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De Vincentis S, Greco C, Fanelli F, Decaroli MC, Diazzi C, Mezzullo M, Milic J, De Santis MC, Roli L, Pagotto U, Guaraldi G, Rochira V. Sarcopenic obesity and reduced BMD in young men living with HIV: body composition and sex steroids interplay. J Endocrinol Invest 2024:10.1007/s40618-024-02375-6. [PMID: 38643322 DOI: 10.1007/s40618-024-02375-6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/09/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE Sex steroids play a key role on male bone homeostasis and body composition (BC), their role in men living with HIV (MLWH) is less recognized. This study aimed at investigating the prevalence of low BMD, sarcopenia, and sarcopenic obesity (SO) and their relationship with sex steroids in MLWH aged < 50. METHODS Prospective, cross-sectional, observational study on MLWH younger than 50 (median age 47.0 years). BC and BMD were evaluated with DXA. Two different definitions of sarcopenia were applied: appendicular lean mass/height2 (ALMI) < 7.26 kg/m2 or appendicular lean mass/body weight (ALM/W) < 28.27%. Low BMD was defined for Z-score < -2.0. Sarcopenia coupled with obesity identified SO. Serum total testosterone (T) and estradiol (E2) were measured by LC-MS/MS; free testosterone (cFT) was calculated by Vermeulen equation. RESULTS Sarcopenia was detected in 107 (34.9%) and 44 (14.3%) out of 307 MLWH according to ALMI and ALM/W, respectively. The prevalence of SO was similar by using both ALMI (11.4%) and ALM/W (12.4%). Sarcopenic and SO MLWH had lower total T and cFT in both the definition for sarcopenia. BMD was reduced in 43/307 (14.0%). Serum E2 < 18 pg/mL was an independent contributing factor for sarcopenia, SO, and low BMD. CONCLUSIONS T and E2 are important determinants of BC even in MLWH. This is among the first studies investigating the distribution of obesity phenotypes and the prevalence of SO among MLWH showing that SO is present in 11-12% of enrolled MLWH regardless of the definition used. However, deep differences emerged using two different diagnostic definitions.
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Affiliation(s)
- S De Vincentis
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy.
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy.
| | - C Greco
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - F Fanelli
- Endocrinology Research Group, Department of Medical and Surgical Sciences, Center for Applied Biomedical Research, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - M C Decaroli
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - C Diazzi
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - M Mezzullo
- Endocrinology Research Group, Department of Medical and Surgical Sciences, Center for Applied Biomedical Research, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - J Milic
- Multidisciplinary Metabolic Clinic, Unit of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - M C De Santis
- Department of Laboratory Medicine and Pathology, Azienda USL of Modena, Modena, Italy
| | - L Roli
- Department of Laboratory Medicine and Pathology, Azienda USL of Modena, Modena, Italy
| | - U Pagotto
- Endocrinology Research Group, Department of Medical and Surgical Sciences, Center for Applied Biomedical Research, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - G Guaraldi
- Multidisciplinary Metabolic Clinic, Unit of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - V Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
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Pollini L, Greco C, Novelli M, Mei D, Pisani F, De Koning‐Tijssen MA, Guerrini R, Leuzzi V, Galosi S. Neurophysiological Analysis of Cortical Myoclonic Tremor and Excessive Startle in ARHGEF9 Deficiency. Mov Disord Clin Pract 2024; 11:434-437. [PMID: 38293791 PMCID: PMC10982589 DOI: 10.1002/mdc3.13986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/28/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024] Open
Affiliation(s)
- Luca Pollini
- Department of Human NeuroscienceSapienza University of RomeRomeItaly
| | - Carlo Greco
- Department of Human NeuroscienceSapienza University of RomeRomeItaly
| | - Maria Novelli
- Department of Human NeuroscienceSapienza University of RomeRomeItaly
| | - Davide Mei
- Neuroscience DepartmentChildren's Hospital Meyer IRCCSFlorenceItaly
| | - Francesco Pisani
- Department of Human NeuroscienceSapienza University of RomeRomeItaly
| | - Marina A.J. De Koning‐Tijssen
- Expertise Centre Movement Disorders GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Department of NeurologyUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Renzo Guerrini
- Neuroscience DepartmentChildren's Hospital Meyer IRCCSFlorenceItaly
| | - Vincenzo Leuzzi
- Department of Human NeuroscienceSapienza University of RomeRomeItaly
| | - Serena Galosi
- Department of Human NeuroscienceSapienza University of RomeRomeItaly
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Mastrangelo M, Manti F, Ricciardi G, Bove R, Greco C, Tolve M, Pisani F. The burden of epilepsy on long-term outcome of genetic developmental and epileptic encephalopathies: A single tertiary center longitudinal retrospective cohort study. Epilepsy Behav 2024; 152:109670. [PMID: 38335860 DOI: 10.1016/j.yebeh.2024.109670] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/11/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND This retrospective cohort analysis highlighted neurodevelopmental outcome predictors of genetic developmental and epileptic encephalopathies (DEE). PATIENTS AND METHODS Patients' demographic, clinical and molecular genetics data were collected. All patients underwent clinical, developmental, and neuropsychological assessments. RESULTS We recruited 100 participants (53 males, 47 females) with a mean follow-up lasting 10.46 ± 8.37 years. Age at epilepsy-onset was predictive of poor adaptive and cognitive functions (VABS-II score, r = 0.350, p = 0.001; BRIEF control subscale, r = -0.253; p = 0.031). Duration of epilepsy correlated negatively with IQ (r = -0.234, p = 0.019) and VABS-II score (r = -0.367, p = 0.001). Correlations were found between delayed/lacking EEG maturation/organization and IQ (r = 0.587, p = 0.001), VABS-II score (r = 0.658, p = 0.001), BRIEF-MI and BRIEF-GEC scores (r = -0.375, p = 0.001; r = -0.236, p = 0.033), ASEBA anxiety (r = -0.220, p = 0.047) and ADHD (r = -0.233, p = 0.035) scores. The number of antiseizure medications (ASMs) correlated with IQ (r = -0.414, p = 0.001), VABS-II (r = -0.496, p = 0.001), and BRIEF-MI (r = 0.294, p = 0.012) scores; while age at the beginning of therapy with ASEBA anxiety score (r = 0.272, p = 0.013). The occurrence of status epilepticus was associated with worse adaptive performances. The linear regression analysis model showed that delayed/lacking EEG maturation/organization had a significant influence on the IQ (R2 = 0.252, p < 0.001) and the BRIEF-GEC variability (R2 = 0.042, p = 0.036). The delayed/lacking EEG maturation/organization and the duration of epilepsy also had a significant influence on the VABS-II score (R2 = 0.455, p = 0.005). CONCLUSIONS Age at seizure-onset, EEG maturation/organization, duration of epilepsy, occurrence of status epilepticus, age at the introduction and number of ASMs used are reliable predictors of long-term outcomes in patients with genetic DEE.
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Affiliation(s)
- Mario Mastrangelo
- Department of Women/Child Health and Urological Science, Sapienza University of Rome, Rome, Italy; Unit of Child Neurology and Psychiatry, Azienda Ospedaliero Universitaria Policlinico Umberto, Rome, Italy.
| | - Filippo Manti
- Unit of Child Neurology and Psychiatry, Azienda Ospedaliero Universitaria Policlinico Umberto, Rome, Italy; Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Giacomina Ricciardi
- Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Rossella Bove
- Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Carlo Greco
- Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Manuela Tolve
- Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy; Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - Francesco Pisani
- Unit of Child Neurology and Psychiatry, Azienda Ospedaliero Universitaria Policlinico Umberto, Rome, Italy; Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
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Boldrini L, D'Aviero A, De Felice F, Desideri I, Grassi R, Greco C, Iorio GC, Nardone V, Piras A, Salvestrini V. Artificial intelligence applied to image-guided radiation therapy (IGRT): a systematic review by the Young Group of the Italian Association of Radiotherapy and Clinical Oncology (yAIRO). Radiol Med 2024; 129:133-151. [PMID: 37740838 DOI: 10.1007/s11547-023-01708-4] [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: 04/05/2023] [Accepted: 08/16/2023] [Indexed: 09/25/2023]
Abstract
INTRODUCTION The advent of image-guided radiation therapy (IGRT) has recently changed the workflow of radiation treatments by ensuring highly collimated treatments. Artificial intelligence (AI) and radiomics are tools that have shown promising results for diagnosis, treatment optimization and outcome prediction. This review aims to assess the impact of AI and radiomics on modern IGRT modalities in RT. METHODS A PubMed/MEDLINE and Embase systematic review was conducted to investigate the impact of radiomics and AI to modern IGRT modalities. The search strategy was "Radiomics" AND "Cone Beam Computed Tomography"; "Radiomics" AND "Magnetic Resonance guided Radiotherapy"; "Radiomics" AND "on board Magnetic Resonance Radiotherapy"; "Artificial Intelligence" AND "Cone Beam Computed Tomography"; "Artificial Intelligence" AND "Magnetic Resonance guided Radiotherapy"; "Artificial Intelligence" AND "on board Magnetic Resonance Radiotherapy" and only original articles up to 01.11.2022 were considered. RESULTS A total of 402 studies were obtained using the previously mentioned search strategy on PubMed and Embase. The analysis was performed on a total of 84 papers obtained following the complete selection process. Radiomics application to IGRT was analyzed in 23 papers, while a total 61 papers were focused on the impact of AI on IGRT techniques. DISCUSSION AI and radiomics seem to significantly impact IGRT in all the phases of RT workflow, even if the evidence in the literature is based on retrospective data. Further studies are needed to confirm these tools' potential and provide a stronger correlation with clinical outcomes and gold-standard treatment strategies.
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Affiliation(s)
- Luca Boldrini
- UOC Radioterapia Oncologica, Fondazione Policlinico Universitario IRCCS "A. Gemelli", Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea D'Aviero
- Radiation Oncology, Mater Olbia Hospital, Olbia, Sassari, Italy
| | - Francesca De Felice
- Radiation Oncology, Department of Radiological, Policlinico Umberto I, Rome, Italy
- Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Isacco Desideri
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Roberta Grassi
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Carlo Greco
- Department of Radiation Oncology, Università Campus Bio-Medico di Roma, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | | | - Valerio Nardone
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Antonio Piras
- UO Radioterapia Oncologica, Villa Santa Teresa, Bagheria, Palermo, Italy.
| | - Viola Salvestrini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
- Cyberknife Center, Istituto Fiorentino di Cura e Assistenza (IFCA), 50139, Florence, Italy
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Alaimo R, Ippolito E, Falconi R, Perrone Congedi F, Sciommari C, Silipigni S, Pellegrini R, Carnevale A, Greco C, Fiore M, D’Angelillo RM, Ramella S. Breast Volume Is a Predictor of Higher Heart Dose in Whole-Breast Supine Free-Breathing Volumetric-Modulated Arc Therapy Planning. Curr Oncol 2023; 30:10530-10538. [PMID: 38132402 PMCID: PMC10742666 DOI: 10.3390/curroncol30120768] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 11/23/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
In breast cancer volumetric-modulated arc therapy (VMAT) planning, the rotation of the gantry around the target implies a greater dose spreading to the whole heart, compared to tangential-field standard treatment. A consecutive cohort of 121 breast cancer patients treated with the VMAT technique was investigated. The correlation of breast volume, heart volume and lung volume with mean heart dose (mHD) and mean and maximum LAD dose (mLAD dose, MLAD dose) was tested, and a subsequent a linear regression analysis was carried out. VMAT treatment plans from 56 left breast cancer and 65 right breast cancer patients were analyzed. For right-sided patients, breast volume was significantly correlated with mHD, mLAD and MLAD dose, while for left-sided patients, breast volume was significantly correlated with mHD and mLAD, while heart volume and lung volume were correlated with mHD, mLAD and MLAD dose. Breast volume was the only predictor of increased heart and LAD dose (p ≤ 0.001) for right-sided patients. In left-sided patients, heart and lung were also predictors of increased mHD (p = 0.005, p ≤ 0.001) and mean LAD dose (p = 0.009, p ≤ 0.001). In this study, we observed an increase in heart and LAD doses in larger-breasted patients treated with VMAT planning. In right-sided patients, breast volume was shown to be the only predictor of increased heart dose and LAD dose.
