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Cicchetti A, Mangili P, Fodor A, Gabellini MGU, Chiara A, Deantoni C, Mori M, Pasetti M, Palazzo G, Rancati T, Del Vecchio A, Gisella Di Muzio N, Fiorino C. Skin dose-volume predictors of moderate-severe late side effects after whole breast radiotherapy. Radiother Oncol 2024; 194:110183. [PMID: 38423138 DOI: 10.1016/j.radonc.2024.110183] [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: 10/10/2023] [Revised: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Toxicity after whole breast Radiotherapy is a relevant issue, impacting the quality-of-life of a not negligible number of patients. We aimed to develop a Normal Tissue Complication Probability (NTCP) model predicting late toxicities by combining dosimetric parameters of the breast dermis and clinical factors. METHODS The skin structure was defined as the outer CT body contour's 5 mm inner isotropic expansion. It was retrospectively segmented on a large mono-institutional cohort of early-stage breast cancer patients enrolled between 2009 and 2017 (n = 1066). Patients were treated with tangential-field RT, delivering 40 Gy in 15 fractions to the whole breast. Toxicity was reported during Follow-Up (FU) using SOMA/LENT scoring. The study endpoint was moderate-severe late side effects consisting of Fibrosis-Atrophy-Telangiectasia-Pain (FATP G ≥ 2) developed within 42 months after RT completion. A machine learning pipeline was designed with a logistic model combining clinical factors and absolute skin DVH (cc) parameters as output. RESULTS The FATP G2 + rate was 3.8 %, with 40/1066 patients experiencing side effects. After the preprocessing of variables, a cross-validation was applied to define the best-performing model. We selected a 4-variable model with Post-Surgery Cosmetic alterations (Odds Ratio, OR = 7.3), Aromatase Inhibitors (as a protective factor with OR = 0.45), V20 Gy (50 % of the prescribed dose, OR = 1.02), and V42 Gy (105 %, OR = 1.09). Factors were also converted into an adjusted V20Gy. CONCLUSIONS The association between late reactions and skin DVH when delivering 40 Gy/15 fr was quantified, suggesting an independent role of V20 and V42. Few clinical factors heavily modulate the risk.
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Affiliation(s)
- Alessandro Cicchetti
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Data Science Unit, Milan, Italy.
| | - Paola Mangili
- IRCCS San Raffaele Scientific Institute, Medical Physics Milan, Italy
| | - Andrei Fodor
- IRCCS San Raffaele Scientific Institute, Radiotherapy, Milan, Italy
| | | | - Anna Chiara
- IRCCS San Raffaele Scientific Institute, Radiotherapy, Milan, Italy
| | - Chiara Deantoni
- IRCCS San Raffaele Scientific Institute, Radiotherapy, Milan, Italy
| | - Martina Mori
- IRCCS San Raffaele Scientific Institute, Medical Physics Milan, Italy
| | - Marcella Pasetti
- IRCCS San Raffaele Scientific Institute, Radiotherapy, Milan, Italy
| | - Gabriele Palazzo
- IRCCS San Raffaele Scientific Institute, Medical Physics Milan, Italy
| | - Tiziana Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Data Science Unit, Milan, Italy
| | | | | | - Claudio Fiorino
- IRCCS San Raffaele Scientific Institute, Medical Physics Milan, Italy
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Cicchetti A, Mangili P, Fodor A, Mori M, Chiara A, Deantoni C, Pasetti M, Palazzo G, Ubeira Gabellini MG, Rancati T, Del Vecchio A, Muzio NGD, Fiorino C. Dosimetry Predictors of Late Skin Reactions after Whole Breast Radiotherapy on a Large Mono-Institutional Cohort of Patients. Int J Radiat Oncol Biol Phys 2023; 117:e171. [PMID: 37784780 DOI: 10.1016/j.ijrobp.2023.06.1012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To develop an NTCP model predicting late skin toxicity using dosimetric parameters from the breast dermis to identify possible RT constraints on such a structure. MATERIALS/METHODS The skin structure was defined as the 5 mm inner isotropic expansion from the outer CT body contour. It was retrospectively segmented on a large mono-Institutional cohort of early-stage breast cancer patients enrolled between 2009 and 2017 (n = 1066). Patients were treated with tangential-field RT, delivering 40 Gy in 15 fractions without a RT boost. Toxicity was reported during FU using SOMA/LENT scoring. The study endpoint was moderate-severe late toxicity consisting of Fibrosis-Atrophy-Telangiectasia-Pain (FATP G2+) developed within 42 months after RT completion. Automatic delineation of skin and DVH extraction were accomplished by scripting using the MIM_assistant software. Also, the impact of changes in the dose calculation algorithms during enrolment time was quantified. A logistic model was created by combining multifactorial variables, considering both clinical factors and the absolute skin DVH (cc). Variance Inflation Factor (VIF) was performed to reduce the multicollinearity. Repeated 5-fold cross-validation with SMOTE approach to overcome the class unbalance was applied for model feature selection. The predictive model was then developed on the entire population due to the limited G2+ events. RESULTS The FATP G2+ rate was 3.8% with 40/1066 experiencing late toxicity. Among them, a 40% had already developed acute symptoms after RT completion showing a consequential effect. The multicollinearity analysis selected 27 clinical-treatment-dosimetric factors. After repeated (20 times) 5-fold cross-validation, the best-performing model included Post-Surgery Cosmetic alterations, Aromatase Inhibitors (as a protective factor), V20 Gy (50% of the prescribed dose - DVH plateau region) and V42 Gy (105% of the prescribed dose - DVH high-dose tail). Accuracy and f1-score were 0.76 and 0.58 in both training and test sets, providing good reliability for selected variables. AUC for the final model on the entire population was 0.76+/-0.04. CONCLUSION We quantified the association between fibrosis and skin DVH when delivering 40 Gy in 15fr. The model suggested an independent role of V20 and V42 Gy and a heavy risk modulation by surgical effects and aromatase inhibitors. This last factor could interfere with adipose tissue and water-content distribution within the breast. For this purpose, a CT-based densitometry characterization of toxicity patients is ongoing.
