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Saldi S, Fulcheri CPL, Zucchetti C, Abdelhamid AMH, Carotti A, Pierini A, Ruggeri L, Tricarico S, Chiodi M, Ingrosso G, Bini V, Velardi A, Martelli MF, Hui SK, Aristei C. Impact of total marrow/lymphoid irradiation dose to the intestine on graft-versus-host disease in allogeneic hematopoietic stem cell transplantation for hematologic malignancies. Front Oncol 2022; 12:1035375. [PMID: 36568236 PMCID: PMC9773831 DOI: 10.3389/fonc.2022.1035375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/10/2022] [Indexed: 12/14/2022] Open
Abstract
Background and purpose Graft-versus-host disease (GvHD) is a leading cause of non-relapse mortality in patients undergoing allogeneic hematopoietic stem cell transplantation. The Perugia Bone Marrow Transplantation Unit designed a new conditioning regimen with total marrow/lymphoid irradiation (TMLI) and adaptive immunotherapy. The present study investigated the impact of radiotherapy (RT) doses on the intestine on the incidence of acute GvHD (aGvHD) in transplant recipients, analyzing the main dosimetric parameters. Materials and methods Between August 2015 and April 2021, 50 patients with hematologic malignancies were enrolled. All patients underwent conditioning with TMLI. Dosimetric parameters (for the whole intestine and its segments) were assessed as risk factors for aGvHD. The RT dose that was received by each intestinal area with aGvHD was extrapolated from the treatment plan for each patient. Doses were compared with those of the whole intestine minus the affected area. Results Eighteen patients (36%) developed grade ≥2 aGvHD (G2 in 5, G3 in 11, and G4 in 2). Median time to onset was 41 days (range 23-69 days). The skin was involved in 11 patients, the intestine in 16, and the liver in 5. In all 50 TMLI patients, the mean dose to the whole intestine was 7.1 Gy (range 5.07-10.92 Gy). No patient developed chronic GvHD (cGvHD). No dosimetric variable emerged as a significant risk factor for aGvHD. No dosimetric parameter of the intestinal areas with aGvHD was associated with the disease. Conclusion In our clinical setting and data sample, we have found no clear evidence that current TMLI dosages to the intestine were linked to the development of aGvHD. However, due to some study limitations, this investigation should be considered as a preliminary assessment. Findings need to be confirmed in a larger cohort and in preclinical models.
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Affiliation(s)
- Simonetta Saldi
- Section of Radiation Oncology, Hospital of Santa Maria della Misericordia, Perugia, Italy
| | | | - Claudio Zucchetti
- Medical Physics, Hospital of Santa Maria della Misericordia, Perugia, Italy
| | - Amr Mohamed Hamed Abdelhamid
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, Italy,Department of Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Alessandra Carotti
- Division of Hematology and Clinical Immunology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Antonio Pierini
- Division of Hematology and Clinical Immunology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Loredana Ruggeri
- Division of Hematology and Clinical Immunology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Sara Tricarico
- Division of Hematology and Clinical Immunology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Marino Chiodi
- Radiology Unit, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Gianluca Ingrosso
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Vittorio Bini
- Internal Medicine, Endocrine and Metabolic Science Section, University of Perugia, Perugia, Italy
| | - Andrea Velardi
- Division of Hematology and Clinical Immunology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Massimo Fabrizio Martelli
- Division of Hematology and Clinical Immunology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Susanta Kumar Hui
- Department of Radiation Oncology, City of Hope National Medical Center, CA, United States
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, Italy,*Correspondence: Cynthia Aristei,
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Abdelhamid AMH, Jiang L, Zuro D, Liu A, Madabushi SS, Ghimire H, Wong JYC, Saldi S, Fulcheri C, Zucchetti C, Pierini A, Sheng K, Aristei C, Hui SK. Feasibility of a Novel Sparse Orthogonal Collimator-Based Preclinical Total Marrow Irradiation for Enhanced Dosimetric Conformality. Front Oncol 2022; 12:941814. [PMID: 35924145 PMCID: PMC9339640 DOI: 10.3389/fonc.2022.941814] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/23/2022] [Indexed: 12/17/2022] Open
Abstract
Total marrow irradiation (TMI) has significantly improved radiation conditioning for hematopoietic cell transplantation in hematologic diseases by reducing conditioning-induced toxicities and improving survival outcomes in relapsed/refractory patients. Recently, preclinical three-dimensional image-guided TMI has been developed to enhance mechanistic understanding of the role of TMI and to support the development of experimental therapeutics. However, a dosimetric comparison between preclinical and clinical TMI reveals that the preclinical TMI treatment lacks the ability to reduce the dose to some of the vital organs that are very close to the skeletal system and thus limits the ability to evaluate radiobiological relevance. To overcome this limit, we introduce a novel Sparse Orthogonal Collimator (SOC)-based TMI and evaluate its ability to enhance dosimetric conformality. The SOC-TMI-based dose modulation technique significantly improves TMI treatment planning by reducing radiation exposures to critical organs that are close to the skeletal system that leads to reducing the gap between clinical and preclinical TMI.
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Affiliation(s)
- Amr M. H. Abdelhamid
- Department of Radiation Oncology, City of Hope Medical Center, Duarte, CA, United States
- Radiation Oncology Section, Department of Medicine and Surgery, Perugia University and General Hospital, Perugia, Italy
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Lu Jiang
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, United States
| | - Darren Zuro
- Department of Radiation Oncology, University of Oklahoma, Norman, OK, United States
| | - An Liu
- Department of Radiation Oncology, City of Hope Medical Center, Duarte, CA, United States
| | | | - Hemendra Ghimire
- Department of Radiation Oncology, City of Hope Medical Center, Duarte, CA, United States
| | - Jeffrey Y. C. Wong
- Department of Radiation Oncology, City of Hope Medical Center, Duarte, CA, United States
| | - Simonetta Saldi
- Radiation Oncology Section, Department of Medicine and Surgery, Perugia University and General Hospital, Perugia, Italy
| | - Christian Fulcheri
- Radiation Oncology Section, Department of Medicine and Surgery, Perugia University and General Hospital, Perugia, Italy
| | - Claudio Zucchetti
- Radiation Oncology Section, Department of Medicine and Surgery, Perugia University and General Hospital, Perugia, Italy
| | - Antonio Pierini
- Radiation Oncology Section, Department of Medicine and Surgery, Perugia University and General Hospital, Perugia, Italy
| | - Ke Sheng
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, United States
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, Perugia University and General Hospital, Perugia, Italy
| | - Susanta K. Hui
- Department of Radiation Oncology, City of Hope Medical Center, Duarte, CA, United States
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Tenti MV, Ingrosso G, Bini V, Mariucci C, Saldi S, Alì E, Zucchetti C, Bellavita R, Aristei C. Tomotherapy-based moderate hypofractionation for localized prostate cancer: a mono-institutional analysis. Rep Pract Oncol Radiother 2022; 27:142-151. [PMID: 35402018 PMCID: PMC8989459 DOI: 10.5603/rpor.a2022.0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background To date, few studies have been published on image-guided helical tomotherapy (HT) in a moderate hypofractionation of localized PCa. We report outcome and toxicity of localized PCa patients treated with HT-based moderate hypofractionated radiotherapy. Materials and methods 76 patients were retrospectively analyzed. A total dose of 60 Gy (20 × 3 Gy) or 67.5 Gy (25 × 2.7 Gy) was prescribed. The χ2 test was used to analyze associations between toxicity and dosimetric and clinical parameters. The Cox proportional hazard regression model was used for multivariate analysis. Kaplan-Meier method was used for survival analysis. Results median follow-up was 42.26 months [interquartile (IQR), 23-76). At 4-year, overall survival (OS) and metastasis-free survival (MFS) were 91% and 89%, respectively. At multivariate analysis, smoking habitude was associated with MFS [hazard ratio (HR) 7.32, 95% CI: 1.57-34.16, p = 0.011]. Acute and late grade ≥ 2 gastro-intestinal (GI) toxicity was observed in 6.5% and 2.6% of patients, respectively. Acute and late grade ≥ 2 genito-urinary (GU) toxicity were 31.5% and 3.9%. Four-year late GI and GU grade ≥ 2 toxicity were 3% and 7%, respectively. Acute GI toxicity was associated with statins medication (p = 0.04) and androgen deprivation therapy (p = 0.013). Acute GU toxicity was associated with the use of anticoagulants (p = 0.029) and antiaggregants (p = 0.013). Conclusions HT-based moderate hypofractionation shows very low rates of toxicity. Smoking habitude is associated with the risk of developing metastases after radical treatment for localized PCa.