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Affiliation(s)
- Rita Alaimo
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
| | - Edy Ippolito
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
- Department of Radiation Oncology (Medicine and Surgery), Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Rita Falconi
- Medical Physics Unit, S. Filippo Neri Hospital, ASL Roma 1, 00135 Rome, Italy;
| | - Francesca Perrone Congedi
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
| | - Cecilia Sciommari
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
| | - Sonia Silipigni
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
| | | | - Alessia Carnevale
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
| | - Carlo Greco
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
- Department of Radiation Oncology (Medicine and Surgery), Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Michele Fiore
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
- Department of Radiation Oncology (Medicine and Surgery), Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | | | - Sara Ramella
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
- Department of Radiation Oncology (Medicine and Surgery), Università Campus Bio-Medico di Roma, 00128 Rome, Italy
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Nibid L, Greco C, Cordelli E, Sabarese G, Fiore M, Liu CZ, Ippolito E, Sicilia R, Miele M, Tortora M, Taffon C, Rakaee M, Soda P, Ramella S, Perrone G. Deep pathomics: A new image-based tool for predicting response to treatment in stage III non-small cell lung cancer. PLoS One 2023; 18:e0294259. [PMID: 38015944 PMCID: PMC10684067 DOI: 10.1371/journal.pone.0294259] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/26/2023] [Indexed: 11/30/2023] Open
Abstract
Despite the advantages offered by personalized treatments, there is presently no way to predict response to chemoradiotherapy in patients with non-small cell lung cancer (NSCLC). In this exploratory study, we investigated the application of deep learning techniques to histological tissue slides (deep pathomics), with the aim of predicting the response to therapy in stage III NSCLC. We evaluated 35 digitalized tissue slides (biopsies or surgical specimens) obtained from patients with stage IIIA or IIIB NSCLC. Patients were classified as responders (12/35, 34.7%) or non-responders (23/35, 65.7%) based on the target volume reduction shown on weekly CT scans performed during chemoradiation treatment. Digital tissue slides were tested by five pre-trained convolutional neural networks (CNNs)-AlexNet, VGG, MobileNet, GoogLeNet, and ResNet-using a leave-two patient-out cross validation approach, and we evaluated the networks' performances. GoogLeNet was globally found to be the best CNN, correctly classifying 8/12 responders and 10/11 non-responders. Moreover, Deep-Pathomics was found to be highly specific (TNr: 90.1) and quite sensitive (TPr: 0.75). Our data showed that AI could surpass the capabilities of all presently available diagnostic systems, supplying additional information beyond that currently obtainable in clinical practice. The ability to predict a patient's response to treatment could guide the development of new and more effective therapeutic AI-based approaches and could therefore be considered an effective and innovative step forward in personalised medicine.
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Affiliation(s)
- Lorenzo Nibid
- Research Unit of Anatomical Pathology, Department of of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Anatomical Pathology Operative Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Carlo Greco
- Radiation Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Ermanno Cordelli
- Unit of Computer Systems and Bioinformatics, Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Giovanna Sabarese
- Anatomical Pathology Operative Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Michele Fiore
- Radiation Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Charles Z. Liu
- Unit of Computer Systems and Bioinformatics, Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Edy Ippolito
- Radiation Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Rosa Sicilia
- Unit of Computer Systems and Bioinformatics, Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Marianna Miele
- Radiation Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Matteo Tortora
- Unit of Computer Systems and Bioinformatics, Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Chiara Taffon
- Research Unit of Anatomical Pathology, Department of of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Anatomical Pathology Operative Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Mehrdad Rakaee
- Department of Clinical Pathology, University Hospital of North Norway, Tromsø, Norway
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Paolo Soda
- Unit of Computer Systems and Bioinformatics, Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Sara Ramella
- Radiation Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Giuseppe Perrone
- Research Unit of Anatomical Pathology, Department of of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Anatomical Pathology Operative Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Mateus D, Greco C, Peralta L. Field output correction factors of small static field for IBA razor nanochamber. Biomed Phys Eng Express 2023; 10:015004. [PMID: 37939486 DOI: 10.1088/2057-1976/ad0ae0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/08/2023] [Indexed: 11/10/2023]
Abstract
Purpose.The goal of this work is present results of field output factors (OF) using an IBA CC003 (Razor NanoChamber) and compare these results with PTW 60019 (MicroDiamond) and IBA Razor Diode. The experimental results for IBA CC003 were also compared with Monte Carlo (MC) Simulation, using Penelope and Ulysses programs. In addition, field output correction factors (kQclin,Qmsrfclin,fmsr) for IBA CC003 were derived with three different methods: (1) using PTW 60019 and IBA Razor as reference detectors; (2) comparison between MC and experimental measurements; and (3) using only MC.Material and Methods. The beam collimation included in this study were (1) square field size between 10 × 10 and 0.5 × 0.5 cm2defined by the MLC and jaws and (2) cones of different diameters. For IBA CC003 it was determined the polarity and ion collection efficiency correction factors in parallel and perpendicular orientation.Results.The results indicate (1) the variation of polarity effect with the field size is relevant for the determination of OF using IBA CC003, especially for parallel orientation; (2) there is no significant variation of the ion collection efficiency with the field size using IBA CC003 in parallel orientation; (3) OF differences between IBA CC003 and PTW 60019/IBA Razor, and experimental and MC results, increase with decreasing field size;ThekQclin,Qmsrfclin,fmsrresults indicate (1) using the first and second method,kQclin,Qmsrfclin,fmsrincrease with decreasing field size, which can be related with the influence of the volume effect and (2) using the third method,kQclin,Qmsrfclin,fmsrdecrease with decreasing field size, which can be explained by the perturbation effect.Conclusions. Our results demonstrate the need of applyingkQclin,Qmsrfclin,fmsrfor IBA CC003 forSclin≤1 cm, to compensate for volume averaging and perturbations effects.
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Affiliation(s)
- D Mateus
- Faculdade de Ciências da Universidade de Lisboa, Lisboa, Portugal
- Mercurius Health S.A, Lisboa, Portugal
- Fundação Champalimaud, Lisboa, Portugal
| | - C Greco
- Fundação Champalimaud, Lisboa, Portugal
| | - L Peralta
- Faculdade de Ciências da Universidade de Lisboa, Lisboa, Portugal
- Laboratório de Instrumentação e Física Experimental de Partículas, Lisboa, Portugal
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Ippolito E, Greco C, Marrocco M, Rinaldi CG, Fiore M, Trodella LE, D’Angelillo RM, Ramella S. Preventing Cardiotoxicity in Personalized Breast Irradiation. Cancers (Basel) 2023; 15:5153. [PMID: 37958327 PMCID: PMC10650895 DOI: 10.3390/cancers15215153] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND This study aims to assess the benefit of a deep inspiration breath hold (DIBH) over the standard irradiation technique, and eventually to identify anatomical and/or treatment preplanning characteristics correlated with the LAD dose. METHODS Patients with left-sided breast cancer undergoing whole breast radiotherapy with DIBH were analyzed. All patients included in the analysis had plans in DIBH and free-breathing (FB). Receiving operating characteristics (ROC analysis) were used to identify the cut-off point of parameters to predict the LAD maximum dose > 10 Gy and LAD mean dose > 4 Gy, and the areas under the curve (AUCs) were computed. Post-test probability has been performed to evaluate the effect of parameters' combination. RESULTS One hundred ninety-seven patients were analyzed. The LAD dose was significantly reduced in DIBH plans with the maximum and mean dose reduced by 31.7% (mean value 3.5 Gy vs. 4.8 Gy, p ≤ 0.001) and 28.1% (mean value 8.2 Gy vs. 12.8 Gy, p ≤ 0.001) in DIBH plans compared to FB plans. The strongest predictor of the LAD dose (maximum > 10 Gy and mean > 4 Gy) was the minimum distance of LAD from tangent open fields. Other parameters were lung volume and heart volume (LAD Dmax > 10 Gy) and lung volume, heart volume, and breast separation (LAD Dmean > 4 Gy). CONCLUSION The dosimetric advantage of DIBH is clear in all patients and DIBH should always be preferred.
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Affiliation(s)
- Edy Ippolito
- Radiation Oncology, Campus Bio-Medico University Rome, 00128 Rome, Italy; (E.I.); (C.G.); (M.M.); (M.F.); (L.E.T.); (S.R.)
| | - Carlo Greco
- Radiation Oncology, Campus Bio-Medico University Rome, 00128 Rome, Italy; (E.I.); (C.G.); (M.M.); (M.F.); (L.E.T.); (S.R.)
| | - Maristella Marrocco
- Radiation Oncology, Campus Bio-Medico University Rome, 00128 Rome, Italy; (E.I.); (C.G.); (M.M.); (M.F.); (L.E.T.); (S.R.)
| | - Carla Germana Rinaldi
- Radiotherapy, Department of Oncoematology, Policlinico Tor Vergata, 00133 Rome, Italy;
| | - Michele Fiore
- Radiation Oncology, Campus Bio-Medico University Rome, 00128 Rome, Italy; (E.I.); (C.G.); (M.M.); (M.F.); (L.E.T.); (S.R.)
| | - Luca Eolo Trodella
- Radiation Oncology, Campus Bio-Medico University Rome, 00128 Rome, Italy; (E.I.); (C.G.); (M.M.); (M.F.); (L.E.T.); (S.R.)
| | - Rolando Maria D’Angelillo
- Radiotherapy, Department of Oncoematology, Policlinico Tor Vergata, 00133 Rome, Italy;
- Radiation Oncology, Università degli Studi di Roma Tor Vergata, 00133 Rome, Italy
| | - Sara Ramella
- Radiation Oncology, Campus Bio-Medico University Rome, 00128 Rome, Italy; (E.I.); (C.G.); (M.M.); (M.F.); (L.E.T.); (S.R.)
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9
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Catania C, Filippi AR, Sangalli C, Piperno G, Russano M, Greco C, Scotti V, Proto C, Bennati C, Di Pietro Paolo M, Platania A, Olmetto E, Agustoni F, Teodorani N, Agbaje V, Russo A. New options and open issues in the management of unresectable stage III and in early-stage NSCLC: A report from an expert panel of Italian medical and radiation oncologists - INTERACTION group. Crit Rev Oncol Hematol 2023; 190:104108. [PMID: 37633350 DOI: 10.1016/j.critrevonc.2023.104108] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/22/2023] [Indexed: 08/28/2023] Open
Abstract
IMPORTANCE After the PACIFIC trial, concurrent chemo-radiotherapy followed by consolidation therapy with durvalumab for 1 year (limited to PD-L1 tumour proportion score ≥ 1% in the EMA region) is the firmly established standard of care treatment for unresectable NSCLC patients. Several relevant questions are emerging with the growing use of this approach, posing novel challenges in clinical practice. Treatment of oncogene-addicted NSCLCs, management of mediastinal disease recurrence after surgery and the optimal management of patients progressing during or after durvalumab are now some of the most clinically relevant issues. OBSERVATIONS Patients with unresectable NSCLC harbouring EGFR and HER2 mutations or ALK/ROS1/RET /NTRK1,2,3 rearrangements are unresponsive to immunotherapy. Importance of knowing the tumour genotyping (NGS, preferable DNA and RNA) from the earliest stages of NSCLC, also for the possible use of immunotherapy both in the adjuvant and perioperative setting. In case of mediastinal disease recurrence after surgery, re-biopsy is essential to re-determine the histological and biological characteristics of the disease and the distinction of recurrence in curable and non-curable disease is of pivotal important for the optimal management of subsequent treatments. CONCLUSIONS AND RELEVANCE Treatment of stage III NSCLC has always been controversial and challenging: Multidisciplinary approach is mandatory and defining resectability is a critical issue. Chemo-radiotherapy followed by maintenance Durvalumab is now the standard of treatment. Herein, we provide a comprehensive overview of the key challenges and open questions that we are currently facing in clinical practice, in unresectable stage III and in early-stage NSCLC, identifying the knowledge gaps and the possible solutions.
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Affiliation(s)
- Chiara Catania
- Unit of Thoracic Oncology, Gavazzeni Humanitas Bergamo, Via Gavazzeni 21, Bergamo, Milan, Italy.
| | - Andrea Riccardo Filippi
- Radiation Oncology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Claudia Sangalli
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gaia Piperno
- Division of Radiotherapy, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Marco Russano
- Medical Oncology Radiation, Campus Bio-Medico University, Rome
| | - Carlo Greco
- Radiation Oncology, Campus Bio-Medico University, Rome
| | - Vieri Scotti
- Radiation Therapy Unit, Department of Oncology, Careggi University Hospital, Firenze, Italy
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Chiara Bennati
- Oncology Unit, Ausl Romagna Ravenna, Emilia Romagna, Oncologia Medica Ravenna, Emilia Romagna, Italy
| | - Marzia Di Pietro Paolo
- Medical Oncology Unit, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | | | - Emanuela Olmetto
- Department of Radiation-Oncology, University of Florence, Firenze, Italy
| | - Francesco Agustoni
- Medical Oncology Department, Fondazione IRCCS Policlinico "San Matteo", Pavia, Italy
| | - Nazario Teodorani
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Vincenzo Agbaje
- Radiotherapy Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
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10
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Greco C, Passerini F, Coluccia S, Teglio M, Bondi M, Mecheri F, Trapani V, Volpe A, Toschi P, Madeo B, Simoni M, Rochira V, Santi D. Long-term trajectories of bone metabolism parameters and bone mineral density (BMD) in obese patients treated with metabolic surgery: a real-world, retrospective study. J Endocrinol Invest 2023; 46:2133-2146. [PMID: 36971952 DOI: 10.1007/s40618-023-02066-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Potential negative effects of metabolic surgery on skeletal integrity remain a concern, since long-term data of different surgical approaches are poor. This study aimed to describe changes in bone metabolism in subjects with obesity undergoing both Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). METHODS A single center, retrospective, observational clinical study on real-world data was performed enrolling subjects undergoing metabolic surgery. RESULTS 123 subjects were enrolled (males 31: females 92; ages 48.2 ± 7.9 years). All patients were evaluated until 16.9 ± 8.1 months after surgery, while a small group was evaluated up to 4.5 years. All patients were treated after surgery with calcium and vitamin D integration. Both calcium and phosphate serum levels significantly increased after metabolic surgery and remained stable during follow-up. These trends did not differ between RYGB and SG (p = 0.245). Ca/P ratio decreased after surgery compared to baseline (p < 0.001) and this decrease remained among follow-up visits. While 24-h urinary calcium remained stable across all visits, 24-h urinary phosphate showed lower levels after surgery (p = 0.014), also according to surgery technique. Parathyroid hormone decreased (p < 0.001) and both vitamin D (p < 0.001) and C-terminal telopeptide of type I collagen (p = 0.001) increased after surgery. CONCLUSION We demonstrated that calcium and phosphorous metabolism shows slight modification even after several years since metabolic surgery, irrespective of calcium and vitamin D supplementation. This different set point is characterized by a phosphate serum levels increase, together with a persistent bone loss, suggesting that supplementation alone may not ensure the maintenance of bone health in these patients.
