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Orlandi E, Barcellini A, Vischioni B, Fiore MR, Vitolo V, Iannalfi A, Bonora M, Chalaszczyk A, Ingargiola R, Riva G, Ronchi S, Valvo F, Fossati P, Ciocca M, Mirandola A, Molinelli S, Pella A, Baroni G, Pullia MG, Facoetti A, Orecchia R, Licitra L, Vago G, Rossi S. The Role of Carbon Ion Therapy in the Changing Oncology Landscape-A Narrative Review of the Literature and the Decade of Carbon Ion Experience at the Italian National Center for Oncological Hadrontherapy. Cancers (Basel) 2023; 15:5068. [PMID: 37894434 PMCID: PMC10605728 DOI: 10.3390/cancers15205068] [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: 07/26/2023] [Revised: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Currently, 13 Asian and European facilities deliver carbon ion radiotherapy (CIRT) for preclinical and clinical activity, and, to date, 55 clinical studies including CIRT for adult and paediatric solid neoplasms have been registered. The National Center for Oncological Hadrontherapy (CNAO) is the only Italian facility able to accelerate both protons and carbon ions for oncological treatment and research. METHODS To summarise and critically evaluate state-of-the-art knowledge on the application of carbon ion radiotherapy in oncological settings, the authors conducted a literature search till December 2022 in the following electronic databases: PubMed, Web of Science, MEDLINE, Google Scholar, and Cochrane. The results of 68 studies are reported using a narrative approach, highlighting CNAO's clinical activity over the last 10 years of CIRT. RESULTS The ballistic and radiobiological hallmarks of CIRT make it an effective option in several rare, radioresistant, and difficult-to-treat tumours. CNAO has made a significant contribution to the advancement of knowledge on CIRT delivery in selected tumour types. CONCLUSIONS After an initial ramp-up period, CNAO has progressively honed its clinical, technical, and dosimetric skills. Growing engagement with national and international networks and research groups for complex cancers has led to increasingly targeted patient selection for CIRT and lowered barriers to facility access.
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Affiliation(s)
- Ester Orlandi
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Amelia Barcellini
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy
| | - Barbara Vischioni
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Maria Rosaria Fiore
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Viviana Vitolo
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Alberto Iannalfi
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Maria Bonora
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Agnieszka Chalaszczyk
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Rossana Ingargiola
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Giulia Riva
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Sara Ronchi
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Francesca Valvo
- Scientific Directorate, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Piero Fossati
- Department of Radiation Oncology, MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria
- Department for Basic and Translational Oncology and Haematology, Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
| | - Mario Ciocca
- Medical Physics Unit, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Alfredo Mirandola
- Medical Physics Unit, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Silvia Molinelli
- Medical Physics Unit, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Andrea Pella
- Bioengineering Unit, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Guido Baroni
- Bioengineering Unit, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Marco Giuseppe Pullia
- Radiobiology Unit, Research and Development Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Angelica Facoetti
- Radiobiology Unit, Research and Development Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Roberto Orecchia
- Scientific Directorate, IEO-European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Lisa Licitra
- Scientific Directorate, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
- Department of Head & Neck Medical Oncology 3, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
- Department of Oncology & Haemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Gianluca Vago
- Presidency, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
- School of Pathology, University of Milan, 20122 Milan, Italy
| | - Sandro Rossi
- General Directorate, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
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2
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Barcellini A, Vitolo V, Cobianchi L, Vanoli A, Butturini G, Brugnatelli S, Pagani A, Fossati P, Preda L, Peloso A, Klersy C, Facoetti A, Molinelli S, Ciocca M, Imparato S, Pecorilla M, Orlandi E, Valvo F. Preoperative Carbon Ion Radiotherapy (CIRT) with Chemotherapy in Resectable and Borderline Resectable Pancreatic Adenocarcinoma (PCa): A Multicenter Prospective Phase II Clinical Study (Pioppo Study NCT 03822936). Int J Radiat Oncol Biol Phys 2023; 117:e347-e348. [PMID: 37785206 DOI: 10.1016/j.ijrobp.2023.06.2417] [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) Preoperative chemoradiation and surgery may improve survival for resectable (Re) or borderline resectable (BRe) PCa. However, there is a lack of evidence regarding the feasibility of combined chemotherapy (CT) and CIRT in the neoadjuvant setting for Re/BRe PCa, especially in the Caucasian population. To assess the safety and efficacy of this challenging combination, we designed a prospective multicentric single-arm phase II trial MATERIALS/METHODS: PIOPPO trial was opened in September 2014. We prospectively treated patients with Re/BRe Pca with a neoadjuvant CT (3 cycles of FOLFIRINOX) and a short-course of CIRT (38.4 GyRBE, 8 fractions, 4 fractions per week) planned with 4D-imaging and delivered with breath-gating and rescanning. Four-6 weeks after CIRT patients (pts) received surgery followed by adjuvant-CT (FOLFIRINOX for 9 or gemcitabine for 6 cycles). After each step patients underwent a re-staging. The primary endpoint was Local Progression Free Survival (LPFS). RESULTS Fourteen (47%) of the foreseen 30 pts were evaluated for enrollment. There were 4 screening failures for duodenum infiltration. Ten Caucasian pts (M = 7; 70%; F = 3;30%) with a median age of 65.5 (range:46-76) started the treatment. There were four (40%) Re and 6 (60%) BRe Pca. 100% of the Re and 50% of BRe PCa completed the planned combined treatment for a total of 7 (70%) pts. Three (30%) pts developed systemic progression after CT and underwent palliative care (2 cases) or a second line of CT (1 case). With regards to toxicities, we recorded 2 (28.6%) cases of neutropenia during CT, none acute CIRT toxicity and one (14%) case of intra-operative ulceration of the gastro-enteric anastomosis. Moreover, we reported one (14%) case of fatal liver failure due to portal vein stenosis due to the combo approach (CT+CIRT+surgery). Six (86%) pts experienced Tumor Regression Grade (TRG) = 2 according to the College of American Pathologists (CAP) and 1 (14%) a TRG = 3. At the last follow-up, among pts who completed the scheme, 2 (28%) are currently alive and disease-free at 57 and 49 months, respectively. With a median follow-up of 13 months, the median LPFS was 9.4 months (range:4.9-57), with 1 case (14%) of systemic progression and 3 cases (43%) of local recurrence + systemic progression. The study was early closed due to low accrual in August 2022. CONCLUSION Although the small sample size limits the interpretation of the endpoints, a neoadjuvant approach combining CT and a short course of CIRT for resectable/borderline Pca seems feasible. Liver toxicity was similar to the Japanese series and needs to deepen investigation on the vascular dose constraints and surgical techniques. Considering the worse outcomes, a better selection of patients to treat also with a centralized imaging interpretation is mandatory.
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Affiliation(s)
- A Barcellini
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy; Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - V Vitolo
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - L Cobianchi
- General Surgery Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - A Vanoli
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - G Butturini
- Hepato Bilio Pancreatic Surgery Department "P. Pederzoli" Hospital, Peschiera del Garda, VR, Italy
| | - S Brugnatelli
- Medical Oncology Department, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Pagani
- Medical Oncology Department, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - P Fossati
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - L Preda
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Radiology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Peloso
- Department of Visceral and Transplantation Surgery, University of Geneva Hospitals, Geneva, GE, Switzerland
| | - C Klersy
- Clinical Epidemiology & Biometry Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - A Facoetti
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - S Molinelli
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - M Ciocca
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - S Imparato
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - M Pecorilla
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - E Orlandi
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - F Valvo
- National Centre of Oncological Hadrontherapy, Pavia, Italy
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3
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Mantello G, Galofaro E, Caravatta L, Di Carlo C, Montrone S, Arpa D, Chiloiro G, De Paoli A, Donato V, Gambacorta MA, Genovesi D, Lupattelli M, Macchia G, Montesi G, Niespolo RM, Palazzari E, Pontoriero A, Scricciolo M, Valvo F, Franco P. Pattern of care for re-irradiation in locally recurrent rectal cancer: a national survey on behalf of the AIRO gastrointestinal tumors study group. Radiol Med 2023:10.1007/s11547-023-01652-3. [PMID: 37365381 DOI: 10.1007/s11547-023-01652-3] [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: 12/19/2022] [Accepted: 05/25/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE Radical resection (R0) represents the best curative treatment for local recurrence (LR) rectal cancer. Re-irradiation (re-RT) can increase the rate of R0 resection. Currently, there is a lack of guidelines on Re-RT for LR rectal cancer. The Italian Association of Radiation and clinical oncology for gastrointestinal tumors (AIRO-GI) study group released a national survey to investigate the current clinical practice of external beam radiation therapy in these patients. MATERIAL AND METHODS In February 2021, the survey was designed and distributed to members of the GI working group. The questionnaire consisted of 40 questions regarding center characteristics, clinical indications, doses, and treatment techniques of re-RT for LR rectal cancer. RESULTS A total of 37 questionnaires were collected. Re-RT was reported as an option for neoadjuvant treatment in resectable and unresectable disease by 55% and 75% of respondents, respectively. Long-course treatment with 30-40 Gy (1.8-2 Gy/die, 1.2 Gy bid) and hypofractionated regimen of 30-35 Gy in 5 fractions were used in most centers. A total dose of 90-100 Gy as EqD2 dose (α/β = 5 Gy) was delivered by 46% of the respondents considering the previous treatment. Modern conformal techniques and daily image-guided radiation therapy protocols were used in 94% of centers. CONCLUSION Our survey showed that re-RT treatment is performed with advanced technology that allow a good management of LR rectal cancer. Significant variations were observed in terms of dose and fractionation, highlighting the need for a consensus on a common treatment strategy that could be validated in prospective studies.
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Affiliation(s)
- Giovanna Mantello
- Radiotherapy Department, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126, Ancona, Italy
| | - Elena Galofaro
- Radiotherapy Department, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126, Ancona, Italy.
| | - Luciana Caravatta
- Department of Radiation Oncology, SS Annunziata Hospital, Chieti, Italy
| | - Clelia Di Carlo
- Radiotherapy Department, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126, Ancona, Italy
| | | | - Donatella Arpa
- IRCCS Istituto Scientifico Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Radiotherapy Unit, Meldola, Italy
| | - Giuditta Chiloiro
- Departments of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonino De Paoli
- Division of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Vittorio Donato
- Radiation Oncology Division, Oncology and Speciality Medicine Department, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Domenico Genovesi
- Department of Radiation Oncology, SS Annunziata Hospital, Chieti, Italy
| | - Marco Lupattelli
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso, Italy
| | | | | | - Elisa Palazzari
- Division of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Antonio Pontoriero
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Melissa Scricciolo
- UOC di Radioterapia Oncologica Mestre, Ospedale dell'Angelo, Venice, Mestre, Italy
| | - Francesca Valvo
- Fondazione CNAO, National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Pierfrancesco Franco
- Department of Translational Medicine, Department of Radiation Oncology, Maggiore Della Carità University Hospital, University of Eastern Piedmont, Novara, Italy
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4
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Franco P, Porreca A, Mantello G, Valvo F, Gasparini L, Slim N, Manfrida S, De Felice F, Gerardi MA, Vagge S, Krengli M, Palazzari E, Osti MF, Gonnelli A, Catalano G, Pittoni P, Ivaldi GB, Lupattelli M, Rosetto ME, Niespolo RM, Guido A, Durante O, Macchia G, Munoz F, El Khouzai B, Lucido MR, Arcadipane F, Casadei Gardini A, Maria D'Angelillo R, Gambacorta MA, Genovesi D, Di Nicola M, Caravatta L. External validation of a composite bio-humoral index in anal cancer patients undergoing concurrent chemoradiation. Radiother Oncol 2022; 177:9-15. [PMID: 36273737 DOI: 10.1016/j.radonc.2022.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 09/25/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE A prognostic scoring system based on laboratory inflammation parameters, [Hemo-Eosinophils-Inflammation (HEI) index], including baseline hemoglobin level, the systemic inflammatory index and eosinophil count was recently proposed in patients with squamous cell carcinoma of the anus (ASCC). HEI was shown to discriminate disease-free (DFS) and overall (OS) survival in ASCC patients treated with concurrent chemoradiation (CRT). We tested the accuracy of the model on a multicentric cohort for external validation. MATERIALS AND METHODS Patients treated with CRT were enrolled. The Kaplan-Meier curves for DFS and OS based on HEI risk group were calculated and the log-rank test was used. Cox proportional hazards models were used to assess the prognostic factors for DFS and OS. The exponential of the regression coefficients provided an estimate of the hazard ratio (HR). For model discrimination, we determined Harrell's C-index, Gönen & Heller K Index and the explained variation on the log relative hazard scale. RESULTS A total of 877 patients was available. Proportional hazards were adjusted for age, gender, tumor-stage, and chemotherapy. Two-year DFS was 77 %(95 %CI:72.0-82.4) and 88.3 %(95 %CI:84.8-92.0 %) in the HEI high- and low- risk groups. Two-year OS was 87.8 %(95 %CI:83.7-92.0) and 94.2 %(95 %CI:91.5-97). Multivariate Cox proportional hazards model showed a HR = 2.02(95 %CI:1.25-3.26; p = 0.004) for the HEI high-risk group with respect to OS and a HR = 1.53(95 %CI:1.04-2.24; p = 0.029) for DFS. Harrel C-indexes were 0.68 and 0.66 in the validation dataset, for OS and DFS. Gonen-Heller K indexes were 0.67 and 0.71, respectively. CONCLUSION The HEI index proved to be a prognosticator in ASCC patients treated with CRT. Model discrimination in the external validation cohort was acceptable.
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Affiliation(s)
- Pierfrancesco Franco
- Division of Radiation Oncology, Department of Translational Medicine, University of Eastern Piedmont, and University Hospital "Maggiore della Carità", Novara, Italy.
| | - Annamaria Porreca
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.
| | - Giovanna Mantello
- Department of Oncology and Radiotherapy, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy.
| | - Francesca Valvo
- Radiotherapy Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy.
| | - Lucrezia Gasparini
- Radiation Oncology Unit, "SS Annunziata" Hospital, "G. d'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy.
| | - Najla Slim
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Stefania Manfrida
- "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario, 00168 Roma, Italy.
