1
|
Procopio G, Chiuri V, Giordano M, Alitto A, Maisano R, Bordonaro R, Cinieri S, Rossetti S, De Placido S, Airoldi M, Galli L, Gasparro D, Ludovico G, Guglielmini P, Carella C, Nova P, Aglietta M, Schips L, Beccaglia P, Sciarra A, Livi L, Santini D, Procopio G, Chiuri V, Mantini G, Roberto Bordonaro RM, Cinieri S, Rossetti S, De Placido S, Airoldi M, Galli L, Gasparro D, Ludovico GM, Guglielmini PF, Santini D, Naglieri E, Fagnani D, Aglietta M, Livi L, Schips L, Passalacqua R, Fiore M, D'Angelillo RM, Ceresoli GL, Magrini S, Rondonotti D, Mirone V, Ferriero MC, Sciarra A, Acquati M, Boccardo F, Scagliotti GV, Mencoboni M, De Giorgi U, Micheletti G, Lanzetta G, Sartori D, Carlini P, Soto Parra HJ, Battaglia M, Uricchio F, Bernardo A, De Lisa A, Carrieri G, Ardizzoia A, Aieta M, Pisconti S, Marchetti P, Paiar F. Real-world experience of abiraterone acetate plus prednisone in chemotherapy-naive patients with metastatic castration-resistant prostate cancer: long-term results of the prospective ABItude study. ESMO Open 2022; 7:100431. [PMID: 35405438 PMCID: PMC9058899 DOI: 10.1016/j.esmoop.2022.100431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/14/2022] [Accepted: 02/07/2022] [Indexed: 12/24/2022] Open
Abstract
Background Limited real-world data exist on the effectiveness and safety of abiraterone acetate plus prednisone (abiraterone hereafter) in the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) naive to chemotherapy. Most of the few available studies had a retrospective design and included a small number of patients. In the interim analysis of the ABItude study, abiraterone showed good clinical effectiveness and safety profile in the chemotherapy-naive setting over a median follow-up of 18 months. Patients and methods We evaluated clinical and patient-reported outcomes (PROs) of chemotherapy-naive mCRPC patients treated with abiraterone as for clinical practice in the Italian, observational, prospective, multicentric ABItude study. mCRPC patients were enrolled at abiraterone start (February 2016-June 2017) and followed up for 3 years; clinical endpoints and PROs, including quality of life (QoL) and pain, were prospectively collected. Kaplan–Meier curves were estimated. Results Of the 481 patients enrolled, 454 were assessable for final study analyses. At abiraterone start, the median age was 77 years, with 58.6% elderly patients and 69% having at least one comorbidity (57.5% cardiovascular diseases). Visceral metastases were present in 8.4% of patients. Over a median follow-up of 24.8 months, median progression-free survival (any progression reported by the investigators), time to abiraterone discontinuation, and overall survival were, respectively, 17.3 months [95% confidence interval (CI) 14.1-19.4 months], 16.0 months (95% CI 13.1-18.2 months), and 37.3 months (95% CI 36.5 months-not estimable); 64.2% of patients achieved ≥50% reduction in prostate-specific antigen. QoL assessed by Functional Assessment of Cancer Therapy—Prostate, the European Quality of Life 5 Dimensions 3 Level, and European Quality of Life Visual Analog Scale remained stable during treatment. Median time to pain progression according to Brief Pain Inventory data was 31.1 months (95% CI 24.8 months-not estimable). Sixty-two patients (13.1%) had at least one adverse drug reaction (ADR) and 8 (1.7%) one serious ADR. Conclusion With longer follow-up, abiraterone therapy remains safe, well tolerated, and active in a large unselected population. A prospective real-life study of abiraterone acetate in mCRPC patients. In 481 chemotherapy-naive mCRPC patients (median follow-up: 25 months), abiraterone plus prednisone was effective and safe. QoL, measured with various tools, remained stable during treatment with abiraterone plus prednisone. The median time to pain progression was 31.1 months.
Collapse
|
2
|
Le Large TYS, Bijlsma MF, El Hassouni B, Mantini G, Lagerweij T, Henneman AA, Funel N, Kok B, Pham TV, de Haas R, Morelli L, Knol JC, Piersma SR, Kazemier G, van Laarhoven HWM, Giovannetti E, Jimenez CR. Focal adhesion kinase inhibition synergizes with nab-paclitaxel to target pancreatic ductal adenocarcinoma. J Exp Clin Cancer Res 2021; 40:91. [PMID: 33750427 PMCID: PMC7941981 DOI: 10.1186/s13046-021-01892-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 10/30/2020] [Accepted: 02/24/2021] [Indexed: 02/08/2023] Open
Abstract
Background Pancreatic ductal adenocarcinoma (PDAC) is a very lethal disease, with minimal therapeutic options. Aberrant tyrosine kinase activity influences tumor growth and is regulated by phosphorylation. We investigated phosphorylated kinases as target in PDAC. Methods Mass spectrometry-based phosphotyrosine proteomic analysis on PDAC cell lines was used to evaluate active kinases. Pathway analysis and inferred kinase activity analysis was performed to identify novel targets. Subsequently, we investigated targeting of focal adhesion kinase (FAK) in vitro with drug perturbations in combination with chemotherapeutics used against PDAC. Tyrosine phosphoproteomics upon treatment was performed to evaluate signaling. An orthotopic model of PDAC was used to evaluate the combination of defactinib with nab-paclitaxel. Results PDAC cell lines portrayed high activity of multiple receptor tyrosine kinases to various degree. The non-receptor kinase, FAK, was identified in all cell lines by our phosphotyrosine proteomic screen and pathway analysis. Targeting of this kinase with defactinib validated reduced phosphorylation profiles. Additionally, FAK inhibition had anti-proliferative and anti-migratory effects. Combination with (nab-)paclitaxel had a synergistic effect on cell proliferation in vitro and reduced tumor growth in vivo. Conclusions Our study shows high phosphorylation of several oncogenic receptor tyrosine kinases in PDAC cells and validated FAK inhibition as potential synergistic target with Nab-paclitaxel against this devastating disease. Supplementary Information The online version contains supplementary material available at 10.1186/s13046-021-01892-z.
Collapse
Affiliation(s)
- T Y S Le Large
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University Amsterdam, Amsterdam, The Netherlands.,Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.,Laboratory for Experimental Oncology and Radiobiology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,OncoProteomics Laboratory, Department of Medical Oncology, Cancer, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - M F Bijlsma
- Laboratory for Experimental Oncology and Radiobiology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Oncode Institute, Amsterdam, The Netherlands
| | - B El Hassouni
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - G Mantini
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.,OncoProteomics Laboratory, Department of Medical Oncology, Cancer, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.,Cancer Pharmacology Lab, AIRC-Start-Up, Fondazione Pisana per la Scienza, Pisa, Italy
| | - T Lagerweij
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.,Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University Amsterdam, Amsterdam, The Netherlands
| | - A A Henneman
- OncoProteomics Laboratory, Department of Medical Oncology, Cancer, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - N Funel
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - B Kok
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - T V Pham
- OncoProteomics Laboratory, Department of Medical Oncology, Cancer, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - R de Haas
- OncoProteomics Laboratory, Department of Medical Oncology, Cancer, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - L Morelli
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - J C Knol
- OncoProteomics Laboratory, Department of Medical Oncology, Cancer, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - S R Piersma
- OncoProteomics Laboratory, Department of Medical Oncology, Cancer, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - G Kazemier
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University Amsterdam, Amsterdam, The Netherlands
| | - H W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.,Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - E Giovannetti
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands. .,Cancer Pharmacology Lab, AIRC-Start-Up, Fondazione Pisana per la Scienza, Pisa, Italy.
| | - C R Jimenez
- OncoProteomics Laboratory, Department of Medical Oncology, Cancer, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.
| |
Collapse
|
3
|
Procopio G, Chiuri VE, Giordano M, Mantini G, Maisano R, Bordonaro R, Calvani N, Facchini G, De Placido S, Airoldi M, Sbrana A, Gasparro D, Ludovico GM, Guglielmini P, Naglieri E, Fagnani D, Aglietta M, Schips L, Beccaglia P, Sciarra A, Livi L, Santini D. Effectiveness of abiraterone acetate plus prednisone in chemotherapy-naïve patients with metastatic castration-resistant prostate cancer in a large prospective real-world cohort: the ABItude study. Ther Adv Med Oncol 2020; 12:1758835920968725. [PMID: 33193831 PMCID: PMC7604981 DOI: 10.1177/1758835920968725] [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: 06/03/2020] [Accepted: 10/02/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Real-world data on chemotherapy-naïve patients with metastatic castration-resistant prostate cancer (mCRPC) treated with abiraterone plus prednisone are limited, largely deriving from small retrospective studies. Methods: ABitude is an Italian, observational, prospective, multicenter study of mCRPC patients receiving abiraterone plus prednisone in clinical practice. Chemotherapy-naïve mCRPC patients were consecutively enrolled at abiraterone start (February 2016 to June 2017) and are being followed for 3 years, with evaluation approximately every 6 months. Several clinical and patients reported outcomes were examined. Results: In this second interim analysis, among 481 enrolled patients, 453 were evaluable for analyses. At baseline, the median age was 77 years and ~69% of patients had comorbidities (mainly cardiovascular diseases). Metastases were located mainly at bones and lymph nodes; 8.4% of patients had visceral metastases. During a median follow-up of 18 months, 1- and 2-year probability of radiographic progression-free survival were 73.9% and 56.2%, respectively; the corresponding rates for overall survival were 87.3% and 70.4%. In multivariable analyses, the number of bone metastases significantly affected radiographic progression-free survival and overall survival. During abiraterone plus prednisone treatment, 65% of patients had a ⩾50% prostate-specific antigen decline, and quality of life remained appreciably high. Among symptomatic patients according to the Brief Pain Inventory) (32%), scores significantly declined after 6 months of treatment. Overall, eight patients (1.7%) had serious adverse reactions to abiraterone. Conclusions: Abiraterone plus prednisone is effective and safe for chemotherapy-naïve mCRPC patients in clinical practice.