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Affiliation(s)
- C Greco
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - F Passerini
- Division of Internal Medicine and Metabolism, Department of Internal Medicine, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
- Unit of Internal and Metabolic Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - S Coluccia
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - M Teglio
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy
| | - M Bondi
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - F Mecheri
- Division of General, Emergency Surgery and New Technologies, Ospedale Civile di Baggiovara, Modena, Italy
| | - V Trapani
- Division of General, Emergency Surgery and New Technologies, Ospedale Civile di Baggiovara, Modena, Italy
| | - A Volpe
- Division of General, Emergency Surgery and New Technologies, Ospedale Civile di Baggiovara, Modena, Italy
| | - P Toschi
- Department of Metabolic Diseases and Clinical Nutrition, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - B Madeo
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - M Simoni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - V Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy.
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy.
| | - D Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
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11
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Ghareeb F, Boukerroui D, Stroom J, Jackson E, Pereira M, Gooding M, Greco C. An approach to generate synthetic 4DCT datasets to benchmark Mid-Position implementations. Phys Med 2023; 114:103144. [PMID: 37778207 DOI: 10.1016/j.ejmp.2023.103144] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 07/14/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023] Open
Abstract
PURPOSE The Mid-Position image is constructed from 4DCT data using Deformable Image Registration and can be used as planning CT with reduced PTV volumes. 4DCT datasets currently-available for testing do not provide the corresponding Mid-P images of the datasets. This work describes an approach to generate human-like synthetic 4DCT datasets with the associated Mid-P images that can be used as reference in the validation of Mid-P implementations. METHODS Twenty synthetic 4DCT datasets with the associated reference Mid-P images were generated from twenty clinical 4DCT datasets. Per clinical dataset, an anchor phase was registered to the remaining nine phases to obtain nine Deformable Vector Fields (DVFs). These DVFs were used to warp the anchor phase in order to generate the synthetic 4DCT dataset and the corresponding reference Mid-P image. Similarly, a reference 4D tumor mask dataset and its corresponding Mid-P tumor mask were generated. The generated synthetic datasets and masks were used to compare and benchmark the outcomes of three independent Mid-P implementations using a set of experiments. RESULTS The Mid-P images constructed by the three implementations showed high similarity scores when compared to the reference Mid-P images except for one noisy dataset. The biggest difference in the estimated motion amplitudes (-2.6 mm) was noticed in the Superior-Inferior direction. The statistical analysis showed no significant differences among the three implementations for all experiments. CONCLUSION The described approach and the proposed experiments provide an independent method that can be used in the validation of any Mid-P implementation being developed.
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Affiliation(s)
- Firass Ghareeb
- Champalimaud Foundation, Department of Radiation Oncology, Lisbon, Portugal
| | | | - Joep Stroom
- Champalimaud Foundation, Department of Radiation Oncology, Lisbon, Portugal.
| | | | - Mariana Pereira
- Champalimaud Foundation, Department of Radiation Oncology, Lisbon, Portugal
| | | | - Carlo Greco
- Champalimaud Foundation, Department of Radiation Oncology, Lisbon, Portugal
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12
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Fiore M, Petrianni GM, Trecca P, D'Ercole G, Coppola A, La Vaccara V, Taralli S, Cimini P, Greco C, Ippolito E, Calcagni ML, Beomonte Zobel B, Caputo D, Coppola R, Ramella S, D'Angelillo RM. The impact of intensified staging and combined therapies in locally advanced pancreatic cancer: a secondary analysis of prospective studies. Int J Surg 2023:01279778-990000000-00637. [PMID: 37737898 DOI: 10.1097/js9.0000000000000755] [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] [Received: 07/28/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023]
Abstract
AIM To investigate the use of comprehensive pre-treatment staging with multiple diagnostic modalities, including functional imaging and minimally invasive surgical procedures, in locally advanced pancreatic cancer (LAPC) patients. The primary objective was to detect occult metastatic disease using staging laparoscopy and 18FFDG-PET/CT scan. The study also evaluated treatment efficacy and outcomes in LAPC patients treated with combined therapies. MATERIALS AND METHODS This study was a secondary analysis of three prospective studies of chemoradiotherapy (CRT) with or without induction chemotherapy (IC). The inclusion period was from December 2009 until February 2023. An intensified pretreatment staging was conducted for all LAPC patients. Patients without distant disease at initial staging, with borderline resectable or unresectable LAPC, were enrolled in chemoradiotherapy combination protocols (CRT with or without IC). IC regimens included GemOx or FOLFIRINOX for four cycles, followed by concurrent CRT with gemcitabine. The primary endpoint was the detection of occult metastatic disease, and secondary objectives included resection rate, treatment toxicity, overall survival (OS), progression-free survival (PFS), local control (LC), and metastasis-free survival (MFS). RESULTS Out of the 134 LAPC patients, 33.5% were identified with metastatic disease. Of these, 23.1% had a positive exploratory laparoscopy. Additionally, 13.4% were identified as having distant metastases by 18-FDG PET/CT. The median PFS for all patients who completed CRT was 14.3 months, and the median OS was 17.2 months. Resected patients after the combined therapies demonstrated significantly improved outcomes compared to non-resected patients (median PFS, 22.5 mo vs. 9.5 mo, P<0.001; median OS, 38.2 mo vs. 13 mo, P<0.001). Moreover, patients treated with IC followed by CRT showed significantly better outcomes compared to upfront CRT group (median PFS, 19 mo vs. 9.9 mo, P<0.001; median OS, 19.3 mo vs. 14.6 mo, P<0.001). At univariate logistic regression analysis, the adding of IC was the only predictor for resection rate (95% CI 0.12-1.02, P=0.05), and this data was confirmed at multivariate analysis (95% CI 0.09-0.98, P=0.04). Haematological and gastrointestinal toxicities were observed during treatment, with manageable adverse events. CONCLUSIONS The use of comprehensive pre-treatment staging, including laparoscopy and 18F-FDG-PET/CT scan, is an effective approach in identifying occult metastatic disease in LAPC patients. Our findings offer valuable insights into accurate staging and treatment efficacy, providing evidence-based support for optimal management strategies in LAPC patients.
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Affiliation(s)
- Michele Fiore
- Research Unit of Radiation Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
- Operative Research Unit of Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Gian Marco Petrianni
- Operative Research Unit of Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Pasquale Trecca
- Operative Research Unit of Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Gabriele D'Ercole
- Research Unit of Radiation Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Alessandro Coppola
- Dipartimento di Chirurgia, Sapienza Università di Roma, Viale Regina Elena 326, Rome 00161, Italy
| | - Vincenzo La Vaccara
- Operative Research Unit of General Surgery Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Silvia Taralli
- Nuclear Medicine Unit, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, 00168, Italy
| | - Paola Cimini
- Operative Research Unit of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Carlo Greco
- Research Unit of Radiation Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
- Operative Research Unit of Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Edy Ippolito
- Research Unit of Radiation Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
- Operative Research Unit of Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Maria Lucia Calcagni
- Nuclear Medicine Unit, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, 00168, Italy
- Dipartimento Universitario di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, 00168, Italy
| | - Bruno Beomonte Zobel
- Operative Research Unit of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Damiano Caputo
- Operative Research Unit of General Surgery Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
- Department of Surgery and Research Unit of General Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Roberto Coppola
- Operative Research Unit of General Surgery Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
- Department of Surgery and Research Unit of General Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Sara Ramella
- Research Unit of Radiation Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
- Operative Research Unit of Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Rolando Maria D'Angelillo
- Radiation Oncology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
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Garofalo G, Ponte M, Greco C, Barbera M, Mammano MM, Fascella G, Greco G, Salsi G, Orlando S, Alfonzo A, Di Grigoli A, Piazzese D, Bonanno A, Settanni L, Gaglio R. Improvement of Fresh Ovine "Tuma" Cheese Quality Characteristics by Application of Oregano Essential Oils. Antioxidants (Basel) 2023; 12:1293. [PMID: 37372023 DOI: 10.3390/antiox12061293] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
In the present work, oregano essential oils (OEOs) were applied to process the fresh ovine cheese "Tuma" obtained by pressed cheese technology. Cheese making trials were performed under industrial conditions using ewe's pasteurized milk and two strains of Lactococcus lactis (NT1 and NT4) as fermenting agents. Two experimental cheese products (ECP) were obtained through the addition of 100 (ECP100) and 200 (ECP200) µL/L of OEO to milk, while the control cheese product (CCP) was OEO-free. Both Lc. lactis strains showed in vitro and in vivo ability to grow in the presence of OEOs and to dominate over indigenous milk lactic acid bacteria (LAB) resistant to pasteurization. In the presence of OEOs, the most abundant compound found in cheese was carvacrol, constituting more than 65% of the volatile fraction in both experimental products. The addition of OEOs did not influence ash, fat, or protein content, but it increased by 43% the antioxidant capacity of the experimental cheeses. ECP100 cheeses showed the best appreciation scores by the sensory panel. In order to investigate the ability OEOs to be used as a natural preservative, a test of artificial contamination was carried out, and the results showed a significant reduction of the main dairy pathogens in OEO-added cheeses.
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Affiliation(s)
- Giuliana Garofalo
- Department of Agricultural, Food and Forest Sciences, University of Palermo, 90128 Palermo, Italy
| | - Marialetizia Ponte
- Department of Agricultural, Food and Forest Sciences, University of Palermo, 90128 Palermo, Italy
| | - Carlo Greco
- Research Centre for Plant Protection and Certification, Council for Agricultural Research and Economics, 90011 Bagheria, Italy
| | - Marcella Barbera
- Department of Earth and Marine Sciences, University of Palermo, 90123 Palermo, Italy
| | - Michele Massimo Mammano
- Research Centre for Plant Protection and Certification, Council for Agricultural Research and Economics, 90011 Bagheria, Italy
| | - Giancarlo Fascella
- Research Centre for Plant Protection and Certification, Council for Agricultural Research and Economics, 90011 Bagheria, Italy
| | - Giuseppe Greco
- Department of Agricultural, Food and Forest Sciences, University of Palermo, 90128 Palermo, Italy
- Research Centre for Plant Protection and Certification, Council for Agricultural Research and Economics, 90011 Bagheria, Italy
| | - Giulia Salsi
- Research Centre for Plant Protection and Certification, Council for Agricultural Research and Economics, 90011 Bagheria, Italy
| | - Santo Orlando
- Department of Agricultural, Food and Forest Sciences, University of Palermo, 90128 Palermo, Italy
| | - Antonio Alfonzo
- Department of Agricultural, Food and Forest Sciences, University of Palermo, 90128 Palermo, Italy
| | - Antonino Di Grigoli
- Department of Agricultural, Food and Forest Sciences, University of Palermo, 90128 Palermo, Italy
| | - Daniela Piazzese
- Department of Earth and Marine Sciences, University of Palermo, 90123 Palermo, Italy
| | - Adriana Bonanno
- Department of Agricultural, Food and Forest Sciences, University of Palermo, 90128 Palermo, Italy
| | - Luca Settanni
- Department of Agricultural, Food and Forest Sciences, University of Palermo, 90128 Palermo, Italy
| | - Raimondo Gaglio
- Department of Agricultural, Food and Forest Sciences, University of Palermo, 90128 Palermo, Italy
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14
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Tubin S, Vozenin M, Prezado Y, Durante M, Prise K, Lara P, Greco C, Massaccesi M, Guha C, Wu X, Mohiuddin M, Vestergaard A, Bassler N, Gupta S, Stock M, Timmerman R. Novel unconventional radiotherapy techniques: Current status and future perspectives - Report from the 2nd international radiation oncology online seminar. Clin Transl Radiat Oncol 2023; 40:100605. [PMID: 36910025 PMCID: PMC9996385 DOI: 10.1016/j.ctro.2023.100605] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/25/2023] Open
Abstract
•Improvement of therapeutic ratio by novel unconventional radiotherapy approaches.•Immunomodulation using high-dose spatially fractionated radiotherapy.•Boosting radiation anti-tumor effects by adding an immune-mediated cell killing.