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Affiliation(s)
- Maria Valentina Tenti
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, Italy
| | - Gianluca Ingrosso
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, Italy
| | - Vittorio Bini
- Internal Medicine, Endocrine and Metabolic Science Section, University of Perugia, Italy
| | - Cristina Mariucci
- Department of Oncology and Radiotherapy, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Simonetta Saldi
- Radiation Oncology Section, Perugia General Hospital, Perugia, Italy
| | - Emanuele Alì
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, Italy
| | - Claudio Zucchetti
- Section of Medical Physics, Perugia General Hospital, Perugia, Italy
| | - Rita Bellavita
- Radiation Oncology Section, Perugia General Hospital, Perugia, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, Italy
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4
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Saldi S, Zucchetti C, Fulcheri CPL, Saccia S, Alì E, Marani S, Ingrosso G, Aristei C. High-dose-rate brachytherapy with surface applicator in penile cancer. Brachytherapy 2021; 20:835-841. [PMID: 33994341 DOI: 10.1016/j.brachy.2021.03.015] [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: 12/13/2020] [Revised: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE An alternative to surgery for penile cancer is radiation therapy which is administered with external beam techniques and/or brachytherapy (BT) either interstitial or using a surface applicator. Here we report our experience in penile cancer patients treated with high-dose-rate (HDR)-BT with the surface technique, analyzing dosimetric parameters and clinical outcomes. METHODS AND MATERIALS Between June 2016 and December 2019, 7 patients with squamous cell carcinoma of the penis received HDR-BT by means of customized applicators that were constructed using a 3D printer or thermoplastic mask. The total dose was 57 Gy in 19 fractions. RESULTS Median clinical target volume percentage receiving 95%, 125%, and 150% of the prescribed dose were 93.1% (range 92.2-98.5), 12% (range 7.4-32.2), and 0.24% (range 0-10.8), respectively. Median urethral volumes receiving 90% and 115% of the prescribed dose were 40.2% (range 21.0-83.8) and 0% (range 0-1), respectively. All patients achieved complete remission. No patient developed G3 or G4 acute or late toxicities. No patient experienced urethral stenosis. CONCLUSIONS Surface HDR-BT in penile cancer is feasible and is associated with a high tolerance profile and good outcomes.
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Affiliation(s)
- Simonetta Saldi
- Section of Radiation Oncology, Perugia General Hospital, Perugia, Italy.
| | | | | | - Stefano Saccia
- Section of Radiation Oncology, Perugia General Hospital, Perugia, Italy
| | - Emanuele Alì
- Radiation Oncology, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Simona Marani
- Radiation Oncology, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Gianluca Ingrosso
- Radiation Oncology, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Cynthia Aristei
- Radiation Oncology, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
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5
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Marchionni A, Palumbo I, Montesi G, Bini V, Zucchetti C, Cenci N, Chiarini P, Saccia S, Aristei C, Lupattelli M. Fractionated Stereotactic Sequential Boost in a Selected Cohort of Glioblastoma Patients: A Mono-institutional Analysis. Anticancer Res 2020; 40:3387-3393. [PMID: 32487635 DOI: 10.21873/anticanres.14322] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 11/10/2022]
Abstract
AIM To retrospectively assess toxicity and survival in 15 selected Glioblastoma patients treated with a sequential fractionated stereotactic radiotherapy (FSRT) boost after chemo-radiotherapy (CHT-RT) and compare their survival outcomes with a control group. PATIENTS AND METHODS Toxicity was assessed with the CTCAE 3.0 scale. The Kaplan-Meier method was used to design survival curves, log-rank test for bivariate analysis and Cox proportional hazard regression model for multivariate analysis. RESULTS The median follow-up was 16 months (range=5-60). One case of headache and one of radionecrosis (RN) occurred. Median overall survival (OS) was 25 months in the boost group vs. 14 in the no-boost group (p=0.004). Median progression-free survival (PFS) was 15 months in the boost group versus 8 in the no-boost group (p=0.046). At multivariate analysis FSRT boost resulted significantly associated with OS and PFS. CONCLUSION In our series a sequential FSRT boost resulted in safe outcomes and significantly associated with survival.
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Affiliation(s)
| | - Isabella Palumbo
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | | | - Vittorio Bini
- Internal Medicine Endocrin and Metabolic Science Section, University of Perugia, Perugia, Italy
| | | | - Nunzia Cenci
- Neurosurgery Unit, Perugia General Hospital, Perugia, Italy
| | - Pietro Chiarini
- Neuroradiology Unit, Perugia General Hospital, Perugia, Italy
| | - Stefano Saccia
- Radiation Oncology Division, Perugia General Hospital, Perugia, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Marco Lupattelli
- Radiation Oncology Division, Perugia General Hospital, Perugia, Italy
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6
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Guillet T, Zucchetti C, Barbedienne Q, Marty A, Isella G, Cagnon L, Vergnaud C, Jaffrès H, Reyren N, George JM, Fert A, Jamet M. Observation of Large Unidirectional Rashba Magnetoresistance in Ge(111). Phys Rev Lett 2020; 124:027201. [PMID: 32004027 DOI: 10.1103/physrevlett.124.027201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/04/2019] [Indexed: 06/10/2023]
Abstract
Relating magnetotransport properties to specific spin textures at surfaces or interfaces is an intense field of research nowadays. Here, we investigate the variation of the electrical resistance of Ge(111) grown epitaxially on semi-insulating Si(111) under the application of an external magnetic field. We find a magnetoresistance term that is linear in current density j and magnetic field B, hence, odd in j and B, corresponding to a unidirectional magnetoresistance. At 15 K, for I=10 μA (or j=0.33 A m^{-1}) and B=1 T, it represents 0.5% of the zero field resistance, a much higher value compared to previous reports on unidirectional magnetoresistance (UMR). We ascribe the origin of this magnetoresistance to the interplay between the externally applied magnetic field and the pseudomagnetic field generated by the current applied in the spin-splitted subsurface states of Ge(111). This unidirectional magnetoresistance is independent of the current direction with respect to the Ge crystal axes. It progressively vanishes, either using a negative gate voltage due to carrier activation into the bulk (without spin-splitted bands), or by increasing the temperature due to the Rashba energy splitting of the subsurface states lower than ∼58k_{B}. We believe that UMR could be used as a powerful probe of the spin-orbit interaction in a wide range of materials.
