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Zerella MA, Zaffaroni M, Ronci G, Dicuonzo S, Rojas DP, Morra A, Gerardi MA, Fodor C, Rondi E, Vigorito S, Penco S, Sargenti M, Baratella P, Vicini E, Morigi C, Kahler-Ribeiro-Fontana S, Galimberti VE, Gandini S, De Camilli E, Renne G, Cattani F, Veronesi P, Orecchia R, Jereczek-Fossa BA, Leonardi MC. A narrative review for radiation oncologists to implement preoperative partial breast irradiation. Radiol Med 2023; 128:1553-1570. [PMID: 37650981 DOI: 10.1007/s11547-023-01706-6] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
The strategy to anticipate radiotherapy (RT) before surgery, for breast cancer (BC) treatment, has recently generated a renewed interest. Historically, preoperative RT has remained confined either to highly selected patients, in the context of personalized therapy, or to clinical research protocols. Nevertheless, in the recent years, thanks to technological advances and increased tumor biology understanding, RT has undergone great changes that have also impacted the preoperative settings, embracing the modern approach to breast cancer. In particular, the reappraisal of preoperative RT can be viewed within the broader view of personalized and tailored medicine. In fact, preoperative accelerated partial breast irradiation (APBI) allows a more precise target delineation, with less variability in contouring among radiation oncologists, and a smaller treatment volume, possibly leading to lower toxicity and to dose escalation programs. The aim of the present review, which represents a benchmark study for the AIRC IG-23118, is to report available data on different technical aspects of preoperative RT including dosimetric studies, patient's selection and set-up, constraints, target delineation and clinical results. These data, along with the ones that will become available from ongoing studies, may inform the design of the future trials and representing a step toward a tailored APBI approach with the potential to challenge the current treatment paradigm in early-stage BC.Trial registration: The study is registered at clinicaltrials.gov (NCT04679454).
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Affiliation(s)
- Maria Alessia Zerella
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Mattia Zaffaroni
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Giuseppe Ronci
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Samantha Dicuonzo
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Damaris Patricia Rojas
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Anna Morra
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | | | - Cristiana Fodor
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Elena Rondi
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sabrina Vigorito
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Silvia Penco
- Division of Breast Radiology, IRCSS, IEO European Institute of Oncology, Milan, Italy
| | - Manuela Sargenti
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Baratella
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Elisa Vicini
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Consuelo Morigi
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | - Sara Gandini
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Elisa De Camilli
- Department of Pathology and Laboratory Medicine, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppe Renne
- Department of Pathology and Laboratory Medicine, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Maria Cristina Leonardi
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy.
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Vavassori A, Mauri G, Mazzola GC, Mastroleo F, Bonomo G, Durante S, Zerini D, Marvaso G, Corrao G, Ferrari ED, Rondi E, Vigorito S, Cattani F, Orsi F, Jereczek-Fossa BA. Cyberknife Radiosurgery for Prostate Cancer after Abdominoperineal Resection (CYRANO): The Combined Computer Tomography and Electromagnetic Navigation Guided Transperineal Fiducial Markers Implantation Technique. Curr Oncol 2023; 30:7926-7935. [PMID: 37754491 PMCID: PMC10529393 DOI: 10.3390/curroncol30090576] [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: 07/25/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
In this technical development report, we present the strategic placement of fiducial markers within the prostate under the guidance of computed tomography (CT) and electromagnetic navigation (EMN) for the delivery of ultra-hypofractionated cyberknife (CK) therapy in a patient with localized prostate cancer (PCa) who had previously undergone chemo-radiotherapy for rectal cancer and subsequent abdominoperineal resection due to local recurrence. The patient was positioned in a prone position with a pillow under the pelvis to facilitate access, and an electromagnetic fiducial marker was placed on the patient's skin to establish a stable position. CT scans were performed to plan the procedure, mark virtual points, and simulate the needle trajectory using the navigation system. Local anesthesia was administered, and a 21G needle was used to place the fiducial markers according to the navigation system information. A confirmatory CT scan was obtained to ensure proper positioning. The implantation procedure was safe, without any acute side effects such as pain, hematuria, dysuria, or hematospermia. Our report highlights the ability to use EMN systems to virtually navigate within a pre-acquired imaging dataset in the interventional room, allowing for non-conventional approaches and potentially revolutionizing fiducial marker positioning, offering new perspectives for PCa treatment in selected cases.
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Affiliation(s)
- Andrea Vavassori
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.V.); (G.C.M.); (S.D.); (D.Z.); (G.M.); (G.C.); (E.D.F.); (B.A.J.-F.)
| | - Giovanni Mauri
- Division of Interventional Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.M.); (G.B.); (F.O.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy
| | - Giovanni Carlo Mazzola
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.V.); (G.C.M.); (S.D.); (D.Z.); (G.M.); (G.C.); (E.D.F.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy
| | - Federico Mastroleo
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.V.); (G.C.M.); (S.D.); (D.Z.); (G.M.); (G.C.); (E.D.F.); (B.A.J.-F.)
- Department of Translational Medicine, University of Piemonte Orientale (UPO), 20188 Novara, Italy
| | - Guido Bonomo
- Division of Interventional Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.M.); (G.B.); (F.O.)
| | - Stefano Durante
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.V.); (G.C.M.); (S.D.); (D.Z.); (G.M.); (G.C.); (E.D.F.); (B.A.J.-F.)
| | - Dario Zerini
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.V.); (G.C.M.); (S.D.); (D.Z.); (G.M.); (G.C.); (E.D.F.); (B.A.J.-F.)
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.V.); (G.C.M.); (S.D.); (D.Z.); (G.M.); (G.C.); (E.D.F.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy
| | - Giulia Corrao
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.V.); (G.C.M.); (S.D.); (D.Z.); (G.M.); (G.C.); (E.D.F.); (B.A.J.-F.)
| | - Elettra Dorotea Ferrari
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.V.); (G.C.M.); (S.D.); (D.Z.); (G.M.); (G.C.); (E.D.F.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy
| | - Elena Rondi
- Unit of Medical Physics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (E.R.); (S.V.); (F.C.)
| | - Sabrina Vigorito
- Unit of Medical Physics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (E.R.); (S.V.); (F.C.)
| | - Federica Cattani
- Unit of Medical Physics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (E.R.); (S.V.); (F.C.)
| | - Franco Orsi
- Division of Interventional Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.M.); (G.B.); (F.O.)
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.V.); (G.C.M.); (S.D.); (D.Z.); (G.M.); (G.C.); (E.D.F.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy
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3
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Piccolo C, Vigorito S, Rondi E, Piperno G, Ferrari A, Pepa M, Riva G, Durante S, Conte E, Catto V, Andreini D, Carbucicchio C, Jereczek-Fossa BA, Pompilio G, Orecchia R, Cattani F. Phantom study of stereotactic radioablation for ventricular tachycardia (STRA-MI-VT) using Cyberknife Synchrony Respiratory Tracking System with a single fiducial marker. Phys Med 2022; 100:135-141. [PMID: 35816942 DOI: 10.1016/j.ejmp.2022.06.019] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/22/2022] [Accepted: 06/29/2022] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Within the STRA-MI-VT phase Ib/II trial (NCT04066517), the aim of this phantom study was to explore the feasibility of Cyberknife treatments on cardiac lesions by tracking as a single marker the lead tip of an implantable cardioverter defibrillator. The residual displacement of the lesion during the tracking was studied, planning margins were found and the dosimetric accuracy of the treatment was checked. MATERIALS AND METHODS A lead was inserted into a phantom (EasyCube phantom, Sun Nuclear Co, USA) and then placed on the translating ExacTrac Gating System (BrainLAB AG, Germany). The phantom was rotated, a virtual lesion was identified and its displacement during the tracking was studied. Two plans were compared, calculated on the unrotated volume and on the envelope of the unrotated and the rotated volumes. The plans were delivered using the Cyberknife System (Accuray Inc, USA) and their dosimetric accuracy verified by gamma analysis with gafchromic films. RESULTS The residual margin increases enhancing the distance between the lead and the lesion. It is 4 mm for distance 0 cm and 5 mm for distance 5 cm. The coverage is reduced by 3.8% (interquartile range 2.5%-4.7%) when the dose is prescribed on the unrotated volume. All treatment plans are accurate and 3% 3 mm gamma analysis results are greater than 94%. CONCLUSIONS Results showed that tracking with a single marker is feasible considering adequate residual planning margins. The volumes could be further reduced by using additional markers, for example by placing them on the patient's skin.