Collapse
Affiliation(s)
- Giuseppe Procopio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, Milan, 20133, Italy
| | | | - Monica Giordano
- Medical Oncology Division, ASST-Lariana, Como, Lombardia, Italy
| | - Giovanna Mantini
- Radiochemotherapy Unit, Department of Diagnostics for Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico A. Gemelli IRCCS, Rome - University Department of Radiological and Hematological Sciences, Università Cattolica Sacro Cuore, Italy
| | - Roberto Maisano
- Department of Oncology, A.O. Bianchi-Melacrino-Morelli, Reggio Calabria, Calabria, Italy
| | | | - Nicola Calvani
- Medical Oncology Unit, Antonio Perrino Hospital, Brindisi, Puglia, Italy
| | - Gaetano Facchini
- Departmental Unit of Experimental Uro-Andrological Clinical Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Campania, Italy
| | - Mario Airoldi
- Oncology Unit 2 - Città della Salute e della Scienza di Torino, Turin, Piemonte, Italy
| | - Andrea Sbrana
- Medical Oncology Unit 2, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Donatello Gasparro
- Medical Oncology Unit, Department of General and Specialistic Medicine, University Hospital of Parma, Parma, Italy
| | | | - Pamela Guglielmini
- Oncology Unit, SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | | | | | - Massimo Aglietta
- Department of Oncology, University of Turin; Candiolo Cancer Institute - FPO- IRCCS, Candiolo, Italy
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio University of Chieti, Urology unit, "SS. Annunziata Hospital", Chieti, Italy
| | | | - Alessandro Sciarra
- Department of Urology, Sapienza Rome University Policlinico Umberto I, Rome, Italy
| | - Lorenzo Livi
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Daniele Santini
- Department of Medical Oncology, University Campus Biomedico, Rome, Italy
| |
Collapse
|
4
|
Buwenge M, Alitto AR, Cilla S, Capocaccia I, Mazzeo E, Ippolito E, Mantini G, Siepe G, Cavallini L, Valentini V, Deodato F, Morganti AG, Macchia G. Simultaneous Integrated Radiotherapy Boost to the Dominant Intraprostatic Lesion: Final Results of a Phase I/II Trial. Anticancer Res 2020; 40:6499-6503. [PMID: 33109589 DOI: 10.21873/anticanres.14672] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/21/2020] [Accepted: 09/29/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Late toxicity and long-term outcomes of a phase I-II trial on patients with prostate cancer treated with an integrated boost to the dominant intraprostatic lesion (DIL) are reported. PATIENTS AND METHODS Patients were treated using intensity-modulated radiotherapy, with a simultaneous integrated boost to the DIL, defined on staging magnetic resonance imaging, delivering 72 Gy in 1.8 Gy/fraction to prostate/seminal vesicles and 80 Gy in 2 Gy/fraction to the DIL. The primary endpoint was acute toxicity and secondary endpoints were late toxicity and biochemical disease-free survival. RESULTS Forty-four patients were enrolled. The median follow-up was 120 (range=25-150) months. Five-year rates of grade 3 late gastrointestinal and genitourinary toxicity were 2.3% and 4.5%, respectively; only one grade 4 late genitourinary toxicity was recorded. Five-year biochemical relapse-free and overall survival rates were 95.3% and 95.5%, respectively. CONCLUSION The treatment was well tolerated and achieved excellent results in terms of outcome in patients with low-intermediate Gleason's score and low risk of nodal metastasis.
Collapse
Affiliation(s)
- Milly Buwenge
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Anna Rita Alitto
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Savino Cilla
- Medical Physic Unit, Gemelli Molise Hospital, Campobasso, Italy
| | - Ilaria Capocaccia
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Ercole Mazzeo
- Radiotherapy Unit - Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Edy Ippolito
- Radiation Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Giovanna Mantini
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giambattista Siepe
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Letizia Cavallini
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Vincenzo Valentini
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Alessio G Morganti
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | | |
Collapse
|
5
|
Alitto A, Buwenge M, Macchia G, Ntreta M, Siepe G, Galofaro E, Bertini F, Ferioli M, Mazzeo E, Ippolito E, Mantini G, Ferro M, Re A, Cilla S, Valentini V, Deodato F, Morganti A, Cammelli S. PO-1185: Results of prostate cancer patients treated by integrated boost to dominant intraprostatic lesion. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01203-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
6
|
Francolini G, Garlatti P, Detti B, Bruni A, Mantini G, Pergolizzi S, Borghetti P, D’Angelillo R, Alongi F, Jereczek-Fossa B, Franzese C, Tagliagambe A, Di Cataldo V, Aquilano M, Mariotti M, Salvestrini V, Ciccone L, Stocchi G, Livi L. Early results from a phase II randomized trial testing stereotactic body radiation therapy in patients with oligometastatic castration resistant prostate cancer undergoing I line treatment with abiraterone acetate (ARTO trial-NCT03449719). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)36207-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
7
|
Mantini G, Vallés AM, Le Large TYS, Capula M, Funel N, Pham TV, Piersma SR, Kazemier G, Bijlsma MF, Giovannetti E, Jimenez CR. Co-expression analysis of pancreatic cancer proteome reveals biology and prognostic biomarkers. Cell Oncol (Dordr) 2020; 43:1147-1159. [PMID: 32860207 PMCID: PMC7716908 DOI: 10.1007/s13402-020-00548-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2020] [Indexed: 01/02/2023] Open
Abstract
Purpose Despite extensive biological and clinical studies, including comprehensive genomic and transcriptomic profiling efforts, pancreatic ductal adenocarcinoma (PDAC) remains a devastating disease, with a poor survival and limited therapeutic options. The goal of this study was to assess co-expressed PDAC proteins and their associations with biological pathways and clinical parameters. Methods Correlation network analysis is emerging as a powerful approach to infer tumor biology from omics data and to prioritize candidate genes as biomarkers or drug targets. In this study, we applied a weighted gene co-expression network analysis (WGCNA) to the proteome of 20 surgically resected PDAC specimens (PXD015744) and confirmed its clinical value in 82 independent primary cases. Results Using WGCNA, we obtained twelve co-expressed clusters with a distinct biology. Notably, we found that one module enriched for metabolic processes and epithelial-mesenchymal-transition (EMT) was significantly associated with overall survival (p = 0.01) and disease-free survival (p = 0.03). The prognostic value of three proteins (SPTBN1, KHSRP and PYGL) belonging to this module was confirmed using immunohistochemistry in a cohort of 82 independent resected patients. Risk score evaluation of the prognostic signature confirmed its association with overall survival in multivariate analyses. Finally, immunofluorescence analysis confirmed co-expression of SPTBN1 and KHSRP in Hs766t PDAC cells. Conclusions Our WGCNA analysis revealed a PDAC module enriched for metabolic and EMT-associated processes. In addition, we found that three of the proteins involved were associated with PDAC survival. Electronic supplementary material The online version of this article (10.1007/s13402-020-00548-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- G Mantini
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Fondazione Pisana Per La Scienza, Pisa, Italy
| | - A M Vallés
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - T Y S Le Large
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Univ of Amsterdam, Laboratory for Experimental Oncology and Radiobiology, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, The Netherlands
| | - M Capula
- Fondazione Pisana Per La Scienza, Pisa, Italy
| | - N Funel
- U.O. Anatomia ed Istologia Patologica II Azienda Ospedaliero Universitaria Pisana , Pisa, Italy
| | - T V Pham
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - S R Piersma
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - G Kazemier
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, The Netherlands
| | - M F Bijlsma
- U.O. Anatomia ed Istologia Patologica II Azienda Ospedaliero Universitaria Pisana , Pisa, Italy.,Oncode Institute, Amsterdam, The Netherlands
| | - E Giovannetti
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands. .,Fondazione Pisana Per La Scienza, Pisa, Italy.
| | - C R Jimenez
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.
| |
Collapse
|
8
|
Marazzi F, Barone R, Masiello V, Magri V, Mulè A, Santoro A, Cacciatori F, Boldrini L, Franceschini G, Moschella F, Naso G, Tomao S, Gambacorta MA, Mantini G, Masetti R, Smaniotto D, Valentini V. Oncotype DX Predictive Nomogram for Recurrence Score Output: The Novel System ADAPTED01 Based on Quantitative Immunochemistry Analysis. Clin Breast Cancer 2020; 20:e600-e611. [PMID: 32565110 DOI: 10.1016/j.clbc.2020.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Oncotype DX (ODX) predicts breast cancer recurrence risk, guiding the choice of adjuvant treatment. In many countries, access to the test is not always available. We used correlation between phenotypical tumor characteristics, quantitative classical immunohistochemistry (IHC), and recurrence score (RS) assessed by ODX to develop a decision supporting system for clinical use. PATIENTS AND METHODS Breast cancer patients who underwent ODX testing between 2014 and 2018 were retrospectively included in the study. The data selected for analysis were age, menopausal status, and pathologic and IHC features. IHC was performed with standardized quantitative methods. The data set was split into two subsets: 70% for the training set and 30% for the internal validation set. Statistically significant features were included in logistic models to predict RS ≤ 25 or ≤ 20. Another set was used for external validation to test reproducibility of prediction models. RESULTS The internal set included 407 patients. Mean (range) age was 53.7 (31-80) years, and 222 patients (54.55%) were > 50 years old. ODX results showed 67 patients (16.6%) had RS between 0 and 10, 272 patients between 11 and 25 (66.8%), and 68 patients > 26 (16.6%). Logistic regression analysis showed that RS score (for threshold ≤ 25) was significantly associated with estrogen receptor (P = .004), progesterone receptor (P < .0001), and Ki-67 (P < .0001). Generalized linear regression resulted in a model that had an area under the receiver operating characteristic curve (AUC) of 92.2 (sensitivity 84.2%, specificity 80.1%) and that was well calibrated. The external validation set (183 patients) analysis confirmed the model performance, with an AUC of 82.3 and a positive predictive value of 91%. A nomogram was generated for further prospective evaluation to predict RS ≤ 25. CONCLUSION RS was related to quantitative IHC in patients with RS ≤ 25, with a good performance of the statistical model in both internal and external validation. A nomogram for enhancing clinical approach in a cost-effective manner was developed. Prospective studies must test this application in clinical practice.
Collapse
Affiliation(s)
- Fabio Marazzi
- UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | | | - Valeria Masiello
- UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy.
| | - Valentina Magri
- Breast Unit, Division of Medical Oncology, Department of Radiological Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Antonino Mulè
- UOC di Anatomia Patologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Angela Santoro
- UOC di Anatomia Patologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Federica Cacciatori
- UOC di Anatomia Patologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Luca Boldrini
- UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Gianluca Franceschini
- UOC di Chirurgia Senologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy
| | - Francesca Moschella
- UOC di Chirurgia Senologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Giuseppe Naso
- Breast Unit, Division of Medical Oncology, Department of Radiological Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Silverio Tomao
- Breast Unit, Division of Medical Oncology, Department of Radiological Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Maria Antonietta Gambacorta
- UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy
| | - Giovanna Mantini
- UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy
| | - Riccardo Masetti
- UOC di Chirurgia Senologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy
| | - Daniela Smaniotto
- UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy
| | - Vincenzo Valentini
- UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy
| |
Collapse
|
9
|
Alitto AR, Tagliaferri L, Lancellotta V, D'Aviero A, Piras A, Frascino V, Catucci F, Fionda B, Staackmann C, Saldi S, Valentini V, Kovacs G, Aristei C, Mantini G. BIT-ART: Multicentric Comparison of HDR-brachytherapy, Intensity-modulated Radiotherapy and Tomotherapy for Advanced Radiotherapy in Prostate Cancer. In Vivo 2020; 34:1297-1305. [PMID: 32354922 PMCID: PMC7279807 DOI: 10.21873/invivo.11905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 01/28/2020] [Accepted: 02/03/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIM The aim of the study was to evaluate acute and late genitourinary (GU) and gastrointestinal (GI) toxicity in patients with high- or intermediate-risk prostate cancer. PATIENTS AND METHODS We evaluated data of patients from three Radiation Oncology Departments (Rome, Lübeck and Perugia). Patients treated in Rome underwent exclusive intensity-modulated-radiotherapy (IMRT) or IMRT plus high-dose-rate interventional radiotherapy (HDR-IRT). IMRT plus two fractions HDR-IRT was performed in Lübeck, while in Perugia Helical Tomotherapy was performed. The Common Toxicity Criteria for Adverse Event (Version 4.03) scale was used to describe acute and late toxicity. RESULTS At a median follow-up of 28 months, all 51 patients were alive and disease-free. Patients treated by HDR-IRT plus VMAT showed only G1-2 genitourinary- gastrointestinal (GU-GI) acute and late toxicity. Univariate analysis showed a lower risk of acute GU toxicity (p=0.048) in IMRT+HDR-IRT. CONCLUSION Low grade and less acute GU toxicity was observed in patients undergoing HDR-IRT boost.
