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Orlandi E, Barcellini A, Vischioni B, Fiore MR, Vitolo V, Iannalfi A, Bonora M, Chalaszczyk A, Ingargiola R, Riva G, Ronchi S, Valvo F, Fossati P, Ciocca M, Mirandola A, Molinelli S, Pella A, Baroni G, Pullia MG, Facoetti A, Orecchia R, Licitra L, Vago G, Rossi S. The Role of Carbon Ion Therapy in the Changing Oncology Landscape-A Narrative Review of the Literature and the Decade of Carbon Ion Experience at the Italian National Center for Oncological Hadrontherapy. Cancers (Basel) 2023; 15:5068. [PMID: 37894434 PMCID: PMC10605728 DOI: 10.3390/cancers15205068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Currently, 13 Asian and European facilities deliver carbon ion radiotherapy (CIRT) for preclinical and clinical activity, and, to date, 55 clinical studies including CIRT for adult and paediatric solid neoplasms have been registered. The National Center for Oncological Hadrontherapy (CNAO) is the only Italian facility able to accelerate both protons and carbon ions for oncological treatment and research. METHODS To summarise and critically evaluate state-of-the-art knowledge on the application of carbon ion radiotherapy in oncological settings, the authors conducted a literature search till December 2022 in the following electronic databases: PubMed, Web of Science, MEDLINE, Google Scholar, and Cochrane. The results of 68 studies are reported using a narrative approach, highlighting CNAO's clinical activity over the last 10 years of CIRT. RESULTS The ballistic and radiobiological hallmarks of CIRT make it an effective option in several rare, radioresistant, and difficult-to-treat tumours. CNAO has made a significant contribution to the advancement of knowledge on CIRT delivery in selected tumour types. CONCLUSIONS After an initial ramp-up period, CNAO has progressively honed its clinical, technical, and dosimetric skills. Growing engagement with national and international networks and research groups for complex cancers has led to increasingly targeted patient selection for CIRT and lowered barriers to facility access.
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Affiliation(s)
- Ester Orlandi
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Amelia Barcellini
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy
| | - Barbara Vischioni
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Maria Rosaria Fiore
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Viviana Vitolo
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Alberto Iannalfi
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Maria Bonora
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Agnieszka Chalaszczyk
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Rossana Ingargiola
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Giulia Riva
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Sara Ronchi
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Francesca Valvo
- Scientific Directorate, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Piero Fossati
- Department of Radiation Oncology, MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria
- Department for Basic and Translational Oncology and Haematology, Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
| | - Mario Ciocca
- Medical Physics Unit, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Alfredo Mirandola
- Medical Physics Unit, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Silvia Molinelli
- Medical Physics Unit, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Andrea Pella
- Bioengineering Unit, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Guido Baroni
- Bioengineering Unit, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Marco Giuseppe Pullia
- Radiobiology Unit, Research and Development Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Angelica Facoetti
- Radiobiology Unit, Research and Development Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Roberto Orecchia
- Scientific Directorate, IEO-European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Lisa Licitra
- Scientific Directorate, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
- Department of Head & Neck Medical Oncology 3, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
- Department of Oncology & Haemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Gianluca Vago
- Presidency, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
- School of Pathology, University of Milan, 20122 Milan, Italy
| | - Sandro Rossi
- General Directorate, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
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Holtzman AL, Seidensaal K, Iannalfi A, Kim KH, Koto M, Yang WC, Shiau CY, Mahajan A, Ahmed SK, Trifiletti DM, Peterson JL, Koffler DM, Vallow LA, Hoppe BS, Rutenberg MS. Carbon Ion Radiotherapy: An Evidence-Based Review and Summary Recommendations of Clinical Outcomes for Skull-Base Chordomas and Chondrosarcomas. Cancers (Basel) 2023; 15:5021. [PMID: 37894388 PMCID: PMC10605639 DOI: 10.3390/cancers15205021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/22/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Skull-base chordoma and chondrosarcoma are rare radioresistant tumors treated with surgical resection and/or radiotherapy. Because of the established dosimetric and biological benefits of heavy particle therapy, we performed a systematic and evidence-based review of the clinical outcomes of patients with skull-base chordoma and chondrosarcoma treated with carbon ion radiotherapy (CIRT). A literature review was performed using a MEDLINE search of all articles to date. We identified 227 studies as appropriate for review, and 24 were ultimately included. The published data illustrate that CIRT provides benchmark disease control outcomes for skull-base chordoma and chondrosarcoma, respectively, with acceptable toxicity. CIRT is an advanced treatment technique that may provide not only dosimetric benefits over conventional photon therapy but also biologic intensification to overcome mechanisms of radioresistance. Ongoing research is needed to define the magnitude of benefit, patient selection, and cost-effectiveness of CIRT compared to other forms of radiotherapy.