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
| | - Marianna A Gerardi
- Department of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy.
| | - Stefano Vagge
- Department of Radiation Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Marco Krengli
- Division of Radiation Oncology, Department of Translational Medicine, University of Eastern Piedmont, and University Hospital "Maggiore della Carità", Novara, Italy.
| | - Elisa Palazzari
- Radiation Oncology Department, Oncological Referral Center, Aviano, Italy.
| | - Mattia Falchetto Osti
- Unit of Radiation Oncology, Sant'Andrea Hospital, Sapienza University of Rome, 00100 Rome, Italy.
| | - Alessandra Gonnelli
- Department of Radiotherapy, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Gianpiero Catalano
- Radiation Oncology Center, IRCCS Multimedica, Sesto San Giovanni, Italy.
| | - Patrizia Pittoni
- Radiation Oncology Unit, Asst Lariana, Ospedale di Como, Como, Italy.
| | | | - Marco Lupattelli
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, 06156, Perugia, Italy.
| | | | | | - Alessandra Guido
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Oreste Durante
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
| | - Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy.
| | - Fernando Munoz
- Department of Radiotherapy, Azienda U. S. L. della Valle d'Aosta, 11100, Aosta, Italy.
| | - Badr El Khouzai
- Radiotherapy and Nuclear Medicine Unit, Veneto Institute of Oncology-IRCCS, Padova, Italy.
| | | | - Francesca Arcadipane
- Radiation Oncology, AOU Citta' della Salute e della Scienza, Presidio San Giovanni Antica Sede, Torino, Italy.
| | - Andrea Casadei Gardini
- Department of Medical Oncology, Università Vita-Salute, San Raffaele Hospital IRCCS, 20019 Milan, Italy.
| | - Rolando Maria D'Angelillo
- Radiation Oncology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Maria Antonietta Gambacorta
- "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario, 00168 Roma, Italy.
| | - Domenico Genovesi
- Radiation Oncology Unit, "SS Annunziata" Hospital, "G. d'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy; Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.
| | - Marta Di Nicola
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.
| | - Luciana Caravatta
- Radiation Oncology Unit, "SS Annunziata" Hospital, "G. d'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy.
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5
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Moglioni M, Kraan AC, Baroni G, Battistoni G, Belcari N, Berti A, Carra P, Cerello P, Ciocca M, De Gregorio A, De Simoni M, Del Sarto D, Donetti M, Dong Y, Embriaco A, Fantacci ME, Ferrero V, Fiorina E, Fischetti M, Franciosini G, Giraudo G, Laruina F, Maestri D, Magi M, Magro G, Malekzadeh E, Marafini M, Mattei I, Mazzoni E, Mereu P, Mirandola A, Morrocchi M, Muraro S, Orlandi E, Patera V, Pennazio F, Pullia M, Retico A, Rivetti A, Da Rocha Rolo MD, Rosso V, Sarti A, Schiavi A, Sciubba A, Sportelli G, Tampellini S, Toppi M, Traini G, Trigilio A, Valle SM, Valvo F, Vischioni B, Vitolo V, Wheadon R, Bisogni MG. In-vivo range verification analysis with in-beam PET data for patients treated with proton therapy at CNAO. Front Oncol 2022; 12:929949. [PMID: 36226070 PMCID: PMC9549776 DOI: 10.3389/fonc.2022.929949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Morphological changes that may arise through a treatment course are probably one of the most significant sources of range uncertainty in proton therapy. Non-invasive in-vivo treatment monitoring is useful to increase treatment quality. The INSIDE in-beam Positron Emission Tomography (PET) scanner performs in-vivo range monitoring in proton and carbon therapy treatments at the National Center of Oncological Hadrontherapy (CNAO). It is currently in a clinical trial (ID: NCT03662373) and has acquired in-beam PET data during the treatment of various patients. In this work we analyze the in-beam PET (IB-PET) data of eight patients treated with proton therapy at CNAO. The goal of the analysis is twofold. First, we assess the level of experimental fluctuations in inter-fractional range differences (sensitivity) of the INSIDE PET system by studying patients without morphological changes. Second, we use the obtained results to see whether we can observe anomalously large range variations in patients where morphological changes have occurred. The sensitivity of the INSIDE IB-PET scanner was quantified as the standard deviation of the range difference distributions observed for six patients that did not show morphological changes. Inter-fractional range variations with respect to a reference distribution were estimated using the Most-Likely-Shift (MLS) method. To establish the efficacy of this method, we made a comparison with the Beam’s Eye View (BEV) method. For patients showing no morphological changes in the control CT the average range variation standard deviation was found to be 2.5 mm with the MLS method and 2.3 mm with the BEV method. On the other hand, for patients where some small anatomical changes occurred, we found larger standard deviation values. In these patients we evaluated where anomalous range differences were found and compared them with the CT. We found that the identified regions were mostly in agreement with the morphological changes seen in the CT scan.
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Affiliation(s)
- Martina Moglioni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | - Aafke Christine Kraan
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- *Correspondence: Aafke Christine Kraan,
| | - Guido Baroni
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
- Politecnico di Milano, Milano, Italy
| | | | - Nicola Belcari
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | - Andrea Berti
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, Pisa, Italy
- Istituto di Scienza e Tecnologie dell’Informazione, Consiglio Nazionale delle Ricerche, Pisa, Italy
| | - Pietro Carra
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | | | - Mario Ciocca
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Angelica De Gregorio
- Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
| | - Micol De Simoni
- Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
| | - Damiano Del Sarto
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | - Marco Donetti
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Yunsheng Dong
- Istituto Nazionale di Fisica Nucleare, Sezione di Milano, Milano, Italy
- Dipartimento di Fisica, Università di Milano, Milano, Italy
| | - Alessia Embriaco
- Istituto Nazionale di Fisica Nucleare, Sezione di Pavia, Pavia, Italy
| | - Maria Evelina Fantacci
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | - Veronica Ferrero
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | - Elisa Fiorina
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | - Marta Fischetti
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Universit `a di Roma, Roma, Italy
| | - Gaia Franciosini
- Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
| | - Giuseppe Giraudo
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | - Francesco Laruina
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | - Davide Maestri
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Marco Magi
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Universit `a di Roma, Roma, Italy
| | - Giuseppe Magro
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Etesam Malekzadeh
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
- Department of Medical Physics, Tarbiat Modares University, Teheran, Iran
| | - Michela Marafini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
- Museo Storico della Fisica e Centro Studi e Ricerche “E. Fermi”, Roma, Italy
| | - Ilaria Mattei
- Istituto Nazionale di Fisica Nucleare, Sezione di Milano, Milano, Italy
| | - Enrico Mazzoni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
| | - Paolo Mereu
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | | | - Matteo Morrocchi
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | - Silvia Muraro
- Istituto Nazionale di Fisica Nucleare, Sezione di Milano, Milano, Italy
| | - Ester Orlandi
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Vincenzo Patera
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Universit `a di Roma, Roma, Italy
| | | | - Marco Pullia
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | | | - Angelo Rivetti
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | | | - Valeria Rosso
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | - Alessio Sarti
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Universit `a di Roma, Roma, Italy
| | - Angelo Schiavi
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Universit `a di Roma, Roma, Italy
| | - Adalberto Sciubba
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Universit `a di Roma, Roma, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione dei Laboratori di Frascati, Frascati, Italy
| | - Giancarlo Sportelli
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | | | - Marco Toppi
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Universit `a di Roma, Roma, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione dei Laboratori di Frascati, Frascati, Italy
| | - Giacomo Traini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
- Museo Storico della Fisica e Centro Studi e Ricerche “E. Fermi”, Roma, Italy
| | - Antonio Trigilio
- Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
| | | | | | | | - Viviana Vitolo
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Richard Wheadon
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | - Maria Giuseppina Bisogni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, Pisa, Italy
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6
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Balosso J, Febvey-Combes O, Iung A, Lozano H, Alloh AS, Cornu C, Hervé M, Akkal Z, Lièvre M, Plattner V, Valvo F, Bono C, Fiore MR, Vitolo V, Vischioni B, Patin S, Allemand H, Gueyffier F, Margier J, Guerre P, Chabaud S, Orecchia R, Pommier P. A randomized controlled phase III study comparing hadrontherapy with carbon ions versus conventional radiotherapy - including photon and proton therapy - for the treatment of radioresistant tumors: the ETOILE trial. BMC Cancer 2022; 22:575. [PMID: 35606739 PMCID: PMC9128242 DOI: 10.1186/s12885-022-09564-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some cancers such as sarcomas (bone and soft tissue sarcomas) and adenoid cystic carcinomas are considered as radioresistant to low linear energy transfer radiation (including photons and protons) and may therefore beneficiate from a carbon ion therapy. Despite encouraging results obtained in phase I/II trials compared to historical data with photons, the spread of carbon ions has been limited mainly because of the absence of randomized medical data. The French health authorities stressed the importance of having randomized data for carbon ion therapy. METHODS The ETOILE study is a multicenter prospective randomized phase III trial comparing carbon ion therapy to either advanced photon or proton radiotherapy for inoperable or macroscopically incompletely resected (R2) radioresistant cancers including sarcomas and adenoid cystic carcinomas. In the experimental arm, carbon ion therapy will be performed at the National Center for Oncological Hadrontherapy (CNAO) in Pavia, Italy. In the control arm, photon or proton radiotherapy will be carried out in referent centers in France. The primary endpoint is progression-free survival (PFS). Secondary endpoints are overall survival and local control, toxicity profile, and quality of life. In addition, a prospective health-economic study and a radiobiological analysis will be conducted. To demonstrate an absolute improvement in the 5-year PFS rate of 20% in favor of carbon ion therapy, 250 patients have to be included in the study. DISCUSSION So far, no clinical study of phase III has demonstrated the superiority of carbon ion therapy compared to conventional radiotherapy, including proton therapy, for the treatment of radioresistant tumors. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02838602 . Date of registration: July 20, 2016. The posted information will be updated as needed to reflect protocol amendments and study progress.
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Affiliation(s)
- Jacques Balosso
- Centre François Baclesse, Service de radiothérapie, BP 45026, F-14076, Caen, Cedex 5, France.
| | | | - Annie Iung
- Hospices Civils de Lyon, Direction de la Recherche en Santé, Lyon, France
| | - Hélène Lozano
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | | | - Catherine Cornu
- UMR 5558, Université Claude Bernard Lyon 1, Lyon, France
- INSERM, CIC1407, Hospices Civils de Lyon, Bron, France
| | - Magali Hervé
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | - Zohra Akkal
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | - Michel Lièvre
- UMR 5558, Université Claude Bernard Lyon 1, Lyon, France
| | - Valérie Plattner
- Hospices Civils de Lyon, Direction de la Recherche en Santé, Lyon, France
| | | | - Cristina Bono
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | | | - Viviana Vitolo
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | | | - Stéphanie Patin
- Groupement Coopération Sanitaire Centre Etoile, Lyon, France
| | - Hubert Allemand
- Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
| | - François Gueyffier
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
- UMR 5558, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Pascale Guerre
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, P2S UR4129, Lyon, France
| | - Sylvie Chabaud
- Centre Léon Bérard, Direction de la Recherche Clinique et de l'Innovation, Lyon, France
| | - Roberto Orecchia
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
- European Institute of Oncology IRCCS, Milan, Italy
| | - Pascal Pommier
- Centre Léon Bérard, Service de Radiothérapie, Lyon, France
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7
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Franco P, Porreca A, Di Nicola M, Mantello G, Valvo F, Slim N, Manfrida S, Gambacorta M, De Felice F, Vagge S, Krengli M, Palazzari E, Osti M, Gonelli A, Catalano G, Pittoni P, Lupattelli M, Niespolo M, Rosetto M, Macchia G, Durante O, Munoz F, D'Angelillo R, Genovesi D, Caravatta L. OC-0272 External validation of the Hemo-Eosinophils-Inflammation index as a prognosticator in anal cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02530-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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8
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Franco P, Chiloiro G, Montesi G, Montrone S, Arcelli A, Comito T, Arcadipane F, Caravatta L, Macchia G, Lupattelli M, Niespolo MR, Munoz F, Palazzari E, Krengli M, Valvo F, Gambacorta MA, Genovesi D, Mantello G. A Pattern of Care Report on the Management of Patients with Squamous Cell Carcinoma of the Anus—A Study by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Gastrointestinal Tumors Study Group. Medicina (B Aires) 2021; 57:medicina57121342. [PMID: 34946287 PMCID: PMC8707820 DOI: 10.3390/medicina57121342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background and objectives: The diagnosis and therapy of squamous cell carcinoma of the anus may vary significantly in daily clinical practice, even if international guidelines are available. Materials and Methods: We conducted a pattern of care survey to assess the management of patients with anal cancer in Italy (38 questions). We analyzed 58 questionnaires. Results: Most of the respondents work in public and/or university hospitals (75.8%) in northern Italy (65.5%). The majority (88.0%) treat less than 20 patients/year. Common examinations for diagnosis and staging are anorectal endoscopy (84.5%), computed tomography scan (86.2%) and pelvic magnetic resonance imaging (MRI) (96.5%). The most frequently prescribed dose to primary tumor is 50–54 Gy (46.5–58.6%) for early stage disease and 54–59.4 Gy (62.1–32.8%) for locally advanced cases. Elective volumes are prescribed around 45 Gy (94.8%). Most participants use volumetric intensity modulated radiotherapy (89.7%) and a simultaneous integrated boost (84.5%). Concurrent radiotherapy, 5-fluorouracil and mitomycin is considered the standard of care (70.6%). Capecitabine is less frequently used (34.4%). Induction chemotherapy is an option for extensive localized disease (65.5%). Consolidation chemotherapy is rarely used (18.9%). A response evaluation is conducted at 26–30 weeks (63.9%) with a pelvic MRI (91.4%). Follow-up is generally run by the multidisciplinary tumor board (62.1%). Conclusions: Differences were observed for radiotherapy dose prescription, calling for a consensus to harmonize treatment strategies.