Collapse
Affiliation(s)
- Anna Rita Alitto
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | | | | | | | - Vincenzo Frascino
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Francesco Catucci
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Bruno Fionda
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Christian Staackmann
- Interdisciplinary Brachytherapy Unit, University of Lübeck - University Hospital S-H, Campus Lübeck, Lübeck, Germany
| | - Simonetta Saldi
- Radiation Oncology Section, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gyorgy Kovacs
- Interdisciplinary Brachytherapy Unit, University of Lübeck - University Hospital S-H, Campus Lübeck, Lübeck, Germany
- Università Cattolica del Sacro Cuore, Educational Program Director Gemelli-INTERACTS, Rome, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Giovanna Mantini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
10
|
Buwenge M, Deodato F, Macchia G, Siepe G, Zhao X, Valicenti RK, Cilla S, Alitto AR, Ntreta M, Bisello S, Mantini G, Valentini V, Morganti AG, Cammelli S. Radiotherapy Plus GnRH Analogue Versus High Dose Bicalutamide: A Case Control Study. Anticancer Res 2019; 39:6373-6378. [PMID: 31704870 DOI: 10.21873/anticanres.13850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Radiotherapy (RT) with adjuvant hormone therapy (HT) improves prognosis in prostate cancer (PC) patients. Gonadotrophin-releasing hormone agonist (GnRHa) with luteinizing hormone-releasing hormone (LH-RH) analogues is the standard HT. High-dose antiandrogen therapy also improves survival in patients with locally advanced PC. The aim of this study was to compare the results of patients treated with RT plus GnRHa and patients treated with RT plus bicalutamide. PATIENTS AND METHODS Our institutional PC database was used to identify patients treated with definitive or postoperative RT +/- HT which were included in this study. RESULTS Three hundred and eighteen patients were retrospectively reviewed (median follow-up=56 months). Five-year biochemical relapse-free survival was 85.5% and 88.3% in patients treated with GnRHa and bicalutamide, respectively (p=0.712). CONCLUSION Bicalutamide may be offered as an adjuvant treatment to RT in patients who refuse GnRHa because of related side effects. Furthermore, our study justifies randomized trials comparing RT plus GnRHa and RT plus bicalutamide.
Collapse
Affiliation(s)
- Milly Buwenge
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Francesco Deodato
- Radiotherapy Unit, Giovanni Paolo II Foundation, Catholic University of Sacred Heart, Campobasso, Italy
| | - Gabriella Macchia
- Radiotherapy Unit, Giovanni Paolo II Foundation, Catholic University of Sacred Heart, Campobasso, Italy
| | - Giambattista Siepe
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Xiao Zhao
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, U.S.A
| | - Richard K Valicenti
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, U.S.A
| | - Savino Cilla
- Medical Physics Unit, Giovanni Paolo II Foundation, Catholic University of Sacred Heart, Campobasso, Italy
| | - Anna Rita Alitto
- Institute of Radiology, Catholic University of Sacred Heart, Rome, Italy
| | - Maria Ntreta
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Silvia Bisello
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giovanna Mantini
- Institute of Radiology, Catholic University of Sacred Heart, Rome, Italy
| | - Vincenzo Valentini
- Institute of Radiology, Catholic University of Sacred Heart, Rome, Italy.,Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Alessio G Morganti
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Silvia Cammelli
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| |
Collapse
|
11
|
Marazzi F, Masiello V, Barone R, Magri V, Mulé A, Santoro A, Cacciatori F, Boldrini L, Franceschini G, Moschella F, Naso G, Tomao S, Mantini G, Masetti R, Smaniotto D, Valentini V. OncotypeDX® predictive nomogram for recurrence score output: A machine learning system based on quantitative immunochemistry analysis - ADAPTED01. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.085] [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: 11/14/2022] Open
|
12
|
Chiloiro G, Boldrini L, Meldolesi E, Re A, Cellini F, Cusumano D, Corvari B, Mantini G, Balducci M, Valentini V, Gambacorta MA. MR-guided radiotherapy in rectal cancer: First clinical experience of an innovative technology. Clin Transl Radiat Oncol 2019; 18:80-86. [PMID: 31341981 PMCID: PMC6630154 DOI: 10.1016/j.ctro.2019.04.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 03/24/2019] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 12/15/2022] Open
Abstract
•This study represents one of the first reports of online MRgRT.•Integrated Low-field MR provides better anatomical visualization than CBCT or MVCT.•Better visualization of the target can help to reduce the margins from CTV to PTV.•MRgRT appears a feasible option in rectal cancer treatment offering potential benefits.•MRgRT represents a promising technology for rectal cancer management.
Collapse
Affiliation(s)
- Giuditta Chiloiro
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
| | - Luca Boldrini
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
| | - Elisa Meldolesi
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
| | - Alessia Re
- Unità di Radioterapia Oncologica, Fondazione di Ricerca e Cura Giovanni Paolo II, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesco Cellini
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
| | - Davide Cusumano
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Fisica Sanitaria, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
| | - Barbara Corvari
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
| | - Giovanna Mantini
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italy
| | - Mario Balducci
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italy
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italy
| |
Collapse
|
13
|
Iezzi R, Larici AR, Posa A, Carchesio F, Congedo MT, Tagliaferri L, Cassano A, D'argento E, Mantini G, Rodolfino E, Margaritora S, Bria E, Tortora G, Valentini V, Manfredi R. Percutaneous radiofrequency ablation using internally cooled wet electrodes for the treatment of patients with lung tumors. Eur Rev Med Pharmacol Sci 2019; 23:6554-6561. [PMID: 31378896 DOI: 10.26355/eurrev_201908_18541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess the safety and feasibility of computed tomography-guided radiofrequency ablation (CT-guided RFA) in unresectable lung neoplasms, using a new 15G monopolar internally cooled wet electrode. PATIENTS AND METHODS 15 consecutive patients with lung neoplasms (< 4 cm), both primary and secondary, unsuitable for or refusing surgery, underwent percutaneous CT-guided RFA using a 15G electrode with a 3-cm exposed tip. The prevalence and grade of adverse events and technical success were evaluated, as well as the extension of the ablation zone, the complete response rates, and the time to progression, determined at CT examination performed 1, 6, and 12 months after the procedure. RESULTS A total of 22 lung neoplasms were treated (mean diameter: 28 mm; range: 20-39 mm). Technical success was obtained in all patients, without major complications or intraprocedural deaths. Mild or moderate pneumothorax was registered in 46.7% of patients, while a perilesional hemorrhage was observed in 5/15 cases. During the follow-up period, a complete response was obtained in 19 out of 22 lesions (86.4%) with three partial response, two of them successfully retreated with the same technique. CONCLUSIONS Percutaneous RFA using a 15G internally cooled wet electrode is a safe and feasible treatment for unresectable lung neoplasms, with high complete response rates.
Collapse
Affiliation(s)
- R Iezzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Smaniotto D, D'Agostino G, Luzi S, Valentini V, Macchia G, Mantini G, Margariti PA, Ferrandina G, Scambia G. Concurrent 5-Fluorouracil, Mitomycin C and Radiation with or without Brachytherapy in Recurrent Cervical Cancer: A Scoring System to Predict Clinical Response and Outcome. Tumori 2019; 91:295-301. [PMID: 16277092 DOI: 10.1177/030089160509100402] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and purpose This is a prospective, phase II study aimed to evaluate the effect of concurrent 5-fluorouracil, mitomycin C, and radiation with or without brachytherapy on the clinical outcome of a series of recurrent cervical cancer patients and to determine the prognostic impact of a subset of factors. Methods Thirty-three patients with locally recurrent, non-metastatic cervical cancer received external beam radiation (4-week split course: 23.4 + 23.4 Gy) plus two courses of concomitant chemotherapy (5-fluorouracil, 96-h continuous infusion, days 1–4, 1 g/m2/day; mitomycin C, 10 mg/m2, bolus iv, day 1). Twelve patients with vaginal recurrence (36.4%) underwent endocavitary low-dose rate brachytherapy boost (20–25 Gy); 11 patients with lateral pelvic recurrence (33.3%) received external beam radiation boost (14–20 Gy). Results Fourteen complete responses (42.4%), 7 partial responses (21.2%), 5 disease stabilizations (15.1%) and 7 progressions (21.2%) were obtained. After a median follow-up of 34 months (range, 6–127), overall actuarial 3-year survival, progression-free survival and local progression-free survival were 59.7%, 48.1% and 51.7%, respectively. Patients with vaginal recurrence of less than 4 cm and negative lymph nodes proved to respond best to the treatment. Two patients (6.1%) experienced hematologic grade 3 toxicity. One patient had grade 3 intestinal toxicity (3.0%). No patient had major skin or urological acute toxicity. Severe late toxicity was infrequent Three patients had prolonged leukopenia (9.0%). Four patients showed severe vaginal stenosis (12.1%). A clinical score of 0 to 1 was assigned to each patient on the basis of the absence (score = 0) or presence (score = 1) of any of the following prognostic factors: time between surgery and recurrence shorter than 12 months, pelvic wall site of recurrence, positive lymph nodes, hemoglobin <11 g/dL. Using this system, it was clear that patients with a low total score had a significantly better outcome (clinical remission, 51% of patients with a score ≤2 vs 12% of patients with a score >2, P = 0.06), local control of the disease (65% vs 20% after 3 years, P = 0.001,) and overall survival (75% vs 30% after 3 years, P = 0.032). Conclusions Our data suggest that this combined modality therapy was relatively well tolerated and resulted in reasonable local control and survival. The scoring system proved to be helpful to identify patients with the greatest chance of benefiting from the treatment Further studies are probably needed to salvage the other patients, whose prognosis remains severe.