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Affiliation(s)
- T Guillet
- Université Grenoble Alpes, CEA, CNRS, Grenoble INP, IRIG-SPINTEC, 38000 Grenoble, France
| | - C Zucchetti
- LNESS-Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
| | - Q Barbedienne
- Unité Mixte de Physique, CNRS, Thales, Univ. Paris-Sud, Université Paris-Saclay, 91767, Palaiseau, France
| | - A Marty
- Université Grenoble Alpes, CEA, CNRS, Grenoble INP, IRIG-SPINTEC, 38000 Grenoble, France
| | - G Isella
- LNESS-Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
| | - L Cagnon
- Université Grenoble Alpes, CNRS, Grenoble INP, Institut NEEL, 38000 Grenoble, France
| | - C Vergnaud
- Université Grenoble Alpes, CEA, CNRS, Grenoble INP, IRIG-SPINTEC, 38000 Grenoble, France
| | - H Jaffrès
- Unité Mixte de Physique, CNRS, Thales, Univ. Paris-Sud, Université Paris-Saclay, 91767, Palaiseau, France
| | - N Reyren
- Unité Mixte de Physique, CNRS, Thales, Univ. Paris-Sud, Université Paris-Saclay, 91767, Palaiseau, France
| | - J-M George
- Unité Mixte de Physique, CNRS, Thales, Univ. Paris-Sud, Université Paris-Saclay, 91767, Palaiseau, France
| | - A Fert
- Unité Mixte de Physique, CNRS, Thales, Univ. Paris-Sud, Université Paris-Saclay, 91767, Palaiseau, France
| | - M Jamet
- Université Grenoble Alpes, CEA, CNRS, Grenoble INP, IRIG-SPINTEC, 38000 Grenoble, France
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Marcantonini M, Chiappiniello A, Beneventi S, Reggioli V, Dipilato AC, Fulcheri CPL, Iacco M, Zucchetti C, Tarducci R. Evaluation of equivalent dose to eye lens through dose equivalent Hp(3). Phys Med 2019; 64:29-32. [PMID: 31515031 DOI: 10.1016/j.ejmp.2019.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 04/15/2019] [Accepted: 04/30/2019] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Individual dosimetry allows to quantify doses from ionizing radiation of exposed workers. Scientific and epidemiological evidences highlight the need for adequate measures for a greater protection of the eye and a reduction in annual doses. ICRP Publication 103, illustrating the operational dose quantity Hp(d) for the individual monitoring, proposes a depth d = 3 mm for eye lens monitoring, indicating that even the Hp(0.07) can be used. In this study, it was investigated if there are differences in the evaluation of the equivalent dose to eye lens (Hlens) using Hp(3) or Hp(0.07). MATERIALS AND METHODS A slab phantom calibration was performed by an Accredited Calibration Laboratory in terms of Hp(3) and Hp(0.07) using ext-rad TLD-100 (LiF:Mg,Ti) dosimeters. Hp(0.07) and Hp(3) were measured for 26 exposed workers to assess Hlens. The measuring took place monthly in 2017 to obtain both semestral and annual doses. RESULTS Hlens(0.07) was always smaller than Hlens(3). However, the differences were not statistically significant (Mann-Whitney test, p > 0.05) for both semestral and annual doses. The percentage differences were 7 ± 3%, 6 ± 3% and 7 ± 2% for I semester, II semester and whole year, respectively. The mean underestimation index <10%, intra-class correlation coefficient >0.99, coefficient of variation <3% and the excellent correlation (R2 ≈ 0.999) for both semestral and annual doses highlighted that Hp(0.07) can be used to evaluate Hlens instead of Hp(3). CONCLUSIONS No statistical evidence was found that the use of Hp(0.07) underestimates the equivalent dose to eye lens obtained through Hp(3).
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Affiliation(s)
| | | | - Sara Beneventi
- Medical Physics Department, Perugia General Hospital, Perugia, Italy
| | | | - Anna C Dipilato
- Surgical and Biomedical Sciences Department, University of Perugia, Perugia, Italy
| | | | - Martina Iacco
- Medical Physics Department, Perugia General Hospital, Perugia, Italy
| | - Claudio Zucchetti
- Medical Physics Department, Perugia General Hospital, Perugia, Italy
| | - Roberto Tarducci
- Medical Physics Department, Perugia General Hospital, Perugia, Italy
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8
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Zuro D, Vagge S, Broggi S, Agostinelli S, Takahashi Y, Brooks J, Leszcynska P, Liu A, Zucchetti C, Saldi S, Han C, Cattaneo M, Giebel S, Mahe MA, Sanchez JF, Alaei P, Anna C, Dusenbery K, Pierini A, Storme G, Aristei C, Wong JYC, Hui S. Multi-institutional evaluation of MVCT guided patient registration and dosimetric precision in total marrow irradiation: A global health initiative by the international consortium of total marrow irradiation. Radiother Oncol 2019; 141:275-282. [PMID: 31421913 DOI: 10.1016/j.radonc.2019.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/09/2019] [Accepted: 07/08/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Total marrow irradiation (TMI) is a highly conformal treatment of the human skeleton structure requiring a high degree of precision and accuracy for treatment delivery. Although many centers worldwide initiated clinical studies using TMI, currently there is no standard for pretreatment patient setup. To this end, the accuracy of different patient setups was measured using pretreatment imaging. Their impact on dose delivery was assessed for multiple institutions. METHODS AND MATERIALS Whole body imaging (WBI) or partial body imaging (PBI) was performed using pretreatment megavoltage computed tomography (MVCT) in a helical Tomotherapy machine. Rigid registration of MVCT and planning kilovoltage computed tomography images were performed to measure setup error and its effect on dose distribution. The entire skeleton was considered the planning target volume (PTV) with five sub regions: head/neck (HN), spine, shoulder and clavicle (SC), and one avoidance structure, the lungs. Sixty-eight total patients (>300 images) across six institutions were analyzed. RESULTS Patient setup techniques differed between centers, creating variations in dose delivery. Registration accuracy varied by anatomical region and by imaging technique, with the lowest to the highest degree of pretreatment rigid shifts in the following order: spine, pelvis, HN, SC, and lungs. Mean fractional dose was affected in regions of high registration mismatch, in particular the lungs. CONCLUSIONS MVCT imaging and whole body patient immobilization was essential for assessing treatment setup, allowing for the complete analysis of 3D dose distribution in the PTV and lungs (or avoidance structures).
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Affiliation(s)
- Darren Zuro
- Department of Radiation Oncology, Beckman Research Institute, City of Hope, Duarte, USA; Department of Radiation Oncology, University of Minnesota, Minneapolis, USA
| | - Stefano Vagge
- Deparment of Medical Imaging and Radiation Sciences, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Broggi
- Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Agostinelli
- Deparment of Medical Imaging and Radiation Sciences, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Yutaka Takahashi
- Department of Radiation Oncology, Osaka University, Suita, Japan
| | - Jamison Brooks
- Department of Radiation Oncology, Beckman Research Institute, City of Hope, Duarte, USA
| | - Paulina Leszcynska
- Department of Radiotherapy Planning, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - An Liu
- Department of Radiation Oncology, Beckman Research Institute, City of Hope, Duarte, USA
| | | | - Simonetta Saldi
- Department of Radiation Oncology, University of Nantes, France
| | - Chunhui Han
- Department of Radiation Oncology, Beckman Research Institute, City of Hope, Duarte, USA
| | - Mauro Cattaneo
- Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - Sebastian Giebel
- Department of Radiotherapy Planning, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Marc Andre Mahe
- Department of Radiation Oncology, University of Nantes, France
| | - James F Sanchez
- Department of Radiation Oncology, Beckman Research Institute, City of Hope, Duarte, USA
| | - Parham Alaei
- Department of Radiation Oncology, University of Minnesota, Minneapolis, USA
| | - Chiara Anna
- Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - Kathryn Dusenbery
- Department of Radiation Oncology, University of Minnesota, Minneapolis, USA
| | - Antonio Pierini
- Division of Hematology and Clinical Immunology, Department of Medicine, University of Perugia, Italy
| | - Guy Storme
- Department of Radiotherapy UZ Brussel, Belgium
| | - Cynthia Aristei
- Department of Radiation Oncology, University of Nantes, France
| | - Jeffrey Y C Wong
- Department of Radiation Oncology, Beckman Research Institute, City of Hope, Duarte, USA
| | - Susanta Hui
- Department of Radiation Oncology, Beckman Research Institute, City of Hope, Duarte, USA.
