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Ferrari A, Orbach D, Bergamaschi L, Schoot RA, van Noesel MM, Di Carlo D, Bisogno G, Alaggio R, Milano GM, Chiaravalli S, Fuccillo F, Laurence V, Corradini N, Gasparini P, Vennarini S, Pasquali S, Casanova M. Treatment at relapse for synovial sarcoma of children and adolescents: A multi-institutional European retrospective analysis. Pediatr Blood Cancer 2024:e31038. [PMID: 38679840 DOI: 10.1002/pbc.31038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Though the prognosis for pediatric patients with localised synovial sarcoma (SS) is generally good, the chances of being cured after relapse are limited. This study describes a retrospective multi-institutional series of relapsing SS patients treated at six selected European referral centers for pediatric sarcoma. PATIENTS AND METHODS The study included 41 patients <21 years with relapsing SS, treated between 2002 and 2022. The analysis included patient's characteristics at first diagnosis, first-line treatments, clinical findings at relapse, and second-line treatment modalities. RESULTS The first relapse occurred within 3-132 months (median 18 months) after first diagnosis and was local in 34%, metastatic in 54%, and both in 12%. Treatment at first relapse included surgery in 56% of cases, radiotherapy in 34%, and systemic therapy in 88%. In all, 36 patients received second-line medical treatment, that was chemotherapy in 32 cases (with 10 different regimens) and targeted therapy in four. No patient was included in an early-phase clinical trial as second-line therapy-line therapy. Overall response rate was 42%. Median event-free survival (EFS) was 12 months, postrelapse 5-year EFS was 15.8%. Median overall survival (OS) was 30 months, postrelapse 5-year OS was 22.2%. At the Cox's multivariable regression analysis, OS was significantly associated with time and type of relapse. CONCLUSION Pediatric patients with relapsed SS have a poor prognosis and generally receive an individualized approach, due to the lack of a uniform standardized approach. New comprehensive strategies are needed to improve the knowledge on the biologic landscape of SS and develop tailored prospective clinical trials.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniel Orbach
- SIREDO Oncology Center Care, (Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, PSL University, Paris, France
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Reineke A Schoot
- Solid Tumors Department, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Max M van Noesel
- Solid Tumors Department, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Division Imaging & Cancer, Pediatric Oncology Department, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daniela Di Carlo
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padua, Padua, Italy
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Gianni Bisogno
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padua, Padua, Italy
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Rita Alaggio
- Pathology Department, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy
| | - Giuseppe Maria Milano
- Hematology/Oncology, Department of Oncohematology, Hematopoietic Transplantation, and Cell Therapy, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Fernando Fuccillo
- Pediatric Oncology Unit, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Nadege Corradini
- Department of Pediatric Hematology and Oncology-IHOPe, Léon Bérard Center, Lyon, France
| | - Patrizia Gasparini
- Department of Research, Tumor Genomics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sabina Vennarini
- Pediatric Radiotherapy Unit, Radiotherapy Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Sandro Pasquali
- Department of Experimental Oncology, Molecular Pharmacology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Surgery, Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Ferrari A, Vennarini S, Fiore M, Bergamaschi L, Chiaravalli S, Morosi C, Colombo C, Pecori E, Puma N, Luksch R, Terenziani M, Spreafico F, Meazza C, Podda M, Biassoni V, Schiavello E, Massimino M, Casanova M. Local treatment in initially unresected non-rhabdomyosarcoma soft-tissue sarcomas of children and adolescents: A retrospective single-center experience. Pediatr Blood Cancer 2024; 71:e30901. [PMID: 38296840 DOI: 10.1002/pbc.30901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/01/2024] [Accepted: 01/21/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Pediatric non-rhabdomyosarcoma soft-tissue sarcomas (NRSTS) are a heterogeneous group of aggressive tumors. Patients with locally advanced/initially unresected disease represent a subset of patients with unsatisfactory outcome: limited data are available on the best treatment approach, in particular regarding local therapy. METHODS This retrospective analysis concerned 71 patients < 21 years old with nonmetastatic, initially unresected adult-type NRSTS, treated at a referral center for pediatric sarcomas from 1990 to 2021. Patients were treated using a multimodal approach, based on the protocols adopted at the time of their diagnosis. RESULTS The series included a selected group of patients with unfavorable clinical characteristics, i.e., most cases had high-grade and large tumors, arising from axial sites in 61% of cases. All patients received neoadjuvant chemotherapy, 58 (82%) had delayed surgery (R0 in 45 cases), and 50 (70%) had radiotherapy. Partial response to chemotherapy was observed in 46% of cases. With a median follow-up of 152 months (range, 18-233), 5-year event-free survival (EFS) and overall survival (OS) were 39.9% and 56.5%, respectively. Survival was significantly better for patients who responded to chemotherapy, and those who had a delayed R0 resection. Local relapse at 5 years was 7.7% for patients who did not undergo delayed surgery. CONCLUSIONS Our series underscores the unsatisfactory outcome of initially unresected NRSTS patients. Improving the outcome of this patient category requires therapeutic strategies able to combine novel effective systemic therapies with a better-defined local treatment approach to offer patients the best chances to have R0 surgery.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sabina Vennarini
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Morosi
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Colombo
- Department of Surgery, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Emilia Pecori
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Cacchione A, Carai A, Biassoni V, Mastronuzzi A, Vennarini S. Editorial: Pediatric diencephalic tumors: a constellation of entities and management modalities. Front Oncol 2023; 13:1346803. [PMID: 38156110 PMCID: PMC10752977 DOI: 10.3389/fonc.2023.1346803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 12/30/2023] Open
Affiliation(s)
- Antonella Cacchione
- Department of Onco-hematology, Gene and Cell Therapy, Bambino Gesù Children’s Hospital-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Andrea Carai
- Oncological Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children’s Hospital-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Veronica Biassoni
- Pediatrics, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Angela Mastronuzzi
- Department of Onco-hematology, Gene and Cell Therapy, Bambino Gesù Children’s Hospital-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Sabina Vennarini
- Pediatric Radiotherapy Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
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Vennarini S, Colombo F, Mirandola A, Chiaravalli S, Orlandi E, Massimino M, Casanova M, Ferrari A. Clinical Insight on Proton Therapy for Paediatric Rhabdomyosarcoma. Cancer Manag Res 2023; 15:1125-1139. [PMID: 37842128 PMCID: PMC10576457 DOI: 10.2147/cmar.s362664] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023] Open
Abstract
This paper offers an insight into the use of Proton Beam Therapy (PBT) in paediatric patients with rhabdomyosarcoma (RMS). This paper provides a comprehensive analysis of the literature, investigating comparative photon-proton dosimetry, outcome, and toxicity. In the complex and multimodal scenario of the treatment of RMS, clear evidence of the therapeutic superiority of PBT compared to other modern photon techniques has not yet been demonstrated; however, PBT can be considered an excellent treatment option, in particular for young children and patients with specific primary sites, such as the head and neck area (and especially the parameningeal regions), genito-urinary, pelvic, and paravertebral regions. The unique depth-dose characteristics of protons can be exploited to achieve significant reductions in normal tissue doses and may allow an escalation of tumour doses and greater sparing of normal tissues, thus potentially improving local control while at the same time reducing toxicity and improving quality of life. However, access of children with RMS (and more in general with solid tumors) to PBT remains a challenge, due to the limited number of available proton therapy installations.
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Affiliation(s)
- Sabina Vennarini
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Francesca Colombo
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
- Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Milan, Italy
| | - Alfredo Mirandola
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Ester Orlandi
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
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5
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Del Baldo G, Vennarini S, Toniutti M, Abbas R, Lorentini S, Piccirilli E, Cacchione A, Megaro G, Di Ruscio V, De Ioris MA, De Salvo A, Albino G, Rossi S, Colafati GS, Carai A, Mastronuzzi A. Unraveling the impact of upfront chemotherapy and proton beam therapy on treatment outcome and follow-up in central nervous system germ cell tumors: a single center experience. Front Oncol 2023; 13:1259403. [PMID: 37860194 PMCID: PMC10584321 DOI: 10.3389/fonc.2023.1259403] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/30/2023] [Indexed: 10/21/2023] Open
Abstract
Background Germ cell tumors (GCT) account for a minority of central nervous system (CNS) malignancies, highly prevalent in adolescents and young adults. Despite their aggressive biological behavior, prognosis is excellent in most cases with risk stratified treatment, consisting in a combination of chemotherapy and radiotherapy. Whole ventricular irradiation (WVI) and craniospinal irradiation, the treatment of choice for localized and metastatic disease, pose significant risk of collateral effects, therefore proton beam radiation (PBT) has been recently proposed for its steep dose fallout. Materials and methods We report our experience in a consecutive series of 17 patients treated for CNS GCT at our Institution from 2015 to 2021. Results Most frequent lesion location were sellar/suprasellar (35%) and bifocal germinoma (35%), followed by pineal (18%) and thalamic (12%). Two patients (12%), had evidence of disseminated disease at the time of diagnosis. At the latest follow-up all but one patient showed complete response to treatment. The only relapse was successfully rescued by additional chemotherapy and PBT. PBT was well tolerated in all cases. No visual, neurological or endocrinological worsening was documented during and after treatment. Neuropsychological evaluation demonstrated preservation of cognitive performance after PBT treatment. Conclusions Our data, albeit preliminary, strongly support the favourable therapeutic profile of PBT for the treatment of CNS germ cell tumors.