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Affiliation(s)
- Pierfrancesco Franco
- Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy;
- Department of Radiation Oncology, ‘Maggiore della Carita’ University Hospital, Via Solaroli 17, 28100 Novara, Italy
- Correspondence: ; Tel.: +39-032137-33-424
| | - Giuditta Chiloiro
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCS, Via della Pineta Sacchetti, 00168 Rome, Italy; (G.C.); (M.A.G.)
| | - Giampaolo Montesi
- Radiation Oncology Department, ‘S.M. Della Misericordia’ Hospital, AULSS 5 Veneto, Viale Tre Martiri 140, 45100 Rovigo, Italy;
| | - Sabrina Montrone
- Radiation Oncology Unit, Pisa University Hospital, Via Roma 67, 56123 Pisa, Italy;
| | - Alessandra Arcelli
- Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy;
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum, Bologna University, Via Massarenti 9, 40138 Bologna, Italy
| | - Tiziana Comito
- Radiotherapy Department, Humanitas Clinical and Research Hospital IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Francesca Arcadipane
- Department of Oncology, Radiation Oncology, AOU ‘Citta’ della Salute e della Scienza’, Via Cavour 31, 10123 Turin, Italy;
| | - Luciana Caravatta
- Radiation Oncology Unit, ‘SS Annunziata Hospital’, ‘G. D’Annunzio’ University of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy; (L.C.); (D.G.)
| | - Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital–Universita’ Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 86100 Campobasso, Italy;
| | - Marco Lupattelli
- Radiation Oncology Section, Perugia General Hospital, Piazzale Meneghini 1, 06156 Perugia, Italy;
| | - Marina Rita Niespolo
- Department of Radiation Oncology, Azienda Ospedaliera S. Gerardo, Via Pergolesi 33, 20900 Monza, Italy;
| | - Fernando Munoz
- Radiation Oncology Department, ‘Umberto Parini’ Regional Hospital, AUSL Valle d’Aosta, Aosta, Viale Ginevra 3, 11100 Aosta, Italy;
| | - Elisa Palazzari
- Radiation Oncology Department, Oncological Referral Center, Via Gallini 2, 33081 Aviano, Italy;
| | - Marco Krengli
- Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy;
- Department of Radiation Oncology, ‘Maggiore della Carita’ University Hospital, Via Solaroli 17, 28100 Novara, Italy
| | - Francesca Valvo
- Scientific Direction Unit, National Center for Oncological Hadrontherapy (CNAO), Strada Campeggi 53, 27100 Pavia, Italy;
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCS, Via della Pineta Sacchetti, 00168 Rome, Italy; (G.C.); (M.A.G.)
| | - Domenico Genovesi
- Radiation Oncology Unit, ‘SS Annunziata Hospital’, ‘G. D’Annunzio’ University of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy; (L.C.); (D.G.)
- Department of Neuroscience, Imaging and Clinical Sciences, ‘G.D’Annunzio’, University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy
| | - Giovanna Mantello
- Department of Oncology and Radiotherapy, Azienda Ospedaliero Universitaria Ospedali Riuniti, Via Conca 71, Torrette, 60002 Ancona, Italy;
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9
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Marvaso G, Vischioni B, Pepa M, Zaffaroni M, Volpe S, Patti F, Bellerba F, Gandini S, Comi S, Corrao G, Zerini D, Augugliaro M, Fodor C, Russo S, Molinelli S, Ciocca M, Ricotti R, Valvo F, Giandini T, Avuzzi B, Valdagni R, De Cobelli O, Cattani F, Orlandi E, Jereczek-Fossa BA, Orecchia R. Mixed-Beam Approach for High-Risk Prostate Cancer Carbon-Ion Boost Followed by Photon Intensity-Modulated Radiotherapy: Preliminary Results of Phase II Trial AIRC-IG-14300. Front Oncol 2021; 11:778729. [PMID: 34869026 PMCID: PMC8635961 DOI: 10.3389/fonc.2021.778729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose This study represents a descriptive analysis of preliminary results of a Phase II trial on a novel mixed beam radiotherapy (RT) approach, consisting of carbon ions RT (CIRT) followed by intensity-modulated photon RT, in combination with hormonal therapy, for high-risk prostate cancer (HR PCa) with a special focus on acute toxicity. Methods Primary endpoint was the evaluation of safety in terms of acute toxicity. Secondary endpoints were early and long-term tolerability of treatment, quality of life (QoL), and efficacy. Data on acute and late toxicities were collected according to RTOG/EORTC. QoL of enrolled patients was assessed by IPSS, EORTC QLQ-C30, EORTC QLQ-PR25, and sexual activity by IIEF-5. Results Twenty-six patients were enrolled in the study, but only 15 completed so far the RT course and were included. Immediately after CIRT, no patients experienced GI/GU toxicity. At 1 and 3 months from the whole course RT completion, no GI/GU toxicities greater than grade 2 were observed. QoL scores were overall satisfactory. Conclusions The feasibility of the proposed mixed treatment schedule was assessed, and an excellent acute toxicity profile was recorded. Such findings instil confidence in the continuation of this mixed approach, with evaluation of long-term tolerability and efficacy.
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Affiliation(s)
- Giulia Marvaso
- Division of Radiotherapy, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Barbara Vischioni
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Matteo Pepa
- Division of Radiotherapy, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiotherapy, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Stefania Volpe
- Division of Radiotherapy, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Filippo Patti
- Division of Radiotherapy, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Federica Bellerba
- Department of Experimental Oncology, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Stefania Comi
- Medical Physics Unit, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giulia Corrao
- Division of Radiotherapy, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Dario Zerini
- Division of Radiotherapy, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Matteo Augugliaro
- Division of Radiotherapy, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Cristiana Fodor
- Division of Radiotherapy, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Stefania Russo
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Silvia Molinelli
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Mario Ciocca
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Rosalinda Ricotti
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Francesca Valvo
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Tommaso Giandini
- Medical Physics Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Barbara Avuzzi
- Department of Radiation Oncology 1, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Riccardo Valdagni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Department of Radiation Oncology 1, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Ottavio De Cobelli
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Division of Urology, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Federica Cattani
- Medical Physics Unit, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Ester Orlandi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiotherapy, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
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10
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Mastella E, Molinelli S, Pella A, Vai A, Maestri D, Vitolo V, Baroni G, Valvo F, Ciocca M. 4D restricted robust optimization in intensity modulated proton therapy for hypofractionated treatments of lung tumors. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00092-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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11
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Iannalfi A, D'Ippolito E, Riva G, Molinelli S, Gandini S, Viselner G, Fiore MR, Vischioni B, Vitolo V, Bonora M, Ronchi S, Petrucci R, Barcellini A, Mirandola A, Russo S, Vai A, Mastella E, Magro G, Maestri D, Ciocca M, Preda L, Valvo F, Orecchia R. Corrigendum to: Proton and carbon ion radiotherapy in skull base chordomas: a prospective study based on a dual particle and a patient-customized treatment strategy. Neuro Oncol 2021; 24:1402-1403. [PMID: 34850206 DOI: 10.1093/neuonc/noab255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alberto Iannalfi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Emma D'Ippolito
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Giulia Riva
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Silvia Molinelli
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Gisela Viselner
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Maria Rosaria Fiore
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Barbara Vischioni
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Viviana Vitolo
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Maria Bonora
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Ronchi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Rachele Petrucci
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Amelia Barcellini
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Alfredo Mirandola
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Stefania Russo
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Alessandro Vai
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Edoardo Mastella
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Giuseppe Magro
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Davide Maestri
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Mario Ciocca
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Lorenzo Preda
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Francesca Valvo
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Roberto Orecchia
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.,Scientific Directorate, European Institute of Oncology, IRCCS, Milan, Italy
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12
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Kraan AC, Berti A, Retico A, Baroni G, Battistoni G, Belcari N, Cerello P, Ciocca M, De Simoni M, Del Sarto D, Donetti M, Dong Y, Embriaco A, Ferrero V, Fiorina E, Fischetti M, Franciosini G, Giraudo G, Laruina F, Maestri D, Magi M, Magro G, Mancini Terracciano C, Marafini M, Mattei I, Mazzoni E, Mereu P, Mirabelli R, Mirandola A, Morrocchi M, Muraro S, Patera A, Patera V, Pennazio F, Rivetti A, Da Rocha Rolo MD, Rosso V, Sarti A, Schiavi A, Sciubba A, Solfaroli Camillocci E, Sportelli G, Tampellini S, Toppi M, Traini G, Valle SM, Valvo F, Vischioni B, Vitolo V, Wheadon R, Bisogni MG. Localization of anatomical changes in patients during proton therapy with in-beam PET monitoring: A voxel-based morphometry approach exploiting Monte Carlo simulations. Med Phys 2021; 49:23-40. [PMID: 34813083 PMCID: PMC9303286 DOI: 10.1002/mp.15336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/30/2021] [Accepted: 10/11/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose In‐beam positron emission tomography (PET) is one of the modalities that can be used for in vivo noninvasive treatment monitoring in proton therapy. Although PET monitoring has been frequently applied for this purpose, there is still no straightforward method to translate the information obtained from the PET images into easy‐to‐interpret information for clinical personnel. The purpose of this work is to propose a statistical method for analyzing in‐beam PET monitoring images that can be used to locate, quantify, and visualize regions with possible morphological changes occurring over the course of treatment. Methods We selected a patient treated for squamous cell carcinoma (SCC) with proton therapy, to perform multiple Monte Carlo (MC) simulations of the expected PET signal at the start of treatment, and to study how the PET signal may change along the treatment course due to morphological changes. We performed voxel‐wise two‐tailed statistical tests of the simulated PET images, resembling the voxel‐based morphometry (VBM) method commonly used in neuroimaging data analysis, to locate regions with significant morphological changes and to quantify the change. Results The VBM resembling method has been successfully applied to the simulated in‐beam PET images, despite the fact that such images suffer from image artifacts and limited statistics. Three dimensional probability maps were obtained, that allowed to identify interfractional morphological changes and to visualize them superimposed on the computed tomography (CT) scan. In particular, the characteristic color patterns resulting from the two‐tailed statistical tests lend themselves to trigger alarms in case of morphological changes along the course of treatment. Conclusions The statistical method presented in this work is a promising method to apply to PET monitoring data to reveal interfractional morphological changes in patients, occurring over the course of treatment. Based on simulated in‐beam PET treatment monitoring images, we showed that with our method it was possible to correctly identify the regions that changed. Moreover we could quantify the changes, and visualize them superimposed on the CT scan. The proposed method can possibly help clinical personnel in the replanning procedure in adaptive proton therapy treatments.
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Affiliation(s)
| | - Andrea Berti
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy.,Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | | | - Guido Baroni
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy.,Politecnico di Milano, Milano, Italy
| | | | - Nicola Belcari
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy.,Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | | | - Mario Ciocca
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Micol De Simoni
- Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy.,Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
| | - Damiano Del Sarto
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy.,Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | - Marco Donetti
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Yunsheng Dong
- Istituto Nazionale di Fisica Nucleare, Sezione di Milano, Milano, Italy.,Dipartimento di Fisica, Università di Milano, Milano, Italy
| | - Alessia Embriaco
- Istituto Nazionale di Fisica Nucleare, Sezione di Pavia, Pavia, Italy
| | - Veronica Ferrero
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | - Elisa Fiorina
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy.,Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | - Marta Fischetti
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy.,Dipartimento di Scienze di Base e Applicate per l'Ingegneria, Sapienza Università di Roma, Roma, Italy
| | - Gaia Franciosini
- Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy.,Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
| | - Giuseppe Giraudo
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | - Francesco Laruina
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy.,Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | - Davide Maestri
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Marco Magi
- Dipartimento di Scienze di Base e Applicate per l'Ingegneria, Sapienza Università di Roma, Roma, Italy
| | - Giuseppe Magro
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Carlo Mancini Terracciano
- Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy.,Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
| | - Michela Marafini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy.,Museo Storico della Fisica e Centro Studi e Ricerche "E. Fermi", Roma, Italy
| | - Ilaria Mattei
- Istituto Nazionale di Fisica Nucleare, Sezione di Milano, Milano, Italy
| | - Enrico Mazzoni
- Istituto Nazionale di Fisica Nucleare, Sezione di Milano, Milano, Italy
| | - Paolo Mereu
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | - Riccardo Mirabelli
- Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy.,Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy.,Museo Storico della Fisica e Centro Studi e Ricerche "E. Fermi", Roma, Italy
| | | | - Matteo Morrocchi
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy.,Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | - Silvia Muraro
- Istituto Nazionale di Fisica Nucleare, Sezione di Milano, Milano, Italy
| | - Alessandra Patera
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | - Vincenzo Patera
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy.,Dipartimento di Scienze di Base e Applicate per l'Ingegneria, Sapienza Università di Roma, Roma, Italy.,Museo Storico della Fisica e Centro Studi e Ricerche "E. Fermi", Roma, Italy
| | | | - Angelo Rivetti
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | | | - Valeria Rosso
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy.,Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | - Alessio Sarti
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy.,Dipartimento di Scienze di Base e Applicate per l'Ingegneria, Sapienza Università di Roma, Roma, Italy.,Museo Storico della Fisica e Centro Studi e Ricerche "E. Fermi", Roma, Italy
| | - Angelo Schiavi
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy.,Dipartimento di Scienze di Base e Applicate per l'Ingegneria, Sapienza Università di Roma, Roma, Italy
| | - Adalberto Sciubba
- Dipartimento di Scienze di Base e Applicate per l'Ingegneria, Sapienza Università di Roma, Roma, Italy.,Museo Storico della Fisica e Centro Studi e Ricerche "E. Fermi", Roma, Italy.,Istituto Nazionale di Fisica Nucleare, Sezione dei Laboratori di Frascati, Frascati, RM, Italy
| | - Elena Solfaroli Camillocci
- Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy.,Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
| | - Giancarlo Sportelli
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy.,Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | | | - Marco Toppi
- Dipartimento di Scienze di Base e Applicate per l'Ingegneria, Sapienza Università di Roma, Roma, Italy.,Istituto Nazionale di Fisica Nucleare, Sezione dei Laboratori di Frascati, Frascati, RM, Italy
| | - Giacomo Traini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy.,Museo Storico della Fisica e Centro Studi e Ricerche "E. Fermi", Roma, Italy
| | | | | | | | - Viviana Vitolo
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Richard Wheadon
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | - Maria Giuseppina Bisogni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy.,Dipartimento di Fisica, Università di Pisa, Pisa, Italy
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13
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Rubatto M, Merli M, Avallone G, Agostini A, Mastorino L, Caliendo V, Barcellini A, Vitolo V, Valvo F, Fierro MT, Ribero S, Quaglino P. Immunotherapy in Xeroderma Pigmentosum: a case of advanced cutaneous squamous cell carcinoma treated with cemiplimab and a literature review. Oncotarget 2021; 12:1116-1121. [PMID: 34084285 PMCID: PMC8169062 DOI: 10.18632/oncotarget.27966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/03/2021] [Indexed: 11/25/2022] Open
Abstract
Xeroderma Pigmentosum (XP) is a rare genetic disorder with a poor prognosis due to high photosensitivity in affected patients. Herein, we describe the first case of the use of cemiplimab in a patient with XP, a 19-year-old girl presented with locally advanced squamous cell carcinoma of the right periorbital and nasal region. This treatment has been undertaken after a cycle of proton beam radiotherapy. Besides, it is reported a description of the few cases in the literature describing the effectiveness of immunotherapy on skin cancers in XP-patients. This case is in line with those reported, underlining how anti-PD1 monoclonal antibodies may be a promising treatment in this genodermatosis.