Collapse
Affiliation(s)
- Daniela Smaniotto
- Department of Radiation Oncology, Catholic University of the Sacred Heart, Rome, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Morganti AG, Trodella L, Valentini V, Barbi S, Macchia G, Mantini G, Turriziani A, Cellini N. Pain Relief with Short Term Irradiation in Locally Advanced Carcinoma of the Pancreas. J Palliat Care 2019. [DOI: 10.1177/082585970301900407] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To evaluate whether a short radiation treatment (30 Gy, 3.0 Gy/fraction) had analgesic efficacy in patients with unresectable pancreatic carcinoma. Methods Twelve patients were included in this analysis. Before starting and at four weeks after radiation therapy, pain intensity was evaluated and analgesic drug therapy was adjusted until a 0–3 pain score was reached (WHO). Results No radiotherapy interruptions, no hospitalisation due to toxic reactions, and no severe toxicity were observed. Six patients (50%) had pain control without pharmacological therapy, three patients (25%) reduced their use (35%–72%) of analgesics, while in the remaining three patients (25%) there was no change in analgesic use. Overall, mean reduction in the use of analgesics was 63.1% ± 43.8%. During follow-up (44 months), two patients (16.7%) showed a worsening of pain that required increased analgesia; in one patient, percutaneous splanchnicectomy was necessary. Conclusion In patients excluded from standard concomitant chemoradiation, hypofractionated-accelerated radiotherapy is feasible and results in pain relief in most patients, documented as a reduced need for analgesics.
Collapse
Affiliation(s)
- Alessio G. Morganti
- Radiation Therapy Department, Università Cattolica del Sacro Cuore, Campobasso
| | - Lucio Trodella
- Radiation Therapy Department, Università Cattolica del Sacro Cuore, Rome
| | - Vincenzo Valentini
- Radiation Therapy Department, Università Cattolica del Sacro Cuore, Rome
| | - Sergio Barbi
- Anesthesiology Department, Università Cattolica del Sacro Cuore, Rome
| | - Gabriella Macchia
- Radiation Therapy Department, Università Cattolica del Sacro Cuore, Campobasso
| | - Giovanna Mantini
- Radiation Therapy Department, Università Cattolica del Sacro Cuore, Rome
| | - Adriana Turriziani
- Radiation Therapy Department, Università Cattolica del Sacro Cuore, Rome
| | - Numa Cellini
- Radiation Therapy Department, Università Cattolica del Sacro Cuore, Rome
| |
Collapse
|
16
|
Marazzi F, Masiello V, Marchesano D, Boldrini L, Luzi S, Ferrara PE, Amabile E, Piccari D, Landi F, Moschella F, Franceschini G, Masetti R, Mantini G, Valentini V, Smaniotto D. Shoulder girdle impairment in breast cancer survivors: the role of range of motion as predictive factor for dose distribution and clinical outcome. Tumori Journal 2019; 105:319-330. [DOI: 10.1177/0300891619839287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background:Pain and functional impairment of the ipsilateral shoulder girdle in patients who underwent surgery and radiotherapy for breast cancer (BC) is a late complication reported in the literature. We analyze a correlation with dosimetric parameters and propose an algorithm for sparing strategies.Methods:A total of 111 patients treated for BC were included in this observational analysis during follow-up protocol visits. Exclusion criteria were the presence of moderate or severe arthrosis history and/or rheumatologic diseases. All the patients had complete physical and multidimensional examinations during joint (physiatrist and radiotherapy oncology) follow-up visits. A scapula–humeral articulation (SHA) standardized contouring was performed retrospectively on Eclipse® treatment plans. A possible correlation between patients’ characteristics, radiotherapy, and dosimetry analysis and functional impairment was investigated at statistical analysis. Results of analysis were summarized into a proposal of algorithm for sparing SHA.Results:A total of 111 patients were selected during follow-up visits. Mean age of patients was 60 years (range 41–85 years). A total of 103 patients (93%) underwent conservative surgery, with 110 patients (99%) undergoing axilla surgery as well. Fifty-two patients (46.8%) presented a reduction of range of motion (ROM) abduction on the treated side at the observational analysis. Mean ROM abduction reduction was 13°06’ (range 0°–100°). Disability of the Arm, Shoulder and Hand questionnaire (DASH) score results were excellent in 79 patients (71.2%), discrete in 15 patients (13.5%), good in 15 patients (13.5%), and sufficient in 2 patients (1.8%). Median EQD2Dmaxat SHA was 18 Gy (range 0.22–51.9 Gy) and median EQD2mean dose at SHA was 2 Gy (range 0.04–24.32 Gy). Univariate analysis showed a linear correlation between DASH score and ROM of abduction of treated side (ρ=−0.7), ROM of abduction and ROM of flexion in ipsilateral arm (ρ=0.8), or ROM of abduction and ROM of flexion in contralateral arm (ρ=0.8). A statistically significant difference in ROM abduction between the 2 arms was found at χ2test ( P<0.05 at χ2confidence interval = 95%). Cox linear regression analysis showed ROM abduction on treated arm as a predictive factor of DASH score ( P<0.0001). Age ( P<0.05), DASH score ( P=0.006), and ROM abduction on treated arm ( P=0.005) were found as independent predictive factors of mean dose at multivariate analysis. A mean dose higher than 7 Gy and ROM abduction reduction more than 30° were related to DASH score level reduction.Conclusions:This hypothesis-generating study introduces an algorithm to be validated for management of sparing SHA and improving quality of survivorship. ROM evaluation after surgery, early physiotherapy, standard contouring, and planning adaptation represent possible indications to preserve shoulder impairment. Further prospective studies are needed to discriminate impairment of surgery and radiotherapy in order to personalized therapeutic plan programs.
Collapse
Affiliation(s)
- Fabio Marazzi
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Valeria Masiello
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Domenico Marchesano
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Luca Boldrini
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Stefano Luzi
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italia
| | - Paola E. Ferrara
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Riabilitazione e Medicina Fisica, Dipartimento di Scienze dell’invecchiamento, neurologiche, ortopediche e della testa-collo, Roma, Italia
| | - Eugenia Amabile
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Riabilitazione e Medicina Fisica, Dipartimento di Scienze dell’invecchiamento, neurologiche, ortopediche e della testa-collo, Roma, Italia
| | - Danila Piccari
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Francesco Landi
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italia
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Riabilitazione e Medicina Fisica, Dipartimento di Scienze dell’invecchiamento, neurologiche, ortopediche e della testa-collo, Roma, Italia
| | - Francesca Moschella
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Chirurgia Senologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Roma, Italia
| | - Gianluca Franceschini
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italia
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Chirurgia Senologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Roma, Italia
| | - Riccardo Masetti
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italia
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Chirurgia Senologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Roma, Italia
| | - Giovanna Mantini
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italia
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italia
| | - Daniela Smaniotto
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italia
| |
Collapse
|
17
|
Chiesa S, Gatta R, Martino A, Piras A, Cusumano D, Boldrini L, Masciocchi C, Massaccesi M, Dinapoli N, Cellini F, D'aviero A, Mattiucci G, Mantini G, Balducci M, Valentini V. EP-1928 Radiomic features and local response in Lung Cancer treated with Stereotactic Radiation Therapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32348-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
18
|
Mazzarella C, Martino A, Alitto A, Preziosi F, Catucci F, Petrone A, Campitelli M, Marazzi F, Mattiucci G, Palazzoni G, Valentini V, Mantini G. EP-1385 Does pneumonitis increase in irradiated lungs during immunotherapy?A generating hypotheses study. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31805-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
19
|
Marazzi F, Mulè A, Masiello V, Masetti R, Barone R, Franceschini G, Cacciatori F, Moschella F, Cannatà C, Boldrini L, Mantini G, Smaniotto D, Valentini V. EP-1325 Personalized Medicine in breast cancer: a nomogram from prognostic score to deescalate radiotherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31745-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
20
|
Mazzarella C, Chiesa S, Catucci F, Dinapoli N, Beghella Bartoli F, Luzi S, Sabatino G, Bracci S, Mantini G, Gambacorta M, Cellini F, Mattiucci G, Valentini V, Balducci M. Edema or Margin in Glioblastoma CTV? Impact on Pattern of Recurrence and Survival of Two Different CTV Delineations Independently Peer Reviewed. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
21
|
Hassouni BE, Sciarrillo R, Mantini G, Minutolo F, Funel N, Lee H, Hergenrother P, Peters G, Giovannetti E. PO-042 Targeting hypoxic pancreatic cancer cells with glucose conjugated lactate dehydrogenase inhibitor NHI-Glc-2. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.575] [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: 11/04/2022] Open
|
22
|
Ippolito E, Guido A, Macchia G, Deodato F, Giaccherini L, Farioli A, Arcelli A, Cuicchi D, Frazzoni L, Cilla S, Buwenge M, Mantini G, Alitto AR, Nuzzo M, Valentini V, Ingrosso M, Morganti AG, Fuccio L. Predictive Factors of Late-onset Rectal Mucosal Changes After Radiotherapy of Prostate Cancer. ACTA ACUST UNITED AC 2018; 31:961-966. [PMID: 28882966 DOI: 10.21873/invivo.11154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/03/2017] [Accepted: 07/06/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND/AIM The Vienna Rectoscopy Score (VRS; from 0, absence of rectal mucosal changes, to 5) assessed 1 year after radiotherapy is a surrogate end-point of late rectal toxicity. The aim of this study was to investigate the association between treatment-related factors and 1-year VRS. PATIENTS AND METHODS We performed a retrospective analysis of prospectively collected data. Patients with prostate adenocarcinoma treated with definitive or postoperative radiotherapy (RT) underwent endoscopy 1 year after RT. Relationships between VRS of 2 or more and treatment parameters were investigated by univariate and multivariate logistic analyses. RESULTS One hundred and ninety-five patients (mean age=69 years; range=43-81 years) were considered eligible for the study. At univariate analysis, patients treated with hypofractionation plus radiosurgery boost (p<0.001) and an equivalent dose in 2 Gy per fraction (EQD2) (α/β=3) ≥75 Gy (p<0.001) was associated with a significantly higher incidence of VRS ≥2 after 1 year of follow-up. At multivariate analysis, radiosurgery boost was an independent risk factor for developing rectal mucosal lesions (VRS ≥2), yielding an odds ratio (OR) of 4.14 (95% confidence interval (CI)=1.2-13.8), while pelvic surgery was inversely associated with VRS ≥2 (OR=0.39; 95% CI=0.17-0.94). CONCLUSION Hypofractionation followed by radiosurgery boost significantly increased the risk of developing late-onset rectal mucosal changes. Therefore, special care and preventative treatment strategies are needed when using radiosurgery boost after hypofractionated RT.
