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Del Re M, Luculli GI, Petrini I, Sbrana A, Scotti V, Perez DDM, Livi L, Crucitta S, Iannopollo M, Mazzoni F, Ruglioni M, Tibaldi C, Olmetto E, Stasi I, Baldini E, Allegrini G, Antonuzzo L, Morelli F, Pierini A, Panzeri N, Fogli S, Chella A, Rolfo C, Danesi R. Clinical utility of Next Generation Sequencing of plasma cell-free DNA for the molecular profiling of patients with NSCLC at diagnosis and disease progression. Transl Oncol 2024; 41:101869. [PMID: 38290249 PMCID: PMC10859238 DOI: 10.1016/j.tranon.2023.101869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/17/2023] [Accepted: 12/15/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND The present study evaluates the utility of NGS analysis of circulating free DNA (cfDNA), which incorporates small amounts of tumor DNA (ctDNA), at diagnosis or at disease progression (PD) in NSCLC patients. METHODS Comprehensive genomic profiling on cfDNA by NGS were performed in NSCLC patients at diagnosis (if tissue was unavailable/insufficient) or at PD to investigate potential druggable molecular aberrations. Blood samples were collected as routinary diagnostic procedures, DNA was extracted, and the NextSeq 550 Illumina platform was used to run the Roche Avenio ctDNA Expanded Kit for molecular analyses. Gene variants were classified accordingly to the ESCAT score. RESULTS A total of 106 patients were included in this study; 44 % of cases were requested because of tissue unavailability at the diagnosis and 56 % were requested at the PD. At least one driver alteration was observed in 62 % of cases at diagnosis. Driver druggable variants classified as ESCAT level I were detected in 34 % of patients, including ALK-EML4, ROS1-CD74, EGFR, BRAF, KRAS p.G12C, PI3KCA. In the PD group, most patients were EGFR-positive, progressing to a first line-therapy. Sixty-three percent of patients had at least one driver alteration detected in blood and 17 % of patients had a known biological mechanism of resistance allowing further therapeutic decisions. CONCLUSIONS The present study confirms the potential of liquid biopsy to detect tumour molecular heterogeneity in NSCLC patients at the diagnosis and at PD, demonstrating that a significant number of druggable mutations and mechanisms of resistance can be detected by NGS analysis on ctDNA.
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Affiliation(s)
- Marzia Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; Thoracic Oncology Center, Tisch Cancer Center, Mount Sinai Hospital System & Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Giovanna Irene Luculli
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Iacopo Petrini
- Unit of Pneumology, Department of Translational Research and New Technologies in Medicine, University Hospital of Pisa, Pisa, Italy
| | - Andrea Sbrana
- Unit of Pneumology, Department of Translational Research and New Technologies in Medicine, University Hospital of Pisa, Pisa, Italy
| | - Vieri Scotti
- Radiation Oncology Unit, Oncology Department, AOU Careggi Firenze, Firenze, Italy
| | - Diego de Miguel Perez
- Thoracic Oncology Center, Tisch Cancer Center, Mount Sinai Hospital System & Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Stefania Crucitta
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mauro Iannopollo
- Oncology Department, Oncology Unit, San Jacopo Hospital, Pistoia, Italy
| | | | - Martina Ruglioni
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Emanuela Olmetto
- Radiation Oncology Unit, Oncology Department, AOU Careggi Firenze, Firenze, Italy
| | - Irene Stasi
- Department of Oncology, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | | | | | - Lorenzo Antonuzzo
- Medical Oncology, Careggi University Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Franco Morelli
- Medical Oncology Unit, Gemelli Hospital Molise, Campobasso, Italy
| | | | | | - Stefano Fogli
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonio Chella
- Unit of Pneumology, Department of Translational Research and New Technologies in Medicine, University Hospital of Pisa, Pisa, Italy
| | - Christian Rolfo
- Thoracic Oncology Center, Tisch Cancer Center, Mount Sinai Hospital System & Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Romano Danesi
- Department of Oncology and Hemato-Oncology, University of Milano, Via Festa del Perdono, 7, 20122 Milano, Italy.
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2
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Francolini G, Ghoshal A, Caini S, Piazzini T, Becherini C, Detti B, Di Cataldo V, Valzano M, Visani L, Salvestrini V, Olmetto E, Desideri I, Meattini I, Livi L. Quality of life after definitive treatment for bladder cancer: A systematic review and meta-analysis. Radiother Oncol 2024; 190:110038. [PMID: 38042498 DOI: 10.1016/j.radonc.2023.110038] [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: 09/15/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/04/2023]
Abstract
Radical cystectomy (RC) is considered the standard treatment for muscle invasive bladder cancer (MIBC). However, RC is often burdened by significant impact on quality of life (QoL); Continence preserving methods (e.g., continent cutaneous urinary diversion and orthotopic neobladder-ONB), have been proposed as alternatives to improve postoperative QoL. Trimodal therapy (TMT) emerged as alternative to surgery. To assess the impact of these treatments from the patients' perspective, we undertook a systematic review and meta-analysis of literature, focusing on studies reporting QoL data about each of the abovementioned approaches. A systematic review was carried out including all prospective and retrospective studies enrolling patientstreated with radical intent for non-metastatic MIBC from 1999 to 2021 (either RC or TMT). All studies included specifically reported QoL for one of the main treatment approaches explored (RC followed by ileal conduit urinary diversion-ICUD, ONB or TMT). Pooled analysis for EORTC QLQ-C30 and BLM-30 questionnaires showed that ONB yielded a significant advantage only for Physical Functioning (pooled mean standardized difference -0.73 SD, p-value 0.019, I 2 = 93 %) and for Emotional Functioning (pooled mean standardized difference -0.16 SD, p-value 0.029, I 2 = 0 %). A trend in favour of higher mean reported values after TMT for Global Health Score, Physical Functioning and Role Functioning was found, if compared to both RC approaches. Significant benefit for ONB if compared to ICUD was detected only for specific subdomains of QoL questionnaires. No direct comparison with TMT is available, but data suggest advantage of this approach when compared to both reconstructive scenarios.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy.
| | | | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Tessa Piazzini
- Biblioteca Biomedica, University of Florence, Florence, Italy
| | - Carlotta Becherini
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Marianna Valzano
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Luca Visani
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Florence, Italy
| | - Viola Salvestrini
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Florence, Italy
| | - Emanuela Olmetto
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
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3
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Francolini G, Carnevale MG, Di Cataldo V, Loi M, Detti B, Orsatti C, Caprara L, Bertini N, Lorenzetti V, Olmetto E, Becherini C, Visani L, Salvestrini V, Simontacchi G, Greto D, Bonomo P, Doro R, Masi L, Desideri I, Meattini I, Serni S, Livi L. Stereotactic reirradiation with Cyberknife R for locally recurrent prostate cancer, long-term toxicity and clinical outcomes from a monocentric cohort. Radiol Med 2023; 128:1580-1588. [PMID: 37728816 DOI: 10.1007/s11547-023-01721-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Up to 47% of patients with localized prostate cancer (PCa) treated with radiotherapy (EBRT) eventually develop local recurrence. To date, no clear consensus exists on optimal management. A growing body of interest supports the use of stereotaxic re-irradiation (rSBRT), with promising oncological outcomes and low toxicity profile. We collected a single-center case series of locally recurrent PCa who underwent re-irradiation after a previous course of postoperative or definitive radiotherapy. METHODS AND MATERIALS Data from 101 patients treated at our institution for locally recurrent PCa from June 2012 to June 2021 were retrospectively collected. Patients underwent rSBRT with CyberKnife system (Accuray Inc., Sunnyvale, CA, USA), delivered to intraprostatic or macroscopic recurrences within the prostate bed, for a total dose of 30 Gy in 5 fractions. RESULTS All patients received prior EBRT. The median EQD2 total dose was 75.0 Gy (range, 60-80 Gy). Thirty-two (32%) patients were receiving androgen deprivation therapy (ADT) after prior biochemical recurrence. After a median follow-up of 57.8 months, BR occurred in 55 patients (54.5%), with a median BR-free survival (BRFS) of 40.4 months (95% C.I. 34.3-58.3). Thirty-two patients (31.7%) developed metastatic disease, with a median metastasis-free survival (MFS) not reached. PSA ≥ 2.5 ng/ml and ADT were associated with worst BRFS (26.06 vs. 39.3 months, p = 0.03 and 22.7 vs. 27 months, p = 0.01, respectively). Castration-resistant status and ADT were found to be predictive of worst MFS (34.1 vs. 50.5 months, p = 0.02 and 33.5 vs. 53.1 months, p = 0.002, respectively). Concomitant ADT was confirmed as an independent factor for MFS (HR 4.8, 95% CI 1.5-10.6, p = 0.007). No grade > /2 adverse were recorded. CONCLUSIONS After almost 5 years of follow-up, with a median BRFS of 40.4 months and no grade ≥ 2 AEs, CyberknifeR rSBRT proved effective and safe in a cohort of 101 patients affected by locally recurrent PCa.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy.
| | - Maria Grazia Carnevale
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Mauro Loi
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Carolina Orsatti
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Luisa Caprara
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Niccolò Bertini
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Victoria Lorenzetti
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Emanuela Olmetto
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Carlotta Becherini
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Luca Visani
- CyberKnife Center, Istituto Fiorentino Di Cura E Assistenza (IFCA), Florence, Italy
| | - Viola Salvestrini
- CyberKnife Center, Istituto Fiorentino Di Cura E Assistenza (IFCA), Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Daniela Greto
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Pierluigi Bonomo
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Raffaela Doro
- CyberKnife Center, Istituto Fiorentino Di Cura E Assistenza (IFCA), Florence, Italy
| | - Laura Masi
- CyberKnife Center, Istituto Fiorentino Di Cura E Assistenza (IFCA), Florence, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, 50100, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50100, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
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4
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Catania C, Filippi AR, Sangalli C, Piperno G, Russano M, Greco C, Scotti V, Proto C, Bennati C, Di Pietro Paolo M, Platania A, Olmetto E, Agustoni F, Teodorani N, Agbaje V, Russo A. New options and open issues in the management of unresectable stage III and in early-stage NSCLC: A report from an expert panel of Italian medical and radiation oncologists - INTERACTION group. Crit Rev Oncol Hematol 2023; 190:104108. [PMID: 37633350 DOI: 10.1016/j.critrevonc.2023.104108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/22/2023] [Indexed: 08/28/2023] Open
Abstract
IMPORTANCE After the PACIFIC trial, concurrent chemo-radiotherapy followed by consolidation therapy with durvalumab for 1 year (limited to PD-L1 tumour proportion score ≥ 1% in the EMA region) is the firmly established standard of care treatment for unresectable NSCLC patients. Several relevant questions are emerging with the growing use of this approach, posing novel challenges in clinical practice. Treatment of oncogene-addicted NSCLCs, management of mediastinal disease recurrence after surgery and the optimal management of patients progressing during or after durvalumab are now some of the most clinically relevant issues. OBSERVATIONS Patients with unresectable NSCLC harbouring EGFR and HER2 mutations or ALK/ROS1/RET /NTRK1,2,3 rearrangements are unresponsive to immunotherapy. Importance of knowing the tumour genotyping (NGS, preferable DNA and RNA) from the earliest stages of NSCLC, also for the possible use of immunotherapy both in the adjuvant and perioperative setting. In case of mediastinal disease recurrence after surgery, re-biopsy is essential to re-determine the histological and biological characteristics of the disease and the distinction of recurrence in curable and non-curable disease is of pivotal important for the optimal management of subsequent treatments. CONCLUSIONS AND RELEVANCE Treatment of stage III NSCLC has always been controversial and challenging: Multidisciplinary approach is mandatory and defining resectability is a critical issue. Chemo-radiotherapy followed by maintenance Durvalumab is now the standard of treatment. Herein, we provide a comprehensive overview of the key challenges and open questions that we are currently facing in clinical practice, in unresectable stage III and in early-stage NSCLC, identifying the knowledge gaps and the possible solutions.
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Affiliation(s)
- Chiara Catania
- Unit of Thoracic Oncology, Gavazzeni Humanitas Bergamo, Via Gavazzeni 21, Bergamo, Milan, Italy.
| | - Andrea Riccardo Filippi
- Radiation Oncology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Claudia Sangalli
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gaia Piperno
- Division of Radiotherapy, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Marco Russano
- Medical Oncology Radiation, Campus Bio-Medico University, Rome
| | - Carlo Greco
- Radiation Oncology, Campus Bio-Medico University, Rome
| | - Vieri Scotti
- Radiation Therapy Unit, Department of Oncology, Careggi University Hospital, Firenze, Italy
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Chiara Bennati
- Oncology Unit, Ausl Romagna Ravenna, Emilia Romagna, Oncologia Medica Ravenna, Emilia Romagna, Italy
| | - Marzia Di Pietro Paolo
- Medical Oncology Unit, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | | | - Emanuela Olmetto
- Department of Radiation-Oncology, University of Florence, Firenze, Italy
| | - Francesco Agustoni
- Medical Oncology Department, Fondazione IRCCS Policlinico "San Matteo", Pavia, Italy
| | - Nazario Teodorani
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Vincenzo Agbaje
- Radiotherapy Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
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5
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Simontacchi G, Sparano C, Loi M, Mangoni M, Olmetto E, Garlatti P, Scoccimarro E, Frosini G, Bertini N, Morelli I, Romei A, Orsatti C, Pallotta S, Calusi S, Cataldo VD, Livi L. The Role of Stereotactic Radiotherapy in Deferring the Need for Systemic Therapies in Patients with Progressive Oligometastatic Iodine-Refractory Thyroid Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e626. [PMID: 37785871 DOI: 10.1016/j.ijrobp.2023.06.2015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Differentiated thyroid cancer (DTC) is usually associated with a good prognosis, although development of metastases in iodine-refractory patients adversely affects quality of life and survival. The advent of tyrosine-kinase inhibitors drugs (TKI) allowed for a significant improvement in patients' outcome: however, in case of oligometastatic disease, a locoregional ablative approach such as Stereotactic Radiation Therapy (SBRT) may be proposed. The aim of our study is to assess if SBRT in oligometastatic DTC patients could effectively control tumor progression and possibly defer the need of systemic therapies. MATERIALS/METHODS We retrospectively analyzed patients with differentiated oligometastatic iodine refractory thyroid cancer treated with SBRT in our Radiation Oncology Unit from 2011 to 2022. We collected demographics and treatment-related characteristics. Local Control (LC), Progression Free Survival (PFS), Overall Survival (OS) and the need for systemic therapy were evaluated. Patients with anaplastic histology, incomplete treatment or without follow-up information were excluded. RESULTS Twenty-two patients were included in our analysis, accounting for 63 tumors: 26 were located in bones (41,2%), 21 in lymph nodes (33,3%), 7 in the brain (11,1%), 6 in the lungs (9,5%) and 3 visceral (4,7%). SBRT was delivered in 1-8 fractions, with a median dose of 30Gy (range 24-60Gy). Median follow-up was 36,8 months (range 6,1-130,9 months). After SBRT we observed a complete response in 29 lesions (46,0%), partial response in 20 (31,7%), stable disease in 13 (20,6%) and only 1 progressive lesion (1,6%). We observed 10 local recurrences (15,8%) with an actuarial LC of 92,4% and 76,1% at 24 and 48 months respectively, while PFS was 62,8% and 52,3% at 12 and 24 months respectively. The OS at 24 and 48 months was 89,2% and 82,3% respectively. Patients with oligoprogressive disease were treated with further SBRT, while patients with polymetastatic progression of disease or oligoprogression not suitable for ablative treatment received systemic therapy. Eleven patients (50%) needed to start TKI treatment (6 Lenvatinib, 3 Sunitinib and 2 Sorafenib) for progressive disease: median time to first systemic treatment from SRT was 18,5 months (range 0,5-67 months). At the time of this analysis, 11 patients (50%) were still without systemic therapy, showing a good disease control after a median follow-up of 26,2 months (range 5,7-83). Freedom from systemic therapy rate from the time of SBRT was 85,6% and 57,6% at 12 and 24 months respectively. CONCLUSION In our experience, SBRT yields satisfying local control rates in oligometastatic Iodine-refractory DTC, potentially allowing for a deferral of systemic therapies, and should always be considered in these patients.