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Affiliation(s)
- Marco Rubatto
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy.,Co-first authors
| | - Martina Merli
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy.,Co-first authors
| | - Gianluca Avallone
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Andrea Agostini
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Luca Mastorino
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Virginia Caliendo
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Amelia Barcellini
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Viviana Vitolo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Maria Teresa Fierro
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Simone Ribero
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy.,Co-first senior authors
| | - Pietro Quaglino
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy.,Co-first senior authors
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14
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Iannalfi A, D'Ippolito E, Riva G, Molinelli S, Gandini S, Viselner G, Fiore MR, Vischioni B, Vitolo V, Bonora M, Ronchi S, Petrucci R, Barcellini A, Mirandola A, Russo S, Vai A, Mastella E, Magro G, Maestri D, Ciocca M, Preda L, Valvo F, Orecchia R. Proton and carbon ion radiotherapy in skull base chordomas: a prospective study based on a dual particle and a patient-customized treatment strategy. Neuro Oncol 2021; 22:1348-1358. [PMID: 32193546 DOI: 10.1093/neuonc/noaa067] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 12/18/2022] Open
Abstract
BACKGROUND The aim of this study is to evaluate results in terms of local control (LC), overall survival (OS), and toxicity profile and to better identify factors influencing clinical outcome of skull base chordoma treated with proton therapy (PT) and carbon ion radiotherapy (CIRT). METHODS We prospectively collected and analyzed data of 135 patients treated between November 2011 and December 2018. Total prescription dose in the PT group (70 patients) and CIRT group (65 patients) was 74 Gy relative biological effectiveness (RBE) delivered in 37 fractions and 70.4 Gy(RBE) delivered in 16 fractions, respectively (CIRT in unfavorable patients). LC and OS were evaluated using the Kaplan-Meier method. Univariate and multivariate analyses were performed, to identify prognostic factors on clinical outcomes. RESULTS After a median follow-up of 44 (range, 6-87) months, 14 (21%) and 8 (11%) local failures were observed in CIRT and PT group, respectively. Five-year LC rate was 71% in CIRT cohort and 84% in PT cohort. The estimated 5-year OS rate in the CIRT and PT group was 82% and 83%, respectively. On multivariate analysis, gross tumor volume (GTV), optic pathways, and/or brainstem compression and dose coverage are independent prognostic factors of local failure risk. High rate toxicity grade ≥3 was reported in 11% of patients. CONCLUSIONS Particle radiotherapy is an effective treatment for skull base chordoma with acceptable late toxicity. GTV, optic pathways, and/or brainstem compression and target coverage were independent prognostic factors for LC. KEY POINTS • Proton and carbon ion therapy are effective and safe in skull base chordoma.• Prognostic factors are GTV, organs at risk compression, and dose coverage.• Dual particle therapy and customized strategy was adopted.
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Affiliation(s)
- Alberto Iannalfi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Emma D'Ippolito
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Giulia Riva
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Silvia Molinelli
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Maria Rosaria Fiore
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Barbara Vischioni
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Viviana Vitolo
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Maria Bonora
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Ronchi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Rachele Petrucci
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Amelia Barcellini
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Alfredo Mirandola
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Stefania Russo
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Alessandro Vai
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Edoardo Mastella
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Giuseppe Magro
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Davide Maestri
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Mario Ciocca
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Lorenzo Preda
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Francesca Valvo
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Roberto Orecchia
- Scientific Directorate, European Institute of Oncology, IRCCS, Milan, Italy
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15
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Elisei G, Pella A, Ricotti R, Via R, Fiore MR, Calvi G, Mastella E, Paganelli C, Tagaste B, Bello F, Fontana G, Meschini G, Buizza G, Valvo F, Orlandi E, Ciocca M, Baroni G. Development and validation of a new set-up simulator dedicated to ocular proton therapy at CNAO. Phys Med 2021; 82:228-239. [PMID: 33657472 DOI: 10.1016/j.ejmp.2021.01.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 11/27/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022] Open
Abstract
An Eye Tracking System (ETS) is used at CNAO for providing a stable and reproducible ocular proton therapy (OPT) set-up, featuring a fixation light (FL) and monitoring stereo-cameras embedded in a rigid case. The aim of this work is to propose an ETS set-up simulation algorithm, that automatically provides the FL positioning in space, according to patient-specific gaze direction and avoiding interferences with patient, beam and collimator. Two configurations are provided: one in the CT room for acquiring images required for treatment planning with the patient lying on a couch, and one related to the treatment room with the patient sitting in front of the beam. Algorithm validation was performed reproducing ETS simulation (CT) and treatment (room) set-up for 30 patients previously treated at CNAO. The positioning accuracy of the device was quantified through a set of 14 control points applied to the ETS case and localizable both in the CT volume and in room X-ray images. Differences between the position of ETS reference points estimated by the algorithm and those measured by imaging systems are reported. The corresponding gaze direction deviation is on average 0.2° polar and 0.3° azimuth for positioning in CT room and 0.1° polar and 0.4° azimuth in the treatment room. The simulation algorithm was embedded in a clinically usable software application, which we assessed as capable of ensuring ETS positioning with an average accuracy of 2 mm in CT room and 1.5 mm in treatment room, corresponding to gaze direction deviations consistently lower than 1°.
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Affiliation(s)
- G Elisei
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department-Bioengineering Unit, Pavia, Italy
| | - A Pella
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department-Bioengineering Unit, Pavia, Italy.
| | - R Ricotti
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department-Bioengineering Unit, Pavia, Italy
| | - R Via
- Center of Proton Therapy, Paul Scherrer Institut, 5232 Villigen, PSI, Switzerland
| | - M R Fiore
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department, Pavia, Italy
| | - G Calvi
- Centro Nazionale di Adroterapia Oncologica CNAO, Particle Accelerator Department, Pavia, Italy
| | - E Mastella
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department - Medical Physics Unit, Pavia, Italy
| | - C Paganelli
- Politecnico di Milano, Department of Electronics Information and Bioengineering, Milano, Italy
| | - B Tagaste
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department-Bioengineering Unit, Pavia, Italy
| | - F Bello
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department-Bioengineering Unit, Pavia, Italy
| | - G Fontana
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department-Bioengineering Unit, Pavia, Italy
| | - G Meschini
- Politecnico di Milano, Department of Electronics Information and Bioengineering, Milano, Italy
| | - G Buizza
- Politecnico di Milano, Department of Electronics Information and Bioengineering, Milano, Italy
| | - F Valvo
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department, Pavia, Italy
| | - E Orlandi
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department, Pavia, Italy
| | - M Ciocca
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department - Medical Physics Unit, Pavia, Italy
| | - G Baroni
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department-Bioengineering Unit, Pavia, Italy; Politecnico di Milano, Department of Electronics Information and Bioengineering, Milano, Italy
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16
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La Corte E, Broggi M, Raggi A, Schiavolin S, Acerbi F, Danesi G, Farinotti M, Felisati G, Maccari A, Pollo B, Saini M, Toppo C, Valvo F, Ghidoni R, Bruzzone MG, DiMeco F, Ferroli P. Peri-operative prognostic factors for primary skull base chordomas: results from a single-center cohort. Acta Neurochir (Wien) 2021; 163:689-697. [PMID: 31950268 DOI: 10.1007/s00701-020-04219-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Skull base chordomas (SBC) are rare malignant tumors and few factors have been found to be reliable markers for clinical decision making and survival prognostication. The aim of the present work was to identify specific prognostic factors potentially useful for the management of SBC patients. METHODS A retrospective review of all the patients diagnosed and treated for SBC at the Fondazione IRCCS Istituto Neurologico "Carlo Besta" between January 1992 and December 2017 has been performed. Survival analysis was performed and a logistic regression model was used. Statistically significant predictors were rated based on their log odds in order to preliminarily build a personalized grading scale-the Peri-Operative Chordoma Scale (POCS). RESULTS Fifty-nine primary chordoma patients were included. The average follow-up from the first treatment was 82.6 months (95% CI, 65.5-99.7). POCS was built over PFS and MR contrast enhancement (intense vs mild/no, value 4), preoperative motor deficit (yes vs no, value 3), and the development of any postoperative complications (yes vs no, value 2). POCS ranges between 0 and 9, with higher scores being associated with reduced likelihood of survival and progression-free state. CONCLUSIONS Our results show that preoperative clinical symptoms (motor deficits), surgical features (extent of tumor resection and surgeon's experience), development of postoperative complications, and KPS decline represent significant prognostic factors. The degree of MR contrast enhancement significantly correlated to both OS and PFS. We also preliminarily developed the POCS as a prognostic grading scale which may help neurosurgeons in the personalized management of patients undergoing potential adjuvant therapies.
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17
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Barcellini A, Vitolo V, Cobianchi L, Peloso A, Vanoli A, Mirandola A, Facoetti A, Fiore MR, Iannalfi A, Vischioni B, Cuccia F, Ronchi S, Bonora M, Riva G, Petrucci R, D'Ippolito E, Mas FD, Preda L, Valvo F. Re-irradiation With Carbon Ion Radiotherapy for Pelvic Rectal Cancer Recurrences in Patients Previously Irradiated to the Pelvis. In Vivo 2021; 34:1547-1553. [PMID: 32354961 DOI: 10.21873/invivo.11944] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 03/09/2020] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND/AIM Re-irradiation of locally recurrent rectal cancer poses challenges due to the proximity of critical organs, such as the bowel. This study aimed at evaluating the safety and efficacy of re-irradiation with Carbon Ion Radiotherapy (CIRT) in rectal cancer patients with local recurrence. PATIENTS AND METHODS Between 2014 and 2018, 14 patients were treated at the National Center of Oncological Hadrontherapy (CNAO Foundation) with CIRT for locally recurrent rectal cancer. RESULTS All patients concluded the treatment. No G≥3 acute/late reaction nor pelvic infections were observed. The 1-year and 2-year local control rates were, 78% and 52%, respectively, and relapse occurred close to the bowel in 6 patients. The 1-year and 2-year overall survival rates were 100% and 76.2% each; while the 1-year and 2-year metastasis free survival rates were 64.3% and 43%. CONCLUSION CIRT as re-irradiation for locally recurrent rectal cancer emerges as a safe and valid treatment with an acceptable rate of morbidity of surrounding healthy tissue.
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Affiliation(s)
- Amelia Barcellini
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Viviana Vitolo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Lorenzo Cobianchi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Peloso
- Division of Abdominal Surgery, Department of Surgery, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,HepatoPancreato-Biliary Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Alessandro Vanoli
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alfredo Mirandola
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Angelica Facoetti
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Maria Rosaria Fiore
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Alberto Iannalfi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Barbara Vischioni
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Francesco Cuccia
- School of Radiation Oncology, University of Palermo, Palermo, Italy
| | - Sara Ronchi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Maria Bonora
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Giulia Riva
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Rachele Petrucci
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Emma D'Ippolito
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Francesca Dal Mas
- Lincoln International Business School, University of Lincoln, Lincoln, U.K.,Department of Law and Economics of Productive Activities, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Preda
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
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Buizza G, Paganelli C, D’Ippolito E, Fontana G, Molinelli S, Preda L, Riva G, Iannalfi A, Valvo F, Orlandi E, Baroni G. Radiomics and Dosiomics for Predicting Local Control after Carbon-Ion Radiotherapy in Skull-Base Chordoma. Cancers (Basel) 2021; 13:339. [PMID: 33477723 PMCID: PMC7832399 DOI: 10.3390/cancers13020339] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/05/2021] [Accepted: 01/14/2021] [Indexed: 02/08/2023] Open
Abstract
Skull-base chordoma (SBC) can be treated with carbon ion radiotherapy (CIRT) to improve local control (LC). The study aimed to explore the role of multi-parametric radiomic, dosiomic and clinical features as prognostic factors for LC in SBC patients undergoing CIRT. Before CIRT, 57 patients underwent MR and CT imaging, from which tumour contours and dose maps were obtained. MRI and CT-based radiomic, and dosiomic features were selected and fed to two survival models, singularly or by combining them with clinical factors. Adverse LC was given by in-field recurrence or tumour progression. The dataset was split in development and test sets and the models' performance evaluated using the concordance index (C-index). Patients were then assigned a low- or high-risk score. Survival curves were estimated, and risk groups compared through log-rank tests (after Bonferroni correction α = 0.0083). The best performing models were built on features describing tumour shape and dosiomic heterogeneity (median/interquartile range validation C-index: 0.80/024 and 0.79/0.26), followed by combined (0.73/0.30 and 0.75/0.27) and CT-based models (0.77/0.24 and 0.64/0.28). Dosiomic and combined models could consistently stratify patients in two significantly different groups. Dosiomic and multi-parametric radiomic features showed to be promising prognostic factors for LC in SBC treated with CIRT.
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Affiliation(s)
- Giulia Buizza
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy; (C.P.); (G.B.)
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy; (C.P.); (G.B.)
| | - Emma D’Ippolito
- Radiotherapists Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy; (E.D.); (G.R.); (A.I.); (F.V.); (E.O.)
| | - Giulia Fontana
- Clinical Bioengineering Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy;
| | - Silvia Molinelli
- Medical Physics Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy;
| | - Lorenzo Preda
- Radiology Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy;
- Unit of Radiology, Department of Intensive Medicine, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Giulia Riva
- Radiotherapists Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy; (E.D.); (G.R.); (A.I.); (F.V.); (E.O.)
| | - Alberto Iannalfi
- Radiotherapists Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy; (E.D.); (G.R.); (A.I.); (F.V.); (E.O.)
| | - Francesca Valvo
- Radiotherapists Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy; (E.D.); (G.R.); (A.I.); (F.V.); (E.O.)
| | - Ester Orlandi
- Radiotherapists Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy; (E.D.); (G.R.); (A.I.); (F.V.); (E.O.)
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy; (C.P.); (G.B.)