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Affiliation(s)
- C Piccolo
- Unit of Medical Physics, IEO European Institute of Oncology, IRCCS, Milan, Italy.
| | - S Vigorito
- Unit of Medical Physics, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - E Rondi
- Unit of Medical Physics, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - G Piperno
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - A Ferrari
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - M Pepa
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - G Riva
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - S Durante
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - E Conte
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - V Catto
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Milan, Italy
| | - D Andreini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - C Carbucicchio
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - B A Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - G Pompilio
- Scientific Directorate, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - R Orecchia
- Scientific Directorate, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - F Cattani
- Unit of Medical Physics, IEO European Institute of Oncology, IRCCS, Milan, Italy
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4
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Dicuonzo S, Colombo F, Bergamaschi L, Piperno G, Ferrari A, Leonardi M, Zaffaroni M, Zerella M, Rojas D, Gerardi M, Morra A, Rondi E, Vigorito S, Cattani F, Orecchia R, Jereczek-Fossa B, Frassoni S, Bagnardi V. PO-1228 Radiosurgery in her2-breast cancer brain metastasis:local control and overall survival in 32 women. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03192-9] [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: 11/15/2022]
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5
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Zerella MA, Zaffaroni M, Ronci G, Dicuonzo S, Rojas DP, Morra A, Fodor C, Rondi E, Vigorito S, Botta F, Cremonesi M, Garibaldi C, Penco S, Galimberti VE, Intra M, Gandini S, Barberis M, Renne G, Cattani F, Veronesi P, Orecchia R, Jereczek-Fossa BA, Leonardi MC. Single fraction ablative preoperative radiation treatment for early-stage breast cancer: the CRYSTAL study – a phase I/II clinical trial protocol. BMC Cancer 2022; 22:358. [PMID: 35366825 PMCID: PMC8977020 DOI: 10.1186/s12885-022-09305-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Breast-conserving surgery (BCS) and whole breast radiation therapy (WBRT) are the standard of care for early-stage breast cancer (BC). Based on the observation that most local recurrences occurred near the tumor bed, accelerated partial breast irradiation (APBI), consisting of a higher dose per fraction to the tumor bed over a reduced treatment time, has been gaining ground as an attractive alternative in selected patients with low-risk BC. Although more widely delivered in postoperative setting, preoperative APBI has also been investigated in a limited, though increasing, and number of studies. The aim of this study is to test the feasibility, safety and efficacy of preoperative radiotherapy (RT) in a single fraction for selected BC patients. Methods This is a phase I/II, single-arm and open-label single-center clinical trial using CyberKnife. The clinical investigation is supported by a preplanning section which addresses technical and dosimetric issues. The primary endpoint for the phase I study, covering the 1st and 2nd year of the research project, is the identification of the maximum tolerated dose (MTD) which meets a specific target toxicity level (no grade 3–4 toxicity). The primary endpoint for the phase II study (3rd to 5th year) is the evaluation of treatment efficacy measured in terms of pathological complete response rate. Discussion The study will investigate the response of BC to the preoperative APBI from different perspectives. While preoperative APBI represents a form of anticipated boost, followed by WBRT, different are the implications for the scientific community. The study may help to identify good responders for whom surgery could be omitted. It is especially appealing for patients unfit for surgery due to advanced age or severe co-morbidities, in addition to or instead of systemic therapies, to ensure long-term local control. Moreover, patients with oligometastatic disease synchronous with primary BC may benefit from APBI on the intact tumor in terms of tumor progression free survival. The study of response to RT can provide useful information about BC radiobiology, immunologic reactions, genomic expression, and radiomics features, to be tested on a larger scale. Trial registration The study was prospectively registered at clinicaltrials.gov (NCT04679454).
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Piccolo C, Vigorito S, Rondi E, Piperno G, Ferrari A, Pepa M, Conte E, Catto V, Andreini D, Carbucicchio C, Jereczek-Fossa B, Cattani F. Phantom study of stereotactic radioablation treatments for ventricular tachycardia (STRA-MI-VT) using Cyberknife synchrony respiratory tracking system with a single fiducial marker. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00164-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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7
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Carbucicchio C, Andreini D, Piperno G, Catto V, Conte E, Cattani F, Bonomi A, Rondi E, Piccolo C, Vigorito S, Ferrari A, Pepa M, Giuliani M, Mushtaq S, Scarà A, Calò L, Gorini A, Veglia F, Pontone G, Pepi M, Tremoli E, Orecchia R, Pompilio G, Tondo C, Jereczek-Fossa BA. Stereotactic radioablation for the treatment of ventricular tachycardia: preliminary data and insights from the STRA-MI-VT phase Ib/II study. J Interv Card Electrophysiol 2021; 62:427-439. [PMID: 34609691 PMCID: PMC8490832 DOI: 10.1007/s10840-021-01060-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/02/2021] [Indexed: 11/28/2022]
Abstract
Purpose We present the preliminary results of the STRA-MI-VT Study (NCT04066517), a spontaneous, phase Ib/II study, designed to prospectively test the safety and efficacy of stereotactic body radiotherapy (SBRT) in patientswith advanced cardiac disease and intractable ventricular tachycardia (VT). Methods Cardiac computed tomography (CT) integrated by electroanatomical mapping was used for substrate identification and merged with dedicated CT scans for treatment plan preparation. A single 25-Gy radioablation dose was delivered by a LINAC-based volumetric modulated arc therapy technique in a non-invasive matter. The primary safety endpoint was treatment-related adverse effects during acute and long-term follow-up (FU), obtained by regular in-hospital controls and implantable cardioverter defibrillator (ICD) remote monitoring. The primary efficacy endpoint was the reduction at 3 and 6 months of VT episodes and ICD shocks. Results Seven out of eight patients (men; age, 70 ± 7 years; ejection fraction, 27 ± 11%; 3 ischemic, 4 non-ischemic cardiomyopathies) underwent SBRT. At a median 8-month FU, no treatment-related serious adverse event occurred. Three patients died from non-SBRT-related causes. Four patients completed the 6-month FU: the number of VT decreased from 29 ± 33 to 11 ± 9 (p = .05) and 2 ± 2 (p = .08), at 3 and 6 months, respectively; shocks decreased from 11 to 0 and 2, respectively. At 6 months, all patients. showed a significant reduction of VT episodes and no electrical storm recurrence, with the complete regression of iterative VTs in 2/2 patients. Conclusion The STRA-MI-VT Study suggests that SBRT can be considered an alternative option for the treatment of VT in patients with structural heart disease and highlights the need for further clinical investigation addressing safety and efficacy. Supplementary Information The online version contains supplementary material available at 10.1007/s10840-021-01060-5.
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Affiliation(s)
- Corrado Carbucicchio
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, Italy.
| | - Daniele Andreini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gaia Piperno
- Division of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Valentina Catto
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, Italy
| | - Edoardo Conte
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Alice Bonomi
- Biostatistics Unit, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Elena Rondi
- Unit of Medical Physics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Consiglia Piccolo
- Unit of Medical Physics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Sabrina Vigorito
- Unit of Medical Physics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Annamaria Ferrari
- Division of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Matteo Pepa
- Division of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Giuliani
- Psycho-Cardiology Service, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Saima Mushtaq
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Antonio Scarà
- Unit of Cardiology, Policlinico Casilino, Rome, Italy
| | - Leonardo Calò
- Unit of Cardiology, Policlinico Casilino, Rome, Italy
| | - Alessandra Gorini
- Psycho-Cardiology Service, Centro Cardiologico Monzino IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Fabrizio Veglia
- Biostatistics Unit, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mauro Pepi
- Clinical Area Directorate, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Elena Tremoli
- Prevention Program Directorate, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Giulio Pompilio
- Scientific Directorate, Centro Cardiologico Monzino IRCCS, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milano, Italy
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milano, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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8
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Piccolo C, Vigorito S, Rondi E, Piperno G, Ferrari A, Pepa M, Conte E, Catto V, Andreini D, Carbucicchio C, Jereczek-Fossa B, Cattani F. PO-1725 Phantom study of Cyberknife Synchrony cardiac treatments with a single fiducial marker. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08176-7] [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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9
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Bergamaschi L, Gerardi MA, Zaffaroni M, Augugliaro M, Vigorito S, Rondi E, Della Vigna P, Varano G, Fumagalli Romario U, Biffi R, Picardi EEE, Ferrari A, Jereczek-Fossa BA. Neobladder and ablative pelvic radiotherapy: still a taboo? Tumori 2021; 107:NP108-NP113. [PMID: 34235994 DOI: 10.1177/03008916211031295] [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] [Indexed: 11/16/2022]
Abstract
The presence of a neobladder constitutes a limitation for the radiation oncologist, as there is no clear evidence about its tolerance to radiotherapy (RT). The limited literature only concerns the conventional postoperative treatment in patients with bladder cancer after cystectomy. Here we report a case of a patient with neobladder who underwent a stereotactic RT for a pelvic recurrence of disease, with response to treatment and no toxicity to the neobladder. This case represents a promising example of the chance to perform RT with ablative intent, using advanced techniques, even on lesions close to the neobladder.
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Affiliation(s)
- Luca Bergamaschi
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Matteo Augugliaro
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sabrina Vigorito
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Elena Rondi
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paolo Della Vigna
- Interventional Radiology Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gianluca Varano
- Interventional Radiology Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Roberto Biffi
- Department of Digestive Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Annamaria Ferrari
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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10
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Cambria R, Ciardo D, Bazani A, Pansini F, Rondi E, Maestri D, Zerini D, Marvaso G, Romanelli P, Timon G, Fodor C, Petralia G, Alessi S, Pricolo P, Vischioni B, Fossati P, Molinelli S, Russo S, Ciocca M, De Cobelli O, Renne G, Orecchia R, Cattani F, Jereczek-Fossa BA. Ultrahypofractionated radiotherapy for localized prostate cancer with simultaneous boost to the dominant intraprostatic lesion: a plan comparison. Tumori 2021; 108:263-269. [PMID: 33896239 DOI: 10.1177/03008916211011667] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare different stereotactic body techniques-intensity-modulated radiotherapy with photons and protons, applied to radiotherapy of prostatic cancer-with simultaneous integrated boost (SIB) on the dominant intraprostatic lesion (DIL). METHODS Ten patients were selected for this planning study. Dosimetric results were compared between volumetric modulated arc therapy, intensity-modulated radiation therapy (IMRT), and intensity-modulated proton therapy both with two (IMPT 2F) and five fields (IMPT 5F) planning while applying the prescription schemes of 7.25 Gy/fraction to the prostate gland and 7.5 Gy/fraction to the DIL in 5 fractions. RESULTS Comparison of the coverages of the planning target volumes showed that small differences exist. The IMPT-2F-5F techniques allowed higher doses in the targets; conformal indexes resulted similar; homogeneity was better in the photon techniques (2%-5%). Regarding the organs at risk, all the techniques were able to maintain the dose well below the prescribed constraints: in the rectum, the IMPT-2F-5F and IMRT were more efficient in lowering the intermediate doses; in the bladder, the median dose was significantly better in the case of IMPT (2F-5F). In the urethra, the best sparing was achieved only by IMPT-5F. CONCLUSIONS Stereotactic radiotherapy with SIB for localized prostate cancer is feasible with all the investigated techniques. Concerning IMPT, the two-beam technique does not seem to have a greater advantage compared to the standard techniques; the 5-beam technique seems more promising also accounting for the range uncertainty.