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Affiliation(s)
- Giada Del Baldo
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Sabina Vennarini
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maristella Toniutti
- Department of Medicine DAME-Division of Pediatrics, University of Udine, Udine, Italy
| | - Rachid Abbas
- CESP, INSERM, Université Paris Sud, Villejuif, France
| | - Stefano Lorentini
- Medical Physics Department, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Eleonora Piccirilli
- Department of Diagnostic Imaging Oncological Neuroradiology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti, Chieti, Italy
| | - Antonella Cacchione
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giacomina Megaro
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Valentina Di Ruscio
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Maria Antonietta De Ioris
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Andrea De Salvo
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giulia Albino
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Sabrina Rossi
- Pathology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giovanna Stefania Colafati
- Department of Diagnostic Imaging Oncological Neuroradiology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti, Chieti, Italy
| | - Andrea Carai
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Angela Mastronuzzi
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Podda MG, Meazza C, Gattuso G, Sironi G, Nigro O, Bergamaschi L, Biassoni V, Casanova M, Chiaravalli S, Ferrari A, Luksch R, Puma N, Schiavello E, Spreafico F, Grampa P, Manoukian S, Vennarini S, Collini P, Daolio PA, Gennaro M, Guzzo M, Morosi C, Biasoni D, Massimino M, Terenziani M. Treating secondary malignant neoplasms: A burden of childhood cancer survivors. Tumori 2023; 109:436-441. [PMID: 36964667 PMCID: PMC10540476 DOI: 10.1177/03008916231160824] [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: 01/24/2023] [Accepted: 02/11/2023] [Indexed: 03/26/2023]
Abstract
Each year approximately 35,000 children and adolescents are diagnosed with cancer in Europe. Five-year survival rates have improved and now reach 80% in most European countries, thanks to a combination of chemotherapy, radiotherapy, and surgery. To date, there are more than 44,000 Italians still living several years after being diagnosed with cancer in developmental age. The risk of premature morbidity and mortality for cancer survivors is well known and documented. Approximately 60% of survivors of cancer in childhood and adolescence have at least one chronic health condition in later life, and more than one in four develop severe or life-threatening disorders. Among the various long-term iatrogenic sequelae of cancer treatments, the most worrisome are second malignant neoplasms. We reported on our mono-institutional experiences of screening and treating secondary breast cancer, secondary thyroid cancer and secondary osteosarcoma. Recommendations on the surveillance needed for cancer survivors because of the risk of late effects of their disease or its treatment suggest that discussing the potential problems early on can be crucial to a patient's future health. These considerations and our consolidated experience strengthen our conviction that survivors of cancer in childhood and adolescence who develop second malignant neoplasms should be treated at highly-specialized centers. Multidisciplinary care requires close communications and high levels of up-to-date professional expertise. This challenging area of health care is also changing rapidly because cancer survivorship is a work in progress, but we cannot wait for definitive conclusions on many aspects because this will take decades, especially for pediatric patients.
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Affiliation(s)
- Marta G Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Olga Nigro
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Grampa
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Siranoush Manoukian
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sabina Vennarini
- Radiotherapy Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Collini
- Pathology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Primo A Daolio
- C.O.O., Azienda Socio Sanitaria Territoriale Gaetano Pini, Milan, Italy
| | - Massimiliano Gennaro
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Guzzo
- Head and Neck Surgery Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Morosi
- Radiology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Davide Biasoni
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Scartoni D, Giacomelli I, Pertile R, Vennarini S, Feraco P, Picori L, Annicchiarico L, Sarubbo S, Amelio D. Proton therapy re-irradiation provides promising clinical results in recurrent brain meningioma. Acta Oncol 2023; 62:1096-1101. [PMID: 37526998 DOI: 10.1080/0284186x.2023.2241994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/20/2023] [Indexed: 08/03/2023]
Affiliation(s)
- Daniele Scartoni
- Proton Therapy Center, 'S. Chiara' Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Irene Giacomelli
- Proton Therapy Center, 'S. Chiara' Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Riccardo Pertile
- Department of Clinical and Evaluative Epidemiology, Health Service of Trento (APSS), Trento, Italy
| | - Sabina Vennarini
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Feraco
- Neuroradiology Unit, 'S. Chiara' Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Lorena Picori
- Department of Nuclear Medicine, 'S. Chiara' Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Luciano Annicchiarico
- Department of Neurosurgery, 'S. Chiara' Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Silvio Sarubbo
- Department of Neurosurgery, 'S. Chiara' Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Dante Amelio
- Proton Therapy Center, 'S. Chiara' Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
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8
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Massimino M, Vennarini S, Buttarelli FR, Antonelli M, Colombo F, Minasi S, Pecori E, Ferroli P, Giussani C, Schiariti M, Schiavello E, Biassoni V, Erbetta A, Chiapparini L, Nigro O, Boschetti L, Gianno F, Miele E, Modena P, De Cecco L, Pollo B, Barretta F. Optimizing reirradiation for relapsed medulloblastoma: identifying the ideal patient and tumor profiles. J Neurooncol 2023; 163:577-586. [PMID: 37326761 DOI: 10.1007/s11060-023-04361-z] [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: 05/05/2023] [Accepted: 06/01/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND First-line therapies for medulloblastoma(MBL) are obtaining higher survival-rates while decreasing late-effects, but treatment at relapse is not standardized. We report here the experience with MBL re-irradiation(re-RT), its timing and outcome in different clinical settings and tumor groups. METHODS Patient's staging/treatment at diagnosis, histotypes/molecular subgroups, relapse site/s, re-treatments outcome are reported. RESULTS 25 patients were included, with a median age of 11.4 years; 8 had metastases. According to 2016-2021 WHO-classification, 14 had SHH subgroup tumors(six TP53 mutated,one + MYC,one + NMYC amplification), 11 non-WNT/non-SHH (two with MYC/MYCN amplification).Thirteen had received HART-CSI, 11 standard-CSI, one HFRT; all post-radiation chemotherapy(CT), 16 also pre-RT. Median time to relapse (local-LR in nine, distant-DR in 14, LR + DR in two) was 26 months. Fourteen patients were re-operated, in five cases excising single DR-sites, thereafter three received CT, two after re-RT; out of 11 patients not re-operated, four had re-RT as first treatment and seven after CT. Re-RT was administered at median 32 months after first RT: focally in 20 cases, craniospinal-CSI in five. Median post-relapse-PFS/after re-RT was 16.7/8.2 months, while overall survival-OS was 35.1/23.9 months, respectively. Metastatic status both at diagnosis/relapse negatively affected outcome and re-surgery was prognostically favorable. PD after re-RT was however significantly more frequent in SHH (with a suggestive association with TP53 mutation, p = 0.050). We did not observe any influence of biological subgroups on PFS from recurrence while SHH showed apparently worse OS compared to non-WNT/non-SHH group. CONCLUSIONS Re-surgery + reRT can prolong survival; a substantial fraction of patients with worse outcome belongs to the SHH-subgroup.
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Affiliation(s)
- Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20133, Italy.
| | - Sabina Vennarini
- Pediatric Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Manila Antonelli
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University, Rome, Italy
| | - Francesca Colombo
- Pediatric Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Simone Minasi
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University, Rome, Italy
| | - Emilia Pecori
- Pediatric Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Ferroli
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Carlo Giussani
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Marco Schiariti
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20133, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20133, Italy
| | - Alessandra Erbetta
- Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Olga Nigro
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20133, Italy
| | - Luna Boschetti
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20133, Italy
| | - Francesca Gianno
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University, Rome, Italy
| | - Evelina Miele
- Department of Pediatric Onco-Hematology and Transfusion Medicine (EM), Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | | | - Loris De Cecco
- Integrated Biology Platform, Department of Applied Research and Technology Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Bianca Pollo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Barretta
- Department of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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9
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Hovsepyan S, Giani C, Pasquali S, Di Giannatale A, Chiaravalli S, Colombo C, Orbach D, Bergamaschi L, Vennarini S, Gatz SA, Gasparini P, Berlanga P, Casanova M, Ferrari A. Desmoplastic small round cell tumor: from state of the art to future clinical prospects. Expert Rev Anticancer Ther 2023; 23:471-484. [PMID: 37017324 DOI: 10.1080/14737140.2023.2200171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/04/2023] [Indexed: 04/06/2023]
Abstract
INTRODUCTION Desmoplastic small round cell tumor (DSRCT) is an extremely rare and highly aggressive soft tissue sarcoma, presenting mainly in male adolescents and young adults with multiple nodules disseminated within the abdominopelvic cavity. Despite a multimodal approach including aggressive cytoreductive surgery, intensive multi-agent chemotherapy, and postoperative whole abdominopelvic radiotherapy, the prognosis for DSRCT remains dismal. Median progression-free survival ranges between 4 and 21 months, and overall survival between 17 and 60 months, with the 5-year overall survival rate in the range of 10-20%. AREA COVERED This review discusses the treatment strategies used for DSRCT over the years, the state of the art of current treatments, and future clinical prospects. EXPERT OPINION The unsatisfactory outcomes for patients with DSRCT warrant investigations into innovative treatment combinations. An international multidisciplinary and multi-stakeholder collaboration, involving both pediatric and adult sarcoma communities, is needed to propel preclinical model generation and drug development, and innovative clinical trial designs to enable the timely testing of treatments involving novel agents guided by biology to boost the chances of survival for patients with this devastating disease.
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Affiliation(s)
- Shushan Hovsepyan
- Department of Pediatric Oncology, Pediatric Cancer and Blood Disorders Center of Armenia, Yerevan, Armenia
| | - Claudia Giani
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sandro Pasquali
- Molecular Pharmacology Unit, Department of Applied Research and Technological Development, Molecular Pharmacology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Sarcoma Service, Department of Surgery, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Angela Di Giannatale
- Department of Hematology/Oncology, Hematology/Oncology, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Colombo
- Sarcoma Service, Department of Surgery, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniel Orbach
- SIREDO Oncology Center, Institut Curie, PSL University, Paris, France
| | - Luca Bergamaschi
- Molecular Pharmacology Unit, Department of Applied Research and Technological Development, Molecular Pharmacology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sabina Vennarini
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Susanne Andrea Gatz
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Patrizia Gasparini
- Tumor Genomics Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Pablo Berlanga
- Department of Pediatric and Adolescent Oncology, Gustave-Roussy, Villejuif, France
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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10
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Casanova M, Bergamaschi L, Chiaravalli S, Morosi C, Livellara V, Hovsepyan S, Sironi G, Puma N, Nigro O, Gattuso G, Luksch R, Terenziani M, Spreafico F, Meazza C, Podda M, Biassoni V, Schiavello E, Gasparini P, Vennarini S, Massimino M, Ferrari A. Relapse after non-metastatic rhabdomyosarcoma: The impact of routine surveillance imaging on early detection and post-relapse survival. Pediatr Blood Cancer 2023; 70:e30095. [PMID: 36411264 DOI: 10.1002/pbc.30095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients with rhabdomyosarcoma (RMS) whose disease relapses have little chance of being cured, so front-line treatments are usually followed up with surveillance imaging in an effort to detect any recurrences as early as possible, and thereby improve post-relapse outcomes. The real benefit of such routine surveillance imaging in RMS remains to be demonstrated, however. This retrospective, single-center study examines how well surveillance imaging identifies recurrent tumors and its impact on post-relapse survival. METHODS The analysis concerned 79 patients <21 years old treated between 1985 and 2020 whose initially localized RMS relapsed. Clinical findings, treatment modalities, and survival were analyzed, comparing patients whose relapse was first suspected from symptoms they developed (clinical symptoms group) with those whose relapse was identified by radiological surveillance (routine imaging group). RESULTS Tumor relapses came to light because of clinical symptoms in 42 cases, and on routine imaging in 37. The time to relapse was much the same in the two groups. The median overall survival (OS) and 5-year OS rate were, respectively, 10 months and 12.6% in the clinical symptoms group, and 11 months and 27.5% in the routine imaging group (p-value .327). Among patients with favorable prognostic scores, survival was better for those in the routine imaging group (5-year OS 75.0% vs. 33.0%, p-value .047). CONCLUSION It remains doubtful whether surveillance imaging has any real impact on RMS relapse detection and patients' post-relapse survival. Further studies are needed to establish the most appropriate follow-up recommendations, taking the potentially negative effects of regular radiological exams into account.
