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Bussu F, Fionda B, Rigante M, Rizzo D, Loperfido A, Gallus R, De Luca LM, Corbisiero MF, Lancellotta V, Tondo A, D’Aviero A, Mattiucci GC, Kovacs G, Galli J, Tagliaferri L. Interventional radiotherapy (brachytherapy) for re-irradiation of recurrent head and neck malignancies: oncologic outcomes and morbidity. Acta Otorhinolaryngol Ital 2024; 44:S28-S36. [PMID: 38745514 PMCID: PMC11098534 DOI: 10.14639/0392-100x-suppl.1-44-2024-n2824] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/12/2024] [Indexed: 05/16/2024]
Abstract
Objective Management of recurrent head and neck cancer (HNC) is challenging. One option in previously irradiated patients is re-irradiation using interventional radiotherapy (IRT), the modern form of brachytherapy. Re-irradiation using IRT can be delivered as an exclusive strategy for salvage or through a postoperative or perioperative approach after salvage surgery. The aim of the present study is to analyse a bicentric Italian series focusing on the use of IRT as a re-irradiation modality and assess the resulting evidence concerning oncologic outcomes and morbidity. Methods This is a retrospective study performed in two referral centres in Italy: Policlinico Universitario Agostino Gemelli in Rome and Azienda Ospedaliera Universitaria in Sassari. All patients who had previously received a full course of external beam RT and have been re-irradiated using high-dose-rate IRT between December 2010 and June 2023 were included. Patients were retreated either by a combination of surgery and perioperative (either endocavitary or interstitial) IRT or by exclusive interstitial IRT. Results Thirty-four patients were included in the present series, 2 of whom underwent more than one IRT re-irradiation. Notably, no patient reported specific IRT-related toxicities. Median follow-up, excluding patients who died of HNC, was 24.5 months. Two-year local relapse-free survival was 26%, disease-specific survival 39.1%, and overall survival 36.6%. Conclusions The present series is the largest reported experience of re-irradiation by IRT for HNC in Italy. The very low rate of toxicity confirms IRT as the safest re-irradiation modality. It is noteworthy to underline that IRT is a multidisciplinary strategy based on the close cooperation between surgeons and radiation oncologists during every phase, from the recommendation of treatment and implantation in the operating theatre, to its prescription and dose painting.
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Affiliation(s)
- Francesco Bussu
- Divisione di Otorinolaringoiatria, Azienda Ospedaliera Universitaria, Sassari, Italy
- Dipartimento di Medicina, Chirurgia e Farmacia, Università di Sassari, Sassari, Italy
| | - Bruno Fionda
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Mario Rigante
- UOC Otorinolaringoiatria, Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Davide Rizzo
- Divisione di Otorinolaringoiatria, Azienda Ospedaliera Universitaria, Sassari, Italy
- Dipartimento di Medicina, Chirurgia e Farmacia, Università di Sassari, Sassari, Italy
| | - Antonella Loperfido
- UOC Otorinolaringoiatria, Dipartimento Testa, Collo e delle Neuroscienze, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Roberto Gallus
- Divisione di Otorinolaringoiatria, Mater Olbia Hospital, Olbia, Italy
| | - Laura Maria De Luca
- Divisione di Otorinolaringoiatria, Azienda Ospedaliera Universitaria, Sassari, Italy
| | - Michaele Francesco Corbisiero
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Valentina Lancellotta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Andrea Tondo
- Divisione di Otorinolaringoiatria, Azienda Ospedaliera Universitaria, Sassari, Italy
| | - Andrea D’Aviero
- UO di Radioterapia Oncologica, Mater Olbia Hospital, Olbia, Italy
| | | | - Gyorgy Kovacs
- Università Cattolica del Sacro Cuore, Gemelli-INTERACTS, Rome, Italy
| | - Jacopo Galli
- UOC Otorinolaringoiatria, Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
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2
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Vagni M, Tran HE, Catucci F, Chiloiro G, D’Aviero A, Re A, Romano A, Boldrini L, Kawula M, Lombardo E, Kurz C, Landry G, Belka C, Indovina L, Gambacorta MA, Cusumano D, Placidi L. Impact of bias field correction on 0.35 T pelvic MR images: evaluation on generative adversarial network-based OARs' auto-segmentation and visual grading assessment. Front Oncol 2024; 14:1294252. [PMID: 38606108 PMCID: PMC11007142 DOI: 10.3389/fonc.2024.1294252] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
