1
|
Bergamaschi L, Vincini MG, Zaffaroni M, Pepa M, Angelicone I, Astone A, Bergamini C, Buonopane S, Conte M, De Rosa N, Deantoni C, Dell'Oca I, Di Gennaro D, Di Muzio N, Osti MF, Federico M, Ferini G, Franzese C, Gatti M, Grillo A, Iorio V, Manzo R, Marmiroli L, Martin G, Mazzuca F, Molinaro MA, Muto M, Pacelli R, Pepe A, Perillo A, Russo D, Salerno F, Spadaro P, Viola A, Iorio GC, Muto P, Ricardi U, Alterio D. Management of radiation-induced oral mucositis in head and neck cancer patients: a real-life survey among 25 Italian radiation oncology centers. Support Care Cancer 2023; 32:38. [PMID: 38110572 PMCID: PMC10728275 DOI: 10.1007/s00520-023-08185-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/12/2023] [Indexed: 12/20/2023]
Abstract
AIM Radiation-induced oral mucositis (RIOM) is the most frequent side effect in head and neck cancer (HNC) patients treated with curative radiotherapy (RT). A standardized strategy for preventing and treating RIOM has not been defined. Aim of this study was to perform a real-life survey on RIOM management among Italian RT centers. METHODS A 40-question survey was administered to 25 radiation oncologists working in 25 different RT centers across Italy. RESULTS A total of 1554 HNC patients have been treated in the participating centers in 2021, the majority (median across the centers 91%) with curative intent. Median treatment time was 41 days, with a mean percentage of interruption due to toxicity of 14.5%. Eighty percent of responders provide written oral cavity hygiene recommendations. Regarding RIOM prevention, sodium bicarbonate mouthwashes, oral mucosa barrier agents, and hyaluronic acid-based mouthwashes were the most frequent topic agents used. Regarding RIOM treatment, 14 (56%) centers relied on literature evidence, while internal guidelines were available in 13 centers (44%). Grade (G)1 mucositis is mostly treated with sodium bicarbonate mouthwashes, oral mucosa barrier agents, and steroids, while hyaluronic acid-based agents, local anesthetics, and benzydamine were the most used in mucositis G2/G3. Steroids, painkillers, and anti-inflammatory drugs were the most frequent systemic agents used independently from the RIOM severity. CONCLUSION Great variety of strategies exist among Italian centers in RIOM management for HNC patients. Whether different strategies could impact patients' compliance and overall treatment time of the radiation course is still unclear and needs further investigation.
Collapse
Affiliation(s)
- Luca Bergamaschi
- Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Maria Giulia Vincini
- Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy.
| | - Mattia Zaffaroni
- Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Matteo Pepa
- Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Ilaria Angelicone
- Radiotherapy Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonio Astone
- Division of Medical Oncology, Fatebenefratelli San Pietro Hospital, 00189, Rome, Italy
| | - Cristiana Bergamini
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sergio Buonopane
- Radiation Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Mario Conte
- Fondazione Muto Onlus, Casavatore, Naples, Italy
| | - Nicola De Rosa
- Centro Aktis Diagnostica e Terapia, Marano, Naples, Italy
| | - Chiara Deantoni
- Radiotherapy Department, IRCCS San Raffaele Scientific Institute, Vita Salute S. Raffaele University, Milan, Italy
| | - Italo Dell'Oca
- Radiotherapy Department, IRCCS San Raffaele Scientific Institute, Vita Salute S. Raffaele University, Milan, Italy
| | | | - Nadia Di Muzio
- Radiotherapy Department, IRCCS San Raffaele Scientific Institute, Vita Salute S. Raffaele University, Milan, Italy
| | - Mattia Falchetto Osti
- Radiotherapy Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Manuela Federico
- Casa di cura Macchiarella, U.O. Radioterapia Oncologica, Palermo, Italy
| | | | - Ciro Franzese
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Marco Gatti
- Radiotherapy Unit, Candiolo Cancer Institute, FPO-IRCCS, Torino, Italy
| | - Antonietta Grillo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Policlinico, Bari, Italy
| | | | - Roberto Manzo
- Radiation Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Luca Marmiroli
- U.O. Radioterapia, Ospedale Fatebenefratelli S. Giovanni Calibita, Isola Tiberina, 00186, Rome, Italy
| | | | - Federica Mazzuca
- Radiotherapy Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Matteo Muto
- Department of Onco-Hematological Diseases, U.O.C. Radiotherapy-Azienda Ospedaliera San Giuseppe Moscati-(AV), 83100, Avellino, Italy
| | - Roberto Pacelli
- Department of Advanced Biomedical Sciences, Federico II University School of Medicine, Naples, Italy
| | | | - Annarita Perillo
- Centro Aktis Diagnostica e Terapia, Marano, Naples, Italy
- Department of Radiation Oncology, San Pio Hospital, Benevento, Italia
| | | | | | - Pietro Spadaro
- U.O. di Oncologia ed Ematologia, Casa di Cura Villa Salus, Messina, Italy
| | - Anna Viola
- Fondazione IOM, Viagrande, Catania, Italy
| | | | - Paolo Muto
- Radiation Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - Daniela Alterio
- Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| |
Collapse
|
2
|
Mori M, Deantoni C, Olivieri M, Spezi E, Chiara A, Baroni S, Picchio M, Del Vecchio A, Di Muzio NG, Fiorino C, Dell'Oca I. External validation of an 18F-FDG-PET radiomic model predicting survival after radiotherapy for oropharyngeal cancer. Eur J Nucl Med Mol Imaging 2023; 50:1329-1336. [PMID: 36604325 DOI: 10.1007/s00259-022-06098-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/24/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE/OBJECTIVE The purpose of the study is to externally validate published 18F-FDG-PET radiomic models for outcome prediction in patients with oropharyngeal cancer treated with chemoradiotherapy. MATERIAL/METHODS Outcome data and pre-radiotherapy PET images of 100 oropharyngeal cancer patients (stage IV:78) treated with concomitant chemotherapy to 66-69 Gy/30 fr were available. Tumors were segmented using a previously validated semi-automatic method; 450 radiomic features (RF) were extracted according to IBSI (Image Biomarker Standardization Initiative) guidelines. Only one model for cancer-specific survival (CSS) prediction was suitable to be independently tested, according to our criteria. This model, in addition to HPV status, SUVmean and SUVmax, included two independent meta-factors (Fi), resulting from combining selected RF clusters. In a subgroup of 66 patients with complete HPV information, the global risk score R was computed considering the original coefficients and was tested by Cox regression as predictive of CSS. Independently, only the radiomic risk score RF derived from Fi was tested on the same subgroup to learn about the radiomics contribution to the model. The metabolic tumor volume (MTV) was also tested as a single predictor and its prediction performances were compared to the global and radiomic models. Finally, the validation of MTV and the radiomic score RF were also tested on the entire dataset. RESULTS Regarding the analysis of the subgroup with HPV information, with a median follow-up of 41.6 months, seven patients died due to cancer. R was confirmed to be associated to CSS (p value = 0.05) with a C-index equal 0.75 (95% CI=0.62-0.85). The best cut-off value (equal to 0.15) showed high ability in patient stratification (p=0.01, HR=7.4, 95% CI=1.6-11.4). The 5-year CSS for R were 97% (95% CI: 93-100%) vs 74% (56-92%) for low- and high-risk groups, respectively. RF and MTV alone were also significantly associated to CSS for the subgroup with an almost identical C-index. According to best cut-off value (RF>0.12 and MTV>15.5cc), the 5-year CSS were 96% (95% CI: 89-100%) vs 65% (36-94%) and 97% (95% CI: 88-100%) vs 77% (58-93%) for RF and MTV, respectively. Results regarding RF and MTV were confirmed in the overall group. CONCLUSION A previously published PET radiomic model for CSS prediction was independently validated. Performances of the model were similar to the ones of using only the MTV, without improvement of prediction accuracy.