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9
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Fellin F, Iacco M, D'Avino V, Tommasino F, Farace P, Palma G, Conson M, Giacomelli I, Zucchetti C, Falcinelli L, Amichetti M, Aristei C, Cella L. Potential skin morbidity reduction with intensity-modulated proton therapy for breast cancer with nodal involvement. Acta Oncol 2019; 58:934-942. [PMID: 30938217 DOI: 10.1080/0284186x.2019.1591638] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Different modern radiation therapy treatment solutions for breast cancer (BC) and regional nodal irradiation (RNI) have been proposed. In this study, we evaluate the potential reduction in radiation-induced skin morbidity obtained by intensity modulated proton therapy (IMPT) compared with intensity modulated photon therapy (IMXT) for left-side BC and RNI. Material and Methods: Using CT scans from 10 left-side BC patients, treatment plans were generated using IMXT and IMPT techniques. A dose of 50 Gy (or Gy [RBE] for IMPT) was prescribed to the target volume (involved breast, the internal mammary, supraclavicular, and infraclavicular nodes). Two single filed optimization IMPT (IMPT1 and IMPT2) plans were calculated without and with skin optimization. For each technique, skin dose-metrics were extracted and normal tissue complication probability (NTCP) models from the literature were employed to estimate the risk of radiation-induced skin morbidity. NTCPs for relevant organs-at-risk (OARs) were also considered for reference. The non-parametric Anova (Friedman matched-pairs signed-rank test) was used for comparative analyses. Results: IMPT improved target coverage and dose homogeneity even if the skin was included into optimization strategy (HIIMPT2 = 0.11 vs. HIIMXT = 0.22 and CIIMPT2 = 0.96 vs. CIIMXT = 0.82, p < .05). A significant relative skin risk reduction (RR = NTCPIMPT/NTCPIMXT) was obtained with IMPT2 including the skin in the optimization with a RR reduction ranging from 0.3 to 0.9 depending on the analyzed skin toxicity endpoint/model. Both IMPT plans attained significant OARs dose sparing compared with IMXT. As expected, the heart and lung doses were significantly reduced using IMPT. Accordingly, IMPT always provided lower NTCP values. Conclusions: IMPT guarantees optimal target coverage, OARs sparing, and simultaneously minimizes the risk of skin morbidity. The applied model-based approach supports the potential clinical relevance of IMPT for left-side BC and RNI and might be relevant for the setup of cost-effectiveness evaluation strategies based on NTCP predictions, as well as for establishing patient selection criteria.
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Affiliation(s)
- Francesco Fellin
- Protontherapy Department, Azienda Provinciale per I Servizi Sanitari (APSS), Trento, Italy
| | - Martina Iacco
- Perugia General Hospital, Medical Physics Unit, Perugia, Italy
| | - Vittoria D'Avino
- Institute of Biostructures and Bioimaging, National Research Council (CNR), Naples, Italy
| | - Francesco Tommasino
- Department of Physics, University of Trento, Povo, Italy
- Trento Institute for Fundamental Physics and Applications (TIFPA), National Institute for Nuclear Physics (INFN), Povo, Italy
| | - Paolo Farace
- Protontherapy Department, Azienda Provinciale per I Servizi Sanitari (APSS), Trento, Italy
| | - Giuseppe Palma
- Institute of Biostructures and Bioimaging, National Research Council (CNR), Naples, Italy
| | - Manuel Conson
- Department of Advanced Biomedical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Irene Giacomelli
- Protontherapy Department, Azienda Provinciale per I Servizi Sanitari (APSS), Trento, Italy
| | | | | | - Maurizio Amichetti
- Protontherapy Department, Azienda Provinciale per I Servizi Sanitari (APSS), Trento, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Perugia General Hospital, Perugia, Italy
- Department of Surgical and Biomedical Science, University of Perugia, Perugia, Italy
| | - Laura Cella
- Institute of Biostructures and Bioimaging, National Research Council (CNR), Naples, Italy
- National Institute for Nuclear Physics (INFN), Naples, Italy
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Lancellotta V, Chierchini S, Perrucci E, Saldi S, Falcinelli L, Iacco M, Zucchetti C, Palumbo I, Bini V, Aristei C. Skin toxicity after chest wall/breast plus level III-IV lymph nodes treatment with helical tomotherapy. Cancer Invest 2018; 36:504-511. [PMID: 30516084 DOI: 10.1080/07357907.2018.1545854] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION To evaluate the incidence of toxicity in breast cancer with helical tomotherapy (HT). MATERIALS AND METHODS 51 patients with breast cancer were assigned to postoperative radiotherapy by means of HT to the chest wall/breast plus draining nodes. During HT treatment, toxicity was monitored and were assessed using the Common Terminology Criteria for Adverse Events 4.0 scale. RESULTS Acute skin G3 toxicity observed in 1.9% cases. No acute or late G4 toxicity was observed. At a median follow-up of 21 months 2 patients have late G1 toxicity. CONCLUSIONS HT was associated with a low incidence of low-grade skin toxicity.
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Affiliation(s)
- Valentina Lancellotta
- a Radiation Oncology Section , Department of Surgical and Biomedical Sciences , University of Perugia and Perugia General Hospital , Italy
| | | | | | | | | | - Martina Iacco
- d Medical Physics Unit, Perugia General Hospital , Italy
| | | | - Isabella Palumbo
- a Radiation Oncology Section , Department of Surgical and Biomedical Sciences , University of Perugia and Perugia General Hospital , Italy
| | - Vittorio Bini
- e Internal Medicine, Endocrine and Metabolic Science Section , University of Perugia , Perugia , Italy
| | - Cynthia Aristei
- a Radiation Oncology Section , Department of Surgical and Biomedical Sciences , University of Perugia and Perugia General Hospital , Italy
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Iacco M, Zucchetti C, Dipilato A, Lupattelli M, Podlesko A, Fulcheri C, Marcantonini M, Reggioli V, Aristei C, Tarducci R. 179. Whole brain radiotherapy with hippocampal sparing and Simultaneous Integrated Boost for patients with one to four metastases with Helical Tomotherapy. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.190] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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12
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Marino C, Carbonini C, Veronese I, Agostinelli S, Aimonetto S, Bagalà P, Barbiero S, Benecchi G, Borzi G, Bresciani S, Broggi S, Cagni E, Casale M, Cilla S, Clemente S, Consorti R, Corletto D, Delana A, Esposito M, Falco M, Fedele D, Fusella M, Garibaldi C, Gasperi C, Giglioli F, Giancaterino S, Iervolino C, Infusino E, Mameli A, Manco L, Masi L, Menghi E, Moretti E, Nardiello B, Paladini L, Panizza D, Pastore G, Radice A, Redaelli I, Rosica F, Russo S, Saiani F, Savini A, Siragusa C, Strigari L, Talamonti C, Vaccara E, Villaggi E, Zucchetti C, Stasi M, Mancosu P. 40. Design of a national survey to assess the technology applied to SBRT. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.050] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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13
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Iacco M, Zucchetti C, Lupattelli M, Aristei C, Tarducci R. 182. Study of the accuracy of non-invasive fixation frames in brain treatments with Helical Tomotherapy. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.193] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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14
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Saldi S, Bellavita R, Lancellotta V, Palumbo I, Lupattelli M, Chierchini S, Falcinelli L, Zucchetti C, Bini V, Aristei C. Acute Toxicity Profiles of Hypofractionated Adjuvant and Salvage Radiation Therapy After Radical Prostatectomy: Results of a Prospective Study. Int J Radiat Oncol Biol Phys 2018; 103:105-111. [PMID: 30121233 DOI: 10.1016/j.ijrobp.2018.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/13/2017] [Revised: 07/29/2018] [Accepted: 08/06/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE Hypofractionated radiation therapy (RT) is controversial after radical prostatectomy (RP). In this interim analysis, our prospective observational study assessed acute genitourinary (GU) and gastrointestinal (GI) toxicity after hypofractionated adjuvant and salvage RT, as delivered by helical tomotherapy (HT), in patients with prostate cancer. METHODS AND MATERIALS After undergoing RP with or without pelvic lymph node dissection, 112 patients were enrolled. Hypofractionated adjuvant RT (2.25 Gy daily for 29 fractions; total 65.25 Gy) was administered to 40 patients with high-risk features. Hypofractionated salvage RT (2.25 Gy daily for 32 or 33 fractions; total 72-74.25 Gy) was prescribed for 72 patients (24 with biochemical relapse, 48 with local relapse). Toxicity was graded according to the Common Terminology Criteria for Adverse Events version 4.02. The impact of RT on urinary flow was assessed by uroflowmetry. RESULTS Acute GU toxicity occurred in 41 of 112 patients (36%) (G1 31, G2 10). Acute GI toxicity was observed in 55 (49%) patients (G1 44, G2 11). Uroflowmetry showed that only salvage RT reduced maximum flow significantly (maximum, 68 vs 50 mL/s; P = .003), perhaps because a higher RT dose had been administered. CONCLUSIONS After RP, moderate hypofractionated adjuvant and salvage RT were associated with acceptable incidences of slight-to-moderate acute GU and GI toxicity and had little impact on urinary flow. Prospective trials are warranted with longer follow-up in larger cohorts to confirm these findings.