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Affiliation(s)
- S. Tubin
- Medaustron Center for Ion Therapy, Marie-Curie Strasse 5, Wiener Neustadt 2700, Austria
- Corresponding author.
| | - M.C. Vozenin
- Radiation Oncology Laboratory, Radiation Oncology Service, Oncology Department, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Y. Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay 91400, France
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay 91400, France
| | - M. Durante
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung, Planckstraße 1, Darmstadt 64291, Germany
- Technsiche Universität Darmstadt, Institute for Condensed Matter Physics, Darmstadt, Germany
| | - K.M. Prise
- Patrick G Johnston Centre for Cancer Research Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, United Kingdom
| | - P.C. Lara
- Canarian Comprehensive Cancer Center, San Roque University Hospital & Fernando Pessoa Canarias University, C/Dolores de la Rocha 9, Las Palmas GC 35001, Spain
| | - C. Greco
- Department of Radiation Oncology Champalimaud Foundation, Av. Brasilia, Lisbon 1400-038, Portugal
| | - M. Massaccesi
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - C. Guha
- Montefiore Medical Center Radiation Oncology, 111 E 210th St, New York, NY, United States
| | - X. Wu
- Executive Medical Physics Associates, 19470 NE 22nd Road, Miami, FL 33179, United States
| | - M.M. Mohiuddin
- Northwestern Medicine Cancer Center Warrenville and Northwestern Medicine Proton Center, 4455 Weaver Pkwy, Warrenville, IL 60555, United States
| | - A. Vestergaard
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - N. Bassler
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - S. Gupta
- The Loop Immuno-Oncology Laboratory, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, United States
| | - M. Stock
- Medaustron Center for Ion Therapy, Marie-Curie Strasse 5, Wiener Neustadt 2700, Austria
- Karl Landsteiner University of Health Sciences, Marie-Curie Strasse 5, Wiener Neustadt 2700, Austria
| | - R. Timmerman
- Department of Radiation Oncology, University of Texas, Southwestern Medical Center, Inwood Road Dallas, TX 2280, United States
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15
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Nardone V, Boldrini L, Salvestrini V, Greco C, Petrianni GM, Desideri I, De Felice F. Are you planning to be a radiation oncologist? A survey by the young group of the Italian Association of Radiotherapy and Clinical Oncology (yAIRO). Radiol Med 2023; 128:252-260. [PMID: 36586084 DOI: 10.1007/s11547-022-01586-2] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 12/22/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE The Young Section of the Italian Association of Radiotherapy and Clinical Oncology (yAIRO) circulated an online questionnaire survey among residents currently enrolled within Italian radiotherapy residency schools to investigate the profiles, motivations, knowledge of the radiotherapy discipline, organizations and the needs of younger members. MATERIALS AND METHODS The survey was developed by the yAIRO steering committee and included questions about the demographic characteristics of the residents (Profile A), the background of their clinical experience during the school of medicine and national residency admission test performance (Profile B) and the residents' knowledge of the scientific associations active in the field of radiotherapy (Profile C). RESULTS Out of 400 residents actually in training, 134 responded to the questionnaire (response rate 33.5%). According to most of the residents, radiotherapy was not adequately studied during the medical school (n. 95; 71%) and an Internship in Radiotherapy was not mandatory (n. 99; 74%). Only a minority of the residents had chosen to complete a master's degree thesis in radiotherapy (n. 12; 9%). A low percentage of the residents stated that they were aware of the Italian Association of Radiotherapy and Clinical Oncology (AIRO), its young section (yAIRO) and the European Society for Radiotherapy and Oncology (ESTRO) when they were in School of Medicine (respectively, 11%, 7% and 13%). CONCLUSIONS The results of the survey require a profound reflection on the current teaching methods of Radiation Oncology in our country, highlighting the need for a better integration in the framework of the School of Medicine core curriculum.
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Affiliation(s)
- Valerio Nardone
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138, Naples, Italy
| | - Luca Boldrini
- Radiation Oncology, IRCCS, Fondazione Policlinico Universitario A. Gemelli, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Viola Salvestrini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134, Florence, Italy.,CyberKnife Center, Istituto Fiorentino di Cura e Assistenza (IFCA), 50139, Florence, Italy
| | - Carlo Greco
- Research Unit of Radiation Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy.,Operative Research Unit of Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Gian Marco Petrianni
- Operative Research Unit of Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy.
| | - Isacco Desideri
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134, Florence, Italy.,Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, 50134, Florence, Italy
| | - Francesca De Felice
- Radiation Oncology, Policlinico Umberto I "Sapienza" University of Rome, Viale Regina Elena 326, 00161, Rome, Italy
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16
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Greco C, Pares O, Pimentel N, Louro V, Nunes B, Kociolek J, Marques J, Fuks Z. Health-related quality of life of salvage prostate reirradiation using stereotactic ablative radiotherapy with urethral-sparing. Front Oncol 2022; 12:984917. [PMID: 36276100 PMCID: PMC9582606 DOI: 10.3389/fonc.2022.984917] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/12/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To explore whether prostate motion mitigation using the rectal distension-mediated technique is safe and effective in stereotactic ablative radiation therapy (SABR) salvage treatment of intraprostatic cancer recurrences following initial radiotherapy for primary prostate cancer. MATERIALS AND METHODS Between July 2013 and December 2020, 30 patients received salvage SABR for 68Ga- PSMA-11 PET/CT-detected intra-prostatic relapses. Median time from primary RT to salvage reirradiation was 70.2 (IQR, 51.3-116.0) months. Median PSA at retreatment was 3.6 ng/mL (IQR, 1.9-6.2). Rectal distension-mediated SABR was achieved with a 150-cm3 air-inflated endorectal balloon and a Foley catheter loaded with 3 beacon transponders was used for urethra visualization and on-line tracking. MRI-based planning employed a 2-mm expansion around the planned target volume (PTV), reduced to 0-mm at the interface with critical organs at risk (OARs). Volumetric Modulated Arc Therapy (VMAT) permitted a 20% dose reduction of the urethra. VMAT simultaneous integrated boost (SIB) of the dominant intraprostatic lesion was deployed when indicated. Median SABR dose was 35 Gy (7 Gy per fraction over 5 consecutive days; range 35-40 Gy). Toxicity assessment used CTCAE v.4 criteria. RESULTS Median follow-up was 44 months (IQR, 18-60). The actuarial 3- and 4-year biochemical relapse free survival was 53.4% and 47.5%, respectively. Intraprostatic post-salvage relapse by PSMA PET/CT was 53.3%. Acute grade 2 and 3 genitourinary (GU) toxicities were 20% and 0%, respectively. There were no instances of acute grade ≥2 rectal (GI) toxicity. Late grade 2 and 3 GU toxicities occurred in 13.3% and 0% of patients, respectively. There were no instances of grade ≥2 late rectal toxicity. Patient-reported QOL measures showed an acute transient deterioration in the urinary domain 1 month after treatment but returned to baseline values at 3 months. The median IPSS scores rose over baseline (≥5 points in 53% of patients) between month 6 and 12 post-treatment as a result of urinary symptoms flare, eventually receding at 18 months. The bowel domain metrics had no appreciable changes over time. CONCLUSION Pursuit of local control in intraprostatic failures is feasible and can be achieved with an acceptably low toxicity profile associated with effective OAR sparing.
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Affiliation(s)
- Carlo Greco
- The Champalimaud Centre for the Unknown, Department of Radiation Oncology, Lisbon, Portugal,*Correspondence: Carlo Greco,
| | - Oriol Pares
- The Champalimaud Centre for the Unknown, Department of Radiation Oncology, Lisbon, Portugal
| | - Nuno Pimentel
- The Champalimaud Centre for the Unknown, Department of Radiation Oncology, Lisbon, Portugal
| | - Vasco Louro
- The Champalimaud Centre for the Unknown, Department of Radiation Oncology, Lisbon, Portugal
| | - Beatriz Nunes
- The Champalimaud Centre for the Unknown, Department of Radiation Oncology, Lisbon, Portugal
| | - Justyna Kociolek
- The Champalimaud Centre for the Unknown, Department of Radiation Oncology, Lisbon, Portugal
| | - Joao Marques
- The Champalimaud Centre for the Unknown, Department of Radiation Oncology, Lisbon, Portugal
| | - Zvi Fuks
- The Champalimaud Centre for the Unknown, Department of Radiation Oncology, Lisbon, Portugal,Memorial Sloan Kettering Cancer Department of Radiation Oncology Center, New York, NY, United States
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17
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Pacifico P, Colciago RR, De Felice F, Boldrini L, Salvestrini V, Nardone V, Desideri I, Greco C, Arcangeli S. A critical review on oligometastatic disease: a radiation oncologist's perspective. Med Oncol 2022; 39:181. [PMID: 36071292 PMCID: PMC9452425 DOI: 10.1007/s12032-022-01788-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022]
Abstract
Since the first definition by Hellman and Weichselbaum in 1995, the concept of OligoMetastatic Disease (OMD) is a growing oncology field. It was hypothesized that OMD is a clinical temporal window between localized primary tumor and widespread metastases deserving of potentially curative treatment. In real-world clinical practice, OMD is a “spectrum of disease” that includes a highly heterogeneous population of patients with different prognosis. Metastasis directed therapy with local ablative treatment have proved to be a valid alternative to surgical approach. Stereotactic body radiation therapy demonstrated high local control rate and increased survival outcomes in this setting with a low rate of toxicity. However, there is a lack of consensus regarding many clinical, therapeutic, and prognostic aspects of this disease entity. In this review, we try to summarize the major critical features that could drive radiation oncologists toward a better selection of patients, treatments, and study endpoints. With the help of a set of practical questions, we aim to integrate the literature discussion.
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Affiliation(s)
- Pietro Pacifico
- School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy. .,Department of Radiation Oncology, Ospedale S. Gerardo, Via G. B. Pergolesi, 20900, Monza, MB, Italy.
| | - Riccardo Ray Colciago
- School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy.,Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Luca Boldrini
- Radiology, Radiation Oncology and Hematology Department, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | | | - Valerio Nardone
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Isacco Desideri
- Department of Radiation Oncology, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Carlo Greco
- Department of Radiation Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Stefano Arcangeli
- School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy.,Department of Radiation Oncology, Ospedale S. Gerardo, Via G. B. Pergolesi, 20900, Monza, MB, Italy
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18
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Iori F, Bruni A, Cozzi S, Ciammella P, Di Pressa F, Boldrini L, Greco C, Nardone V, Salvestrini V, Desideri I, De Felice F, Iotti C. Can Radiotherapy Empower the Host Immune System to Counterattack Neoplastic Cells? A Systematic Review on Tumor Microenvironment Radiomodulation. Curr Oncol 2022; 29:4612-4624. [PMID: 35877226 PMCID: PMC9319790 DOI: 10.3390/curroncol29070366] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Despite the rising evidence in favor of immunotherapy (IT), the treatment of oncological patients affected by so-called “cold tumors” still represents an open issue. Cold tumors are characterized by an immunosuppressive (so-called cold) tumor microenvironment (TME), which favors host immune system suppression, cancer immune-escape, and a worse response to IT. However, the TME is not a static element, but dynamically mutates and can be changed. Radiotherapy (RT) can modulate a cold microenvironment, rendering it better at tumor killing by priming the quiescent host immune system, with a consequent increase in immunotherapy response. The combination of TME radiomodulation and IT could therefore be a strategy for those patients affected by cold tumors, with limited or no response to IT. Thus, this review aims to provide an easy, rapid, and practical overview of how RT could convert the cold TME and why cold tumor radiomodulation could represent an interesting strategy in combination with IT.
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Affiliation(s)
- Federico Iori
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42124 Reggio Emilia, Italy; (S.C.); (P.C.); (C.I.)
- Correspondence:
| | - Alessio Bruni
- Radiotherapy Unit, Oncology and Hematology Department, University Hospital of Modena, 41121 Modena, Italy; (A.B.); (F.D.P.)
| | - Salvatore Cozzi
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42124 Reggio Emilia, Italy; (S.C.); (P.C.); (C.I.)
| | - Patrizia Ciammella
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42124 Reggio Emilia, Italy; (S.C.); (P.C.); (C.I.)
| | - Francesca Di Pressa
- Radiotherapy Unit, Oncology and Hematology Department, University Hospital of Modena, 41121 Modena, Italy; (A.B.); (F.D.P.)
| | - Luca Boldrini
- Radiation Oncology Unit, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy;
| | - Carlo Greco
- Radiation Oncology, Campus Bio-Medico University, 00128 Rome, Italy;
| | | | - Viola Salvestrini
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, 50134 Florence, Italy; (V.S.); (I.D.)
| | - Isacco Desideri
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, 50134 Florence, Italy; (V.S.); (I.D.)
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy;
| | - Cinzia Iotti
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42124 Reggio Emilia, Italy; (S.C.); (P.C.); (C.I.)
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19
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Mazzocca A, Paternostro F, Minelli A, Silletta M, Greco C, Valeri S, Ramella S, Tonini G, Vincenzi B. How I treat localized soft tissue sarcomas: update on diagnosis, risk-stratification and treatment. Chemotherapy 2022; 67:234-247. [PMID: 35728569 DOI: 10.1159/000525539] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/26/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adult-type soft tissue sarcomas (STS) are rare tumors representing about 1% of all adult malignant tumors. Their extreme histological heterogeneity places them among the most challenging fields of diagnostic pathology. The variability of clinical and prognostic presentation between the various histotypes reflects the different management that should be followed on a case-by-case basis. These features make soft tissue sarcomas the case in point of how important it is a centralized and multidisciplinary approach. SUMMARY Surgery represents the mainstay in the treatment of localized soft tissue sarcomas. Recently, more and more studies are making efforts to understand what the contribution of chemotherapy and radiotherapy with neoadjuvant and adjuvant intent may be both in unselected and selected histological subgroups. In fact, despite the improvement in overall survival seen in the past few years thanks to the adoption of a more radical surgical approach, mortality remains relatively high and the five-year overall survival is around 65%. KEY MESSAGES In this review, we comment upon the treatment of localized soft tissue sarcomas of the extremity, trunk wall and retroperitoneum and how surgery, radiotherapy and chemotherapy can be integrated with each other and individually tailored. Nomograms can assist clinicians in this complex therapeutic-decision making process, through the identification of patients at higher risk of death or disease relapse.