Collapse
Affiliation(s)
- Edy Ippolito
- Radiotherapy Unit, Campus Bio-Medico University, Rome, Italy
| | - Alessandra Guido
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine DIMES, University of Bologna, Bologna, Italy
| | - Gabriella Macchia
- Radiotherapy Unit, Giovanni Paolo II Research and Care Foundation, Campobasso, Italy
| | - Francesco Deodato
- Radiotherapy Unit, Giovanni Paolo II Research and Care Foundation, Campobasso, Italy
| | - Lucia Giaccherini
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine DIMES, University of Bologna, Bologna, Italy
| | - Andrea Farioli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Alessandra Arcelli
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine DIMES, University of Bologna, Bologna, Italy
| | - Dajana Cuicchi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Leonardo Frazzoni
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Savino Cilla
- Medical Physics Unit, Giovanni Paolo II Research and Care Foundation, Campobasso, Italy
| | - Milly Buwenge
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine DIMES, University of Bologna, Bologna, Italy
| | - Giovanna Mantini
- Department of Radiotherapy, A. Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - Anna R Alitto
- Department of Radiotherapy, A. Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - Marianna Nuzzo
- Radiotherapy Unit, Giovanni Paolo II Research and Care Foundation, Campobasso, Italy
| | - Vincenzo Valentini
- Department of Radiotherapy, A. Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - Marcello Ingrosso
- Endoscopy Unit, Giovanni Paolo II Research and Care Foundation, Campobasso, Italy
| | - Alessio G Morganti
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine DIMES, University of Bologna, Bologna, Italy
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| |
Collapse
|
23
|
Abstract
Sixty per cent of oncologic patients need radiation therapy for cure or palliation. In fact, in most neoplastic diseases, a better local control positively impacts on disease-free survival and overall survival. The efficacy of radiotherapy depends on several factors: while some are tumor-related, others are host-related. Radiobiological phenomena are also important: ionizing radiation is responsible for cell damage (double rupture of DNA chains), mostly an indirect mechanism with the formation of free radicals. Their toxic action is enhanced by the oxygen partial pressure at the cellular level. A number of studies have confirmed that good tissue oxygenation is a function of a high hemoglobin level in the peripheral blood (Hb≥13g/dL). Unfortunately, these values are rarely present in oncologic patients due to the disease-related toxicosis as well as to the therapy induced hematologic toxicity. The treatment of anemia is free of risk for the recent developments in technology which with gene cloning and the technique of recombinant DNA has allowed the production of human recombinant erythropoietin. Erythropoietin is produced by the interstitial cells of renal tubules in response to hypoxia. It prevents apoptosis and promotes erythroid proliferation and differentiation with consequent reticulocyte release and hemoglobin synthesis. It is not completely understood whether the efficacy of radiotherapy depends on hemoglobin values present at the start of irradiation (often less than 12-13 g/dL) or on the higher ones observed during and at the end of radiotherapy. Therefore, preventive systemic erythropoietin therapy in non anemic patients in terms of costs/benefits is at present non sustainable. To the contrary, in patients undergoing radiotherapy to extended fields or aggressive multimodal treatments, for the higher risk of anemia, the early use of this treatment can be hypothesized in case of initial anemia to improve therapy compliance and prevent negative conditioning of results. Keeping in mind that grade 1 minimum toxicity for red cells, according to the Radiation Therapy Oncology Group (RTOG) is equal to 11gHb/dL we think that this value can be considered as cutoff to start erythropoietin therapy.
Collapse
Affiliation(s)
- L Trodella
- Divisione di Radioterapia, Università Cattolica Sacro Cuore, Roma
| | | | | | | |
Collapse
|
24
|
Cellini N, Luzi S, Morganti AG, Mantini G, Valentini V, Racioppi M, Leone M, Mattiucci GC, Di Gesù C, Giustacchini M, Destito A, Smaniotto D, Alcini E. Hormono-Radiotherapy in Prostatic Carcinoma: Prognostic Factors and Implications for Combined Modality Treatment. Tumori 2018; 88:495-9. [PMID: 12597145 DOI: 10.1177/030089160208800612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to evaluate the prognostic role of several clinical variables in a patient population undergoing neoadjuvant hormonotherapy (NHT) with external beam radiotherapy (ERT) to identify subsets of patients with an unfavorable prognosis who require intensified therapy. Eighty-four patients (mean age, 68.2 +/– 6.1 years; range, 52–81 years) underwent ERT (45 Gy to pelvic volume; 65 Gy mean dose to prostate volume) and NHT (oral flutamide: 250 mg three times daily for 30 days; LH-RH analogue: one vial every 28 days starting two months before radiotherapy and for its entire duration). The distribution according to clinical stage was T2: 46.4%, T3: 50.0%, T4: 3.6%. The distribution according to the Gleason score was grade 2–4: 17.9%; grade 5–7: 53.6%; grade 8–10: 28.5%. The distribution according to pretreatment PSA levels (in ng/mL) was 0–4: 5.9%; 4–10: 26.2%; 10–20: 16.7%; ≥20: 51.2%. With a median follow-up of 36 months, 3.6% of patients died; hematogenous metastases and local disease progression were found in 16.7% and 6% of patients, respectively. Overall, the incidence of disease progression was 17.9%. 32.9% of patients showed biochemical failure during follow-up. Overall, metastasis-free, local progression-free and biochemical failure-free actuarial survival at five years was 89.2%, 66.5%, 85.0% and 41.9%, respectively. At univariate analysis (log-rank) clinical stage (cT) was shown to be significantly correlated with the incidence of metastasis (P = 0.0004), local progression (P <0.0001) and disease-free survival (P = 0.0005). At multivariate analysis (Cox) the correlations between clinical stage and metastasis (P = 0.0175), local progression (P = 0.0200) and disease-free survival (P = 0.0175) were confirmed. Gleason score and pretreatment PSA levels did not show any significant correlation with these endpoints. These results confirm the indications of the recent literature, which, in prostate carcinoma at higher clinical stages, suggest the use of prolonged hormonal therapy after radiotherapy.
Collapse
Affiliation(s)
- Numa Cellini
- Istituto di Radiologia, Cattedra di Radioterapia, Universitá Cattolica del Sacro Cuore, Policlinico a Gemelli, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Martino A, Lenkowicz J, Mattiucci G, Petrone A, Piras A, Smaniotto D, Alitto A, Mazzarella C, Palazzoni G, Congedo M, Chiappetta M, Margaritora S, Valentini V, Mantini G. EP-1399: HEmatologic paRaMeters as prEdictive biomarkerS in NSCLC (HERMES-Lung) for metastasis development. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31708-0] [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: 10/14/2022]
|
26
|
Gambacorta MA, Valentini V, Coco C, Manno A, Doglietto GB, Ratto C, Cosimelli M, Miccichè F, Maurizi F, Tagliaferri L, Mantini G, Balducci M, La Torre G, Barbaro B, Picciocchi A. Sphincter Preservation in Four Consecutive Phase II Studies of Preoperative Chemoradiation: Analysis of 247 T3 Rectal Cancer Patients. Tumori 2018; 93:160-9. [PMID: 17557563 DOI: 10.1177/030089160709300209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background To evaluate the impact of preoperative chemoradiation on sphincter preservation in patients with low- medium locally advanced resectable rectal cancer treated by four chemoradiation schedules. Materials and Methods Between 1990 and 2002, 247 patients were treated according to four schedules of chemoradiotherapy: FUMIR (5-fluorouracil, mitomycin, external beam radiotherapy 37.8 Gy), PLAFUR (cisplatinum, 5-fluorouracil, external beam radiotherapy 50.4 Gy), TOMRT (raltitrexed, external beam radiotherapy 50.4 Gy), and TOMOXRT (raltitrexed, oxaliplatin, external beam radiotherapy 50.4 Gy). Four to five weeks after chemoradiation, patients were restaged and surgery was performed 2-3 weeks later. Results Overall, the sphincter-saving surgery was performed in 82.5% of patients. In patients candidate to an abdominoperineal resection before chemoradiaton (distance tumor-anorectal ring, <30 mm) a sphincter-saving surgery was possible in 58% of cases: 44% (FUMIR), 52% (PLAFUR), 63% (TOMRT), 76% (TOMOXRT) (P <0.017). The involved surgeons kept the same surgical criteria in performing sphincter-saving surgery. After chemoradiation, patients with tumor location still between 0 and 30 mm received sphincter-saving surgery according to the protocols: 33% (FUMIR), 42% (PLAFUR), 50% (TOMRT), 64% (TOMOXRT) (P = 0.066) Conclusions Even though the surgeons’ skill in performing sphincter-saving surgery could be improved with time, the high rate of this procedure in the latest schedules suggests an impact of the new drugs in promoting tumor downsizing and therefore sphincter-saving surgery.
Collapse
|
27
|
Nardone L, Valentini V, Marino L, De Santis MC, Terribile D, Franceschini G, Balducci M, Mantini G, Mattiucci G, Mulè A, Belli P, Masetti R. A Feasibility Study of Neo-Adjuvant Low-Dose Fractionated Radiotherapy with Two Different Concurrent Anthracycline-Docetaxel Schedules in Stage IIA/B-IIIA Breast Cancer. Tumori 2018; 98:79-85. [DOI: 10.1177/030089161209800110] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background The aim of the study was to evaluate the feasibility of neoadjuvant low-dose fractionated radiotherapy, in combination with two anthracycline-docetaxel regimens, in breast cancer treatment. Materials and Methods Women with stage IIA/B-IIIA breast cancer were assigned to receive the treatment of low-dose fractionated radiotherapy (0.4 Gy/per fraction, 2 fractions per day, for 2 days, every 21 days for 8–6 cycles) with concomitant neoadjuvant chemotherapy with non-pegylated liposomal doxorubicin and docetaxel. Two chemotherapy schedules were planned to be combined with low-dose fractionated radiotherapy. The first schedule consisted of four cycles of non-pegylated liposomal doxorubicin sequentially followed by four cycles of docetaxel, and the second schedule consisted of six cycles of non-pegylated liposomal doxorubicin plus concomitant docetaxel. Acute toxicity was evaluated according to the Radiation Therapy Oncology Group score system. Pathological response was evaluated by the Mandard score and expressed as tumor regression grade. Results Between March 2008 and February 2009, 10 patients underwent low-dose fractionated radiotherapy and concomitant chemotherapy. No grade 3–4 breast toxicity was observed. Five patients had a clinical complete response. Seven patients underwent conservative surgery. Overall, tumor regression grade 1 (absence of residual cancer) was achieved in one patient (10%) and grade 2 (residual isolated cells scattered through the fibrosis) in 4 patients (40%). The pathologic major response rate (tumor regression grade 1 + 2) was 20% in patients receiving low-dose fractionated radiotherapy and sequential non-pegylated liposomal doxorubicin and docetaxel and 80% in the group receiving low-dose fractionated radiotherapy and concurrent non-pegylated liposomal doxorubicin and docetaxel treatment. Conclusions Concomitant low-dose fractionated radiotherapy combined with anthracycline and docetaxel is feasible. The toxicity profile of radio-chemotherapy was similar to that of chemotherapy alone: there was no acute skin or cardiac toxicity. The concurrent application of liposomal doxorubicin and docetaxel with low-dose fractionated radiation led to higher histological response rates compared to the sequential application of the same two drugs.