Collapse
Affiliation(s)
- Martina Mori
- Department of Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Chiara Deantoni
- Department of Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Michela Olivieri
- Department of Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Emiliano Spezi
- School of Engineering, Cardiff University, Cardiff, UK
- Department of Medical Physics, Velindre Cancer Centre, Cardiff, UK
| | - Anna Chiara
- Department of Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Simone Baroni
- Department of Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Maria Picchio
- Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Nadia Gisella Di Muzio
- Department of Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Claudio Fiorino
- Department of Medical Physics, San Raffaele Scientific Institute, Milano, Italy.
| | - Italo Dell'Oca
- Department of Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| |
Collapse
|
3
|
Nuccio A, Torrisi M, Ogliari F, Giannini L, Pasetti M, Fodor A, Gigliotti C, Fiorino C, Arcangeli S, Bulotta A, Dell'Oca I, Cascinu S, Di Muzio N. 105P Thoracic radiotherapy and tyrosine kinase inhibitors association: Results from a monoinstitutional experience. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100963] [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: 04/05/2023] Open
|
4
|
Fodor A, Deantoni C, Fiorino C, Cozzarini C, Dell'Oca I, Mangili P, Tummineri R, Zerbetto F, Sanchez Galvan A, Mandurino G, Villa S, Baroni S, Saddi J, Pacifico P, Perna L, Broggi S, Del Vecchio A, Picchio M, Gianolli L, Di Muzio N. MO-0553 ENRT+ PET-guided SIB for prostate cancer lymph nodal relapses: long-term outcomes. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02387-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
5
|
deantoni C, Chiara A, Mirabile A, Broggi S, Fiorino C, Fodor A, Pasetti M, Tummineri R, Zerbetto F, Baroni S, Sanchez Galvan A, Gregorc V, Dell'Oca I, Di Muzio N. PO-1100 Impact of sarcopenia in oropharyngeal cancer patients treated with radical chemo-radiotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03064-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: 10/18/2022]
|
6
|
Mori M, Deantoni C, Olivieri M, Spezi E, Chiara A, Baroni S, Picchio M, Del Vecchio A, Di Muzio N, Fiorino C, Dell'Oca I. PO-1760 Independent validation of a PET radiomic model predicting outcome after Radiotherapy for HN cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03724-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
7
|
Baroni S, Gulletta S, Pasetti M, Vergara P, Broggi S, Tummineri R, Deantoni C, Zerbetto F, Fodor A, Mandurino G, Sanchez Galvan A, Fierro N, Dell'Oca I, Arcangeli S, Di Muzio N. MO-0717 Radiation Therapy and Cardiovascular Implanted Electronic Devices: a single center years expierence. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02415-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Fodor A, Brombin C, Mangili P, Borroni F, Pasetti M, Tummineri R, Zerbetto F, Longobardi B, Perna L, Dell'Oca I, Deantoni CL, Deli AM, Chiara A, Broggi S, Castriconi R, Esposito PG, Slim N, Passoni P, Baroni S, Villa SL, Rancoita PMV, Fiorino C, Del Vecchio A, Bianchini G, Gentilini OD, Di Serio MS, Di Muzio NG. Impact of molecular subtype on 1325 early-stage breast cancer patients homogeneously treated with hypofractionated radiotherapy without boost: Should the indications for radiotherapy be more personalized? Breast 2020; 55:45-54. [PMID: 33326894 PMCID: PMC7736720 DOI: 10.1016/j.breast.2020.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/09/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022] Open
Abstract
Aim We report molecular subtype impact on 1325 early breast cancer (BCa) patients treated with whole breast hypofractionated (WBH) adjuvant forward-planned intensity modulated radiotherapy (F-IMRT) without boost. Methods and materials From 02/2009-05/2017 1325 patients with pTis-pT3, pNx-N1aM0 BCa who underwent breast conservation surgery were treated with WBHF-IMRT in our institute, to a total dose of 40 Gy/15 fractions, without boost. Median age: 62 (interquartile range-IQR-:51.14–70.53) years. Histology: 8% in situ carcinoma (ISC), 92% invasive tumors. Molecular subtypes (invasive tumors): 49.9% Luminal A, 33.1% Luminal B Her2 negative (−), 6.2% Luminal B Her2 positive (+), 3.6% Hormone Receptor (HR)- Her2+, 7.1% Triple negative (TNBC), and 0.2% HR+. Chemotherapy (CT) was prescribed in 28% of patients, hormonal therapy in 80.3%, monoclonal antibodies (MAb) in 86.8% of Luminal B Her2+ and 97.7% of HR- Her2+ patients. Results Median follow up was 72.43 (IQR: 44.63–104.13) months. The 5-year Kaplan-Meier estimates of local relapse-free survival (LRFS) was 97.8%, regional-(RRFS) 98.6%, loco-regional- (LRRFS) 96.9%, distant- (DRFS) 96.6%, disease-free survival (DFS) 94.8% and overall survival (OS) 95.5%. Considering molecular subtypes, 5-year LRFS was: 99.8% for Luminal A, 96.7% for Luminal B Her2-, 94.1% for Luminal B Her2+, 87.9% for HR- Her2+, 95.1% for TNBC and 99.1% for in situ carcinoma. Conclusion While the overall estimated probability of LR within 5 years after WBHF-IMRT without boost is good (2.2%), molecular subtypes have a strong impact, despite MAb therapy in Her2+ patients, and CT for TNBC patients, and could be used as a parameter in deciding the boost prescription. Hypofractionated three-weeks radiotherapy ensures good local control whitout boost. In 1325 early stage breast cancers 5-year local relapse without boost was 2.2%. Molecular subtypes have a strong impact on estimated probability of local relapse. 5-year local control (LC) was 99.8% for Luminal A vs 87.9% for HR- Her2+. 5-year LC was 96.7% for Luminal B Her2-, 94.1% for Luminal B Her2+, 95.1% for TNBC.
