rodrigues G. An Individual Patient Data Meta-analysis of Outcomes and Prognostic Factors After Treatment of Oligometastatic Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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343
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Moretto F, Mantovani C, Giaj Levra N, Levis M, De Colle C, Trevisan E, Magistrello M, Ruda R, Soffietti R, Ricardi U. P13.19 * HYPOFRACTIONATED RADIOTHERAPY IN PATIENTS WITH HIGH GRADE GLIOMAS AND POOR PROGNOSTIC FACTORS: A RETROSPECTIVE STUDY. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou174.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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344
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Fiandra C, Guarneri A, Muñoz F, Moretto F, Filippi AR, Levis M, Ragona R, Ricardi U. Impact of the observers' experience on daily prostate localization accuracy in ultrasound-based IGRT with the Clarity platform. J Appl Clin Med Phys 2014; 15:4795. [PMID: 25207407 PMCID: PMC5875522 DOI: 10.1120/jacmp.v15i4.4795] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 04/15/2014] [Accepted: 04/02/2014] [Indexed: 12/03/2022] Open
Abstract
The aim of this study is to evaluate the accuracy of daily prostate localization with ultrasound imaging of various radiation oncologists with nonhomogeneous expertise. For ten patients who underwent radical radiotherapy for localized prostate cancer, 11 radiation oncologists reviewed daily ultrasound scans acquired during three different treatment sessions. The average values of two senior radiation oncologists, considered to be expert observers, were selected as reference. The remaining nine observers were divided into two groups, Group 1 and Group 2, with more and less than one year of experience, respectively. The recorded shifts in prostate position were divided in three classes: <3 mm, 3–5 mm, and > 5 mm. Deviations from reference were less than 3 mm in all directions in 91% and 81% of measurements in Groups 1 and 2, respectively. The maximum difference in terms of root mean square error (RMSE) was reported for superior‐inferior (SI) direction, in particular a mean difference of 3.24 mm was observed for Group 2 in respect to the reference; moreover RMSE was 1 and 1.3 mm higher for Group 2 for anterior‐posterior (AP) and left‐right (LR) directions, respectively. The difference between Groups 1 and 2 was significant (p < 0.01) for all directions. The mean values for the shifts in all three directions between Group 1 and the references were 0.235 mm, 0.385 mm, and 0.009 mm for the LR, SI, and AP directions, respectively. The position of the prostate gland is more easily detectable (p=0.02) in the AP direction, while the visibility is lower for LR (p=0.02) and SI boundaries (p < 0.05). The observers' experience is essential for positioning the target correctly; therefore, a training period is recommended before putting the system into clinical practice. PACS number: 87.63.dh
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Maggio A, Magli A, Rancati T, Fiorino C, Valvo F, Fellin G, Ricardi U, Munoz F, Cosentino D, Cazzaniga LF, Valdagni R, Vavassori V. Daily Sodium Butyrate Enema for the Prevention of Radiation Proctitis in Prostate Cancer Patients Undergoing Radical Radiation Therapy: Results of a Multicenter Randomized Placebo-Controlled Dose-Finding Phase 2 Study. Int J Radiat Oncol Biol Phys 2014; 89:518-24. [DOI: 10.1016/j.ijrobp.2014.03.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/10/2014] [Accepted: 03/12/2014] [Indexed: 11/29/2022]
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Fusella M, Fiandra C, Giglioli F, Ricardi U, Ragona R. SU-E-T-84: Comparison of Three Different Systems for Patient-Specific Quality Assurance: Cranial Stereotactic Radiosurgery Using VMAT with Multiple Non Coplanar Arcs. Med Phys 2014. [DOI: 10.1118/1.4888414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kannan V, Misra BK, Kapadia A, Bajpai R, Deshpande S, Almel S, Sankhe M, Desai K, Shaikh M, Anand V, Kannan A, Teo WY, Ross J, Bollo R, Seow WT, Tan AM, Kang SG, Kim DS, Li XN, Lau CC, Mohila CA, Adesina A, Su J, Ichimura K, Fukushima S, Matsushita Y, Tomiyama A, Niwa T, Suzuki T, Nakazato Y, Mukasa A, Kumabe T, Nagane M, Iuchi T, Mizoguchi M, Tamura K, Sugiyama K, Nakada M, Kanemura Y, Yokogami K, Matsutani M, Shibata T, Nishikawa R, Takami H, Fukushima S, Fukuoka K, Yanagisawa T, Nakamura T, Arita H, Narita Y, Shibui S, Nishikawa R, Ichimura K, Matsutani M, Sands S, Guerry W, Kretschmar C, Donahue B, Allen J, Matsutani