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Affiliation(s)
- Michela Casanova
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Morosi
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Virginia Livellara
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Shushan Hovsepyan
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Olga Nigro
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Podda
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrizia Gasparini
- Tumor Genomics Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sabina Vennarini
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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11
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Bergamaschi L, Chiaravalli S, Livellara V, Sironi G, Puma N, Nigro O, Gattuso G, Luksch R, Terenziani M, Spreafico F, Meazza C, Podda M, Biassoni V, Schiavello E, Hovsepyan S, Morosi C, Vennarini S, Massimino M, Casanova M, Ferrari A. Relapse after nonmetastatic rhabdomyosarcoma: Salvage rates and prognostic variables. Pediatr Blood Cancer 2023; 70:e30050. [PMID: 36215173 DOI: 10.1002/pbc.30050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/24/2022] [Accepted: 09/19/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with relapsing rhabdomyosarcoma (RMS) pose a therapeutic challenge, and the survival rate is reportedly poor. We describe a retrospective series of relapsing RMS patients treated at a referral center for pediatric sarcoma, investigating the pattern of relapse, salvage rates, and factors correlating with final outcomes. METHODS The analysis concerned 105 patients <21 years old treated from 1985 to 2020 with initially localized RMS at first relapse. For risk-adapted stratification purposes, patient outcomes were examined using univariable and multivariable analyses based on patients' clinical features at first diagnosis, first-line treatments, clinical findings at first relapse, and second-line treatments. RESULTS First relapses occurred 0.08-4.8 years (median 1 year) following initial diagnosis and were local/locoregional in 59% of cases. Treatment at first relapse included chemotherapy in all but two cases, radiotherapy in 38, and surgery in 21. Median event-free survival (EFS) after first relapse was 4 months, while 5-year EFS was 16.3%; median overall survival (OS) was 9 months, while 5-year OS was 16.7%. Several variables influenced survival rates. Considering only clinical findings and treatment at relapse, Cox's multivariable analysis showed that OS correlated significantly with time to relapse, radiotherapy administered at relapse, response to chemotherapy, and whether a second remission was achieved. CONCLUSION Survival following first relapse of patients with localized RMS at initial diagnosis is poor. The variables found to influence survival can be utilized in a risk-adapted model to estimate the chances of salvage to guide decisions for second-line treatments.
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Affiliation(s)
- Luca Bergamaschi
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Virginia Livellara
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Olga Nigro
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Podda
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Shushan Hovsepyan
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Morosi
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sabina Vennarini
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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12
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Montante C, Fabozzi F, Villani MF, D’Andrea ML, Stracuzzi A, Natali GL, Del Baldo G, Del Bufalo F, Garganese MC, Serra A, Tomà P, Alaggio R, Vennarini S, Colafati GS, Mastronuzzi A, De Ioris MA. The Pitfall of Ganglioneuroblastoma-Nodular Diagnosis: Clinical and Imaging Considerations over a Rare Bifocal Sporadic Case. Diagnostics (Basel) 2022; 12:diagnostics12123221. [PMID: 36553228 PMCID: PMC9777706 DOI: 10.3390/diagnostics12123221] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Neuroblastic tumors (NTs) represent the most common extracranial neoplasm occurring in childhood. Although ganglioneuroblastoma intermixed (GNBI) and ganglioneuroma (GN) are classified as very low-risk tumors, neuroblastoma (NB) and ganglioneuroblastoma-nodular (GNBN) may represent a serious risk to survival. Unfortunately, areas of GNBI and GNBN can coexist in the same mass, leading to incorrect risk staging when only biopsy is performed. Herein, we describe a case of multifocal NT (thoracic and abdominal localization) occurring in a 4-year-old male. Different histological subtypes, namely GNBI and GNBN, were revealed in the two lesions. We focus on the difficulties of proper diagnosis and risk stratification, underlining the usefulness of several diagnostic tools for appropriate management and therapeutic choices.
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Affiliation(s)
- Claudio Montante
- Department of Onco-Hematology, Cell and Gene Therapies, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Francesco Fabozzi
- Department of Onco-Hematology, Cell and Gene Therapies, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | | | - Maria Luisa D’Andrea
- Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Alessandra Stracuzzi
- Department of Pathology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Gian Luigi Natali
- Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Giada Del Baldo
- Department of Onco-Hematology, Cell and Gene Therapies, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Francesca Del Bufalo
- Department of Onco-Hematology, Cell and Gene Therapies, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | | | - Annalisa Serra
- Department of Onco-Hematology, Cell and Gene Therapies, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Rita Alaggio
- Department of Pathology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Sabina Vennarini
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy
| | | | - Angela Mastronuzzi
- Department of Onco-Hematology, Cell and Gene Therapies, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Maria Antonietta De Ioris
- Department of Onco-Hematology, Cell and Gene Therapies, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
- Correspondence:
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13
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Ferrari A, Bergamaschi L, Chiaravalli S, Livellara V, Sironi G, Nigro O, Puma N, Gattuso G, Morosi C, Gasparini P, Caccavo R, Pecori E, Alessandro O, Vennarini S, Gandola L, Massimino M, Casanova M. Metastatic rhabdomyosarcoma: Evidence of the impact of radiotherapy on survival. A retrospective single-center experience. Pediatr Blood Cancer 2022; 69:e29853. [PMID: 35731852 DOI: 10.1002/pbc.29853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/14/2022] [Accepted: 06/05/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The prognosis for patients with metastatic rhabdomyosarcoma (RMS) remains largely unsatisfactory despite the adoption of intensive multimodal therapy. To assess the role of different treatments adopted over the years, we retrospectively analyzed a cohort of patients <21 years old with metastatic RMS, treated from 1990 to 2020 at a referral center for pediatric sarcomas. METHODS Patients were treated using a multimodal approach that included surgery, radiotherapy, and chemotherapy (both high-dose chemotherapy and maintenance therapy in some cases). The type of radiotherapy administered was categorized as radical (to all sites of disease); partial (to at least one, but not all sites of disease); or none. A landmark analysis was used to examine the impact of radiotherapy on survival, that is, patients who had an event before day 221 were excluded from the analysis. RESULTS The series included 80 patients. Event-free survival (EFS) and overall survival (OS) rates at 5 years were 17.3% and 21.3%, respectively. Survival was significantly associated with radiotherapy to metastatic sites, and with the radiotherapy category. In particular, 5-year EFS and OS rates were 70.6% and 76.0% for patients given radical radiotherapy, and 4.8% and 10.7%, respectively, for those given partial radiotherapy or none. Using the Cox multivariable analysis, OS correlated significantly with radiotherapy category. CONCLUSIONS While confirming the poor overall outcome of patients with metastatic RMS, this study identified radiotherapy-when given to all sites of disease (including metastases)-as the main variable influencing survival.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Virginia Livellara
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Olga Nigro
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Morosi
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrizia Gasparini
- Tumor Genomics Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberta Caccavo
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emilia Pecori
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Ombretta Alessandro
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Sabina Vennarini
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Lorenza Gandola
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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14
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Massimino M, Vennarini S, Barretta F, Colombo F, Antonelli M, Pollo B, Pignoli E, Pecori E, Alessandro O, Schiavello E, Boschetti L, Podda M, Puma N, Gattuso G, Sironi G, Barzanò E, Nigro O, Bergamaschi L, Chiaravalli S, Luksch R, Meazza C, Spreafico F, Terenziani M, Casanova M, Ferrari A, Chisari M, Pellegrini C, Clerici CA, Modena P, Biassoni V. How ten-years of reirradiation for paediatric high-grade glioma may shed light on first line treatment. J Neurooncol 2022; 159:437-445. [PMID: 35809148 DOI: 10.1007/s11060-022-04079-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/25/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Recurrence incidence for paediatric/adolescent high-grade glioma (HGG) exceeds 80%. Reirradiation (reRT) palliates symptoms and delays further progression. Strategies for reRT are scarce: we retrospectively analysed our series to develop rational future approaches. METHODS We re-evaluated MRI + RT plans of 21 relapsed HGG-patients, accrued 2010-2021, aged under 18 years. All underwent surgery and RT + chemotherapy at diagnosis. Pathologic/molecular re-evaluation allowed classification based on WHO 2021 criteria in 20/21 patients. Survival analyses and association with clinical parameters were performed. RESULTS Relapse after 1st RT was local in 12 (7 marginal), 4 disseminated, 5 local + disseminated. Re-RT obtained 8 SD, 1 PR, 1PsPD, 1 mixed response, 10 PD; neurological signs/symptoms improved in 8. Local reRT was given to 12, followed again by 6 local (2 marginal) and 4 local + disseminated second relapses in 10/12 re-evaluated. The 4 with dissemination had 1 whole brain, 2 craniospinal irradiation (CSI), 1 spine reRT and further relapsed with dissemination and local + dissemination in 3/four assessed. Five local + disseminated tumours had 3 CSI, 1 spine reRT, further progressing locally (2), disseminated (1), n.a. (1). Three had a third RT; three were alive at 19.4, 29, 50.3 months after diagnosis. Median times to progression/survival after re-RT were 3.7 months (0.6-16.2 months)/6.9 months (0.6-17.9 months), improved for longer interval between 1st RT and re-RT (P = 0.017) and for non-PD after reRT (P < 0.001). First marginal relapse showed potential association with dissemination after re-RT (P = 0.081). CONCLUSIONS This is the biggest series of re-RT in paediatric HGG. Considering the dissemination observed at relapse, our results could prompt the investigation of different first RT fields in a randomized trial.