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Affiliation(s)
- Adam L. Holtzman
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Katharina Seidensaal
- Department of Radiation Oncology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Alberto Iannalfi
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Kyung Hwan Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Masashi Koto
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan
| | - Wan-Chin Yang
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, Taipei City 11217, Taiwan
| | - Cheng-Ying Shiau
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, Taipei City 11217, Taiwan
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Safia K. Ahmed
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | | | | | - Daniel M. Koffler
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Laura A. Vallow
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Bradford S. Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
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Zoia C, Todeschini G, Lovati E, Lucotti P, Iannalfi A, Bongetta D, Di Sabatino A, Riva G, Cavallo I, Orlandi E, Spena G. Evaluation of endocrinological sequelae following particle therapy performed on anterior skull base lesions in the adult population. Surg Neurol Int 2023; 14:293. [PMID: 37680918 PMCID: PMC10481810 DOI: 10.25259/sni_41_2023] [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: 01/13/2023] [Accepted: 07/29/2023] [Indexed: 09/09/2023] Open
Abstract
Background Radiotherapy has increasingly assumed a central role in the multidisciplinary treatment of skull base lesions. Unfortunately, it is often burdened by relevant radio-induced damage to the pituitary function and the surrounding structures and systems. Patients who were treated with radiotherapy around the sellar region especially have a high risk of developing radio-induced hypopituitarism. Particle therapy has the potential advantage of delivering a higher radiation dose to the target while potentially sparing the sellar region and pituitary function. The aim of this study is to evaluate the pituitary function in adult patients who have undergone hadron therapy for anterior skull base lesions involving or surrounding the pituitary gland. Methods This is a retrospective, observational, and noncontrolled study. We evaluated pituitary and peripheral hormone levels in all patients referring to National Center for Oncological Hadrontherapy, Pavia, Italy for anterior skull base tumors. Furthermore, we performed a magnetic resonance imaging for every follow-up to evaluate potential tumoral growth. Results We evaluated 32 patients with different tumoral lesions with a mean follow-up of 27.9 months. The mean hadron therapy (HT) dose was 60 ± 14 Gray, with a mean dose per fraction of 2.3 ± 2.1 Gray. Six patients were treated with carbon ions and 26 with protons. Pituitary hormone alteration of some kind was reported for six patients. No patient experienced unexpected severe adverse events related to particle therapy. Conclusion Particle radiotherapy performed on anterior skull base lesions has proved to cause limited damage to pituitary function in the adult population.