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Affiliation(s)
- Raffaella Cambria
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Delia Ciardo
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Alessia Bazani
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Floriana Pansini
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Elena Rondi
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Davide Maestri
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Dario Zerini
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Giulia Marvaso
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, via Festa del Perdono, Milan, Italy
| | - Pola Romanelli
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Giorgia Timon
- Radiotherapy Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cristiana Fodor
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Giuseppe Petralia
- Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, Istituto Europeo di Oncologia IRCCS, via Ripamonti 435, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, via Festa del Perdono, Milan, Italy
| | - Sarah Alessi
- Department of Radiology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Paola Pricolo
- Department of Radiology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | | | - Piero Fossati
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, via Festa del Perdono, Milan, Italy
| | | | - Stefania Russo
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Mario Ciocca
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Ottavio De Cobelli
- Department of Urology, Istituto Europeo di Oncologia IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, via Festa del Perdono, Milan, Italy
| | - Giuseppe Renne
- Uropathology and Intraoperative Diagnostic Division, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Federica Cattani
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Barbara A Jereczek-Fossa
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, via Festa del Perdono, Milan, Italy
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11
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Marvaso G, Corrao G, Oneta O, Gugliandolo S, Pepa M, Cecconi A, Gandini S, Piperno G, Cossu Rocca M, Verri E, Aurilio G, Corso F, Cullurà D, Rondi E, Vigorito S, Nolè F, Orecchia R, Jereczek-Fossa B. PO-1218: Oligo Metastatic renal cell carcinoma: SBRT, if, when and how? Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01236-6] [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: 10/22/2022]
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12
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Durante S, Corrao G, Marvaso G, Piperno G, Colombo F, Gugliandolo S, Rondi E, Vigorito S, Frassoni S, Bagnardi V, Fodor C, Spaggiari L, De Marinis F, Orecchia R, Jereczek-Fossa B. PO-1023: Impact of biological features in radiosurgery for Brain metastases from Non Small Cell Lung Cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01040-9] [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: 11/29/2022]
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13
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Francia CM, Marvaso G, Piperno G, Gandini S, Ferrari A, Zerella MA, Arculeo S, Sibio D, Fodor C, Pepa M, Trivellato S, Rondi E, Vigorito S, Cattani F, Spaggiari L, De Marinis F, Orecchia R, Ciardo D, Jereczek-Fossa BA. Lung optimized treatment with CyberKnife® in inoperable lung cancer patients: feasibility analysis of a mono-institutional 115 patient series. Neoplasma 2020; 67:684-691. [PMID: 32182088 DOI: 10.4149/neo_2020_190717n645] [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: 07/17/2019] [Accepted: 09/29/2019] [Indexed: 11/08/2022]
Abstract
CyberKnife® Lung Optimized Treatment (LOT) allows the treatment of lung cancer without invasive fiducial implantation. The aim of this retrospective analysis was to evaluate the feasibility, toxicity and clinical outcome. One hundred fifteen patients (124 lesions) were treated with CyberKnife® using LOT. The median age was 72.6 years (range 31.8-90.3). From 124 treated lesions, 52 were with histopathological confirmation (41 primitive pulmonary cancers, 8 pulmonary metastases) and 72 as untyped tumors. For 5 patients (6 lesions) treatment was an in-field re-irradiation. Concomitant therapy was administered in 7 patients. Zero-View tracking was applied in 69 patients, 1-View in 33 patients, 2-View in 22 patients. The median total dose was 45 Gy (range 18-54), median dose/fraction was 15 Gy (range 4-18) with a median prescription isodose of 80% (range 68-85). The median planning target volume (PTV) was 25 cm3 (range 3-195). The median follow-up was 20 months (range 7-47). Thirty-seven patients (32%) were alive with no evidence of disease, 39 patients (34%) were alive with clinically evident disease, and 38 patients (33%) died of the disease. The 1- and 2-year overall survival (OS) rate was 83% and 61%. The median time to progression was 19 months (95% confidence interval: 11-19 months), 1- and 2-year progression-free survival (PFS) rates were 62% and 41%, respectively. Smaller PTV was significantly associated with better OS, PFS and in-field PFS in univariate and multivariate analyses. Acute toxicity was observed in 36 patients (41%). Late toxicity was registered in 25 patients (29%). G3 late toxicity was observed in one patient (1.1%). Our data suggest that fiducial less-stereotactic body radiation therapy (SBRT) is a feasible, well-tolerated and potentially effective treatment with high compliance in the setting of inoperable patients due to concomitant disease or previous treatments.
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Affiliation(s)
- C Maria Francia
- Department of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - G Marvaso
- Department of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - G Piperno
- Department of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - S Gandini
- Department of Experimental Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - A Ferrari
- Department of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - M Alessia Zerella
- Department of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - S Arculeo
- Department of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - D Sibio
- Department of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - C Fodor
- Department of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - M Pepa
- Department of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - S Trivellato
- Unit of Medical Physics, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - E Rondi
- Unit of Medical Physics, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - S Vigorito
- Unit of Medical Physics, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - F Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - L Spaggiari
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - F De Marinis
- Division of Thoracic Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - R Orecchia
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Scientific Directorate, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - D Ciardo
- Department of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - B Alicja Jereczek-Fossa
- Department of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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14
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Trivellato S, Rondi E, Vigorito S, Miglietta E, Castellini F, Piperno G, Ferrari A, Jereczek-Fossa B, Cattani F. PO-0905 Validation of a 4D Monte Carlo optimization and planning feature for CyberKnife lung treatment. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31325-8] [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: 10/26/2022]
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15
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Riva G, Ferrari A, Durante S, Ciardo D, Piperno G, Leonardi M, Vigorito S, Rondi E, Orecchia R, Jereczek-Fossa B. EP-1212 Clinical outcome in brain metastases from breast cancer treated with stereotactic radiotherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31632-9] [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: 11/26/2022]
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16
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Trivellato S, Rondi E, Vigorito S, Miglietta E, Castellini F, Piperno G, Ferrari A, Jereczek-Fossa B, Cattani F. OC-0094 Retrospective evaluation of motion effects in robotic radiosurgery treatments of lung cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30514-6] [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: 11/27/2022]
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17
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Augugliaro M, Marvaso G, Ciardo D, Zerini D, Riva G, Rondi E, Vigorito S, Comi S, Cobelli OD, Orecchia R, Jereczek-Fossa BA. Recurrent oligometastatic transitional cell bladder carcinoma: is there room for radiotherapy? Neoplasma 2019; 66:160-165. [DOI: 10.4149/neo_2018_180522n333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/24/2018] [Indexed: 11/08/2022]
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18
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Volpe S, Jereczek-Fossa BA, Zerini D, Rojas DP, Fodor C, Vavassori A, Romanelli P, Vigorito S, Rondi E, Comi S, Cambria R, Cattani F, Dicuonzo S, De Marco P, Beltramo G, Musi G, De Cobelli O, Marvaso G, Orecchia R. Case series on multiple prostate re-irradiation for locally recurrent prostate cancer: something ventured, something gained. Neoplasma 2018; 66:308-314. [PMID: 30509110 DOI: 10.4149/neo_2018_180723n520] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/16/2018] [Indexed: 11/08/2022]
Abstract
The aim is to present the technical feasibility and efficacy of multiple re-irradiation (re-EBRT) for local recurrence of prostate cancer (PCa) using retrospective analysis of an updated series of patients who received ablative re-EBRT with stereotactic image-guided technique for isolated local recurrence of PCa. Eight patients received three RT courses (2 re-RTs); of those 2 received 4 RT courses (3 re-RTs). Local relapse in the prostate was assessed by multiparametric magnetic resonance and/ or choline positron emission tomography. Before treatment planning, all patients had been evaluated for late toxicity from previous RT according to RTOG/EORTC. Biochemical control was assessed according to Phoenix definition. Mean age at the third RT course was 68 (standard deviation, SD: 7.2); all patients had a good performance status. At diagnosis, four cases were classified as high risk PCa, three as intermediate and one as low per NCCN 2017. Biochemical progression free interval after first and second RT-course were 74 (IQR: 59.3-133.6) months and 33 (IQR: 20.8-53.1) months, respectively. Biochemical and radiological response was registered in all patients. At present, seven out of eight patients are disease free. Overall toxicity profile was good; no severe acute or late genitourinary or gastrointestinal events were recorded. Multiple RT courses with high precision technology and image guidance can be proposed as a possible salvage therapy for locally recurrent, low-burden PCa recurrence in adequately selected patients. Deeper understanding of radiobiological effects of hypofractionation and larger series of patients are warranted to fully evaluate the applicability of multiple RT courses in the setting of locally recurrent PCa.