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Affiliation(s)
- A Cicchetti
- Fondazione IRCCS Istituto Nazionale dei Tumori, Data Science Unit, Milan, Italy
| | - P Mangili
- San Raffaele Scientific Institute, Milan, Italy
| | - A Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Mori
- San Raffaele Scientific Institute - IRCCS, Milano, Italy
| | - A Chiara
- San Raffaele Scientific Institute, Milan, Italy
| | - C Deantoni
- San Raffaele Scientific Institute, Milan, Italy
| | - M Pasetti
- San Raffaele Scientific Institute, Milano, Italy
| | - G Palazzo
- San Raffaele Scientific Institute, Milan, Italy
| | | | - T Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori, Data Science Unit, Milan, Italy
| | | | - N G Di Muzio
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - C Fiorino
- San Raffaele Scientific Institute - IRCCS, Milano, Italy
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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
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Esposito PG, Castriconi R, Mangili P, Broggi S, Fodor A, Pasetti M, Tudda A, Di Muzio NG, del Vecchio A, Fiorino C. Knowledge-based automatic plan optimization for left-sided whole breast tomotherapy. Phys Imaging Radiat Oncol 2022; 23:54-59. [PMID: 35814259 PMCID: PMC9256826 DOI: 10.1016/j.phro.2022.06.009] [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: 12/30/2021] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 12/01/2022] Open
Abstract
Background/Purpose Tomotherapy may deliver high-quality whole breast irradiation at static angles. The aim of this study was to implement Knowledge-Based (KB) automatic planning for left-sided whole breast using this modality. Materials/Methods Virtual volumetric plans were associated to the dose distributions of 69 Tomotherapy (TT) clinical plans of previously treated patients, aiming to train a KB-model using a commercial tool completely implemented in our treatment planning system. An individually optimized template based on the resulting KB-model was generated for automatic plan optimization. Thirty patients of the training set and ten new patients were considered for internal/external validation. Fully-automatic plans (KB-TT) were generated and compared using the same geometry/number of fields of the corresponding clinical plans. Results KB-TT plans were successfully generated in 26/30 and 10/10 patients of the internal/external validation sets; for 4 patients whose original plans used only two fields, the manual insertion of one/two fields before running the automatic template was sufficient to obtain acceptable plans. Concerning internal validation, planning target volume V95%/D1%/dose distribution standard deviation improved by 0.9%/0.4Gy/0.2Gy (p < 0.05) against clinical plans; Organs at risk mean doses were also slightly improved (p < 0.05) by 0.07/0.4/0.2/0.01 Gy for left lung/heart/right breast/right lung respectively. Similarly satisfactory results were replicated in the external validation set. The resulting treatment duration was 8 ± 1 min, consistent with our clinical experience. The active planner time per patient was 5–10 minutes. Conclusion Automatic TT left-sided breast KB-plans are comparable to or slightly better than clinical plans and can be obtained with limited planner time. The approach is currently under clinical implementation.