Purpose Magnetic resonance imaging (MRI)-guided radiotherapy enables adaptive treatment plans based on daily anatomical changes and accurate organ visualization. However, the bias field artifact can compromise image quality, affecting diagnostic accuracy and quantitative analyses. This study aims to assess the impact of bias field correction on 0.35 T pelvis MRIs by evaluating clinical anatomy visualization and generative adversarial network (GAN) auto-segmentation performance. Materials and methods 3D simulation MRIs from 60 prostate cancer patients treated on MR-Linac (0.35 T) were collected and preprocessed with the N4ITK algorithm for bias field correction. A 3D GAN architecture was trained, validated, and tested on 40, 10, and 10 patients, respectively, to auto-segment the organs at risk (OARs) rectum and bladder. The GAN was trained and evaluated either with the original or the bias-corrected MRIs. The Dice similarity coefficient (DSC) and 95th percentile Hausdorff distance (HD95th) were computed for the segmented volumes of each patient. The Wilcoxon signed-rank test assessed the statistical difference of the metrics within OARs, both with and without bias field correction. Five radiation oncologists blindly scored 22 randomly chosen patients in terms of overall image quality and visibility of boundaries (prostate, rectum, bladder, seminal vesicles) of the original and bias-corrected MRIs. Bennett's S score and Fleiss' kappa were used to assess the pairwise interrater agreement and the interrater agreement among all the observers, respectively. Results In the test set, the GAN trained and evaluated on original and bias-corrected MRIs showed DSC/HD95th of 0.92/5.63 mm and 0.92/5.91 mm for the bladder and 0.84/10.61 mm and 0.83/9.71 mm for the rectum. No statistical differences in the distribution of the evaluation metrics were found neither for the bladder (DSC: p = 0.07; HD95th: p = 0.35) nor for the rectum (DSC: p = 0.32; HD95th: p = 0.63). From the clinical visual grading assessment, the bias-corrected MRI resulted mostly in either no change or an improvement of the image quality and visualization of the organs' boundaries compared with the original MRI. Conclusion The bias field correction did not improve the anatomy visualization from a clinical point of view and the OARs' auto-segmentation outputs generated by the GAN.
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Affiliation(s)
- Marica Vagni
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Huong Elena Tran
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | | | - Giuditta Chiloiro
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | | | | | - Angela Romano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Maria Kawula
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Elia Lombardo
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christopher Kurz
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, A Partnership Between DKFZ and LMU University Hospital Munich, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Luca Indovina
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Maria Antonietta Gambacorta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Davide Cusumano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
- Mater Olbia Hospital, Olbia, Italy
| | - Lorenzo Placidi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
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D’Aviero A, Re A, Catucci F, Piccari D, Votta C, Piro D, Piras A, Di Dio C, Iezzi M, Preziosi F, Menna S, Quaranta F, Boschetti A, Marras M, Miccichè F, Gallus R, Indovina L, Bussu F, Valentini V, Cusumano D, Mattiucci GC. Clinical Validation of a Deep-Learning Segmentation Software in Head and Neck: An Early Analysis in a Developing Radiation Oncology Center. Int J Environ Res Public Health 2022; 19:ijerph19159057. [PMID: 35897425 PMCID: PMC9329735 DOI: 10.3390/ijerph19159057] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/12/2022] [Accepted: 07/20/2022] [Indexed: 02/01/2023]
Abstract
Background: Organs at risk (OARs) delineation is a crucial step of radiotherapy (RT) treatment planning workflow. Time-consuming and inter-observer variability are main issues in manual OAR delineation, mainly in the head and neck (H & N) district. Deep-learning based auto-segmentation is a promising strategy to improve OARs contouring in radiotherapy departments. A comparison of deep-learning-generated auto-contours (AC) with manual contours (MC) was performed by three expert radiation oncologists from a single center. Methods: Planning computed tomography (CT) scans of patients undergoing RT treatments for H&N cancers were considered. CT scans were processed by Limbus Contour auto-segmentation software, a commercial deep-learning auto-segmentation based software to generate AC. H&N protocol was used to perform AC, with the structure set consisting of bilateral brachial plexus, brain, brainstem, bilateral cochlea, pharyngeal constrictors, eye globes, bilateral lens, mandible, optic chiasm, bilateral optic nerves, oral cavity, bilateral parotids, spinal cord, bilateral submandibular glands, lips and thyroid. Manual revision of OARs was performed according to international consensus guidelines. The AC and MC were compared using the Dice similarity coefficient (DSC) and 95% Hausdorff distance transform (DT). Results: A total of 274 contours obtained by processing CT scans were included in the analysis. The highest values of DSC were obtained for the brain (DSC 1.00), left and right eye globes and the mandible (DSC 0.98). The structures with greater MC editing were optic chiasm, optic nerves and cochleae. Conclusions: In this preliminary analysis, deep-learning auto-segmentation seems to provide acceptable H&N OAR delineations. For less accurate organs, AC could be considered a starting point for review and manual adjustment. Our results suggest that AC could become a useful time-saving tool to optimize workload and resources in RT departments.