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Affiliation(s)
- Maura Massimino
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
| | - Sabina Vennarini
- Pediatric Radiotherapy (SV, FC, EP, OA), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Francesco Barretta
- Medical Statistics, Biometry and Bioinformatics (FB), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | | | - Manila Antonelli
- Radiological, Oncological and Anatomo-Pathological Sciences (MA), Department of La Sapienza University, Rome, Italy
| | - Bianca Pollo
- Neuropathology (BP) Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Emanuele Pignoli
- Medical Physics (EP), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Emilia Pecori
- Pediatric Radiotherapy (SV, FC, EP, OA), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Ombretta Alessandro
- Pediatric Radiotherapy (SV, FC, EP, OA), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Elisabetta Schiavello
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Luna Boschetti
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Marta Podda
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Nadia Puma
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Giovanna Sironi
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Elena Barzanò
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Olga Nigro
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Luca Bergamaschi
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Roberto Luksch
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Cristina Meazza
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Michela Casanova
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Marco Chisari
- Pain Therapy and Rehabilitation Units (MC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Chiara Pellegrini
- Pain Therapy and Rehabilitation Units (MC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Carlo Alfredo Clerici
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Hemato-Oncology Department La Statale University, Milan, Italy
| | | | - Veronica Biassoni
- Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
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15
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Massimino M, Biassoni V, Mastronuzzi A, Schiavello E, Barretta F, Quaglietta L, Milanaccio C, Pecori E, Cacchione A, Boschetti L, Ruscio VD, Chiesa S, Scimone G, Barra S, De Martino L, Ramaglia A, Picariello S, Verrico A, Alessandro O, Vennarini S, Podda M, Gattuso G, Cinalli G, Antonelli M, Modena P, De Cecco L, Buttarelli FR, Gandola L. DIPG-04. Feasibility and early results of phase 2 open label randomized study of radiotherapy(RT), concomitant nimotuzumab and vinorelbine and re-irradiation at relapse, versus multiple elective radiotherapy courses with concomitant vinorelbine and nimotuzumab for newly diagnosed childhood and adolescence Diffuse intrinsic Pontine Glioma (DIPG). Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: The purposes of this trial were to evaluate the feasibility, response, PFS/OS of a randomized study comparing two different RT schedules for DIPG while administering the same systemic treatment. METHODS: Patients: 2-21 years-old with a not-pretreated radiologically verified DIPG (MRI blindly reviewed at diagnosis and every 12 weeks thereafter) and symptoms duration below 6 months. Biopsy was required if suggested by atypical imaging. Vinorelbine 20 mg/m2+nimotuzumab 150 mg/m2 were administered weekly for 12 weeks; thereafter every other week until tumor progression or for up to 2 years. Standard(ST) arm included focal RT at total dose of 54Gy (1.8Gy/day); for local progression re-irradiation was proposed at 19.8Gy, in case of dissemination craniospinal irradiation(CSI) at 36Gy was adopted. Experimental(SP) arm included three elective courses of RT at defined timepoints at 36Gy, 19.8Gy and 19.8Gy with possible reirradiation for relapse at 9 Gy. Incidences of local(L) and distant(D) progression were assessed in a competing risk setting. RESULTS: Aggregated preliminary results are given for 4 Italian centers. 54 pts were screened and 51 included, 27 in ST, 28 males, median age 7 years (range 3-17). Median time of observation was 17.9 months. Twelve patients needed a shunt, 10 during treatment; 20 were biopsied, in 18 cases according local protocols. 19/20 tumors had H3.3 K27 mutation. 41 relapsed, 28 locally, 13 with a component of dissemination. 36 died, one for tracheotomy bleeding. SP irradiation was feasible and never produced significant radionecrosis. Median EFS/OS were 7.3/12.9 months, respectively; EFS/OS at 1 year were 19.0%/57.3%, not differing between patients with local vs. disseminated relapses. Patients submitted to biopsies had more dissemination (P=0.04) and less local progression (P=0.077). CONCLUSIONS: Treatment was feasible and OS confirmed previous results obtained in a single center. Randomization results will be later reported.
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Affiliation(s)
- Maura Massimino
- Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | | | | | | | | | | | | | - Emilia Pecori
- Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | | | - Luna Boschetti
- Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | | | - Silvia Chiesa
- , Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Roma , Italy
| | - Giuseppe Scimone
- Ospedale San Giovanni di Dio e Ruggi D’Aragona , Salerno , Italy
| | | | | | | | | | | | | | | | - Marta Podda
- Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | | | | | | | | | - Loris De Cecco
- Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | | | - Lorenza Gandola
- Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
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16
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Biassoni V, Busia A, Barretta F, Gandola L, Vennarini S, Meroni S, Mastronuzzi A, Del Baldo G, Chiesa S, Pignoli E, Terenziani M, Pecori E, Schiavello E, Massimino M. MEDB-75. Treatment-induced pulmonary toxicity in patients with medulloblastoma: a retrospective analysis on 2 Italian institutions’ cohorts. Neuro Oncol 2022. [PMCID: PMC9164846 DOI: 10.1093/neuonc/noac079.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND: Incidence of iatrogenic pulmonary toxicity is around 20%. Apart from bleomycin fibrosis, the role of lomustine, HD-thiotepa, autologous stem-cells transplantation(APBSCT) and their synergy with craniospinal irradiation(CSI) are unclear. To elucidate their role in lung-function impairment, we retrospectively evaluated 39 medulloblastoma patients treated at INT-Milan and OPBG-Rome. METHODS: 39 patients (17 females, median RT age 8 years) treated for localized(29) or metastatic(10) medulloblastoma in 2000-2020 and with spirometric assessment, were considered. Treatment included: SIOP-like-PNET IV(19), high-risk protocol(19), infant protocol without RT(1). CSI doses were: 23.4Gy(20), 31.2Gy(8), 36Gy(6) and 39Gy(4); 4 received protons and 34 photons(9 VMAT, 25 3D), 11 hyperfractionated-accelerated-RT; 33 had 6 median CCNU cycles; 6 APBSCT. RESULTS: Median follow-up: 98 months. All patients performed at least one spirometry at median 5 years after RT. Eight (20.6%) had mildly pathological spirometries, 8 Forced Vital Capacity (FVC%)<90%. RT age was not associated with FVC%/ PEF% (p=0.319 and 0.405). A lower Peak Expiratory Flow(PEF%) was marginally associated to APBSCT group (p=0.062) with FVC%(≤90% vs >90%) similar but less significant(p=0.163). Median FVC%/PEF% were higher in the CCNU-group without reaching significance (p=0.436 and 0.062): this was a standard-risk group not receiving APBSCT nor higher RT doses. Even though the lung volume encompassed by 5-10 Gy isodoses was greater in VMATvs3D RT(p<0.001 and p=0.015), there were no significant differences in ventilatory parameters. FVC%/PEF% were negatively associated to CSI dose. Since no relevant lung volume is involved in high doses, a multifactorial etiology could be speculated. CONCLUSIONS: Preliminary data show no significant FVC%/PEF% reduction. Small sample size and differences in spirometry techniques impose larger cohorts accrual to elucidate potential treatment-induced pulmonary impairment in the pediatric population thus validating the use of spirometry during treatment/follow-up.
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Affiliation(s)
- Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori , Milan , Italy
| | - Alessandra Busia
- Pneumologia e FisiopPneumology, Fondazione IRCCS, Istituto Nazionale Tumori , Milan , Italy
| | - Francesco Barretta
- Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Lorenza Gandola
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Sabina Vennarini
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Silvia Meroni
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Angela Mastronuzzi
- Department of Paediatric Haematology/Oncology, IRCCS Bambino Gesù Children's Hospital , Rome , Italy
| | - Giada Del Baldo
- Department of Paediatric Haematology/Oncology, IRCCS Bambino Gesù Children's Hospital , Rome , Italy
| | - Silvia Chiesa
- UOC Oncologic Radiotherapy, Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome , Italy
| | - Emanuele Pignoli
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori , Milan , Italy
| | - Emilia Pecori
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | | | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori , Milan , Italy
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17
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Barcellini A, Massaro M, Dal Mas F, Langendijk JA, Høyer M, Calugaru V, Haustermans K, Timmermann B, Thariat J, Scartoni D, Vennarini S, Georg P, Orlandi E. A year of pandemic for European particle radiotherapy: A survey on behalf of EPTN working group. Clin Transl Radiat Oncol 2022; 34:1-6. [PMID: 35243028 PMCID: PMC8885798 DOI: 10.1016/j.ctro.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/11/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Amelia Barcellini
- Radiation Oncology, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
- Corresponding author at: Radiation Oncology, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.