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Affiliation(s)
- S Volpe
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - B Alicja Jereczek-Fossa
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - D Zerini
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - D Patricia Rojas
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - C Fodor
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - A Vavassori
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - P Romanelli
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - S Vigorito
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - E Rondi
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - S Comi
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - R Cambria
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - F Cattani
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - S Dicuonzo
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - P De Marco
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | | | - G Musi
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - O De Cobelli
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - G Marvaso
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - R Orecchia
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Scientific Directorate, European Institute of Oncology, Milan, Italy
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19
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Jereczek-Fossa BA, Rojas DP, Zerini D, Fodor C, Viola A, Fanetti G, Volpe S, Luraschi R, Bazani A, Rondi E, Cattani F, Vavassori A, Garibaldi C, Alessi S, Pricolo P, Petralia G, Cozzi G, De Cobelli O, Musi G, Orecchia R, Marvaso G, Ciardo D. Reirradiation for isolated local recurrence of prostate cancer: Mono-institutional series of 64 patients treated with salvage stereotactic body radiotherapy (SBRT). Br J Radiol 2018; 92:20180494. [PMID: 30379566 DOI: 10.1259/bjr.20180494] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE: To evaluate high-precision external beam reirradiation (re-EBRT) for local relapse of prostate cancer (PCa) after radiotherapy. METHODS: This retrospective study included patients with biochemical failure and evidence of isolated local recurrence of PCa after radical/salvage EBRT or brachytherapy that received salvage stereotactic body radiation therapy (SBRT, re-EBRT). Biopsy was not mandatory if all diagnostic elements were univocal (prostate specific antigen evolution, choline-positron emission tomography or magnetic resonance imaging). Salvage SBRT (re-EBRT) was delivered with image-guided radiation therapy (RapidArc®, VERO® and CyberKnife®). RESULTS: Data of 64 patients were included, median age at salvage SBRT was 73.2 years, median pre-salvage SBRT prostate specific antigen was 3.89 ng ml-1 . Median total dose was 30 Gy in five fractions, biologically effective dose (BED) of 150 Gy. One acute G3 genitourinary event and one late G3 genitourinary event were observed. No G ≥ 3 bowel toxicity was registered. At the median follow-up of 26.1 months, tumor progression was observed in 41 patients (64%). 18 patients (28%) experienced local relapse. 2-year local control, biochemical and clinical relapse free survival rates were 75, 40 and 53%, respectively. With BED ≥130 Gy 1-year biochemical and clinical progression-free survival rate were 85 and 90%, respectively. CONCLUSIONS: Salvage SBRT (re-EBRT) for isolated local PCa recurrence is a safe, feasible and noninvasive salvage treatment. Further investigation is warranted to define the optimal patient selection, dose and volume parameters. ADVANCES IN KNOWLEDGE: Salvage SBRT reirradiation for the locally recurrent PCa offer a satisfactory tumor control and excellent toxicity profile, if BED ≥130 Gy is administered.
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Affiliation(s)
- Barbara Alicja Jereczek-Fossa
- 1 Division of Radiation Oncology, European Institute of Oncology IRCCS , Milan , Italy.,2 Department of Oncology and Hemato-oncology, University of Milan , Milan , Italy
| | - Damaris Patricia Rojas
- 1 Division of Radiation Oncology, European Institute of Oncology IRCCS , Milan , Italy.,2 Department of Oncology and Hemato-oncology, University of Milan , Milan , Italy
| | - Dario Zerini
- 1 Division of Radiation Oncology, European Institute of Oncology IRCCS , Milan , Italy
| | - Cristiana Fodor
- 1 Division of Radiation Oncology, European Institute of Oncology IRCCS , Milan , Italy
| | - Anna Viola
- 1 Division of Radiation Oncology, European Institute of Oncology IRCCS , Milan , Italy.,2 Department of Oncology and Hemato-oncology, University of Milan , Milan , Italy
| | - Giuseppe Fanetti
- 1 Division of Radiation Oncology, European Institute of Oncology IRCCS , Milan , Italy.,2 Department of Oncology and Hemato-oncology, University of Milan , Milan , Italy
| | - Stefania Volpe
- 1 Division of Radiation Oncology, European Institute of Oncology IRCCS , Milan , Italy.,2 Department of Oncology and Hemato-oncology, University of Milan , Milan , Italy
| | - Rosa Luraschi
- 3 Unit of Medical Physics, European Institute of Oncology IRCCS , Milan , Italy
| | - Alessia Bazani
- 3 Unit of Medical Physics, European Institute of Oncology IRCCS , Milan , Italy
| | - Elena Rondi
- 3 Unit of Medical Physics, European Institute of Oncology IRCCS , Milan , Italy
| | - Federica Cattani
- 3 Unit of Medical Physics, European Institute of Oncology IRCCS , Milan , Italy
| | - Andrea Vavassori
- 1 Division of Radiation Oncology, European Institute of Oncology IRCCS , Milan , Italy
| | - Cristina Garibaldi
- 4 Radiation Research Unit, European Institute of Oncology IRCCS , Milano , Italy
| | - Sarah Alessi
- 5 Division of Radiology, European Institute of Oncology IRCCS , Milan , Italy
| | - Paola Pricolo
- 5 Division of Radiology, European Institute of Oncology IRCCS , Milan , Italy
| | - Giuseppe Petralia
- 5 Division of Radiology, European Institute of Oncology IRCCS , Milan , Italy
| | - Gabriele Cozzi
- 6 Division of Urology, European Institute of Oncology IRCCS , Milan , Italy
| | - Ottavio De Cobelli
- 6 Division of Urology, European Institute of Oncology IRCCS , Milan , Italy
| | - Gennaro Musi
- 6 Division of Urology, European Institute of Oncology IRCCS , Milan , Italy
| | - Roberto Orecchia
- 7 Scientific Directorate, European Institute of Oncology IRCCS , Milan , Italy
| | - Giulia Marvaso
- 1 Division of Radiation Oncology, European Institute of Oncology IRCCS , Milan , Italy
| | - Delia Ciardo
- 1 Division of Radiation Oncology, European Institute of Oncology IRCCS , Milan , Italy
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20
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Fanetti G, Marvaso G, Ciardo D, Rese A, Ricotti R, Rondi E, Comi S, Cattani F, Zerini D, Fodor C, de Cobelli O, Orecchia R, Jereczek-Fossa BA. Stereotactic body radiotherapy for castration-sensitive prostate cancer bone oligometastases. Med Oncol 2018; 35:75. [PMID: 29671075 DOI: 10.1007/s12032-018-1137-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 03/19/2018] [Accepted: 04/13/2018] [Indexed: 02/06/2023]
Abstract
To evaluate outcome in patients treated with stereotactic body radiotherapy (SBRT) on bone oligometastases from castration-sensitive prostate cancer after primary treatment. We retrospectively collected data of patients with less than five lesions at time of SBRT and hormone-naïve disease at the first extra-regional localization, treated between 03/2012 and 11/2016. Prostate-specific antigen (PSA) was measured every 3 months after SBRT. Imaging was performed in case of progression. Survival analysis was performed with Kaplan-Meier (log-rank test) approach. Fifty-five patients were treated on 77 bone oligometastases. Median age, initial PSA and pre-SBRT PSA were 72 years, 9.12 and 3.5 ng/mL, respectively. Twenty-five patients (45%) received SBRT alone while the remaining 30 patients (55%) received concomitant ADT. Median follow-up was 24.6 months (range 3.0-67.2 months). No acute or late toxicity of grade > 1 was reported. Clinical progression was observed in 38 (69%) patients. 1-year biochemical progression-free survival (b-PFS), clinical progression-free survival (c-PFS), prostate-specific survival (PCSS) and local control (LC) rates were 51, 56, 100 and 83%, respectively. Comparing patients treated with SBRT alone and with concomitant ADT, no significant differences were found for those outcomes. SBRT is safe and allows high 1-year LC rate (83%) with low toxicity profile. No significant improvement in outcomes was registered with the addition of ADT to SBRT.