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Affiliation(s)
- Andrea D’Aviero
- Radiation Oncology, Mater Olbia Hospital, 07026 Olbia, Italy; (A.D.); (A.R.); (F.C.); (C.V.); (D.P.); (C.D.D.); (M.I.); (F.P.); (A.B.); (M.M.); (G.C.M.)
| | - Alessia Re
- Radiation Oncology, Mater Olbia Hospital, 07026 Olbia, Italy; (A.D.); (A.R.); (F.C.); (C.V.); (D.P.); (C.D.D.); (M.I.); (F.P.); (A.B.); (M.M.); (G.C.M.)
| | - Francesco Catucci
- Radiation Oncology, Mater Olbia Hospital, 07026 Olbia, Italy; (A.D.); (A.R.); (F.C.); (C.V.); (D.P.); (C.D.D.); (M.I.); (F.P.); (A.B.); (M.M.); (G.C.M.)
| | - Danila Piccari
- Radiation Oncology, Mater Olbia Hospital, 07026 Olbia, Italy; (A.D.); (A.R.); (F.C.); (C.V.); (D.P.); (C.D.D.); (M.I.); (F.P.); (A.B.); (M.M.); (G.C.M.)
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (F.M.); (L.I.); (V.V.)
- Correspondence:
| | - Claudio Votta
- Radiation Oncology, Mater Olbia Hospital, 07026 Olbia, Italy; (A.D.); (A.R.); (F.C.); (C.V.); (D.P.); (C.D.D.); (M.I.); (F.P.); (A.B.); (M.M.); (G.C.M.)
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (F.M.); (L.I.); (V.V.)
| | - Domenico Piro
- Radiation Oncology, Mater Olbia Hospital, 07026 Olbia, Italy; (A.D.); (A.R.); (F.C.); (C.V.); (D.P.); (C.D.D.); (M.I.); (F.P.); (A.B.); (M.M.); (G.C.M.)
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (F.M.); (L.I.); (V.V.)
| | - Antonio Piras
- UO Radioterapia Oncologica, Villa Santa Teresa, 90011 Bagheria, Italy;
| | - Carmela Di Dio
- Radiation Oncology, Mater Olbia Hospital, 07026 Olbia, Italy; (A.D.); (A.R.); (F.C.); (C.V.); (D.P.); (C.D.D.); (M.I.); (F.P.); (A.B.); (M.M.); (G.C.M.)
| | - Martina Iezzi
- Radiation Oncology, Mater Olbia Hospital, 07026 Olbia, Italy; (A.D.); (A.R.); (F.C.); (C.V.); (D.P.); (C.D.D.); (M.I.); (F.P.); (A.B.); (M.M.); (G.C.M.)
| | - Francesco Preziosi
- Radiation Oncology, Mater Olbia Hospital, 07026 Olbia, Italy; (A.D.); (A.R.); (F.C.); (C.V.); (D.P.); (C.D.D.); (M.I.); (F.P.); (A.B.); (M.M.); (G.C.M.)
| | - Sebastiano Menna
- Medical Physics, Mater Olbia Hospital, 07026 Sassari, Italy; (S.M.); (F.Q.); (D.C.)
| | | | - Althea Boschetti
- Radiation Oncology, Mater Olbia Hospital, 07026 Olbia, Italy; (A.D.); (A.R.); (F.C.); (C.V.); (D.P.); (C.D.D.); (M.I.); (F.P.); (A.B.); (M.M.); (G.C.M.)
| | - Marco Marras
- Radiation Oncology, Mater Olbia Hospital, 07026 Olbia, Italy; (A.D.); (A.R.); (F.C.); (C.V.); (D.P.); (C.D.D.); (M.I.); (F.P.); (A.B.); (M.M.); (G.C.M.)
| | - Francesco Miccichè
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (F.M.); (L.I.); (V.V.)
| | - Roberto Gallus
- Otolaryngology, Mater Olbia Hospital, 07026 Sassari, Italy;
| | - Luca Indovina
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (F.M.); (L.I.); (V.V.)
| | - Francesco Bussu
- Otolaryngology, Azienda Ospedaliero Universitaria di Sassari, 07100 Sassari, Italy;
- Dipartimento delle Scienze Mediche, Chirurgiche e Sperimentali, Università di Sassari, 07100 Sassari, Italy
| | - Vincenzo Valentini
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (F.M.); (L.I.); (V.V.)