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Affiliation(s)
- G Simontacchi
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - C Sparano
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - M Loi
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - M Mangoni
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy; Medical Physics Unit, AOU Careggi Florence, Italy, Florence, Italy
| | - E Olmetto
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - P Garlatti
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - E Scoccimarro
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - G Frosini
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - N Bertini
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - I Morelli
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - A Romei
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - C Orsatti
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - S Pallotta
- University of Florence, Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", Florence, Italy
| | - S Calusi
- Medical Physics, Careggi University Hospital, University of Florence, Florence, Italy
| | - V Di Cataldo
- Radiation Oncology, Careggi University Hospital, University of Florence, Florence, Italy
| | - L Livi
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
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6
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Francolini G, Banini M, Di Cataldo V, Detti B, Caini S, Loi M, Simontacchi G, Desideri I, Greto D, Valzano M, Roghi M, Serni S, Vaggelli L, Salvestrini V, Visani L, Becherini C, Olmetto E, Franzese C, Baldaccini D, Scorsetti M, Sollini M, Chiti A, Meattini I, Valicenti RK, Livi L. PSMA guided approach for bIoCHEmical relapse after prostatectomy- (PSICHE) trial (NCT05022914). Detection rate and treatment decision after 68Ga-PSMA PET/CT within a prospective study. Prostate 2023; 83:1201-1206. [PMID: 37290915 DOI: 10.1002/pros.24579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/23/2023] [Accepted: 05/07/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Ultrasensitive imaging has been demonstrated to influence biochemical relapse treatment. PSICHE is a multicentric prospective study, aimed at exploring detection rate with 68Ga-PSMA-11 positron emission tomography/computed tomography (PET/CT) and outcomes with a predefined treatment algorithm tailored to the imaging. METHODS Patients affected by biochemical recurrence after surgery (prostate specific antigen [PSA] > 0.2 < 1 ng/mL) underwent staging with 68Ga-PSMA PET/CT. Management followed this treatment algorithm accordingly with PSMA results: prostate bed salvage radiotherapy (SRT) if negative or positive within prostate bed, stereotactic body radiotherapy (SBRT) if pelvic nodal recurrences or oligometastatic disease, androgen deprivation therapy (ADT) if nonoligometastatic disease. Chi-square test was used to evaluate the relationship between baseline features and rate of positive PSMA PET/CT. RESULTS One hundred patients were enrolled. PSMA results were negative/positive in the prostate bed in 72 patients, pelvic nodal or extrapelvic metastatic disease were detected in 23 and 5 patients. Twenty-one patients underwent observation because of prior postoperative radiotherapy (RT)/treatment refusal. Fifty patients were treated with prostate bed SRT, 23 patients underwent SBRT to pelvic nodal disease, five patients were treated with SBRT to oligometastatic disease. One patient underwent ADT. NCCN high-risk features, stage > pT3 and ISUP score >3 reported a significantly higher rate of positive PSMA PET/CT after restaging (p = 0.01, p = 0.02, and p = 0.002). By quartiles of PSA, rate of positive PSMA PET/CT was 26.9% (>0.2; <0.29 ng/mL), 24% (>0.3; <0.37 ng/mL), 26.9% (>0.38; <0.51 ng/mL), and 34.7% (>0. 52; <0.98 ng/mL). CONCLUSIONS PSICHE trial constitute a useful platform to collect data within a clinical framework where modern imaging and metastasis-directed therapy are integrated.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marco Banini
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Mauro Loi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Isacco Desideri
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Daniela Greto
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marianna Valzano
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Manuele Roghi
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation and Department of Experimental and Clinical Medicine, University of Florence, Careggi Hospital, Florence, Italy
| | - Luca Vaggelli
- Nuclear Medicine Division, Careggi University Hospital, Florence, Italy
| | - Viola Salvestrini
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Luca Visani
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Carlotta Becherini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Emanuela Olmetto
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ciro Franzese
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Milan-Rozzano, Italy
| | - Davide Baldaccini
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Milan-Rozzano, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Milan-Rozzano, Italy
| | - Martina Sollini
- Department of Biomedical Sciences and Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Arturo Chiti
- Nuclear Medicine Department, IRCCS San Raffaele, Milan, Italy
| | - Icro Meattini
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | | | - Lorenzo Livi
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
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Francolini G, Ganovelli M, Di Cataldo V, Detti B, Caini S, Loi M, Simontacchi G, Desideri I, Greto D, Valzano M, Serni S, Vaggelli L, Salvestrini V, Visani L, Becherini C, Olmetto E, Franzese C, Baldaccini D, Scorsetti M, Sollini M, Chiti A, Meattini I, Valicenti RK, Livi L. Early biochemical outcomes following PSMA guided approach for bIoCHEmical relapse after prostatectomy-PSICHE trial (NCT05022914): preliminary results. Clin Exp Metastasis 2023; 40:197-201. [PMID: 37012498 PMCID: PMC10113311 DOI: 10.1007/s10585-023-10204-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/10/2023] [Indexed: 04/05/2023]
Abstract
PSICHE (NCT05022914) is a prospective trial to test a [68Ga]Ga- PSMA-11 PET/CT imaging tailored strategy. All evaluable patients had biochemical relapse after surgery and underwent centralized [68Ga]Ga-PSMA-11 PET/CT imaging. The treatment was performed according pre-defined criteria. Observation and re-staging at further PSA progression were proposed to patients with negative PSMA and previous postoperative RT. Prostate bed SRT was proposed to all patients with a negative staging or positive imaging within prostate bed. Stereotactic body radiotherapy (SBRT) to all sites of disease was used for all patients with pelvic nodal recurrence (nodal disease < 2 cm under aortic bifurcation) or oligometastatic disease. At 3 months after treatment, 54.7% of patients had a complete biochemical response Only 2 patients experienced G2 Genitourinary toxicity. No G2 Gastrointestinal toxicity was recorded. A PSMA targeted treatment strategy led to encouraging results and was well tolerated.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Michele Ganovelli
- Department of Biomedical, Experimental and Clinical Sciences, Serio" University of Florence, Florence, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
- Radiation Oncology Department, AOU Careggi, Viale Morgagni 85, Florence, 50134, Italy.
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Mauro Loi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Isacco Desideri
- Department of Biomedical, Experimental and Clinical Sciences, Serio" University of Florence, Florence, Italy
| | - Daniela Greto
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marianna Valzano
- Department of Biomedical, Experimental and Clinical Sciences, Serio" University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Luca Vaggelli
- Nuclear Medicine Division, Careggi University Hospital, Florence, Italy
| | - Viola Salvestrini
- CyberKnife Center, Istituto Fiorentino di Cura e Assistenza (IFCA), Florence, Italy
| | - Luca Visani
- CyberKnife Center, Istituto Fiorentino di Cura e Assistenza (IFCA), Florence, Italy
| | - Carlotta Becherini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Emanuela Olmetto
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ciro Franzese
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Davide Baldaccini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marta Scorsetti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Arturo Chiti
- Nuclear Medicine Department, IRCCS San Raffaele, Milan, Italy
| | - Icro Meattini
- Department of Biomedical, Experimental and Clinical Sciences, Serio" University of Florence, Florence, Italy
| | | | - Lorenzo Livi
- Department of Biomedical, Experimental and Clinical Sciences, Serio" University of Florence, Florence, Italy
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8
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Francolini G, Ganovelli M, Di Cataldo V, Detti B, Allegra AG, Burchini L, Becherini C, Frosini G, Roghi M, Salvestrini V, Franzese C, Scorsetti M, Chiti A, Sollini M, Desideri I, Vaggelli L, Visani L, Olmetto E, Meattini I, Livi L. Early biochemical outcomes following PSMA-guided approach for biochemical relapse after prostatectomy: PSICHE trial. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
137 Background: Main approach for early biochemical relapse (BR) after radical prostatectomy (RP) is prostate bed salvage radiotherapy (SRT). PSICHE is a prospective trial aimed to explore oncological results of a 68Ga-PSMA-11 PET/CT tailored strategy based on a pre-defined treatment algorithm. We present results focusing on early biochemical outcomes after therapy. Biochemical response was defined as Complete (CBR) or Partial (PBR) if a PSA < 0.2 or <50% of baseline was reached. Methods: Enrolled patients were affected by BR (defined as PSA > 0.2 ng/ml) after RP +/- postoperative SRT. PSA >1 at recurrence or PSA persistence after surgery (PSA >0.2 ng within 16 weeks from RP) were exclusion criteria. All patients underwent centralized 68Ga-PSMA PET/CT and treatment approach was performed according to predefined criteria. Observation and re-staging at further PSA progression were proposed to patients with negative PSMA and previous postoperative RT. Prostate bed SRT was proposed to all patients with negative staging or positive imaging within the prostate bed. Stereotactic body radiotherapy (SBRT) to all sites of disease was proposed to patients with pelvic nodal recurrence (nodal disease <2 cm under aortic bifurcation) or oligometastatic disease (< 3 non visceral metastatic lesions). Non oligometastatic disease was treated with Androgen deprivation therapy +/- other systemic treatment. Results: Enrollment started on 19/03/2021 and 104 patients have been enrolled, with a median baseline PSA of 0.39 ng/ml. Overall, PSMA results were negative/positive in prostate bed in 75 patients (72.1%), while pelvic nodal or extrapelvic metastatic disease were detected in 23 (22.1%) and 6 (5.76%) patients, respectively. Twenty-two patients were observed after re-staging and were excluded from the current analysis. Treatment provided was SRT, SBRT or ADT in 50 (48.1%), 29 (27.8%) and 3 (2.9%) patients, respectively. Data about biochemical response at 3 months after treatment were available for 53 patients. Of these, 33 (62.3%) had a PBR, out of whom CBR was detected in 29 (54.7%). Any reduction in PSA if compared to baseline was detected in 44 patients, for an overall biochemical response rate of 83%. Five patients had biochemical progression and underwent a second PSMA re-staging with distant metastases detection. Only 2 patients experienced G2 Genitourinary toxicity, no G2 Gastrointestinal toxicity was recorded. Chi square test did not detect impact of ISUP score (< or >3) or time to recurrence (measured between surgery and biochemical relapse) on CBR rate. Conclusions: A PSMA targeted salvage treatment strategy offered promising results in terms of early biochemical response, with optimal toxicity profile, and avoided unnecessary overtreatment in this setting. Longer follow up is needed to explore biochemical relapse free and progression free survival after this approach. Clinical trial information: NCT05022914 .