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Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Policlinico San Matteo, Pavia, Italy
| | - Giada Todeschini
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Elisabetta Lovati
- Internal Medicine Unit, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Policlinico San Matteo, Pavia, Italy
| | - Pietro Lucotti
- Internal Medicine Unit, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Policlinico San Matteo, Pavia, Italy
| | - Alberto Iannalfi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Daniele Bongetta
- Neurosurgery Unit, Ospedale Fatebenefratelli e Oftalmico, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli Sacco, Milan, Italy
| | - Antonio Di Sabatino
- Internal Medicine Unit, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Policlinico San Matteo, Pavia, Italy
| | - Giulia Riva
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Iacopo Cavallo
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
- Department of Experimental Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Ester Orlandi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Giannantonio Spena
- Neurosurgery Unit, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Policlinico San Matteo, Pavia, Italy
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Iannalfi A, Riva G, Ciccone L, Orlandi E. The role of particle radiotherapy in the treatment of skull base tumors. Front Oncol 2023; 13:1161752. [PMID: 37350949 PMCID: PMC10283010 DOI: 10.3389/fonc.2023.1161752] [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: 02/08/2023] [Accepted: 05/19/2023] [Indexed: 06/24/2023] Open
Abstract
The skull base is an anatomically and functionally critical area surrounded by vital structures such as the brainstem, the spinal cord, blood vessels, and cranial nerves. Due to this complexity, management of skull base tumors requires a multidisciplinary approach involving a team of specialists such as neurosurgeons, otorhinolaryngologists, radiation oncologists, endocrinologists, and medical oncologists. In the case of pediatric patients, cancer management should be performed by a team of pediatric-trained specialists. Radiation therapy may be used alone or in combination with surgery to treat skull base tumors. There are two main types of radiation therapy: photon therapy and particle therapy. Particle radiotherapy uses charged particles (protons or carbon ions) that, due to their peculiar physical properties, permit precise targeting of the tumor with minimal healthy tissue exposure. These characteristics allow for minimizing the potential long-term effects of radiation exposure in terms of neurocognitive impairments, preserving quality of life, and reducing the risk of radio-induced cancer. For these reasons, in children, adolescents, and young adults, proton therapy should be an elective option when available. In radioresistant tumors such as chordomas and sarcomas and previously irradiated recurrent tumors, particle therapy permits the delivery of high biologically effective doses with low, or however acceptable, toxicity. Carbon ion therapy has peculiar and favorable radiobiological characteristics to overcome radioresistance features. In low-grade tumors, proton therapy should be considered in challenging cases due to tumor volume and involvement of critical neural structures. However, particle radiotherapy is still relatively new, and more research is needed to fully understand its effects. Additionally, the availability of particle therapy is limited as it requires specialized equipment and expertise. The purpose of this manuscript is to review the available literature regarding the role of particle radiotherapy in the treatment of skull base tumors.
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Paganelli C, Zampini MA, Morelli L, Buizza G, Fontana G, Anemoni L, Imparato S, Riva G, Iannalfi A, Orlandi E, Baroni G. Optimizing b-values schemes for diffusion MRI of the brain with segmented Intravoxel Incoherent Motion (IVIM) model. J Appl Clin Med Phys 2023:e13986. [PMID: 37031365 DOI: 10.1002/acm2.13986] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 02/02/2023] [Accepted: 03/21/2023] [Indexed: 04/10/2023] Open
Abstract
PURPOSE To define an optimal set of b-values for accurate derivation of diffusion MRI parameters in the brain with segmented Intravoxel Incoherent Motion (IVIM) model. METHODS Simulations of diffusion signals were performed to define an optimal set of b-values targeting different perfusion regimes, by relying on an optimization procedure which minimizes the total relative error on estimated IVIM parameters computed with a segmented fitting procedure. Then, the optimal b-values set was acquired in vivo on healthy subjects and skull base chordoma patients to compare the optimized protocol with a clinical one. RESULTS The total relative error on simulations decreased of about 40% when adopting the optimal set of 13 b-values (0 10 20 40 50 60 200 300 400 1200 1300 1400 1500 s/mm2 ), showing significant differences and increased precision on D and f estimates with respect to simulations with a non-optimized b-values set. Similarly, in vivo acquisitions demonstrated a dependency of IVIM parameters on the b-values array, with differences between the optimal set of b-values and a clinical non-optimized acquisition. IVIM parameters were compatible to literature values, with D (0.679/0.701 [0.022/0.008] ·10-3 mm2 /s), f (5.49/5.80 [0.70/1.14] %), and D* (8.25/7.67 [0.92/0.83] ·10-3 mm2 /s) median [interquartile range] estimates for white matter/gray matter in volunteers and D (0.709/0.715/1.06 [0.035/0.023/0.271] ·10-3 mm2 /s), f (7.08/7.84/21.54 [1.20/1.06/6.05] %), and D* (10.85/11.84/2.32 [1.38/2.32/4.94] ·10-3 mm2 /s) for white matter/gray matter/Gross Tumor Volume in patients with skull-base chordoma tumor. CONCLUSIONS The definition of an optimal b-values set can improve the estimation of quantitative IVIM parameters. This allows setting up an optimized approach that can be adopted for IVIM studies in the brain.