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Affiliation(s)
- Simonetta Saldi
- Section of Radiation Oncology, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy.
| | - Rita Bellavita
- Section of Radiation Oncology, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Valentina Lancellotta
- Section of Radiation Oncology, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Isabella Palumbo
- Section of Radiation Oncology, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Marco Lupattelli
- Section of Radiation Oncology, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Sara Chierchini
- Section of Radiation Oncology, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Lorenzo Falcinelli
- Section of Radiation Oncology, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Claudio Zucchetti
- Section of Medical Physics, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Vittorio Bini
- Department of Medicine, Section of Internal Medicine, Endocrinology & Metabolism, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Cynthia Aristei
- Section of Radiation Oncology, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
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Aristei C, Lancellotta V, Carotti A, Zucchetti C, Pierini A, Saldi S, Ruggeri L, Amico L, Iacco M, Velardi A, Martelli MF. Low-toxic myeloablative conditioning regimen in haploidentical hematopietic stem cell transplantation for elderly patients with acute myeloid leukemia. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7038] [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: 11/20/2022] Open
Affiliation(s)
- Cynthia Aristei
- Radiation Oncology Section, Department of Surgery and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Valentina Lancellotta
- Radiation Oncology Section, Department of Surgery and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Alessandra Carotti
- Division of Hematology and Clinical Immunology and Bone Marrow Transplant Program, Department of Medicine, Perugia General Hospital and University, Perugia, Italy., Perugia, Italy
| | - Claudio Zucchetti
- Department of Medical Physics, Medical Physics Unit, Santa Maria della Misericordia Hospital, Perugia, Italy., Perugia, Italy
| | - Antonio Pierini
- Division of Hematology and Clinical Immunology and Bone Marrow Transplant Program, Department of Medicine, Perugia General Hospital and University, Perugia, Italy., Perugia, Italy
| | - Simonetta Saldi
- Radiation Oncology Section, University of Perugia, Perugia, Italy., Perugia, Italy
| | - Loredana Ruggeri
- Division of Hematology and Clinical Immunology and Bone Marrow Transplant Program, Department of Medicine, Perugia General Hospital and University, Perugia, Italy., Perugia, Italy
| | - Lucia Amico
- Division of Hematology and Clinical Immunology and Bone Marrow Transplant Program, Department of Medicine, Perugia General Hospital and University, Perugia, Italy., Perugia, Italy
| | - Martina Iacco
- Department of Medical Physics, Medical Physics Unit, Santa Maria della Misericordia Hospital, Perugia, Italy., Perugia, Italy
| | - Andrea Velardi
- Division of Hematology and Clinical Immunology and Bone Marrow Transplant Program, Department of Medicine, Perugia General Hospital and University, Perugia, Italy., Perugia, Italy
| | - Massimo Fabrizio Martelli
- Division of Hematology and Clinical Immunology and Bone Marrow Transplant Program, Department of Medicine, Perugia General Hospital and University, Perugia, Italy., Perugia, Italy
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Iacco M, Saldi S, Zucchetti C, Dipilato A, Lancellotta V, Aristei C, Tarducci R. EP-1961: Classical Kaposi’s sarcoma treatment with helical tomotherapy: impact of polyurethane foam cushion. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32270-9] [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: 11/16/2022]
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Didona A, Lancellotta V, Zucchetti C, Panizza BM, Frattegiani A, Iacco M, Di Pilato AC, Saldi S, Aristei C. Is volumetric modulated arc therapy with constant dose rate a valid option in radiation therapy for head and neck cancer patients? Rep Pract Oncol Radiother 2018; 23:175-182. [PMID: 29765265 DOI: 10.1016/j.rpor.2018.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/17/2018] [Accepted: 02/16/2018] [Indexed: 01/17/2023] Open
Abstract
Background Intensity-modulated radiotherapy (IMRT) improves dose distribution in head and neck (HN) radiation therapy. Volumetric-modulated arc therapy (VMAT), a new form of IMRT, delivers radiation in single or multiple arcs, varying dose rates (VDR-VMAT) and gantry speeds, has gained considerable attention. Constant dose rate VMAT (CDR-VMAT) associated with a fixed gantry speed does not require a dedicated linear accelerator like VDR-VMAT. The present study explored the feasibility, efficiency and delivery accuracy of CDR-VMAT, by comparing it with IMRT and VDR-VMAT in treatment planning for HN cancer. Methods and materials Step and shoot IMRT (SS-IMRT), CDR-VMAT and VDR-VMAT plans were created for 15 HN cancer patients and were generated by Pinnacle3 TPS (v 9.8) using 6 MV photon energy. Three PTVs were defined to receive respectively prescribed doses of 66 Gy, 60 Gy and 54 Gy, in 30 fractions. Organs at risk (OARs) included the mandible, spinal cord, brain stem, parotids, salivary glands, esophagus, larynx and thyroid. SS-IMRT plans were based on 7 co-planar beams at fixed gantry angles. CDR-VMAT and VDR-VMAT plans, generated by the SmartArc module, used a 2-arc technique: one clockwise from 182° to 178° and the other one anti-clockwise from 178° to 182°. Comparison parameters included dose distribution to PTVs (Dmean, D2%, D50%, D95%, D98% and Homogeneity Index), maximum or mean doses to OARs, specific dose-volume data, the monitor units and treatment delivery times. Results Compared with SS-IMRT, CDR-VMAT significantly reduced the maximum doses to PTV1 and PTV2 and significantly improved all PTV3 parameters, except D98% and D95%. It significantly spared parotid and submandibular glands and was associated with a lower Dmean to the larynx. Compared with VDR-VMAT, CDR-VMAT was linked to a significantly better Dmean, to the PTV3 but results were worse for the parotids, left submandibular gland, esophagus and mandible. Furthermore, the Dmean to the larynx was also worse. Compared with SS-IMRT and VDR-VMAT, CDR-VMAT was associated with higher average monitor unit values and significantly shorter average delivery times. Conclusions CDR-VMAT appeared to be a valid option in Radiation Therapy Centers that lack a dedicated linear accelerator for volumetric arc therapy with variable dose-rates and gantry velocities, and are unwilling or unable to sanction major expenditure at present but want to adopt volumetric techniques.