Collapse
Affiliation(s)
- Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Chiara Brombin
- University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Mangili
- Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fulvio Borroni
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marcella Pasetti
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Tummineri
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Flavia Zerbetto
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Lucia Perna
- Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Italo Dell'Oca
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara L Deantoni
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Aniko M Deli
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Chiara
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Broggi
- Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Najla Slim
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Passoni
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simone Baroni
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano L Villa
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola M V Rancoita
- University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Claudio Fiorino
- Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Giampaolo Bianchini
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Oreste D Gentilini
- Department of Breast Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mariaclelia S Di Serio
- University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - N G Di Muzio
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
9
|
Di Muzio N, Deantoni C, Cozzarini C, Dell'Oca I, Zerbetto F, Mangili P, Broggi S, Pasetti M, Chiara A, Borroni F, Tummineri R, Perna L, Calandrino R, Fiorino C, Fodor A. PO-1173: Long term results of IG-IMRT in high risk prostate cancer patients: a monoinstitutional experience. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01191-9] [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: 10/22/2022]
|
10
|
Fodor A, Mangili P, Brombin C, Zerbetto F, Longobardi B, Borroni F, Tummineri R, Pasetti M, Rancoita P, Perna L, Dell'Oca I, Deantoni C, Esposito P, Deli A, Rossi E, Chiara A, Broggi S, Slim N, Passoni P, Cattaneo M, Bolognesi A, Fiorino C, Di Serio M, Di Muzio N. PO-0955: Molecular subtypes and local control in 1054 breast cancer patients treated with de-escalated 3DCRT. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00973-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
11
|
Mori M, Dell'Oca I, Branchini M, Foti S, Broggi S, Perna L, Cattaneo GM, Calandrino R, Di Muzio NG, Fiorino C. Monitoring skin dose changes during image-guided helical tomotherapy for head and neck cancer patients. Strahlenther Onkol 2019; 196:243-251. [PMID: 31586231 DOI: 10.1007/s00066-019-01520-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/10/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE An increase of skin dose during head and neck cancer (HNC) radiotherapy is potentially dangerous. Aim of this study was to quantify skin dose variation and to assess the need of planning adaptation (ART) to counteract it. METHODS Planning CTs of 32 patients treated with helical tomotherapy (HT) according to a Simultaneous Integrated Boost (SIB) technique delivering 54/66 Gy in 30 fractions were deformably co-registered to MVCTs taken at fractions 15 and 30; in addition, the first fraction was also considered. The delivered dose-of-the-day was calculated on the corresponding deformed images. Superficial body layers (SL) were considered as a surrogate for skin, considering a layer thickness of 2 mm. Variations of SL DVH (∆SL) during therapy were quantified, focusing on ∆SL95% (i.e., 62.7 Gy). RESULTS Small changes (within ± 1 cc for ∆SL95%) were seen in 15/32 patients. Only 2 patients experienced ∆SL95% > 1 cc in at least one of the two monitored fractions. Negative ∆SL95% > 1 cc (up to 17 cc) were much more common (15/32 patients). The trend of skin dose changes was mostly detected at the first fraction. Negative changes were correlated with the presence of any overlap between PTV and SL at planning and were explained in terms of how the planning system optimizes the PTV dose coverage near the skin. Acute toxicity was associated with planning DVH and this association was not improved if considering DVHs referring to fractions 15/30. CONCLUSION About half of the patients treated with SIB with HT for HNC experienced a skin-sparing effect during therapy; only 6% experienced an increase. Our findings do not support skin-sparing ART, while suggesting the introduction of improved skin-sparing planning techniques.
Collapse
Affiliation(s)
- Martina Mori
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy.
| | - Italo Dell'Oca
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Marco Branchini
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| | - Silvia Foti
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Sara Broggi
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| | - Lucia Perna
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| | | | - Riccardo Calandrino
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| | | | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| |
Collapse
|
12
|
De Sanctis V, Merlotti A, De Felice F, Trignani M, Dell'Oca I, Lastrucci L, Molteni M, Frakulli R, Bunkheila F, Bacigalupo A, Paiar F. Intensity modulated radiation therapy and oral mucosa sparing in Head and neck cancer patients: A systematic review on behalf of Italian Association of Radiation Oncology - Head and neck working group. Crit Rev Oncol Hematol 2019; 139:24-30. [PMID: 31112879 DOI: 10.1016/j.critrevonc.2019.04.022] [Citation(s) in RCA: 9] [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: 01/30/2019] [Revised: 04/20/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022] Open
Abstract
Oral mucositis is a common dose-limiting toxicity during radiotherapy with or without chemotherapy in head and neck cancer patients. This potentially severe complication globally worsens quality of life and negatively impacts local control and survival's outcomes. Several studies have been published on feasibility and/or clinical benefit of intensity modulated radiotherapy (IMRT) mucosa-sparing technique. In 2017, the Italian Association of Radiation Oncology Head and Neck Cancer Working Group organized a study group to perform a systematic review. The aim was to verify if practical indications, including dose-constraints and demonstrated clinical benefit, could be proposed for oral mucosa (OM)-sparing IMRT in order to reduce the incidence of severe acute mucositis. Although dose to OM should be reduced as much as possible without compromising target volumes coverage, it is still tricky to firmly state that OM-sparing procedure should be considered the standard of care, especially due to high subjective variability in OM contour.
Collapse
Affiliation(s)
- V De Sanctis
- Radiation Oncology, Department of Medical-Surgery and Translational Medicine, "Sapienza" University of Rome, S Andrea Hospital, Rome, Italy
| | - A Merlotti
- Radiation Oncology A.S.O. S.Croce e Carle, Cuneo, Italy
| | - F De Felice
- Department of Radiotherapy, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy.
| | - M Trignani
- Radiation Oncolgy Department, "SS Annunziata Hospital", Chieti, Italy
| | - I Dell'Oca
- Radiation Oncology, Scientific Institute San Raffaele, Segrate, Milan, Italy
| | - L Lastrucci
- Radiation Oncology, San Donato Hospital, Arezzo, Italy
| | - M Molteni
- Radioterapia Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - R Frakulli
- Radiation Oncology Unit, Bellaria Hospital, Bologna, Italy
| | - F Bunkheila
- Radiation Oncology Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - A Bacigalupo
- Radiation Oncology, Policlinico San Martino, Genova, Italy
| | - F Paiar
- Radiation Oncology, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| |
Collapse
|
13
|
Di Muzio N, Deantoni C, Zerbetto F, Cozzarini C, Broggi S, Mangili P, Chiara A, Dell'Oca I, Deli A, Calandrino R, Fiorino C, Fodor A. EP-1553 High-dose hypofractionated helical IG-IMRT in high-risk prostate cancer patients. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31973-5] [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]
|
14
|
Branchini M, Broggi S, Dell'Oca I, Cattaneo GM, Calandrino R, Di Muzio NG, Fiorino C. Skin dose calculation during radiotherapy of head and neck cancer using deformable image registration of planning and mega-voltage computed tomography scans. Phys Imaging Radiat Oncol 2018; 8:44-50. [PMID: 33458416 PMCID: PMC7807680 DOI: 10.1016/j.phro.2018.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 11/29/2022] Open
Abstract
Background and Purpose Head-Neck (HN) patients may experience severe acute skin complications that can cause treatment interruption and increase the risk of late fibrosis. This study assessed a method for accurately monitoring skin dose changes during helical tomotherapy for HN cancer based on deformable image registration of planning computed tomography (CT) and mega-voltage CT (MVCT). Materials and Methods Planning CTs of nine patients were deformably registered to mid-treatment MVCT (MV15) images resulting in CTdef images. The original plans were recalculated on both CTdef and mid-treatment kilo-voltage CT (CT15) taken as ground truth. Superficial layers (SL) of the body with thicknesses of 2, 3 and 5 mm (SL2, SL3, SL5) were considered as derma surrogates. SL V95%, V97%, V98%, V100%, V102%, V105% and V107% of the prescribed PTV dose were extracted for CT15/CTdef and compared (considering patients with skin dose > 95%). For comparison, doses were calculated directly on the calibrated MVCT and analyzed in the same way. Results Differences between SL2/SL3/SL5 V95%-V107% in CT15/CTdef were very small: for eight of nine patients the difference between the considered SL2 Vd% computed on CTdef and CT15 was less than 1.4 cm3 for all d%. A larger value was found when using MVCT for skin dose calculation (4.8 cm3 for SL2), although CTdef body contour matched CT15 body with accuracy similar to that of MV15. Conclusions Deforming the planning CT-to-MVCT was shown to be accurate considering external body contours and skin DVHs. The method was able to accurately identify superficial overdosing.