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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]
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Esposito P, Castriconi R, Mangili P, Broggi S, Fodor A, Pasetti M, Tudda A, Di Muzio N, del Vecchio A, Fiorino C. MO-0790 Knowledge-Based automatic plan optimization for left-sided whole breast tomotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02426-4] [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: 10/18/2022]
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Tummineri R, Fodor A, Zerbetto F, Pasetti M, Deantoni C, Sanchez Galvan A, Castriconi R, Mangili P, Del Vecchio A, Di Muzio N. PO-1177 Acute toxicity of hypofractionated locoregional radiotherapy in advanced breast cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03141-3] [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]
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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]
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Castriconi R, Esposito P, Mangili P, Pasetti M, Fodor A, Di Muzio N, del Vecchio A, Fiorino C. Knowledge-based (KB) automatic plan optimization can replace manual planning in tangential field irradiation for right breast cancer radiotherapy. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00128-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Di Muzio NG, Deantoni CL, Brombin C, Fiorino C, Cozzarini C, Zerbetto F, Mangili P, Tummineri R, Dell’Oca I, Broggi S, Pasetti M, Chiara A, Rancoita PMV, Del Vecchio A, Di Serio MS, Fodor A. Ten Year Results of Extensive Nodal Radiotherapy and Moderately Hypofractionated Simultaneous Integrated Boost in Unfavorable Intermediate-, High-, and Very High-Risk Prostate Cancer. Cancers (Basel) 2021; 13:cancers13194970. [PMID: 34638454 PMCID: PMC8508068 DOI: 10.3390/cancers13194970] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/27/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Several phase III randomized trials of moderate hypofractionation, including a higher proportion of high-risk prostate cancer patients treated only to the prostate, failed to demonstrate the superiority of hypofractionated regimens. There is only one randomized phase III trial, of moderately hypofractionated high-dose radiotherapy to the prostate-only versus pelvic irradiation and prostate boost, with a sufficiently long follow-up. It demonstrated better biochemical and disease-free survival when lymph nodal radiotherapy was added. Here we present the 10-year results of our experience based on an Institutional protocol adopted after a phase I–II study, on patients with unfavorable intermediate- (UIR), high- (HR), and very high-risk (VHR) prostate cancer (PCa) treated with pelvic lymph nodal irradiation (WPRT) and moderately hypofractionated high-dose (HD) simultaneous integrated boost (SIB) to the prostate. Prognostic factors for relapse, as well as acute and late gastro-intestinal (GI) and genito-urinary (GU) toxicity were also analyzed. Abstract Aims: To report 10-year outcomes of WPRT and HD moderately hypofractionated SIB to the prostate in UIR, HR, and VHR PCa. Methods: From 11/2005 to 12/2015, 224 UIR, HR, and VHR PCa patients underwent WPRT at 51.8 Gy/28 fractions and SIB at 74.2 Gy (EQD2 88 Gy) to the prostate. Androgen deprivation therapy (ADT) was prescribed in up to 86.2% of patients. Results: Median follow-up was 96.3 months (IQR: 71–124.7). Median age was 75 years (IQR: 71.3–78.1). At last follow up, G3 GI–GU toxicity was 3.1% and 8%, respectively. Ten-year biochemical relapse-free survival (bRFS) was 79.8% (95% CI: 72.3–88.1%), disease-free survival (DFS) 87.8% (95% CI: 81.7–94.3%), overall survival (OS) 65.7% (95% CI: 58.2–74.1%), and prostate cancer-specific survival (PCSS) 94.9% (95% CI: 91.0–99.0%). Only two patients presented local relapse. At univariate analysis, VHR vs. UIR was found to be a significant risk factor for biochemical relapse (HR: 2.8, 95% CI: 1.17–6.67, p = 0.021). After model selection, only Gleason Score ≥ 8 emerged as a significant factor for biochemical relapse (HR = 2.3, 95% CI: 1.12–4.9, p = 0.023). Previous TURP (HR = 3.5, 95% CI: 1.62–7.54, p = 0.001) and acute toxicity ≥ G2 (HR = 3.1, 95% CI = 1.45–6.52, p = 0.003) were significant risk factors for GU toxicity ≥ G3. Hypertension was a significant factor for GI toxicity ≥ G3 (HR = 3.63, 95% CI: 1.06–12.46, p = 0.041). ADT (HR = 0.31, 95% CI: 0.12–0.8, p = 0.015) and iPsa (HR = 0.37, 95% CI: 0.16–0.83, p = 0.0164) played a protective role. Conclusions: WPRT and HD SIB to the prostate combined with long-term ADT, in HR PCa, determine good outcomes with acceptable toxicity.
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Affiliation(s)
- Nadia Gisella Di Muzio
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, 60 Olgettina Street, 20132 Milan, Italy; (C.L.D.); (C.C.); (F.Z.); (R.T.); (I.D.); (M.P.); (A.C.); (A.F.)
- Vita-Salute San Raffaele University, 20132 Milan, Italy; (C.B.); (P.M.V.R.); (M.S.D.S.)
- Correspondence: ; Tel.: +39-0226437643; Fax: +39-0226437639
| | - Chiara Lucrezia Deantoni
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, 60 Olgettina Street, 20132 Milan, Italy; (C.L.D.); (C.C.); (F.Z.); (R.T.); (I.D.); (M.P.); (A.C.); (A.F.)
| | - Chiara Brombin
- Vita-Salute San Raffaele University, 20132 Milan, Italy; (C.B.); (P.M.V.R.); (M.S.D.S.)
- University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, 58 Olgettina Street, 20132 Milan, Italy
| | - Claudio Fiorino
- Vita-Salute San Raffaele University, 20132 Milan, Italy; (C.B.); (P.M.V.R.); (M.S.D.S.)