M, Nishikawa R, Kumabe T, Sugiyama K, Nakamura H, Sawamura Y, Fujimaki T, Hattori E, Arakawa Y, Kawabata Y, Aoki T, Miyamoto S, Kagawa N, Hirayama R, Fujimoto Y, Chiba Y, Kinoshita M, Takano K, Eino D, Fukuya S, Nakanishi K, Yamamoto F, Hashii Y, Hashimoto N, Hara J, Yoshimine T, Murray M, Bartels U, Nishikawa R, Fangusaro J, Matsutani M, Nicholson J, Sumerauer D, Zapotocky M, Churackova M, Cyprova S, Zamecnik J, Malinova B, Kyncl M, Tichy M, Stary J, Lassen-Ramshad Y, von Oettingen G, Agerbaek M, Ohnishi T, Kohno S, Inoue A, Ohue S, Kohno S, Iwata S, Inoue A, Ohue S, Kumon Y, Ohnishi T, Acharya S, DeWees T, Shinohara E, Perkins S, Kato H, Fuji H, Nakasu Y, Ishida Y, Okawada S, Yang Q, Guo C, Chen Z, Alapetite C, Faure-Conter C, Verite C, Pagnier A, Laithier V, Entz-Werle N, Gorde-Grosjean S, Palenzuela G, Lemoine P, Frappaz D, Nguyen HA, Bui L, Ngoc, Cerbone M, Ederies A, Losa L, Moreno C, Sun K, Spoudeas HA, Nakano Y, Okada K, Kosaka Y, Nagashima T, Hashii Y, Kagawa N, Soejima T, Osugi Y, Sakamoto H, Hara J, Nicholson J, Alapetite C, Kortmann RD, Garre ML, Ricardi U, Saran F, Frappaz D, Calaminus G, Muda Z, Menon B, Ibrahim H, Rahman EJA, Muhamad M, Othman IS, Thevarajah A, Cheng S, Kilday JP, Laperriere N, Drake J, Bouffet E, Bartels U, Sakamoto H, Matsusaka Y, Watanabe Y, Umaba R, Hara J, Osugi Y, Alapetite C, Ruffier-Loubiere A, De Marzi L, Bolle S, Claude L, Habrand JL, Brisse H, Frappaz D, Doz F, Bourdeaut F, Dendale R, Mazal A, Fournier-Bidoz N, Fujimaki T, Fukuoka K, Shirahata M, Suzuki T, Adachi JI, Mishima K, Wakiya K, Matsutani M, Nishikawa R, Fukushima S, Yamashita S, Kato M, Nakamura H, Takami H, Suzuki T, Yanagisawa T, Mukasa A, Kumabe T, Nagane M, Sugiyama K, Tamura K, Narita Y, Shibui S, Shibata T, Ushijima T, Matsutani M, Nishikawa R, Ichimura K, Consortium IGA, Calaminus G, Kortmann RD, Frappaz D, Alapetite C, Garre ML, Ricardi U, Saran FH, Nicholson J, Calaminus G, Kortmann RD, Frappaz D, Alapetite C, Garre ML, Ricardi U, Saran FH, Nicholson J, Czech T, Nicholson J, Frappaz D, Kortmann RD, Alapetite C, Garre ML, Ricardi U, Saran F, Calaminus G, Hayden J, Bartels U, Calaminus G, Joseph R, Nicholson J, Hale J, Lindsay H, Kogiso M, Qi L, Yee TW, Huang Y, Mao H, Lin F, Baxter P, Su J, Terashima K, Perlaky L, Lau C, Parsons D, Chintagumpala M, Li XAN, Osorio D, Vaughn D, Gardner S, Mrugala M, Ferreira M, Keene C, Gonzalez-Cuyar L, Hebb A, Rockhill J, Wang L, Yamaguchi S, Burstein M, Terashima K, Ng HK, Nakamura H, He Z, Suzuki T, Nishikawa R, Natsume A, Terasaka S, Dauser R, Whitehead W, Adesina A, Sun J, Munzy D, Gibbs R, Leal S, Wheeler D, Lau C, Dhall G, Robison N, Judkins A, Krieger M, Gilles F, Park J, Lee SU, Kim T, Choi Y, Park HJ, Shin SH, Kim JY, Robison N, Dhir N, Khamani J, Margol A, Wong K, Britt B, Evans A, Nelson M, Grimm J, Finlay J, Dhall G. GERM CELL TUMOURS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ricardi U, Frezza G, Filippi AR, Badellino S, Levis M, Navarria P, Salvi F, Marcenaro M, Trovò M, Guarneri A, Corvò R, Scorsetti M. Stereotactic Ablative Radiotherapy for stage I histologically proven non-small cell lung cancer: An Italian multicenter observational study. Lung Cancer 2014; 84:248-53. [DOI: 10.1016/j.lungcan.2014.02.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 02/23/2014] [Accepted: 02/25/2014] [Indexed: 10/25/2022]
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Franco P, Zeverino M, Migliaccio F, Torielli P, Angelini V, Sciacero P, Girelli G, Cante D, Arrichiello C, Casanova Borca V, Numico G, La Porta MR, Tofani S, Ricardi U. Minimizing a tricky situation in breast irradiation with helical tomotherapy. Tumori 2014. [PMID: 24852873 DOI: 10.1700/1491.16429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report on a patient with breast cancer undergoing adjuvant intensity-modulated whole breast and lymph node irradiation with static angle tomotherapy (TomoDirect), who experienced a traumatic ipsilateral humeral fracture and was able to continue radiotherapy with helical tomotherapy and daily dosimetric monitoring by means of the Planned Adaptive module.
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Zucca E, Copie-Bergman C, Ricardi U, Thieblemont C, Raderer M, Ladetto M. Gastric marginal zone lymphoma of MALT type: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 24 Suppl 6:vi144-8. [PMID: 24078657 DOI: 10.1093/annonc/mdt343] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- E Zucca
- Lymphoma Unit, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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