| | | | - Francesca Dal Mas
- Department of Management, Lincoln International Business School, University of Lincoln, Lincoln, UK and Interdepartmental Research Center “Organization and Governance of the Public Administration”, University of Pavia, Pavia, Italy
| | - Johannes A. Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Morten Høyer
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Karin Haustermans
- Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WTZ), German Cancer Consortium (DKTK), Germany
| | - Juliette Thariat
- Radiation Oncology Department, François Baclesse Center/ARCHADE, Normandy University, Caen, France
| | - Daniele Scartoni
- Proton Therapy Unit, Hospital of Trento, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Sabina Vennarini
- Proton Therapy Unit, Hospital of Trento, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Petra Georg
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Ester Orlandi
- Radiation Oncology, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
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18
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Dionisi F, Scartoni D, Rombi B, Vennarini S, Righetto R, Farace P, Lorentini S, Schwarz M, Di Murro L, Demofonti C, D'Angelillo RM, Petrongari MG, Sanguineti G, Amichetti M. Consolidative active scanning proton therapy for mediastinal lymphoma: selection criteria, treatment implementation and clinical feasibility. Strahlenther Onkol 2022; 198:558-565. [PMID: 35394144 DOI: 10.1007/s00066-022-01918-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/22/2022] [Indexed: 11/27/2022]
Abstract
AIMS Proton therapy (PT) represents an advanced form of radiotherapy with unique physical properties which could be of great advantage in reducing long-term radiation morbidity for cancer survivors. Here, we aim to describe the whole process leading to the clinical implementation of consolidative active scanning proton therapy treatment (PT) for mediastinal lymphoma. METHODS The process included administrative, technical and clinical issues. Authorization of PT is required in all cases as mediastinal lymphoma is currently not on the list of diseases reimbursable by the Italian National Health Service. Technically, active scanning PT treatment for mediastinal lymphoma is complex, due to the interaction between actively scanned protons and the usually irregular and large volumes to be irradiated, the nearby healthy tissues and the target motion caused by breathing. A road map to implement the technical procedures was prepared. The clinical selection of patients was of utmost importance and took into account both patient and tumor characteristics. RESULTS The first mediastinal lymphoma was treated at our PT center in 2018, four years after the start of the clinical activities. The treatment technique implementation included mechanical deep inspiration breath-hold simulation computed tomography (CT), clinical target volume (CTV)-based multifield optimization planning and plan robustness analysis. The ultimate authorization rate was 93%. In 4 cases a proton-photon plan comparison was required. Between May 2018 and February, 2021, 14 patients were treated with consolidative PT. The main clinical reasons for choosing PT over photons was a bulky disease in 8 patients (57%), patient's age in 11 patients (78%) and the proximity of the lymphoma to cardiac structures in 10 patients (71%). With a median follow-up of 15 months (range, 1-33 months) all patients but one (out-of-field relapse) are without evidence of disease, all are alive and no late toxicities were observed during the follow-up period. CONCLUSIONS The clinical implementation of consolidative active scanning PT for mediastinal lymphoma required specific technical procedures and a prolonged experience with PT treatments. An accurate selection of patients for which PT could be of advantage in comparison with photons is mandatory.
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Affiliation(s)
- F Dionisi
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy.
| | - D Scartoni
- Proton Therapy unit, APSS, Trento, Italy
| | - B Rombi
- Proton Therapy unit, APSS, Trento, Italy
| | | | - R Righetto
- Proton Therapy unit, APSS, Trento, Italy
| | - P Farace
- Proton Therapy unit, APSS, Trento, Italy
| | | | - M Schwarz
- Proton Therapy unit, APSS, Trento, Italy
| | - L Di Murro
- Department of Radiotherapy, University of Tor Vergata, Rome, Italy
| | - C Demofonti
- Department of Radiotherapy, University of Tor Vergata, Rome, Italy
| | - R M D'Angelillo
- Department of Radiotherapy, University of Tor Vergata, Rome, Italy
| | - M G Petrongari
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - G Sanguineti
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
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19
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Novello L, Agarwal N, Vennarini S, Lorentini S, Zacà D, Mussano A, Pasternak O, Jovicich J. Longitudinal Changes in Brain Diffusion MRI Indices during and after Proton Beam Therapy in a Child with Pilocytic Astrocytoma: A Case Report. Diagnostics (Basel) 2021; 12:diagnostics12010026. [PMID: 35054192 PMCID: PMC8775026 DOI: 10.3390/diagnostics12010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 11/16/2022] Open
Abstract
Proton beam therapy (PBT) is an effective pediatric brain tumor treatment. However, the resulting microstructural changes within and around irradiated tumors are unknown. We retrospectively applied diffusion tensor imaging (DTI) and free-water imaging (FWI) on diffusion-weighted magnetic resonance imaging (dMRI) data to monitor microstructural changes during the PBT and after 8 months in a pilocytic astrocytoma (PA) and normal-appearing white matter (NAWM). We evaluated the conventional MRI- and dMRI-derived indices from six MRI sessions (t0–t5) in a Caucasian child with a hypothalamic PA: at baseline (t0), during the PBT (t1–t4) and after 8 months (t5). The tumor voxels were classified as “solid” or “fluid” based on the FWI. While the tumor volume remained stable during the PBT, the dMRI analyses identified two different response patterns: (i) an increase in fluid content and diffusivity with anisotropy reductions in the solid voxels at t1, followed by (ii) smaller variations in fluid content but higher anisotropy in the solid voxels at t2–t4. At follow-up (t5), the tumor volume, fluid content, and diffusivity in the solid voxels increased. The NAWM showed dose-dependent microstructural changes. The use of the dMRI and FWI showed complex dynamic microstructural changes in the irradiated mass during the PBT and at follow-up, opening new avenues in our understanding of radiation-induced pathophysiologic mechanisms in tumors and the surrounding tissues.
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Affiliation(s)
- Lisa Novello
- Center for Mind/Brain Sciences (CIMeC), University of Trento, 38068 Rovereto, Italy; (N.A.); (D.Z.); (J.J.)
- Correspondence:
| | - Nivedita Agarwal
- Center for Mind/Brain Sciences (CIMeC), University of Trento, 38068 Rovereto, Italy; (N.A.); (D.Z.); (J.J.)
- Proton Therapy Center, Hospital of Trento, Azienda Provinciale per i Servizi Sanitari (APSS), 38123 Trento, Italy; (S.V.); (S.L.)
- Radiology Unit, Santa Maria del Carmine Hospital, 38068 Rovereto, Italy
- Neuroradiology & Radiology Services, Scientific Institute, IRCCS “Eugenio Medea”, 23842 Bosisio Parini, Italy
| | - Sabina Vennarini
- Proton Therapy Center, Hospital of Trento, Azienda Provinciale per i Servizi Sanitari (APSS), 38123 Trento, Italy; (S.V.); (S.L.)
| | - Stefano Lorentini
- Proton Therapy Center, Hospital of Trento, Azienda Provinciale per i Servizi Sanitari (APSS), 38123 Trento, Italy; (S.V.); (S.L.)
| | - Domenico Zacà
- Center for Mind/Brain Sciences (CIMeC), University of Trento, 38068 Rovereto, Italy; (N.A.); (D.Z.); (J.J.)
| | - Anna Mussano
- Pediatric Radiotherapy Service, S. Anna Hospital, A.O. Città della Salute e della Scienza, 10121 Torino, Italy;
| | - Ofer Pasternak
- Departments of Psychiatry and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Jorge Jovicich
- Center for Mind/Brain Sciences (CIMeC), University of Trento, 38068 Rovereto, Italy; (N.A.); (D.Z.); (J.J.)
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20
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Vennarini S, Amelio D, Lorentini S, Colafati GS, Cacchione A, De Vito R, Carai A, Pettorini B, Amichetti M, Mastronuzzi A. Magnetic Resonance Imaging during Proton Therapy Irradiation Allows for the Early Response Assessment of Pediatric Chordoma. Diagnostics (Basel) 2021; 11:diagnostics11061117. [PMID: 34207471 PMCID: PMC8235054 DOI: 10.3390/diagnostics11061117] [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: 03/21/2021] [Revised: 06/07/2021] [Accepted: 06/16/2021] [Indexed: 11/16/2022] Open
Abstract
Chordoma in pediatric patients is very rare. Proton therapy has become a gold standard in the treatment of these neoplasms, as high dose escalation can be achieved regarding the target while maximizing the sparing of the healthy tissues near the tumor. The aim of the work was to assess the evolution of morphological sequences during treatment using T1/T2-weighted magnetic resonance imaging (MRI) for the early response assessment of a classic chordoma of the skull base in a pediatric patient who had undergone surgical excision. Our results demonstrated a significant quantitative reduction in the residual nodule component adhered to the medullary bulb junction, with an almost complete recovery of normal anatomy at the end of the irradiation treatment. This was mainly shown in the T2-weighted MRI. On the other hand, the classic component of the lesion was predominantly present and located around the tooth of the axis. The occipital condyles were morphologically and dimensionally stable for the entire irradiation period. In conclusion, the application of this type of monitoring methodology, which is unusual during the administration of a proton treatment for chordoma, highlighted the unexpected early response of the disease. At the same time, it allowed the continuous assessment of the reliability of the treatment plan.
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Affiliation(s)
- Sabina Vennarini
- Proton Therapy Center, Hospital of Trento, Azienda Provinciale per I Servizi Sanitari (APSS), 38123 Trento, Italy; (D.A.); (S.L.); (M.A.)
- Correspondence:
| | - Dante Amelio
- Proton Therapy Center, Hospital of Trento, Azienda Provinciale per I Servizi Sanitari (APSS), 38123 Trento, Italy; (D.A.); (S.L.); (M.A.)
| | - Stefano Lorentini
- Proton Therapy Center, Hospital of Trento, Azienda Provinciale per I Servizi Sanitari (APSS), 38123 Trento, Italy; (D.A.); (S.L.); (M.A.)
| | - Giovanna Stefania Colafati
- Oncological Neuroradiology Unit, Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Antonella Cacchione
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (A.M.)
| | - Rita De Vito
- Histopathology Unit, Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Andrea Carai
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Benedetta Pettorini
- Paediatric Neurosurgery Department, Alder Hey Children’s Hospital, Liverpool 00165, UK;
| | - Maurizio Amichetti
- Proton Therapy Center, Hospital of Trento, Azienda Provinciale per I Servizi Sanitari (APSS), 38123 Trento, Italy; (D.A.); (S.L.); (M.A.)
| | - Angela Mastronuzzi
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (A.M.)
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21
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Cacchione A, Mastronuzzi A, Carai A, Colafati GS, Diomedi-Camassei F, Marrazzo A, Carboni A, Miele E, Pedace L, Tartaglia M, Amichetti M, Fellin F, Lodi M, Vennarini S. Rosette-Forming Glioneuronal Tumor of the Fourth Ventricle: A Case of Relapse Treated with Proton Beam Therapy. Diagnostics (Basel) 2021; 11:diagnostics11050903. [PMID: 34069450 PMCID: PMC8159123 DOI: 10.3390/diagnostics11050903] [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: 03/31/2021] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022] Open
Abstract
Rosette-forming glioneuronal tumors (RGNTs) are rare, grade I, central nervous system (CNS) tumors typically localized to the fourth ventricle. We describe a 9-year-old girl with dizziness and occipital headache. A magnetic resonance imaging (MRI) revealed a large hypodense posterior fossa mass lesion in relation to the vermis, with cystic component. Surgical resection of the tumor was performed. A RGNT diagnosis was made at the histopathological examination. During follow-up, the patient experienced a first relapse, which was again surgically removed. Eight months after, MRI documented a second recurrence at the local level. She was a candidate for the proton beam therapy (PBT) program. Three years after the end of PBT, the patient had no evidence of disease recurrence. This report underlines that, although RGNTs are commonly associated with an indolent course, they may have the potential for aggressive behavior, suggesting the need for treatment in addition to surgery. Controversy exists in the literature regarding effective management of RGNTs. Chemotherapy and radiation are used as adjuvant therapy, but their efficacy management has not been adequately described in the literature. This is the first case report published in which PBT was proposed for adjuvant therapy in place of chemotherapy in RGNT relapse.