- Medical Physics, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (C.F.); (P.M.); (S.B.); (A.D.V.)
| | - Cesare Cozzarini
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, 60 Olgettina Street, 20132 Milan, Italy; (C.L.D.); (C.C.); (F.Z.); (R.T.); (I.D.); (M.P.); (A.C.); (A.F.)
| | - Flavia Zerbetto
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, 60 Olgettina Street, 20132 Milan, Italy; (C.L.D.); (C.C.); (F.Z.); (R.T.); (I.D.); (M.P.); (A.C.); (A.F.)
| | - Paola Mangili
- Medical Physics, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (C.F.); (P.M.); (S.B.); (A.D.V.)
| | - Roberta Tummineri
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, 60 Olgettina Street, 20132 Milan, Italy; (C.L.D.); (C.C.); (F.Z.); (R.T.); (I.D.); (M.P.); (A.C.); (A.F.)
| | - Italo Dell’Oca
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, 60 Olgettina Street, 20132 Milan, Italy; (C.L.D.); (C.C.); (F.Z.); (R.T.); (I.D.); (M.P.); (A.C.); (A.F.)
| | - Sara Broggi
- Medical Physics, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (C.F.); (P.M.); (S.B.); (A.D.V.)
| | - Marcella Pasetti
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, 60 Olgettina Street, 20132 Milan, Italy; (C.L.D.); (C.C.); (F.Z.); (R.T.); (I.D.); (M.P.); (A.C.); (A.F.)
| | - Anna Chiara
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, 60 Olgettina Street, 20132 Milan, Italy; (C.L.D.); (C.C.); (F.Z.); (R.T.); (I.D.); (M.P.); (A.C.); (A.F.)
| | - Paola Maria Vittoria Rancoita
- Vita-Salute San Raffaele University, 20132 Milan, Italy; (C.B.); (P.M.V.R.); (M.S.D.S.)
- University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, 58 Olgettina Street, 20132 Milan, Italy
| | - Antonella Del Vecchio
- Medical Physics, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (C.F.); (P.M.); (S.B.); (A.D.V.)
| | - Mariaclelia Stefania Di Serio
- Vita-Salute San Raffaele University, 20132 Milan, Italy; (C.B.); (P.M.V.R.); (M.S.D.S.)
- University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, 58 Olgettina Street, 20132 Milan, Italy
| | - Andrei Fodor
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, 60 Olgettina Street, 20132 Milan, Italy; (C.L.D.); (C.C.); (F.Z.); (R.T.); (I.D.); (M.P.); (A.C.); (A.F.)
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Castriconi R, Esposito PG, Tudda A, Mangili P, Broggi S, Fodor A, Deantoni CL, Longobardi B, Pasetti M, Perna L, Del Vecchio A, Di Muzio NG, Fiorino C. Replacing Manual Planning of Whole Breast Irradiation With Knowledge-Based Automatic Optimization by Virtual Tangential-Fields Arc Therapy. Front Oncol 2021; 11:712423. [PMID: 34504790 PMCID: PMC8423088 DOI: 10.3389/fonc.2021.712423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/02/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To implement Knowledge Based (KB) automatic planning for right and left-sided whole breast treatment through a new volumetric technique (ViTAT, Virtual Tangential-fields Arc Therapy) mimicking conventional tangential fields (TF) irradiation. Materials and Method A total of 193 clinical plans delivering TF with wedged or field-in-field beams were selected to train two KB-models for right(R) and left(L) sided breast cancer patients using the RapidPlan (RP) tool implemented in the Varian Eclipse system. Then, a template for ViTAT optimization, incorporating individual KB-optimized constraints, was interactively fine-tuned. ViTAT plans consisted of four arcs (6 MV) with start/stop angles consistent with the TF geometry variability within our population; the delivery was completely blocked along the arcs, apart from the first and last 20° of rotation for each arc. Optimized fine-tuned KB templates for automatic plan optimization were generated. Validation tests were performed on 60 new patients equally divided in R and L breast treatment: KB automatic ViTAT-plans (KB-ViTAT) were compared against the original TF plans in terms of OARs/PTVs dose-volume parameters. Wilcoxon-tests were used to assess the statistically significant differences. Results KB models were successfully generated for both L and R sides. Overall, 1(3%) and 7(23%) out of 30 automatic KB-ViTAT plans were unacceptable compared to TF for R and L side, respectively. After the manual refinement of the start/stop angles, KB-ViTAT plans well fitted TF-performances for these patients as well. PTV coverage was comparable, while PTV D1% was improved with KB-ViTAT by R:0.4/L:0.2 Gy (p < 0.05); ipsilateral OARs Dmean were similar with a slight (i.e., few % volume) improvement/worsening in the 15–35 Gy/2–15 Gy range, respectively. KB-ViTAT better spared contralateral OARs: Dmean of contralateral OARs was 0.1 Gy lower (p < 0.05); integral dose was R:5%/L:8% lower (p < 0.05) than TF. The overall time for the automatic plan optimization and final dose calculation was 12 ± 2 minutes. Conclusions Fully automatic KB-optimization of ViTAT can efficiently replace manually optimized TF planning for whole breast irradiation. This approach was clinically implemented in our institute and may be suggested as a large-scale strategy for efficiently replacing manual planning with large sparing of time, elimination of inter-planner variability and of, seldomly occurring, sub-optimal manual plans.