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Affiliation(s)
- Giulio Francolini
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Florence, Italy
| | - Michele Ganovelli
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Vanessa Di Cataldo
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Florence, Florence, Italy
| | - Beatrice Detti
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Florence, Florence, Italy
| | - Andrea Gaetano Allegra
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Firenze, Italy
| | - Luca Burchini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Carlotta Becherini
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Florence, Firenze, Italy
| | - Giulio Frosini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Manuele Roghi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Viola Salvestrini
- CyberKnife Center, Istituto Fiorentino di Cura e Assistenza (IFCA), Florence, Florence, Italy
| | - Ciro Franzese
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy, Milan, Italy
| | - Marta Scorsetti
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy, Pieve Emanuele, Italy
| | - Arturo Chiti
- Humanitas University, Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Department of Nuclear Medicine, Pieve Emanuele (Milan), Italy
| | - Martina Sollini
- Humanitas University, Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Department of Nuclear Medicine, Pieve Emanuele, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Luca Vaggelli
- Azienda Ospedaliero Univeristaria Careggi - Nuclear Medicine Department, Florence, Italy
| | - Luca Visani
- CyberKnife Center, Istituto Fiorentino di Cura e Assistenza (IFCA), Florence, Firenze, Italy
| | - Emanuela Olmetto
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Florence, Florence, Italy
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
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Francolini G, Ghoshal A, Caini S, Piazzini T, Becherini C, Detti B, Di Cataldo V, Valzano M, Ganovelli M, Allegra AG, Frosini G, Burchini L, Visani L, Salvestrini V, Olmetto E, Loi M, Simontacchi G, Desideri I, Meattini I, Livi L. Quality of life after radical treatment for muscle invasive bladder cancer: A systematic review and meta-analysis. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
489 Background: Radical cystectomy (RC) with or without perioperative chemotherapy is considered the standard treatment option for Muscle invasive bladder cancer (MIBC), despite poor oncological outcomes. However, RC is often burdened by significant impact on quality of life (QoL); Continence preserving methods (e.g continent cutaneous urinary diversion and orthotopic neobladder-ONB), have been proposed as alternatives to improve the postoperative QoL, but real benefit of these approaches is questioned. Bladder sparing approach, such as trimodal therapy (TMT) emerged as an alternative to surgery. Aiming to assess the impact of these treatment options from the patients’ perspective, we undertook a systematic review and meta-analysis of literature, focusing on studies specifically reporting QoL data about each of the above mentioned approaches. Main purpose of this review is to compare available treatment options from the QoL point of view and highlight the potential advantage of a bladder sparing approach if compared to different postoperative urinary diversion methods. Methods: A systematic review was carried out including all prospective and retrospective studies enrolling patients treated with radical intent for non-metastatic MIBC from 1999 to 2021 (either RC or TMT). All studies included specifically reported QoL for one of the main treatment approaches explored (RC followed by ileal conduit urinary diversion-ICUD, ONB or TMT). Review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement Results: Fifty studies were included in the final analysis, assessing QoL after RC followed by ICUD or ONB in 6 and 15 cases, respectively. Six studies addressed QoL after TMT. ICUD vs ONB and TMT vs ICUD/ONB comparisons were carried out in 21 and 1 studies, respectively. Pooled analysis for EORTC QLQ- C30 and BLM-30 questionnaires showed that ONB yielded a significant advantage if compared to ICUD only for Physical Functioning (pooled mean standardized difference -0.73 SD, p-value 0.019, I 2 =93%) and for Emotional Functioning (pooled mean standardized difference -0.16 SD, p-value 0.029, I 2 =0%). A trend in favour of higher mean reported values after TMT for Global Health Score, Physical Functioning and Role Functioning was found, if compared to both RC approaches. Conclusions: Significant benefit for ONB if compared to ICUD was detected only for specific subdomains of QoL questionnaires. No direct comparison with TMT is available, but data suggest advantage of this approach if compared to both reconstructive scenarios. These data should be used in clinical practice to help well informed patients decision about local treatment choice.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Arun Ghoshal
- University of Toronto, Canada., Toronto, ON, Canada
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology, Cancer Research and Prevention Institute (ISPO), Florence, Italy
| | | | - Carlotta Becherini
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Vanessa Di Cataldo
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Florence, Florence, Italy
| | - Marianna Valzano
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Firenze, Italy
| | - Michele Ganovelli
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Andrea Gaetano Allegra
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy
| | - Giulio Frosini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Luca Burchini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Luca Visani
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Florence, Italy, Florence, Italy
| | - Viola Salvestrini
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Florence, Italy, Florence, Italy
| | - Emanuela Olmetto
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Florence, Florence, Italy
| | - Mauro Loi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Firenze, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy, Florence, Italy
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
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Francolini G, Allegra A, Caini S, Detti B, Di Cataldo V, Alitto A, Parisi S, D’Angelillo R, Bruni A, Ingrosso G, Timon G, Burchini L, Frosini G, Valzano M, Ganovelli M, Desideri I, Visani L, Olmetto E, Becherini C, Salvestrini V, Lapini A, Meattini I, Livi L. Early outcomes from a phase II randomized trial testing stereotactic body radiation therapy in patients undergoing I line treatment with abiraterone acetate for oligometastatic castration resistant prostate cancer (ARTO trial-NCT03449719). Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01226-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Francolini G, Frosini G, Di Cataldo V, Detti B, Carnevale MG, Banini M, Peruzzi A, Salvestrini V, Visani L, Olmetto E, Becherini C, Allegra A, Burchini L, Scotti V, Mangoni M, Meattini I, Desideri I, Livi L. Predictive factors for tolerance to taxane based chemotherapy in older adults affected by metastatic prostate cancer (ANCHISES-NCT05471427): A prospective observational trial including patients with metastatic hormone sensitive and castrate resistant prostate cancer treated with taxane chemotherapy. J Geriatr Oncol 2023; 14:101411. [PMID: 36496347 DOI: 10.1016/j.jgo.2022.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/10/2022] [Revised: 11/02/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Taxane-based chemotherapy is one of the main cornerstones for treatment of metastatic prostate cancer (mPCa). In aged and well-fit patients, an indication for taxane chemotherapy should remain similar to the general population. Aiming to explore predictive factors of fitness to taxane chemotherapy in older adult patients, a prospective observational study was carried out in our institution. MATERIALS AND METHODS We collected data from a prospective mono-centric database of patients aged ≥70 years old that were treated in our department. All patients underwent taxane treatment (either docetaxel or cabazitaxel, the latter only in second line setting) starting with standard treatment schedules (75 mg/m2 or 25 mg/m2 every three weeks, respectively). Data about G8 score post treatment decreases were collected and reported. We explored associations between baseline age, G8 score, and Charlson Comorbidity Index (CCI) with taxane dose reduction (DR), treatment temporary suspension (TS), or definitive interruption (TDI). Logistic regression analysis was performed to explore potential predictive factors for tolerability in patients treated with docetaxel. RESULTS One hundred-eighteen patients underwent taxane chemotherapy between 2011 and 2022, the majority of cases in metastatic castrate resistant prostate cancer (mCRPC) setting (85.6%). In the overall population, DR was performed in 40.7% of cases, and TS and TDI were deemed necessary in 28% and 22.9% of patients, respectively. Forty-seven percent of patients reported a significant deterioration in terms of G8 score (from > to ≤14). Sixty-two percent of the overall population were deemed fit for further treatment after taxane chemotherapy. Rate of DR, TS, and TDI was 29.4%, 11.8% and 9.2% in the docetaxel subgroup, vs 48%, 60% and 12% of patients treated with cabazitaxel, respectively. Lower baseline G8 was reported as a continuous variable and the only independent predictive factor for TDI in docetaxel subgroup (odds ratio [OR] 0.41, 95% confidence interval [CI] 0.25-0.68, p = 0.0008). DISCUSSION Our data suggest that tolerability of taxane regimens in a pre-treated population of older patients with prostate cancer is acceptable, despite a non-negligible rate of TDI. Taxane chemotherapy should not be denied a priori in order to avoid undertreatment of older adult patients.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Largo G. A. Brambilla 3, 50134 Florence, Italy
| | - Giulio Frosini
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Largo G. A. Brambilla 3, 50134 Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Largo G. A. Brambilla 3, 50134 Florence, Italy.
| | - Maria Grazia Carnevale
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Marco Banini
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Anna Peruzzi
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Viola Salvestrini
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Luca Visani
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Emanuela Olmetto
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Largo G. A. Brambilla 3, 50134 Florence, Italy
| | - Carlotta Becherini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Largo G. A. Brambilla 3, 50134 Florence, Italy
| | - Andrea Allegra
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Luca Burchini
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Vieri Scotti
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Largo G. A. Brambilla 3, 50134 Florence, Italy
| | - Monica Mangoni
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Icro Meattini
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Isacco Desideri
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
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Ramella S, Morabito A, Silipigni S, Russo A, Capelletto E, Rossi S, Leonetti A, Montrone M, Facilissimo I, Romano G, Stasi I, Ceresoli G, Gridelli C, Lugini A, Pilotto S, Tagliaferri P, Bria E, Canova S, Rijavec E, Borghetti P, Brighenti M, Carta A, Ciuffreda L, Giusti R, Macerelli M, Verderame F, Zanelli F, Berardi R, Gregorc V, Sergi C, Vattemi E, Manglaviti S, Piovano P, Olmetto E, Borra G, Gori S, Aieta M, Bertolini A, Cecere F, Pasello G, Rocco D, Zulian M, Roncari B, Novello S. EP06.01-006 Multidisciplinary Team during the COVID-19 Pandemic: The BE-PACIFIC Italian Observational Study Analysis. J Thorac Oncol 2022. [PMCID: PMC9452007 DOI: 10.1016/j.jtho.2022.07.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Olmetto E, Perna M, Cerbai C, Aquilano M, Banini M, Mariotti M, Livi L, Scotti V. A narrative review of postoperative adjuvant radiotherapy for non-small cell lung cancer. Mediastinum 2022; 6:4. [PMID: 35340837 PMCID: PMC8841548 DOI: 10.21037/med-21-31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 12/28/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To summarize the principal studies investigating the role of postoperative radiation therapy (PORT) for non-small cell lung cancer (NSCLC) and to discuss the recent major breakthroughs deriving from the Lung ART trial, in order to provide a real-world scenario of the management of resected NSCLC patients. BACKGROUND Surgery followed by platinum-based chemotherapy remains the mainstay of adjuvant treatments for completely resected stage II and IIIA NSCLC. Less consistent is the employment of PORT, as no significant benefit was clearly identified from the previous published meta-analysis. Furthermore, the recent results of Lung ART trial questioned for the first time the efficacy of PORT for pathological N2 (pN2) NSCLC patients. Hence, the need to define if PORT still has a role for resected NSCLC and which subgroup of patients could benefit most from this treatment. METHODS A literature search of PubMed was performed to identify publications, including prospective and retrospective clinical studies, meta-analysis and systematic review of PORT for NSCLC. No limit concerning years of publication or publication status were applied. Only papers using the English language were selected. The ESMO 2020 and ESMO 2021 online resources were used to analyze the Lung ART trial results. The authors provide a narrative summary of the findings and implications of these studies and how they improve the clinical practice. CONCLUSIONS PORT was considered the standard of care for patients with completely resected pN2 NSCLC based on the results of an old meta-analysis that did not demonstrate a detrimental effect. The more recent randomized phase III Lung ART trial concluded that PORT could not anymore be recommended for pN2 NSCLC as a significant benefit in terms of 3 years disease-free survival (DFS) was not reached and an increased rate of radiotherapy related toxicity was observed. Retrospective studies suggest a possible role of PORT for incompletely resected NSCLC patients and those with an extranodal extension (ENE), but this issue needs to be reinforced from randomized prospective trials. The extensive publication of Lung ART trial is largely awaited to define if there is a role of PORT for resected NSCLC patients.
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Affiliation(s)
- Emanuela Olmetto
- Thoracic Oncology Unit, Department of Medical Oncology, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Italy
| | - Marco Perna
- Department of Medical Oncology, Medical Oncology Unit, Ospedale Santa Maria Annunziata, Florence, Italy
- Department of Medical Oncology, Medical Oncology Unit, Ospedale del Mugello, Florence, Italy
| | - Cecilia Cerbai
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Michele Aquilano
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Marco Banini
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Matteo Mariotti
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Lorenzo Livi
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Vieri Scotti
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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14
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Tagliamento M, Bironzo P, Curcio H, De Luca E, Pignataro D, Rapetti SG, Audisio M, Bertaglia V, Paratore C, Bungaro M, Olmetto E, Artusio E, Reale ML, Zichi C, Capelletto E, Carnio S, Buffoni L, Passiglia F, Novello S, Scagliotti GV, Di Maio M. A systematic review and meta-analysis of trials assessing PD-1/PD-L1 immune checkpoint inhibitors activity in pre-treated advanced stage malignant mesothelioma. Crit Rev Oncol Hematol 2022; 172:103639. [DOI: 10.1016/j.critrevonc.2022.103639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 12/29/2022] Open
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15
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Passiglia F, Bertaglia V, Reale ML, Delcuratolo MD, Tabbò F, Olmetto E, Capelletto E, Bironzo P, Novello S. Major breakthroughs in lung cancer adjuvant treatment: Looking beyond the horizon. Cancer Treat Rev 2021; 101:102308. [PMID: 34757306 DOI: 10.1016/j.ctrv.2021.102308] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 12/15/2022]
Abstract
We are witnessing a silent revolution in the treatment of early stage non-small cell lung cancer (NSCLC), with a series of practice-changing clinical trials enriching the therapeutic perspectives of lung cancer patients with potentially curable disease. The ADAURA study marked the advent of precision medicine and biomarker testing to the early stages setting. The IMPower-010 trial interrupted the negative trend of adjuvant lung cancer immunotherapy, paving the way to the application of immune-checkpoint inhibition in the resected disease. The ITACA trial definitively established no role for tailored adjuvant chemotherapy in NSCLC, while the Lung Art data questioned the efficacy of post-operative radiotherapy for pN2 resected disease. Growing evidence is supporting MRD as effective adjuvant prognostic biomarker to stratify disease's recurrence risk after radical interventions and select best candidates to the adjuvant strategies. This work summarizes the recent major breakthroughs in lung cancer adjuvant treatment, and provides a snapshot of the current real-world scenario, discussing the upcoming challenges and opportunities featuring the clinical management of early stage NSCLC patients.
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Affiliation(s)
- Francesco Passiglia
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Valentina Bertaglia
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Maria Lucia Reale
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | | | - Fabrizio Tabbò
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Emanuela Olmetto
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Enrica Capelletto
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Paolo Bironzo
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Silvia Novello
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
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16
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Bironzo P, Jacobs F, Cani M, Reale M, Tabbò F, Olmetto E, Capelletto E, Napoli V, Passiglia F, Listì A, Righi L, Di Maio M, Novello S, Scagliotti G. P59.20 Natural History of KRAS Mutant Non-Small-Cell Lung Cancer in the Immunotherapy Era: A Single-Centre Retrospective Study. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.609] [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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17
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Mariniello A, Bironzo P, Pisano C, De Filippis M, Persano I, Olmetto E, Caramello V, Boccuzzi A, Capelletto E, Passiglia F, Di Maio M, Novello S. Descriptive Comparative Analysis of Patients With Cancer Referring to the Emergency Department of an Italian University Hospital Across the Severe Acute Respiratory Syndrome Coronavirus 2 Waves. JCO Oncol Pract 2021; 17:e1887-e1894. [PMID: 34228511 DOI: 10.1200/op.21.00098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE COVID-19 cancer patients (C19-CP) represent a population at high risk for mortality, whose clinical characteristics are still unknown in the second SARS-CoV-2 wave. The aim of this retrospective study was to compare epidemiology and clinical presentation of C19-CP referring to the emergency department (ED) of our institution (San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy), in a 3-week observation period of the first and second COVID-19 waves, starting from the introduction of the corresponding national lockdowns. METHODS We retrieved ED admissions from March 9 to 29, 2020, for the first wave, and from October 24 to November 13, 2020, for the second wave. We collected clinical characteristics of consecutive patients with molecularly confirmed SARS-CoV-2 infection. We also considered untested or SARS-CoV-2-negative cancer patients referring to the ED in the reference time frames. RESULTS C19-CP in the second wave exceeded those in the first wave despite the nonsignificant difference (39 of 576 v 8 of 163; P = .5). Compared with nononcological patients, C19-CP were older (median age 70 years [interquartile range 61-77] v 60 years [interquartile range 45-73]; P = .02) and presented more often with ≥ 2 comorbidities (40.4% v 24.3%; P = .02). Compared with nononcological patients, in C19-CP, respiratory failure (29 of 47 v 321 of 692; P = .049) and hospitalization (37 of 47 v 363 of 692; P = .0004) were higher, with comparable frequencies across the waves. Five of 24 and 10 of 27 hospitalized cancer patients in the first and second waves developed SARS-CoV-2 infection during hospitalization. CONCLUSION C19-CP were a vulnerable population, irrespective of the COVID-19 waves. This highlights the need to prioritize vaccinations in oncological patients to safeguard and guarantee optimal anticancer care.