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Affiliation(s)
- Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | - Letizia Morelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Giulia Buizza
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Giulia Fontana
- Bioengineering Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Luca Anemoni
- Radiation Therapy Technologist Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Imparato
- Radiology Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Giulia Riva
- Clinical Department, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Alberto Iannalfi
- Clinical Department, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Ester Orlandi
- Clinical Department, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- Bioengineering Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
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Morelli L, Palombo M, Buizza G, Riva G, Pella A, Fontana G, Imparato S, Iannalfi A, Orlandi E, Paganelli C, Baroni G. Microstructural parameters from DW-MRI for tumour characterization and local recurrence prediction in particle therapy of skull-base chordoma. Med Phys 2023; 50:2900-2913. [PMID: 36602230 DOI: 10.1002/mp.16202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/21/2022] [Accepted: 12/15/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Quantitative imaging such as Diffusion-Weighted MRI (DW-MRI) can be exploited to non-invasively derive patient-specific tumor microstructure information for tumor characterization and local recurrence risk prediction in radiotherapy. PURPOSE To characterize tumor microstructure according to proliferative capacity and predict local recurrence through microstructural markers derived from pre-treatment conventional DW-MRI, in skull-base chordoma (SBC) patients treated with proton (PT) and carbon ion (CIRT) radiotherapy. METHODS Forty-eight patients affected by SBC, who underwent conventional DW-MRI before treatment and were enrolled for CIRT (n = 25) or PT (n = 23), were retrospectively selected. Clinically verified local recurrence information (LR) and histological information (Ki-67, proliferation index) were collected. Apparent diffusion coefficient (ADC) maps were calculated from pre-treatment DW-MRI and, from these, a set of microstructural parameters (cellular radius R, volume fraction vf, diffusion D) were derived by applying a fine-tuning procedure to a framework employing Monte Carlo simulations on synthetic cell substrates. In addition, apparent cellularity (ρapp ) was estimated from vf and R for an easier clinical interpretation. Histogram-based metrics (mean, median, variance, entropy) from estimated parameters were considered to investigate differences (Mann-Whitney U-test, α = 0.05) in estimated tumor microstructure in SBCs characterized by low or high cell proliferation (Ki-67). Recurrence-free survival analyses were also performed to assess the ability of the microstructural parameters to stratify patients according to the risk of local recurrence (Kaplan-Meier curves, log-rank test α = 0.05). RESULTS Refined microstructural markers revealed optimal capabilities in discriminating patients according to cell proliferation, achieving best results with mean values (p-values were 0.0383, 0.0284, 0.0284, 0.0468, and 0.0088 for ADC, R, vf, D, and ρapp, respectively). Recurrence-free survival analyses showed significant differences between populations at high and low risk of local recurrence as stratified by entropy values of estimated microstructural parameters (p = 0.0110). CONCLUSION Patient-specific microstructural information was non-invasively derived providing potentially useful tools for SBC treatment personalization and optimization in particle therapy.