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Davide Cusumano
- Medical Physics, Mater Olbia Hospital, 07026 Sassari, Italy; (S.M.); (F.Q.); (D.C.)
| | - Gian Carlo Mattiucci
- Radiation Oncology, Mater Olbia Hospital, 07026 Olbia, Italy; (A.D.); (A.R.); (F.C.); (C.V.); (D.P.); (C.D.D.); (M.I.); (F.P.); (A.B.); (M.M.); (G.C.M.)
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
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Piras A, Venuti V, D’Aviero A, Cusumano D, Pergolizzi S, Daidone A, Boldrini L. Covid-19 and radiotherapy: a systematic review after 2 years of pandemic. Clin Transl Imaging 2022; 10:611-630. [PMID: 35910079 PMCID: PMC9308500 DOI: 10.1007/s40336-022-00513-9] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/12/2022] [Indexed: 02/08/2023]
Abstract
Introduction Following the Covid-19 pandemic spread, changes in clinical practice were necessary to limit the pandemic diffusion. Also, oncological practice has undergone changes with radiotherapy (RT) treatments playing a key role.Although several experiences have been published, the aim of this review is to summarize the current evidence after 2 years of pandemic to provide useful conclusions for clinicians. Methods A Pubmed/MEDLINE and Embase systematic review was conducted. The search strategy was "Covid AND Radiotherapy" and only original articles in the English language were considered. Results A total of 2.733 papers were obtained using the mentioned search strategy. After the complete selection process, a total of 281 papers were considered eligible for the analysis of the results. Discussion RT has played a key role in Covid-19 pandemic as it has proved more resilient than surgery and chemotherapy. The impact of the accelerated use of hypofractionated RT and telemedicine will make these strategies central also in the post-pandemic period.
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Affiliation(s)
- Antonio Piras
- Radioterapia Oncologica, Villa Santa Teresa, Palermo, Italy
| | - Valeria Venuti
- Radioterapia Oncologica, Università degli Studi di Palermo, Palermo, Italy
| | - Andrea D’Aviero
- Radiation Oncology, Mater Olbia Hospital, Olbia, Sassari Italy
| | | | - Stefano Pergolizzi
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | | | - Luca Boldrini
- Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica - Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
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5
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Tagliaferri L, Lancellotta V, Fionda B, Mangoni M, Casà C, Di Stefani A, Pagliara MM, D’Aviero A, Schinzari G, Chiesa S, Mazzarella C, Manfrida S, Colloca GF, Marazzi F, Morganti AG, Blasi MA, Peris K, Tortora G, Valentini V. Immunotherapy and radiotherapy in melanoma: a multidisciplinary comprehensive review. Hum Vaccin Immunother 2022; 18:1903827. [PMID: 33847208 PMCID: PMC9122308 DOI: 10.1080/21645515.2021.1903827] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Melanoma is an extremely aggressive tumor and is considered to be an extremely immunogenic tumor because compared to other cancers it usually presents a well-expressed lymphoid infiltration. The aim of this paper is to perform a multidisciplinary comprehensive review of the evidence available about the combination of radiotherapy and immunotherapy for melanoma. Radiation, in fact, can increase tumor antigens visibility and promote priming of T cells but can also exert immunosuppressive action on tumor microenvironment. Combining radiotherapy with immunotherapy provides an opportunity to increase immunostimulatory potential of radiation. We therefore provide the latest clinical evidence about radiobiological rationale, radiotherapy techniques, timing, and role both in advanced and systemic disease (with a special focus on ocular melanoma and brain, liver, and bone metastases) with a particular attention also in geriatric patients. The combination of immunotherapy and radiotherapy seems to be a safe therapeutic option, supported by a clear biological rationale, even though the available data confirm that radiotherapy is employed more for metastatic than for non-metastatic disease. Such a combination shows promising results in terms of survival outcomes; however, further studies, hopefully prospective, are needed to confirm such evidence.