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Affiliation(s)
- Annapaola Mariniello
- Department of Oncology, University of Torino at San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Paolo Bironzo
- Department of Oncology, University of Torino at San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Chiara Pisano
- Department of Oncology, University of Torino at San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Marco De Filippis
- Department of Oncology, University of Torino at San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Irene Persano
- Department of Oncology, University of Torino at San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Emanuela Olmetto
- Department of Oncology, University of Torino at San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Valeria Caramello
- Emergency Department, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Adriana Boccuzzi
- Emergency Department, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Enrica Capelletto
- Department of Oncology, University of Torino at San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Francesco Passiglia
- Department of Oncology, University of Torino at San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Torino at Mauriziano Hospital, Torino, Italy
| | - Silvia Novello
- Department of Oncology, University of Torino at San Luigi Gonzaga University Hospital, Orbassano, Italy
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18
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Scoccianti S, Olmetto E, Pinzi V, Osti MF, Di Franco R, Caini S, Anselmo P, Matteucci P, Franceschini D, Mantovani C, Beltramo G, Pasqualetti F, Bruni A, Tini P, Giudice E, Ciammella P, Merlotti A, Pedretti S, Trignani M, Krengli M, Giaj-Levra N, Desideri I, Pecchioli G, Muto P, Maranzano E, Fariselli L, Navarria P, Ricardi U, Scotti V, Livi L. Immunotherapy in association with stereotactic radiotherapy for Non-Small Cell Lung Cancer brain metastases: results from a multicentric retrospective study on behalf of AIRO. Neuro Oncol 2021; 23:1750-1764. [PMID: 34050669 DOI: 10.1093/neuonc/noab129] [Citation(s) in RCA: 9] [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] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To define efficacy and toxicity of Immunotherapy (IT) with stereotactic radiotherapy (SRT) including radiosurgery (RS) or hypofractionated SRT (HFSRT) for brain metastases (BM) from Non-Small Cell Lung Cancer (NSCLC) in a multicentric retrospective study from AIRO (Italian Association of Radiotherapy and Clinical Oncology). METHODS NSCLC patients with BM receiving SRT+IT and treated in 19 Italian centers were analysed and compared with a control group of patients treated with exclusive SRT. RESULTS One hundred patients treated with SRT+IT and 50 patients treated with SRT-alone were included. Patients receiving SRT+IT had a longer intracranial Local Progression Free Survival (iLPFS) (propensity score-adjusted p=0.007). Among patients who, at the diagnosis of BM, received IT and had also extracranial progression (n=24), IT administration after SRT was shown to be related to a better overall survival (OS) (p=0.037). At multivariate analysis, non-adenocarcinoma histology, KPS =70 and use of HFSRT were associated with a significantly worse survival (p=0.019, p=0.017 and p=0.007 respectively). Time interval between SRT and IT ≤7 days (n=90) was shown to be related to a longer OS if compared to SRT-IT interval >7 days (n=10) (propensity score-adjusted p=0.008). The combined treatment was well tolerated. No significant difference in terms of radionecrosis between SRT+IT patients and SRT-alone patients was observed. Time interval between SRT and IT had no impact on toxicity rate. CONCLUSIONS Combined SRT+IT was a safe approach, associated with a better iLPFS if compared to exclusive SRT.
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Affiliation(s)
- Silvia Scoccianti
- Radiation Oncology Unit, Ospedale Santa Maria Annunziata, Department of Oncology, Bagno a Ripoli, Florence, Italy
| | - Emanuela Olmetto
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Florence, Italy
| | - Valentina Pinzi
- U.O Radioterapia, Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Neurosurgery, Milan, Italy
| | - Mattia Falchetto Osti
- U.O.C Radioterapia, A.O.U Sant'Andrea Facoltà Medicina e Psicologia Università Sapienza, Department of Medicine,Surgery and Translational Medicine,Rome, Italy
| | - Rossella Di Franco
- Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, Department of Radiotherapy, Naples, Italy
| | - Saverio Caini
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Cancer Risk Factors and Life-Style Epidemiology Unit, Florence, Italy
| | - Paola Anselmo
- Radiotherapy Oncology Center, S. Maria Hospital, Department of Oncology, Terni, Italy
| | - Paolo Matteucci
- Radioterapia Oncologica, Campus Biomedico, Department of Radiation Oncology, Rome, Italy
| | - Davide Franceschini
- Humanitas Research Hospital, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | | | - Giancarlo Beltramo
- Cyberknife Centro Diagnostico Italiano, Department of Radiology, Milan, Italy
| | - Francesco Pasqualetti
- Radiation Oncology, Azienda Ospedaliero Universitaria Pisana, Department of Translational Medicine, Pisa, Italy
| | - Alessio Bruni
- Radiotherapy Unit, University Hospital of Modena, Department of Oncology and Hematology, Modena, Italy
| | - Paolo Tini
- Radiotherapy Unit, University of Siena, Department of Radiotherapy and Oncology, Siena, Italy
| | - Emilia Giudice
- UOC di Radioterapia, Policlinico Universitario Tor Vergata, Department of Onco-Haematology, Rome, Italy
| | - Patrizia Ciammella
- Radioterapia Oncologica "G. Prodi", AO-IRCCS Arcispedale S. Maria Nuova, Department of Oncology and Advanced Technology, Reggio Emilia, Italy
| | - Anna Merlotti
- Radiation Oncology A.S.O. S.Croce e Carle, Department of Radiation Oncology, Cuneo, Italy
| | - Sara Pedretti
- U.O. Radioterapia oncologica, Department of Radiation Oncology, ASST Spedali Civili di Brescia e Università degli studi di Brescia, Brescia, Italy
| | - Marianna Trignani
- U.O.C. Radioterapia Oncologica, Ospedale Clinicizzato SS Annunziata- Università Chieti G. D'Annunzio, Department of Radiation Oncology, Chieti, Italy
| | - Marco Krengli
- Radiation Oncology, University Hospital Maggiore della Carità, Department of Translational Medicine, Novara, Italy
| | - Niccolò Giaj-Levra
- IRCCS Ospedale Sacro Cuore Don Calabria, Department of Advanced Radiation Oncology, Verona, Italy
| | - Isacco Desideri
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Florence, Italy
| | - Guido Pecchioli
- Neurosurgery Unit, Azienda Ospedaliero Universitaria Careggi, Department of Neurosurgery, Florence, Italy
| | - Paolo Muto
- Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, Department of Radiotherapy, Naples, Italy
| | - Ernesto Maranzano
- Radiotherapy Oncology Center, S. Maria Hospital, Department of Oncology, Terni, Italy
| | - Laura Fariselli
- U.O Radioterapia, Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Neurosurgery, Milan, Italy
| | - Piera Navarria
- Humanitas Research Hospital, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | | | - Vieri Scotti
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Florence, Italy
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Passiglia F, Leone G, Olmetto E, Delcuratolo MD, Tabbò F, Reale ML, Bertaglia V, Consito L, Bironzo P, Capelletto E, Novello S. Immune-checkpoint inhibition in stage III unresectable NSCLC: Challenges and opportunities in the post-PACIFIC era. Lung Cancer 2021; 157:85-91. [PMID: 33994198 DOI: 10.1016/j.lungcan.2021.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 12/25/2022]
Abstract
The PACIFIC trial marked a new era in the treatment of stage III unresectable NSCLC, establishing durvalumab consolidation as new standard of care worldwide, with about 14 % increase of long-term survival and half of the patients alive at 4 years. A series of intensified immune-checkpoint inhibition regimens are currently under investigation in clinical trials in order to optimize the therapeutic benefit obtained in this population, while the identification of personalized approaches as well as the development of effective treatments in the post-durvalumab progression setting represent an actual and controversial topic for clinical lung cancer research. This review describes the current real-word treatment scenario for stage III unresectable NSCLC in Italy, and provides an updated overview of the upcoming therapeutic strategies under clinical investigation, discussing the most relevant challenges and opportunities featuring the post-PACIFIC era.
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Affiliation(s)
- Francesco Passiglia
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Gianmarco Leone
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Emanuela Olmetto
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | | | - Fabrizio Tabbò
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Maria Lucia Reale
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Valentina Bertaglia
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Lorena Consito
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Paolo Bironzo
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Enrica Capelletto
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Silvia Novello
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
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20
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Buti S, Bersanelli M, Perrone F, Bracarda S, Di Maio M, Giusti R, Nigro O, Cortinovis DL, Aerts JGJV, Guaitoli G, Barbieri F, Ferrara MG, Bria E, Grossi F, Bareggi C, Berardi R, Torniai M, Cantini L, Sforza V, Genova C, Chiari R, Rocco D, Della Gravara L, Gori S, De Tursi M, Di Marino P, Mansueto G, Zoratto F, Filetti M, Citarella F, Russano M, Mazzoni F, Garassino MC, De Toma A, Signorelli D, Gelibter A, Siringo M, Follador A, Bisonni R, Tuzi A, Minuti G, Landi L, Ricciardi S, Migliorino MR, Tabbò F, Olmetto E, Metro G, Adamo V, Russo A, Spinelli GP, Banna GL, Addeo A, Friedlaender A, Cannita K, Porzio G, Ficorella C, Carmisciano L, Pinato DJ, Mazzaschi G, Tiseo M, Cortellini A. Predictive ability of a drug-based score in patients with advanced non-small-cell lung cancer receiving first-line immunotherapy. Eur J Cancer 2021; 150:224-231. [PMID: 33934059 DOI: 10.1016/j.ejca.2021.03.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 03/04/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND We previously demonstrated the cumulative poor prognostic role of concomitant medications on the clinical outcome of patients with advanced cancer treated with immune checkpoint inhibitors, creating and validating a drug-based prognostic score to be calculated before immunotherapy initiation in patients with advanced solid tumours. This 'drug score' was calculated assigning score 1 for each between proton-pump inhibitor and antibiotic administration until a month before cancer therapy initiation and score 2 in case of corticosteroid intake. The good risk group included patients with score 0, intermediate risk with score 1-2 and poor risk with score 3-4. METHODS Aiming at validating the prognostic and putative predictive ability depending on the anticancer therapy, we performed the present comparative analysis in two cohorts of advanced non-small-cell lung cancer (NSCLC), respectively, receiving first-line pembrolizumab or chemotherapy through a random case-control matching and through a pooled multivariable analysis including the interaction between the computed score and the therapeutic modality (pembrolizumab vs chemotherapy). RESULTS Nine hundred fifty and 595 patients were included in the pembrolizumab and chemotherapy cohorts, respectively. After the case-control random matching, 589 patients from the pembrolizumab cohort and 589 from the chemotherapy cohort were paired, with no statistically significant differences between the characteristics of the matched subjects. Among the pembrolizumab-treated group, good, intermediate and poor risk evaluable patients achieved an objective response rate (ORR) of 50.0%, 37.7% and 23.4%, respectively, (p < 0.0001), whereas among the chemotherapy-treated group, patients achieved an ORR of 37.0%, 40.0% and 32.4%, respectively (p = 0.4346). The median progression-free survival (PFS) of good, intermediate and poor risk groups was 13.9 months, 6.3 months and 2.8 months, respectively, within the pembrolizumab cohort (p < 0.0001), and 6.2 months, 6.2 months and 4.3 months, respectively, within the chemotherapy cohort (p = 0.0280). Among the pembrolizumab-treated patients, the median overall survival (OS) for good, intermediate and poor risk patients was 31.4 months, 14.5 months and 5.8 months, respectively, (p < 0.0001), whereas among the chemotherapy-treated patients, it was 18.3 months, 16.8 months and 10.6 months, respectively (p = 0.0003). A similar trend was reported considering the two entire populations. At the pooled analysis, the interaction term between the score and the therapeutic modality was statistically significant with respect to ORR (p = 0.0052), PFS (p = 0.0003) and OS (p < 0.0001), confirming the significantly different effect of the score within the two cohorts. CONCLUSION Our 'drug score' showed a predictive ability with respect to ORR in the immunotherapy cohort only, suggesting it might be a useful tool for identifying patients unlikely to benefit from first-line single-agent pembrolizumab. In addition, the prognostic stratification in terms of PFS and OS was significantly more pronounced among the pembrolizumab-treated patients.
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Affiliation(s)
- Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Fabiana Perrone
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Sergio Bracarda
- Struttura Complessa di Oncologia Medica e Traslazionale, Azienda Ospedaliera Santa Maria di Terni, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin and Medical Oncology, AO Ordine Mauriziano, Turin, Italy
| | | | - Olga Nigro
- Medical Oncology, ASST-Sette Laghi, Varese, Italy
| | | | - Joachim G J V Aerts
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Giorgia Guaitoli
- Dipartimeto di Oncologia Ed Ematologia, AOU Policlinico Modena, Modena, Italy
| | - Fausto Barbieri
- Dipartimeto di Oncologia Ed Ematologia, AOU Policlinico Modena, Modena, Italy
| | - Miriam G Ferrara
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Lazio, Italy
| | - Emilio Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Lazio, Italy
| | - Francesco Grossi
- Division of Medical Oncology, University of Insubria, Varese, Italy
| | - Claudia Bareggi
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Mariangela Torniai
- Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Luca Cantini
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, the Netherlands; Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Vincenzo Sforza
- Thoracic Medical Oncology, Istituto Nazionale Tumori "Fondazione G Pascale", IRCCS, Napoli, Italy
| | - Carlo Genova
- Lung Cancer Unit IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Rita Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud "Madre Teresa Di Calcutta", Monselice, Italy
| | - Danilo Rocco
- Pneumo-Oncology Unit, Monaldi Hospital, Naples, Italy
| | | | - Stefania Gori
- Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, VR, Italy
| | - Michele De Tursi
- Dipartimento di Terapie Innovative in Medicina e Odontoiatria, Università G. D'Annunzio, Chieti-Pescara, Chieti, Italy
| | | | | | | | | | | | - Marco Russano
- Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - Francesca Mazzoni
- Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Marina C Garassino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Alessandro De Toma
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Diego Signorelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy; Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alain Gelibter
- Medical Oncology (B), Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Marco Siringo
- Medical Oncology (B), Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Alessandro Follador
- Department of Oncology, University Hospital Santa Maria Della Misericordia, Udine, Italy
| | | | | | - Gabriele Minuti
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | - Lorenza Landi
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | - Serena Ricciardi
- Pneumo-Oncology Unit, St. Camillo-Forlanini Hospital, Rome, Italy
| | | | - Fabrizio Tabbò
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, (TO), Italy
| | - Emanuela Olmetto
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, (TO), Italy
| | - Giulio Metro
- Department of Medical Oncology, Santa Maria Della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Vincenzo Adamo
- Medical Oncology, A.O. Papardo & Department of Human Pathology, University of Messina, Italy
| | - Alessandro Russo
- Medical Oncology, A.O. Papardo & Department of Human Pathology, University of Messina, Italy
| | - Gian P Spinelli
- UOC Territorial Oncology of Aprilia, AUSL Latina, University of Rome Sapienza, Aprilia, Italy
| | | | - Alfredo Addeo
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Alex Friedlaender
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Katia Cannita
- Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
| | | | - Corrado Ficorella
- Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy; Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - David J Pinato
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK; Department of Translational Medicine, Università del Piemonte Orientale "A. Avogadro", Novara, Italy
| | - Giulia Mazzaschi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alessio Cortellini
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy; Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK.