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Affiliation(s)
- Letizia Morelli
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Marco Palombo
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK
- School of Computer Science and Informatics, Cardiff University, Cardiff, UK
| | - Giulia Buizza
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Giulia Riva
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Andrea Pella
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Giulia Fontana
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Imparato
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Alberto Iannalfi
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Ester Orlandi
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
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Loap P, Orlandi E, De Marzi L, Vitolo V, Barcellini A, Iannalfi A, Dendale R, Kirova Y, Mirandola A. Cardiotoxicity model-based patient selection for Hodgkin lymphoma proton therapy. Acta Oncol 2022; 61:979-986. [PMID: 35668710 DOI: 10.1080/0284186x.2022.2084639] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Hodgkin lymphoma (HL) is a highly curable hematological malignancy. Consolidation radiation therapy techniques have made significant progresses to improve organ-at-risk sparing in order to reduce late radiation-induced toxicity. Recent technical breakthroughs notably include intensity modulated proton therapy (IMPT), which has demonstrated a major dosimetric benefit at the cardiac level for mediastinal HL patients. However, its implementation in clinical practice is still challenging, notably due to the limited access to proton therapy facilities. In this context, the purpose of this study was to estimate the benefit of IMPT for HL proton therapy for diverse cardiac adverse events and to propose a general frame for mediastinal HL patient selection strategy for IMPT based on cardiotoxicity reduction, patient clinical factors, and IMPT treatment availability. MATERIAL AND METHODS This retrospective dosimetric study included 30 mediastinal HL patients treated with VMAT. IMPT plans were generated on the initial simulation scans. Dose to the heart, to the left ventricle and to the valves were retrieved to calculate the relative risk (RR) of ischemic heart disease (IHD), congestive heart failure (CHF) and valvular disease (VD). Composite relative risk reduction (cRRR) of late cardiotoxicity, between VMAT and IMPT, were calculated as the weighted mean of relative risk reduction for IHD, CHF and VD, calculated across a wide range of cardiovascular risk factor combinations. The proportion of mediastinal HL patients who could benefit from IMPT was estimated in European countries, based on the country population and on the number of active gantries, to propose country-specific cRRR thresholds for patient selection. RESULTS Compared with VMAT, IMPT significantly reduced average mean doses to the heart (2.36 Gy vs 0.99 Gy, p < 0.01), to the left ventricle (0.67 Gy vs 0.03, p < 0.01) and to the valves (1.29 Gy vs. 0.06, p < 0.01). For a HL patient without cardiovascular risk factor other than anthracycline-based chemotherapy, the relative risks of late cardiovascular complications were significantly lower after IMPT compared with VMAT for ischemic heart disease (1.07 vs 1.17, p < 0.01), for congestive heart failure (2.84 vs. 3.00, p < 0.01), and for valvular disease (1.01 vs. 1.06, p < 0.01). The median cRRR of cardiovascular adverse events with IMPT was 4.8%, ranging between 0.1% and 30.5%, depending on the extent of radiation fields and on the considered cardiovascular risk factors. The estimated proportion of HL patients currently treatable with IMPT in European countries with proton therapy facilities ranged between 8.0% and 100% depending on the country, corresponding to cRRR thresholds ranging from 24.0% to 0.0%. CONCLUSION While a statistically significant clinical benefit is theoretically expected for ischemic heart disease, cardiac heart failure and valvular disease for mediastinal HL patients with IMPT, the overall cardiotoxicity risk reduction is notable only for a minority of patients. In the context of limited IMPT availability, this study proposed a general model-based selection approach for mediastinal HL patient based on calculated cardiotoxicity reduction, taking into consideration patient clinical characteristics and IMPT facility availability.