Collapse
Affiliation(s)
- Marco Branchini
- Department of Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Sara Broggi
- Department of Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Italo Dell'Oca
- Department of Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | | | - Riccardo Calandrino
- Department of Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | | | - Claudio Fiorino
- Department of Medical Physics, San Raffaele Scientific Institute, Milano, Italy
- Corresponding author at: Medical Physics Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, MI, Italy.
| |
Collapse
|
15
|
Fodor A, Broggi S, Incerti E, Dell'Oca I, Fiorino C, Samanes Gajate AM, Pasetti M, Cattaneo MG, Passoni P, Gianolli L, Calandrino R, Picchio M, Di Muzio N. Moderately Hypofractionated Helical IMRT, FDG-PET/CT-guided, for Progressive Malignant Pleural Mesothelioma in Patients With Intact Lungs. Clin Lung Cancer 2018; 20:e29-e38. [PMID: 30253920 DOI: 10.1016/j.cllc.2018.08.019] [Citation(s) in RCA: 6] [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: 01/31/2018] [Revised: 08/21/2018] [Accepted: 08/29/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The objective of this study was to present the outcomes of moderately hypofractionated helical intensity-modulated radiation therapy (HT) with/without simultaneous integrated boost (SIB) on fluorodeoxyglucose-positron emission tomography (FDG-PET) positive areas (gross tumor volume [GTV]-PET) for patients with progressive malignant pleural mesothelioma (MPM) after previous treatments. METHODS AND MATERIALS From May 2006 to April 2014, 51 patients with a median age of 68.8 years (range, 38.6-82 years) were treated. There were 41 men and 10 women; 43 epithelioid MPM and 8 sarcomatoid, involving the left pleura in 25 patients and the right pleura in 26 patients. The initial stage was: I, 11 patients; II, 14 patients; III, 17 patients; and IV, 9 patients. Chemotherapy was prescribed for 46 patients, for 6 cycles (range, 0-18 cycles). Eighteen patients had pleurectomy/decortication, and 33 had talc pleurodesis. FDG-PET was used for target identification. A median dose of 56 Gy/25 fractions was prescribed to the involved pleura, and SIB to 62.5 Gy to GTV-PET was added in 38 patients. RESULTS The median survival from diagnosis was 25.8 months (range, 8.4-99.0 months). One patient, treated with SIB, was alive at the October 2017 follow-up. Two cases of grade 5 radiation pneumonitis were registered. A GTV-PET ≤ 205 cc was predictive of late ≥ grade 2 lung toxicity, but also of better survival in stage III and IV disease: 5.9 versus 11.7 months (P = .04). A GTV-PET ≥ 473 cc was predictive of early death (P = .001). CONCLUSIONS Moderately hypofractionated, FDG-PET guided salvage HT in patients with progressive MPM after previous treatments showed acceptable toxicity and outcome results similar to adjuvant radiotherapy after pleurectomy/decortication, suggesting that the delay of radiotherapy is not detrimental to survival, and has the associated benefit of postponing inherent toxicity.
Collapse
Affiliation(s)
- Andrei Fodor
- Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy.
| | - Sara Broggi
- Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - Elena Incerti
- Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Italo Dell'Oca
- Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Fiorino
- Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | | | - Marcella Pasetti
- Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro G Cattaneo
- Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Passoni
- Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Gianolli
- Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Calandrino
- Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - Maria Picchio
- Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy; Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Nadia Di Muzio
- Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
16
|
Belli ML, Mori M, Broggi S, Cattaneo GM, Bettinardi V, Dell'Oca I, Fallanca F, Passoni P, Vanoli EG, Calandrino R, Di Muzio N, Picchio M, Fiorino C. Quantifying the robustness of [ 18 F]FDG-PET/CT radiomic features with respect to tumor delineation in head and neck and pancreatic cancer patients. Phys Med 2018; 49:105-111. [PMID: 29866335 DOI: 10.1016/j.ejmp.2018.05.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/08/2018] [Accepted: 05/10/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the robustness of PET radiomic features (RF) against tumour delineation uncertainty in two clinically relevant situations. METHODS Twenty-five head-and-neck (HN) and 25 pancreatic cancer patients previously treated with 18F-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT)-based planning optimization were considered. Seven FDG-based contours were delineated for tumour (T) and positive lymph nodes (N, for HN patients only) following manual (2 observers), semi-automatic (based on SUV maximum gradient: PET_Edge) and automatic (40%, 50%, 60%, 70% SUV_max thresholds) methods. Seventy-three RF (14 of first order and 59 of higher order) were extracted using the CGITA software (v.1.4). The impact of delineation on volume agreement and RF was assessed by DICE and Intra-class Correlation Coefficients (ICC). RESULTS A large disagreement between manual and SUV_max method was found for thresholds ≥50%. Inter-observer variability showed median DICE values between 0.81 (HN-T) and 0.73 (pancreas). Volumes defined by PET_Edge were better consistent with the manual ones compared to SUV40%. Regarding RF, 19%/19%/47% of the features showed ICC < 0.80 between observers for HN-N/HN-T/pancreas, mostly in the Voxel-alignment matrix and in the intensity-size zone matrix families. RFs with ICC < 0.80 against manual delineation (taking the worst value) increased to 44%/36%/61% for PET_Edge and to 69%/53%/75% for SUV40%. CONCLUSIONS About 80%/50% of 72 RF were consistent between observers for HN/pancreas patients. PET_edge was sufficiently robust against manual delineation while SUV40% showed a worse performance. This result suggests the possibility to replace manual with semi-automatic delineation of HN and pancreas tumours in studies including PET radiomic analyses.
Collapse
Affiliation(s)
| | - Martina Mori
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Sara Broggi
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | | | | | - Italo Dell'Oca
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | | | - Paolo Passoni
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | | | | | - Nadia Di Muzio
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Maria Picchio
- Nuclear Medicine, San Raffaele Scientific Institute, Milano, Italy
| | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy.