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Affiliation(s)
- Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Valentina Lancellotta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Bruno Fionda
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
- CONTACT Bruno Fionda UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli, 8, Roma00168, Italy
| | - Monica Mangoni
- Sezione di Radioterapia Oncologica, Dipartimento di Scienze Biomediche Sperimentali e Cliniche, Università di Firenze, Florence, Italy
| | - Calogero Casà
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Alessandro Di Stefani
- UOC Dermatologia, Dipartimento di Scienze mediche e chirurgiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Monica Maria Pagliara
- UOC Oncologia Oculare, Dipartimento di Scienze dell'Invecchiamento, neurologiche ortopediche e della testa collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Andrea D’Aviero
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Giovanni Schinzari
- UOC Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Silvia Chiesa
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Ciro Mazzarella
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Stefania Manfrida
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Giuseppe Ferdinando Colloca
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Fabio Marazzi
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Alessio Giuseppe Morganti
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Settore Scientifico Disciplinare, Università di Bologna, Bologna, Italy
| | - Maria Antonietta Blasi
- UOC Oncologia Oculare, Dipartimento di Scienze dell'Invecchiamento, neurologiche ortopediche e della testa collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Ketty Peris
- UOC Dermatologia, Dipartimento di Scienze mediche e chirurgiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giampaolo Tortora
- UOC Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Vincenzo Valentini
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
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6
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Iezzi M, Cusumano D, Piccari D, Menna S, Catucci F, D’Aviero A, Re A, Di Dio C, Quaranta F, Boschetti A, Marras M, Piro D, Tomei F, Votta C, Valentini V, Mattiucci GC. Dosimetric Impact of Inter-Fraction Variability in the Treatment of Breast Cancer: Towards New Criteria to Evaluate the Appropriateness of Online Adaptive Radiotherapy. Front Oncol 2022; 12:838039. [PMID: 35480103 PMCID: PMC9035849 DOI: 10.3389/fonc.2022.838039] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/11/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose As a discipline in its infancy, online adaptive RT (ART) needs new ontologies and ad hoc criteria to evaluate the appropriateness of its use in clinical practice. In this experience, we propose a predictive model able to quantify the dosimetric impact due to daily inter-fraction variability in a standard RT breast treatment, to identify in advance the treatment fractions where patients might benefit from an online ART approach. Methods The study was focused on right breast cancer patients treated using standard adjuvant RT on an artificial intelligence (AI)-based linear accelerator. Patients were treated with daily CBCT images and without online adaptation, prescribing 40.05 Gy in 15 fractions, with four IMRT tangential beams. ESTRO guidelines were followed for the delineation on planning CT (pCT) of organs at risk and targets. For each patient, all the CBCT images were rigidly aligned to pCT: CTV and PTV were manually re-contoured and the original treatment plan was recalculated. Various radiological parameters were measured on CBCT images, to quantify inter-fraction variability present in each RT fraction after the couch shifts compensation. The variation of these parameters was correlated with the variation of V95% of PTV (ΔV95%) using the Wilcoxon Mann–Whitney test. Fractions where ΔV95% > 2% were considered as adverse events. A logistic regression model was calculated considering the most significant parameter, and its performance was quantified with a receiver operating characteristic (ROC) curve. Results A total of 75 fractions on 5 patients were analyzed. The body variation between daily CBCT and pCT along the beam axis with the highest MU was identified as the best predictor (p = 0.002). The predictive model showed an area under ROC curve of 0.86 (95% CI, 0.82–0.99) with a sensitivity of 85.7% and a specificity of 83.8% at the best threshold, which was equal to 3 mm. Conclusion A novel strategy to identify treatment fractions that may benefit online ART was proposed. After image alignment, the measure of body difference between daily CBCT and pCT can be considered as an indirect estimator of V95% PTV variation: a difference larger than 3 mm will result in a V95% decrease larger than 2%. A larger number of observations is needed to confirm the results of this hypothesis-generating study.
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Affiliation(s)
| | - Davide Cusumano
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- UOC Radioterapia Oncologica, Mater Olbia Hospital, Olbia, Italy
- *Correspondence: Davide Cusumano,
| | - Danila Piccari
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- UOC Radioterapia Oncologica, Mater Olbia Hospital, Olbia, Italy
| | - Sebastiano Menna
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- UOC Radioterapia Oncologica, Mater Olbia Hospital, Olbia, Italy
| | | | - Andrea D’Aviero
- UOC Radioterapia Oncologica, Mater Olbia Hospital, Olbia, Italy
| | - Alessia Re
- UOC Radioterapia Oncologica, Mater Olbia Hospital, Olbia, Italy
| | - Carmela Di Dio
- UOC Radioterapia Oncologica, Mater Olbia Hospital, Olbia, Italy
| | | | | | - Marco Marras
- UOC Radioterapia Oncologica, Mater Olbia Hospital, Olbia, Italy
| | - Domenico Piro
- UOC Radioterapia Oncologica, Mater Olbia Hospital, Olbia, Italy
| | - Flavia Tomei
- UOC Radioterapia Oncologica, Mater Olbia Hospital, Olbia, Italy
| | - Claudio Votta
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- UOC Radioterapia Oncologica, Mater Olbia Hospital, Olbia, Italy
| | - Vincenzo Valentini
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gian Carlo Mattiucci
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- UOC Radioterapia Oncologica, Mater Olbia Hospital, Olbia, Italy
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7
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Cellini F, Manfrida S, Casà C, Romano A, Arcelli A, Zamagni A, De Luca V, Colloca GF, D’Aviero A, Fuccio L, Lancellotta V, Tagliaferri L, Boldrini L, Mattiucci GC, Gambacorta MA, Morganti AG, Valentini V. Modern Management of Esophageal Cancer: Radio-Oncology in Neoadjuvancy, Adjuvancy and Palliation. Cancers (Basel) 2022; 14:431. [PMID: 35053594 PMCID: PMC8773768 DOI: 10.3390/cancers14020431&n974851=v901586] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The modern management of esophageal cancer is crucially based on a multidisciplinary and multimodal approach. Radiotherapy is involved in neoadjuvant and adjuvant settings; moreover, it includes radical and palliative treatment intention (with a focus on the use of a stent and its potential integration with radiotherapy). In this review, the above-mentioned settings and approaches will be described. Referring to available international guidelines, the background evidence bases will be reviewed, and the ongoing, more relevant trials will be outlined. Target definitions and radiotherapy doses to administer will be mentioned. Peculiar applications such as brachytherapy (interventional radiation oncology), and data regarding innovative approaches including MRI-guided-RT and radiomic analysis will be reported. A focus on the avoidance of surgery for major clinical responses (particularly for SCC) is detailed.