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Affiliation(s)
| | | | - Alessia Tudda
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Paola Mangili
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Sara Broggi
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Andrei Fodor
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | | | | | | | - Lucia Perna
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | | | | | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
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Fodor A, Brombin C, Mangili P, Pasetti M, Tummineri R, Longobardi B, Zerbetto F, Castriconi R, Esposito P, Broggi S, Dell’Oca I, Deantoni C, Sanchez Galvan A, Perna L, Deli A, Chiara A, Rancoita P, Fiorino C, Del Vecchio A, Di Serio M, Di Muzio N. PO-1139 Skin toxicity in 1325 breast cancer patients treated with hypofractionated RT without boost. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07590-3] [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: 11/28/2022]
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Esposito P, Castriconi R, Mangili P, Broggi S, Fodor A, Longobardi B, Pasetti M, Perna L, Di Muzio N, Del Vecchio A, Fiorino C. OC-0468 Implementation of a Knowledge-Based automated approach for whole breast tangential field planning. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06917-6] [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: 10/20/2022]
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Fodor A, Deantoni C, Tummineri R, Fiorino C, Dell’Oca I, Mori M, Broggi S, Pasetti M, Perna L, Villa S, Mandurino G, Sanchez Galvan A, Baroni S, Pacifico P, Del Vecchio A, Di Muzio N. PO-1189 Stereotactic radiotherapy for lung oligometastases from colorectal cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07640-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zerbetto F, Foti S, Deantoni C, Pasetti M, Chiara A, Roberta T, Broggi S, Di Muzio N. PO-1401 Lung metastasis from renal cell carcinoma: SBRT alone or in association with target therapy as a potential treatment option. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07852-x] [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: 12/01/2022]
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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.
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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
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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]
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18
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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]
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19
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Esposito P, Castriconi R, Mangili P, Fodor A, Pasetti M, Di Muzio N, Fiorino C, Calandrino R. PD-0301: Virtual Tangential Arc Therapy (ViTAT): toward large scale auto-planning for breast cancer treatment. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00325-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: 10/22/2022]
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20
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Tummineri R, Fodor A, Borroni F, Zerbetto F, Deantoni C, Deli A, Slim N, Pasetti M, Broggi S, Fiorino C, Di Muzio N. PO-0879: Stereotactic radiotherapy for re-irradiation of relapsed intracranic lesions. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00896-3] [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: 11/25/2022]
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21
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Zerbetto F, Deantoni C, Borroni F, Tummineri R, Fodor A, Pasetti M, Chiara A, Broggi S, Longobardi B, Perna L, Fiorino C, Di Muzio N. PO-1246: Stereotactic Body Radiotherapy For Bone Metastases In Oligometastatic-Oligoprogressive Patients. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01264-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Chiara A, Broggi S, Salvadori G, Peccatori J, Assanelli A, Piemontese S, Pasetti M, Selli S, Calandrino R, Ciceri F, Fiorino C, Di Muzio N. PO-0915: Clinical Activation Of An Efficient Low-Dose Total Body Irradiation Using The Tomodirect Approach. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00932-4] [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: 11/24/2022]
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23
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Esposito PG, Castriconi R, Mangili P, Fodor A, Pasetti M, Di Muzio NG, Del Vecchio A, Fiorino C. Virtual Tangential-fields Arc Therapy (ViTAT) for whole breast irradiation: Technique optimization and validation. Phys Med 2020; 77:160-168. [PMID: 32866777 DOI: 10.1016/j.ejmp.2020.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/07/2020] [Accepted: 08/09/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To test the performances of a volumetric arc technique named ViTAT (Virtual Tangential-fields Arc Therapy) mimicking tangential field irradiation for whole breast radiotherapy. METHODS ViTAT plans consisted in 4 arcs whose starting/ending position were established based on gantry angle distribution of clinical plans for right and left-breast. The arcs were completely blocked excluding the first and last 20°. Different virtual bolus densities and thicknesses were preliminarily evaluated to obtain the best plan performances. For 40 patients with tumor laterality equally divided between right and left sides, ViTAT plans were optimized considering the clinical DVHs for OARs (resulting from tangential field manual planning) to constrain them: ViTAT plans were compared with the clinical tangential-fields in terms of DVH parameters for both PTV and OARs. RESULTS Distal angle values were suggested in the ranges [220°,240°] for the right-breast and [115°,135°] for the left-breast cases; medial angles were [60°,40°] for the right side and [295°,315°] for the left side, limiting the risk of collision. The optimal virtual bolus had -500 HU density and 1.5 cm thickness. ViTAT plans generated dose distributions very similar to the tangential-field plans, with significantly improved PTV homogeneity. The mean doses of ipsilateral OARs were comparable between the two techniques with minor increase of the low-dose spread in the range 2-15 Gy (few % volume); contralateral OARs were slightly better spared with ViTAT. CONCLUSION ViTAT dose distributions were similar to tangential-fields. ViTAT should allow automatic plan optimization by developing knowledge-based DVH prediction models of patients treated with tangential-fields.