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Affiliation(s)
- Annamaria Didona
- Phys, Medical Physic Unit, Grosseto General Hospital, Grosseto, Italy
| | - Valentina Lancellotta
- Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Claudio Zucchetti
- Phys, Medical Physics Unit, Perugia General Hospital, Perugia, Italy
| | | | | | - Martina Iacco
- Phys, Medical Physics Unit, Perugia General Hospital, Perugia, Italy
| | | | - Simonetta Saldi
- Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
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18
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Lancellotta V, Iacco M, Perrucci E, Falcinelli L, Zucchetti C, de Bari B, Saldi S, Aristei C. Comparing four radiotherapy techniques for treating the chest wall plus levels III-IV draining nodes after breast reconstruction. Br J Radiol 2018; 91:20160874. [PMID: 29474098 DOI: 10.1259/bjr.20160874] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To compare the dosimetric outcomes of four radiotherapy (RT) techniques for treating the chest wall plus draining nodes after mastectomy and breast reconstruction. METHODS Three-dimensional conformal radiotherapy, linac-based intensity modulated RT, helical tomotherapy (HT) and direct tomotherapy treatments were planned for 40 breast cancer patients. Dose prescription was 50 Gy. Plans were compared in terms of doses to the planning target volume, organs at risk and the homogeneity index. The non-parametric Friedman test for paired data and the Conover post hoc analysis were used for data analysis. RESULTS HT provided the highest D90 and D98% and the lowest HI, V107% and D2%. HT was associated with the lowest D2% and V25 Gy to the heart in left-sided treatments but the mean cardiac dose was highest. HT provided the highest V5 Gy and V20 Gy to the ipsilateral lung, but the V30 Gy was lower. The contralateral breast and lung were more exposed with HT. CONCLUSION The present dosimetric study together with daily use of CT-MV image guided RT have led us to opt for HT after mastectomy and breast reconstruction and to draw up a suitable protocol for treating the chest wall and levels III and IV draining nodes. Advances in knowledge: HT is a suitable for treating the chest wall and levels III and IV draining nodes.
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Affiliation(s)
- Valentina Lancellotta
- 1 Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital , Perugia , Italy.,2 Medical Physics Unit, Perugia General Hospital , Perugia , Italy
| | - Martina Iacco
- 1 Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital , Perugia , Italy.,2 Medical Physics Unit, Perugia General Hospital , Perugia , Italy
| | | | - Lorenzo Falcinelli
- 3 Radiation Oncology Division, Perugia General Hospital , Perugia , Italy
| | - Claudio Zucchetti
- 1 Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital , Perugia , Italy.,2 Medical Physics Unit, Perugia General Hospital , Perugia , Italy
| | - Berardino de Bari
- 4 Department of radiation Oncology, University Bourgogne Franche-Comté, CHRU Besançon, INSERM U1098 EFS/BFC , Besançon , France
| | - Simonetta Saldi
- 5 Radiation Oncology Section, University of Perugia , Perugia , Italy
| | - Cynthia Aristei
- 1 Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital , Perugia , Italy.,2 Medical Physics Unit, Perugia General Hospital , Perugia , Italy
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Lancellotta V, Iacco M, Perrucci E, Zucchetti C, Dipilato AC, Falcinelli L, Palumbo I, Aristei C. Comparison of Helical Tomotherapy and Direct Tomotherapy in Bilateral Whole Breast Irradiation in a Case of Bilateral Synchronous Grade 1 and Stage 1 Breast Cancer. Am J Case Rep 2017; 18:1020-1023. [PMID: 28935854 PMCID: PMC5627865 DOI: 10.12659/ajcr.905245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Patient: Female, 60 Final Diagnosis: Complete remission Symptoms: None Medication: — Clinical Procedure: Radiotherapy Specialty: Oncology
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Affiliation(s)
- Valentina Lancellotta
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Martina Iacco
- Medical Physics Unit, Perugia General Hospital, Perugia, Italy
| | | | | | | | | | - Isabella Palumbo
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia, Perugia General Hospital, Perugia, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia, Perugia General Hospital, Perugia, Italy
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Iacco M, Zucchetti C, Lupattelli M, Aristei C, Fulcheri C, Tarducci R. EP-1578: Frameless intracranial radiosurgery with Helical Tomotherapy: preliminary results. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)32013-3] [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: 10/19/2022]
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Iacco M, Zucchetti C, Lupattelli M, Dipilato A, Aristei C, Tarducci R. EP-1636: Evaluation of the accuracy in frame-less image-guided radiotherapy and radiosurgery. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)32071-6] [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: 10/19/2022]
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Bottegoni F, Zucchetti C, Dal Conte S, Frigerio J, Carpene E, Vergnaud C, Jamet M, Isella G, Ciccacci F, Cerullo G, Finazzi M. Spin-Hall Voltage over a Large Length Scale in Bulk Germanium. Phys Rev Lett 2017; 118:167402. [PMID: 28474919 DOI: 10.1103/physrevlett.118.167402] [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] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Indexed: 06/07/2023]
Abstract
We exploit the spin-Hall effect to generate a uniform pure spin current in an epitaxial n-doped Ge channel, and we detect the electrically induced spin accumulation, transverse to the injected charge current density, with polar magneto-optical Kerr microscopy at a low temperature. We show that a large spin density up to 400 μm^{-3} can be achieved at the edges of the 100-μm-wide Ge channel for an applied electric field lower than 5 mV/μm. We find that the spin density linearly decreases toward the center of the Ge bar, due to the large spin diffusion length, and such a decay is much slower than the exponential one observed in III-V semiconductors, allowing very large spin accumulations over a length scale of tens of micrometers. This lays the foundation for multiterminal spintronic devices, where different spin voltages can be exploited as inputs for magnetologic gates on the same Ge platform.
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Affiliation(s)
- F Bottegoni
- LNESS-Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
| | - C Zucchetti
- LNESS-Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
| | - S Dal Conte
- Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
| | - J Frigerio
- LNESS-Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
| | - E Carpene
- IFN-CNR, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
| | - C Vergnaud
- Université Grenoble Alpes, INAC-SPINTEC, F38000 Grenoble, France
- CEA-INAC-SPINTEC, F38054 Grenoble, France
| | - M Jamet
- Université Grenoble Alpes, INAC-SPINTEC, F38000 Grenoble, France
- CEA-INAC-SPINTEC, F38054 Grenoble, France
| | - G Isella
- LNESS-Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
| | - F Ciccacci
- LNESS-Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
| | - G Cerullo
- IFN-CNR, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
| | - M Finazzi
- LNESS-Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
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Lancellotta V, Russo G, Lupattelli M, Iacco M, Perrucci E, Zucchetti C, Falcinelli L, Aristei C. Helical tomotherapy for duodenal adenocarcinoma in an elderly patient: A case report. World J Gastrointest Oncol 2017; 9:94-97. [PMID: 28255431 PMCID: PMC5314206 DOI: 10.4251/wjgo.v9.i2.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 08/31/2016] [Accepted: 12/02/2016] [Indexed: 02/05/2023] Open
Abstract
To evaluate the efficacy and feasibility of external beam radiotherapy (EBRT) for duodenal adenocarcinoma in an 84-year-old female who underwent EBRT (2.2 Gy/d for a total dose of 46.2 Gy) using helical tomotherapy (HT). Toxicity was evaluated on the National Cancer Institute’s common toxicity criteria (CTCAE 3.0). The patient completed the treatment without G3-G4 toxicity. After 22-mo follow-up, she is alive and well, in complete remission with no late side effects. HT seems to be feasible and effective for duodenal adenocarcinoma in old to very old patients.