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Affiliation(s)
- Antonella Cacchione
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy; (A.M.); (E.M.); (L.P.); (M.L.)
- Correspondence: ; Tel.: +39-0668594828
| | - Angela Mastronuzzi
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy; (A.M.); (E.M.); (L.P.); (M.L.)
| | - Andrea Carai
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy;
| | - Giovanna Stefania Colafati
- Oncological Neuroradiology Unit, Department of Imaging, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy; (G.S.C.); (A.M.); (A.C.)
| | - Francesca Diomedi-Camassei
- Department of Laboratories, Pathology Unit, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy;
| | - Antonio Marrazzo
- Oncological Neuroradiology Unit, Department of Imaging, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy; (G.S.C.); (A.M.); (A.C.)
| | - Alessia Carboni
- Oncological Neuroradiology Unit, Department of Imaging, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy; (G.S.C.); (A.M.); (A.C.)
| | - Evelina Miele
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy; (A.M.); (E.M.); (L.P.); (M.L.)
| | - Lucia Pedace
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy; (A.M.); (E.M.); (L.P.); (M.L.)
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy;
| | - Maurizio Amichetti
- Proton Therapy Center, Hospital of Trento, Azienda Provinciale per I Servizi Sanitari (APSS), 38123 Trento, Italy; (M.A.); (F.F.); (S.V.)
| | - Francesco Fellin
- Proton Therapy Center, Hospital of Trento, Azienda Provinciale per I Servizi Sanitari (APSS), 38123 Trento, Italy; (M.A.); (F.F.); (S.V.)
| | - Mariachiara Lodi
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy; (A.M.); (E.M.); (L.P.); (M.L.)
| | - Sabina Vennarini
- Proton Therapy Center, Hospital of Trento, Azienda Provinciale per I Servizi Sanitari (APSS), 38123 Trento, Italy; (M.A.); (F.F.); (S.V.)
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22
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Ranalli M, Boni A, Caroleo AM, Del Baldo G, Rinelli M, Agolini E, Rossi S, Miele E, Colafati GS, Boccuto L, Alessi I, De Ioris MA, Cacchione A, Capolino R, Carai A, Vennarini S, Mastronuzzi A. Molecular Characterization of Medulloblastoma in a Patient with Neurofibromatosis Type 1: Case Report and Literature Review. Diagnostics (Basel) 2021; 11:diagnostics11040647. [PMID: 33918520 PMCID: PMC8067061 DOI: 10.3390/diagnostics11040647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 03/27/2021] [Accepted: 03/28/2021] [Indexed: 12/31/2022] Open
Abstract
Brain tumors are the most common solid neoplasms of childhood. They are frequently reported in children with Neurofibromatosis type 1 (NF1). The most frequent central nervous system malignancies described in NF1 are optic pathway gliomas and brainstem gliomas. Medulloblastoma (MB) in NF1 patients is extremely rare, and to our knowledge, only 10 cases without molecular characterization are described in the literature to date. We report the case of a 14-year-old girl with NF1 that came to our attention for an incidental finding of a lesion arising from cerebellar vermis. The mass was completely resected, revealing a localized classic medulloblastoma (MB), subgroup 4. She was treated as a standard-risk MB with a dose-adapted personalized protocol. The treatment proved to be effective, with minor toxicity. Brain and spine MRI one year after diagnosis confirmed the complete remission of the disease. To our knowledge, this is the only case of MB reported in a patient with NF1 with molecular characterization by the methylation profile. The association between NF1 and MB, although uncommon, may not be an accidental occurrence.
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Affiliation(s)
- Marco Ranalli
- Department of Pediatrics, Sapienza University, Viale Regina Elena 324, 00161 Rome, Italy; (M.R.); (A.B.); (E.M.)
| | - Alessandra Boni
- Department of Pediatrics, Sapienza University, Viale Regina Elena 324, 00161 Rome, Italy; (M.R.); (A.B.); (E.M.)
| | - Anna Maria Caroleo
- Department of Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital (IRCCS), 00165 Rome, Italy; (A.M.C.); (G.D.B.); (I.A.); (M.A.D.I.); (A.C.)
| | - Giada Del Baldo
- Department of Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital (IRCCS), 00165 Rome, Italy; (A.M.C.); (G.D.B.); (I.A.); (M.A.D.I.); (A.C.)
| | - Martina Rinelli
- Laboratory of Medical Genetics, Bambino Gesù Children’s Hospital (IRCCS), 00165 Rome, Italy; (M.R.); (E.A.)
| | - Emanuele Agolini
- Laboratory of Medical Genetics, Bambino Gesù Children’s Hospital (IRCCS), 00165 Rome, Italy; (M.R.); (E.A.)
| | - Sabrina Rossi
- Pathology Unit, Department of Laboratories, Bambino Gesù Children’s Hospital (IRCCS), 00165 Rome, Italy;
| | - Evelina Miele
- Department of Pediatrics, Sapienza University, Viale Regina Elena 324, 00161 Rome, Italy; (M.R.); (A.B.); (E.M.)
| | - Giovanna Stefania Colafati
- Neuroradiology Unit, Department of Imaging, Bambino Gesù Children’s Hospital (IRCCS), 00165 Rome, Italy;
| | - Luigi Boccuto
- School of Nursing, College of Behavioral, Social and Health Sciences Healthcare Genetics Interdisciplinary Doctoral Program, Clemson University, Clemson, SC 29631, USA;
| | - Iside Alessi
- Department of Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital (IRCCS), 00165 Rome, Italy; (A.M.C.); (G.D.B.); (I.A.); (M.A.D.I.); (A.C.)
| | - Maria Antonietta De Ioris
- Department of Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital (IRCCS), 00165 Rome, Italy; (A.M.C.); (G.D.B.); (I.A.); (M.A.D.I.); (A.C.)
| | - Antonella Cacchione
- Department of Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital (IRCCS), 00165 Rome, Italy; (A.M.C.); (G.D.B.); (I.A.); (M.A.D.I.); (A.C.)
| | - Rossella Capolino
- Medical Genetics Unit, Bambino Gesù Children Hospital, Bambino Gesù Children’s Hospital (IRCCS), 00165 Rome, Italy;
| | - Andrea Carai
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital (IRCCS), 00165 Rome, Italy;
| | - Sabina Vennarini
- Proton Therapy Center, Hospital of Trento, Azienda Provinciale per I Servizi Sanitari (APSS), 38122 Trento, Italy;
| | - Angela Mastronuzzi
- Department of Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital (IRCCS), 00165 Rome, Italy; (A.M.C.); (G.D.B.); (I.A.); (M.A.D.I.); (A.C.)
- Correspondence:
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23
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Mahajan A, Stavinoha PL, Rongthong W, Brodin NP, McGovern SL, El Naqa I, Palmer JD, Vennarini S, Indelicato DJ, Aridgides P, Bowers DC, Kremer L, Ronckers C, Constine L, Avanzo M. Neurocognitive Effects and Necrosis in Childhood Cancer Survivors Treated With Radiation Therapy: A PENTEC Comprehensive Review. Int J Radiat Oncol Biol Phys 2021:S0360-3016(21)00127-9. [PMID: 33810950 DOI: 10.1016/j.ijrobp.2020.11.073] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/08/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE A PENTEC review of childhood cancer survivors who received brain radiation therapy (RT) was performed to develop models that aid in developing dose constraints for RT-associated central nervous system (CNS) morbidities. METHODS AND MATERIALS A comprehensive literature search, through the PENTEC initiative, was performed to identify published data pertaining to 6 specific CNS toxicities in children treated with brain RT. Treatment and outcome data on survivors were extracted and used to generate normal tissue complication probability (NTCP) models. RESULTS The search identified investigations pertaining to 2 of the 6 predefined CNS outcomes: neurocognition and brain necrosis. For neurocognition, models for 2 post-RT outcomes were developed to (1) calculate the risk for a below-average intelligence quotient (IQ) (IQ <85) and (2) estimate the expected IQ value. The models suggest that there is a 5% risk of a subsequent IQ <85 when 10%, 20%, 50%, or 100% of the brain is irradiated to 35.7, 29.1, 22.2, or 18.1 Gy, respectively (all at 2 Gy/fraction and without methotrexate). Methotrexate (MTX) increased the risk for an IQ <85 similar to a generalized uniform brain dose of 5.9 Gy. The model for predicting expected IQ also includes the effect of dose, age, and MTX. Each of these factors has an independent, but probably cumulative effect on IQ. The necrosis model estimates a 5% risk of necrosis for children after 58.9 Gy or 59.9 Gy (2 Gy/fraction) to any part of the brain if delivered as primary RT or reirradiation, respectively. CONCLUSIONS This PENTEC comprehensive review establishes objective relationships between patient age, RT dose, RT volume, and MTX to subsequent risks of neurocognitive injury and necrosis. A lack of consistent RT data and outcome reporting in the published literature hindered investigation of the other predefined CNS morbidity endpoints.