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Affiliation(s)
- Pierre Loap
- Department of Radiation Oncology, Institut Curie, Paris, France.,Centre de Protonthérapie (CPO), Institut Curie, Orsay, France.,Radiation Oncology Clinical Department, Centro Nazionale di Adronterapia Oncologica (CNAO), Pavia, Italia
| | - Ester Orlandi
- Radiation Oncology Clinical Department, Centro Nazionale di Adronterapia Oncologica (CNAO), Pavia, Italia
| | - Ludovic De Marzi
- Department of Radiation Oncology, Institut Curie, Paris, France.,Centre de Protonthérapie (CPO), Institut Curie, Orsay, France
| | - Viviana Vitolo
- Radiation Oncology Clinical Department, Centro Nazionale di Adronterapia Oncologica (CNAO), Pavia, Italia
| | - Amelia Barcellini
- Radiation Oncology Clinical Department, Centro Nazionale di Adronterapia Oncologica (CNAO), Pavia, Italia
| | - Alberto Iannalfi
- Radiation Oncology Clinical Department, Centro Nazionale di Adronterapia Oncologica (CNAO), Pavia, Italia
| | - Rémi Dendale
- Department of Radiation Oncology, Institut Curie, Paris, France.,Centre de Protonthérapie (CPO), Institut Curie, Orsay, France
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France.,Centre de Protonthérapie (CPO), Institut Curie, Orsay, France
| | - Alfredo Mirandola
- Radiation Oncology Clinical Department, Centro Nazionale di Adronterapia Oncologica (CNAO), Pavia, Italia
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Loap P, Mirandola A, De Marzi L, Barcellini A, Vitolo V, Iannalfi A, Dendale R, Kirova Y, Orlandi E. PD-0172 Multi-parameter patient selection strategy for Hodgkin lymphoma proton therapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02777-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Loap P, Mirandola A, De Marzi L, Barcellini A, Vitolo V, Iannalfi A, Dendale R, Orlandi E, Kirova Y. PD-0175 Cardiac conduction system exposure during modern radiation therapy for mediastinal Hodgkin lymphoma. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02780-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Riva G, Fiorina E, Cavallo I, Molinelli S, Vai A, Ciocca M, Iannalfi A, Orlandi E. OC-0090 Temporal lobe necrosis after proton therapy for skull base tumors and NTCP models evaluation. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02466-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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11
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Loap P, Mirandola A, De Marzi L, Vitolo V, Barcellini A, Iannalfi A, Dendale R, Kirova Y, Orlandi E. Cardiac conduction system exposure with modern radiotherapy techniques for mediastinal Hodgkin lymphoma irradiation. Acta Oncol 2022; 61:496-499. [PMID: 35012415 DOI: 10.1080/0284186x.2021.2025265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Pierre Loap
- Department of Radiation Oncology, Institut Curie, Paris, France
- Centre de Protonthérapie (CPO), Institut Curie, Orsay, France
- Radiation Oncology Clinical Department, Centro Nazionale di Adronterapia Oncologica (CNAO), Pavia, Italia
| | - Alfredo Mirandola
- Radiation Oncology Clinical Department, Centro Nazionale di Adronterapia Oncologica (CNAO), Pavia, Italia
| | - Ludovic De Marzi
- Department of Radiation Oncology, Institut Curie, Paris, France
- Centre de Protonthérapie (CPO), Institut Curie, Orsay, France
- Institut Curie, PSL Research University, University Paris Saclay, INSERM LITO, Campus Universitaire, Orsay, France
| | - Viviana Vitolo
- Radiation Oncology Clinical Department, Centro Nazionale di Adronterapia Oncologica (CNAO), Pavia, Italia
| | - Amelia Barcellini
- Radiation Oncology Clinical Department, Centro Nazionale di Adronterapia Oncologica (CNAO), Pavia, Italia
| | - Alberto Iannalfi
- Radiation Oncology Clinical Department, Centro Nazionale di Adronterapia Oncologica (CNAO), Pavia, Italia
| | - Rémi Dendale
- Department of Radiation Oncology, Institut Curie, Paris, France
- Centre de Protonthérapie (CPO), Institut Curie, Orsay, France
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
- Centre de Protonthérapie (CPO), Institut Curie, Orsay, France
| | - Ester Orlandi
- Radiation Oncology Clinical Department, Centro Nazionale di Adronterapia Oncologica (CNAO), Pavia, Italia
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Iannalfi A, D'Ippolito E, Riva G, Molinelli S, Gandini S, Viselner G, Fiore MR, Vischioni B, Vitolo V, Bonora M, Ronchi S, Petrucci R, Barcellini A, Mirandola A, Russo S, Vai A, Mastella E, Magro G, Maestri D, Ciocca M, Preda L, Valvo F, Orecchia R. Corrigendum to: Proton and carbon ion radiotherapy in skull base chordomas: a prospective study based on a dual particle and a patient-customized treatment strategy. Neuro Oncol 2021; 24:1402-1403. [PMID: 34850206 DOI: 10.1093/neuonc/noab255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alberto Iannalfi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Emma D'Ippolito