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Bottegoni F, Calloni A, Bussetti G, Camera A, Zucchetti C, Finazzi M, Duò L, Ciccacci F. Spin polarized surface resonance bands in single layer Bi on Ge(1 1 1). J Phys Condens Matter 2016; 28:195001. [PMID: 27073190 DOI: 10.1088/0953-8984/28/19/195001] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The spin features of surface resonance bands in single layer Bi on Ge(1 1 1) are studied by means of spin- and angle-resolved photoemission spectroscopy and inverse photoemission spectroscopy. We characterize the occupied and empty surface states of Ge(1 1 1) and show that the deposition of one monolayer of Bi on Ge(1 1 1) leads to the appearance of spin-polarized surface resonance bands. In particular, the C 3v symmetry, which Bi adatoms adopt on Ge(1 1 1), allows for the presence of Rashba-like occupied and unoccupied electronic states around the [Formula: see text] point of the Bi surface Brillouin zone with a giant spin-orbit constant [Formula: see text] eV · Å.
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Affiliation(s)
- F Bottegoni
- LNESS-Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
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Didona A, Zucchetti C, Dipilato A, Iacco M, Panizza M, Frattegiani A, Bini V, Aristei C, Tarducci R. EP-1693: Constant dose rate VMAT and step-and-shoot IMRT in head and neck cancer: a comparative plan analysis. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32944-9] [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: 12/01/2022]
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Didona A, Zucchetti C, Aristei C, Tarducci R. Volumetric modulated arc therapy for delivery of head and neck radiotherapy: Comparison between constant and variable dose rate. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.070] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Iacco M, Zucchetti C, Marcantonini M, Dipilato A, Lancellotta V, Aristei C, Tarducci R. Dosimetric comparison between four irradiation techniques for breast cancer. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.112] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Dipilato A, Zucchetti C, Iacco M, Tarducci R. Evaluation of superficial dose in tomotherapy: A phantom study. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.072] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Didona A, Zucchetti C, Dipilato A, Fulcheri C, Tarducci R. Evaluation of delivery accuracy of head and neck radiotherapy with constant dose rate VMAT. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.069] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Perrucci E, Lancellotta V, Bini V, Zucchetti C, Mariucci C, Montesi G, Saccia S, Palumbo I, Aristei C. Recurrences and toxicity after adjuvant vaginal brachytherapy in Stage I-II endometrial cancer: A monoinstitutional experience. Brachytherapy 2015; 15:177-84. [PMID: 26727332 DOI: 10.1016/j.brachy.2015.10.010] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 10/08/2015] [Accepted: 10/28/2015] [Indexed: 01/20/2023]
Abstract
PURPOSE To evaluate the incidences of vaginal recurrence and toxicity after vaginal brachytherapy in Stage I-II endometrial cancer. METHODS AND MATERIALS Between 2003 and 2012, 150 high-intermediate-risk Stage I and 7 Stage II patients, median age 64 years, underwent surgery, with or without lymphadenectomy, and 3D brachytherapy: 7 Gy, at 5 mm depth from applicator surface, for 3-week fractions. The effects of age, grading, number of excised lymph nodes and pathologic stage on loco-regional relapse (LRR), metastases, and tumor-related death were investigated. Vaginal toxicity was evaluated during followup visits. RESULTS At 83 months of median followup, 144 patients were disease free, 2 in relapse, 7 deceased from disease, and 4 from other causes. One vaginal (0.6%), five nodal (3.2%), three pelvic over the vaginal cuff (1.9%), and one distant recurrences were seen (0.6%). The 5-year probability of LRR-free, distant metastasis-free and cause-specific survivals for all patients were 93.6% (95% confidence interval [CI]: 88.1-96.7), 97.8% (95% CI: 93.2-99.3), and 96.5% (95% CI: 93.5-99.5) and for Stage I 95.7% (95% CI: 92.2-9.1), 99.3% (95% CI: 98.0-100), and 97.7% (95% CI: 95.2-100), respectively. At multivariate analysis, Stage II disease and more than 12 lymph nodes sampled were associated with LRR (hazard ratio [HR]: 3.88; 95% CI: 1.390-10.878; p = 0.010 and HR: 6.952; 95% CI: 1.591-30.385; p = 0.010) and Stage II with metastasis and tumor-related death (HR: 23.057; 95% CI: 2.296-231.485; p = 0.008 and HR: 4.324; 95% CI: 1.223-15.290; p = 0.023). Vaginal acute and chronic toxicity was 16% and 55.4%, respectively, all only Grades 1-2. CONCLUSIONS For high-to-intermediate-risk Stage I endometrial cancer, 3D vaginal brachytherapy achieved good local control and low toxicity. In Stage II, patients brachytherapy could be administered after complete surgical staging.
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Affiliation(s)
- Elisabetta Perrucci
- Department of Onco-Hemato-Gastroenterological Sciences, Radiation Oncology Section, Santa Maria della Misericordia Hospital, Perugia, Italy.
| | - Valentina Lancellotta
- Department of Surgical and Biomedical Sciences, Radiation Oncology Section, University of Perugia, Perugia, Italy
| | - Vittorio Bini
- Department of Medicine, Endocrine and Metabolic Sciences Section, Internal Medicine, Endocrine and Metabolic Sciences Section, University of Perugia, Perugia, Italy
| | - Claudio Zucchetti
- Department of Medical Physics, Medical Physics Unit, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Cristina Mariucci
- Department of Surgical and Biomedical Sciences, Radiation Oncology Section, University of Perugia, Perugia, Italy
| | - Giampaolo Montesi
- Department of Surgical and Biomedical Sciences, Radiation Oncology Section, University of Perugia, Perugia, Italy
| | - Stefano Saccia
- Department of Onco-Hemato-Gastroenterological Sciences, Radiation Oncology Section, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Isabella Palumbo
- Department of Surgical and Biomedical Sciences, Radiation Oncology Section, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Cynthia Aristei
- Department of Surgical and Biomedical Sciences, Radiation Oncology Section, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
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Falcinelli L, Palumbo I, Radicchia V, Arcidiacono F, Lancellotta V, Montesi G, Matrone F, Zucchetti C, Marcantonini M, Bini V, Aristei C. Prostate cancer: contouring target and organs at risk by kilovoltage and megavoltage CT and MRI in patients with and without hip prostheses. Br J Radiol 2015; 88:20150509. [PMID: 26462970 DOI: 10.1259/bjr.20150509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE In radiotherapy treatment, planning target volume and organs at risk are contoured on kilovoltage CT (kVCT) images. Unlike MR images, kVCT does not provide precise information on target volume extension. Since neither kVCT nor MRI may be suitable for contouring in patients with ferrous hip prostheses, this study evaluated whether megavoltage CT (MVCT) reduced interobserver variability. METHODS Two patients without hip prostheses and one patient (Patient 3) with hip prostheses were enrolled. Six radiation oncologists contoured prostate, rectum and bladder on kVCT (Patients 1 and 3), MRI (Patient 2) and MVCT images (Patient 3). MVCT was acquired with fine, normal and coarse modalities. Interobserver variability for each organ was analysed using conformity index (CI) and coefficient of variation (CV). RESULTS In patients without hip prostheses, CIs were higher in prostate contouring with MRI than with kVCT, indicating lower interobserver variability with MRI. Very slight variations were seen in rectum and bladder contouring. In the patient with hip prostheses (Patient 3), contouring on kVCT lowered CI and increased CV in the prostate, bladder and rectum. The differences were more marked in the prostate. Only fine modality MVCT reduced interobserver variability and only for the prostate. CONCLUSION Even though greater noise and less soft-tissue contrast increase contouring variability with MVCT than with kVCT, lack of artefacts on MVCT could provide better image definition by this modality in hip prosthesis patients in whom MRI is precluded. ADVANCES IN KNOWLEDGE We recommend the fine modality MVCT for contouring hip prostheses patients.