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Affiliation(s)
| | - Roberta Castriconi
- Medical Physics, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - Paola Mangili
- Medical Physics, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - Andrei Fodor
- Radiotherapy, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - Marcella Pasetti
- Radiotherapy, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - Nadia G Di Muzio
- Radiotherapy, San Raffaele Hospital Scientific Institute, Milan, Italy
| | | | - Claudio Fiorino
- Medical Physics, San Raffaele Hospital Scientific Institute, Milan, Italy.
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24
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Viale G, Licata L, Sica L, Zambelli S, Zucchinelli P, Rognone A, Aldrighetti D, Di Micco R, Zuber V, Pasetti M, Di Muzio N, Rodighiero M, Panizza P, Sassi I, Petrella G, Cascinu S, Gentilini OD, Bianchini G. Personalized Risk-Benefit Ratio Adaptation of Breast Cancer Care at the Epicenter of COVID-19 Outbreak. Oncologist 2020; 25:e1013-e1020. [PMID: 32412693 PMCID: PMC7272798 DOI: 10.1634/theoncologist.2020-0316] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/06/2020] [Indexed: 12/26/2022] Open
Abstract
Northern Italy has been one of the European regions reporting the highest number of COVID-19 cases and deaths. The pandemic spread has challenged the National Health System, requiring reallocation of most of the available health care resources to treat COVID-19-positive patients, generating a competition with other health care needs, including cancer. Patients with cancer are at higher risk of developing critical illness after COVID-19 infection. Thus, mitigation strategies should be adopted to reduce the likelihood of infection in all patients with cancer. At the same time, suboptimal care and treatments may result in worse cancer-related outcome. In this article, we attempt to estimate the individual risk-benefit balance to define personalized strategies for optimal breast cancer management, avoiding as much as possible a general untailored approach. We discuss and report the strategies our Breast Unit adopted from the beginning of the COVID-19 outbreak to ensure the continuum of the best possible cancer care for our patients while mitigating the risk of infection, despite limited health care resources. IMPLICATIONS FOR PRACTICE: Managing patients with breast cancer during the COVID-19 outbreak is challenging. The present work highlights the need to estimate the individual patient risk of infection, which depends on both epidemiological considerations and individual clinical characteristics. The management of patients with breast cancer should be adapted and personalized according to the balance between COVID-19-related risk and the expected benefit of treatments. This work also provides useful suggestions on the modality of patient triage, the conduct of clinical trials, the management of an oncologic team, and the approach to patients' and health workers' psychological distress.
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Affiliation(s)
- Giulia Viale
- Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele HospitalMilanItaly
| | - Luca Licata
- Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele HospitalMilanItaly
| | - Lorenzo Sica
- Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele HospitalMilanItaly
| | - Stefania Zambelli
- Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele HospitalMilanItaly
| | - Patrizia Zucchinelli
- Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele HospitalMilanItaly
| | - Alessia Rognone
- Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele HospitalMilanItaly
| | - Daniela Aldrighetti
- Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele HospitalMilanItaly
| | - Rosa Di Micco
- Breast Surgery Unit, IRCCS San Raffaele HospitalMilanItaly
- Department of Clinical Medicine and Surgery, University of Naples Federico IINaplesItaly
| | - Veronica Zuber
- Breast Surgery Unit, IRCCS San Raffaele HospitalMilanItaly
| | | | - Nadia Di Muzio
- Radiotherapy Unit, IRCCS San Raffaele HospitalMilanItaly
- Vita‐Salute S. Raffaele UniversityMilanItaly
| | | | - Pietro Panizza
- Breast Imaging Unit, IRCCS San Raffaele HospitalMilanItaly
| | | | - Giovanna Petrella
- Department of Medical Oncology, IRCCS San Raffaele HospitalMilanItaly
| | - Stefano Cascinu
- Department of Medical Oncology, IRCCS San Raffaele HospitalMilanItaly
| | | | - Giampaolo Bianchini
- Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele HospitalMilanItaly
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Broggi S, Fiorino C, Chiara A, Salvadori G, Peccatori J, Assanelli A, Piementose S, Pasetti M, Simone S, Ciceri F, Di Muzio NG, Calandrino R. Clinical implementation of low-dose total body irradiation using topotherapy technique. Phys Imaging Radiat Oncol 2019; 12:74-79. [PMID: 33458299 PMCID: PMC7807637 DOI: 10.1016/j.phro.2019.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE The topotherapy technique was recently suggested as a robust alternative to helical radiation delivery for total body irradiation (TBI). It allows to deliver a discrete number of beams with fixed gantry. A Topotherapy-based low-dose TBI technique was optimized and clinically implemented. MATERIALS AND METHODS TBI delivery was split in two parts: the first treating from the head to half thigh and the second the remaining legs. An in-silico investigation aimed to optimize plan parameters was first carried out on four patients. For the upper plan, field width and pitch were fixed to 5 cm and 0.5: the combined impact of five modulation factor (MF) values and different field configurations (6/8/12 fields) was investigated. For the lower plan, two anterior/posterior beams (field width: 5 cm; pitch: 0.5; MF:1.5) were used. After assessing the optimal technique, set-up/quality assurance/image-guidance procedures were defined and the technique clinically implemented: 23 patients were treated up to now. RESULTS The best compromise between treatment time and planning target volume (PTV) coverage/homogeneity was found for MF = 1.5 and 8 fields. All clinical plans were automatically optimized using an "ad-hoc" plan template: excellent PTV coverage (PTV95%>98.5%) and homogeneity (median SD:4%) were found with a median beam-on time of 17/9 min for the upper/lower plan. All patients were successfully treated and transplanted. CONCLUSIONS TBI delivered with the topotherapy approach robustly guarantees adequate coverage and dose homogeneity. Semi-automatic clinical plans can be quickly generated and efficiently delivered.