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Affiliation(s)
| | - Flavia Paternostro
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Alessandro Minelli
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Marianna Silletta
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Carlo Greco
- Department of Radiation Oncology, University Campus Bio-Medico, Rome, Italy
| | - Sergio Valeri
- Department of General Surgery, University Campus Bio-Medico, Rome, Italy
| | - Sara Ramella
- Department of Radiation Oncology, University Campus Bio-Medico, Rome, Italy
| | - Giuseppe Tonini
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Bruno Vincenzi
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
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20
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Leci E, Carinci V, Bugani G, Greco C, D‘Angelo C, Pecoraro A, Casella G. P23 TIMING OF EJECTION FRACTION REASSESSMENT AFTER SACUBITRIL–VALSARTAN INITIATION FOR INDICATION TO DEFIBRILLATOR IMPLANTATION. A SINGLE CENTER EXPERIENCE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.021] [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: 11/12/2022]
Abstract
Abstract
Background
Sacubitril/Valsartan (SV) has been validated for heart failure (HF) with reduced ejection fraction (EF) treatment. SV is effective on hard end–points as well as symptoms and heart remodeling. Present guidelines reccomend at least 3 month of optimized medical therapy (OMT). However, the best timing of EF assessment after SV initiation in order to proceed with defibrillator (ICD) implantation, is still unknown.
Purpose
Evaluate timing of improvement of EF after SV initiation in patients (pts) with systolic HF, candidates to primary prevention ICD implantation.
Methods
From 1 of february 2018, we evaluated retrospectively clinical and echocardiographic data of all consecutive pts with EF < 35% treated with SV and candidates to primary prevention ICD implantation. We evaluated clinical and echo follow up (Fup). Results have been analyzed with paired T–test.
Results
The study involved 95 pts (mean age 67±10 years, 70% male, ischaemic etiology 48%). Mean EF at enrollment was 30 ± 5% (ED vol 90 ±23 ml/m2; ES vol 62 ± 19 ml/m2, severe MR 23%) and NYHA III–IV 50%. In 58% pts reached the target dose of SV (97/103 mg bid). After a mean Fup of 6 months, mean EF of the study population increased to 37±7% (ED vol 80±19 ml/m2, ES vol 51±17 ml/m2, severe MR 5%, p < 0.001), and NYHA III–IV decreased to 8% (p = 0.01). Interestingly, thirty–one pts (32%) had their first Fup within 3 months and showed already an improvement [meanEF 28±5% to 35±6%; ΔEF 7±6%; NYHA III–IV 10 %]. Moreover, 49 pts (51%) had last Fup echo after 1 year (mean 13±6 months) and showed a further EF improvement (meanEF 41±8%; ΔEF 12±9%; p < 0.001).Sixteen pt (16%) underwent ICD (62%) or CRT–D (38%) implantation after 3±2 months of treatment and excluded from further FUP analysis. More favorable effects of treatment with SV were more evident in patient with non–ischaemic etiology of heart failure.
Conclusions
After SV initiation in systolic HF, favourable heart remodeling is clearly evident at 6 months FUP, but could be already observed after 3 months . These findings need to be validated from larger trials but suggest that the best timing of EF reassessment to decide for primary prevention ICD is likely between 3 and 6 months after SV initiation. However decision must be taken following close and individualized FUP for every patient, based on clinical characteristics and response to OMT.
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Affiliation(s)
- E Leci
- U.O CARDIOLOGIA; OSPEDALE MAGGIORE BOLOGNA, BOLOGNA
| | - V Carinci
- U.O CARDIOLOGIA; OSPEDALE MAGGIORE BOLOGNA, BOLOGNA
| | - G Bugani
- U.O CARDIOLOGIA; OSPEDALE MAGGIORE BOLOGNA, BOLOGNA
| | - C Greco
- U.O CARDIOLOGIA; OSPEDALE MAGGIORE BOLOGNA, BOLOGNA
| | - C D‘Angelo
- U.O CARDIOLOGIA; OSPEDALE MAGGIORE BOLOGNA, BOLOGNA
| | - A Pecoraro
- U.O CARDIOLOGIA; OSPEDALE MAGGIORE BOLOGNA, BOLOGNA
| | - G Casella
- U.O CARDIOLOGIA; OSPEDALE MAGGIORE BOLOGNA, BOLOGNA
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Matteucci P, Ippolito E, Silipigni S, Talocco C, Petrianni G, Palumbo V, Onorati E, Greco C, Cirnigliaro V, Fiore M, Ramella S. PO-1206 Patients Needs Undergoing Breast Radiotherapy for the Development of a Mobile Application (RADIOSA). Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03170-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: 11/25/2022]
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22
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D'Ercole G, Fiore M, Alaimo R, Trecca P, Petrianni G, Trodella L, Marrocco M, Greco C, Ippolito E, Ramella S. PD-0494 Secondary dosimetric analysis of a phase II study on radiation volume de-escalation in rectal cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02865-1] [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: 10/18/2022]
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23
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Pereira M, Stroom J, Rocha A, Greco C, Nijsten S. PD-0805 3D Portal Dosimetry for extreme hypofraction: pre-treatment and in vivo verification. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02946-2] [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: 10/18/2022]
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trecca P, Fiore M, D'Ercole G, Petrianni G, Greco C, Ippolito E, Marinelli L, Valeri S, Vincenzi B, Ramella S. PO-1431 Integrated therapies for soft tissue sarcomas: a single institution experience from Italy using hyperthermia in association with radiotherapy and chemotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03395-3] [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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25
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Vieira S, Parés O, Stroom J, Greco C. MO-0224 Simultaneous integrated boost in short-course radiotherapy; a novel approach for rectal cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02326-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: 11/27/2022]
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26
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Ghareeb F, Sarbazvatan S, Stroom J, Boukerroui D, Greco C. PO-1603 Evaluating the geometric accuracy of the constructed Mid-P CT using mathematically deformed phantoms. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03567-8] [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: 11/25/2022]
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27
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Greco C, Pares O, Pimentel N, Louro V, Nunes B, Kociolek J, Stroom J, Vieira S, Mateus D, Cardoso MJ, Soares A, Marques J, Freitas E, Coelho G, Fuks Z. Urethra Sparing With Target Motion Mitigation in Dose-Escalated Extreme Hypofractionated Prostate Cancer Radiotherapy: 7-Year Results From a Phase II Study. Front Oncol 2022; 12:863655. [PMID: 35433469 PMCID: PMC9012148 DOI: 10.3389/fonc.2022.863655] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/24/2022] [Indexed: 11/15/2022] Open
Abstract
Purpose To explore whether the rectal distension-mediated technique, harnessing human physiology to achieve intrafractional prostate motion mitigation, enables urethra sparing by inverse dose painting, thus promoting dose escalation with extreme hypofractionated stereotactic ablative radiotherapy (SABR) in prostate cancer. Materials and Methods Between June 2013 and December 2018, 444 patients received 5 × 9 Gy SABR over 5 consecutive days. Rectal distension-mediated SABR was employed via insertion of a 150-cm3 air-inflated endorectal balloon. A Foley catheter loaded with 3 beacon transponders was used for urethra visualization and online tracking. MRI-based planning using Volumetric Modulated Arc Therapy - Image Guided Radiotherapy (VMAT-IGRT) with inverse dose painting was employed in delivering the planning target volume (PTV) dose and in sculpting exposure of organs at risk (OARs). A 2-mm margin was used for PTV expansion, reduced to 0 mm at the interface with critical OARs. All plans fulfilled Dmean ≥45 Gy. Target motion ≥2 mm/5 s motions mandated treatment interruption and target realignment prior to completion of the planned dose delivery. Results Patient compliance to the rectal distension-mediated immobilization protocol was excellent, achieving reproducible daily prostate localization at a patient-specific retropubic niche. Online tracking recorded ≤1-mm intrafractional target deviations in 95% of treatment sessions, while target realignment in ≥2-mm deviations enabled treatment completion as scheduled in all cases. The cumulative incidence rates of late grade ≥2 genitourinary (GU) and gastrointestinal (GI) toxicities were 5.3% and 1.1%, respectively. The favorable toxicity profile was corroborated by patient-reported quality of life (QOL) outcomes. Median prostate-specific antigen (PSA) nadir by 5 years was 0.19 ng/ml. The cumulative incidence rate of biochemical failure using the Phoenix definition was 2%, 16.6%, and 27.2% for the combined low/favorable–intermediate, unfavorable intermediate, and high-risk categories, respectively. Patients with a PSA failure underwent a 68Ga-labeled prostate-specific membrane antigen (68Ga-PSMA) scan showing a 20.2% cumulative incidence of intraprostatic relapses in biopsy International Society of Urological Pathology (ISUP) grade ≥3. Conclusion The rectal distension-mediated technique is feasible and well tolerated. Dose escalation to 45 Gy with urethra-sparing results in excellent toxicity profiles and PSA relapse rates similar to those reported by other dose-escalated regimens. The existence of intraprostatic recurrences in patients with high-risk features confirms the notion of a high α/β ratio in these phenotypes resulting in diminished effectiveness with hypofractionated dose escalation.
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Affiliation(s)
- Carlo Greco
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Oriol Pares
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Nuno Pimentel
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Vasco Louro
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Beatriz Nunes
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Justyna Kociolek
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Joep Stroom
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Sandra Vieira
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Dalila Mateus
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Maria Joao Cardoso
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Ana Soares
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Joao Marques
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Elda Freitas
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Graça Coelho
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Zvi Fuks
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Memorial Sloan Kettering Cancer Center, New York, NY, United States
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Greco C, Fiore M, Valenza V, Venanzio CD, Rovera G, Ippolito E, Zollino M, D’Angelillo RM, Giordano A, Ramella S. Precision radiotherapy by SPECT lung functional imaging in NSCLC. J Mens Health 2022. [DOI: 10.31083/j.jomh1804101] [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: 11/06/2022] Open
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Ippolito E, Silipigni S, Matteucci P, Greco C, Carrafiello S, Palumbo V, Tacconi C, Talocco C, Fiore M, D’Angelillo RM, Ramella S. Radiotherapy for HER 2 Positive Brain Metastases: Urgent Need for a Paradigm Shift. Cancers (Basel) 2022; 14:cancers14061514. [PMID: 35326665 PMCID: PMC8946529 DOI: 10.3390/cancers14061514] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 01/09/2023] Open
Abstract
Brain metastases (BMs) are common among patients affected by HER2+ metastatic breast cancer (>30%). The management of BMs is usually multimodal, including surgery, radiotherapy, systemic therapy and palliative care. Standard brain radiotherapy (RT) includes the use of stereotactic radiotherapy (SRT) for limited disease and whole brain radiotherapy (WBRT) for extensive disease. The latter is an effective palliative treatment but has a reduced effect on brain local control and BM overall survival, as it is also associated with severe neurocognitive sequelae. Recent advances both in radiation therapy and systemic treatment may change the paradigm in this subset of patients who can experience long survival notwithstanding BMs. In fact, in recent studies, SRT for multiple BM sites (>4) has shown similar efficacy when compared to irradiation of a limited number of lesions (one to three) without increasing toxicity. These findings, in addition to the introduction of new drugs with recognized intracranial activity, may further limit the use of WBRT in favor of SRT, which should be employed for treatment of both multiple-site BMs and for oligo-progressive brain disease. This review summarizes the supporting literature and highlights the need for optimizing combinations of the available treatments in this setting, with a particular focus on radiation therapy.
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Affiliation(s)
- Edy Ippolito
- Radiation Oncology, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy; (E.I.); (S.S.); (C.G.); (S.C.); (V.P.); (C.T.); (C.T.); (M.F.); (S.R.)
| | - Sonia Silipigni
- Radiation Oncology, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy; (E.I.); (S.S.); (C.G.); (S.C.); (V.P.); (C.T.); (C.T.); (M.F.); (S.R.)
| | - Paolo Matteucci
- Radiation Oncology, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy; (E.I.); (S.S.); (C.G.); (S.C.); (V.P.); (C.T.); (C.T.); (M.F.); (S.R.)
- Correspondence: ; Tel.: +39-06225411708
| | - Carlo Greco
- Radiation Oncology, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy; (E.I.); (S.S.); (C.G.); (S.C.); (V.P.); (C.T.); (C.T.); (M.F.); (S.R.)
| | - Sofia Carrafiello
- Radiation Oncology, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy; (E.I.); (S.S.); (C.G.); (S.C.); (V.P.); (C.T.); (C.T.); (M.F.); (S.R.)
| | - Vincenzo Palumbo
- Radiation Oncology, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy; (E.I.); (S.S.); (C.G.); (S.C.); (V.P.); (C.T.); (C.T.); (M.F.); (S.R.)
| | - Claudia Tacconi
- Radiation Oncology, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy; (E.I.); (S.S.); (C.G.); (S.C.); (V.P.); (C.T.); (C.T.); (M.F.); (S.R.)
| | - Claudia Talocco
- Radiation Oncology, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy; (E.I.); (S.S.); (C.G.); (S.C.); (V.P.); (C.T.); (C.T.); (M.F.); (S.R.)
| | - Michele Fiore
- Radiation Oncology, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy; (E.I.); (S.S.); (C.G.); (S.C.); (V.P.); (C.T.); (C.T.); (M.F.); (S.R.)
| | | | - Sara Ramella
- Radiation Oncology, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy; (E.I.); (S.S.); (C.G.); (S.C.); (V.P.); (C.T.); (C.T.); (M.F.); (S.R.)