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Detti B, Ingrosso G, Becherini C, Lancia A, Olmetto E, Alì E, Marani S, Teriaca MA, Francolini G, Sardaro A, Aristei C, Filippi AR, Sanguineti G, Livi L. Management of prostate cancer radiotherapy during the COVID-19 pandemic: A necessary paradigm change. Cancer Treat Res Commun 2021; 27:100331. [PMID: 33581491 PMCID: PMC7864785 DOI: 10.1016/j.ctarc.2021.100331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/13/2020] [Accepted: 12/02/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To adapt the management of prostate malignancy in response to the COVID-19 pandemic. METHODS In according to the recommendations of the European Association of Urology, we have developed practical additional document on the treatment of prostate cancer. RESULTS Low-Risk Group Watchful Waiting should be offered to patients >75 years old, with a limited life expectancy and unfit for local treatment. In Active Surveillance (AS) patients re-biopsy, PSA evaluation and visits should be deferred for up to 6 months, preferring non-invasive multiparametric-MRI. The active treatment should be delayed for 6-12 months. Intermediate-Risk Group AS should be offered in favorable-risk patients. Short-course neoadjuvant androgen deprivation therapy (ADT) combined with ultra-hypo-fractionation radiotherapy should be used in unfavorable-risk patients. High-Risk Group Neoadjuvant ADT combined with moderate hypofractionation should be preferred. Whole-pelvis irradiation should be offered to patients with positive lymph nodes in locally advanced setting. ADT should be initiated if PSA doubling time is < 12 months in radio-recurrent patients, as well as in low priority/low volume of metastatic hormone sensitive prostate cancer. If radiotherapy cannot be delayed, hypo-fractionated regimens should be preferred. In high priority class metastatic disease, treatment with androgen receptor-targeted agents should be offered. When palliative radiotherapy for painful bone metastasis is required, single fraction of 8 Gy should be offered. CONCLUSIONS In Covid-19 Era, the challenge should concern a correct management of the oncologic patient, reducing the risk of spreading the virus without worsening tumor prognosis.
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Affiliation(s)
- Beatrice Detti
- RadiationOncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Gianluca Ingrosso
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Carlotta Becherini
- RadiationOncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Andrea Lancia
- Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emanuela Olmetto
- RadiationOncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Emanuele Alì
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Simona Marani
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | | | - Giulio Francolini
- RadiationOncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Angela Sardaro
- Diagnostic Imaging and Radiotherapy Section, Department of Interdisciplinary Medicine, University Aldo Moro, Bari, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | | | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Lorenzo Livi
- RadiationOncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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22
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Pignataro D, Bertaglia V, Bironzo P, Olmetto E, Pisano C, Napoli VM, Mantovani C, Righi L, Novello S. Oligoprogressive Disease With SCLC Transformation in EGFR-Mutated NSCLC: How Biology Knowledge Can Change the Game Rules. J Thorac Oncol 2021; 15:e170-e172. [PMID: 32981608 DOI: 10.1016/j.jtho.2020.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Daniele Pignataro
- Division of Medical Oncology, Cardinal Massaia Hospital, Asti, Italy.
| | - Valentina Bertaglia
- Thoracic Oncology Unit, Department of Oncology, University of Torino, Torino, Italy
| | - Paolo Bironzo
- Thoracic Oncology Unit, Department of Oncology, University of Torino, Torino, Italy
| | - Emanuela Olmetto
- Thoracic Oncology Unit, Department of Oncology, University of Torino, Torino, Italy
| | - Chiara Pisano
- Thoracic Oncology Unit, Department of Oncology, University of Torino, Torino, Italy
| | - Valerio Maria Napoli
- Thoracic Oncology Unit, Department of Oncology, University of Torino, Torino, Italy
| | - Cristina Mantovani
- Radiotherapy Unit, Department of Oncology, Città della Salute e della Scienza, Torino, Italy
| | - Luisella Righi
- Pathology Unit, Department of Oncology, University of Torino, Torino, Italy
| | - Silvia Novello
- Thoracic Oncology Unit, Department of Oncology, University of Torino, Torino, Italy
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23
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Scoccianti S, Perna M, Olmetto E, Delli Paoli C, Terziani F, Ciccone LP, Detti B, Greto D, Simontacchi G, Grassi R, Scoccimarro E, Bonomo P, Mangoni M, Desideri I, Di Cataldo V, Vernaleone M, Casati M, Pallotta S, Livi L. Local treatment for relapsing glioblastoma: A decision-making tree for choosing between reirradiation and second surgery. Crit Rev Oncol Hematol 2020; 157:103184. [PMID: 33307416 DOI: 10.1016/j.critrevonc.2020.103184] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/21/2020] [Accepted: 11/23/2020] [Indexed: 12/22/2022] Open
Abstract
In case of circumscribed recurrent glioblastoma (rec-GBM), a second surgery (Re-S) and reirradiation (Re-RT) are local strategies to consider. The aim is to provide an algorithm to use in the daily clinical practice. The first step is to consider the life expectancy in order to establish whether the patient should be a candidate for active treatment. In case of a relatively good life expectancy (>3 months) and a confirmed circumscribed disease(i.e. without multiple lesions that are in different lobes/hemispheres), the next step is the assessment of the prognostic factors for local treatments. Based on the existing prognostic score systems, patients who should be excluded from local treatments may be identified; based on the validated prognostic factors, one or the other local treatment may be preferred. The last point is the estimation of expected toxicity, considering patient-related, tumor-related and treatment-related factors impacting on side effects. Lastly, patients with very good prognostic factors may be considered for receiving a combined treatment.
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Affiliation(s)
- Silvia Scoccianti
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy.
| | - Marco Perna
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Emanuela Olmetto
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Camilla Delli Paoli
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Francesca Terziani
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Lucia Pia Ciccone
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Beatrice Detti
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Daniela Greto
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Gabriele Simontacchi
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Roberta Grassi
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Erika Scoccimarro
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Pierluigi Bonomo
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Monica Mangoni
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Isacco Desideri
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Vanessa Di Cataldo
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Marco Vernaleone
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Marta Casati
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Medical Physics Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Stefania Pallotta
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Medical Physics Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
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24
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Olmetto E, Scoccianti S, Di Franco R, Anselmo P, Beltramo G, Mantovani C, Osti M, Pinzi V, Giaj-Levra N, Bruni A, Matteucci P, Pedretti S, Giudice E, Tini P, Krengli M, Ciammella P, Pasqualetti F, Trignani M, Merlotti A, Borzillo V, Franceschini D, Maranzano E, Umberto R, Pierina N, Scotti V. PD-0175: TTIRS trial:a retrospective analysis of the association between TT or IT and RS for BM from NSCLC. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00199-7] [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: 11/29/2022]
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25
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Scoccianti S, Simontacchi G, Greto D, Perna M, Terziani F, Talamonti C, Teriaca MA, Caramia G, Lo Russo M, Olmetto E, Delli Paoli C, Grassi R, Carfora V, Saieva C, Bonomo P, Detti B, Mangoni M, Desideri I, Francolini G, Di Cataldo V, Marrazzo L, Pallotta S, Livi L. Dosimetric Predictors of Acute and Chronic Alopecia in Primary Brain Cancer Patients Treated With Volumetric Modulated Arc Therapy. Front Oncol 2020; 10:467. [PMID: 32322558 PMCID: PMC7156544 DOI: 10.3389/fonc.2020.00467] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/16/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose: To determine dose constraints that correlate with alopecia in patients treated with photon-based Volumetric Modulated Arc Therapy (VMAT) for primary brain tumors. Methods: During the treatment planning process, the scalp was drawn as a region of interest. Dose received by 0.1 cc (D0.1cc), mean dose (Dmean), absolute volumes receiving different doses (V16Gy, V20Gy, V25Gy, V30Gy, V35Gy, V40Gy, and V43Gy) were registered for the scalp. Alopecia was assessed according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Receiver operating characteristics (ROC) curve analysis was used to identify parameters associated with hair-loss. Results: One-hundred and one patients were included in this observational study. At the end of radiotherapy (RT), 5 patients did not develop alopecia (Dmean scalp 3.1 Gy). The scalp of the patients with G1 (n = 11) and G2 (n = 85) alopecia received Dmean of 10.6 Gy and 11.8 Gy, respectively. At ROC analysis, V16Gy20Gy ≥ 5.2 cc were the strongest predictors of acute alopecia risk. Chronic hair-loss assessment was available for 74 patients: median time to recovery from G2 alopecia was 5, 9 months. The actuarial rate of hair regrowth was 98.1% at 18 months after the end of RT. At ROC analysis, V40Gy43Gy ≥2.2 cc were the strongest predictors of chronic G2-alopecia risk. V20Gy, V40Gy, and D0,1cc were shown to be independent variables according to correlation coefficient r. Conclusions: V20Gy and V40Gy were the strongest predictors for acute and chronic G2 hair-loss, respectively. The low-dose bath typical of VMAT corresponds to large areas of acute but transient alopecia. However, the steep dose gradient of VMAT allows to reduce the areas of the scalp that receive higher doses, minimizing the risk of permanent alopecia. The application of our dosimetric findings for the scalp may help in reducing the alopecia risk and also in estimating the probability of hair-loss during patient counseling before starting radiotherapy.
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Affiliation(s)
- Silvia Scoccianti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Daniela Greto
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Marco Perna
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Francesca Terziani
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Cinzia Talamonti
- Medical Physics Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio," Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Maria Ausilia Teriaca
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Giorgio Caramia
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Monica Lo Russo
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Emanuela Olmetto
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Camilla Delli Paoli
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Roberta Grassi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Vincenzo Carfora
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Calogero Saieva
- SC Epidemiology of Risk Factors and Lifestyles, Institute for Study, Prevention, and Oncology Network (ISPRO), Florence, Italy
| | - Pierluigi Bonomo
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Monica Mangoni
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Isacco Desideri
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Livia Marrazzo
- Medical Physics Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio," Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Stefania Pallotta
- Medical Physics Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio," Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
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Meattini I, Poortmans P, Kirova Y, Saieva C, Visani L, Salvestrini V, Kim J, Jung W, Olmetto E, Mariotti M, Desideri I, Fourquet A, Livi L, Kim K. Hypofractionated whole breast irradiation after conservative surgery for patients aged less than 60 years: a multi-centre comparative study. Acta Oncol 2020; 59:188-195. [PMID: 31760849 DOI: 10.1080/0284186x.2019.1695061] [Citation(s) in RCA: 3] [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] [Indexed: 10/25/2022]
Abstract
Background: For decades, conventional fractionated whole breast irradiation (CF-WBI) was used after breast conserving surgery (BCS). Pivotal phase-3 trials on hypofractionated-WBI (HF-WBI) showed its non-inferiority as compared to CF-WBI. However, younger patients are often not treated with HF-WBI. The aim of this multi-centre comparative study is to confirm the safety of HF-WBI in a real-life series of younger patients.Material and methods: Between 2010 and 2016, a total of 786 patients aged less than 60 years old with early-stage breast cancer were treated with postoperative WBI after BCS in three breast cancer centres: 340 underwent HF-WBI while 446 were treated with CF-WBI. Acute toxicity was evaluated at the end of WBI. Late toxicity was evaluated at 6, 12, 24 and 36 months.Results: At univariate logistic analysis, hypofractionation showed a significant protective effect in terms of acute oedema, acute wet desquamation, chronic oedema, chronic erythema/pigmentation and breast fibrosis. At multivariate logistic analysis, hypofractionation was an independent significant factor for acute oedema, acute wet desquamation, and chronic oedema. There were not differences in tumour-related outcomes.Conclusions: HF-WBI showed significantly improved outcomes in terms of acute skin oedema, wet desquamation and chronic skin oedema. HF-WBI after BCS should be strongly encouraged to replace CF-WBI independently of age.
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Affiliation(s)
- Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Youlia Kirova
- Radiation Oncology Department, Institut Curie, Paris, France
| | - Calogero Saieva
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Luca Visani
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
| | - Viola Salvestrini
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
| | - Jiyoung Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Wonguen Jung
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Emanuela Olmetto
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
- Radiation Oncology Department, Institut Curie, Paris, France
| | - Matteo Mariotti
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Alain Fourquet
- Radiation Oncology Department, Institut Curie, Paris, France
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
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27
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Tagliamento M, Bironzo P, De Luca E, Pignataro D, Rapetti S, Audisio M, Bertaglia V, Paratore C, Bungaro M, Olmetto E, Artusio E, Reale M, Zichi C, Capelletto E, Carnio S, Buffoni L, Passiglia F, Novello S, Di Maio M. A systematic review and meta-analysis of trials assessing activity of PD-1/PD-L1 immune checkpoint inhibitors (ICIs) for pre-treated advanced malignant mesothelioma (aMM). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz449.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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28
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Meattini I, Livi L, Kim K, Kim J, Jung W, Olmetto E, Desideri I, Saieva C, Becherini C, Salvestrini V, Fourquet A, Kirova Y, Poortmans P. Safety of hypofractionated whole breast irradiation after conservative surgery for patients aged less than 60 years: A multi-center comparative study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.040] [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: 11/12/2022] Open
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29
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Olmetto E, Paoli CD, Ciccone L, Perna M, Grassi R, Erika S, Scoccianti S, Greto D, Desideri I, Simontacchi G, Marrazzo L, Arilli C, Casati M, Compagnucci A, Pecchioli G, Pallotta S, Livi L. OC-0276 Stereotactic radiosurgery plus immunotherapy or targeted therapy for brain metastases from NSCLC. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30696-6] [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: 10/26/2022]
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30
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Meattini I, Kirova Y, Saieva C, Visani L, Olmetto E, Salvestrini V, Kim J, Jung W, Desideri I, Fourquet A, Poortmans P, Livi L, Kim K. PO-0761 Hypofractionated whole breast irradiation safety after breast-conserving surgery for young patients. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31181-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Meattini I, Bernini M, Saieva C, Desideri I, Scotti V, Salvestrini V, Visani L, Mariotti M, Delli Paoli C, Olmetto E, Maragna V, Orzalesi L, Sanchez L, Nori J, Bianchi S, Livi L. Abstract P3-12-07: Conservative breast reconstruction: Outcomes of 146 consecutive cases of prepectoral, subcutaneous implant-based breast reconstruction in a single-Institution series. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-12-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Aims. To evaluate acute and late toxicity-related factors among breast cancer (BC) patients who underwent prepectoral breast reconstruction (BR).
Methods. We performed a retrospective analysis of BC patients who underwent therapeutic or prophylactic mastectomy from October 2012 to May 2016 at our Center. We recorded individual patient-related features (i.e. age, body mass index [BMI], smoke-history, comorbidity, BRCA-carrier), BC-related treatments characteristics (i.e. axillary surgery, adjuvant radiotherapy [RT], adjuvant chemotherapy, primary systemic therapy [PST], endocrine therapy, and use of trastuzumab). Toxicity profile was evaluated in terms of complications related to BR; we recorded acute and late toxicity data and prosthesis/implant explant rate.