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Affiliation(s)
- Francesco Cellini
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.C.); (G.C.M.); (M.A.G.); (V.V.)
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Stefania Manfrida
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Calogero Casà
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Angela Romano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
- Correspondence:
| | - Alessandra Arcelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.A.); (A.Z.); (A.G.M.)
| | - Alice Zamagni
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.A.); (A.Z.); (A.G.M.)
| | - Viola De Luca
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Giuseppe Ferdinando Colloca
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Andrea D’Aviero
- Radiation Oncology, Mater Olbia Hospital, 07026 Olbia, Italy;
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, IRCSS—S. Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Valentina Lancellotta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Gian Carlo Mattiucci
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.C.); (G.C.M.); (M.A.G.); (V.V.)
- Radiation Oncology, Mater Olbia Hospital, 07026 Olbia, Italy;
| | - Maria Antonietta Gambacorta
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.C.); (G.C.M.); (M.A.G.); (V.V.)
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.A.); (A.Z.); (A.G.M.)
- Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES), Alma Mater Studiorum, Bologna University, 40126 Bologna, Italy
| | - Vincenzo Valentini
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.C.); (G.C.M.); (M.A.G.); (V.V.)
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
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8
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Cellini F, Manfrida S, Casà C, Romano A, Arcelli A, Zamagni A, De Luca V, Colloca GF, D’Aviero A, Fuccio L, Lancellotta V, Tagliaferri L, Boldrini L, Mattiucci GC, Gambacorta MA, Morganti AG, Valentini V. Modern Management of Esophageal Cancer: Radio-Oncology in Neoadjuvancy, Adjuvancy and Palliation. Cancers (Basel) 2022; 14:cancers14020431. [PMID: 35053594 PMCID: PMC8773768 DOI: 10.3390/cancers14020431] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/28/2021] [Accepted: 01/11/2022] [Indexed: 02/07/2023] Open
Abstract
The modern management of esophageal cancer is crucially based on a multidisciplinary and multimodal approach. Radiotherapy is involved in neoadjuvant and adjuvant settings; moreover, it includes radical and palliative treatment intention (with a focus on the use of a stent and its potential integration with radiotherapy). In this review, the above-mentioned settings and approaches will be described. Referring to available international guidelines, the background evidence bases will be reviewed, and the ongoing, more relevant trials will be outlined. Target definitions and radiotherapy doses to administer will be mentioned. Peculiar applications such as brachytherapy (interventional radiation oncology), and data regarding innovative approaches including MRI-guided-RT and radiomic analysis will be reported. A focus on the avoidance of surgery for major clinical responses (particularly for SCC) is detailed.
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Affiliation(s)
- Francesco Cellini
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.C.); (G.C.M.); (M.A.G.); (V.V.)
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Stefania Manfrida
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Calogero Casà
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Angela Romano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
- Correspondence:
| | - Alessandra Arcelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.A.); (A.Z.); (A.G.M.)
| | - Alice Zamagni
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.A.); (A.Z.); (A.G.M.)
| | - Viola De Luca
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Giuseppe Ferdinando Colloca
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Andrea D’Aviero
- Radiation Oncology, Mater Olbia Hospital, 07026 Olbia, Italy;
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, IRCSS—S. Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Valentina Lancellotta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Gian Carlo Mattiucci
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.C.); (G.C.M.); (M.A.G.); (V.V.)