- Clinical Bioengineering Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy;
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19
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Sorrentino L, Belli F, Valvo F, Villa S, Guaglio M, Scaramuzza D, Gronchi A, Di Bartolomeo M, Cosimelli M. Neoadjuvant (re)chemoradiation for locally recurrent rectal cancer: Impact of anatomical site of pelvic recurrence on long-term results. Surg Oncol 2020; 35:89-96. [DOI: 10.1016/j.suronc.2020.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/23/2020] [Accepted: 08/19/2020] [Indexed: 12/11/2022]
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20
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Dusi V, Vitolo V, Frigerio L, Totaro R, Valentini A, Barcellini A, Mirandola A, Perego GB, Coccia M, Greco A, Ghio S, Valvo F, De Ferrari GM, Gnecchi M, Oltrona Visconti L, Rordorf R. First-in-man case of non-invasive proton radiotherapy for the treatment of refractory ventricular tachycardia in advanced heart failure. Eur J Heart Fail 2020; 23:195-196. [PMID: 33179329 DOI: 10.1002/ejhf.2056] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/10/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Veronica Dusi
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Section of Cardiology, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Viviana Vitolo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Laura Frigerio
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Rossana Totaro
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Adele Valentini
- Department of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Amelia Barcellini
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Alfredo Mirandola
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Giovanni B Perego
- Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, Milan, Italy
| | - Michela Coccia
- Section of Cardiology, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Alessandra Greco
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Ghio
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Massimiliano Gnecchi
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Section of Cardiology, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Roberto Rordorf
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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21
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Dale JE, Molinelli S, Vischioni B, Vitolo V, Bonora M, Magro G, Mairani A, Hasegawa A, Ohno T, Dahl O, Valvo F, Fossati P. Brainstem NTCP and Dose Constraints for Carbon Ion RT-Application and Translation From Japanese to European RBE-Weighted Dose. Front Oncol 2020; 10:531344. [PMID: 33330020 PMCID: PMC7735105 DOI: 10.3389/fonc.2020.531344] [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: 01/31/2020] [Accepted: 09/04/2020] [Indexed: 12/19/2022] Open
Abstract
Background and Purpose The Italian National Center of Oncological Hadrontherapy (CNAO) has applied dose constraints for carbon ion RT (CIRT) as defined by Japan’s National Institute of Radiological Sciences (NIRS). However, these institutions use different models to predict the relative biological effectiveness (RBE). CNAO applies the Local Effect Model I (LEM I), which in most clinical situations predicts higher RBE than NIRS’s Microdosimetric Kinetic Model (MKM). Equal constraints therefore become more restrictive at CNAO. Tolerance doses for the brainstem have not been validated for LEM I-weighted dose (DLEM I). However, brainstem constraints and a Normal Tissue Complication Probability (NTCP) model were recently reported for MKM-weighted dose (DMKM), showing that a constraint relaxation to DMKM|0.7 cm3 <30 Gy (RBE) and DMKM|0.1 cm3 <40 Gy (RBE) was feasible. The aim of this work was to evaluate the brainstem NTCP associated with CNAO’s current clinical practice and to propose new brainstem constraints for LEM I-optimized CIRT at CNAO. Material and Methods We reproduced the absorbed dose of 30 representative patient treatment plans from CNAO. Subsequently, we calculated both DLEM I and DMKM, and the relationship between DMKM and DLEM I for various brainstem dose metrics was analyzed. Furthermore, the NTCP model developed for DMKM was applied to estimate the NTCPs of the delivered plans. Results The translation of CNAO treatment plans to DMKM confirmed that the former CNAO constraints were conservative compared with DMKM constraints. Estimated NTCPs were 0% for all but one case, in which the NTCP was 2%. The relationship DMKM/DLEM I could be described by a quadratic regression model which revealed that the validated DMKM constraints corresponded to DLEM I|0.7 cm3 <41 Gy (RBE) (95% CI, 38–44 Gy (RBE)) and DLEM I|0.1 cm3 <49 Gy (RBE) (95% CI, 46–52 Gy (RBE)). Conclusion Our study demonstrates that RBE-weighted dose translation is of crucial importance in order to exchange experience and thus harmonize CIRT treatments globally. To mitigate uncertainties involved, we propose to use the lower bound of the 95% CI of the translation estimates, i.e., DLEM I|0.7 cm3 <38 Gy (RBE) and DLEM I|0.1 cm3 <46 Gy (RBE) as brainstem dose constraints for 16 fraction CIRT treatments optimized with LEM I.
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Affiliation(s)
- Jon Espen Dale
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | | | | | - Viviana Vitolo
- National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Maria Bonora
- National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Giuseppe Magro
- National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Andrea Mairani
- National Center of Oncological Hadrontherapy, Pavia, Italy.,Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany
| | - Azusa Hasegawa
- National Center of Oncological Hadrontherapy, Pavia, Italy.,Osaka Heavy Ion Therapy Center, Osaka, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Olav Dahl
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | | | - Piero Fossati
- National Center of Oncological Hadrontherapy, Pavia, Italy.,MedAustron Ion Therapy Center, Wiener Neustadt, Austria
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Ronchi S, Vischioni B, Bonora M, Vitolo V, Fiore M, Iannalfi A, Barcellini A, Molinelli S, Russo S, Maestri D, Ciocca M, Preda L, Valvo F. PO-0850: Proton Beam Reirradiation In Head And Neck Patients at CNAO: preliminary results. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00867-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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23
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Mancin A, Villani E, Montana S, Tampellini S, Iannalfi A, Valvo F, Gandola L. PO-1925: “The journey of the superhero MeV”: the CNAO's pediatric project. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01942-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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24
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Vischioni B, Mirandola A, Bonora M, Ronchi S, Mastella E, Orlandi E, Iacovelli N, Cavallo A, Licitra L, Fallai C, Ciocca M, Pignoli E, Magrini S, Antognoni P, Valvo F. PO-1798: Quality of radiotherapy treatment plans for locally advanced sinonasal tumors in a phase II trial. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01816-8] [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: 10/22/2022]
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25
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Scipilliti E, Fiore M, Cuccia F, Durante S, Ronchi S, Bonora M, Barcellini A, Valvo F. PO-1229: Preliminary data on long term toxicity in young patients with chordoma: C.N.A.O. experience. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01247-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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26
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Marvaso G, Gugliandolo S, Comi S, Pepa M, Russo S, Vischioni B, Valvo F, Giandini T, Avuzzi B, Valdagni R, Ciardo D, Jereczek-Fossa B, Cattani F, Orecchia R. PO-1748: Carbon-ion boost followed by photon IMRT for PCa: dosimetric and geometric evaluations, AIRCIG. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01766-7] [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: 11/30/2022]
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Meschini G, Vai A, Paganelli C, Molinelli S, Maestri D, Fontana G, Pella A, Vitolo V, Valvo F, Ciocca M, Baroni G. Investigating the use of virtual 4DCT from 4DMRI in gated carbon ion radiation therapy of abdominal tumors. Z Med Phys 2020; 32:98-108. [PMID: 33069586 PMCID: PMC9948849 DOI: 10.1016/j.zemedi.2020.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/27/2020] [Accepted: 08/31/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To generate virtual 4DCT from 4DMRI with field of view (FOV) extended to the entire involved patient anatomy, in order to evaluate its use in carbon ion radiation therapy (CIRT) of the abdominal site in a clinical scenario. MATERIALS AND METHODS The virtual 4DCT was generated by deforming a reference CT in order to (1) match the anatomy depicted in the 4DMRI within its FOV, by calculating deformation fields with deformable image registration to describe inter-fractional and breathing motion, and (2) obtain physically plausible deformation outside of the 4DMRI FOV, by propagating and modulating the previously obtained deformation fields. The implemented method was validated on a digital anthropomorphic phantom, for which a ground truth (GT) 4DCT was available. A CIRT treatment plan was optimized at the end-exhale reference CT and the RBE-weighted dose distribution was recalculated on both the virtual and GT 4DCTs. The method estimation error was quantified by comparing the virtual and GT 4DCTs and the corresponding recomputed doses. The method was then evaluated on 8 patients with pancreas or liver tumors treated with CIRT using respiratory gating at end-exhale. The clinical treatment plans adopted at the National Center for Oncological Hadrontherapy (CNAO, Pavia, Italy) were considered and the dose distribution was recomputed on all respiratory phases of the planning and virtual 4DCTs. By comparing the two datasets and the corresponding dose distributions, the geometrical and dosimetric impact of organ motion was assessed. RESULTS For the phantom, the error outside of the 4DMRI FOV was up to 4.5mm, but it remained sub-millimetric in correspondence to the target within the 4DMRI FOV. Although the impact of motion on the target D95% resulted in variations ranging from 22% to 90% between the planned dose and the doses recomputed on the GT 4DCT phases, the corresponding estimation error was ≤2.2%. In the patient cases, the variation of the baseline tumor position between the planning and the virtual end-exhale CTs presented a median (interquartile range) value of 6.0 (4.9) mm. For baseline variations larger than 5mm, the tumor D95% variation between the plan and the dose recomputed on the end-exhale virtual CT resulted larger than 10%. Median variations higher than 10% in the target D95% and gastro-intestinal OARs D2% were quantified at the end-inhale, whereas close to the end-exhale phase, limited variations of relevant dose metrics were found for both tumor and OARs. CONCLUSIONS The negligible impact of the geometrical inaccuracy in the estimated anatomy outside of the 4DMRI FOV on the overall dosimetric accuracy suggests the feasibility of virtual 4DCT with extended FOV in CIRT of the abdominal site. In the analyzed patient group, inter-fractional variations such as baseline variation and breathing variability were quantified, demonstrating the method capability to support treatment planning in gated CIRT of the abdominal site.
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Affiliation(s)
- Giorgia Meschini
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano 20133, Italy.
| | - Alessandro Vai
- Centro Nazionale di Adroterapia Oncologica, Pavia 27100, Italy
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano 20133, Italy
| | | | - Davide Maestri
- Centro Nazionale di Adroterapia Oncologica, Pavia 27100, Italy
| | - Giulia Fontana
- Centro Nazionale di Adroterapia Oncologica, Pavia 27100, Italy
| | - Andrea Pella
- Centro Nazionale di Adroterapia Oncologica, Pavia 27100, Italy
| | - Viviana Vitolo
- Centro Nazionale di Adroterapia Oncologica, Pavia 27100, Italy
| | - Francesca Valvo
- Centro Nazionale di Adroterapia Oncologica, Pavia 27100, Italy
| | - Mario Ciocca
- Centro Nazionale di Adroterapia Oncologica, Pavia 27100, Italy
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano 20133, Italy,Centro Nazionale di Adroterapia Oncologica, Pavia 27100, Italy
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Barcellini A, Roccio M, Laliscia C, Zanellini F, Pettinato D, Valvo F, Mirandola A, Orlandi E, Gadducci A. Endometrial Cancer: When Upfront Surgery Is Not an Option. Oncology 2020; 99:65-71. [PMID: 33032278 DOI: 10.1159/000510690] [Citation(s) in RCA: 8] [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: 07/03/2020] [Accepted: 08/04/2020] [Indexed: 11/19/2022]
Abstract
Background and Summary: The management of endometrial cancer, in an ever-older population with considerable comorbidity, remains a challenge for gynecological and radiation oncologists. Key Message: The present paper reviews literature data on treatment options for endometrial cancer patients unfit for surgery.
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Affiliation(s)
- Amelia Barcellini
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy,
| | - Marianna Roccio
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Concetta Laliscia
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Francesca Zanellini
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Diana Pettinato
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Alfredo Mirandola
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Ester Orlandi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
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Barcellini A, Vitolo V, Cobianchi L, Valvo F, Vischioni B, Bonora M, Fiore MR, Iannalfi A, Riva G, Ronchi S, Tornari E, Orlandi E. Pancreatic cancer: Does a short course of carbon ion radiotherapy worth during COVID-19 outbreak? Pancreatology 2020; 20:1004-1005. [PMID: 32418757 PMCID: PMC7217079 DOI: 10.1016/j.pan.2020.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | - Viviana Vitolo
- Corresponding author. National Center of Oncological Hadrontherapy (Fondazione CNAO), Strada Campeggi 53, Pavia, Italy
| | - Lorenzo Cobianchi
- General Surgery Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Barbara Vischioni
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Maria Bonora
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Maria Rosaria Fiore
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Alberto Iannalfi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Giulia Riva
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Sara Ronchi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Elena Tornari
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Ester Orlandi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
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Sacco S, Ballati F, Gaetani C, Lomoro P, Farina LM, Bacila A, Imparato S, Paganelli C, Buizza G, Iannalfi A, Baroni G, Valvo F, Bastianello S, Preda L. Multi-parametric qualitative and quantitative MRI assessment as predictor of histological grading in previously treated meningiomas. Neuroradiology 2020; 62:1441-1449. [PMID: 32583368 DOI: 10.1007/s00234-020-02476-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 03/03/2020] [Accepted: 06/10/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Meningiomas are mainly benign tumors, though a considerable proportion shows aggressive behaviors histologically consistent with atypia/anaplasia. Histopathological grading is usually assessed through invasive procedures, which is not always feasible due to the inaccessibility of the lesion or to treatment contraindications. Therefore, we propose a multi-parametric MRI assessment as a predictor of meningioma histopathological grading. METHODS Seventy-three patients with 74 histologically proven and previously treated meningiomas were retrospectively enrolled (42 WHO I, 24 WHO II, 8 WHO III) and studied with MRI including T2 TSE, FLAIR, Gradient Echo, DWI, and pre- and post-contrast T1 sequences. Lesion masks were segmented on post-contrast T1 sequences and rigidly registered to ADC maps to extract quantitative parameters from conventional DWI and intravoxel incoherent motion model assessing tumor perfusion. Two expert neuroradiologists assessed morphological features of meningiomas with semi-quantitative scores. RESULTS Univariate analysis showed different distributions (p < 0.05) of quantitative diffusion parameters (Wilcoxon rank-sum test) and morphological features (Pearson's chi-square; Fisher's exact test) among meningiomas grouped in low-grade (WHO I) and higher grade forms (WHO II/III); the only exception consisted of the tumor-brain interface. A multivariate logistic regression, combining all parameters showing statistical significance in the univariate analysis, allowed discrimination between the groups of meningiomas with high sensitivity (0.968) and specificity (0.925). Heterogeneous contrast enhancement and low ADC were the best independent predictors of atypia and anaplasia. CONCLUSION Our multi-parametric MRI assessment showed high sensitivity and specificity in predicting histological grading of meningiomas. Such an assessment may be clinically useful in characterizing lesions without histological diagnosis. Key points • When surgery and biopsy are not feasible, parameters obtained from both conventional and diffusion-weighted MRI can predict atypia and anaplasia in meningiomas with high sensitivity and specificity. • Low ADC values and heterogeneous contrast enhancement are the best predictors of higher grade meningioma.