Results. We analyzed 146 consecutive BC patients treated with subcutaneous BR, 117 therapeutic and 29 prophylactic mastectomies. Thirty-seven patients received postmastectomy RT. Significant factors related to acute toxicity were: previous RT (34.5% [RT] vs 8.5% [no RT]; p=0.001), BMI (31.3% [BMI ≥25] vs 8.8% [<25]; p=0.003), previous breast surgery (22.2% [surgery] vs 8.7% [no surgery]; p=0.027), and diabetes (100% [diabetes] vs 11.9% [no diabetes]; p=0.002). Factors significantly correlated to implant/prosthesis explant were: current or previous smoking exposition (13.8% [smokers] vs 2.6% [non-smokers]; p=0.029) and PST (18.8% [PST] vs 3.5% [no PST]; p=0.022); axillary lymph node dissection (ALND) was significantly related to late toxicity (5.7% [ALND] vs 0%; p=0.04). At a 3-year median follow up, three deaths, five locoregional recurrences (LRR), and fourteen distant metastasis (DM) occurred among 117 patients treated by therapeutic mastectomy. Overall survival was 78.1%, LRR free-survival was 95%, and DM free-survival was 71.6%. Postmastectomy RT was not significantly related to acute, late toxicity, and explant occurrence.
Conclusions. In our experience prepectoral subcutaneous implant-based BR is a safe and effective approach, with low rates of acute toxicity. Major risk factors were evidenced for patients previously treated with RT or surgery, and in case of diabetes or BMI ≥25; postmastectomy RT seems not to be related to higher rate of toxicity. ALND seems to be the only factor significantly related to late toxicity. PST, and smoking exposition were significantly associated with higher rate of implant/prosthesis explant. However, further investigations and mature follow-up are warranted to confirm these encouraging results.
Citation Format: Meattini I, Bernini M, Saieva C, Desideri I, Scotti V, Salvestrini V, Visani L, Mariotti M, Delli Paoli C, Olmetto E, Maragna V, Orzalesi L, Sanchez L, Nori J, Bianchi S, Livi L. Conservative breast reconstruction: Outcomes of 146 consecutive cases of prepectoral, subcutaneous implant-based breast reconstruction in a single-Institution series [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-07.
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Affiliation(s)
- I Meattini
- Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy
| | - M Bernini
- Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy
| | - C Saieva
- Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy
| | - I Desideri
- Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy
| | - V Scotti
- Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy
| | - V Salvestrini
- Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy
| | - L Visani
- Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy
| | - M Mariotti
- Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy
| | - C Delli Paoli
- Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy
| | - E Olmetto
- Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy
| | - V Maragna
- Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy
| | - L Orzalesi
- Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy
| | - L Sanchez
- Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy
| | - J Nori
- Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy
| | - S Bianchi
- Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy
| | - L Livi
- Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy
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Meattini I, Scotti V, Desideri I, Saieva C, Visani L, Salvestrini V, Cecchini S, De Feo ML, Mariotti M, Olmetto E, Delli Paoli C, Francolini G, Bernini M, Orzalesi L, Sanchez L, Nori J, Bianchi S, Livi L. Abstract P4-16-04: Oral ibandronate for osteopenic breast cancer patients receiving adjuvant aromatase inhibitors: secondary 5-year survival outcomes analysis of the single-center phase 2 BONADIUV trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-16-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background. Several randomized trials demonstrated aromatase inhibitors (AI) superiority in terms of disease-free survival (DFS) compared to tamoxifen treatment for postmenopausal hormone receptor-positive breast cancer (BC) patients. Anyway, AI toxicity profile is a concern due to estrogen suppression. Pivotal trials demonstrated a significant bone mineral density (BMD) loss due to AI, with a consistent 5-year risk of bone fractures, thus impacting on patients' quality of life. Bisphosphonates represent an effective treatment in postmenopausal osteoporosis fractures prevention. However, an adequate patient's selection for adjuvant bisphosphonates treatment during AI endocrine therapy is still a challenge. Final results of BONADIUV trial presented at San Antonio Breast cancer Symposium in 2016 showed that treatment with ibandronate, as compared to placebo, significantly improved BMD change in osteopenic women treated with adjuvant AI, and consistently protected patients' bone loss. We present the secondary 5-year analysis on survival outcomes of the trial.
Patients and methods. The BONADIUV trial is a single-blind, randomized, placebo-controlled phase 2 study designed to evaluate the impact of ibandronate treatment on BMD in osteopenic women taking AI. Between January 2011 and May 2014, 171 osteopenic patients (lumbar spine [LS] and/or trochanter -1< T-score <-2.5), were randomized in a 1:1 ratio to receive either placebo or oral monthly ibandronate (150 mg). Treatment duration was 2 years, with 6-months evaluation. Primary endpoint was the mean BMD difference between the two arms at a 2-year follow up. Secondary analysis on survival outcomes (overall survival [OS] and invasive DFS [iDFS]) have been performed at 5-year median follow-up time. ClinicalTrials.gov identifier: NCT02616744.
Results. At the database cutoff time for the present analysis on May 4, 2018, median follow up was 63.3 months (mean 61.2; range 2.7-87.3) for whole series, 64.9 months (range 33.8-84.0) for the placebo arm, and 62.2 months (range 24.2-87.3) for the ibandronate arm. Ten patients in the placebo group and 17 patients in the ibandronate group withdrew the allocated arm before any follow up data collection, and so were excluded from the analysis, performed on 144 patients (72 patients per arm). At the database cutoff time, the OS rate was 97.2% in the placebo group and 100% in the ibandronate arm. We observed four loco-regional relapse (three in the placebo arm, one in the ibandronate arm; p=0.33), three distant metastases (none in the placebo arm, three in the ibandronate arm; p=0.075), and three contralateral BC (one in the placebo arm, two in the ibandronate arm; p=0.65). The number of iDFS events did not differ between groups: four in the placebo group and six in the ibandronate group (p=0.56). Up to data cutoff, two deaths have occurred; none in the placebo arm and two in the ibandronate arm (p=0.15). The OS rate did not differ between arms.
Conclusions. The secondary analysis of survival outcomes showed no difference between arms in terms of OS and iDFS rates. Further large investigations and mature follow-up from the published ones are awaited.
Citation Format: Meattini I, Scotti V, Desideri I, Saieva C, Visani L, Salvestrini V, Cecchini S, De Feo ML, Mariotti M, Olmetto E, Delli Paoli C, Francolini G, Bernini M, Orzalesi L, Sanchez L, Nori J, Bianchi S, Livi L. Oral ibandronate for osteopenic breast cancer patients receiving adjuvant aromatase inhibitors: secondary 5-year survival outcomes analysis of the single-center phase 2 BONADIUV trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-16-04.
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Affiliation(s)
- I Meattini
- AOU Careggi Hospital - University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy; Onco-Hematology Unit - Policlinico San Marco-IOB, Zingonia, Bergamo, Italy; UOSD Diabetologia Endocrinologia, Ospedale S. Giuseppe, Empoli, Florence, Italy
| | - V Scotti
- AOU Careggi Hospital - University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy; Onco-Hematology Unit - Policlinico San Marco-IOB, Zingonia, Bergamo, Italy; UOSD Diabetologia Endocrinologia, Ospedale S. Giuseppe, Empoli, Florence, Italy
| | - I Desideri
- AOU Careggi Hospital - University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy; Onco-Hematology Unit - Policlinico San Marco-IOB, Zingonia, Bergamo, Italy; UOSD Diabetologia Endocrinologia, Ospedale S. Giuseppe, Empoli, Florence, Italy
| | - C Saieva
- AOU Careggi Hospital - University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy; Onco-Hematology Unit - Policlinico San Marco-IOB, Zingonia, Bergamo, Italy; UOSD Diabetologia Endocrinologia, Ospedale S. Giuseppe, Empoli, Florence, Italy
| | - L Visani
- AOU Careggi Hospital - University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy; Onco-Hematology Unit - Policlinico San Marco-IOB, Zingonia, Bergamo, Italy; UOSD Diabetologia Endocrinologia, Ospedale S. Giuseppe, Empoli, Florence, Italy
| | - V Salvestrini
- AOU Careggi Hospital - University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy; Onco-Hematology Unit - Policlinico San Marco-IOB, Zingonia, Bergamo, Italy; UOSD Diabetologia Endocrinologia, Ospedale S. Giuseppe, Empoli, Florence, Italy
| | - S Cecchini
- AOU Careggi Hospital - University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy; Onco-Hematology Unit - Policlinico San Marco-IOB, Zingonia, Bergamo, Italy; UOSD Diabetologia Endocrinologia, Ospedale S. Giuseppe, Empoli, Florence, Italy
| | - ML De Feo
- AOU Careggi Hospital - University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy; Onco-Hematology Unit - Policlinico San Marco-IOB, Zingonia, Bergamo, Italy; UOSD Diabetologia Endocrinologia, Ospedale S. Giuseppe, Empoli, Florence, Italy
| | - M Mariotti
- AOU Careggi Hospital - University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy; Onco-Hematology Unit - Policlinico San Marco-IOB, Zingonia, Bergamo, Italy; UOSD Diabetologia Endocrinologia, Ospedale S. Giuseppe, Empoli, Florence, Italy
| | - E Olmetto
- AOU Careggi Hospital - University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy; Onco-Hematology Unit - Policlinico San Marco-IOB, Zingonia, Bergamo, Italy; UOSD Diabetologia Endocrinologia, Ospedale S. Giuseppe, Empoli, Florence, Italy
| | - C Delli Paoli
- AOU Careggi Hospital - University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy; Onco-Hematology Unit - Policlinico San Marco-IOB, Zingonia, Bergamo, Italy; UOSD Diabetologia Endocrinologia, Ospedale S. Giuseppe, Empoli, Florence, Italy
| | - G Francolini
- AOU Careggi Hospital - University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy; Onco-Hematology Unit - Policlinico San Marco-IOB, Zingonia, Bergamo, Italy; UOSD Diabetologia Endocrinologia, Ospedale S. Giuseppe, Empoli, Florence, Italy
| | - M Bernini
- AOU Careggi Hospital - University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy; Onco-Hematology Unit - Policlinico San Marco-IOB, Zingonia, Bergamo, Italy; UOSD Diabetologia Endocrinologia, Ospedale S. Giuseppe, Empoli, Florence, Italy
| | - L Orzalesi
- AOU Careggi Hospital - University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy; Onco-Hematology Unit - Policlinico San Marco-IOB, Zingonia, Bergamo, Italy; UOSD Diabetologia Endocrinologia, Ospedale S. Giuseppe, Empoli, Florence, Italy
| | - L Sanchez
- AOU Careggi Hospital - University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy; Onco-Hematology Unit - Policlinico San Marco-IOB, Zingonia, Bergamo, Italy; UOSD Diabetologia Endocrinologia, Ospedale S. Giuseppe, Empoli, Florence, Italy
| | - J Nori
- AOU Careggi Hospital - University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy; Onco-Hematology Unit - Policlinico San Marco-IOB, Zingonia, Bergamo, Italy; UOSD Diabetologia Endocrinologia, Ospedale S. Giuseppe, Empoli, Florence, Italy
| | - S Bianchi
- AOU Careggi Hospital - University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy; Onco-Hematology Unit - Policlinico San Marco-IOB, Zingonia, Bergamo, Italy; UOSD Diabetologia Endocrinologia, Ospedale S. Giuseppe, Empoli, Florence, Italy
| | - L Livi
- AOU Careggi Hospital - University of Florence, Florence, Italy; Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy; Onco-Hematology Unit - Policlinico San Marco-IOB, Zingonia, Bergamo, Italy; UOSD Diabetologia Endocrinologia, Ospedale S. Giuseppe, Empoli, Florence, Italy
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Desideri I, Meattini I, Becherini C, Francolini G, Scotti V, Olmetto E, Perna M, Topulli J, Livi L. Abstract P3-12-09: Dosimetric analysis of the pattern of local recurrence in breast cancer patients undergoing breast reconstruction and post-mastectomy radiotherapy. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-12-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
This study aims to identify spatial and dosimetric patterns of breast cancer relapse in a mono-institutional large series of patients treated with mastectomy and various forms of breast reconstruction.
Material and Methods
We retrospectively reviewed 196 patients with Stage II-III breast cancer treated with modified radical mastectomy between 1995 and 2016 at the Radiotherapy Department of Careggi Hospital, Florence. All patients performed Skin-sparing mastectomy or nipple-sparing mastectomy with immediate or delayed breast reconstruction and subsequently received post-mastectomy radiotherapy (PMRT). Systemic therapy was prescribed as per local and international guidelines both in neoadjuvant and adjuvant setting. All patients were treated with 3DCRT technique. Diagnostic imaging (e.g. CT, MRI) obtained at recurrence were registered with the original planning computed tomography (pCT) for the dosimetric analysis. Recurrence gross tumor volume (rGTV) were delineated and co-registered with pCT. All rGTV were compared dosimetrically to planned dose and spatially with planning target volumes. Locoregional recurrence (LR) were divided in three categories relative to the high dose region, 95% of prescription dose (D95%). We defined “in field LR” those with more than 90% of their volume within D95% region,“marginal LR” when recurrence volume was between 20 and 90% within D95% and “outfield LR” those with less than 20% of their volume D95%.
Results
The median age was 49 years (range, 26 - 83 years).163 women (83 %) were classified as stage III; 118 women (60 %) had more than three positive axillary nodes. The majority of lesions were estrogen receptor positive ( 75 %), grade 3 (52%) ,with the presence of LVI (60 %). Adjuvant RT at chest wall were performed in all patients, most of whom underwent a RT of chest wall +infra- supraclavicular nodes (71%).Prescribed RT dose was 50 Gy in 25 fractions. With a median follow-up of 60 months (range, 12-240 months), 22 (11%) patients experienced a locoregional relapse: 10 patients in the chest wall; 7 in ipsilateral axillary region +/- chest wall; 3 in internal mammary nodes -/+ chest wall; one locoregional relapse was observed in the supraclavicular nodes. Most of relapses were G3 (75%) with documented LVI (79%). The topographic analysis of the local failure patterns showed: thirteen (59 %) were “in-field LR”; 9 (41%) were “out-field LR” . For the spatial analysis, all relapses on the chest wall were observed above the breast tissue expander or mammary prosthesis. Free time from recurrence disease was 30 months (range 5-86 months).
Conclusion
This study suggests that chest wall recurrences are rare after PMRT and are related to biologic aggressiveness of the disease than to inadequate irradiation of target volumes. Prospective studies are warranted to evaluate the relationship between treatment volumes and patterns of recurrences in order to refine new delineation guidelines for women undergoing PMRT and breast reconstruction.