Collapse
Affiliation(s)
- Luigia Nardone
- Radiotherapy Department, Policlinico Universitario “A. Gemelli”, Catholic University, Rome, Italy
| | - Vincenzo Valentini
- Radiotherapy Department, Policlinico Universitario “A. Gemelli”, Catholic University, Rome, Italy
| | - Lorenza Marino
- Radiotherapy Department, Policlinico Universitario “A. Gemelli”, Catholic University, Rome, Italy
| | - Maria Carmen De Santis
- Radiotherapy Department, Policlinico Universitario “A. Gemelli”, Catholic University, Rome, Italy
| | - Daniela Terribile
- Breast Surgery Unit Department, Policlinico Universitario “A. Gemelli”, Catholic University, Rome, Italy
| | - Gianluca Franceschini
- Breast Surgery Unit Department, Policlinico Universitario “A. Gemelli”, Catholic University, Rome, Italy
| | - Mario Balducci
- Radiotherapy Department, Policlinico Universitario “A. Gemelli”, Catholic University, Rome, Italy
| | - Giovanna Mantini
- Radiotherapy Department, Policlinico Universitario “A. Gemelli”, Catholic University, Rome, Italy
| | - Giancarlo Mattiucci
- Radiotherapy Department, Policlinico Universitario “A. Gemelli”, Catholic University, Rome, Italy
| | - Antonino Mulè
- Pathology Department, Policlinico Universitario “A. Gemelli”, Catholic University, Rome, Italy
| | - Paolo Belli
- Radiology Department, Policlinico Universitario “A. Gemelli”, Catholic University, Rome, Italy
| | - Riccardo Masetti
- Breast Surgery Unit Department, Policlinico Universitario “A. Gemelli”, Catholic University, Rome, Italy
| |
Collapse
|
28
|
Balducci M, Di Rito A, Mantini G, Manfrida S, Chiesa S, Frascino V, D'Agostino GR, Valentini V, De Bari B. Role of Radiotherapy in the Treatment of Fibrosarcoma of the Spermatic Cord: A Case Report and Review of the Literature. Tumori 2018; 97:36e-8e. [DOI: 10.1177/030089161109700624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Spermatic cord sarcomas are rare. The therapeutic approach is based only on case reports and small series. The standard treatment is radical orchiectomy with wide local resection, while the role of adjuvant therapies is not clear. We present a case of fibrosarcoma of the spermatic cord treated with surgery and adjuvant radiotherapy. A review of the literature about the role of adjuvant treatments is also discussed. Case Report A 59-year-old man presented a right testicular mass of about 4 × 3 cm in size. Biopsy showed a high-grade polymorphous sarcoma, consistent with a diagnosis of poorly differentiated fibromyosarcoma. He underwent a right radical inguinal orchiectomy and adjuvant radiotherapy (total dose: 5940 cGy). During treatment the patient developed a G3 skin toxicity (RTOG score) in the inguinal fold. After a follow-up of 57 months, he is alive and without evidence of local or distant recurrence. No late toxicity was noted. Conclusion The optimal adjuvant management of spermatic cord sarcoma is still uncertain. Looking at the literature, it seems that adjuvant radiotherapy can improve locoregional control and disease-free survival without additional late toxicity.
Collapse
Affiliation(s)
- Mario Balducci
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | - Alessia Di Rito
- Service de Radiothérapie, Centre Medical de Forcilles, Ferolles-Attilly, France
| | - Giovanna Mantini
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | - Stefania Manfrida
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | - Silvia Chiesa
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | - Vincenzo Frascino
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | | | - Vincenzo Valentini
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | - Berardino De Bari
- Service de Radiothérapie-Oncologie, Centre Hospitalier Lyon-Sud, Pierre Benite, France
| |
Collapse
|
29
|
Macchia G, Valentini V, Mattiucci GC, Mantini G, Alfieri S, Digesù C, Deodato F, Trodella L, Doglietto GB, Cellini N, Morganti AG. Preoperative Chemoradiation and Intra-Operative Radiotherapy for Pancreatic Carcinoma. Tumori 2018; 93:53-60. [PMID: 17455872 DOI: 10.1177/030089160709300110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aims and background In recent years, preoperative chemoradiation has received growing interest for the treatment of locally advanced pancreatic cancer. In an attempt to improve resectability and disease control, we used preoperative radiation therapy and concomitant 5-fluorouracil in a combined modality therapy protocol. The aim of the study was to evaluate definitive results in terms of toxicity, response and clinical outcome. Material and methods Twenty-eight patients with unresectable (cT4,19 patients) or resectable (cT3, 9 patients) nonmetastatic pancreatic tumors received radiotherapy (39.6 Gy) plus 5-fluorouracil (continuous infusion, days 1-4 at 1000 mg/m2/day). After 4 weeks, patients were evaluated for surgical resection. In 9 resected patients, electron-beam intra-operative radiotherapy (10 Gy) was given before reconstruction. Thereafter, in resected patients, adjuvant chemotherapy was prescribed. Results During chemoradiation, 1 patient (3.6%) developed grade 3 acute gastrointestinal toxicity and 2 patients (7.1%) developed grade 3 hematological toxicity. Three of 19 patients with unresectable tumors had tumor downstaging (15.8%). Two patients showed partial response (response rate, 7.1%; 95% CI, 0.2-25.3) and 4 patients (14.3%) had minimal tumor response. Four patients (14.3%) showed progressive disease after chemoradiation. One postoperative death was recorded. The median survival time was 11.3 months (20.5 and 9.0 months in resected and unresected patients, respectively). Only one local failure was recorded in 8 patients resected with negative margins. Conclusions Although the response rate is still low, our preliminary results suggest that preoperative 5-fluorouracil chemoradiation is well tolerated and may result in tumor downstaging. Delivery of intra-operative radiotherapy seems to be associated with a low rate of local recurrences.
Collapse
Affiliation(s)
- Gabriella Macchia
- Unità Operativa di Radioterapia, Universitti Cattolica del S. Cuore, Campobasso.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Alitto AR, Gatta R, Vanneste B, Vallati M, Meldolesi E, Damiani A, Lanzotti V, Mattiucci GC, Frascino V, Masciocchi C, Catucci F, Dekker A, Lambin P, Valentini V, Mantini G. PRODIGE: PRediction models in prOstate cancer for personalized meDIcine challenGE. Future Oncol 2017; 13:2171-2181. [PMID: 28758431 DOI: 10.2217/fon-2017-0142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
AIM Identifying the best care for a patient can be extremely challenging. To support the creation of multifactorial Decision Support Systems (DSSs), we propose an Umbrella Protocol, focusing on prostate cancer. MATERIALS & METHODS The PRODIGE project consisted of a workflow for standardizing data, and procedures, to create a consistent dataset useful to elaborate DSSs. Techniques from classical statistics and machine learning will be adopted. The general protocol accepted by our Ethical Committee can be downloaded from cancerdata.org . RESULTS A standardized knowledge sharing process has been implemented by using a semi-formal ontology for the representation of relevant clinical variables. CONCLUSION The development of DSSs, based on standardized knowledge, could be a tool to achieve a personalized decision-making.
Collapse
Affiliation(s)
- A R Alitto
- Radiation Oncology Area, Gemelli-ART, Catholic University of the Sacred Heart, Rome, Italy
| | - R Gatta
- Radiation Oncology Area, Gemelli-ART, Catholic University of the Sacred Heart, Rome, Italy
| | - Bgl Vanneste
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M Vallati
- School of Computing & Engineering, University of Huddersfield, Huddersfield, UK
| | - E Meldolesi
- Radiation Oncology Area, Gemelli-ART, Catholic University of the Sacred Heart, Rome, Italy
| | - A Damiani
- Radiation Oncology Area, Gemelli-ART, Catholic University of the Sacred Heart, Rome, Italy
| | - V Lanzotti
- Radiation Oncology Area, Gemelli-ART, Catholic University of the Sacred Heart, Rome, Italy
| | - G C Mattiucci
- Radiation Oncology Area, Gemelli-ART, Catholic University of the Sacred Heart, Rome, Italy
| | - V Frascino
- Radiation Oncology Area, Gemelli-ART, Catholic University of the Sacred Heart, Rome, Italy
| | - C Masciocchi
- Radiation Oncology Area, Gemelli-ART, Catholic University of the Sacred Heart, Rome, Italy
| | - F Catucci
- Radiation Oncology Area, Gemelli-ART, Catholic University of the Sacred Heart, Rome, Italy
| | - A Dekker
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P Lambin
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - V Valentini
- Radiation Oncology Area, Gemelli-ART, Catholic University of the Sacred Heart, Rome, Italy
| | - G Mantini
- Radiation Oncology Area, Gemelli-ART, Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
31
|
Mattoli MV, Massaccesi M, Castelluccia A, Scolozzi V, Mantini G, Calcagni ML. The predictive value of 18F-FDG PET-CT for assessing the clinical outcomes in locally advanced NSCLC patients after a new induction treatment: low-dose fractionated radiotherapy with concurrent chemotherapy. Radiat Oncol 2017; 12:4. [PMID: 28057034 PMCID: PMC5217210 DOI: 10.1186/s13014-016-0737-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 12/06/2016] [Indexed: 12/25/2022] Open
Abstract
Background Patients with locally advanced non-small-cell lung cancer (LA-NSCLC) have poor prognosis despite several multimodal approaches. Recently, low-dose fractionated radiotherapy concurrent to the induction chemotherapy (IC-LDRT) has been proposed to further improve the effects of chemotherapy and prognosis. Until now, the predictive value of metabolic response after IC-LDRT has not yet been investigated. Aim: to evaluate whether the early metabolic response, assessed by 18F-fluoro-deoxyglucose positron emission-computed tomography (18F-FDG PET-CT), could predict the prognosis in LA-NSCLC patients treated with a multimodal approach, including IC-LDRT. Methods Forty-four consecutive patients (35males, mean age: 66 ± 7.8 years) with stage IIIA/IIIB NSCLC were retrospectively evaluated. Forty-four patients underwent IC-LDRT (2 cycles of chemotherapy, 40 cGy twice daily), 26/44 neo-adjuvant chemo-radiotherapy (CCRT: 50.4Gy), and 20/44 surgery. 18F-FDG PET-CT was performed before (baseline), after IC-LDRT (early) and after CCRT (final), applying PET response criteria in solid tumours (PERCIST). Patients with complete/partial metabolic response were classified as responders; patients with stable/progressive disease as non-responders. Progression free survival (PFS) and overall survival (OS) were assessed using Kaplan-Meyer analysis; the relationship between clinical factors and survivals were assessed using uni-multivariate regression analysis. Results Forty-four out of 44, 42/44 and 23/42 patients underwent baseline, early and final PET-CT, respectively. SULpeak of primary tumour and lymph-node significantly (p = 0.004, p = 0.0002, respectively) decreased after IC-LDRT with a further reduction after CCRT (p = 0.0006, p = 0.02, respectively). At early PET-CT, 20/42 (47.6%) patients were classified as responders, 22/42 (52.3%) as non-responders. At final PET-CT, 19/23 patients were classified as responders (12 responders and 7 non-responders at early PET-CT), and 4/23 as non-responders (all non-responders at early PET-CT). Early responders had better PFS and OS than early non-responders (p ≤ 0.01). Early metabolic response was predictive factor for loco-regional, distant and global PFS (p = 0.02, p = 0.01, p = 0.005, respectively); surgery for loco-regional and global PFS (p = 0.03, p = 0.009, respectively). Conclusions In LA-NSCLC patients, 18F-FDG metabolic response assessed after only two cycles of IC-LDRT predicts the prognosis. The early evaluation of metabolic changes could allow to personalize therapy. This multimodality approach, including both low-dose radiotherapy that increases the effects of induction chemotherapy, and surgery that removes the disease, improved clinical outcomes. Further prospective investigation of this new induction approach is warranted.