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Affiliation(s)
- Giuseppe Fanetti
- Division of Radiotherapy, European Institute of Oncology, Ripamonti 435, 20141, Milan, Italy. .,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
| | - Giulia Marvaso
- Division of Radiotherapy, European Institute of Oncology, Ripamonti 435, 20141, Milan, Italy
| | - Delia Ciardo
- Division of Radiotherapy, European Institute of Oncology, Ripamonti 435, 20141, Milan, Italy
| | - Annaisabel Rese
- Division of Radiotherapy, A.O.U. Federico II, Naples, Italy.,University of Naples, Naples, Italy
| | - Rosalinda Ricotti
- Division of Radiotherapy, European Institute of Oncology, Ripamonti 435, 20141, Milan, Italy
| | - Elena Rondi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Stefania Comi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Dario Zerini
- Division of Radiotherapy, European Institute of Oncology, Ripamonti 435, 20141, Milan, Italy
| | - Cristiana Fodor
- Division of Radiotherapy, European Institute of Oncology, Ripamonti 435, 20141, Milan, Italy
| | - Ottavio de Cobelli
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Division of Urology, European Institute of Oncology, Milan, Italy
| | - Roberto Orecchia
- Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Milan, Italy
| | - Barbara A Jereczek-Fossa
- Division of Radiotherapy, European Institute of Oncology, Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Riva G, Alessandro O, Spoto R, Ferrari A, Garibaldi C, Cattani F, Luraschi R, Rondi E, Colombo N, Giovenzana FLF, Cipolla CM, Winnicki M, Persiani M, Castelluccia F, Fiore MS, Orecchia R, Jereczek-Fossa BA. Radiotherapy in patients with cardiac implantable electronic devices: clinical and dosimetric aspects. Med Oncol 2018; 35:73. [DOI: 10.1007/s12032-018-1126-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
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22
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Volpe S, Jereczek Fossa B, Zerini D, Rojas D, Fodor C, Vavassori A, Romanelli P, Vigorito S, Rondi E, Comi S, Cambria R, Cattani F, Di Cuonzo S, De Marco P, Beltramo G, Musi G, De Cobelli O, Marvaso G, Orecchia R. EP-1555: Multiple re-irradiation for locally recurrent prostate cancer: proof of concept and clinical outcome. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31864-4] [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: 11/27/2022]
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23
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Rojas D, Jereczek-Fossa B, Zerini D, Fodor C, Viola A, Fanetti G, Volpe S, Marvaso G, Luraschi R, Bazani A, Rondi E, Cattani F, Vavassori A, Bazzani A, Ronchi S, Maucieri A, Alessi S, Petralia G, De Cobelli O, Musi G, Orecchia O. Ep-2372: High-Precision Salvage Re-Irradiation For Local Recurrence Of Prostate Cancer: Series Of 64 Patients. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32680-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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24
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Riva G, Augugliaro M, Piperno G, Ferrari A, Rondi E, Vigorito S, Ciardo D, Orecchia R, Jereczek-Fossa BA. CyberKnife radiotherapy for orbital metastases: A single-center experience on 24 lesions. Eur J Ophthalmol 2018; 29:61-68. [PMID: 29587486 DOI: 10.1177/1120672118761728] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVES: To evaluate the feasibility, in terms of acute toxicity and symptom control, of CyberKnife (Accuray, Sunnyvale, CA)-based stereotactic radiotherapy (CyberKnife-SRT) for metastatic orbital lesions. METHODS: This retrospective study included patients with symptomatic metastases wholly located within the orbit. Palliative radiation treatment was performed using CyberKnife image-guided technology. Gross tumor volume was defined on a pre-radiotherapy magnetic resonance imaging. Acute and late toxicity was recorded according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Scale. RESULTS: Between April 2012 and July 2016, 21 patients underwent CyberKnife-SRT for 24 orbital metastases from different primary tumors. Median treatment dose was 18 Gy (15-24 Gy) given in a median of 3 fractions (2-3 fractions) with a median dose of 6 Gy/fraction (5-10 Gy/fraction). Acute grade 1 toxicity was observed in eight cases. No local recurrence occurred after median follow-up of 6.2 months (1.1-30.0 months) among 16 lesions that underwent post-stereotactic radiotherapy magnetic resonance imaging. All patients reported decreasing pre-stereotactic radiotherapy symptoms without late toxicity. Follow-up >6 months (median 22.8 months) was available for nine lesions; complete and partial radiological response was registered in four and five of them, respectively. CONCLUSION: In our experience, CyberKnife-SRT is a well-tolerated treatment that offers high local and symptom control in patients with intraocular and periocular malignant lesions.
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Affiliation(s)
- Giulia Riva
- 1 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,2 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Matteo Augugliaro
- 1 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,2 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Gaia Piperno
- 2 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Annamaria Ferrari
- 2 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Elena Rondi
- 3 Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Sabrina Vigorito
- 3 Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Delia Ciardo
- 2 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Roberto Orecchia
- 4 Scientific Directorate, European Institute of Oncology, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- 1 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,2 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
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25
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Ricotti R, Seregni M, Ciardo D, Vigorito S, Rondi E, Piperno G, Ferrari A, Zerella MA, Arculeo S, Francia CM, Sibio D, Cattani F, De Marinis F, Spaggiari L, Orecchia R, Riboldi M, Baroni G, Jereczek-Fossa BA. Evaluation of target coverage and margins adequacy during CyberKnife Lung Optimized Treatment. Med Phys 2018; 45:1360-1368. [DOI: 10.1002/mp.12804] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/26/2017] [Accepted: 01/29/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Rosalinda Ricotti
- Division of Radiation Oncology; European Institute of Oncology; Milan Italy
| | - Matteo Seregni
- Dipartimento di Elettronica Informazione e Bioingegneria; Politecnico di Milano; Milan Italy
| | - Delia Ciardo
- Division of Radiation Oncology; European Institute of Oncology; Milan Italy
| | - Sabrina Vigorito
- Unit of Medical Physics; European Institute of Oncology; Milan Italy
| | - Elena Rondi
- Unit of Medical Physics; European Institute of Oncology; Milan Italy
| | - Gaia Piperno
- Division of Radiation Oncology; European Institute of Oncology; Milan Italy
| | - Annamaria Ferrari
- Division of Radiation Oncology; European Institute of Oncology; Milan Italy
| | - Maria Alessia Zerella
- Department of Oncology and Hemato-oncology; University of Milan; Milan Italy
- Division of Radiation Oncology; European Institute of Oncology; Milan Italy
| | - Simona Arculeo
- Department of Oncology and Hemato-oncology; University of Milan; Milan Italy
- Division of Radiation Oncology; European Institute of Oncology; Milan Italy
| | - Claudia Maria Francia
- Department of Oncology and Hemato-oncology; University of Milan; Milan Italy
- Division of Radiation Oncology; European Institute of Oncology; Milan Italy
| | - Daniela Sibio
- Department of Oncology and Hemato-oncology; University of Milan; Milan Italy
- Division of Radiation Oncology; European Institute of Oncology; Milan Italy
| | - Federica Cattani
- Unit of Medical Physics; European Institute of Oncology; Milan Italy
| | - Filippo De Marinis
- Division of Thoracic Oncology; European Institute of Oncology; Milan Italy
| | - Lorenzo Spaggiari
- Department of Oncology and Hemato-oncology; University of Milan; Milan Italy
- Division of Thoracic Oncology; European Institute of Oncology; Milan Italy
| | - Roberto Orecchia
- Scientific Directorate; European Institute of Oncology; Milan Italy
- Department of Medical Imaging and Radiation Sciences; European Institute of Oncology; Milan Italy
| | - Marco Riboldi
- Dipartimento di Elettronica Informazione e Bioingegneria; Politecnico di Milano; Milan Italy
| | - Guido Baroni
- Dipartimento di Elettronica Informazione e Bioingegneria; Politecnico di Milano; Milan Italy
- Bioengineering Unit; Centro Nazionale di Adroterapia Oncologica (CNAO); Pavia Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology; European Institute of Oncology; Milan Italy
- Department of Oncology and Hemato-oncology; University of Milan; Milan Italy
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26
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Ferrari A, Ivaldi G, Leonardi MC, Rondi E, Orecchia R. Prone Breast Radiotherapy in a Patient with Early Stage Breast Cancer and a Large Pendulous Breast. Tumori 2018; 95:394-7. [DOI: 10.1177/030089160909500323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In women with large and pendulous breasts postoperative radiotherapy in the supine position could represent a technical challenge because of the resulting dose inhomogeneity and the large amount of lung and heart receiving a high percentage of the prescribed dose. Breast-conserving surgery is therefore relatively contraindicated in these patients. Alternative positions for radiation therapy treatment have been proposed, and prone breast irradiation in particular has been recognized as a useful alternative to conventional treatment in the supine position. We report the case of a large-breasted patient treated in prone position in our radiation therapy division.
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Affiliation(s)
- Annamaria Ferrari
- Radiation Oncology Department, European Institute of Oncology, Milan, Italy
| | - Giovanni Ivaldi
- Radiation Oncology Department, European Institute of Oncology, Milan, Italy
| | | | - Elena Rondi
- Medical Physics Department, European Institute of Oncology, Milan, Italy
| | - Roberto Orecchia
- Radiation Oncology Department, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
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27
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Alterio D, Ansarin M, Jereczek-Fossa BA, Zorzi S, Santoro L, Zerini D, Massaro M, Rondi E, Ferrario S, Piperno G, Rocca MC, Griseri M, Preda L, Chiesa F, Orecchia R. What is the price of functional surgical organ preservation in local-regionally advanced supraglottic cancer? Long-term outcome for partial laryngectomy followed by radiotherapy in 32 patients. Tumori 2018; 99:667-75. [DOI: 10.1177/030089161309900605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background To achieve the goal of organ preservation, both a chemoradiotherapy and a conservative surgical approach can be proposed. The aim of the study was to review all patients treated in our Institute with conservative surgery and postoperative radiotherapy for locally advanced supraglottic tumor. Methods and study design A retrospective analysis of 32 patients treated between 2000 and 2010 was performed. Overall survival, disease-free survival and late laryngeal toxicity were evaluated. The impact of surgical procedures, radiotherapy characteristics and addition of chemotherapy on late laryngeal toxicity was studied. Results The median follow-up was 38 months. Overall survival and disease-free survival at 5 years were 73% and 66%, respectively. Three (9%) patients experienced local recurrence (after 22, 25 and 40 months, respectively) and were treated with total laryngectomy. The larynx preservation rate was 93%. Severe treatment-related late laryngeal toxicity (grade 3 and 4 laryngeal edema, laryngeal stenosis, presence of tracheotomy at last follow-up because of treatment-related toxicity, and the need for enteral nutrition) was experienced by 34% of patients. The functional larynx preservation rate was 81%. The statistically significant risk factors for severe late toxicity were: female gender, extension of the surgical procedure, removal of one arytenoid and association with concomitant chemotherapy. Conclusions We confirmed literature data on the feasibility and efficacy of a surgical organ preservation strategy. However, the high incidence of severe late toxicity requires further studies to improve patient selection and to reduce side effects.