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Affiliation(s)
- Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| | - Peter L Stavinoha
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Warissara Rongthong
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - N Patrik Brodin
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Susan L McGovern
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Joshua D Palmer
- Department of Radiation Oncology, James Cancer Hospital at Ohio State University, Nationwide Children's Hospital, Columbus, Ohio
| | - Sabina Vennarini
- Proton Therapy Center, Azienda Provinciale per I Servizi Sanitari, Trento, Italy
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida, Gainesville, Florida
| | - Paul Aridgides
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, New York
| | - Daniel C Bowers
- Division of Pediatric Hematology and Oncology, University of Texas Southwestern Medical School, Dallas, Texas
| | - Leontien Kremer
- Department of Pediatrics, UMC Amsterdam, Location AMC, Amsterdam, the Netherlands; Department of Pediatric Oncology, Princess Máxima Center for Paediatric Oncology, Utrecht, the Netherlands
| | - Cecile Ronckers
- Department of Pediatrics, UMC Amsterdam, Location AMC, Amsterdam, the Netherlands; Department of Pediatric Oncology, Princess Máxima Center for Paediatric Oncology, Utrecht, the Netherlands; Institute of Biostatistics and Registry Research, Medical University Brandenburg-Theodor Fontane, Neuruppin, Germany
| | - Louis Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Michele Avanzo
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
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24
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Voicu IP, Napolitano A, Carboni A, Caulo M, Carai A, Vinci M, Miele E, Rossi S, Cacchione A, Vennarini S, Ferretti E, Mastronuzzi A, Tomà P, Colafati GS. IMG-16. WHOLE TUMOR DIFFUSION KURTOSIS IMAGING ANALYSIS FOR DISCRIMINATING PEDIATRIC POSTERIOR FOSSA TUMORS: ACCURACY AND REPEATABILITY. Neuro Oncol 2020. [PMCID: PMC7715186 DOI: 10.1093/neuonc/noaa222.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
PURPOSE
Diffusion kurtosis imaging (DKI) has not yet been tested for pediatric brain tumors. Estimating diffusion values from whole-tumor based (VOI) segmentations may improve diffusion measurement repeatability compared to conventional region-of-interest (ROI) approaches. Our purpose was to compare repeatability between ROI and VOI DKI-derived diffusion measurements and to assess VOI-based DKI accuracy in discriminating among pediatric posterior fossa tumors.
MATERIALS AND METHODS
We retrospectively analyzed 34 children (19 M, 15F, mean age 7.48 years) with posterior fossa tumors who underwent preoperative 3T MRI including DKI. For each patient, two neuroradiologists independently segmented the whole solid tumor (VOI), the area of maximum tumor diameter and a smallROI.Inter-observer variability was assessed with coefficient of variation (COV) and Bland-Altman plots. VOI-based DKI metrics accuracy in discriminating among tumor histology and for tumor grading were assessed with MANOVA and ROC analyses respectively. Correlation between grading accuracy and inter-observer variability was assessed with Spearman’s rho.
RESULTS
Tumor histology included medulloblastoma (15), pilocytic astrocytoma (14) and ependymoma (5). VOI-based measurements presented lower variability than ROI-based measurements across all DKI metrics. DKI-derived metrics could accurately discriminate between tumor subtypes (Pillai’s trace: p<0.001) and were accurate for tumor grading (AUCs of 0.919, 0.986, 0.996, 0.842 and 0.926 for RK, MK, AK, FA and MD respectively). VOI-based COV was significantly correlated to AUC values (R=-0.900, p<0.037).
CONCLUSIONS
DKI-derived metrics are useful for pediatric posterior fossa tumor discrimination and grading. VOI-based diffusion measurements present improved repeatability compared to ROI-based measurements and are significantly correlated to diagnostic accuracy.
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Affiliation(s)
| | | | | | - Massimo Caulo
- Institute for Advanced Biomedical Technologies-ITAB, Chieti, Italy
| | | | - Maria Vinci
- Bambino Gesù Children’s Hospital, Rome, Italy
| | | | | | | | | | | | | | - Paolo Tomà
- Bambino Gesù Children’s Hospital, Rome, Italy
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25
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Turkaj A, Giacomelli I, Cianchetti M, Scartoni D, Amelio D, Vennarini S, Rombi B, Dionisi F, Amichetti M. PO-0883: Early outcomes in patients with skull base chordomas and chondrosarcomas treated with proton therapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00900-2] [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: 11/29/2022]
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26
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Amelio D, Scartoni D, Vennarini S, Turkaj A, Giacomelli I, Amichetti M. PH-0357: Proton therapy re-irradiation of intracranial meningiomas failing after previous radiation therapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00381-9] [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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27
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Fellin F, Fracchiolla F, Rombi B, Lipparini M, Vennarini S, Farace P. An advanced junction concept in pediatric craniospinal irradiation by proton pencil beam scanning. Phys Med 2019; 60:168-173. [DOI: 10.1016/j.ejmp.2019.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/03/2019] [Accepted: 04/06/2019] [Indexed: 11/24/2022] Open
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28
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Scala M, Vennarini S, Garrè ML, Tortora D, Cianchetti M, Fellin F, Lorentini S, Pavanello M. Radiation-Induced Moyamoya Syndrome After Proton Therapy in Child with Clival Chordoma: Natural History and Surgical Treatment. World Neurosurg 2018; 123:306-309. [PMID: 30583132 DOI: 10.1016/j.wneu.2018.12.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 12/12/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Proton therapy has proven to be effective and safe in the treatment of radioresistant skull base tumors such as chordomas. Thanks to the peculiar physical properties of the proton beam, radiation energy is delivered in a narrow space called the Bragg peak and the surrounding normal tissues receive a minimal amount of the radiation dose. This is important to lower the risk of radiation-induced damage, especially in children. However, local adverse effects in proximity to the target volume may occur. In particular, the development of moyamoya syndrome (MMS) has been rarely reported in children receiving proton beam therapy for brain tumors. CASE DESCRIPTION We report on a child who developed rapidly progressive MMS after proton beam therapy for a clivus chordoma. A combined indirect revascularization procedure by encephalo-duro-arterio-synangiosis and encephalo-myo-synangiosis was performed with good neuroradiologic and clinical outcome. CONCLUSIONS Regardless of the presence of known risk factors for MMS, strict neuroimaging surveillance is indicated in all patients treated with radiotherapy including those receiving proton beam therapy. We suggest that an early revascularization procedure should be considered in patients with worsening symptoms and/or sign of neuroradiologic progression of cerebral vasculopathy. This management of MMS could lower the risk of permanent neurologic deficits and improve patients' quality of life.
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Affiliation(s)
- Marcello Scala
- Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, Genoa, Italy.
| | | | - Maria Luisa Garrè
- Department of Neuroncology Unit, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, Genoa, Italy
| | - Domenico Tortora
- Department of Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, Genoa, Italy
| | | | | | | | - Marco Pavanello
- Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, Genoa, Italy
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29
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Fracchiolla F, Fellin F, Innocenzi M, Lipparini M, Cianchetti M, Dionisi F, Vennarini S, Schwarz M. 221. A pre-absorber optimization technique for pencil beam scanning (PBS) proton therapy treatments. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.232] [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: 10/27/2022] Open
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30
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Algranati C, Strigari L, Vennarini S, Pinnarò P, Fellin F, Sanguineti G, Amichetti M. 113. Eligibility and feasibility of adjuvant breast cancer treatments with pencil beam scanning (PBS) proton therapy. An inter-institutional study. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.124] [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: 10/27/2022] Open
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31
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Amelio D, Scartoni D, Farace P, Widesott L, Vennarini S, Fellin F, Brugnara S, Pagone R, Schwarz M, Amichetti M. P01.084 Re-irradiation in recurrent glioblastoma: proton therapy with or without chemotherapy. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.126] [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: 11/15/2022] Open
Affiliation(s)
- D Amelio
- Proton Therapy Center - Trento Hospital, Trento, Italy
| | - D Scartoni
- Proton Therapy Center - Trento Hospital, Trento, Italy
| | - P Farace
- Proton Therapy Center - Trento Hospital, Trento, Italy
| | - L Widesott
- Proton Therapy Center - Trento Hospital, Trento, Italy
| | - S Vennarini
- Proton Therapy Center - Trento Hospital, Trento, Italy
| | - F Fellin
- Proton Therapy Center - Trento Hospital, Trento, Italy
| | - S Brugnara
- Medical Oncology Dept. - Trento Hospital, Trento, Italy
| | - R Pagone
- Medical Oncology Dept. - Trento Hospital, Trento, Italy
| | - M Schwarz
- Proton Therapy Center - Trento Hospital, Trento, Italy
| | - M Amichetti
- Proton Therapy Center - Trento Hospital, Trento, Italy
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32
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Colafati GS, Carducci C, Rombi B, Lorentini S, Carai A, Voicu IP, Cacchione A, Mastronuzzi A, Amichetti M, Vennarini S. RONC-16. RISK OF PREMATURE RADIONECROSIS IN PAEDIATRIC PATIENTS WITH HIGH RISK MEDULLOBLASTOMA TREATED WITH PROTONS ON THE CRANIUM SPINAL AXIS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Chiara Carducci
- Department of Neuroradiology – IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | | | | | - Andrea Carai
- Department of Neuroscience and Neurorehabilitation, Neurosurgery Unit- IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - I Paul Voicu
- Department of Pediatric Hematology and Oncology – IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Antonella Cacchione
- Department of Pediatric Hematology and Oncology – IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Angela Mastronuzzi
- Department of Pediatric Hematology and Oncology – IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
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Rombi B, Zucchelli M, Vennarini S, Lipparini M, Micò S, Ammendolia I, Zama D, Prete A, Cammelli S, Toni F, Ronchi L, Morganti AG, Pession A, Amichetti M, Melchionda F. RONC-15. CYSTIC DYNAMIC EVALUATION AND EARLY LATE TOXICITY IN TWO PEDIATRIC LOW GRADE GLIOMAS TREATED WITH ACTIVE SCANNING PROTON BEAM RADIOTHERAPY. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Barbara Rombi
- Proton Therapy Center, Santa Chiara Hospital, Trento, Italy
| | - Mino Zucchelli
- Pediatric Neurosurgery, Bellaria Hospital, Bologna, Italy
| | | | | | - Soraia Micò