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Affiliation(s)
- Sara Broggi
- Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - Anna Chiara
- Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
| | | | - Jacopo Peccatori
- Haematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Assanelli
- Haematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Simona Piementose
- Haematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Selli Simone
- Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- Haematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
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Di Micco R, Zuber V, Fiacco E, Carriero F, Gattuso MI, Nazzaro L, Panizza P, Gianolli L, Canevari C, Di Muzio N, Pasetti M, Sassi I, Zambetti M, Gentilini OD. Corrigendum to "Sentinel node biopsy after primary systemic therapy in node positive breast cancer patients: Time trend, imaging staging power and nodal downstaging according to molecular subtype" [Eur. J. Surg. Oncol. 45, (6) (2019) 969-975]. Eur J Surg Oncol 2019; 45:1754. [PMID: 31307816 DOI: 10.1016/j.ejso.2019.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] Open
Affiliation(s)
- Rosa Di Micco
- Breast Surgery Unit, San Raffaele Hospital, Milan, Italy; Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Veronica Zuber
- Breast Surgery Unit, San Raffaele Hospital, Milan, Italy
| | - Enrico Fiacco
- Breast Surgery Unit, San Raffaele Hospital, Milan, Italy
| | | | | | | | - Pietro Panizza
- Breast Radiology Unit, San Raffaele Hospital, Milan, Italy
| | - Luigi Gianolli
- Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy
| | - Carla Canevari
- Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy
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27
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Chiara A, Broggi S, Pasetti M, Dell'oca I, Azizi M, Salvadori G, Selli S, Marcatti M, Assanelli A, Peccatori J, Cattaneo M, Ciceri F, Di Muzio N. PO-0868 Total Marrow Irradiation in Myeloma Multiple patients candidate to allogeneic transplant. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31288-5] [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]
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28
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Mangili P, Mori M, Fodor A, Longobardi B, Signorotto P, Pasetti M, Zerbetto F, Di Muzio N, Calandrino R, Fiorino C. EP-1993 Evidence of CTV underdosing due to anatomical changes during breast Helical Tomotherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32413-2] [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: 11/15/2022]
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29
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Di Micco R, Zuber V, Fiacco E, Carriero F, Gattuso MI, Nazzaro L, Panizza P, Gianolli L, Canevari C, Di Muzio N, Pasetti M, Sassi I, Zambetti M, Gentilini OD. Sentinel node biopsy after primary systemic therapy in node positive breast cancer patients: Time trend, imaging staging power and nodal downstaging according to molecular subtype. Eur J Surg Oncol 2019; 45:969-975. [PMID: 30744944 DOI: 10.1016/j.ejso.2019.01.219] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/20/2019] [Accepted: 01/29/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The management of axilla after Primary Systemic Therapy (PST) for breast cancer is a highly debated field. Despite the proven axillary downstaging occurring after PST, there is still some degree of reluctance in applying sentinel node biopsy (SNB) in the neoadjuvant setting. PATIENTS AND METHODS We performed a retrospective analysis on 181 PST patients with axillary positive nodes at presentation treated between 2005 and 2017 at San Raffaele Hospital in Milan. The aim was to observe the application time trend of SNB, to determine the imaging staging power and the axillary downstaging according to molecular subtypes. RESULTS Median follow-up after surgery was 32.5(IQR: 12-59) months. After PST, 119 (65.7%) patients had no clinically palpable nodes, 72 (39.7%) converted to N0 on final imaging and 34 (18.8%) underwent SNB with an increasing application trend. Axillary-US showed the highest accuracy (69.3%) in re-staging axilla after PST. Staging power of preoperative testing varied with tumour biology: Positive Predictive Value was higher in Luminal A (80% for clinical examination and 100% for axillary-US) and Luminal B (72% and 70.5%) tumours, whilst Negative Predictive Value was higher in HER2 positive (100% and 93.3%), and triple negative (71.4% and 93.3%) tumours. Ninety five (52.5%) patients experienced axillary downstaging after PST, by molecular subtype 15% (3/20) in Luminal A, 46.4% (45/97) in Luminal B, 90.9% (20/22) in HER2+ and 70.3% (26/37) in triple negative breast tumours. CONCLUSION SNB application after PST for breast cancer in node positive patients at presentation is increasing. Pre-operative axillary imaging and tumour biology help identify patients who might be candidates for SNB as a single staging procedure.