| |
Collapse
|
17
|
Di Muzio N, Deantoni C, Brombin C, Cozzarini C, Broggi S, Mangili P, Di Serio M, Dell'Oca I, Chiara A, Calandrino R, Fiorino C, Fodor A. EP-1593: Hypofractionated IGRT in high-intermediate and high/very-high risk prostate cancer patients. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31902-9] [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: 10/14/2022]
|
18
|
Deli A, Zerbetto F, Fodor A, Deantoni C, Slim N, Dell'Oca I, Gumina C, Rossi G, Foti S, Broggi S, Mangili P, Bolognesi A, Di Muzio N. EP-1191: Outcomes of a mono-institutional experience of IG-IMRT in Glioblastoma. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31501-9] [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: 10/14/2022]
|
19
|
Fodor A, Broggi S, Incerti E, Dell'Oca I, Fiorino C, Samanes Gajate A, Passoni P, Pasetti M, Cattaneo M, Gianolli L, Calandrino R, Picchio M, Di Muzio N. EP-1390: Salvage (postponed) hypofractionated tomotherapy for progressive MPM in patients with intact lungs. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31699-2] [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: 10/14/2022]
|
20
|
Mori M, Broggi S, Dell'Oca I, Branchini M, Cattaneo G, Perna L, Raso R, Calandrino R, Di Muzio N, Fiorino C. Skin Dose Variations during Tomotherapy for Head and Neck Cancer Patients: Need for Adaptive Replanning? Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.2289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
21
|
Branchini M, Fiorino C, Dell'Oca I, Belli M, Perna L, Di Muzio N, Calandrino R, Broggi S. Validation of a method for “dose of the day” calculation in head-neck tomotherapy by using planning ct-to-MVCT deformable image registration. Phys Med 2017; 39:73-79. [DOI: 10.1016/j.ejmp.2017.05.070] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/29/2017] [Accepted: 05/28/2017] [Indexed: 01/25/2023] Open
|
22
|
Di Muzio N, Fodor A, Deantoni C, Noris Chiorda B, Broggi S, Mangili P, Dell'Oca I, Chiara A, Passoni P, Slim N, Pasetti M, Calandrino R, Cozzarini C, Fiorino C. EP-1318: Is hypofractionation combined to WPRT effective in high risk prostate cancer patients? Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
23
|
Fodor A, Sini C, Deantoni C, Fiorino C, Cozzarini C, Noris Chiorda B, Dell'Oca I, Picchio M, Mangili P, Incerti E, Calandrino R, Gianolli L, Di Muzio N. EP-1315: Prostate cancer lymph nodal disease: SBRT only or extensive prophylactic irradiation and boost? Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31750-4] [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: 11/30/2022]
|
24
|
Branchini M, Fiorino C, Mori M, Dell'Oca I, Cattaneo M, Perna L, Di Muzio N, Calandrino R, Broggi S. EP-1671: Calculation of the skin dose-of- the-day during Tomotherapy for head and neck cancer patients. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)32203-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]
|
25
|
Fodor A, Berardi G, Fiorino C, Picchio M, Busnardo E, Kirienko M, Incerti E, Dell'Oca I, Cozzarini C, Mangili P, Pasetti M, Calandrino R, Gianolli L, Di Muzio NG. Toxicity and efficacy of salvage carbon 11-choline positron emission tomography/computed tomography-guided radiation therapy in patients with lymph node recurrence of prostate cancer. BJU Int 2016; 119:406-413. [DOI: 10.1111/bju.13510] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Andrei Fodor
- Department of Radiation Oncology; San Raffaele Scientific Institute; Milan Italy
| | - Genoveffa Berardi
- Department of Radiation Oncology; San Raffaele Scientific Institute; Milan Italy
| | - Claudio Fiorino
- Department of Medical Physics; San Raffaele Scientific Institute; Milan Italy
| | - Maria Picchio
- Department of Nuclear Medicine; San Raffaele Scientific Institute; Milan Italy
| | - Elena Busnardo
- Department of Nuclear Medicine; San Raffaele Scientific Institute; Milan Italy
| | | | - Elena Incerti
- Department of Nuclear Medicine; San Raffaele Scientific Institute; Milan Italy
| | - Italo Dell'Oca
- Department of Radiation Oncology; San Raffaele Scientific Institute; Milan Italy
| | - Cesare Cozzarini
- Department of Radiation Oncology; San Raffaele Scientific Institute; Milan Italy
| | - Paola Mangili
- Department of Medical Physics; San Raffaele Scientific Institute; Milan Italy
| | - Marcella Pasetti
- Department of Radiation Oncology; San Raffaele Scientific Institute; Milan Italy
| | - Riccardo Calandrino
- Department of Medical Physics; San Raffaele Scientific Institute; Milan Italy
| | - Luigi Gianolli
- Department of Nuclear Medicine; San Raffaele Scientific Institute; Milan Italy
| | - Nadia G Di Muzio
- Department of Radiation Oncology; San Raffaele Scientific Institute; Milan Italy
| |
Collapse
|
26
|
Deantoni C, Cozzarini C, Fodor A, Noris Chiorda B, Mangili P, Picchio M, Incerti E, Dell'Oca I, Passoni P, Fiorino C, Calandrino R, Di Muzio N. EP-1347: Could “radical” RT be a reasonable choice in bone oligometastatic prostate cancer patients? Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32597-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: 11/28/2022]
|
27
|
Broggi S, Dell'Oca I, Fiorino C, Incerti E, Picchio M, Belli M, Mapelli P, Chiara A, Muzio ND, Cattaneo G, Calandrino R. EP-1852: Predictive role of FDG-PET/CT image-derived parameters in locally advanced oropharyngeal cancer. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33103-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
28
|
Chiara A, Fiorino C, Picchio M, Fodor A, Broggi S, Pasetti M, Incerti E, Mapelli P, Zerbetto F, De Antoni C, Azizi M, Calandrino R, Dell'Oca I, Di Muzio N. EP-1079: Clinical outcomes in locally advanced oropharyngeal cancer 18FDG PET-guided dose escalation IMRT-SIB. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32329-5] [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: 11/17/2022]
|
29
|
Di Muzio NG, Fodor A, Noris Chiorda B, Broggi S, Mangili P, Valdagni R, Dell'Oca I, Pasetti M, Deantoni CL, Chiara A, Berardi G, Briganti A, Calandrino R, Cozzarini C, Fiorino C. Moderate Hypofractionation with Simultaneous Integrated Boost in Prostate Cancer: Long-term Results of a Phase I-II Study. Clin Oncol (R Coll Radiol) 2016; 28:490-500. [PMID: 26961088 DOI: 10.1016/j.clon.2016.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 01/18/2016] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Abstract
AIMS To report 5 year outcome and late toxicity in prostate cancer patients treated with image-guided tomotherapy with a moderate hypofractionated simultaneous integrated boost approach. MATERIALS AND METHODS In total, 211 prostate cancer patients, 78 low risk, 53 intermediate risk and 80 high risk were treated between 2005 and 2011. Intermediate- and high-risk patients received 51.8 Gy to pelvic lymph nodes and concomitant simultaneous integrated boost to prostate up to 74.2 Gy/28 fractions, whereas low-risk patients were treated to the prostate only with 71.4 Gy/28 fractions. Daily megavoltage computed tomography (MVCT) image guidance was applied. Androgen deprivation was prescribed for a median duration of 6 months for low-risk patients (for downsizing), 12 months for intermediate-risk and 36 months for high-risk patients. The 5 year biochemical relapse-free survival (bRFS), cancer-specific survival (CSS), overall survival and late gastrointestinal and genitourinary CTCAE.v3 toxicity were assessed. The effect of several clinical variables on both outcome and gastrointestinal/genitourinary toxicity was tested by uni- and multivariate Cox regression analyses. RESULTS After a median follow-up of 5 years, the late toxicity actuarial incidence was: genitourinary ≥ grade 2: 20.2%; genitourinary ≥ grade 3: 5.9%; gastrointestinal ≥ grade 2: 17%; gastrointestinal ≥ grade 3: 6.3% with lower prevalence at the last follow-up visit (≥ grade 3: genitourinary: 1.9%; gastrointestinal: 1.9%). Major predictors of ≥ grade 3 genitourinary and gastrointestinal late toxicity were genitourinary acute toxicity ≥ grade 2 (hazard ratio: 4.9) and previous surgery (hazard ratio: 3.4). The overall 5 year bRFS was 93.7% (low risk: 94.6%; intermediate risk: 96.2%; high risk: 91.1%), overall survival and CSS were 88.6% (low risk: 90.5%; intermediate risk: 87.4%; high risk: 87%) and 97.5% (low risk: 98.7%; intermediate risk: 95%; high risk: 94.3%), respectively. Risk classes and androgen deprivation were not significantly correlated with either bRFS, overall survival or CSS. Twelve patients experienced a biochemical relapse but none experienced clinically proven local and/or pelvic recurrence. CONCLUSION A satisfactory 5 year outcome with an acceptable toxicity profile was observed. The combination of image-guided radiotherapy-intensity-modulated radiotherapy, high equivalent 2 Gy dose (EQD2) with a moderate hypofractionated approach and extensive prophylactic lymph node irradiation also leads to very good outcome in high-risk patients.