- Radiation Oncology Department, Vall D’ Hebron, Barcelona, Spain
| | - Ilario Ammendolia
- Radiation Oncology Department, Bologna University, S. Orsola Hospital, Bologna, Italy
| | - Daniele Zama
- Onco-Hematology Department, Bologna University, S. Orsola Hospital, Bologna, Italy
| | - Arcangelo Prete
- Onco-Hematology Department, Bologna University, S. Orsola Hospital, Bologna, Italy
| | - Silvia Cammelli
- Radiation Oncology Department, Bologna University, S. Orsola Hospital, Bologna, Italy
| | - Francesco Toni
- Neuro Radiology Department, Bellaria Hospital, Bologna, Italy
| | - Letizia Ronchi
- Radiation Oncology Department, Bologna University, S. Orsola Hospital, Bologna, Italy
| | - Alessio G Morganti
- Radiation Oncology Department, Bologna University, S. Orsola Hospital, Bologna, Italy
| | - Andrea Pession
- Onco-Hematology Department, Bologna University, S. Orsola Hospital, Bologna, Italy
| | | | - Fraia Melchionda
- Onco-Hematology Department, Bologna University, S. Orsola Hospital, Bologna, Italy
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Secco DE, Cacchione A, Del Bufalo F, Vennarini S, Colafati GS, Voicu IPP, Gentile S, Santato F, Anzeneder S, Carai A, Mastronuzzi A. RONC-19. LATE NEUROPSYCHOLOGICAL OUTCOMES WITH PROTON RADIATION IN CHILDREN WITH BRAIN TUMOR. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Giacomelli I, Cianchetti M, Dionisi F, Amelio D, Scartoni D, Vennarini S, Amichetti M. EP-1638: Trento Proton Therapy Centre Experience For Spine Chordoma, Chondrosarcomas And Other Sarcomas. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31947-9] [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]
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Cianchetti M, Giacomelli I, Scartoni D, Dionisi F, Amelio D, Rombi B, Vennarini S, Amichetti M. Spine Chordoma, Chondrosarcomas, and Other Sarcomas: The Initial Experience of 1 Institution. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.2408] [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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Amelio D, Scartoni D, Farace P, Widesott L, Lorentini S, Vennarini S, Fellin F, Brugnara S, Maines F, Schwarz M, Amichetti M. Proton Therapy Reirradiation in Difficult-to-Treat Recurrent Glioblastoma. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.741] [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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Farace P, Bizzocchi N, Righetto R, Fellin F, Fracchiolla F, Lorentini S, Widesott L, Algranati C, Rombi B, Vennarini S, Amichetti M, Schwarz M. Supine craniospinal irradiation in pediatric patients by proton pencil beam scanning. Radiother Oncol 2017; 123:112-118. [DOI: 10.1016/j.radonc.2017.02.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/19/2017] [Accepted: 02/12/2017] [Indexed: 10/20/2022]
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Amelio D, Scartoni D, Palucci A, Vennarini S, Giacomelli I, Lemoine S, Donner D, Farace P, Chierichetti F, Amichetti M. P04.02 Analysis of 18F-DOPA PET imaging for target volume definition in patients with recurrent glioblastoma treated with proton therapy. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Indelicato DJ, Merchant T, Laperriere N, Lassen Y, Vennarini S, Wolden S, Hartsell W, Pankuch M, Brandal P, Law CCK, Taylor R, Laskar S, Okcu MF, Bouffet E, Mandeville H, Björk-Eriksson T, Nilsson K, Nyström H, Constine LS, Story M, Timmermann B, Roberts K, Kortmann RD. Consensus Report From the Stockholm Pediatric Proton Therapy Conference. Int J Radiat Oncol Biol Phys 2016; 96:387-392. [DOI: 10.1016/j.ijrobp.2016.06.2446] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/26/2016] [Accepted: 06/14/2016] [Indexed: 11/15/2022]
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Amelio D, Widesott L, Vennarini S, Fellin F, Maines F, Righetto R, Lorentini S, Farace P, Schwarz M, Amichetti M. P08.52 Proton therapy re-Irradiation in large-volume recurrent glioblastoma. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.185] [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: 11/12/2022] Open
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Bizzocchi N, Rombi B, Farace P, Vennarini S, Righetto R, Schwarz M, Amichetti M. RO-20A PLANNING APPROACH FOR LENS SPARING PROTON CRANIOSPINAL IRRADIATION IN A PEDIATRIC PATIENT. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now082.20] [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: 11/12/2022] Open
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Rombi B, Vennarini S, Meneghello L, Bonazza C, Pedrotti D, Dipalma A, Menegotti L, Amichetti M. RO-17INITIAL EXPERIENCE WITH SPOT SCANNING PROTON THERAPY FOR PEDIATRIC CNS TUMORS AT PROTON THERAPY CENTER IN TRENTO-ITALY. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now082.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vennarini S, Bizzocchi N, Rombi B, Lorentini S, Calisto A, Carai A, Cacchione A, Pettorini B, Mastronuzzi A, Amichetti M. RO-22FIRST EXPERIENCE OF MONITORING RADIOLOGICAL RESPONSE USING MRI DURING A PROTON IRRADIATION OF A PAEDIATRIC CHORDOMA: A NEW APPROACH? Neuro Oncol 2016. [DOI: 10.1093/neuonc/now082.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rombi B, Fellin F, Vennarini S, Bizzocchi N, Farace P, Cammelli S, Paone G, Prete A, Schwarz M, Amichetti M. RO-18PROTON PENCIL BEAM SCANNING VS VMAT FOR CRANIOSPINAL IRRADIATION IN FULLY GROWN PEDIATRIC PATIENT: A CASE REPORT. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now082.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lin LL, Vennarini S, Dimofte A, Ravanelli D, Shillington K, Batra S, Tochner Z, Both S, Freedman G. Proton beam versus photon beam dose to the heart and left anterior descending artery for left-sided breast cancer. Acta Oncol 2015; 54:1032-9. [PMID: 25789715 DOI: 10.3109/0284186x.2015.1011756] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to compare the dose to heart, left anterior descending (LAD) artery and lung between proton and photon beam irradiation for left-sided early stage breast cancer. MATERIAL AND METHODS Ten women with early stage left-sided breast cancer were treated with breast conserving surgery and radiation. Whole breast radiation was delivered for actual treatment via a tangential technique with deep inspiration breath hold (DIBH) utilizing inverse planned intensity-modulated radiation therapy (IMRT). Each patient was replanned on an Institutional Review Board (IRB)-approved prospective study using en face proton beam radiation with both uniform scanning (US) and pencil beam scanning (PBS) techniques. RESULTS Both PBS (0.011 Gy) and US (0.009 Gy) proton plans resulted in a significantly lower mean heart dose compared to IMRT (1.612 Gy) (p < 0.05 for PBS vs. IMRT and US vs. IMRT). The Dmean, Dmin, Dmax, and D0.2cm(3) of the LAD with either proton technique were significantly lower (p = 0.005) compared to IMRT. Both US and PBS reduced the mean dose to the lungs compared to IMRT. The coverage of the breast planning target volume was comparable between photon and proton plans. CONCLUSIONS The dose to whole heart was relatively low in this study of patients treated under conditions of DIBH. However, proton beam radiation was associated with lower minimum, maximum, and dose to 0.2 cm(3) of the LAD, which is the critical structure for late radiation therapy effects, compared to even the most optimized photon beam plan with DIBH and IMRT.
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Affiliation(s)
- Lilie L. Lin
- Radiation Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sabina Vennarini
- Proton Therapy Center, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Andreea Dimofte
- Radiation Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniele Ravanelli
- Proton Therapy Center, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Katie Shillington
- Radiation Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sonny Batra
- Radiation Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Zelig Tochner
- Radiation Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Stefan Both
- Radiation Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Gary Freedman
- Radiation Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
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Farace P, Vinante L, Ravanelli D, Bizzocchi N, Vennarini S. Planning field-junction in proton cranio-spinal irradiation - the ancillary-beam technique. Acta Oncol 2015; 54:1075-8. [PMID: 25350525 DOI: 10.3109/0284186x.2014.970667] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Paolo Farace
- Proton Therapy Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Lorenzo Vinante
- Proton Therapy Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Daniele Ravanelli
- Proton Therapy Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Nicola Bizzocchi
- Proton Therapy Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Sabina Vennarini
- Proton Therapy Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
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White B, Kiely JB, Vennarini S, Lin L, Freedman G, Santhanam A, Low D, Both S. TU-EF-304-04: A Heart Motion Model for Proton Scanned Beam Chest Radiotherapy. Med Phys 2015. [DOI: 10.1118/1.4925659] [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: 11/07/2022] Open
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White BM, Vennarini S, Lin L, Freedman G, Santhanam A, Low DA, Both S. Accuracy of Routine Treatment Planning 4-Dimensional and Deep-Inspiration Breath-Hold Computed Tomography Delineation of the Left Anterior Descending Artery in Radiation Therapy. Int J Radiat Oncol Biol Phys 2015; 91:825-31. [DOI: 10.1016/j.ijrobp.2014.11.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 11/21/2014] [Accepted: 11/24/2014] [Indexed: 10/23/2022]
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Rombi B, Vennarini S, Vinante L, Ravanelli D, Amichetti M. Proton radiotherapy for pediatric tumors: review of first clinical results. Ital J Pediatr 2014; 40:74. [PMID: 25260976 PMCID: PMC4421929 DOI: 10.1186/s13052-014-0074-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 08/04/2014] [Indexed: 12/03/2022] Open
Abstract
Radiation therapy is a part of multidisciplinary management of several childhood cancers. Proton therapy is a new method of irradiation, which uses protons instead of photons. Proton radiation has been used safely and effectively for medulloblastoma, primitive neuro-ectodermal tumors, craniopharyngioma, ependymoma, germ cell intracranial tumors, low-grade glioma, retinoblastoma, rhabdomyosarcoma and other soft tissue sarcomas, Ewing’s sarcoma and other bone sarcomas. Moreover, other possible applications are emerging, in particular for lymphoma and neuroblastoma. Although both photon and proton techniques allow similar target volume coverage, the main advantage of proton radiation therapy is to sparing of intermediate-to-low-dose to healthy tissues. This characteristic could translate into clinical reduction of side effects, including a lower risk for secondary cancers. The following review presents the state of the art of proton therapy in the treatment of pediatric malignancies.
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Affiliation(s)
- Barbara Rombi
- Unità Operativa di Protonterapia, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy.
| | - Sabina Vennarini
- Unità Operativa di Protonterapia, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy.
| | - Lorenzo Vinante
- Unità Operativa di Protonterapia, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy. .,Dipartimento di Medicina, Università di Padova, Padova, Italy.
| | - Daniele Ravanelli
- Unità Operativa di Protonterapia, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy.
| | - Maurizio Amichetti
- Unità Operativa di Protonterapia, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy.
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