Collapse
Affiliation(s)
- Maria Vittoria Mattoli
- Institute of Nuclear Medicine, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Mariangela Massaccesi
- Department of Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Alessandra Castelluccia
- Department of Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Valentina Scolozzi
- Institute of Nuclear Medicine, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Giovanna Mantini
- Department of Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Maria Lucia Calcagni
- Institute of Nuclear Medicine, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| |
Collapse
|
32
|
Ntreta M, Siepe G, Galuppi A, Cammelli S, Nuzzo M, Macchia G, Deodato F, Cilla S, Mantini G, Farioli A, Arcelli A, Bertini F, Pieri M, Ronchi L, Martorana G, Morganti A, Frezza G. EP-1357: Moderately hypofractionated IGRT / IMRT-SIB in prostate carcinoma: toxicity and QoL in 300 patients. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32607-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
33
|
Nuzzo M, Frascino V, Alitto A, Mattiucci G, Fionda B, Vernaleone M, Catucci F, Bassi P, Macchia G, Deodato F, Siepe G, Ntreta M, Morganti A, Cammelli S, Arcelli A, Bertini F, Ippolito E, Frezza G, Mantini G, Valentini V. EP-1355: Combined and modulated adjuvant therapy in prostate carcinoma: a phase I-II trial. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32605-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
34
|
De Filippo L, Mattiucci G, Morganti A, Falconi M, Van Stiphout R, Alfieri S, Balducci M, Calvo F, Herman J, Macchia G, Maidment III B, Mantini G, Miller R, Regine W, Reni M, Valentini V. PO-0707: The impact of dose on survival in adjuvant chemoradiation pancreatic cancer. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31957-0] [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: 10/21/2022]
|
35
|
Deodato F, Macchia G, Cilla S, Nuzzo M, Ronchi L, Ianiro A, Autorino R, Mantini G, Frakulli R, Cammelli S, Compagnone G, Angelini A, Frezza G, Caravatta L, Farioli A, Valentini V, Morganti A. OC-0446: Extra-cranial SBRT in patients with oligometastatic disease: a dose-escalation study. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31695-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
36
|
Farchione A, Dinapoli N, Gatta R, Larici A, Masciocchi C, Damiani A, Franchi P, Castelluccia A, Mantini G, Bonomo L, Valentini V. EP-1877: Lung cancer textural analysis: to contrast or not to contrast? Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33128-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
37
|
Ippolito E, Nuzzo M, Macchia G, Deodato F, Cilla S, Ingrosso M, Fuccio L, Farioli A, Mantini G, Valentini V, Mattiucci G, Siepe G, Ntreta M, Cammelli S, Guido A, Pieri M, Arcelli A, Bertini F, Ronchi L, Morganti A. EP-1287: Radiation-induced rectal toxicity in prostate cancer: a proctoscopy evaluation. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32537-3] [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: 12/01/2022]
|
38
|
Frascino V, Ferro M, Alitto A, Castelluccia A, Petrone A, Nicolini G, Teodoli S, Mattiucci G, Mantini G, Gambacorta M, Chiesa S, Deodato F, Azario L, Luzi S, Valentini V, Balducci M. EP-2094: Can Radiation Oncologist delegate to Therapist the kV setup control in patients with pelvic cancers? Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33345-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
39
|
Autorino R, Mattiucci GC, Ardito F, Balducci M, Deodato F, Macchia G, Mantini G, Perri V, Tringali A, Gambacorta MA, Tagliaferri L, Giuliante F, Morganti AG, Valentini V. Radiochemotherapy with Gemcitabine in Unresectable Extrahepatic Cholangiocarcinoma: Long-term Results of a Phase II Study. Anticancer Res 2016; 36:737-740. [PMID: 26851032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE To evaluate the outcome of patients affected by unresectable extrahepatic cholangiocarcinoma treated with radiotherapy (ERT) and concurrent gemcitabine-based chemotherapy with or without intraluminal brachytherapy (BT). PATIENTS AND METHODS Twenty-seven patients underwent weekly gemcitabine (100 mg/m(2)) as a 24-h infusion during the course of three-dimensional radiotherapy (50.4 Gy to the tumor and 39.6 Gy to the nodes). Among them, certain patients received a boost of intraluminal high-dose rate (HDR) brachytherapy with 192 Ir. The outcome of patients was evaluated in terms of response to therapy, local control (LC), overall survival (OS) and toxicity. RESULTS We analyzed a total of 27 patients with the diagnosis of unresectable, non-metastatic adenocarcinoma of the extrahepatic biliary ducts, treated with radiochemotherapy with gemcitabine. After a dose of 50 Gy, a boost of HDR intraluminal brachytherapy was administered in 6 patients (22%): 4 patients received 15 Gy and 2 patients 20 Gy. With a median follow-up of 16 months (range=3-52 months), for the entire group, 2-year LC was 29% (median=12 months), 2-year MFS was 36% (median 16 months). Two-year and three-year OS were 27% and 7% respectively, with a median of 14 months. Toxicities were acceptable. Median OS in patients treated with brachytherapy boost was 21 months versus 14 months for the group treated with gemcitabine-based radiochemotherapy only; 2-year LC was 53% versus 25%, respectively. CONCLUSION Gemcitabine appears to be a potent radiation sensitizer, and when combined with radiation therapy, it shows encouraging tumor response. Moreover, patients treated with a boost of brachytherapy after radiochemotherapy seem to have a better local control with an acceptable toxicity. Further investigation is warranted to confirm these data and define the optimal combined treatments.
Collapse
Affiliation(s)
- Rosa Autorino
- Institute of Radiotherapy, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gian Carlo Mattiucci
- Digestive Endoscopy Unit, Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Ardito
- Digestive Endoscopy Unit, Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Mario Balducci
- Institute of Radiotherapy, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Deodato
- Department of Radiation Oncology, Catholic University of the Sacred Heart, Campobasso, Italy
| | - Gabriella Macchia
- Department of Radiation Oncology, Catholic University of the Sacred Heart, Campobasso, Italy
| | - Giovanna Mantini
- Institute of Radiotherapy, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Perri
- Digestive Endoscopy Unit, Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Tringali
- Digestive Endoscopy Unit, Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Luca Tagliaferri
- Institute of Radiotherapy, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Felice Giuliante
- Digestive Endoscopy Unit, Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Vincenzo Valentini
- Institute of Radiotherapy, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
40
|
Valentini C, Boldrini L, Mattiucci G, Mantini G, Chiloiro G, Pasini D, Bral S, Turian J, Chu J, Valentini V. Multicenter Autocontouring Effectiveness Evaluation in Lung Cancer. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.2119] [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]
|
41
|
Abstract
BACKGROUND Computerized automation is likely to play an increasingly important role in radiotherapy. The objective of this study was to report the results of the first part of a program to implement a model for economical evaluation based on micro-costing method. To test the efficacy of the model, the financial impact of the introduction of an automation tool was estimated. A single- and multi-center validation of the model by a prospective collection of data is planned as the second step of the program. MATERIAL AND METHODS The model was implemented by using an interactive spreadsheet (Microsoft Excel, 2010). The variables to be included were identified across three components: productivity, staff, and equipment. To calculate staff requirements, the workflow of Gemelli ART center was mapped out and relevant workload measures were defined. Profit and loss, productivity and staffing were identified as significant outcomes. Results were presented in terms of earnings before interest and taxes (EBIT). Three different scenarios were hypothesized: baseline situation at Gemelli ART (scenario 1); reduction by 2 minutes of the average duration of treatment fractions (scenario 2); and increased incidence of advanced treatment modalities (scenario 3). By using the model, predicted EBIT values for each scenario were calculated across a period of eight years (from 2015 to 2022). RESULTS For both scenarios 2 and 3 costs are expected to slightly increase as compared to baseline situation that is particularly due to a little increase in clinical personnel costs. However, in both cases EBIT values are more favorable than baseline situation (EBIT values: scenario 1, 27%, scenario 2, 30%, scenario 3, 28% of revenues). CONCLUSION A model based on a micro-costing method was able to estimate the financial consequences of the introduction of an automation tool in our radiotherapy department. A prospective collection of data at Gemelli ART and in a consortium of centers is currently under way to prospectively validate the model.