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Affiliation(s)
- Daniela Alterio
- Division of Radiotherapy, European Institute of Oncology, Milan
| | - Mohssen Ansarin
- Department of Head and Neck Surgery, European Institute of Oncology, Milan
| | | | - Stefano Zorzi
- Department of Head and Neck Surgery, European Institute of Oncology, Milan
| | - Luigi Santoro
- Department of Experimental Oncology, European Institute of Oncology, Milan
| | - Dario Zerini
- Division of Radiotherapy, European Institute of Oncology, Milan
| | - Mariangela Massaro
- Department of Head and Neck Surgery, European Institute of Oncology, Milan
| | - Elena Rondi
- Department of Medical Physics, European Institute of Oncology, Milan
| | - Silvia Ferrario
- Division of Radiotherapy, European Institute of Oncology, Milan
- University of Milan, Milan
| | - Gaia Piperno
- Division of Radiotherapy, European Institute of Oncology, Milan
| | | | - Mara Griseri
- Division of Radiotherapy, European Institute of Oncology, Milan
- University of Milan, Milan
| | - Lorenzo Preda
- Division of Radiology, European Institute of Oncology, Milan
| | - Fausto Chiesa
- Department of Head and Neck Surgery, European Institute of Oncology, Milan
| | - Roberto Orecchia
- Division of Radiotherapy, European Institute of Oncology, Milan
- University of Milan, Milan
- National Center for Oncological Hadrontherapy, Pavia, Italy
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28
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Orecchia R, Jereczek-Fossa BA, Rondi E, Bossi-Zanetti I, Meaglia I, Luraschi R, Leonardi MC, Rotmensz N, Botteri E, Fodor C, Cecconi A, Morra A, Lazzari R, Ferrari A, Cattani F, Galimberti V, Luini A, Veronesi P, Zurrida S, Magrini S, Doerr W, Humble N, Trott KR, Ottolenghi A, Smyth V, Veronesi U. Second Malignancies following Breast Cancer Treatment: A Case-Control Study Based on the Peridose Methodology. ALLEGRO Project (Task 5.4). Tumori 2018; 98:715-21. [DOI: 10.1177/030089161209800607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Aims and background To calculate peripheral radiation dose to the second primary site in patients who have developed a second malignancy after breast cancer radiotherapy (index cases) and to compare it with dose in the analogous anatomical site in radiotherapy-treated breast cancer patients who did not experience a second malignancy (controls). To evaluate the feasibility of Peridose-software peripheral dose calculation in retrospective case-control studies. Material and study design A case-control study on 12,630 patients who underwent adjuvant breast radiotherapy was performed. Minimum 5-year follow-up was required. Each index case was matched with 5 controls by 1) year of birth, 2) year of radiotherapy and 3) follow-up duration. Peridose-software was used to calculate peripheral dose. Results 195 second cancers were registered (0.019% of all patients treated with adjuvant irradiation). Several methodological limitations of the Peridose calculation were encountered including impossibility to calculate the peripheral dose in the patients treated with intraoperative or external electron beam radiotherapy, in case of second tumors located at <15 cm from the radiotherapy field etc. Moreover, Peridose requires full radiotherapy data and the distance between radiotherapy field and second primary site. Due to these intrinsic limitations, only 6 index cases were eligible for dose calculation. Calculated doses at the second cancer site in index cases and in an analogous site in controls ranged between 7.5 and 145 cGy. The mean index-control dose difference was −3.15 cGy (range, −15.8 cGy and +2.7 cGy). Conclusions The calculated peripheral doses were low and the index-control differences were small. However, the small number of eligible patients precludes a reliable analysis of a potential dose-response relationship. Large patient series followed for a long period and further improvement in the methodology of the peripheral dose calculation are necessary in order to overcome the methodological challenges of the study.
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Affiliation(s)
- Roberto Orecchia
- Department of Radiation Oncology, European Institute of Oncology, Milan
- University of Milan, Milan
| | - Barbara A Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology, Milan
- University of Milan, Milan
| | - Elena Rondi
- Department of Medical Physics, European Institute of Oncology, Milan
| | - Isa Bossi-Zanetti
- Department of Radiation Oncology, European Institute of Oncology, Milan
- University of Milan, Milan
| | - Ilaria Meaglia
- Department of Radiation Oncology, European Institute of Oncology, Milan
| | - Rosa Luraschi
- Department of Medical Physics, European Institute of Oncology, Milan
| | | | - Nicole Rotmensz
- Department of Epidemiology and Biostatistics, European Institute of Oncology, Milan
| | - Edoardo Botteri
- Department of Epidemiology and Biostatistics, European Institute of Oncology, Milan
| | - Cristiana Fodor
- Department of Radiation Oncology, European Institute of Oncology, Milan
| | - Agnese Cecconi
- Department of Radiation Oncology, European Institute of Oncology, Milan
| | - Anna Morra
- Department of Radiation Oncology, European Institute of Oncology, Milan
| | - Roberta Lazzari
- Department of Radiation Oncology, European Institute of Oncology, Milan
| | - Annamaria Ferrari
- Department of Radiation Oncology, European Institute of Oncology, Milan
| | - Federica Cattani
- Department of Medical Physics, European Institute of Oncology, Milan
| | | | - Alberto Luini
- Department of Senology, European Institute of Oncology, Milan
| | - Paolo Veronesi
- Department of Senology, European Institute of Oncology, Milan
- University of Milan, Milan
| | - Stefano Zurrida
- Department of Senology, European Institute of Oncology, Milan
- University of Milan, Milan
| | | | - Wolfgang Doerr
- Technische Universität Dresden, Medizinische Fakultät Carl Gustav Carus, Klinik für Strahlentherapie und Radioonkologie, Dresden, Germany
- Dept of Radiation Oncology & Christian Doppler Laboratory for Medical Radiation Research in Radiooncology, Medical University, Vienna, Austria
| | - Nicole Humble
- Department of Radiation Oncology, University Hospital, Ulm, Germany
| | - Klaus R Trott
- University College of London, Cancer Institute, London, UK
- Physics Dept, University of Pavia, Pavia, Italy
| | | | - Vere Smyth
- Physics Dept, University of Pavia, Pavia, Italy
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29
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Leonardi M, Cecconi A, Luraschi R, Rondi E, Cattani F, Lazzari R, Morra A, Soto S, Zanagnolo V, Galimberti V, Gentilini O, Peccatori F, Jereczek-Fossa B, Orecchia R. Electron Beam Intraoperative Radiotherapy (ELIOT) in Pregnant Women with Breast Cancer: From in Vivo Dosimetry to Clinical Practice. Breast Care (Basel) 2017; 12:396-400. [PMID: 29456472 PMCID: PMC5803713 DOI: 10.1159/000479862] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aim of this study was to confirm our preliminary results with in vivo dosimetry in non-pregnant breast cancer patients receiving electron beam intraoperative radiotherapy (ELIOT) and to report on the first treatment in a pregnant woman. PATIENTS AND METHODS Following our previous experience, 5 non-pregnant patients receiving ELIOT to the tumor bed after breast-conserving surgery (BCS) were studied with thermoluminescent dosimeters positioned in the subdiaphragmatic region, within the uterus, and in the ovarian region. In December 2011, the first pregnant breast cancer patient underwent BCS and ELIOT (21 Gy at 90% isodose) during the 15th week of gestation. RESULTS The mean dose to the subdiaphragmatic external region in the 5 non-pregnant patients was 5.57 mGy, while pelvic measurements were below 1 mGy. The actual dosimetry of the pregnant patient showed a mean subdiaphragmatic dose of 4.34 mGy, a mean suprapubic dose of 1.64 mGy, and mean ovarian doses of 1.48 mGy (right-sided) and 1.44 mGy (left-sided). The expected dose to the fetus was estimated as 0.84 mGy (0.004% of the prescribed dose). CONCLUSION ELIOT as an anticipated boost to the breast could be considered in pregnant women in the early second trimester, postponing whole-breast irradiation after delivery.
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Affiliation(s)
- Maria Leonardi
- Advanced Radiotherapy Center, European Institute of Oncology, Milan, Italy
| | - Agnese Cecconi
- Scientific Direction, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
| | - Rosa Luraschi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Elena Rondi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Roberta Lazzari
- Advanced Radiotherapy Center, European Institute of Oncology, Milan, Italy
| | - Anna Morra
- Advanced Radiotherapy Center, European Institute of Oncology, Milan, Italy
| | - Santos Soto
- Medica Sur Hospital Breast Center, Mexico City, Mexico
| | - Vanna Zanagnolo
- Gynecologic Cancer Surgery, European Institute of Oncology, Milan, Italy
| | | | - Oreste Gentilini
- Breast Cancer Surgery, European Institute of Oncology, Milan, Italy
- Current address: Breast Surgery Unit, San Raffaele University Hospital, Milan, Italy
| | - Fedro Peccatori
- Fertility and Procreation Unit, European Institute of Oncology, Milan, Italy
| | - Barbara Jereczek-Fossa
- Advanced Radiotherapy Center, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
| | - Roberto Orecchia
- Scientific Direction, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
- National Center of Oncology Hadrontherapy (CNAO foundation), Pavia, Italy
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30
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Alterio D, Gerardi MA, Cella L, Spoto R, Zurlo V, Sabbatini A, Fodor C, D'Avino V, Conson M, Valoriani F, Ciardo D, Pacelli R, Ferrari A, Maisonneuve P, Preda L, Bruschini R, Cossu Rocca M, Rondi E, Colangione S, Palma G, Dicuonzo S, Orecchia R, Sanguineti G, Jereczek-Fossa BA. Radiation-induced acute dysphagia : Prospective observational study on 42 head and neck cancer patients. Strahlenther Onkol 2017; 193:971-981. [PMID: 28884310 DOI: 10.1007/s00066-017-1206-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 05/05/2017] [Accepted: 08/17/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Acute toxicity in head and neck (H&N) cancer patients treated with definitive radiotherapy (RT) has a crucial role in compliance to treatments. The aim of this study was to correlate doses to swallowing-associated structures and acute dysphagia. METHODS We prospectively analyzed 42 H&N cancer patients treated with RT. Dysphagia (grade ≥ 3) and indication for percutaneous endoscopic gastrostomy (PEG) insertion were classified as acute toxicity. Ten swallowing-related structures were considered for the dosimetric analysis. The correlation between clinical information and the dose absorbed by the contoured structures was analyzed. Multivariate logistic regression method using resampling methods (bootstrapping) was applied to select model order and parameters for normal tissue complication probability (NTCP) modelling. RESULTS A strong multiple correlation between dosimetric parameters was found. A two-variable model was suggested as the optimal order by bootstrap method. The optimal model (Rs = 0.452, p < 0.001) includes V45 of the cervical esophagus (odds ratio [OR] = 1.016) and Dmean of the cricopharyngeal muscle (OR = 1.057). The model area under the curve was 0.82 (95% confidence interval 0.69-0.95). CONCLUSION Our results suggested that the absorbed dose to the cricopharyngeal muscle and cervical esophagus might play a relevant role in the development of acute RT-related dysphagia.