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Affiliation(s)
- Simone Sacco
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Francesco Ballati
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Clara Gaetani
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Pascal Lomoro
- Department of Radiology, Valduce Hospital, Como, Italy
| | | | - Ana Bacila
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Sara Imparato
- Diagnostic Imaging Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100, Pavia, PV, Italy
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Giulia Buizza
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Alberto Iannalfi
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- Bioengineering Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Francesca Valvo
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Stefano Bastianello
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Lorenzo Preda
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
- Diagnostic Imaging Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100, Pavia, PV, Italy.
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Cuccia F, Fiore MR, Barcellini A, Iannalfi A, Vischioni B, Ronchi S, Bonora M, Riva G, Vai A, Facoetti A, Preda L, Valvo F, Vitolo V. Outcome and Toxicity of Carbon Ion Radiotherapy for Axial Bone and Soft Tissue Sarcomas. Anticancer Res 2020; 40:2853-2859. [PMID: 32366434 DOI: 10.21873/anticanres.14260] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 03/25/2020] [Accepted: 03/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Definitive radiotherapy for bone and soft tissues sarcomas benefits patients deemed unfit for surgery; poor outcomes have been reported with conventional photons, while interesting preliminary results have been described with particle in single-Institution experiences. The aim of the study was to retrospectively evaluate preliminary results of carbon ion radiotherapy (CIRT) in patients with axial bone and soft tissue sarcomas (BSTS) treated with curative intent at the National Center for Oncological Hadrontherapy (CNAO). PATIENTS AND METHODS From January 2013 to September 2018, 54 patients with axial BSTS were treated with CIRT at CNAO. Their median age was 50 years (range=19-79 years), males/females=1.4:1. Tumor site was the pelvis in 50% of cases (n=27), thoracic region in 24% (n=13), cervical spine in 15% (n=8) and lumbar in 11% (n=6). A total of 76% (n=41) of patients had primary disease, while 24% (n=13) had recurrent disease. Before CIRT, surgery was performed in 47% of cases, including positive margins (R1) in 8 patients, and macroscopic residual disease (R2) in 17. Histological subtypes were mainly represented by chondrosarcomas in 39% (n=21) of patients and osteosarcomas in 24% (n=13). Pre-treatment chemotherapy was administered in 40% of cases (n=22); no patient received previous radiotherapy. All treatments were performed with active scanning CIRT for a median total dose of 73.6 Gy (range=70.4-76.8 Gy), in 16 fractions (4 fractions per week). RESULTS Median follow-up was 24 months (range=4-61 months). Four patients were lost to follow-up. Acute toxicities were mild, no >G2 event was reported and no treatment interruption was required. For late toxicity, only G3 neuropathy was detected in 4% of cases (n=2). With a median time to local progression of 13 months (3-35), 15 local failures were observed, resulting in 2- and 3-year local control rates of 67.4% for both. Distant progression occurred in 12 patients, with 1-year progression-free survival (PFS) rate of 97.5%; 2- and 3-year rates were 92.2%. Fifteen patients died resulting in 1- 2- and 3-years overall survival (OS) rates of 87.1%, 75.4% and 64%, respectively. At log-rank test, gross total volume (GTV) >1,000 ml was found to be predictive of local failure (p=0.04), pre-treatment chemotherapy was found to be significantly related to PFS and OS (p=0.02 and p=0.016); also, recurrent disease and distant progression were significantly related to OS (p=0.019 and p=0.0013). Cox proportional-hazards model confirmed that GTV >1,000 ml was related to worse local control (p=0.0010). CONCLUSION CIRT for axial BSTS resulted in mild toxicity, showing promising results in terms of clinical outcomes. A longer follow-up is warranted.
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Affiliation(s)
- Francesco Cuccia
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy.,Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Maria Rosaria Fiore
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Amelia Barcellini
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Alberto Iannalfi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Barbara Vischioni
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Sara Ronchi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Maria Bonora
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Giulia Riva
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Alessandro Vai
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Angelica Facoetti
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Lorenzo Preda
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Viviana Vitolo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
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Kalantzopoulos C, Meschini G, Paganelli C, Fontana G, Vai A, Preda L, Vitolo V, Valvo F, Baroni G. Organ motion quantification and margins evaluation in carbon ion therapy of abdominal lesions. Phys Med 2020; 75:33-39. [PMID: 32485596 DOI: 10.1016/j.ejmp.2020.05.014] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 04/03/2020] [Accepted: 05/17/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE In image-guided particle radiotherapy of abdominal lesions, respiratory motion hinders treatment accuracy. In this study, 2D cineMRI data were used to quantify the tumor (GTV) motion and to evaluate the clinical approach based on deriving an internal target volume (ITV) from a planning 4DCT for gating treatments. METHODS Seven patients with abdominal lesions were treated with carbon-ion therapy at the National Centre of Oncological Hadron-therapy (Italy). The MR scan was performed on the same day of the 4DCT acquisition. For four patients, an additional MR was acquired approximately after 1 week. The cineMRI combined with deformable image registration algorithm was used to quantify tumor motion. Afterwards, two ITVs were defined considering (1) all phases (ITVFB) and (2) only phases within the gating window (ITVG), and then compared with the clinical (4DCT-derived) ITVs (ITVCG and ITVCFB). RESULTS Tumor residual motion estimated by cineMRI data in the two MRI sessions resulted not significantly different from 4DCT, although cineMRI accounted for cycle-to-cycle variations. The ITV normalized for the GTV median values were higher for ITVFB with respect to ITVG, ITVCFB and ITVCG. The Hausdorff distances with respect to the GTV were up to 10.55 mm, 3.13 mm, 5.56 mm and 2.51 mm, for ITVFB, ITVG, ITVCFB and ITVCG, respectively. According to both metrics, ITVCG and ITVG were not found significantly different. CONCLUSIONS CineMRI acquisitions allowed to quantify organ motion without delivering additional dose to the patient and to verify treatment margins in gated carbon-ion therapy of abdominal lesions.
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Affiliation(s)
| | - Giorgia Meschini
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milan, Italy
| | - Chiara Paganelli
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milan, Italy
| | - Giulia Fontana
- Centro Nazionale di Adroterapia Oncologica, Str. Campeggi, 53, 27100 Pavia, Italy
| | - Alessandro Vai
- Centro Nazionale di Adroterapia Oncologica, Str. Campeggi, 53, 27100 Pavia, Italy
| | - Lorenzo Preda
- Centro Nazionale di Adroterapia Oncologica, Str. Campeggi, 53, 27100 Pavia, Italy
| | - Viviana Vitolo
- Centro Nazionale di Adroterapia Oncologica, Str. Campeggi, 53, 27100 Pavia, Italy
| | - Francesca Valvo
- Centro Nazionale di Adroterapia Oncologica, Str. Campeggi, 53, 27100 Pavia, Italy
| | - Guido Baroni
- Centro Nazionale di Adroterapia Oncologica, Str. Campeggi, 53, 27100 Pavia, Italy; Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milan, Italy
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Belli F, Sorrentino L, Gallino G, Gronchi A, Scaramuzza D, Valvo F, Cattaneo L, Cosimelli M. A proposal of an updated classification for pelvic relapses of rectal cancer to guide surgical decision-making. J Surg Oncol 2020; 122:350-359. [PMID: 32424824 DOI: 10.1002/jso.25938] [Citation(s) in RCA: 8] [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: 04/02/2020] [Accepted: 04/05/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Selection of patients affected by pelvic recurrence of rectal cancer (PRRC) who are likely to achieve a R0 resection is mandatory. The aim of this study was to propose a classification for PRRC to predict both radical surgery and disease-free survival (DFS). METHODS PRRC patients treated at the National Cancer Institute of Milan (Italy) were included in the study. PRRC were classified as S1, if located centrally (S1a-S1b) or anteriorly (S1c) within the pelvis; S2, in case of sacral involvement below (S2a) or above (S2b) the second sacral vertebra; S3, in case of lateral pelvic involvement. RESULTS Of 280 reviewed PRRC patients, 152 (54.3%) were evaluated for curative surgery. The strongest predictor of R+ resection was the S3 category (OR, 6.37; P = .011). Abdominosacral resection (P = .012), anterior exenteration (P = .012) and extended rectal re-excision (P = .003) were predictive of R0 resection. S3 category was highly predictive of poor DFS (HR 2.53; P = .038). DFS was significantly improved after R0 surgery for S1 (P < .0001) and S2 (P = .015) patients but not for S3 cases (P = .525). CONCLUSIONS The proposed classification allows selection of subjects candidates to curative surgery, emphasizing that lateral pelvic involvement is the main predictor of R+ resection and independently affects the DFS.
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Affiliation(s)
- Filiberto Belli
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Sorrentino
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gianfrancesco Gallino
- Melanoma and Sarcoma Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Melanoma and Sarcoma Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Davide Scaramuzza
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesca Valvo
- Radiotherapy Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Laura Cattaneo
- Pathology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maurizio Cosimelli
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Barcellini A, Gadducci A, Laliscia C, Imparato S, Vitolo V, Preda L, Valvo F. Adenoid Cystic Carcinoma of Bartholin's Gland: What Is the Best Approach? Oncology 2020; 98:513-519. [PMID: 32408297 DOI: 10.1159/000506485] [Citation(s) in RCA: 8] [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: 01/30/2020] [Accepted: 02/13/2020] [Indexed: 11/19/2022]
Abstract
Background and summary: Among all vulvar cancers, primary adenoid cystic carcinoma (ACC) of Bartholin's gland is a very rare tumor characterized by a slow growth, a high local aggressiveness, and a remarkable recurrence rate. Due to its rarity, treatment remains a challenge for oncologists and gynecological surgeons. Key message: The present paper reports clinical, radiological, and histological features of ACC of Bartholin's gland and reviews the literature data on the treatment options with a particular focus on the potential role of particle radiation therapy.
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Affiliation(s)
- Amelia Barcellini
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy,
| | - Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Concetta Laliscia
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Sara Imparato
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Viviana Vitolo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Lorenzo Preda
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
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Alterio D, D’Ippolito E, Vischioni B, Fossati P, Gandini S, Bonora M, Ronchi S, Vitolo V, Mastella E, Magro G, Franco P, Ricardi U, Krengli M, Ivaldi G, Ferrari A, Fanetti G, Comi S, Tagliabue M, Verri E, Ricotti R, Ciardo D, Jereczek-Fossa BA, Valvo F, Orecchia R. Mixed-beam approach in locally advanced nasopharyngeal carcinoma: IMRT followed by proton therapy boost versus IMRT-only. Evaluation of toxicity and efficacy. Acta Oncol 2020; 59:541-548. [PMID: 32090645 DOI: 10.1080/0284186x.2020.1730001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To compare radiation-induced toxicity and dosimetry parameters in patients with locally advanced nasopharyngeal cancer (LANPC) treated with a mixed-beam (MB) approach (IMRT followed by proton therapy boost) with an historic cohort of patients treated with a full course of IMRT-only.Material and methods: Twenty-seven patients with LANPC treated with the MB approach were compared to a similar cohort of 17 patients treated with IMRT-only. The MB approach consisted in a first phase of IMRT up to 54-60 Gy followed by a second phase delivered with a proton therapy boost up to 70-74 Gy (RBE). The total dose for patients treated with IMRT-only was 69.96 Gy. Induction chemotherapy was administrated to 59 and 88% and concurrent chemoradiotherapy to 88 and 100% of the MB and IMRT-only patients, respectively. The worst toxicity occurring during the entire course of treatment (acute toxicity) and early-late toxicity were registered according to the Common Terminology Criteria Adverse Events V4.03.Results: The two cohorts were comparable. Patients treated with MB received a significantly higher median total dose to target volumes (p = .02). Acute grade 3 mucositis was found in 11 and 76% (p = .0002) of patients treated with MB and IMRT-only approach, respectively, while grade 2 xerostomia was found in 7 and 35% (p = .02) of patients treated with MB and IMRT-only, respectively. There was no statistical difference in late toxicity. Local progression-free survival (PFS) and progression-free survival curves were similar between the two cohorts of patients (p = .17 and p = .40, respectively). Local control rate was 96% and 81% for patients treated with MB approach and IMRT-only, respectively.Conclusions: Sequential MB approach for LANPC patients provides a significantly lower acute toxicity profile compared to full course of IMRT. There were no differences in early-late morbidities and disease-related outcomes (censored at two-years) but a longer follow-up is required to achieve conclusive results.
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Affiliation(s)
- Daniela Alterio
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Emma D’Ippolito
- Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Barbara Vischioni
- Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Piero Fossati
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
- Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Maria Bonora
- Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Sara Ronchi
- Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Viviana Vitolo
- Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Edoardo Mastella
- Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Giuseppe Magro
- Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy, Pavia, Italy
| | | | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Torino, Turin, Italy
| | - Marco Krengli
- Department of Translational Medicine, Novara, University of Piemonte Orientale, Vercelli, Italy
| | - Giovanni Ivaldi
- Unit of Radiation Oncology, ICS Maugeri, IRCSS, Pavia, Italy
| | - Annamaria Ferrari
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppi Fanetti
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Stefania Comi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Marta Tagliabue
- Department of Head and Neck Surgery and Otorhinolaryngology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Elena Verri
- Department of Medical Oncology, European Institute of Oncology, Milan, Italy
| | - Rosalinda Ricotti
- Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Delia Ciardo
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Francesca Valvo
- Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Roberto Orecchia
- Scientific Direction, European Institute of Oncology IRCCS, Milan, Italy
- Scientific Direction, National Center of Oncological Hadrontherapy, Pavia, Italy
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Vitolo V, Barcellini A, Mirandola A, Facoetti A, Iannalfi A, Vischioni B, Fiore MR, Brugnatelli S, Secondino S, Ronchi S, Bonora M, Preda L, Valvo F. Is Proton Beam Radiotherapy Worthwhile in the Management of Angiosarcoma of the Scalp? Anticancer Res 2020; 40:1645-1649. [PMID: 32132069 DOI: 10.21873/anticanres.14114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/06/2020] [Accepted: 02/13/2020] [Indexed: 11/10/2022]
Abstract
In inoperable patients, the management of angiosarcoma of the scalp is challenging. Due to intrinsic, dosimetric and radiobiological properties, proton beam radiotherapy may be an effective and safe option to offer to these difficult-to-cure patients. Here, we report a case of angiosarcoma of the scalp treated successfully with proton beam radiotherapy. Angiosarcoma is a rare malignancy concerning around 2% of soft-tissue sarcomas and 5% of cutaneous soft-tissue sarcomas. Cutaneous angiosarcomas can occur in any part of the body, but the head and neck region is a common primary site and the scalp is a frequent site in elderly patients.