Collapse
Affiliation(s)
| | | | - Luigi Azario
- a Radiation Oncology Department, Gemelli-ART , Università Cattolica S. Cuore , Rome
| | - Mario Balducci
- a Radiation Oncology Department, Gemelli-ART , Università Cattolica S. Cuore , Rome
| | - Milena Ferro
- a Radiation Oncology Department, Gemelli-ART , Università Cattolica S. Cuore , Rome
| | - Giovanna Mantini
- a Radiation Oncology Department, Gemelli-ART , Università Cattolica S. Cuore , Rome
| | - Gian Carlo Mattiucci
- a Radiation Oncology Department, Gemelli-ART , Università Cattolica S. Cuore , Rome
| | - Vincenzo Valentini
- a Radiation Oncology Department, Gemelli-ART , Università Cattolica S. Cuore , Rome
| |
Collapse
|
42
|
Morgia G, Russo GI, Tubaro A, Bortolus R, Randone D, Gabriele P, Trippa F, Zattoni F, Porena M, Mirone V, Serni S, Del Nero A, Lay G, Ricardi U, Rocco F, Terrone C, Pagliarulo A, Ludovico G, Vespasiani G, Brausi M, Simeone C, Novella G, Carmignani G, Leonardi R, Pinnarò P, De Paula U, Corvò R, Tenaglia R, Siracusano S, Mantini G, Gontero P, Savoca G, Ficarra V. Patterns of prescription and adherence to European Association of Urology guidelines on androgen deprivation therapy in prostate cancer: an Italian multicentre cross-sectional analysis from the Choosing Treatment for Prostate Cancer (CHOICE) study. BJU Int 2015; 117:867-73. [PMID: 26332130 DOI: 10.1111/bju.13307] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate both the patterns of prescription of androgen deprivation therapy (ADT) in patients with prostate cancer (PCa) and the adherence to European Association of Urology (EAU) guidelines for ADT prescription. METHODS The Choosing Treatment for Prostate Cancer (CHOICE) study was an Italian multicentre cross-sectional study conducted between December 2010 and January 2012. A total of 1 386 patients, treated with ADT for PCa (first prescription or renewal of ADT), were selected. With regard to the EAU guidelines on ADT, the cohort was categorized into discordant ADT (Group A) and concordant ADT (Group B). RESULTS The final cohort included 1 075 patients with a geographical distribution including North Italy (n = 627, 58.3%), Central Italy (n = 233, 21.7%) and South Italy (n = 215, 20.0%). In the category of patients treated with primary ADT, a total of 125 patients (56.3%) were classified as low risk according to D'Amico classification. With regard to the EAU guidelines, 285 (26.51%) and 790 patients (73.49%) were classified as discordant (Group A) and concordant (Group B), respectively. In Group A, patients were more likely to receive primary ADT (57.5%, 164/285 patients) than radical prostatectomy (RP; 30.9%, 88/285 patients), radiation therapy (RT; 6.7%, 19/285 patients) or RP + RT (17.7%, 14/285 patients; P < 0.01). Multivariate logistic regression analysis, adjusted for clinical and pathological variables, showed that patients from Central Italy (odds ratio [OR] 2.86; P < 0.05) and South Italy (OR 2.65; P < 0.05) were more likely to receive discordant ADT. CONCLUSION EAU guideline adherence for ADT was low in Italy and was influenced by geographic area. Healthcare providers and urologists should consider these results in order to quantify the inadequate use of ADT and to set policy strategies to overcome this risk.
Collapse
Affiliation(s)
- Giuseppe Morgia
- Department of Urology, University of Catania, Catania, Italy
| | | | - Andrea Tubaro
- Department of Urology, Sant' Andrea Hospital, 'La Sapienza' University of Roma, Roma, Italy
| | | | | | | | | | | | - Massimo Porena
- Department of Urology, University of Perugia, Perugia, Italy
| | - Vincenzo Mirone
- Department of Urology, Università Federico II of Napoli, Napoli, Italy
| | - Sergio Serni
- Department of Urology, University of Firenze, Firenze, Italy
| | | | | | - Umberto Ricardi
- Radiotherapy, AOU University S. Giovanni Battista Molinette, Torino, Italy
| | | | - Carlo Terrone
- Urology, University Hospital 'Maggiore della Carità', Novara, Italy
| | | | - Giuseppe Ludovico
- Urology, Ospedale Generale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | | | | | - Claudio Simeone
- Department of Urology, University of Brescia, Brescia, Italy
| | - Giovanni Novella
- Department of Surgery, Urology Clinic, AOUI Verona, Verona, Italy
| | | | | | | | - Ugo De Paula
- Radiotherapy, AO S. Giovanni Addolorata, Roma, Italy
| | - Renzo Corvò
- Radiotherapy, Istituto Nazionale per la Ricerca, Genova, Italy
| | | | | | - Giovanna Mantini
- Radiotherapy, Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Paolo Gontero
- Department of Surgical Sciences, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Gianfranco Savoca
- Urology, Fondazione Istituto San Raffaele - G. Giglio di Cefalù, Cefalù, Italy
| | - Vincenzo Ficarra
- Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy
| | | |
Collapse
|
43
|
Chiesa S, Placidi L, Azario L, Mattiucci GC, Greco F, Damiani A, Mantini G, Frascino V, Piermattei A, Valentini V, Balducci M. Adaptive optimization by 6 DOF robotic couch in prostate volumetric IMRT treatment: rototranslational shift and dosimetric consequences. J Appl Clin Med Phys 2015; 16:35-45. [PMID: 26699314 PMCID: PMC5690171 DOI: 10.1120/jacmp.v16i5.5525] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 12/23/2014] [Revised: 06/02/2015] [Accepted: 05/21/2015] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to investigate the magnitude and dosimetric relevance of translational and rotational shifts on IGRT prostate volumetric‐modulated arc therapy (VMAT) using Protura six degrees of freedom (DOF) Robotic Patient Positioning System. Patients with cT3aN0M0 prostate cancer, treated with VMAT simultaneous integrated boost (VMAT‐SIB), were enrolled. PTV2 was obtained adding 0.7 cm margin to seminal vesicles base (CTV2), while PTV1 adding to prostate (CTV1) 0.7 cm margin in all directions, except 1.2 cm, as caudal margin. A daily CBCT was acquired before dose delivery. The translational and rotational displacements were corrected through Protura Robotic Couch, collected and applied to the simulation CT to obtain a translated CT (tCT) and a rototranslated CT (rtCT) on which we recalculated the initial treatment plan (TP). We analyzed the correlation between dosimetric coverage, organs at risk (OAR) sparing, and translational or rotational displacements. The dosimetric impact of a rototranslational correction was calculated. From October 2012 to September 2013, a total of 263 CBCT scans from 12 patients were collected. Translational shifts were <5mm in 81% of patients and the rotational shifts were <2∘ in 93% of patient scans. The dosimetric analysis was performed on 172 CBCT scans and calculating 344 VMAT‐TP. Two significant linear correlations were observed between yaw and the V20 femoral heads and between pitch rotation and V50 rectum (p<0.001); rototranslational correction seems to impact more on PTV2 than on PTV1, especially when margins are reduced. Rotational errors are of dosimetric significance in sparing OAR and in target coverage. This is relevant for femoral heads and rectum because of major distance from isocenter, and for seminal vesicles because of irregular shape. No correlation was observed between translational and rotational errors. A study considering the intrafractional error and the deformable registration is ongoing. PACS number: 87.55.de
Collapse
|
44
|
Deodato F, Milani A, Ippolito E, Ferro M, Mantini G, Macchia G, Cammelli S, Cilla S, Valentini V, Morganti A. PO-0724: Hypofractionated RT, radiosurgical boost, hormone therapy for prostate cancer: a dose escalation study (ISIDEP3). Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40716-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
45
|
Alitto A, Dinapoli N, Gatta R, Fionda B, Catucci F, Balducci M, Frascino V, Valentini V, Mantini G. PO-0744: Develope predictive models to foresee toxicity: validation of a software to help clinicians. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40736-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
46
|
Valentini C, Boldrini L, Chiloiro G, Mattiucci G, Mantini G, Pasini D, Dinapoli N, Caria N, Valentini V. OC-0561: Hypothesis-generating prospective study for auto-delineation in lung tumors: READY LUNG-01. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40556-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
47
|
Alitto A, Dinapoli N, Catucci F, Vernaleone M, Fionda B, Frascino V, Balducci M, Valentini V, Mantini G. PO-0743: Reduction of volume through IGRT method: personalize a prostate cancer treatment. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40735-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
48
|
Diletto B, Dinapoli N, Chiesa S, Alitto A, Mattiucci G, Frascino V, Mantini G, Micciché F, Valentini V, Balducci M. EP-1298: A predictive model of local response for oligometastases treated by stereotactic radiotherapy. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41290-3] [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: 10/23/2022]
|
49
|
Alitto A, Gatta R, Damiani A, Meldolesi E, Dinapoli N, Mattiucci G, Valentini V, Mantini G. EP-1252: From datasets to predictive models: could an ontology development improves clinical choices in prostate cancer? Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41244-7] [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: 10/23/2022]
|
50
|
Mattiucci GC, Autorino R, Tringali A, Perri V, Balducci M, Deodato F, Gambacorta MA, Mantini G, Tagliaferri L, Mutignani M, Morganti AG. A Phase I study of high-dose-rate intraluminal brachytherapy as palliative treatment in extrahepatic biliary tract cancer. Brachytherapy 2015; 14:401-4. [PMID: 25591935 DOI: 10.1016/j.brachy.2014.12.002] [Citation(s) in RCA: 16] [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: 10/26/2014] [Revised: 12/04/2014] [Accepted: 12/05/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the recommended dose of endoscopically assisted high-dose-rate intraluminal brachytherapy (HDR-192Ir-ILBT) as a palliative treatment of extrahepatic biliary tract cancer. METHODS AND MATERIALS Patients with non-metastatic extrahepatic biliary cancer with age <80 years, unsuitable for surgical resection or radiochemotherapy for comorbidities or Eastern Cooperative Oncology Group (ECOG) ≥2 or patients with age ≥80 years were included. They were undergone to implantation of metal stents by endoscopic retrograde cholangiopancreatography followed by HDR-192Ir-ILBT. The initial dose of HDR-192-Ir-ILBT was 15 Gy. Three levels of dose were planned. At each dose level almost three patients were treated, and if no Grade 3-4 toxicity (considering as dose-limiting toxicity) was recorded, dose escalation was applied with 5 Gy increments until the maximum tolerated dose was established. A high dose Iridium-192 after loading system was used (Nucletron Microselectron HDR). RESULTS From May 2007 to January 2010, 18 patients underwent HDR-192Ir-ILBT, with one catheter in 12 patients and two catheters in six patients. Three levels of dose were planned: 15 Gy in three patients, 20 Gy in nine patients, and 25 Gy in six patients with daily dose of 500 cGy per fraction. One patient at Dose Level II experienced acute toxicity (cholangitis) related to brachytherapy procedure, so the cohort was expanded. No patient of Level III had a dose-limiting toxicity and we stopped at this dose level waiting to assess the late toxicity that has not yet appeared at the time of the analysis. Six months and 1 year overall survival was 77% and 59%, respectively, with a median of 12 months. CONCLUSIONS The recommended dose was defined as 25 Gy in five fractions. It will be used in a Phase II study to better evaluate tumor and symptom control in patients with extrahepatic biliary tract cancer.
Collapse
Affiliation(s)
| | - Rosa Autorino
- Institute of Radiotherapy, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Andrea Tringali
- Digestive Endoscopy Unit, Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Vincenzo Perri
- Digestive Endoscopy Unit, Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Mario Balducci
- Institute of Radiotherapy, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Deodato
- Department of Radiation Oncology, Catholic University of the Sacred Heart, Campobasso, Italy
| | | | - Giovanna Mantini
- Institute of Radiotherapy, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Tagliaferri
- Institute of Radiotherapy, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimiliano Mutignani
- Digestive Endoscopy Unit, Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | | |
Collapse
|