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Greco C, Pares O, Pimentel N, Louro V, Nunes B, Kociolek J, Marques J, Fuks Z. Early PSA density kinetics predicts biochemical and local failure following extreme hypofractionated radiotherapy in intermediate-risk prostate cancer. Radiother Oncol 2022; 169:35-42. [DOI: 10.1016/j.radonc.2022.02.016] [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] [Received: 10/10/2021] [Revised: 02/05/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
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Greco C, Pares O, Pimentel N, Louro V, Morales J, Nunes B, Antunes I, Vasconcelos AL, Kociolek J, Castanheira J, Oliveira C, Silva A, Vaz S, Oliveira F, Carrasquinha E, Costa D, Fuks Z. Positron Emission Tomography-Derived Metrics Predict the Probability of Local Relapse After Oligometastasis-Directed Ablative Radiation Therapy. Adv Radiat Oncol 2022; 7:100864. [PMID: 35036636 PMCID: PMC8752878 DOI: 10.1016/j.adro.2021.100864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/05/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose Early positron emission tomography–derived metrics post–oligometastasis radioablation may predict impending local relapses (LRs), providing a basis for a timely ablation. Methods and Materials Positron emission tomography data of 623 lesions treated with either 24 Gy single-dose radiation therapy (SDRT) (n = 475) or 3 × 9 Gy stereotactic body radiation therapy (SBRT) (n = 148) were analyzed in a training data set (n = 246) to obtain optimal cutoffs for pretreatment maximum standardized uptake value (SUVmax) and its 3-month posttreatment decline (ΔSUVmax) in predicting LR risk, validated in a data set unseen to testing (n = 377). Results At a median of 21.7 months, 91 lesions developed LRs: 39 of 475 (8.2%) after SDRT and 52 of 148 (35.1%) after SBRT. The optimal cutoff values were 12 for SUVmax and –75% for ΔSUVmax. Bivariate SUVmax/ΔSUVmax permutations rendered a 3-tiered LR risk stratification of dual-favorable (low risk), 1 adverse (intermediate risk) and dual-adverse (high risk). Actuarial 5-year local relapse-free survival rates were 93.9% versus 89.6% versus 57.1% (P < .0001) and 76.1% versus 48.3% versus 8.2% (P < .0001) for SDRT and SBRT, respectively. The SBRT area under the ROC curve was 0.71 (95% CI, 0.61-0.79) and the high-risk subgroup yielded a 76.5% true positive LR prediction rate. Conclusions The SBRT dual-adverse SUVmax/ΔSUVmax category LR prediction power provides a basis for prospective studies testing whether a timely ablation of impending LRs affects oligometastasis outcomes.
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Affiliation(s)
- Carlo Greco
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
- Corresponding author: Carlo Greco, MD
| | - Oriol Pares
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Nuno Pimentel
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Vasco Louro
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Javier Morales
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Beatriz Nunes
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Inês Antunes
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Ana Luisa Vasconcelos
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Justyna Kociolek
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Joana Castanheira
- Department of Nuclear Medicine-Radiopharmacology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Carla Oliveira
- Department of Nuclear Medicine-Radiopharmacology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Angelo Silva
- Department of Nuclear Medicine-Radiopharmacology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Sofia Vaz
- Department of Nuclear Medicine-Radiopharmacology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Francisco Oliveira
- Department of Nuclear Medicine-Radiopharmacology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Eunice Carrasquinha
- Computational Clinical Imaging Group, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Durval Costa
- Department of Nuclear Medicine-Radiopharmacology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Zvi Fuks
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
- Memorial Sloan Kettering Cancer Center, New York, New York
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Ippolito E, Silipigni S, Matteucci P, Greco C, Pantano F, D’Auria G, Quattrocchi CC, Floreno B, Fiore M, Gamucci T, Tonini G, Ramella S. Stereotactic Radiation and Dual Human Epidermal Growth Factor Receptor 2 Blockade with Trastuzumab and Pertuzumab in the Treatment of Breast Cancer Brain Metastases: A Single Institution Series. Cancers (Basel) 2022; 14:cancers14020303. [PMID: 35053467 PMCID: PMC8774076 DOI: 10.3390/cancers14020303] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 01/19/2023] Open
Abstract
(1) Background: This study aims to assess the safety and efficacy of fractionated SRT (fSRT) and pertuzumab-trastuzumab (PT) in patients with breast cancer brain metastases (BCBM). (2) Methods: Patients with HER2+ BCBM who received FSRT from 2015 to 2019 were identified. Patients were included if they were treated with fSRT within 21 days of receiving PT. All lesions were treated with LINAC-based fSRT to a total dose of 27 Gy delivered in three consecutive fractions. All patients received concurrent PT. Patients were evaluated 4-6 weeks after SRS and subsequently every 2-3 months with MRI re-imaging (3) Results: A total of 49 patients with HER2+ brain metastases were identified. Of these patients, a total of 10 patients with 32 HER2+ BCBM were treated with concurrent SRT and PT and included in the analysis. No local progression was observed. Overall response rate was 68.7%. Only one patient developed asymptomatic radionecrosis. Median time to BM occurrence was 15.6 (range: 1-40.5 months). Distant intracranial failure occurred in 4/10 patients (40.0%). Overall BCBM median survival was 33.9 months (95%CI 24.1-43.6). Mean duration of PT treatment was 27.9 months (range: 10.1-53.7 months). (4) Conclusions: In our single institution experience, fSRT and PT showed to be a safe treatment for patients with BCBM with an adequate overall response rate.
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Affiliation(s)
- Edy Ippolito
- Department of Radiation Oncology, Campus Bio-Medico University, 00128 Rome, Italy; (S.S.); (P.M.); (C.G.); (B.F.); (M.F.); (S.R.)
- Correspondence: ; Tel.: +39-06-22541-1708
| | - Sonia Silipigni
- Department of Radiation Oncology, Campus Bio-Medico University, 00128 Rome, Italy; (S.S.); (P.M.); (C.G.); (B.F.); (M.F.); (S.R.)
| | - Paolo Matteucci
- Department of Radiation Oncology, Campus Bio-Medico University, 00128 Rome, Italy; (S.S.); (P.M.); (C.G.); (B.F.); (M.F.); (S.R.)
| | - Carlo Greco
- Department of Radiation Oncology, Campus Bio-Medico University, 00128 Rome, Italy; (S.S.); (P.M.); (C.G.); (B.F.); (M.F.); (S.R.)
| | - Francesco Pantano
- Department of Medical Oncology, Campus Bio-Medico University, 00128 Rome, Italy; (F.P.); (G.T.)
| | - Giuliana D’Auria
- Department of Medical Oncology, Sandro Pertini Hospital, 00157 Rome, Italy; (G.D.); (T.G.)
| | - Carlo Cosimo Quattrocchi
- Department of Diagnostic Imaging and Interventional Radiology, Campus Bio-Medico University, 00128 Rome, Italy;
| | - Barnaba Floreno
- Department of Radiation Oncology, Campus Bio-Medico University, 00128 Rome, Italy; (S.S.); (P.M.); (C.G.); (B.F.); (M.F.); (S.R.)
| | - Michele Fiore
- Department of Radiation Oncology, Campus Bio-Medico University, 00128 Rome, Italy; (S.S.); (P.M.); (C.G.); (B.F.); (M.F.); (S.R.)
| | - Teresa Gamucci
- Department of Medical Oncology, Sandro Pertini Hospital, 00157 Rome, Italy; (G.D.); (T.G.)
| | - Giuseppe Tonini
- Department of Medical Oncology, Campus Bio-Medico University, 00128 Rome, Italy; (F.P.); (G.T.)
| | - Sara Ramella
- Department of Radiation Oncology, Campus Bio-Medico University, 00128 Rome, Italy; (S.S.); (P.M.); (C.G.); (B.F.); (M.F.); (S.R.)
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Coppola A, La Vaccara V, Cascone C, Farolfi T, Carbone L, Greco C, Ramella S, Ciccozzi M, Angeletti S, Coppola R, Caputo D. Laparoscopic total mesorectal excision (L-TME) for rectal cancer surgery: does elective diverting ileostomy really protect? An observational retrospective cohort study. Ann Ital Chir 2021; 92:S0003469X21036101. [PMID: 35642649] [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: 06/15/2023]
Abstract
AIMS Elective diverting ileostomy may reduce consequences of anastomotic leakage after laparoscopic total mesorectal excision (L-TME); however, its safety is debated because of morbidity related to stoma creation and closure. We aimed to investigate the impact of diverting ileostomy on clinical behavior of anastomotic leakage and complications related to stoma itself. MATERIAL OF THE STUDY We retrospectively evaluated 150 L-TMEs with (Group 1, 100 patients) or without (Group 2, 50 patients) elective ileostomy for rectal cancer. RESULTS Overall anastomotic fistula rate was 26% without significant differences between the two groups (28% in the Group 1 and 22% in the Group 2, respectively). In all the series, NAD was significantly associated with higher risk of postoperative complications (OR=2.14, p=0.02). In Group 2, NAD particularly increased the risk of anastomotic fistula (OR=6.6, p=0.014). Instead, patients of Group 1 showed higher odd of post-operative complications (OR: 3.8; CI 95%: 1.8483-8.0492; p = 0.0003) and notably 79 (79%) developed complications related to the ileostomy itself (hydroelectrolytic, metabolic and peristomal skin disorders). Moreover, thirty-two (32%) ileostomies were never reversed; among the reversed patients, 27 (39.7%) developed at least one postoperative complication and in 9 (33.3%) cases an urgent re-intervention was needed. DISCUSSION Diverting ileostomy may mitigate clinical behavior of anastomotic leakage after L-TME. However, there is non-negligible morbidity of stoma creation and closure. CONCLUSION Diverting ileostomy should be selectively considered in higher risk patients as those who received NAD. KEY WORDS Anastomotic leakage, Ileostomy, Rectal cancer.
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Salvestrini V, Iorio GC, Borghetti P, De Felice F, Greco C, Nardone V, Fiorentino A, Gregucci F, Desideri I. The impact of modern radiotherapy on long-term cardiac sequelae in breast cancer survivor: a focus on deep inspiration breath-hold (DIBH) technique. J Cancer Res Clin Oncol 2021; 148:409-417. [PMID: 34853887 DOI: 10.1007/s00432-021-03875-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/25/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION One of the most feared side effects of radiotherapy (RT) in the setting of breast cancer (BC) patients is cardiac toxicity. This side effect can jeopardize the quality of life (QoL) of long-term survivors. The impact of modern techniques of RT such as deep inspiration breath hold (DIBH) have dramatically changed this setting. We report and discuss the results of the literature overview of this paper. MATERIALS AND METHODS Literature references were obtained with a PubMed query, hand searching, and clinicaltrials.gov. RESULTS We reported and discussed the toxicity of RT and the improvements due to the modern techniques in the setting of BC patients. CONCLUSIONS BC patients often have a long life expectancy, thus the RT should aim at limiting toxicities and at the same time maintaining the same high cure rates. Further studies are needed to evaluate the risk-benefit ratio to identify patients at higher risk and to tailor the treatment choices.
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Affiliation(s)
- V Salvestrini
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - G C Iorio
- Radiation Oncology, University of Turin, Turin, Italy
| | - P Borghetti
- Radiation Oncology, University and SpedaliCivili, Brescia, Italy
| | - F De Felice
- Radiation Oncology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - C Greco
- Radiation Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - V Nardone
- RadiationOncology, Ospedale del Mare, Viale della Metamorfosi, Naples, Italy
| | - A Fiorentino
- Radiation Oncology, General Regional Hospital "F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - F Gregucci
- Radiation Oncology, General Regional Hospital "F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - I Desideri
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
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Salvestrini V, Greco C, Guerini AE, Longo S, Nardone V, Boldrini L, Desideri I, De Felice F. The role of feature-based radiomics for predicting response and radiation injury after stereotactic radiation therapy for brain metastases: A critical review by the Young Group of the Italian Association of Radiotherapy and Clinical Oncology (yAIRO). Transl Oncol 2021; 15:101275. [PMID: 34800918 PMCID: PMC8605350 DOI: 10.1016/j.tranon.2021.101275] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction differential diagnosis of tumor recurrence and radiation injury after stereotactic radiotherapy (SRT) is challenging. The advances in imaging techniques and feature-based radiomics could aid to discriminate radionecrosis from progression. Methods we performed a systematic review of current literature, key references were obtained from a PubMed query. Data extraction was performed by 3 researchers and disagreements were resolved with a discussion among the authors. Results we identified 15 retrospective series, one prospective trial, one critical review and one editorial paper. Radiomics involves a wide range of imaging features referred to necrotic regions, rate of contrast-enhancing area or the measure of edema surrounding the metastases. Features were mainly defined through a multistep extraction/reduction/selection process and a final validation and comparison. Conclusions feature-based radiomics has an optimal potential to accurately predict response and radionecrosis after SRT of BM and facilitate differential diagnosis. Further validation studies are eagerly awaited to confirm radiomics reliability.
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Affiliation(s)
- Viola Salvestrini
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Carlo Greco
- Radiation Oncology, Campus Bio-Medico University of Rome, Rome, Italy.
| | - Andrea Emanuele Guerini
- Radiation Oncology Department, Università degli Studi di Brescia and ASST Spedali Civili, Piazzale Spedali Civili 1, Brescia 25123, Italy.
| | - Silvia Longo
- Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, Rome 00168, Italy.
| | - Valerio Nardone
- Section of Radiology and Radiotherapy, Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples 80138, Italy.
| | - Luca Boldrini
- Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, Rome 00168, Italy.
| | - Isacco Desideri
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy.
| | - Francesca De Felice
- Radiation Oncology, Policlinico Umberto I "Sapienza" University of Rome, Viale Regina Elena 326, Rome 00161, Italy.