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Affiliation(s)
- Lorenzo Falcinelli
- 1 Department of Onco-Haematological and Gastroenterological Science, Radiation Oncology Division, Perugia General Hospital, Perugia, Italy
| | - Isabella Palumbo
- 2 Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Valentina Radicchia
- 2 Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Fabio Arcidiacono
- 2 Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Valentina Lancellotta
- 2 Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Giampaolo Montesi
- 2 Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Fabio Matrone
- 2 Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Claudio Zucchetti
- 3 Department of Imaging and Laboratory Diagnosis, Medical Physics Unit, Perugia General Hospital, Perugia, Italy
| | - Marta Marcantonini
- 3 Department of Imaging and Laboratory Diagnosis, Medical Physics Unit, Perugia General Hospital, Perugia, Italy
| | - Vittorio Bini
- 4 Internal Medicine, Endocrine and Metabolic Sciences Section, Perugia General Hospital, Perugia, Italy
| | - Cynthia Aristei
- 2 Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
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Aristei C, Palumbo I, Falcinelli L, Crisci R, Cardinali L, Palumbo B, Lancellotta V, Montesi G, Gobbi G, Zucchetti C, Bini V. Does ultrasound provide any added value in breast contouring for radiotherapy after conserving surgery for cancer? Radiat Oncol 2015; 10:179. [PMID: 26296659 PMCID: PMC4554322 DOI: 10.1186/s13014-015-0487-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/09/2015] [Accepted: 08/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whole breast irradiation after conserving surgery for breast cancer requires precise definition of the target volume. The standard approach uses computed tomography (CT) images. However, since fatty breast and non-breast tissues have similar electronic densities, difficulties in differentiating between them hamper breast volume delineation. To overcome this limitation the breast contour is defined by palpation and then radio-opaque wire is put around it before the CT scan. To optimize assessment of breast margins in the cranial, caudal, medial, lateral and posterior directions, the present study evaluated palpation and CT and determined whether ultrasound (US) provided any added value. METHODS Twenty consecutive patients were enrolled after they had provided informed consent to participating in this prospective study which was approved by the Regional Public Health Ethics Committee. Palpation and US defined breast margins and each contour was marked and outlined with a fine plastic wire. Breasts were then contoured on axial CT images using the breast window width (WW) and window level (WL) (401 and 750 Hounsfield Units -HU- respectively), at which setting the plastic wires were invisible. Then, the lung window function (WW 1601 HU; WL -300 HU) was inserted to visualize the plastic wires which were used as guidelines to contour the palpable and US breast volumes. As each wire had a different diameter, both volumes were easily defined on CT slices. Results were analyzed using descriptive statistics, percentage overlap and reproducibility measures (agreement and reliability). RESULTS Volumes: US gave the largest and palpation the smallest. Agreement was best between palpation and CT. Reliability was almost perfect in all correlations. Extensions: Cranial and posterior were highest with US and smallest with palpation. Agreement was best between palpation and CT in all extensions except the cranial. Since strong to almost perfect agreement emerged for all comparisons, reliability was high. CONCLUSIONS US may be useful in defining the cranial and posterior extensions, mainly when tumours are localized there. This study demonstrates that the now standard radio-opaque wires around the palpable breast may not be needed in breast contouring.
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Affiliation(s)
- Cynthia Aristei
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, 06156, Italy.
| | - Isabella Palumbo
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, 06156, Italy.
| | | | - Rossana Crisci
- Radiation Oncology, University of Perugia, Perugia, Italy.
| | - Laura Cardinali
- Nuclear Medicine, University of Perugia and Perugia General Hospital, Perugia, Italy.
| | - Barbara Palumbo
- Nuclear Medicine, University of Perugia and Perugia General Hospital, Perugia, Italy.
| | | | | | - Gianni Gobbi
- Medical Physics Unit, Perugia General Hospital, Perugia, Italy.
| | | | - Vittorio Bini
- Internal Medicine, Endocrinal and Metabolic Science, University of Perugia, Perugia, Italy.
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Lancellotta V, Chirico L, Palumbo I, Anselmo P, Zucchetti C, Italiani M, Bini V, Maranzano E, Aristei C. OC-0041: PBI with interstitial high-dose-rate brachytherapy: results of a phase II prospective study. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40041-6] [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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Bellavita R, Mariucci C, Lupattelli M, Matrone F, Didona A, Mendichi M, Cecchetti S, Russo S, Zucchetti C, Aristei C. EP-1251: Prostate cancer reirradiation with Helical Tomotherapy. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41243-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Matrone F, Montesi G, Saldi S, Bellavita R, Frattegiani A, Lupattelli M, Zucchetti C, Cusco S, Bini V, Aristei C. EP-1260: Risk factors for acute toxicity in prostate cancer patients receiving hypofractionated IMRT. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41252-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Iacco M, Didona A, Marcantonini M, Zucchetti C, Dipilato A, Bellavita R, Falcinelli L, Palumbo I, Gobbi G. EP-1864: A treatment planning protocol for hypofractionated helical tomotherapy of prostate cancer. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31982-4] [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: 11/29/2022]
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Aristei C, Palumbo I, Capezzali G, Farneti A, Bini V, Falcinelli L, Margaritelli M, Lancellotta V, Zucchetti C, Perrucci E. Outcome of a phase II prospective study on partial breast irradiation with interstitial multi-catheter high-dose-rate brachytherapy. Radiother Oncol 2013; 108:236-41. [PMID: 24044802 DOI: 10.1016/j.radonc.2013.08.005] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 07/23/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE Partial breast irradiation (PBI) is an alternative to whole-breast irradiation after breast-conserving surgery in selected patients. Until the results of randomized phase III studies are available, phase II studies inform about PBI. We report the 5 year results of a phase II prospective study with PBI using interstitial multi-catheter high-dose-rate brachytherapy (ClinicalTrials.gov Identifier: NCT00499057). METHODS Hundred patients received PBI (4 Gy, twice a day for 4 days, until 32 Gy). Inclusion criteria were: age ≥ 40years, infiltrating carcinoma without lobular histology, ductal in situ carcinoma, tumor size ≤ 2.5 cm, negative surgical margins and axillary lymph nodes. RESULTS At a median follow-up of 60 months late toxicity occurred in 25 patients; the 5-year probability of freedom from late toxicity was 72.6% (95% CI: 63.7-81.7). Tamoxifen was the only significant risk factor for late toxicity. Cosmetic results, judged by physicians and patients, were good/excellent in 98 patients. Three local relapses (1 true, 2 elsewhere) and 1 regional relapse occurred. The 5-year probability of local or regional relapse-free survival was 97.7% (95% CI: 91.1-99.4) and 99.0% (95% CI: 92.9-99.8), respectively. CONCLUSION PBI with interstitial multi-catheter brachytherapy is associated with low relapse and late toxicity rates.
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Affiliation(s)
- Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Santa Maria della Misericordia Hospital, Italy.
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Scricciolo M, Bellavita R, Bini V, Lupattelli M, Arcidiacono F, Matrone F, Zucchetti C, Aristei C. PO-0712: Early-stage prostate cancer in patients under 70 years: the curative role of radiotherapy. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33018-8] [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: 11/29/2022]
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Perrucci E, Lancellotta V, Bini V, Farneti A, Falcinelli L, Palumbo I, Zucchetti C, Capezzali G, Aristei C. EP-1045: Quality of life and cosmetic results in breast cancer patients after whole breast or partial breast irradiation. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33351-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: 10/23/2022]
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Marcantonini M, Raymondi C, Leogrande M, Zucchetti C, Aristei C, Gobbi G. EP-1203: A protocol for prostate IMRT plan with step and shoot tecnique and inverse planning process. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33509-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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Marcantonini M, Raymondi C, Zucchetti C, Leogrande M, Aristei C, Gobbi G. 1370 poster DOSIMETRIC VERIFICATION OF IMRT TREATMENTS USING A 2D ION CHAMBER ARRAY. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)71492-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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