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Affiliation(s)
- D Alterio
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
| | - M A Gerardi
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - L Cella
- Institute of Biostructures and Bioimaging, National Research Council (CNR), Naples, Italy
| | - R Spoto
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - V Zurlo
- Division of Head and Neck Surgery, European Institute of Oncology, Milan, Italy
| | - A Sabbatini
- Dietetic and Clinical Nutrition Unit, European Institute of Oncology, Milan, Italy
| | - C Fodor
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - V D'Avino
- Institute of Biostructures and Bioimaging, National Research Council (CNR), Naples, Italy
| | - M Conson
- Institute of Biostructures and Bioimaging, National Research Council (CNR), Naples, Italy
| | - F Valoriani
- Dietetic and Clinical Nutrition Unit, European Institute of Oncology, Milan, Italy
| | - D Ciardo
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - R Pacelli
- Institute of Biostructures and Bioimaging, National Research Council (CNR), Naples, Italy.,Department of Advanced Biomedical Sciences, Federico II University School of Medicine, Naples, Italy
| | - A Ferrari
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - P Maisonneuve
- Department of Epidemiology and Statistics, European Institute of Oncology, Milan, Italy
| | - L Preda
- Department of Radiology, European Institute of Oncology, Milan, Italy
| | - R Bruschini
- Division of Head and Neck Surgery, European Institute of Oncology, Milan, Italy
| | - M Cossu Rocca
- Division of Urogenital and Head and Neck Tumors, Department of Medical Oncology, European Institute of Oncology, Milan, Italy
| | - E Rondi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - S Colangione
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - G Palma
- Institute of Biostructures and Bioimaging, National Research Council (CNR), Naples, Italy
| | - S Dicuonzo
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - R Orecchia
- Scientific Directorate, European Institute of Oncology, Milan, Italy
| | | | - B A Jereczek-Fossa
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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31
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Ciardo D, Jereczek-Fossa BA, Petralia G, Timon G, Zerini D, Cambria R, Rondi E, Cattani F, Bazani A, Ricotti R, Garioni M, Maestri D, Marvaso G, Romanelli P, Riboldi M, Baroni G, Orecchia R. Multimodal image registration for the identification of dominant intraprostatic lesion in high-precision radiotherapy treatments. Br J Radiol 2017; 90:20170021. [PMID: 28830203 DOI: 10.1259/bjr.20170021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE The integration of CT and multiparametric MRI (mpMRI) is a challenging task in high-precision radiotherapy for prostate cancer. A simple methodology for multimodal deformable image registration (DIR) of prostate cancer patients is presented. METHODS CT and mpMRI of 10 patients were considered. Organs at risk and prostate were contoured on both scans. The dominant intraprostatic lesion was additionally delineated on MRI. After a preliminary rigid image registration, the voxel intensity of all the segmented structures in both scans except the prostate was increased by a specific amount (a constant additional value, A), in order to enhance the contrast of the main organs influencing its position and shape. 70 couples of scans were obtained by varying A from 0 to 800 and they were subsequently non-rigidly registered. Quantities derived from image analysis and contour statistics were considered for the tuning of the best performing A. RESULTS A = 200 resulted the minimum enhancement value required to obtain statistically significant superior registration results. Mean centre of mass distance between corresponding structures decreases from 7.4 mm in rigid registration to 5.3 mm in DIR without enhancement (DIR-0) and to 2.7 mm in DIR with A = 200 (DIR-200). Mean contour distance was 2.5, 1.9 and 0.67 mm in rigid registration, DIR-0 and DIR-200, respectively. In DIR-200 mean contours overlap increases of +13 and +24% with respect to DIR-0 and rigid registration, respectively. CONCLUSION Contour propagation according to the vector field resulting from DIR-200 allows the delineation of dominant intraprostatic lesion on CT scan and its use for high-precision radiotherapy treatment planning. Advances in knowledge: We investigated the application of a B-spline, mutual information-based multimodal DIR coupled with a simple, patient-unspecific but efficient contrast enhancement procedure in the pelvic body area, thus obtaining a robust and accurate methodology to transfer the functional information deriving from mpMRI onto a planning CT reference volume.
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Affiliation(s)
- Delia Ciardo
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.,2 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Giuseppe Petralia
- 3 Division of Radiology, European Institute of Oncology, Milan, Italy
| | - Giorgia Timon
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Dario Zerini
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Raffaella Cambria
- 4 Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Elena Rondi
- 4 Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Federica Cattani
- 4 Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Alessia Bazani
- 4 Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Rosalinda Ricotti
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Maria Garioni
- 4 Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Davide Maestri
- 4 Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Giulia Marvaso
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Paola Romanelli
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Marco Riboldi
- 5 Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Guido Baroni
- 5 Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.,6 Bioengineering Unit, Centro Nazionale di Adroterapia Oncologica (CNAO Foundation), Pave, Italy
| | - Roberto Orecchia
- 2 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,7 Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Milan, Italy
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Russo S, Masi L, Dicarolo P, Doro R, De Martin E, Fumagalli M, Martinotti A, Bergantin A, Rondi E, Vigorito S, Mancosu P. PO-0778: New Razor silicon diode for Cyber Knife small beam relative dosimetry: a multi-site evaluation. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31215-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: 10/19/2022]
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Riva G, Augugliaro M, Piperno G, Ferrari A, Rondi E, Vigorito S, Orecchia R, Jereczek-Fossa B. EP-1395: CyberKnife treatment of intraorbital metastases: a single center experience on 24 lesions. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31830-3] [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: 11/17/2022]
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Alterio D, Gerardi M, Cella L, D’Avino V, Palma G, Ciardo D, Rondi E, Ferrari A, Muto M, Spoto R, Pacelli R, Orecchia R, Jereczek B. EP-1077: Predictive modeling for radiation-induced acute dysphagia in head and neck cancer patients. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31513-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: 11/17/2022]
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Jereczek-Fossa BA, Fanetti G, Fodor C, Ciardo D, Santoro L, Francia CM, Muto M, Surgo A, Zerini D, Marvaso G, Timon G, Romanelli P, Rondi E, Comi S, Cattani F, Golino F, Mazza S, Matei DV, Ferro M, Musi G, Nolè F, de Cobelli O, Ost P, Orecchia R. Salvage Stereotactic Body Radiotherapy for Isolated Lymph Node Recurrent Prostate Cancer: Single Institution Series of 94 Consecutive Patients and 124 Lymph Nodes. Clin Genitourin Cancer 2017; 15:e623-e632. [PMID: 28185875 DOI: 10.1016/j.clgc.2017.01.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/23/2016] [Accepted: 01/03/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND The purpose of the study was to evaluate the prostate serum antigen (PSA) response, local control, progression-free survival (PFS), and toxicity of stereotactic body radiotherapy (SBRT) for lymph node (LN) oligorecurrent prostate cancer. PATIENTS AND METHODS Between May 2012 and October 2015, 124 lesions were treated in 94 patients with a median dose of 24 Gy in 3 fractions. Seventy patients were treated for a single lesion and 25 for > 1 lesion. In 34 patients androgen deprivation (AD) was combined with SBRT. We evaluated biochemical response according to PSA level every 3 months after SBRT: a 3-month PSA decrease from pre-SBRT PSA of more than 10% identified responder patients. In case of PSA level increase, imaging was performed to evaluate clinical progression. Toxicity was assessed every 6 to 9 months after SBRT. RESULTS Median follow-up was 18.5 months. In 13 patients (14%) Grade 1 to 2 toxicity was reported without any Grade 3 to 4 toxicity. Biochemical response, stabilization, and progression were observed in 64 (68%), 10 (11%), and 20 (21%) of 94 evaluable patients. Clinical progression was observed in 31 patients (33%) after a median time of 8.1 months. In-field progression occurred in 12 lesions (9.7%). Two-year local control and PFS rates were 84% and 30%, respectively. Age older than 75 years correlated with better biochemical response rate. Age older than 75 years, concomitant AD administered up to 12 months, and pelvic LN involvement correlated with longer PFS. CONCLUSION SBRT is safe and offers good in-field control. At 2 years after SBRT, 1 of 3 patients is progression-free. Further investigation is warranted to identify patients who benefit most from SBRT and to define the optimal combination with AD.