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Carinci V, Leci E, Bugani G, Greco C, D'Angelo C, Pecoraro A, Casella G. Timing of ejection fraction reassessment after sacubitril-valsartan initiation for indication to defibrillator implantation. A single center experience. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0699] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Sacubitril/Valsartan (SV) has recently been validated in the therapy of heart failure (HF) with reduced ejection fraction (EF). SV is effective on symptoms and heart remodeling. At the moment the best timing to EF assessment after SV initiation in order to proceed with defibrillator (ICD) implantation, it's unknown.
Purpose
Evaluate the timing of improvement of EF after SV initiation in patients (pts) with systolic HF, candidates to primary prevention ICD implantation.
Methods
We enrolled all consecutive pts candidates to primary prevention ICD implantation that underwent SV initiation from February 2018. We evaluated clinical and echo follow up (Fup). Results have been analyzed with paired T-test).
Results
The study involved 61 pts (mean age 67±10 years, 71% male, ischemic cardiopathy 44%, mean time from diagnosis 31 months) with mean EF at enrollment 30±5% (ED vol 94 ml/m2, ES vol 64 ml/m2, severe MR 21%) and mean NYHA 3±0.6. After a mean Fup of 6 months mean EF increased to 37±7% (ED vol 80 ml/m2, ES vol 51 ml/m2, severe MR 8%, p<0.004), NYHA decreased to 2±0.6 (p<0.04). In 69% pts SV dosage reached 97/103 mg bid. 28 pts (45%) had first Fup at 3 months and showed already mean EF 34±6% and mean NYHA 1.6±0.6 (p<0.04). 26 pts (43%) had last Fup echo after 1 year (mean 17±10 months) and showed further EF little improvement (38.3±8%, p 0.05).
Conclusions
After SV initiation in systolic HF, heart remodeling is already evident at 3 months Fup and better appreciable at 6 months Fup. Little non significant further EF improvement could be seen later. In our study best timing to decide for primary prevention ICD is likely between 3 and 6 months after SV initiation.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- V Carinci
- Maggiore Hospital, Department of Cardiology, Bologna, Italy
| | - E Leci
- Maggiore Hospital, Department of Cardiology, Bologna, Italy
| | - G Bugani
- Maggiore Hospital, Department of Cardiology, Bologna, Italy
| | - C Greco
- Maggiore Hospital, Department of Cardiology, Bologna, Italy
| | - C D'Angelo
- Maggiore Hospital, Department of Cardiology, Bologna, Italy
| | - A Pecoraro
- Maggiore Hospital, Department of Cardiology, Bologna, Italy
| | - G Casella
- Maggiore Hospital, Department of Cardiology, Bologna, Italy
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Orso F, Di Lenarda A, Oliva F, Aspromonte N, Greco C, Di Tano G, Lucci D, Maggioni A, Mortara A, Pagnoni N, Pajes G, Uguccioni M, Gulizia M. BLITZ-HF study: a nationwide initiative to assess and improve guidelines recommendations adherence in cardiology centers managing patients with acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0832] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Physicians adherence to heart failure (HF) guidelines is generally sub-optimal with consequent negative prognostic implications. Strategies to improve adherence to guideline recommendations are strongly needed.
Aims
To assess and improve adherence of Italian cardiology sites to guidelines recommendations on performance indicators in patients with acute (AHF) and chronic heart failure (CHF).
Methods
BLITZ-HF was a prospective study based on a web based recording system used during two enrollment periods (phase 1 and 3), interspersed by face-to-face macro-regional benchmark analysis and educational meetings (phase 2). Both management (creatinine and echocardiographic evaluations or discharge follow-up planning) and treatment (according to ejection fraction categories, focusing on guidelines directed medical treatments - GDMTs) performance indicators were considered for patients in both settings.
Results
Overall, 7218 patients with acute and chronic HF were enrolled at 106 sites. During the enrollment phases, 3920 and 3298 patients were included respectively, 84% with CHF and 16% with AHF in phase 1, 74% with CHF and 26% with AHF in phase 3. In Figure 1 we report adherence to management and treatment indicators in the two enrollment phases. Among AHF patients improvement was obtained in two of seven indicators. A significant rise in echocardiographic evaluation was observed, while discharge schedule of a cardiology ambulatory evaluation within four weeks was overall poor (less than 50%) and did not improve in the 3 phase. Overall GDMTs prescription rate in HFrEF was good and we observed a nominal increase in betablockers prescription rate in Phase 3. Among CHF patients with HFpEF and HFmrEF we observed a performance increase in two of three indicators: creatinine end echocardiographic evaluations, while oral anticoagulation in atrial fibrillation remained stably high. Performance measures in CHF HFrEF patients improved in six of nine indicators although significantly only in two. Prescription rate of GDMTs was good already in phase 1 and a significant increase in ACE-I/ARB or ARNI prescription was reported, with a nominal increase in the use of one of these three drugs in combination with MRAs and a BB.
Conclusions
A structured multifaceted educational intervention can improve adherence to HF guidelines on several indicators in a context of an already elevated level of adherence to guideline recommendations. Extension of this approach to other non-cardiology health professional settings, in which patients with HF are generally managed, should be considered.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): The study was funded by Heart Care Foundation with a partial unrestricted support from Abbott, Daiichi Sankyo, Medtronic, Servier, Vifor.
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Affiliation(s)
- F Orso
- Careggi University Hospital (AOUC), Heart Failure Clinic, Division of Geriatric Medicine and Intensive Care Unit, Florence, Italy
| | - A Di Lenarda
- Giuliano Isontina University Health Authority, Cardiovascular Department, Trieste, Italy
| | - F Oliva
- ASST Grande Ospedale Metropolitano Niguarda, Intensive Cardiac Care Unit, De Gasperis Cardio Center, Milan, Italy
| | - N Aspromonte
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Cardiovascular & Thoracic Sciences, Rome, Italy
| | - C Greco
- AO San Giovanni Addolorata, Cardiology Department, Rome, Italy
| | - G Di Tano
- Hospital of Cremona, Division of Cardiology, Cremona, Italy
| | - D Lucci
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - A.P Maggioni
- Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy
| | - A Mortara
- Polyclinic of Monza, Department of Clinical Cardiology, Monza, Italy
| | - N Pagnoni
- AO San Giovanni Addolorata, Cardiology Department, Rome, Italy
| | - G Pajes
- Castelli Hospital, ICU & Cardiology Unit, Ariccia, Italy
| | - M Uguccioni
- Azienda Ospedaliera San Camillo Forlanini, Cardiology 1, Rome, Italy
| | - M.M Gulizia
- National Hospital of High Relevance and Specialization “Garibaldi”, Cardiology Department, Catania, Italy
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Pagnoni C, Improta L, Alloni R, Mallozzi Santa Maria F, Aprile I, Brunetti B, Greco C, Vincenzi B, Gronchi A, Valeri S. Recurrent neck myxofibrosarcoma: a case report. J Med Case Rep 2021; 15:484. [PMID: 34593019 PMCID: PMC8485472 DOI: 10.1186/s13256-021-03053-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/10/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Myxofibrosarcoma (MFS) is a rare soft tissue sarcoma with a high recurrence rate and a low risk of distant metastasis. It occurs mainly in the extremities of elderly men. Head and neck MFS is extremely rare. Surgery is the cornerstone of treatment. The role of radiotherapy (RT) and chemotherapy (CHT) on MFS is still debated. CASE PRESENTATION A 67-year-old Caucasian man presented to our sarcoma referral center (SRC) with a history of MFS of the neck excised with microscopic positive surgical margins in a non-referral center. Staging imaging exams did not reveal distant metastasis. After a multidisciplinary discussion, preoperative RT was administered with a total dose of 50 Gy followed by wide surgical excision. Histological examination was negative for viable tumor cells. No relapse occurred during the 24-month postoperative follow-up. CONCLUSIONS The case described suggests the importance of planned combined treatments with both RT and surgery for high-grade soft tissue sarcoma. RT seems to be promising within this specific histotype. Close follow-up is advisable in all cases. Further studies are needed to confirm if the observed efficacy of combined treatments results in a prolonged time of disease-free survival and overall survival.
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Affiliation(s)
- Chiara Pagnoni
- Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Roma, RM, Italy
| | - Luca Improta
- Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Roma, RM, Italy.
| | - Rossana Alloni
- Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Roma, RM, Italy
| | | | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi-Onlus, Florence, Italy
| | - Beniamino Brunetti
- Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Roma, RM, Italy
| | - Carlo Greco
- Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Roma, RM, Italy
| | - Bruno Vincenzi
- Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Roma, RM, Italy
| | - Alessandro Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, MI, Italy
| | - Sergio Valeri
- Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Roma, RM, Italy
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Has C, El Hachem M, Bučková H, Fischer P, Friedová M, Greco C, Nevoránková P, Salavastru C, Mellerio JE, Zambruno G, Bodemer C. Practical management of epidermolysis bullosa: consensus clinical position statement from the European Reference Network for Rare Skin Diseases. J Eur Acad Dermatol Venereol 2021; 35:2349-2360. [PMID: 34545960 DOI: 10.1111/jdv.17629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/13/2021] [Indexed: 01/13/2023]
Abstract
Inherited epidermolysis bullosa (EB) comprises rare disorders that manifest with fragility and blistering of the skin and mucous membranes, with variable clinical severity. Management of EB is challenging due to disease rarity and complexity, the wide range of extracutaneous manifestations and a profound impact on daily life for the patient and family members. Although reference centres providing multidisciplinary care for EB exist in each European country, it is common for healthcare professionals that are not specialized in this rare disorder to treat EB patients. Here, experts of the European Reference Network for Rare and Undiagnosed Skin Diseases (ERN-Skin, https://ern-skin.eu) propose practical recommendations for the diagnosis and management of the commonest clinical issues, skin blisters and wounds, oral manifestations, pain and itch.
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Affiliation(s)
- C Has
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M El Hachem
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - H Bučková
- Department of Dermatology, Children's Hospital, University Hospital Brno, Brno, Czech Republic
| | - P Fischer
- Department of Prosthetic Dentistry, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Friedová
- NevDent, Dental Private Clinic, Brno, Czech Republic
| | - C Greco
- Pain and Palliative Care Unit, Hôpital Necker Enfants Malades, Paris, France
| | - P Nevoránková
- NevDent, Dental Private Clinic, Brno, Czech Republic
| | - C Salavastru
- Paediatric Dermatology Department, "Carol Davila" University of Medicine and Pharmacy, Colentina Clinical Hospital, Bucharest, Romania
| | - J E Mellerio
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - G Zambruno
- Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - C Bodemer
- Service de Dermatologie, Hôpital Necker Enfants Malades, Paris, France
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Zelefsky MJ, Greco C, Yamada Y, Powell SN, Fuks Z. In Reply to Rans et al. Int J Radiat Oncol Biol Phys 2021; 110:911-912. [PMID: 34089683 DOI: 10.1016/j.ijrobp.2021.02.040] [Citation(s) in RCA: 1] [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: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Carlo Greco
- Department of Radiation Oncology, Champalimaud Center for the Unknown, Lisbon, Portugal
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Simon N Powell
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zvi Fuks
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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41
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Greco C, Fuks Z. Single-Dose Radiotherapy for Prostate Cancer-Lessons Learned From Single-Fraction High-Dose-Rate Brachytherapy-Reply. JAMA Oncol 2021; 7:1573. [PMID: 34351361 DOI: 10.1001/jamaoncol.2021.2694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Carlo Greco
- Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Zvi Fuks
- Champalimaud Centre for the Unknown, Lisbon, Portugal.,Memorial Sloan Kettering Cancer Center, New York, New York
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Floreno B, Greco C, Ippolito E, Fiore M, Silipigni S, D’Ercole G, Ramella S. PO-1410 Hypofractionated radiotherapy in elderly patients with non-melanoma skin cancer: preliminary results. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07861-0] [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: 11/15/2022]
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43
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Ramella S, Greco C, Fiore M, Ippolito E. SP-0704 No ENI based on randomised evidence in NSCLC and SCLC. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08682-5] [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: 10/20/2022]
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44
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Parés i Grau O, Costa B, Vieira S, Stroom J, Cardoso M, Coutinho R, Rio-Tinto R, Bispo M, Santiago I, Fernandez L, Figueiredo N, Greco C, Fior R. PH-0116 Zebrafish avatars as radiosensitivity predictors in Rectal Cancer: towards personalized treatment. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07250-9] [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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45
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Stroom J, Taborda A, Vieira S, Greco C, Nijsten B. OC-0310 Planning dose constraint corrections due to changes in treatment and measurement accuracy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06857-2] [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: 10/20/2022]
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46
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Greco C, Stroom J, Vieira S, Mateus D, Cardoso MJ, Soares A, Pares O, Pimentel N, Louro V, Nunes B, Kociolek J, Fuks Z. Reproducibility and accuracy of a target motion mitigation technique for dose-escalated prostate stereotactic body radiotherapy. Radiother Oncol 2021; 160:240-249. [PMID: 33992627 DOI: 10.1016/j.radonc.2021.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE To quantitate the accuracy, reproducibility and prostate motion mitigation efficacy rendered by a target immobilization method used in an intermediate-risk prostate cancer dose-escalated 5×9Gy SBRT study. MATERIAL AND METHODS An air-inflated (150 cm3) endorectal balloon and Foley catheter with three electromagnetic beacon transponders (EBT) were used to mitigate and track intra-fractional target motion. A 2 mm margin was used for PTV expansion, reduced to 0 mm at the interface with critical OARs. EBT-detected ≥ 2 mm/5 s motions mandated treatment interruption and target realignment prior to completion of planned dose delivery. Geometrical uncertainties were measured with an in-house ESAPI script. RESULTS Quantitative data were obtained in 886 sessions from 189 patients. Mean PTV dose was 45.8 ± 0.4 Gy (D95 = 40.5 ± 0.4 Gy). A mean of 3.7 ± 1.7 CBCTs were acquired to reach reference position. Mean treatment time was 19.5 ± 12 min, 14.1 ± 11 and 5.4 ± 5.9 min for preparation and treatment delivery, respectively. Target motion of 0, 1-2 and >2 mm/10 min were observed in 59%, 30% and 11% of sessions, respectively. Temporary beam-on hold occurred in 7.4% of sessions, while in 6% a new reference CBCT was required to correct deviations. Hence, all sessions were completed with application of the planned dose. Treatment preparation time > 15 min was significantly associated with the need of a second reference CBCT. Overall systematic and random geometrical errors were in the order of 1 mm. CONCLUSION The prostate immobilization technique explored here affords excellent accuracy and reproducibility, enabling normal tissue dose sculpting with tight PTV margins.