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Affiliation(s)
- Rosa Di Micco
- Breast Surgery Unit, San Raffaele Hospital, Milan, Italy; Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Veronica Zuber
- Breast Surgery Unit, San Raffaele Hospital, Milan, Italy
| | - Enrico Fiacco
- Breast Surgery Unit, San Raffaele Hospital, Milan, Italy
| | | | | | | | - Pietro Panizza
- Breast Radiology Unit, San Raffaele Hospital, Milan, Italy
| | - Luigi Gianolli
- Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy
| | - Carla Canevari
- Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy
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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.
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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
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Tucker S, Kim L, Liebowitz D, Lin K, Kasparek K, Nazareno J, Gottlieb K, Pasetti M. Oral immunization of a rAd vector expressing norovirus VP1 elicits a potent mucosal immune response without an increase in anti-vector immunity. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.3583] [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] Open
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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]
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Cozzarini C, Noris Chiorda B, Fiorino C, Pasetti M, Briganti A, Deantoni C, Deli A, Fodor A, Fossati N, Gandaglia G, Sini C, Montorsi F, Di Muzio N. PO-0730: The independent benefit deriving from high doses and WPRT in salvage post-prostatectomy radiotherapy. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31167-2] [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: 11/25/2022]
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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]
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Pasetti M, Fodor A, Sini C, Zerbetto F, Mangili P, Signorotto P, Dell’Oca I, Gumina C, Azizi M, Deli A, Passoni P, Slim N, Deantoni C, Noris Chiorda B, Foti S, Chiara A, Rossi G, Fiorino C, Bolognesi A, Di Muzio N. EP-1159: Hypofractionated adjuvant radiotherapy and concomitant trastuzumab for breast cancer: 5-year results. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31595-5] [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: 10/19/2022]
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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
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Sini C, Fiorino C, Perna L, Noris Chiorda B, Sacco V, Pasetti M, Chiara A, Calandrino R, Di Muzio N, Cozzarini C. EP-1725: Predictors of diarrhea after whole-pelvis post-prostatectomy radiotherapy. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32976-0] [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]
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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]
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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.
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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
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Di Muzio N, Fodor A, Cozzarini C, Broggi S, Chiorda BN, Pasetti M, Briganti A, Valdagni R, Calandrino R, Fiorino C. Five-Year Outcomes and Late Toxicity in Prostate Cancer Patients Treated With Moderate Hypofractionated Helical Tomotherapy and Simultaneous Integrated Boost in a Phase 1-2 Study. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cozzarini C, Zuppardi F, Fiorino C, Briganti A, Fodor A, Naimo S, Noris Chiorda B, Pasetti M, Slim N, Suardi N, Sarno L, Montorsi F, Di Muzio N. OC-0321: Impact of urinary symptoms and incontinence on anxiety and depression 1 year after postprostatectomy radiotherapy. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40319-6] [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: 10/23/2022]
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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]
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Tennant S, Simon R, Wang J, Pasetti M, Ernst R, Lees A, Galen J, Levine M. Bivalent vaccine strategies for invasive non-typhoidal Salmonella infections. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.426] [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] Open
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Noris Chiorda B, Cozzarini C, Fiorino C, Briganti A, Berardi G, Pasetti M, Sbalchiero A, Suardi N, Zerbetto F, Di Muzio N. PD-0306: Factors influencing urinary incontinence following post-prostatectomy IMRT irradiation. A prospective study. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30411-4] [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: 10/23/2022]
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Di Muzio N, Fiorino C, Fodor A, Noris Chiorda B, Berardi G, Cozzarini C, Pasetti M, Broggi S, Mangili P, Calandrino R. High-Dose Moderately Hypofractionated Tomotherapy for Prostate Cancer: 5-Year Results. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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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]
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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]
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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.
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Affiliation(s)
- Andrei Fodor
- Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy.
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Fodor A, Bolognesi A, Mangili P, Pasetti M, Fiorino C, Chiara A. 753 poster EARLY TOXICITY RESULTS OF A FORWARD PLANNED HYPOFRACTIONATED IMRT FOR WHOLE BREAST ADJUVANT TREATMENT. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70875-1] [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: 10/18/2022]
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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]
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