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Affiliation(s)
- Viviana Vitolo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Amelia Barcellini
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Alfredo Mirandola
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Angelica Facoetti
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Alberto Iannalfi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Barbara Vischioni
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Maria Rosaria Fiore
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Silvia Brugnatelli
- Department of Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simona Secondino
- Department of Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Ronchi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Maria Bonora
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Lorenzo Preda
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy.,Department of Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
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Zoia C, Lombardi F, Fiore MR, Montalbetti A, Iannalfi A, Sansone M, Bongetta D, Valvo F, Del Maestro M, Luzzi S, Galzio RJ. Sacral solitary fibrous tumour: surgery and hadrontherapy, a combined treatment strategy. Rep Pract Oncol Radiother 2020; 25:241-244. [PMID: 32025222 DOI: 10.1016/j.rpor.2020.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 10/24/2019] [Accepted: 01/24/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Cesare Zoia
- Neurosurgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Francesco Lombardi
- Neurosurgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Maria Rosaria Fiore
- National Center of Oncological Hadrontherapy (CNAO) Clinical Radiotherapy Unit, Pavia, Italy
| | - Andrea Montalbetti
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alberto Iannalfi
- National Center of Oncological Hadrontherapy (CNAO) Clinical Radiotherapy Unit, Pavia, Italy
| | - Mattia Sansone
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Daniele Bongetta
- Neurosurgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy (CNAO) Clinical Radiotherapy Unit, Pavia, Italy
| | - Mattia Del Maestro
- Neurosurgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Renato Juan Galzio
- Neurosurgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
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Meschini G, Vai A, Paganelli C, Molinelli S, Fontana G, Pella A, Preda L, Vitolo V, Valvo F, Ciocca M, Riboldi M, Baroni G. Virtual 4DCT from 4DMRI for the management of respiratory motion in carbon ion therapy of abdominal tumors. Med Phys 2020; 47:909-916. [PMID: 31880819 DOI: 10.1002/mp.13992] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To evaluate a method for generating virtual four-dimensional computed tomography (4DCT) from four-dimensional magnetic resonance imaging (4DMRI) data in carbon ion radiotherapy with pencil beam scanning for abdominal tumors. METHODS Deformable image registration is used to: (a) register each respiratory phase of the 4DMRI to the end-exhale MRI; (b) register the reference end-exhale CT to the end-exhale MRI volume; (c) generate the virtual 4DCT by warping the registered CT according to the obtained deformation fields. A respiratory-gated carbon ion treatment plan is optimized on the planning 4DCT and the corresponding dose distribution is recalculated on the virtual 4DCT. The method was validated on a digital anthropomorphic phantom and tested on eight patients (18 acquisitions). For the phantom, a ground truth dataset was available to assess the method performances from the geometrical and dosimetric standpoints. For the patients, the virtual 4DCT was compared with the planning 4DCT. RESULTS In the phantom, the method exhibits a geometrical accuracy within the voxel size and Dose Volume Histograms deviations up to 3.3% for target V95% (mean dose difference ≤ 0.2% of the prescription dose, gamma pass rate > 98%). For patients, the virtual and the planning 4DCTs show good agreement at end-exhale (3% median D95% difference), whereas other respiratory phases exhibit moderate motion variability with consequent dose discrepancies, confirming the need for motion mitigation strategies during treatment. CONCLUSIONS The virtual 4DCT approach is feasible to evaluate treatment plan robustness against intra- and interfraction motion in carbon ion therapy delivered at the abdominal site.
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Affiliation(s)
- Giorgia Meschini
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, 20133, Italy
| | - Alessandro Vai
- Centro Nazionale di Adroterapia Oncologica, Pavia, 27100, Italy
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, 20133, Italy
| | | | - Giulia Fontana
- Centro Nazionale di Adroterapia Oncologica, Pavia, 27100, Italy
| | - Andrea Pella
- Centro Nazionale di Adroterapia Oncologica, Pavia, 27100, Italy
| | - Lorenzo Preda
- Centro Nazionale di Adroterapia Oncologica, Pavia, 27100, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, 27100, Italy
| | - Viviana Vitolo
- Centro Nazionale di Adroterapia Oncologica, Pavia, 27100, Italy
| | - Francesca Valvo
- Centro Nazionale di Adroterapia Oncologica, Pavia, 27100, Italy
| | - Mario Ciocca
- Centro Nazionale di Adroterapia Oncologica, Pavia, 27100, Italy
| | - Marco Riboldi
- Chair of Experimental Physics - Medical Physics, Ludwig-Maximilians-Universität (LMU), Munich, 80539, Germany
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, 20133, Italy.,Centro Nazionale di Adroterapia Oncologica, Pavia, 27100, Italy
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Monti S, Paganelli C, Buizza G, Preda L, Valvo F, Baroni G, Palma G, Cella L. A novel framework for spatial normalization of dose distributions in voxel-based analyses of brain irradiation outcomes. Phys Med 2020; 69:164-169. [PMID: 31918368 DOI: 10.1016/j.ejmp.2019.12.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/05/2019] [Accepted: 12/17/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To devise a novel Spatial Normalization framework for Voxel-based analysis (VBA) in brain radiotherapy. VBAs rely on accurate spatial normalization of different patients' planning CTs on a common coordinate system (CCS). The cerebral anatomy, well characterized by MRI, shows instead poor contrast in CT, resulting in potential inaccuracies in VBAs based on CT alone. METHODS We analyzed 50 meningioma patients treated with proton-therapy, undergoing planning CT and T1-weighted (T1w) MRI. The spatial normalization pipeline based on MR and CT images consisted in: intra-patient registration of CT to T1w, inter-patient registration of T1w to MNI space chosen as CCS, doses propagation to MNI. The registration quality was compared with that obtained by Statistical Parametric Mapping software (SPM), used as benchmark. To evaluate the accuracy of dose normalization, the dose organ overlap (DOO) score was computed on gray matter, white matter and cerebrospinal fluid before and after normalization. In addition, the trends in the DOOs distribution were investigated by means of cluster analysis. RESULTS The registration quality was higher for the proposed method compared to SPM (p < 0.001). The DOO scores showed a significant improvement after normalization (p < 0.001). The cluster analysis highlighted 2 clusters, with one of them including the majority of data and exhibiting acceptable DOOs. CONCLUSIONS Our study presents a robust tool for spatial normalization, specifically tailored for brain dose VBAs. Furthermore, the cluster analysis provides a formal criterion for patient exclusion in case of non-acceptable normalization results. The implemented framework lays the groundwork for future reliable VBAs in brain irradiation studies.
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Affiliation(s)
- S Monti
- National Research Council, Institute of Biostructures and Bioimaging, Napoli, Italy.
| | - C Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - G Buizza
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - L Preda
- National Centre of Oncological Hadrontherapy, Pavia, Italy
| | - F Valvo
- National Centre of Oncological Hadrontherapy, Pavia, Italy
| | - G Baroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - G Palma
- National Research Council, Institute of Biostructures and Bioimaging, Napoli, Italy
| | - L Cella
- National Research Council, Institute of Biostructures and Bioimaging, Napoli, Italy
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Molinelli S, Bonora M, Magro G, Casale S, Dale JE, Fossati P, Hasegawa A, Mirandola A, Ronchi S, Russo S, Preda L, Valvo F, Orecchia R, Ciocca M, Vischioni B. RBE-weighted dose in carbon ion therapy for ACC patients: Impact of the RBE model translation on treatment outcomes. Radiother Oncol 2019; 141:227-233. [DOI: 10.1016/j.radonc.2019.08.022] [Citation(s) in RCA: 12] [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: 05/17/2019] [Revised: 07/23/2019] [Accepted: 08/26/2019] [Indexed: 11/30/2022]
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Vischioni B, Petrucci R, Valvo F. Hypofractionation in prostate cancer radiotherapy: a step forward towards clinical routine. Transl Androl Urol 2019; 8:S528-S532. [PMID: 32042639 DOI: 10.21037/tau.2019.11.06] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Barbara Vischioni
- Radiation Oncology Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Rachele Petrucci
- Radiation Oncology Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Francesca Valvo
- Radiation Oncology Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
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Zoia C, Lombardi F, Custodi VM, Lovati E, Lucotti P, Iannalfi A, D'ippolito E, Valvo F, Bongetta D. Evaluation of the early endocrinological sequelae after hadron therapy on anterior skull base lesions in the adult population. MINERVA ENDOCRINOL 2019; 45:162-164. [PMID: 31738035 DOI: 10.23736/s0391-1977.19.03071-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, IRCCS San Matteo Polyclinic Hospital and Foundation, Pavia, Italy -
| | - Francesco Lombardi
- Neurosurgery Unit, IRCCS San Matteo Polyclinic Hospital and Foundation, Pavia, Italy
| | - Viola M Custodi
- Neurosurgery Unit, IRCCS San Matteo Polyclinic Hospital and Foundation, Pavia, Italy
| | - Elisabetta Lovati
- Endocrinology Unit, Internal Medicine I, IRCCS San Matteo Polyclinic Hospital and Foundation, Pavia, Italy
| | - Pietro Lucotti
- Endocrinology Unit, Internal Medicine I, IRCCS San Matteo Polyclinic Hospital and Foundation, Pavia, Italy
| | - Alberto Iannalfi
- Clinical Radiotherapy Unit, National Center of Oncological Hadron Therapy (CNAO), Pavia, Italy
| | - Emma D'ippolito
- Clinical Radiotherapy Unit, National Center of Oncological Hadron Therapy (CNAO), Pavia, Italy
| | - Francesca Valvo
- Clinical Radiotherapy Unit, National Center of Oncological Hadron Therapy (CNAO), Pavia, Italy
| | - Daniele Bongetta
- Neurosurgery Unit, Ospedale Fatebenefratelli e Oftalmico, ASST Fatebenefratelli Sacco, Milan, Italy
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Ricotti R, Pella A, Tagaste B, Elisei G, Fontana G, Bonora M, Ciocca M, Valvo F, Orecchia R, Baroni G. Long-time clinical experience in patient setup for several particle therapy clinical indications: management of patient positioning and evaluation of setup reproducibility and stability. Br J Radiol 2019; 93:20190595. [PMID: 31687833 DOI: 10.1259/bjr.20190595] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Accurate patient positioning is crucial in particle therapy due to the geometrical selectivity of particles. We report and discuss the National Center for Oncological Hadrontherapy (CNAO) experience in positioning accuracy and stability achieved with solid thermoplastic masks fixed on index base plates and assessed by daily orthogonal X-ray imaging. METHODS Positioning data were retrospectively collected (between 2012 and 2018) and grouped according to the treated anatomical site. 19696 fractions of 1325 patients were evaluated.The study was designed to assess:(i) the number of fractions in which a single correction vector was applied(SCV);(ii) the number of fractions in which further setup verification was performed (SV);(iii) the number of fractions in which SV lead to an additional correction within (MCV<5min) or after (MCV>5min) 5 minutes from the first setup correction;(iv) the systematic (Σ) and random (σ) error components of the correction vectors applied. RESULTS A SCV was applied in 71.5% of fractions, otherwise SV was required. In 30.6% of fractions with SV, patient position was not further revised. In the remaining fractions, MCV<5min and MCV>5min were applied mainly in extracranial and cranial sites respectively.Interfraction Σ was ≤ 1.7 mm/0.7° and σ was ≤ 1.2 mm/0.6° in cranial sites while in extracranial sites Σ was ≤ 5.5 mm/0.9° and σ was ≤4.4 mm/0.9°. Setup residuals were submillimetric in all sites. In cranial patients, maximum intrafractional Σ was 0.8 mm/0.4°. CONCLUSION This report extensively quantifies inter- and intrafraction setup accuracy on an institutional basis and confirms the need of image guidance to fully benefit from the geometrical selectivity of particles. ADVANCES IN KNOWLEDGE The reported analysis provides a board institutional data set on the evaluation of patient immobilization and bony anatomy alignment for several particle therapy clinical indications.
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Affiliation(s)
- Rosalinda Ricotti
- Bioengineering Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Andrea Pella
- Bioengineering Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Barbara Tagaste
- Bioengineering Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Giovanni Elisei
- Bioengineering Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Giulia Fontana
- Bioengineering Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Maria Bonora
- Radiotherapy Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Mario Ciocca
- Medical Physics Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Francesca Valvo
- Radiotherapy Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Roberto Orecchia
- CNAO National Center for Oncological Hadrontherapy, Pavia, Italy.,European Institute of Oncology, Milan, Italy
| | - Guido Baroni
- Bioengineering Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano University, Milan, Italy
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Facoetti A, Barcellini A, Valvo F, Pullia M. The Role of Particle Therapy in the Risk of Radio-induced Second Tumors: A Review of the Literature. Anticancer Res 2019; 39:4613-4617. [PMID: 31519558 DOI: 10.21873/anticanres.13641] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 07/18/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 11/10/2022]
Abstract
One of the most important late side-effects of radiation therapy is the development of radiation-induced secondary malignancies. In the last years, this topic has significantly influenced treatment decision-making as the number of long-term cancer survivors has significantly increased with advances in treatment modalities. All efforts are being made to prevent the incidence of tumors induced by radiation. In this review article we summarize the current knowledge about treatment-related secondary cancers with a particular attention to hadrontherapy.