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Affiliation(s)
- Carlo Greco
- The Champalimaud Centre for the Unknown, Lisbon, Portugal.
| | - Joep Stroom
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Sandra Vieira
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Dalila Mateus
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | | | - Ana Soares
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Oriol Pares
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Nuno Pimentel
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Vasco Louro
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Beatriz Nunes
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | | | - Zvi Fuks
- The Champalimaud Centre for the Unknown, Lisbon, Portugal; Memorial Sloan Kettering Cancer Center, New York, USA
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Greco C, Pares O, Pimentel N, Louro V, Santiago I, Vieira S, Stroom J, Mateus D, Soares A, Marques J, Freitas E, Coelho G, Seixas M, Lopez-Beltran A, Fuks Z. Safety and Efficacy of Virtual Prostatectomy With Single-Dose Radiotherapy in Patients With Intermediate-Risk Prostate Cancer: Results From the PROSINT Phase 2 Randomized Clinical Trial. JAMA Oncol 2021; 7:700-708. [PMID: 33704378 DOI: 10.1001/jamaoncol.2021.0039] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Importance Ultra-high single-dose radiotherapy (SDRT) represents a potential alternative to curative extreme hypofractionated stereotactic body radiotherapy (SBRT) in organ-confined prostate cancer. Objective To compare toxic effect profiles, prostate-specific antigen (PSA) responses, and quality-of-life end points of SDRT vs extreme hypofractionated SBRT. Design, Setting, and Participants The PROSINT single-institution phase 2 randomized clinical trial accrued, between September 2015 and January 2017, 30 participants with intermediate-risk prostate cancer to receive SDRT or extreme hypofractionated SBRT. Androgen deprivation therapy was not permitted. Data were analyzed from March to May 2020. Interventions Patients were randomized in a 1:1 ratio to receive 5 × 9 Gy SBRT (control arm) or 24 Gy SDRT (test arm). Main Outcomes and Measures The primary end point was toxic effects; the secondary end points were PSA response, PSA relapse-free survival, and patient-reported quality of life measured with the International Prostate Symptom Score (IPSS) and Expanded Prostate Cancer Index Composite (EPIC)-26 questionnaires. Results A total of 30 men were randomized; median (interquartile range) age was 66.3 (61.2-69.9) and 73.6 (64.7-75.9) years for the SBRT and SDRT arms, respectively. Time to appearance and duration of acute and late toxic effects were similar in the 2 trial arms. Cumulative late actuarial urinary toxic effects did not differ for grade 1 (hazard ratio [HR], 0.41; 90% CI, 0.13-1.27) and grade 2 or greater (HR, 1.07; 90% CI, 0.21-5.57). Actuarial grade 1 late gastrointestinal (GI) toxic effects were comparable (HR, 0.37; 90% CI, 0.07-1.94) and there were no grade 2 or greater late GI toxic effects. Declines in PSA level to less than 0.5 ng/mL occurred by 36 months in both study arms. No PSA relapses occurred in favorable intermediate-risk disease, while in the unfavorable category, the actuarial 4-year PSA relapse-free survival values were 75.0% vs 64.0% (HR, 0.76; 90% CI, 0.17-3.31) for SBRT vs SDRT, respectively. The EPIC-26 median summary scores for the genitourinary and GI domains dropped transiently at 1 month and returned to pretreatment scores by 3 months in both arms. The IPSS-derived transient late urinary flare symptoms occurred at 9 to 18 months in 20% (90% CI, 3%-37%) of patients receiving SDRT. Conclusions and Relevance In this randomized clinical trial among patients with intermediate-risk prostate cancer, SDRT was safe and associated with low toxicity, and the tumor control and quality-of-life end points closely match the SBRT arm outcomes. Further studies are encouraged to explore indications for SDRT in the cure of prostate cancer. Trial Registration ClinicalTrials.gov Identifier: NCT02570919.
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Affiliation(s)
- Carlo Greco
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Oriol Pares
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Nuno Pimentel
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Vasco Louro
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Inês Santiago
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Sandra Vieira
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Joep Stroom
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Dalila Mateus
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Ana Soares
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - João Marques
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Elda Freitas
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Graça Coelho
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Manuela Seixas
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | | | - Zvi Fuks
- The Champalimaud Centre for the Unknown, Lisbon, Portugal.,Memorial Sloan Kettering Cancer Center, New York, New York
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48
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Iorio GC, Salvestrini V, Borghetti P, De Felice F, Greco C, Nardone V, Fiorentino A, Gregucci F, Desideri I. The impact of modern radiotherapy on radiation-induced late sequelae: Focus on early-stage mediastinal classical Hodgkin Lymphoma. A critical review by the Young Group of the Italian Association of Radiotherapy and Clinical Oncology (AIRO). Crit Rev Oncol Hematol 2021; 161:103326. [PMID: 33862247 DOI: 10.1016/j.critrevonc.2021.103326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/07/2021] [Accepted: 03/26/2021] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The historically feared radiation-induced secondary cancers and cardiac toxicities observed among mediastinal classical Hodgkin Lymphoma (cHL) patients may still negatively burden the benefit of radiotherapy among long-term survivors. Modern radiotherapy (RT) delivery techniques, including intensity-modulated RT (IMRT) and deep inspiration breath-hold (DIBH) solutions, are drastically changing this scenario. Results of a literature overview are reported and discussed in this paper. MATERIALS AND METHODS Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used. RESULTS This paper contains a narrative report and a critical discussion of organs-at-risk dose-volume metrics linked with radiation-induced toxicities in cHL patients. CONCLUSIONS The scenario of early-stage cHL presents long-life expectancies, thus the goal of treatment should aim at maintaining high cure rates and limiting the onset of late complications. Further evaluations of dosimetric measures and clinical outcomes are warranted to identify patients at higher risk to target treatment tailoring.
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Affiliation(s)
| | - Viola Salvestrini
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Paolo Borghetti
- Department of Radiation Oncology, University and Spedali Civili, Brescia, Italy
| | - Francesca De Felice
- Department of Radiation Oncology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Carlo Greco
- Department of Radiation Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Valerio Nardone
- Department of Radiation Oncology, Ospedale del Mare, Viale della Metamorfosi, Naples, Italy
| | - Alba Fiorentino
- Department of Radiation Oncology, General Regional Hospital "F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Fabiana Gregucci
- Department of Radiation Oncology, General Regional Hospital "F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Isacco Desideri
- Department of Radiation Oncology, University of Florence, Florence, Italy
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Giordano FM, Ippolito E, Quattrocchi CC, Greco C, Mallio CA, Santo B, D’Alessio P, Crucitti P, Fiore M, Zobel BB, D’Angelillo RM, Ramella S. Radiation-Induced Pneumonitis in the Era of the COVID-19 Pandemic: Artificial Intelligence for Differential Diagnosis. Cancers (Basel) 2021; 13:cancers13081960. [PMID: 33921652 PMCID: PMC8074058 DOI: 10.3390/cancers13081960] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/02/2021] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 12/25/2022] Open
Abstract
(1) Aim: To test the performance of a deep learning algorithm in discriminating radiation therapy-related pneumonitis (RP) from COVID-19 pneumonia. (2) Methods: In this retrospective study, we enrolled three groups of subjects: pneumonia-free (control group), COVID-19 pneumonia and RP patients. CT images were analyzed by mean of an artificial intelligence (AI) algorithm based on a novel deep convolutional neural network structure. The cut-off value of risk probability of COVID-19 was 30%; values higher than 30% were classified as COVID-19 High Risk, and values below 30% as COVID-19 Low Risk. The statistical analysis included the Mann-Whitney U test (significance threshold at p < 0.05) and receiver operating characteristic (ROC) curve, with fitting performed using the maximum likelihood fit of a binormal model. (3) Results: Most patients presenting RP (66.7%) were classified by the algorithm as COVID-19 Low Risk. The algorithm showed high sensitivity but low specificity in the detection of RP against COVID-19 pneumonia (sensitivity = 97.0%, specificity = 2%, area under the curve (AUC = 0.72). The specificity increased when an estimated COVID-19 risk probability cut-off of 30% was applied (sensitivity 76%, specificity 63%, AUC = 0.84). (4) Conclusions: The deep learning algorithm was able to discriminate RP from COVID-19 pneumonia, classifying most RP cases as COVID-19 Low Risk.
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Affiliation(s)
- Francesco Maria Giordano
- Departmental Faculty of Medicine and Surgery, Diagnostic Imaging and Interventional Radiology, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (F.M.G.); (C.A.M.); (P.D.); (B.B.Z.)
| | - Edy Ippolito
- Departmental Faculty of Medicine and Surgery, Radiation Oncology, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (E.I.); (C.G.); (B.S.); (M.F.); (S.R.)
| | - Carlo Cosimo Quattrocchi
- Departmental Faculty of Medicine and Surgery, Diagnostic Imaging and Interventional Radiology, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (F.M.G.); (C.A.M.); (P.D.); (B.B.Z.)
- Correspondence: ; Tel.: +39-06225411708
| | - Carlo Greco
- Departmental Faculty of Medicine and Surgery, Radiation Oncology, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (E.I.); (C.G.); (B.S.); (M.F.); (S.R.)
| | - Carlo Augusto Mallio
- Departmental Faculty of Medicine and Surgery, Diagnostic Imaging and Interventional Radiology, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (F.M.G.); (C.A.M.); (P.D.); (B.B.Z.)
| | - Bianca Santo
- Departmental Faculty of Medicine and Surgery, Radiation Oncology, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (E.I.); (C.G.); (B.S.); (M.F.); (S.R.)
| | - Pasquale D’Alessio
- Departmental Faculty of Medicine and Surgery, Diagnostic Imaging and Interventional Radiology, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (F.M.G.); (C.A.M.); (P.D.); (B.B.Z.)
| | - Pierfilippo Crucitti
- Departmental Faculty of Medicine and Surgery, Thoracic Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy;
| | - Michele Fiore
- Departmental Faculty of Medicine and Surgery, Radiation Oncology, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (E.I.); (C.G.); (B.S.); (M.F.); (S.R.)
| | - Bruno Beomonte Zobel
- Departmental Faculty of Medicine and Surgery, Diagnostic Imaging and Interventional Radiology, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (F.M.G.); (C.A.M.); (P.D.); (B.B.Z.)
| | - Rolando Maria D’Angelillo
- Departmental Faculty of Medicine and Surgery, Radiation Oncology, Università degli Studi Tor Vergata, 00133 Rome, Italy;
| | - Sara Ramella
- Departmental Faculty of Medicine and Surgery, Radiation Oncology, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (E.I.); (C.G.); (B.S.); (M.F.); (S.R.)
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Mastrangelo M, Commone C, Greco C, Leuzzi V. TSC1 as a Novel Gene for Sleep-Related Hypermotor Epilepsy: A Child with a Mild Phenotype of Tuberous Sclerosis. Neuropediatrics 2021; 52:146-149. [PMID: 33578443 DOI: 10.1055/s-0041-1722881] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Sleep-related hypermotor epilepsy (SHE) is a rare syndrome that presents with hyperkinetic asymmetric tonic/dystonic seizures with vegetative signs, vocalization, and emotional facial expression, mainly during light non-rapid eye movement sleep stages. The role of various genes (CHRNA4, CHRNB2, CHRNA2, KCNT1, DEPDC5, NPRL2, NPRL3, and PRIMA1) has previously been reported, though genetic etiology is assessed in less than 10% of cases. We report the case of a 5-year-old female carrying the TSC1 variant c.843del p.(Ser282Glnfs*36) who presented with a mild phenotype of tuberous sclerosis, including carbamazepine-responsive SHE, normal neurocognitive functioning, hypomelanotic macules, no abnormalities outside the central nervous system, and tubers at neuroimaging. The presented case extends the list of SHE-related genes to include TSC1, thus suggesting a central pathogenic role of mammalian target of rapamycin (mTOR) cascade dysfunction in SHE and introducing a possible use of mTOR inhibitors in this epileptic syndrome.
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Affiliation(s)
- Mario Mastrangelo
- Child Neurology and Infantile Psychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, Italy
| | - Chiara Commone
- Child Neurology and Infantile Psychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, Italy
| | - Carlo Greco
- Child Neurology and Infantile Psychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, Italy
| | - Vincenzo Leuzzi
- Child Neurology and Infantile Psychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, Italy
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