Citation Format: Desideri I, Meattini I, Becherini C, Francolini G, Scotti V, Olmetto E, Perna M, Topulli J, Livi L. Dosimetric analysis of the pattern of local recurrence in breast cancer patients undergoing breast reconstruction and post-mastectomy radiotherapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-09.
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Affiliation(s)
| | | | | | | | - V Scotti
- University of Florence, Florence, Italy
| | - E Olmetto
- University of Florence, Florence, Italy
| | - M Perna
- University of Florence, Florence, Italy
| | - J Topulli
- University of Florence, Florence, Italy
| | - L Livi
- University of Florence, Florence, Italy
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Detti B, Baki M, Becherini C, Saieva C, Scartoni D, Giacomelli I, Trombetta L, Muntoni C, Olmetto E, Francolini G, Turkaj A, Topulli J, Ciabatti C, Carta G, Poggesi L, Delli Paoli C, Terziani F, Grassi R, Livi L. High-dose intensity-modulated radiation therapy as primary treatment of prostate cancer: genitourinary/gastrointestinal toxicity and outcomes, a single-institution experience. Radiol Med 2019; 124:422-431. [PMID: 30607866 DOI: 10.1007/s11547-018-0977-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/05/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Prostatectomy, radiotherapy and watchful waiting are the main therapeutic options available for local stage of prostate cancer (PCa). We report our experience on 394 patients affected by prostate cancer primarily treated with high-dose, image-guided, IMRT, focusing on gastrointestinal, genitourinary toxicities and biochemical control. METHODS From July 2003 to August 2014, 394 patients were treated with radical high-dose radiotherapy (HDRT) for prostate cancer; the mean total radiation dose was 79 Gy in standard fractions. Hormonal therapy (HT) was administered to 7.6% of low-risk patients, to 20.3% of intermediate-risk patients and to 72% of high-risk patients. Patients were evaluated for biochemical failure, local recurrence (LR) and metastases. RESULTS Ninety-seven patients (26.65%) developed acute GU toxicity at the medium dose of 25.4 Gy, grade 1 (G1) or grade 2 (G2) in 94 cases. Only 16 patients (4.06%) reported chronic GU toxicity (G1 or G2), and one case developed G3 cystitis. No G3 GI acute and late toxicity were detected. Fifty-six (14.2%) patients experienced LR, 26 (6.6%) developed metastases and 70 patients (17.8%) were deceased. Gleason sum score > 7 was predictive for worse overall survival (GS = 7 was borderline) and for metastasis. No factors resulted predictive for local relapse. HT pre-RT had been demonstrated as a negative predictor for OS and DFS-DM. CONCLUSIONS Data confirm the safety of HDRT for PCa. Treatment was efficient with low toxicity profile. Moreover, continued technologic advancements, as image-guided radiotherapy, could lead to further reduction in toxicity, thus increasing the therapeutic index.
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Affiliation(s)
- Beatrice Detti
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Muhammed Baki
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Carlotta Becherini
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Calogero Saieva
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), University of Florence, Florence, Italy
| | - Daniele Scartoni
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Irene Giacomelli
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Laura Trombetta
- Department of Radiation Oncology, University of Florence, Florence, Italy.
| | - Cristina Muntoni
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Emanuela Olmetto
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Giulio Francolini
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Ana Turkaj
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Juliana Topulli
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Cinzia Ciabatti
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Giulio Carta
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Linda Poggesi
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | | | - Francesca Terziani
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Roberta Grassi
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Radiation Oncology, University of Florence, Florence, Italy
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Bonomo P, Merlotti A, Olmetto E, Bianchi A, Desideri I, Bacigalupo A, Franco P, Franzese C, Orlandi E, Livi L, Caini S. What is the prognostic impact of FDG PET in locally advanced head and neck squamous cell carcinoma treated with concomitant chemo-radiotherapy? A systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 2018; 45:2122-2138. [PMID: 29948105 PMCID: PMC6182396 DOI: 10.1007/s00259-018-4065-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/10/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE Evidence is conflicting on the prognostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in head and neck squamous cell carcinoma. The aim of our study was to determine the impact of semiquantitative and qualitative metabolic parameters on the outcome in patients managed with standard treatment for locally advanced disease. METHODS A systematic review of the literature was conducted. A meta-analysis was performed of studies providing estimates of relative risk (RR) for the association between semiquantitative metabolic parameters and efficacy outcome measures. RESULTS The analysis included 25 studies, for a total of 2,223 subjects. The most frequent primary tumour site was the oropharynx (1,150/2,223 patients, 51.7%). According to the available data, the majority of patients had stage III/IV disease (1,709/1,799, 94.9%; no information available in four studies) and were treated with standard concurrent chemoradiotherapy (1,562/2,009 patients, 77.7%; only one study without available information). A total of 11, 8 and 4 independent studies provided RR estimates for the association between baseline FDG PET metrics and overall survival (OS), progression-free survival (PFS) and locoregional control (LRC), respectively. High pretreatment metabolic tumour volume (MTV) was significantly associated with a worse OS (summary RR 1.86, 95% CI 1.08-3.21), PFS (summary RR 1.81, 95% CI 1.14-2.89) and LRC (summary RR 3.49, 95% CI 1.65-7.35). Given the large heterogeneity (I2 > 50%) affecting the summary measures, no cumulative threshold for an unfavourable prognosis could be defined. No statistically significant association was found between SUVmax and any of the outcome measures. CONCLUSION FDG PET has prognostic relevance in the context of locally advanced head and neck squamous cell carcinoma. Pretreatment MTV is the only metabolic variable with a significant impact on patient outcome. Because of the heterogeneity and the lack of standardized methodology, no definitive conclusions on optimal cut-off values can be drawn.
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Affiliation(s)
- Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero - Universitaria Careggi, University of Florence, largo Brambilla 3, 50134, Florence, Italy.
| | - A Merlotti
- Radiation Oncology, Azienda Ospedaliera S.Croce e Carle, Cuneo, Italy
| | - E Olmetto
- Radiation Oncology, Azienda Ospedaliero - Universitaria Careggi, University of Florence, largo Brambilla 3, 50134, Florence, Italy
| | - A Bianchi
- Nuclear Medicine Department, Azienda Ospedaliera S.Croce e Carle, Cuneo, Italy
| | - I Desideri
- Radiation Oncology, Azienda Ospedaliero - Universitaria Careggi, University of Florence, largo Brambilla 3, 50134, Florence, Italy
| | - A Bacigalupo
- Radiation Oncology Department, Ospedale Policlinico San Martino, Genoa, Italy
| | - P Franco
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - C Franzese
- Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy
| | - E Orlandi
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Livi
- Radiation Oncology, Azienda Ospedaliero - Universitaria Careggi, University of Florence, largo Brambilla 3, 50134, Florence, Italy
| | - S Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy
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Scotti V, Bruni A, Francolini G, Perna M, Vasilyeva P, Loi M, Simontacchi G, Viggiano D, Lanfranchi B, Gonfiotti A, Topulli J, Olmetto E, Maragna V, Ferrari K, Bonti V, Comin C, Balduzzi S, D'Amico R, Lohr F, Voltolini L, Livi L. Stereotactic Ablative Radiotherapy as an Alternative to Lobectomy in Patients With Medically Operable Stage I NSCLC: A Retrospective, Multicenter Analysis. Clin Lung Cancer 2018; 20:e53-e61. [PMID: 30348595 DOI: 10.1016/j.cllc.2018.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 05/14/2018] [Revised: 09/02/2018] [Accepted: 09/04/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Stereotactic ablative body radiation therapy (SBRT) has evolved as the standard treatment for patients with inoperable stage I non-small-cell lung cancer (NSCLC). We report the results of a retrospective analysis conducted on a large, well-controlled cohort of patients with stage I to II NSCLC who underwent lobectomy (LOB) or SBRT. MATERIALS AND METHODS One hundred eighty-seven patients with clinical-stage T1a-T2bNoMO NSCLC were treated in 2 academic hospitals between August 2008 and May 2015. Patients underwent LOB or SBRT; those undergoing SBRT were sub-classified as surgical candidates and nonsurgical candidates, according to the presence of surgical contraindications or comorbidities. RESULTS In univariate analysis, no significant difference was found in local control between patients who underwent SBRT and LOB, with a trend in favor of surgery (hazard ratio [HR], 0.27; 95% confidence interval [CI], 0.07-1.01; P < .053). Univariate analysis showed that overall survival (OS) was significantly better in patients who underwent LOB (HR, 0.44; 95% CI, 0.23-0.85) with a 3-year OS of 73.4% versus 65.2% for surgery and radiation therapy patients, respectively (P < .01). However, no difference in OS was observed between operable patients undergoing SBRT and patients who underwent LOB (HR, 1.68; 95% CI, 0.72-3.90). Progression-free survival was comparable between patients who underwent LOB and SBRT (HR, 0.61; P = .09). CONCLUSION SBRT is a valid therapeutic approach in early-stage NSCLC. Furthermore, SBRT seems to be very well-tolerated and might lead to the same optimal locoregional control provided by surgery for patients with either operable or inoperable early-stage NSCLC.
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Affiliation(s)
- Vieri Scotti
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Alessio Bruni
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Giulio Francolini
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Marco Perna
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Polina Vasilyeva
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Mauro Loi
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Gabriele Simontacchi
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy
| | | | - Biancaluisa Lanfranchi
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | | | - Juljana Topulli
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Emanuela Olmetto
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy.
| | - Virginia Maragna
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Katia Ferrari
- Section of Respiratory Medicine, Careggi University Hospital, Florence, Italy
| | - Viola Bonti
- Section of Respiratory Medicine, Careggi University Hospital, Florence, Italy
| | - Camilla Comin
- Department of Pathology, Careggi University Hospital, Florence, Italy
| | - Sara Balduzzi
- Department of Diagnostic, Clinical and Public Health Medicine, Modena and Reggio Emilia University Hospital, Modena, Italy
| | - Roberto D'Amico
- Department of Maternal-Infant and Adult Medical and Surgical Sciences, Research and Innovation Area, Modena and Reggio Emilia University Hospital, Modena, Italy
| | - Frank Lohr
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Luca Voltolini
- Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Livi
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy
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Loi M, Desideri I, Olmetto E, Francolini G, Greto D, Bonomo P, Simontacchi G, Di Brina L, Meattini I, Livi L. BRCA mutation in breast cancer patients: Prognostic impact and implications on clinical management. Breast J 2018; 24:1019-1023. [PMID: 30066348 DOI: 10.1111/tbj.13100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/08/2017] [Accepted: 06/08/2017] [Indexed: 11/29/2022]
Abstract
BRCA1/2 mutations are involved in breast cancer (BC) susceptibility but their influence on outcome is unclear. We reviewed BC patients tested for BRCA to determine biological features and influence on outcome. BRCA-1 was correlated to younger age (P = 0.035), nodal involvement (P = 0.030), higher tumor grade (P = 0.0022) and Ki-67 (P = 0.014), ER/PgR negative status (P = 0.00042 and 0.0091, respectively), and use of adjuvant chemotherapy (P = 0.000038); BRCA was neither predictive for chemotherapy administration nor resulted in impaired outcome or occurrence of secondary BC. BRCA status did not influence outcome despite higher biological aggressiveness and younger age at presentation.
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Affiliation(s)
- Mauro Loi
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Isacco Desideri
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Emanuela Olmetto
- Radiotherapy Department, University of Florence, Florence, Italy
| | | | - Daniela Greto
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Pierluigi Bonomo
- Radiotherapy Department, University of Florence, Florence, Italy
| | | | - Lucia Di Brina
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Icro Meattini
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiotherapy Department, University of Florence, Florence, Italy
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Carmignani I, Locatello LG, Desideri I, Bonomo P, Olmetto E, Livi L, Le Saec O, Coscarelli S, Mannelli G. Analysis of dysphagia in advanced-stage head-and-neck cancer patients: impact on quality of life and development of a preventive swallowing treatment. Eur Arch Otorhinolaryngol 2018; 275:2159-2167. [PMID: 29978259 DOI: 10.1007/s00405-018-5054-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/02/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Swallowing and voice dysfunctions are common side effects following head-and-neck squamous-cell carcinoma (HNSCC) treatment. Our aim was to analyze the relationships between quality of life, swallowing, and phonatory problems in patients with an advanced-stage HNSCC and to prospectively evaluate the effects of a prophylactic swallowing program. METHODS First, we retrospectively studied 60 advanced HNSCC patients treated with exclusive or adjuvant radiotherapy/chemoradiotherapy (RT/CRT). Subjects were classified according to general and clinical-therapeutic features. Outcome measures included EORTC QLQ-C30, EORTC QLQ-H&N35, Dysphagia Handicap Index (DHI), M.D.Anderson Dysphagia Inventory (MDADI), and Voice Handicap Index (VHI). Then, we conducted a prospective evaluation of a prophylactic swallowing counselling in 12 consecutive advanced-stage HNSCC patients by a two-arm case-control analysis. These patients were treated with exclusive or adjuvant RT/CRT. RESULTS 71% of the retrospective population studied reported swallowing dysfunction as a major side effect. No differences were detected in the severity of dysphagia or dysphonia according to type of treatment or staging of the primary tumour, while hypopharyngeal and laryngeal cancer patients showed significantly better swallowing ability and better QoL compared to oral cavity and oropharyngeal localisation (p < 0.05). In addition, a relevant correlation between swallowing and voice problems emerged (p < 0.05). In the prospective part, while no statistical correlation was evident before the start of RT/CRT in the experimental group compared to the control one, the former showed better performances at MDADI (p = 0.006) and DHI (p = 0.002) test 3 months after its end. CONCLUSION Dysphagia is both an acute-and-long-term side effect which greatly affects QoL of HNSCC patients undergoing multimodality treatment. Our data show that a prophylactic swallowing program could actually produce a beneficial effect on patients' outcomes. LEVEL OF EVIDENCE 1b and 2b.
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Affiliation(s)
- Ilaria Carmignani
- Otorhinolaryngology-Head and Neck Surgery Unit, Department of Surgery and Translational Medicine, University of Florence, AOU-Careggi, Via Largo Palagi 1, 50134, Florence, Italy
| | - Luca Giovanni Locatello
- Otorhinolaryngology-Head and Neck Surgery Unit, Department of Surgery and Translational Medicine, University of Florence, AOU-Careggi, Via Largo Palagi 1, 50134, Florence, Italy
| | - Isacco Desideri
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Emanuela Olmetto
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Odile Le Saec
- Phoniatrics Unit, University Hospital Careggi, Florence, Italy
| | | | - Giuditta Mannelli
- Otorhinolaryngology-Head and Neck Surgery Unit, Department of Surgery and Translational Medicine, University of Florence, AOU-Careggi, Via Largo Palagi 1, 50134, Florence, Italy.