- Radiation Oncology, Mater Olbia Hospital, 07026 Olbia, Italy;
| | - Maria Antonietta Gambacorta
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.C.); (G.C.M.); (M.A.G.); (V.V.)
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.A.); (A.Z.); (A.G.M.)
- Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES), Alma Mater Studiorum, Bologna University, 40126 Bologna, Italy
| | - Vincenzo Valentini
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.C.); (G.C.M.); (M.A.G.); (V.V.)
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
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9
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Cellini F, Manfrida S, Casà C, Romano A, Arcelli A, Zamagni A, De Luca V, Colloca GF, D’Aviero A, Fuccio L, Lancellotta V, Tagliaferri L, Boldrini L, Mattiucci GC, Gambacorta MA, Morganti AG, Valentini V. Modern Management of Esophageal Cancer: Radio-Oncology in Neoadjuvancy, Adjuvancy and Palliation. Cancers (Basel) 2022; 14:431. [PMID: 35053594 PMCID: PMC8773768 DOI: 10.3390/cancers14020431&n923648=v907986] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The modern management of esophageal cancer is crucially based on a multidisciplinary and multimodal approach. Radiotherapy is involved in neoadjuvant and adjuvant settings; moreover, it includes radical and palliative treatment intention (with a focus on the use of a stent and its potential integration with radiotherapy). In this review, the above-mentioned settings and approaches will be described. Referring to available international guidelines, the background evidence bases will be reviewed, and the ongoing, more relevant trials will be outlined. Target definitions and radiotherapy doses to administer will be mentioned. Peculiar applications such as brachytherapy (interventional radiation oncology), and data regarding innovative approaches including MRI-guided-RT and radiomic analysis will be reported. A focus on the avoidance of surgery for major clinical responses (particularly for SCC) is detailed.
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Affiliation(s)
- Francesco Cellini
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.C.); (G.C.M.); (M.A.G.); (V.V.)
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Stefania Manfrida
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Calogero Casà
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Angela Romano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
- Correspondence:
| | - Alessandra Arcelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.A.); (A.Z.); (A.G.M.)
| | - Alice Zamagni
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.A.); (A.Z.); (A.G.M.)
| | - Viola De Luca
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Giuseppe Ferdinando Colloca
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Andrea D’Aviero
- Radiation Oncology, Mater Olbia Hospital, 07026 Olbia, Italy;
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, IRCSS—S. Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Valentina Lancellotta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Gian Carlo Mattiucci
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.C.); (G.C.M.); (M.A.G.); (V.V.)
- Radiation Oncology, Mater Olbia Hospital, 07026 Olbia, Italy;
| | - Maria Antonietta Gambacorta
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.C.); (G.C.M.); (M.A.G.); (V.V.)
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.A.); (A.Z.); (A.G.M.)
- Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES), Alma Mater Studiorum, Bologna University, 40126 Bologna, Italy
| | - Vincenzo Valentini
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.C.); (G.C.M.); (M.A.G.); (V.V.)
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.M.); (C.C.); (V.D.L.); (G.F.C.); (V.L.); (L.T.); (L.B.)
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10
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Casà C, Piras A, D’Aviero A, Preziosi F, Mariani S, Cusumano D, Romano A, Boskoski I, Lenkowicz J, Dinapoli N, Cellini F, Gambacorta MA, Valentini V, Mattiucci GC, Boldrini L. The impact of radiomics in diagnosis and staging of pancreatic cancer. Ther Adv Gastrointest Endosc 2022; 15:26317745221081596. [PMID: 35342883 PMCID: PMC8943316 DOI: 10.1177/26317745221081596] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 02/02/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Pancreatic cancer (PC) is one of the most aggressive tumours, and better risk stratification among patients is required to provide tailored treatment. The meaning of radiomics and texture analysis as predictive techniques are not already systematically assessed. The aim of this study is to assess the role of radiomics in PC. METHODS A PubMed/MEDLINE and Embase systematic review was conducted to assess the role of radiomics in PC. The search strategy was 'radiomics [All Fields] AND ("pancreas" [MeSH Terms] OR "pancreas" [All Fields] OR "pancreatic" [All Fields])' and only original articles referred to PC in humans in the English language were considered. RESULTS A total of 123 studies and 183 studies were obtained using the mentioned search strategy on PubMed and Embase, respectively. After the complete selection process, a total of 56 papers were considered eligible for the analysis of the results. Radiomics methods were applied in PC for assessment technical feasibility and reproducibility aspects analysis, risk stratification, biologic or genomic status prediction and treatment response prediction. DISCUSSION Radiomics seems to be a promising approach to evaluate PC from diagnosis to treatment response prediction. Further and larger studies are required to confirm the role and allowed to include radiomics parameter in a comprehensive decision support system.