Collapse
Affiliation(s)
- N G Di Muzio
- Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy.
| | - A Fodor
- Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - B Noris Chiorda
- Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - S Broggi
- Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - P Mangili
- Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - R Valdagni
- Fondazione IRCCS Istituto Nazionale dei Tumori, Radiotherapy, Milan, Italy
| | - I Dell'Oca
- Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - M Pasetti
- Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - C L Deantoni
- Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - A Chiara
- Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - G Berardi
- Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - A Briganti
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy
| | - R Calandrino
- Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - C Cozzarini
- Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - C Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
30
|
Belli M, Dell'Oca I, Raso R, Zerbetto F, Chiara A, Cattaneo G, Picchio M, Di Muzio N, Fiorino C, Calandrino R. FDG-PET positive lymph node variations during image-guided IMRT for head and neck cancer identify non-responding patients. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
31
|
Belli ML, Broggi S, Scalco E, Cattaneo GM, Dell'Oca I, Logghe G, Moriconi S, Sanguineti G, Valentini V, Di Muzio N, Fiorino C, Calandrino R. Analysis of serial CT images for studying the RT effects in head-neck cancer patients. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:5235-8. [PMID: 26737472 DOI: 10.1109/embc.2015.7319572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Images taken during and after RT for head and neck cancer have the potential to quantitatively assess xerostomia. Image information may be used as biomarkers of RT effects on parotid glands with significant potential to support adaptive treatment strategies. We investigated the possibility to extract information based on in-room CT images (kVCT, MVCT), acquired for daily image-guided radiotherapy treatment of head-and-neck cancer patients, in order to predict individual response in terms of toxicity. Follow-up MRI images were also used in order to investigate long term parotid gland deformation.
Collapse
|
32
|
Di Muzio N, Fodor A, Noris Chiorda B, Cozzarini C, Broggi S, Mangili P, Valdagni R, Dell'Oca I, Pasetti M, Deantoni C, Chiara A, Berardi G, Briganti A, Calandrino R, Fiorino C. PO-0719: Excellent 5 year outcome with image guided moderate hypofractionation in prostate cancer : phase I-II study results. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40711-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
33
|
Broggi S, Perna L, Bonsignore F, Rinaldin G, Fiorino C, Chiara A, Frigerio C, Butti I, Sangalli G, Dell'Oca I, Di Muzio N, Cattaneo GM, Declich F. Static and rotational intensity modulated techniques for head-neck cancer radiotherapy: A planning comparison. Phys Med 2014; 30:973-9. [DOI: 10.1016/j.ejmp.2014.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 07/09/2014] [Accepted: 07/12/2014] [Indexed: 10/24/2022] Open
|
34
|
Belli M, Zerbetto F, Raso R, Cattaneo G, Chiara A, Dell'Oca I, Fiorino C, Di Muzio N, Calandrino R. PO-0899: Lymphnodes shrinkage measured during RT by daily MVCT predicts tumour relapses of head-and-neck cancer. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31017-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
35
|
Picchio M, Kirienko M, Mapelli P, Dell'Oca I, Villa E, Gallivanone F, Gianolli L, Messa C, Castiglioni I. Predictive value of pre-therapy (18)F-FDG PET/CT for the outcome of (18)F-FDG PET-guided radiotherapy in patients with head and neck cancer. Eur J Nucl Med Mol Imaging 2013; 41:21-31. [PMID: 23990143 DOI: 10.1007/s00259-013-2528-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 07/25/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the predictive role of pre-therapy fluorodeoxyglucose (FDG) uptake parameters of primary tumour in head and neck cancer (HNC) patients undergoing intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) on FDG-positive volume-positron emission tomography (PET) gross tumour volume (PET-GTV). METHODS This retrospective study included 19 patients (15 men and 4 women, mean age 59.2 years, range 23-81 years) diagnosed with HNC between 2005 and 2011. Of 19 patients, 15 (79 %) had stage III-IV. All patients underwent FDG PET/CT before treatment. Metabolic indexes of primary tumour, including metabolic tumour volume (MTV), maximum and mean standardized uptake value (SUVmax, SUVmean) and total lesion glycolysis (TLG) were considered. Partial volume effect correction (PVC) was performed for SUVmean and TLG estimation. Correlations between PET/CT parameters and 2-year disease-free survival (DFS), local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) were assessed. Median patient follow-up was 19.2 months (range 4-24 months). RESULTS MTV, TLG and PVC-TLG predicting patients' outcome with respect to all the considered local and distant disease control endpoints (LRFS, DMFS and DFS) were 32.4 cc, 469.8 g and 547.3 g, respectively. SUVmean and PVC-SUVmean cut-off values predictive of LRFS and DFS were 10.8 and 13.3, respectively. PVC was able to compensate errors up to 25 % in the primary HNC tumour uptake. Moreover, PVC enhanced the statistical significance of the results. CONCLUSION FDG PET/CT uptake parameters are predictors of patients' outcome and can potentially identify patients with higher risk of treatment failure that could benefit from more aggressive approaches. Application of PVC is recommended for accurate measurement of PET parameters.