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Loi M, Incrocci L, Desideri I, Bonomo P, Detti B, Simontacchi G, Greto D, Olmetto E, Francolini G, Meattini I, Livi L. Prognostic impact of nodal relapse in definitive prostate-only irradiation. Radiol Med 2018; 123:631-637. [PMID: 29651712 DOI: 10.1007/s11547-018-0888-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 08/23/2017] [Accepted: 04/05/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Whole pelvic irradiation in prostate cancer patients might prevent metastatic spread of cancer cells through lymphatic drainages in patients eligible for definitive radiotherapy, but its use has declined in the last decades in favor of prostate-only irradiation (POI). The aim of our study is to assess the incidence of pelvic lymph nodal relapse and outcome in prostate cancer patients receiving POI. MATERIALS AND METHODS Data from 207 consecutive patients were collected. Clinical and treatment variables were collected. Biochemical relapse-free survival (BRFS), pelvic nodal relapse-free survival (PNRFS), distant metastasis-free survival (DMFS), disease-specific survival (DSS) and overall survival (OS) were calculated; analysis of prognostic variables was performed. RESULTS Five-year BRFS, PNRFS, DMFS, DSS and OS were, respectively, 90, 98, 96, 97 and 91%. On multivariate analysis, independent negative predictors of BRFS were Gleason score ≥ 7 (HR: 3.25) and PSA nadir ≥ 0.08 (HR: 4.86). Pelvic nodal relapse was not correlated to impaired outcome. CONCLUSIONS Lymph nodal pelvic relapse occurs in 2% of patients at 5 years and does not correlate with impaired outcome, suggesting the lack of theoretical benefit of a prophylactic nodal irradiation. Tumor biology and response to treatment are the main determinants of outcome.
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Affiliation(s)
- Mauro Loi
- Radiation Oncology Unit, University of Florence, L.go brambilla 3, Florence, Italy.
- Radiotherapy Department, Erasmus MC Hospital, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands.
| | - Luca Incrocci
- Radiotherapy Department, Erasmus MC Hospital, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands
| | - Isacco Desideri
- Radiation Oncology Unit, University of Florence, L.go brambilla 3, Florence, Italy
| | - Pierluigi Bonomo
- Radiation Oncology Unit, University of Florence, L.go brambilla 3, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, University of Florence, L.go brambilla 3, Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit, University of Florence, L.go brambilla 3, Florence, Italy
| | - Daniela Greto
- Radiation Oncology Unit, University of Florence, L.go brambilla 3, Florence, Italy
| | - Emanuela Olmetto
- Radiation Oncology Unit, University of Florence, L.go brambilla 3, Florence, Italy
| | - Giulio Francolini
- Radiation Oncology Unit, University of Florence, L.go brambilla 3, Florence, Italy
| | - Icro Meattini
- Radiation Oncology Unit, University of Florence, L.go brambilla 3, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, University of Florence, L.go brambilla 3, Florence, Italy
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Meattini I, Pasinetti N, Meduri B, De Rose F, De Santis M, Lancellotta V, Rossi F, Franco P, Alongi F, Saieva C, Olmetto E, Desideri I, D'Angelo E, Triggiani L, Ricardi U, Bastiani P, Aristei C, Lozza L, Scorsetti M, Livi L. OC-0160: DCIS treated with breast conservative surgery and radiotherapy: a national multicentre experience. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30470-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Meattini I, Bernini M, Casella D, Maragna V, Sordi S, Desideri I, Gaggelli I, Dominici L, Fausto A, Delli Paoli C, Olmetto E, Francolini G, Loi M, Scotti V, Greto D, Bonomo P, Simontacchi G, Nori J, Bianchi S, Livi L. EP-1299: Postmastectomy radiation therapy after subcutaneous direct-to-implant breast reconstruction. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31609-8] [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: 10/14/2022]
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42
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Vernaleone M, Bonomo P, Di Cataldo V, Masi L, Desideri I, Greto D, Francolini G, Visani L, Olmetto E, Terziani F, Livi L. EP-1448: Robotic SBRT on liver lesions in oligometastatic CRC patients: a single center experience. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31757-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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43
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Bonomo P, Loi M, Desideri I, Olmetto E, Delli Paoli C, Terziani F, Greto D, Mangoni M, Scoccianti S, Simontacchi G, Francolini G, Meattini I, Caini S, Livi L. Incidence of skin toxicity in squamous cell carcinoma of the head and neck treated with radiotherapy and cetuximab: A systematic review. Crit Rev Oncol Hematol 2017; 120:98-110. [DOI: 10.1016/j.critrevonc.2017.10.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 09/28/2017] [Accepted: 10/29/2017] [Indexed: 12/27/2022] Open
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Bonomo P, Desideri I, Loi M, Lo Russo M, Olmetto E, Maragna V, Francolini G, Delli Paoli C, Grassi R, Pezzulla D, Greto D, Meattini I, Livi L. Elderly patients affected by head and neck squamous cell carcinoma unfit for standard curative treatment: Is de-intensified, hypofractionated radiotherapy a feasible strategy? Oral Oncol 2017; 74:142-147. [DOI: 10.1016/j.oraloncology.2017.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/01/2017] [Accepted: 10/04/2017] [Indexed: 12/22/2022]
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Detti B, D'Angelillo RM, Ingrosso G, Olmetto E, Francolini G, Triggiani L, Bruni A, Borghesi S, Fondelli S, Carfagno T, Santini R, Santoni R, Trodella LE, Livi L. Combining Abiraterone and Radiotherapy in Prostate Cancer Patients Who Progressed During Abiraterone Therapy. Anticancer Res 2017; 37:3717-3722. [PMID: 28668865 DOI: 10.21873/anticanres.11744] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM This multicenter, retrospective, 'field-practice' study investigated treatment outcomes of ongoing abiraterone therapy with the addition of radiotherapy (RT) - initiated for oligoprogression or with a palliative intent. PATIENTS AND METHODS Consecutive patients affected by metastatic castration-resistant prostate cancer (mCRPC) treated with abiraterone acetate were considered if they had received RT after the initiation of abiraterone treatment. RESULTS A total of 32 patients were enrolled in the study. Median duration of abiraterone treatment was 13.0 months (range=3.8-40.9 months). Median duration of abiraterone treatment before RT was 5.9 months (range=0.4-40.0 months), and 7.2 months after RT (range=0.1-29.7 months). Median progression-free survival (PFS) was 12.6 months (95%CI=10.5-14.7) from the initiation of abiraterone treatment. From RT administration, PFS was 9.6 months (95%CI=6.4-12.9). Median overall survival (OS) since abiraterone initiation was 18.9 months (95%CI=4.7-33.0). CONCLUSION RT prolongs abiraterone treatment in mCRPC patients leading to better clinical outcomes with this molecule.
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Affiliation(s)
- Beatrice Detti
- Department of Radiation Oncology, AOU Careggi, Florence, Italy
| | | | - Gianluca Ingrosso
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
| | | | | | - Luca Triggiani
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Alessio Bruni
- Department of Radiation Oncology, AOU Policlinico di Modena, Modena, Italy
| | - Simona Borghesi
- Department of Radiation Oncology, Ospedale San Donato Arezzo, Arezzo, Italy
| | - Simona Fondelli
- Department of Radiation Oncology, Azienda USL Toscana-Centro, Ospedale S. Maria Annunziata, Florence, Italy
| | - Tommaso Carfagno
- Department of Radiation Oncology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Roberto Santini
- Department of Radiation Oncology, Ospedale San Jacopo Pistoia, Pistoia, Italy
| | - Riccardo Santoni
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
| | - Luca E Trodella
- Department of Radiation Oncology, University Campus Bio-Medico di Roma, Rome, Italy
| | - Lorenzo Livi
- Department of Radiation Oncology, AOU Careggi, Florence, Italy
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Di Cataldo V, Simontacchi G, Detti B, Loi M, Bonomo P, Masi L, Doro R, Bonucci I, Cipressi S, Greto D, Mangoni M, Desideri I, Meattini I, Scoccianti S, Olmetto E, Muntoni C, Carta G, Livi L. EP-1350: Stereotactic re-irradiation for prostate cancer recurrence after upfront surgery and radiotherapy. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31785-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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47
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Loi M, Desideri I, Greto D, Mangoni M, Sottili M, Meattini I, Becherini C, Terziani F, Delli Paoli C, Olmetto E, Bonomo P, Livi L. Radiotherapy in the age of cancer immunology: Current concepts and future developments. Crit Rev Oncol Hematol 2017; 112:1-10. [PMID: 28325250 DOI: 10.1016/j.critrevonc.2017.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 07/18/2016] [Revised: 11/24/2016] [Accepted: 02/06/2017] [Indexed: 02/06/2023] Open
Abstract
Major advances in the knowledge of cancer biology and its interactions with tumor immune environment led to the emergence, in the last five years of new immunotherapy-based treatment strategies in cancer patients. At the same time, improvement in radiation technique and progress in radiobiology allowed in the last decade to expand the applications of radiotherapy in a growing number of settings. At present, there are strong theoretical basis to propose immune-enhanced radiation therapy that may represent in the future a new paradigm of treatment, combining the intrinsic power of radiotherapy to elicit a specific, systemic, tumor-directed immune response with modern highly conformal and precise dose delivery, in order to maximize response at the major site of disease and obtain durable disease control. The aim of this review is to describe the principal mechanisms of immune modulation of response to radiation and investigational strategies to harness the potential of radiation-inducible immune response: radiation therapy is expected to be not just a local treatment but the cornerstone of a multimodal strategy that might achieve long-lasting tumor remission at the primary site and systemic efficacy metastatic lesions.
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Affiliation(s)
- Mauro Loi
- Department of Radiation Oncology, University of Florence, Florence, Italy.
| | - Isacco Desideri
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Daniela Greto
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Monica Mangoni
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Mariangela Sottili
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Icro Meattini
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Carlotta Becherini
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Francesca Terziani
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | | | - Emanuela Olmetto
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Pierluigi Bonomo
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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Loi M, Olmetto E, Desideri I, Meattini I, Francolini G, Greto D, Bonomo P, Di Brina L, Becherini C, Muntoni C, Mangoni M, Livi L. BRCA1/2 mutation in breast cancer: biological aspects, patterns of care and impact on outcome in a monoinstitutional cohort. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30141-7] [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: 11/16/2022]
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49
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Mangoni M, Sottili M, Gerini C, Desideri I, Bastida C, Pallotta S, Castiglione F, Bonomo P, Meattini I, Greto D, Olmetto E, Terziani F, Becherini C, Delli Paoli C, Trombetta L, Loi M, Biti G, Livi L. A PPAR gamma agonist protects against oral mucositis induced by irradiation in a murine model. Oral Oncol 2016; 64:52-58. [PMID: 28024724 DOI: 10.1016/j.oraloncology.2016.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/17/2016] [Accepted: 11/28/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Due to its anti-inflammatory, antifibrotic and antineoplastic properties, the PPAR gamma agonist rosiglitazone is of interest in prevention and therapy of radiation-induced toxicities. We aimed to evaluate the radioprotective effect of rosiglitazone in a mouse model of radiation-induced oral mucositis. MATERIAL AND METHODS Oral mucositis was obtained by irradiation of the oral region of C57BL/6J mice, pretreated or not with rosiglitazone. Mucositis was assessed by macroscopic scoring, histology and molecular analysis. Tumor xenograft was obtained by s.c. injection of Hep-2 cells in CD1 mice. Tumor volume was measured twice a week to evaluate effect of rosiglitazone alone and combined with radiotherapy. RESULTS Irradiated mice showed typical features of oral mucositis, such as oedema and reddening, reaching the peak of damage after 12-15days. Rosiglitazone markedly reduced visible signs of mucositis and significantly reduced the peak. Histological analysis showed the presence of an inflammatory cell infiltrate after irradiation; the association with rosiglitazone noticeably reduced infiltration. Rosiglitazone significantly inhibited radiation-induced tnfα, Il-6 and Il-1β gene expression. Rosiglitazone controlled the increase of TGF-β and NF-kB p65 subunit proteins induced by irradiation, and enhanced the expression of catalase. Irradiation and rosiglitazone significantly reduced tumor volume as compared to control. Rosiglitazone did not protect tumor from the therapeutic effect of radiation. CONCLUSION Rosiglitazone exerted a protective action on normal tissues in radiation-induced mucositis. Moreover, it showed antineoplastic properties on head-neck carcinoma xenograft model and selective protection of normal tissues. Thus, PPAR gamma agonists should be further investigated as radioprotective agents in head and neck cancer.
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Affiliation(s)
- Monica Mangoni
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Mariangela Sottili
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy.
| | - Chiara Gerini
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Isacco Desideri
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Cinzia Bastida
- Medical Physic Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Stefania Pallotta
- Medical Physic Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Francesca Castiglione
- Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Pierluigi Bonomo
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Icro Meattini
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Daniela Greto
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Emanuela Olmetto
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Francesca Terziani
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Carlotta Becherini
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Camilla Delli Paoli
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Laura Trombetta
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Mauro Loi
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Giampaolo Biti
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Lorenzo Livi
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
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Detti B, Francolini G, Becherini C, Olmetto E, Giacomelli I, Scartoni D, Greto D, Baldazzi V, Simontacchi G, Meattini I, Livi L. Complete response in metastatic renal cell carcinoma after radiotherapy and everolimus: a clinical case and review of the literature. J Chemother 2016; 28:432-4. [PMID: 27376403 DOI: 10.1080/1120009x.2016.1173869] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We report the case of a man affected by renal cell carcinoma with vertebral metastases, who presented a radiological complete response after systemic treatment with everolimus.
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Affiliation(s)
- Beatrice Detti
- a Radioterapia , Azienda Ospedaliero-Universitaria Careggi , Florence , Italy
| | - Giulio Francolini
- a Radioterapia , Azienda Ospedaliero-Universitaria Careggi , Florence , Italy
| | - Carlotta Becherini
- a Radioterapia , Azienda Ospedaliero-Universitaria Careggi , Florence , Italy
| | - Emanuela Olmetto
- a Radioterapia , Azienda Ospedaliero-Universitaria Careggi , Florence , Italy
| | - Irene Giacomelli
- a Radioterapia , Azienda Ospedaliero-Universitaria Careggi , Florence , Italy
| | - Daniele Scartoni
- a Radioterapia , Azienda Ospedaliero-Universitaria Careggi , Florence , Italy
| | - Daniela Greto
- a Radioterapia , Azienda Ospedaliero-Universitaria Careggi , Florence , Italy
| | - Valentina Baldazzi
- a Radioterapia , Azienda Ospedaliero-Universitaria Careggi , Florence , Italy
| | | | - Icro Meattini
- a Radioterapia , Azienda Ospedaliero-Universitaria Careggi , Florence , Italy
| | - Lorenzo Livi
- a Radioterapia , Azienda Ospedaliero-Universitaria Careggi , Florence , Italy
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