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Affiliation(s)
- Angelica Facoetti
- National Center of Oncological Hadrontherapy, Fondazione CNAO, Pavia, Italy
| | - Amelia Barcellini
- National Center of Oncological Hadrontherapy, Fondazione CNAO, Pavia, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy, Fondazione CNAO, Pavia, Italy
| | - Marco Pullia
- National Center of Oncological Hadrontherapy, Fondazione CNAO, Pavia, Italy
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Viselner G, Farina L, Lucev F, Turpini E, Lungarotti L, Bacila A, Iannalfi A, D'Ippolito E, Vischioni B, Ronchi S, Marchioni E, Valvo F, Bastianello S, Preda L. Brain MR findings in patients treated with particle therapy for skull base tumors. Insights Imaging 2019; 10:94. [PMID: 31549243 PMCID: PMC6757093 DOI: 10.1186/s13244-019-0784-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/19/2019] [Indexed: 12/27/2022] Open
Abstract
Nowadays, hadrontherapy is increasingly used for the treatment of various tumors, in particular of those resistant to conventional radiotherapy. Proton and carbon ions are characterized by physical and biological features that allow a high radiation dose to tumors, minimizing irradiation to adjacent normal tissues. For this reason, radioresistant tumors and tumors located near highly radiosensitive critical organs, such as skull base tumors, represent the best target for this kind of therapy. However, also hadrontherapy can be associated with radiation adverse effects, generally referred as acute, early-delayed and late-delayed. Among late-delayed effects, the most severe form of injury is radiation necrosis. There are various underlying mechanisms involved in the development of radiation necrosis, as well as different clinical presentations requiring specific treatments. In most cases, radiation necrosis presents as a single focal lesion, but it can be multifocal and involve a single or multiple lobes simulating brain metastasis, or it can also involve both cerebral hemispheres. In every case, radiation necrosis results always related to the extension of radiation delivery field. Multiple MRI techniques, including diffusion, perfusion imaging, and spectroscopy, are important tools for the radiologist to formulate the correct diagnosis. The aim of this paper is to illustrate the possible different radiologic patterns of radiation necrosis that can be observed in different MRI techniques in patients treated with hadrontherapy for tumors involving the skull base. The images of exemplary cases of radiation necrosis are also presented.
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Affiliation(s)
- Gisela Viselner
- Diagnostic Imaging Unit, National Center of Oncological Hadrontherapy (CNAO), 27100, Pavia, Italy
| | - Lisa Farina
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Federica Lucev
- Diagnostic Radiology Residency School, University of Pavia, Pavia, Italy
| | - Elena Turpini
- Diagnostic Radiology Residency School, University of Pavia, Pavia, Italy
| | - Luca Lungarotti
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ana Bacila
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Alberto Iannalfi
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Emma D'Ippolito
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Barbara Vischioni
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Ronchi
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | | | - Francesca Valvo
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Stefano Bastianello
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Lorenzo Preda
- Diagnostic Imaging Unit, National Center of Oncological Hadrontherapy (CNAO), 27100, Pavia, Italy. .,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
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Vitolo V, Cobianchi L, Brugnatelli S, Barcellini A, Peloso A, Facoetti A, Vanoli A, Delfanti S, Preda L, Molinelli S, Klersy C, Fossati P, Orecchia R, Valvo F. Preoperative chemotherapy and carbon ions therapy for treatment of resectable and borderline resectable pancreatic adenocarcinoma: a prospective, phase II, multicentre, single-arm study. BMC Cancer 2019; 19:922. [PMID: 31521134 PMCID: PMC6744648 DOI: 10.1186/s12885-019-6108-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 05/17/2019] [Accepted: 08/29/2019] [Indexed: 12/17/2022] Open
Abstract
Background Pancreatic adenocarcinoma is a high-mortality neoplasm with a documented 5-years-overall survival around 5%. In the last decades, a real breakthrough in the treatment of the disease has not been achieved. Here we propose a prospective, phase II, multicentre, single-arm study aiming to assess the efficacy and the feasibility of a therapeutic protocol combining chemotherapy, carbon ion therapy and surgery for resectable and borderline resectable pancreatic adenocarcinoma. Method The purpose of this trial (PIOPPO Protocol) is to assess the efficacy and the feasibility of 3 cycles of FOLFIRINOX neoadjuvant chemotherapy followed by a short-course of carbon ion radiotherapy (CIRT) for resectable or borderline resectable pancreatic adenocarcinoma patients. Primary outcome of this study is the assessment of local progression free survival (L-PFS). The calculation of sample size is based on the analysis of the primary endpoint “progression free survival” according to Fleming’s Procedure. Discussion Very preliminary results provide initial evidence of the feasibility of the combined chemotherapy and CIRT in the neoadjuvant setting for resectable or borderline resectable pancreatic cancer. Completion of the accrual and long term results are awaited to see if this combination of treatment is advisable and will provide the expected benefits. Trial registration ClinicalTrials.gov Identifier: NCT03822936 registered on January 2019.
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Affiliation(s)
- Viviana Vitolo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Lorenzo Cobianchi
- General Surgery Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Silvia Brugnatelli
- Department of Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Amelia Barcellini
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy.
| | - Andrea Peloso
- Hepatology and Transplantation Laboratory, Department of Surgery, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Divisions of Abdominal and Transplantation Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Angelica Facoetti
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Alessandro Vanoli
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Delfanti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Lorenzo Preda
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Silvia Molinelli
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Catherine Klersy
- Service of Clinical Epidemiology & Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Piero Fossati
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy.,MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Roberto Orecchia
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy.,European Institute of Oncology (IEO), Milan, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
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Monti S, Paganelli C, Buizza G, Preda L, Valvo F, Magliulo M, Baroni G, Cella L, Palma G. A Novel Framework for Spatial Normalization of Dose Distributions in Voxel-Based Analyses of Brain Irradiation Outcomes. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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Dale JE, Molinelli S, Vitolo V, Vischioni B, Bonora M, Magro G, Pettersen HES, Mairani A, Hasegawa A, Dahl O, Valvo F, Fossati P. Optic nerve constraints for carbon ion RT at CNAO - Reporting and relating outcome to European and Japanese RBE. Radiother Oncol 2019; 140:175-181. [PMID: 31310888 DOI: 10.1016/j.radonc.2019.06.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Until now, carbon ion RT (CIRT) dose constraints for the optic nerve (ON) have only been validated and reported in the NIRS RBE-weighted dose (DNIRS). The aim of this work is to improve CNAO's RBE-weighted dose (DLEM) constraints by analyzing institutional toxicity data and by relating it to DNIRS. MATERIAL AND METHODS A total of 65 ONs from 38 patients treated with CIRT to the head and neck region in the period 2013-14 were analyzed. The absorbed dose (DAbs) of the treatment plans was reproduced and subsequently both DLEM and DNIRS were applied, thus relating CNAO clinical toxicity to DNIRS. RESULTS Median FU was 47 (26-67) months. Visual acuity was preserved for the 56 ONs in which the old constraints were respected. Three ONs developed visual decline at DLEM|1% ≥71 Gy(RBE)/DLEM|20% ≥68 Gy(RBE), corresponding to DNIRS|1% ≥68 Gy(RBE)/DNIRS|20% ≥62 Gy(RBE). Dose recalculation revealed that NIRS constraints of DNIRS|1% ≤40 Gy(RBE)/DNIRS|20% ≤28 Gy(RBE) corresponded to DLEM|1% ≤50 Gy(RBE)/DLEM|20% ≤40 Gy(RBE). Reoptimization of treatment plans with these new DLEM constraints showed that the dose distribution still complied with NIRS constraints when evaluated in DNIRS. However, due to uncertainties in the method, and to comply with the EQD2-based constraints used at GSI/HIT, a more moderate constraint relaxation to DLEM|1% ≤45 Gy(RBE)/DLEM|20% ≤37 Gy(RBE) has been implemented in CNAO clinical routine since October 2018. CONCLUSION New DLEM constraints for the ON were derived by analyzing CNAO toxicity data and by linking our results to the experience of NIRS and GSI/HIT. This work demonstrates the value of recalculating and reporting results in both DLEM and DNIRS.
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Affiliation(s)
- Jon Espen Dale
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Faculty of Medicine, University of Bergen, Norway.
| | | | - Viviana Vitolo
- National Center of Oncological Hadrontherapy, Pavia, Italy
| | | | - Maria Bonora
- National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Giuseppe Magro
- National Center of Oncological Hadrontherapy, Pavia, Italy
| | | | - Andrea Mairani
- National Center of Oncological Hadrontherapy, Pavia, Italy; Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany
| | - Azusa Hasegawa
- National Center of Oncological Hadrontherapy, Pavia, Italy; Osaka Heavy Ion Therapy Center, Osaka, Japan
| | - Olav Dahl
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Faculty of Medicine, University of Bergen, Norway
| | | | - Piero Fossati
- National Center of Oncological Hadrontherapy, Pavia, Italy; MedAustron Ion Therapy Center, Wiener Neustadt, Austria
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Meschini G, Seregni M, Molinelli S, Vai A, Phillips J, Sharp GC, Pella A, Valvo F, Ciocca M, Riboldi M, Paganetti H, Baroni G. Validation of a model for physical dose variations in irregularly moving targets treated with carbon ion beams. Med Phys 2019; 46:3663-3673. [PMID: 31206718 DOI: 10.1002/mp.13662] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 06/07/2019] [Accepted: 06/07/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE In particle therapy, conventional treatment planning systems rely on an imaging representation of the irradiated region to compute the dose. For irregular breathing, when an imaging dataset describing the actual motion is not available, a different approach for dose estimation is needed. To this aim, we validate a method for the estimation of physical dose variations in gated carbon ion treatments, providing also a demonstration of the feasibility of physical dose metrics to assess the method performance. Finally, we describe a sample use case, in which this method is used to assess plan robustness with respect to undetected irregular tumor motion. METHODS The method entails the definition of a patient- and beam-specific water equivalent depth (WED) space, the simulation of motion as a translation equal to tumor displacement, and the reconstruction of the altered dose. We validated the approach using four-dimensional computed tomographies (4DCTs) and clinical plans in 12 patients, treated with respiratory gated carbon ion beams at the National Centre for Oncological Hadrontherapy (Pavia, Italy). Using the end-exhale CT and dose distribution as a reference, the physical dose delivered at the end-inhale tumor position was estimated and compared to the ground-truth dose recalculation on the end-inhale CT. Biologically effective and physical dose variations between the plan and the recalculation were compared as well. As a use case, we evaluated dose changes caused by simulated irregular tumor motion, that is, linear and nonlinear baseline shifts and/or amplitude variations with hysteresis. RESULTS The ratio between biologically effective and physical equivalent uniform dose (EUD) variations due to end-exhale to end-inhale motion was less than one for 96% of investigated structures. In the validation study, we found a median error corresponding to a 14% EUD overestimation for the tumor and 4% EUD underestimation for a subgroup of organs at risk, together with a high EUD variation due to motion [median 352% EUD variation between end-exhale and end-inhale doses in the planning tumor volume (PTV)]. Considering relevant dose-volume histogram (DVH) metrics, the median difference between estimated and ground truth doses was ≤ 4%. Gamma analysis between estimated and recalculated dose distributions resulted in a pass rate > 80% for 83% of the target volumes. For the two patients selected for the sample use case, a patient-specific assessment of the method performance was performed on the 4DCT and it was possible to relate EUD variations of both tumor and organs at risk to the simulated target motion. CONCLUSIONS The physical dose distribution was found to be more sensitive to motion with respect to the biologically effective one, suggesting the suitability of the physical dose metrics for the WED-space method validation. We showed that the method can compensate for intra-fractional tumor motion with proper accuracy in the selected patient group, although its use is recommended when limited deformations are expected. In conclusion, the WED-space method can provide simulations of dose alteration due to irregular breathing when imaging data are lacking, and, once integrated with relative biological effectiveness (RBE) modeling, it would be useful in evaluating the robustness of carbon ion treatment plans.
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Affiliation(s)
| | | | | | - Alessandro Vai
- Centro Nazionale Adroterapia Oncologica, Pavia, 27100, Italy
| | - Justin Phillips
- Alexian Brothers Medical Center, Elk Grove Village, IL, 60007, USA
| | | | - Andrea Pella
- Centro Nazionale Adroterapia Oncologica, Pavia, 27100, Italy
| | - Francesca Valvo
- Centro Nazionale Adroterapia Oncologica, Pavia, 27100, Italy
| | - Mario Ciocca
- Centro Nazionale Adroterapia Oncologica, Pavia, 27100, Italy
| | - Marco Riboldi
- Ludwig-Maximilians-Universität, Munich, 80539, Germany
| | | | - Guido Baroni
- Politecnico di Milano, Milan, 20133, Italy.,Centro Nazionale Adroterapia Oncologica, Pavia, 27100, Italy
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Buizza G, Molinelli S, D'Ippolito E, Fontana G, Pella A, Valvo F, Preda L, Orecchia R, Baroni G, Paganelli C. MRI-based tumour control probability in skull-base chordomas treated with carbon-ion therapy. Radiother Oncol 2019; 137:32-37. [PMID: 31051372 DOI: 10.1016/j.radonc.2019.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 01/14/2019] [Revised: 03/30/2019] [Accepted: 04/18/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE To derive personalized tumour control probability (TCP) models, using diffusion-weighted (DW-) MRI for defining initial tumour cellular density in skull-base chordoma patients undergoing carbon-ion radiotherapy (CIRT). MATERIALS AND METHODS 67 patients affected by skull-base chordoma were enrolled for a standardized CIRT treatment (70.4 Gy (RBE) prescription dose). Local control information was clinically assessed. For 20 of them, apparent diffusion coefficient (ADC) maps were computed from DW-MRI and then converted into cellular density. Radiosensitivity parameters (α, β) were estimated from the available data through an optimization procedure, taking advantage of a relationship observed between local control and the dose received by at least the 98% of the gross tumour volume. These parameters were fed into two poissonian TCP models, based on the LQ model, being the first (TCPLIT) computed from literature parameters and the second (TCPADC) enriched by a personalized initial cellular density derived from ADC maps. RESULTS The inclusion of the cellular density derived from ADC into TCPADC yielded slightly higher dose values at which TCP = 0.5 (D50 = 38.91 Gy (RBE)) with respect to TCPLIT (D5034.16 Gy (RBE)). This suggested a more conservative approach, even if the prognostic power of TCPADC and TCPLIT, tested with respect to local control, was equivalent in terms of sensitivity (0.867) and specificity (0.600). CONCLUSIONS Both TCPADC and TCPLIT exhibited good agreement with a clinically validated information of local control, the former providing more conservative predictions.
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Affiliation(s)
- Giulia Buizza
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy.
| | - Silvia Molinelli
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Emma D'Ippolito
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Giulia Fontana
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Andrea Pella
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Lorenzo Preda
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
| | - Roberto Orecchia
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy; National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy
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