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Affiliation(s)
- Calogero Casà
- UOC Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Francesco Preziosi
- Dipartimento Universitario di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Mariani
- Dipartimento Universitario di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide Cusumano
- UOC Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Angela Romano
- UOC Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ivo Boskoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Jacopo Lenkowicz
- UOC Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Nicola Dinapoli
- UOC Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Cellini
- UOC Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Antonietta Gambacorta
- UOC Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Universitario di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- UOC Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Universitario di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gian Carlo Mattiucci
- UOC Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Universitario di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Boldrini
- UOC Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Universitario di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
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11
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Chiloiro G, Romano A, D’Aviero A, Dinapoli L, Zane E, Tenore A, Boldrini L, Balducci M, Gambacorta MA, Mattiucci GC, Malavasi P, Cesario A, Valentini V. Patients' Satisfaction by SmileIn TM Totems in Radiotherapy: A Two-Year Mono-Institutional Experience. Healthcare (Basel) 2021; 9:healthcare9101268. [PMID: 34682948 PMCID: PMC8535794 DOI: 10.3390/healthcare9101268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/06/2021] [Revised: 09/14/2021] [Accepted: 09/23/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Patient’s satisfaction is recognized as an indicator to monitor quality in healthcare services. Patient-reported experience measures (PREMs) may contribute to create a benchmark of hospital performance by assessing quality and safety in cancer care. Methods: The areas of interest assessed were: patient-centric welcome perception (PCWP), punctuality, professionalism and comfort using the Lean Six Sigma (LSS) methodology. The RAMSI (Radioterapia Amica Mia SmileINTM (SI) My Friend RadiotherapySI), project provided for the placement of SI totems with four push buttons using HappyOrNot technology in a high-volume radiation oncology (RO) department. The SI technology was implemented in the RO department of the Fondazione Policlinico Universitario A. Gemelli IRCCS. SI totems were installed in different areas of the department. The SI Experience Index was collected, analyzed and compared. Weekly and monthly reports were created showing hourly, daily and overall trends. Results: From October 2017 to November 2019, a total of 42,755 votes were recorded: 8687, 10,431, 18,628 and 5009 feedback items were obtained for PCWP, professionalism, punctuality, and comfort, respectively. All areas obtained a SI-approved rate ≥ 8.0. Conclusions: The implementation of the RAMSI system proved to be doable according to the large amount of feedback items collected in a high-volume clinical department. The application of the LSS methodology led to specific corrective actions such as modification of the call-in-clinic system during operations planning. In order to provide healthcare optimization, a multicentric and multispecialty network should be defined in order to set up a benchmark.
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Affiliation(s)
- Giuditta Chiloiro
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.C.); (L.B.); (M.A.G.); (V.V.)
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (L.D.); (A.T.); (M.B.); (G.C.M.)
| | - Angela Romano
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (L.D.); (A.T.); (M.B.); (G.C.M.)
| | - Andrea D’Aviero
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (L.D.); (A.T.); (M.B.); (G.C.M.)
- Correspondence:
| | - Loredana Dinapoli
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (L.D.); (A.T.); (M.B.); (G.C.M.)
- UOS Psicologia Clinica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Elisa Zane
- Alta Scuola per l’Ambiente—ASA—Università Cattolica del Sacro Cuore, 25121 Brescia, Italy; (E.Z.); (p.m.)
| | - Angela Tenore
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (L.D.); (A.T.); (M.B.); (G.C.M.)
| | - Luca Boldrini
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.C.); (L.B.); (M.A.G.); (V.V.)
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (L.D.); (A.T.); (M.B.); (G.C.M.)
| | - Mario Balducci
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (L.D.); (A.T.); (M.B.); (G.C.M.)
| | - Maria Antonietta Gambacorta
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.C.); (L.B.); (M.A.G.); (V.V.)
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (L.D.); (A.T.); (M.B.); (G.C.M.)
| | - Gian Carlo Mattiucci
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (L.D.); (A.T.); (M.B.); (G.C.M.)
| | - Pierluigi Malavasi
- Alta Scuola per l’Ambiente—ASA—Università Cattolica del Sacro Cuore, 25121 Brescia, Italy; (E.Z.); (p.m.)
- Facoltà di Scienze della Formazione, Università Cattolica del Sacro Cuore, 25121 Brescia, Italy
| | - Alfredo Cesario
- Open Innovation, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy;
| | - Vincenzo Valentini
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.C.); (L.B.); (M.A.G.); (V.V.)
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (L.D.); (A.T.); (M.B.); (G.C.M.)
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