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Affiliation(s)
- Barbara Alicja Jereczek-Fossa
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Giuseppe Fanetti
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
| | - Cristiana Fodor
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Delia Ciardo
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Luigi Santoro
- Department of Epidemiology and Statistics, European Institute of Oncology, Milan, Italy
| | - Claudia Maria Francia
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Matteo Muto
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Alessia Surgo
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Dario Zerini
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Giulia Marvaso
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Giorgia Timon
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Paola Romanelli
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Elena Rondi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Stefania Comi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Federica Golino
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Stefano Mazza
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | | | - Matteo Ferro
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Franco Nolè
- Division of Urogenital and Head and Neck Tumours, Department of Medical Oncology, European Institute of Oncology, Milan, Italy
| | | | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Roberto Orecchia
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Scientific Directorate, European Institute of Oncology, Milan, Italy
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Mastella E, Vigorito S, Rondi E, Piperno G, Ferrari A, Strata E, Rozza D, Jereczek-Fossa BA, Cattani F. Validation of a pretreatment delivery quality assurance method for the CyberKnife Synchrony system. Med Phys 2016; 43:4565. [DOI: 10.1118/1.4955437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Russo S, Masi L, Bergantin A, De Martin E, Doro R, Frassanito C, Fumagalli M, Martinotti A, Rondi E, Vigorito S, Mancosu P. EP-1580: CyberKnife multi-site small beam dosimetry with a new plastic scintillator detector. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32830-4] [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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38
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Luraschi R, Lazzari R, Galimberti V, Bazani A, Rondi E, Leonardi M, Corso G, Colombo N, Jereczek-Fossa B, Cattani F. EP-1596: Intraoperative radiotherapy with electrons in breast cancer patients with cardiac devices. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32846-8] [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: 10/21/2022]
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Mastella E, Vigorito S, Rondi E, Piperno G, Ferrari A, Strata E, Rozza D, Jereczek-Fossa B, Cattani F. PO-0803: Validation of a pre-treatment delivery quality assurance method for the CyberKnife Synchrony System. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32053-9] [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: 10/21/2022]
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40
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Cecconi A, Piperno G, Ferrari A, Rondi E, Vigorito S, Zerini D, Cattani F, Nolè F, De Cobelli O, Jereczek-Fossa B, Orecchia R. EP-1389: Stereotactic radiotherapy for oligometastatic patients with renal cell carcinoma. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32639-1] [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: 11/17/2022]
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41
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Masi L, Russo S, Demartin E, Doro R, Frassanito C, Fumagalli M, Marinelli M, Martinotti A, Pimpinella M, Verona-Rinati G, Rondi E, Vigorito S, Vite C, Mancosu P. CyberKnife beam output factor measurements: A multi-site, multi-detector study. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.149] [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: 11/26/2022] Open
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42
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Mastella E, Vigorito S, Rondi E, Piperno G, Ferrari A, Strata E, Rozza D, Jereczek-Fossa B, Cattani F. Verification of the geometric and dosimetric accuracy of the CyberKnife synchrony system. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.150] [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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43
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Bazani A, Pansini F, Garibaldi C, Comi S, Rondi E, Piperno G, Ferrari A, Jereczek-Fossa B, Cattani F. A comparison between different patient QA devices for IMRT treatments on VERO system. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.012] [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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Cremonesi M, Alterio D, Garibaldi C, Ferrari A, Botta F, Ferrari M, Vigorito S, Rondi E, Cattani F, Rocca MC, Strigari L, Pedicini P, Jereczek-Fosa B, Orecchia R. Combined RT and epidermal growth factor receptor inhibitor monoclonal antibody-MoAb-EGFr treatment of head and neck cancer (HNC): Radiobiological model for FAMOSO. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.055] [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: 11/25/2022] Open
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Ciardo D, Alterio D, Jereczek-Fossa BA, Riboldi M, Zerini D, Santoro L, Preve E, Rondi E, Comi S, Serafini F, Laudati A, Ansarin M, Preda L, Baroni G, Orecchia R. Set-up errors in head and neck cancer patients treated with intensity modulated radiation therapy: Quantitative comparison between three-dimensional cone-beam CT and two-dimensional kilovoltage images. Phys Med 2015; 31:1015-1021. [PMID: 26459318 DOI: 10.1016/j.ejmp.2015.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 05/11/2015] [Revised: 07/13/2015] [Accepted: 08/01/2015] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To compare the patient set-up error detection capabilities of three-dimensional cone beam computed tomography (3D-CBCT) and two-dimensional orthogonal kilovoltage (2D-kV) techniques. METHODS 3D-CBCT and 2D-kV projections were acquired on 29 head-and-neck (H&N) patients undergoing Intensity Modulated Radiotherapy (IMRT) on the first day of treatment (time 0) and after the delivery of 40 Gy and 50 Gy. Set-up correction vectors were analyzed after fully automatic image registration as well as after revision by radiation oncologists. The dosimetric effects of the different sensitivities of the two image guidance techniques were assessed. RESULTS A statistically significant correlation among detected set-up deviations by the two techniques was found along anatomical axes (0.60 < ρ < 0.72, p < 0.0001); no correlation was found for table rotation (p = 0.41). No evidence of statistically significant differences between the indications provided along the course of the treatment was found; this was also the case when full automatic versus manually refined correction vectors were compared. The dosimetric effects analysis revealed slight statistically significant differences in the median values of the maximum relative dose to mandible, spinal cord and its 5 mm Planning Organ at Risk Volume (0.95%, 0.6% and 2.45%, respectively), with higher values (p < 0.01) observed when 2D-kV corrections were applied. CONCLUSION A similar sensitivity to linear set-up errors was observed for 2D-kV and 3D-CBCT image guidance techniques in our H&N patient cohort. Higher rotational deviations around the table vertical axis were detected by the 3D-CBCT with respect to the 2D-kV method, leading to a consistent better sparing of organs at risk.
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Affiliation(s)
- Delia Ciardo
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy.
| | - Daniela Alterio
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy; Department of Health Sciences, University of Milan, via Festa del Perdono 7, Milano 20122, Italy
| | - Marco Riboldi
- Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano, Italy; Centro Nazionale di Adroterapia Oncologica (CNAO), Strada Campeggi 53, Pavia 27100, Italy
| | - Dario Zerini
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy
| | - Luigi Santoro
- Division of Epidemiology and Biostatistics, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
| | - Eleonora Preve
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy
| | - Elena Rondi
- Unit of Medical Physics, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
| | - Stefania Comi
- Unit of Medical Physics, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
| | - Flavia Serafini
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy
| | - Antonio Laudati
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy
| | - Mohssen Ansarin
- Division of Head and Neck Surgery, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
| | - Lorenzo Preda
- Department of Radiology, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
| | - Guido Baroni
- Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano, Italy; Centro Nazionale di Adroterapia Oncologica (CNAO), Strada Campeggi 53, Pavia 27100, Italy
| | - Roberto Orecchia
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy; Department of Health Sciences, University of Milan, via Festa del Perdono 7, Milano 20122, Italy
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Masi L, Russo S, De Martin E, Frassanito C, Fumagalli M, Martinotti A, Rondi E, Vigorito S, Vite C, Redaelli I, Marino C, Fiandra C, Clemente S, Strigari L, Esposito M, Giglioli F, Stasi M, Begnozzi L, Verona Rinati G, Marinelli M, Pimpinella M, Mancosu P. PO-0839: Synthetic diamond detector for CyberKnife beam output measurements: a multi-site study. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40831-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: 11/26/2022]
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Bazani A, Pansini F, Garibaldi C, Rondi E, Cattani F, Piperno G, Ferrari A, Orecchia R. EP-1389: Comparison of two PTW 2-D arrays for step and shoot IMRT QA with VEROÆ system. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41381-7] [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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Alterio D, Ansarin M, Jereczek-Fossa BA, Zorzi S, Santoro L, Zerini D, Massaro M, Rondi E, Ferrario S, Piperno G, Cossu Rocca M, Griseri M, Preda L, Chiesa F, Orecchia R. What is the price of functional surgical organ preservation in local-regionally advanced supraglottic cancer? Long-term outcome for partial laryngectomy followed by radiotherapy in 32 patients. Tumori 2014. [PMID: 24503789 DOI: 10.1700/1390.15454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND BACKGROUND To achieve the goal of organ preservation, both a chemoradiotherapy and a conservative surgical approach can be proposed. The aim of the study was to review all patients treated in our Institute with conservative surgery and postoperative radiotherapy for locally advanced supraglottic tumor. METHODS AND STUDY DESIGN A retrospective analysis of 32 patients treated between 2000 and 2010 was performed. Overall survival, disease-free survival and late laryngeal toxicity were evaluated. The impact of surgical procedures, radiotherapy characteristics and addition of chemotherapy on late laryngeal toxicity was studied. RESULTS The median follow-up was 38 months. Overall survival and disease-free survival at 5 years were 73% and 66%, respectively. Three (9%) patients experienced local recurrence (after 22, 25 and 40 months, respectively) and were treated with total laryngectomy. The larynx preservation rate was 93%. Severe treatment-related late laryngeal toxicity (grade 3 and 4 laryngeal edema, laryngeal stenosis, presence of tracheotomy at last follow-up because of treatment-related toxicity, and the need for enteral nutrition) was experienced by 34% of patients. The functional larynx preservation rate was 81%. The statistically significant risk factors for severe late toxicity were: female gender, extension of the surgical procedure, removal of one arytenoid and association with concomitant chemotherapy. CONCLUSIONS We confirmed literature data on the feasibility and efficacy of a surgical organ preservation strategy. However, the high incidence of severe late toxicity requires further studies to improve patient selection and to reduce side effects.
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Ciardo D, Jereczek-Fossa B, Zerini D, Petralia G, Cambria R, Rondi E, Cattani F, Fodor C, Baroni G, Orecchia R. EP-1695: Multimodal image registration to identify the dominant intraprostatic lesion in radiotherapy - AIRC grant IG 13218. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31813-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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50
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Rondi E, Vigorito S, Bazani A, Mastella E, Russo S, Piperno G, Ferrari A, Rozza D, Castellini F, Orecchia R. EP-1162: Validation of a pre treatment specific patient QA method for Cyberknife. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33468-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: 12/01/2022]
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