Collapse
Affiliation(s)
- M Picchio
- Nuclear Medicine, Scientific Institute San Raffaele, via Olgettina, 60, 20132, Milan, Italy,
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Fodor A, Pasetti M, Fodor C, Mangili P, Rinaldin G, Dell'Oca I, Fiorino C, Calandrino R, Bolognesi A, Di Muzio N. PD-0316: Forward planned intensity modulated whole breast hypofractionated radiotherapy: results in 500 patients. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)32622-0] [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: 11/26/2022]
|
37
|
Dell'Oca I, Pasetti M, Cattaneo M, Fodor A, Berardi G, Noris Chiorda B, Perna L, Broggi S, Calandrino R, Di Muzio N. EP-1120: Stereotactic ablative radiotherapy for small lung tumors by means of TomoTherapy: preliminary results and toxicity. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33426-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
38
|
Fiorino C, Rizzo G, Scalco E, Broggi S, Belli ML, Dell'Oca I, Dinapoli N, Ricchetti F, Rodriguez AM, Di Muzio N, Calandrino R, Sanguineti G, Valentini V, Cattaneo GM. Density variation of parotid glands during IMRT for head–neck cancer: Correlation with treatment and anatomical parameters. Radiother Oncol 2012; 104:224-9. [PMID: 22809587 DOI: 10.1016/j.radonc.2012.06.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 05/15/2012] [Accepted: 06/17/2012] [Indexed: 11/17/2022]
|
39
|
Fiorino C, Rizzo G, Scalco E, Belli M, Dell'Oca I, Rodriguez AM, Ricchetti F, Sanguineti G, Valentini V, Calandrino R. PD-0398 DENSITY VARIATION OF PAROTID GLANDS DURING IMRT: CORRELATION WITH TREATMENT PARAMETERS AND PAROTID SHRINKAGE. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70737-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
40
|
Broggi S, Fiorino C, Scalco E, Belli M, Dell'Oca I, Sanguineti G, Richetti F, Dinapoli N, Valentini V, Di Muzio N, Calandrino R, Rizzo G, Cattaneo G. 119 QUANTITATIVE PARAMETERS OF PAROTID DEFORMATION DURING IMRT FOR HEAD-NECK CANCER CORRELATE WITH INDIVIDUALLY ASSESSED CLINICAL AND DOSIMETRY INFORMATION. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70091-9] [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: 10/28/2022]
|
41
|
Fodor A, Fiorino C, Dell'Oca I, Broggi S, Pasetti M, Cattaneo GM, Gianolli L, Calandrino R, Di Muzio NG. PET-guided dose escalation tomotherapy in malignant pleural mesothelioma. Strahlenther Onkol 2011; 187:736-43. [PMID: 22037650 DOI: 10.1007/s00066-011-2234-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 05/23/2011] [Indexed: 12/29/2022]
Abstract
PURPOSE To test the feasibility of salvage radiotherapy using PET-guided helical tomotherapy in patients with progressive malignant pleural mesothelioma (MPM). PATIENTS AND METHODS A group of 12 consecutive MPM patients was treated with 56 Gy/25 fractions to the planning target volume (PTV); FDG-PET/CT simulation was always performed to include all positive lymph nodes and MPM infiltrations. Subsequently, a second group of 12 consecutive patients was treated with the same dose to the whole pleura adding a simultaneous integrated boost of 62.5 Gy to the FDG-PET/CT positive areas (BTV). RESULTS Good dosimetric results were obtained in both groups. No grade 3 (RTOG/EORTC) acute or late toxicities were reported in the first group, while 3 cases of grade 3 late pneumonitis were registered in the second group: the duration of symptoms was 2-10 weeks. Median overall survival was 8 months (1.2-50.5 months) and 20 months (4.3-33.8 months) from the beginning of radiotherapy, for groups I and II, respectively (p=0.19). A significant impact on local relapse from radiotherapy was seen (median time to local relapse: 8 vs 17 months; 1-year local relapse-free rate: 16% vs 81%, p=0.003). CONCLUSIONS The results of this pilot study support the planning of a phase III study of combined sequential chemoradiotherapy with dose escalation to BTV in patients not able to undergo resection.
Collapse
Affiliation(s)
- Andrei Fodor
- Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Dell'Oca I, Fiorino C, Fodor A, Chiara A, Villa E, Casagrande W, Rognone A, Pasetti M, Broggi S, Busnardo E, Landoni C, Gianolli L, Calandrino R, Di Muzio N. 868 poster SIMULTANEOUS INTEGRATED BOOST 18FDG-PET BASED HELICAL TOMOTHERAPY IN RADICAL LOCALLY ADVANCED HEAD AND NECK CANCER. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70990-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
43
|
Faggiano E, Cattaneo GM, Ciavarro C, Dell'Oca I, Persano D, Calandrino R, Rizzo G. Validation of an elastic registration technique to estimate anatomical lung modification in non-small-cell lung cancer tomotherapy. Radiat Oncol 2011; 6:31. [PMID: 21470411 PMCID: PMC3094364 DOI: 10.1186/1748-717x-6-31] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 11/03/2010] [Accepted: 04/06/2011] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The study of lung parenchyma anatomical modification is useful to estimate dose discrepancies during the radiation treatment of Non-Small-Cell Lung Cancer (NSCLC) patients. We propose and validate a method, based on free-form deformation and mutual information, to elastically register planning kVCT with daily MVCT images, to estimate lung parenchyma modification during Tomotherapy. METHODS We analyzed 15 registrations between the planning kVCT and 3 MVCT images for each of the 5 NSCLC patients. Image registration accuracy was evaluated by visual inspection and, quantitatively, by Correlation Coefficients (CC) and Target Registration Errors (TRE). Finally, a lung volume correspondence analysis was performed to specifically evaluate registration accuracy in lungs. RESULTS Results showed that elastic registration was always satisfactory, both qualitatively and quantitatively: TRE after elastic registration (average value of 3.6 mm) remained comparable and often smaller than voxel resolution. Lung volume variations were well estimated by elastic registration (average volume and centroid errors of 1.78% and 0.87 mm, respectively). CONCLUSIONS Our results demonstrate that this method is able to estimate lung deformations in thorax MVCT, with an accuracy within 3.6 mm comparable or smaller than the voxel dimension of the kVCT and MVCT images. It could be used to estimate lung parenchyma dose variations in thoracic Tomotherapy.
Collapse
Affiliation(s)
- Elena Faggiano
- Istituto di Bioimmagini e Fisiologia Molecolare, CNR, via Fratelli Cervi 93 Segrate (Milan), 20090, Italy
| | | | | | | | | | | | | |
Collapse
|
44
|
Faggiano E, Fiorino C, Scalco E, Broggi S, Cattaneo M, Maggiulli E, Dell'Oca I, Di Muzio N, Calandrino R, Rizzo G. An automatic contour propagation method to follow parotid gland deformation during head-and-neck cancer tomotherapy. Phys Med Biol 2011; 56:775-91. [PMID: 21239848 DOI: 10.1088/0031-9155/56/3/015] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We developed an efficient technique to auto-propagate parotid gland contours from planning kVCT to daily MVCT images of head-and-neck cancer patients treated with helical tomotherapy. The method deformed a 3D surface mesh constructed from manual kVCT contours by B-spline free-form deformation to generate optimal and smooth contours. Deformation was calculated by elastic image registration between kVCT and MVCT images. Data from ten head-and-neck cancer patients were considered and manual contours by three observers were included in both kVCT and MVCT images. A preliminary inter-observer variability analysis demonstrated the importance of contour propagation in tomotherapy application: a high variability was reported in MVCT parotid volume estimation (p = 0.0176, ANOVA test) and a larger uncertainty of MVCT contouring compared with kVCT was demonstrated by DICE and volume variability indices (Wilcoxon signed rank test, p < 10(-4) for both indices). The performance analysis of our method showed no significant differences between automatic and manual contours in terms of volumes (p > 0.05, in a multiple comparison Tukey test), center-of-mass distances (p = 0.3043, ANOVA test), DICE values (p = 0.1672, Wilcoxon signed rank test) and average and maximum symmetric distances (p = 0.2043, p = 0.8228 Wilcoxon signed rank tests). Results suggested that our contour propagation method could successfully substitute human contouring on MVCT images.
Collapse
Affiliation(s)
- E Faggiano
- Istituto di Bioimmagini e Fisiologia Molecolare (IBFM), CNR, Milan, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Broggi S, Fiorino C, Dell'Oca I, Dinapoli N, Paiusco M, Muraglia A, Maggiulli E, Ricchetti F, Valentini V, Sanguineti G, Cattaneo G, Di Muzio N, Calandrino R. A TWO – VARIABLES LINEAR MODEL OF PAROTID SHRINKAGE DURING IMRT FOR HEAD AND NECK CANCER. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72688-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
46
|
Fiorino C, Dell'Oca I, Pierelli A, Broggi S, Cattaneo GM, Chiara A, De Martin E, Di Muzio N, Fazio F, Calandrino R. Simultaneous integrated boost (SIB) for nasopharynx cancer with helical tomotherapy. A planning study. Strahlenther Onkol 2008; 183:497-505. [PMID: 17762924 DOI: 10.1007/s00066-007-1698-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 06/01/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE To explore the potential of helical tomotherapy (HT) in the treatment of nasopharynx cancer. PATIENTS AND METHODS Six T1-4 N1-3 patients were considered. A simultaneous integrated boost (SIB) technique was planned with inversely optimized conventional intensity-modulated radiotherapy (IMRT; dynamic multileaf collimator using the Eclipse-Helios Varian system) and HT. The prescribed (median) doses were 54 Gy, 61.5 Gy, and 64.5 Gy delivered in 30 fractions to PTV1 (planning target volume), PTV2, and PTV3, respectively. The same constraints for PTV coverage and for parotids, spinal cord, mandible, optic structures, and brain stem were followed in both modalities. The planner also tried to reduce the dose to other structures (mucosae outside PTV1, larynx, esophagus, inner ear, thyroid, brain, lungs, submental connective tissue, bony structures) as much as possible. RESULTS The fraction of PTV receiving >95% of the prescribed dose (V95%) increased from 97.6% and 94.3% (IMRT) to 99.6% and 97% (HT) for PTV1 and PTV3, respectively (p<0.05); median dose to parotids decreased from 30.1 Gy for IMRT to 25.0 Gy for HT (p<0.05). Significant gains (p<0.05) were found for most organs at risk (OARs): mucosae (V30 decreased from 44 cm(3) [IMRT] to 18 cm(3) [HT]); larynx (V30: 25 cm(3) vs. 11 cm(3)); thyroid (mean dose: 48.7 Gy vs. 41.5 Gy); esophagus (V45: 4 cm(3) vs. 1 cm(3)); brain stem (D1%: 45.1 Gy vs. 37.7 Gy). CONCLUSION HT improves the homogeneity of dose distribution within PTV and PTV coverage together with a significantly greater sparing of OARs compared to linac five-field IMRT.
Collapse
|
47
|
Widesott L, Pierelli A, Fiorino C, Dell'Oca I, Cattaneo G, Alber M, Soukup M, Fazio F, Calandrino R, Schwarz M. Intensity Modulated Proton Therapy (IMPT) vs. Helicoidal Tomotherapy (HT) in the Treatment of Nasopharynx Cancer: A Planning Comparison. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.2016] [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]
|
48
|
Giovannini M, Gregorc V, Viganò MG, Spreafico A, Ghio D, Dell'Oca I, Bolognesi A, Villa E. Endothelial growth factor receptor inhibition after radiotherapy. J Thorac Oncol 2007; 2:662. [PMID: 17607125 DOI: 10.1097/jto.0b013e318074de48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Monica Giovannini
- Department of Medical Oncology, San Raffaele Scientific Institute, Milan, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Fiorino C, Dell'Oca I, Pierelli A, Broggi S, De Martin E, Di Muzio N, Longobardi B, Fazio F, Calandrino R. Significant improvement in normal tissue sparing and target coverage for head and neck cancer by means of helical tomotherapy. Radiother Oncol 2006; 78:276-82. [PMID: 16546279 DOI: 10.1016/j.radonc.2006.02.009] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Revised: 02/16/2006] [Accepted: 02/24/2006] [Indexed: 01/20/2023]
Abstract
PURPOSE In order to explore the potential of helical Tomotherapy in the treatment of head and neck cancers (HNC), a planning study comparing our routinely delivered IMRT technique (dynamic MLC Varian 600CD Linac, inversely optimised by the Helios/Eclipse system) against two different Tomotherapy planning approaches was performed. MATERIALS AND METHODS In the first Tomotherapy plan (TOMO-a), we merely applied the same constraints used for the IMRT-Linac technique; in the second one (TOMO-b), we tried to stress the sparing of parotids and mandible while keeping PTV coverage and spinal cord Dmax similar to their values in the TOMO-a plan. Five patients with locally advanced oropharinx (n=3), hypopharinx (n=1) and larynx (n=1) cancer were considered. For each patient, CTV1 including neck nodes and the tumour was defined and was expanded with a margin of 0.5 cm (PTV1); then, CTV2 including high risk nodes and CTV3 including only T were defined and the corresponding PTV2/PTV3 were defined by a 0.5 cm expansion. IMRT and Tomotherapy planning were optimised to deliver 54 Gy in 30 fractions on PTV1 and 16.2 Gy in 9 fractions on PTV3; in the case a PTV2 was defined, 15 Gy were concomitantly delivered while delivering 16.2 Gy on PTV3. Separated plans for the two phases (Phase 1: first 30 fractions; Phase 2: last 9 fractions) were compared in terms of dose-volume histograms (DVH) and dose statistics on PTVs and OARs. RESULTS When considering Phase 1, Tomotherapy improved the homogeneity of the dose distribution within PTV1 while delivering the same prescribed dose (assessed to be the median dose to PTV): the fraction of PTV1 receiving more than 95% of the prescribed dose (V95%) increased from 90% (IMRT) to 96-97% for Tomotherapy plans. Dmax within PTV1 decreased from 60.3 Gy (IMRT) to 57.4 Gy (TOMO-a) and 58.7 Gy (TOMO-b). Spinal cord Dmax decreased from 31.6 Gy (IMRT) to 26.5 Gy (TOMO-a) and 24.6 Gy (TOMO-b). No attempts to further reduce spinal cord Dmax were done. Mean dose to the parotids decreased from 26.1 Gy (IMRT) to 25.1 Gy (TOMO-a) and 20.8 Gy (TOMO-b). Mandible was significantly better spared with Tomotherapy: mean dose decreased from 34.9 Gy (IMRT) to 34.0 Gy (TOMO-a) and 30.7 Gy (TOMO-b). When considering phase 2, the average gains (TOMO-b vs IMRT) were more modest and depended on the location of PTV2/PTV3. CONCLUSIONS Preliminary findings obtained in a sequential approach for HNC suggest that Tomotherapy has the potential to significantly improve the therapeutic ratio with respect to a conventional IMRT delivery method.
Collapse
Affiliation(s)
- Claudio Fiorino
- Medical Physics, Department of Radiotherapy, S. Raffaele Institute, Milano, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Fiorino C, Dell'Oca I, Pierelli A, Cattaneo G, De Martin E, Broggi S, Di Muzio N, Fazio F, Calandrino R. 246 The potentials of tomotherapy in simultaneous integrated boost (sib) “mucosa-sparing” irradiation of nasopharinx cancers. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80723-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|