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Giulia Riva
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Silvia Molinelli
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Gisela Viselner
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Maria Rosaria Fiore
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Barbara Vischioni
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Viviana Vitolo
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Maria Bonora
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Ronchi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Rachele Petrucci
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Amelia Barcellini
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Alfredo Mirandola
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Stefania Russo
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Alessandro Vai
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Edoardo Mastella
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Giuseppe Magro
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Davide Maestri
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Mario Ciocca
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Lorenzo Preda
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Francesca Valvo
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Roberto Orecchia
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.,Scientific Directorate, European Institute of Oncology, IRCCS, Milan, Italy
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Morelli L, Buizza G, Palombo M, Riva G, Fontana G, Imparato S, Iannalfi A, Orlandi E, Paganelli C, Baroni G. Analysis of tumour microstructure estimation from conventional diffusion MRI and application to skull-base chordoma . Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:3761-3764. [PMID: 34892054 DOI: 10.1109/embc46164.2021.9630129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Skull-base chordoma (SBC) is a rare tumour whose molecular and radiological characteristics are still being investigated. In neuro-oncology microstructural imaging techniques, like diffusion-weighted MRI (DW-MRI), have been widely investigated, with the apparent diffusion coefficient (ADC) being one of the most used DW-MRI parameters due to its ease of acquisition and computation. ADC is a potential biomarker without a clear link to microstructure. The aim of this work was to derive microstructural information from conventional ADC, showing its potential for the characterisation of skull-base chordomas. Sixteen patients affected by SBC, who underwent conventional DW-MRI were retrospectively selected. From mono-exponential fits of DW-MRI, ADC maps were estimated using different sets of b-values. DW-MRI signals were simulated from synthetic substrates , which mimic the cellular packing of a tumour tissue with well-defined microstructural features. Starting from a published method, an error-driven procedure was evaluated to improve the estimates of microstructural parameters obtained through the simulated signals. A quantitative description of the tumour microstructure was then obtained from the DW-MRI images. This allowed successfully differentiating patients according to histologically-verified cell proliferation information.Clinical Relevance - The impact on cancer management derives from the expected improvement of radiation treatment quality tailored to a patient-specific non-invasive description of tumour microstructure.
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Riva G, Vischioni B, Gandini S, Cavalieri S, Ronchi S, Barcellini A, Bonora M, Chalaszczyk A, Ingargiola R, Vitolo V, Fiore MR, Iannalfi A, Orlandi E. Particle Beam Therapy Tolerance and Outcome on Patients with Autoimmune Diseases: A Single Institution Matched Case-Control Study. Cancers (Basel) 2021; 13:cancers13205183. [PMID: 34680331 PMCID: PMC8534022 DOI: 10.3390/cancers13205183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022] Open
Abstract
It is unclear whether autoimmune diseases (ADs) may predispose patients to higher radiation-induced toxicity, and no data are available regarding particle therapy. Our objective was to determine if cancer patients with ADs have a higher incidence of complications after protons (PT) or carbon ion (CIRT) therapy. METHODS In our retrospective monocentric study, 38 patients with ADs over 1829 patients were treated with particle therapy between 2011 and 2020. Thirteen patients had collagen vascular disease (CVD), five an inflammatory bowel disease (IBD) and twenty patients an organ-specific AD. Each patient was matched with two control patients without ADs on the basis of type/site of cancer, type of particle treatment, age, sex, hypertension and/or diabetes and previous surgery. RESULTS No G4-5 complications were reported. In the AD group, the frequency of acute grade 3 (G3) toxicity was higher than in the control group (15.8% vs. 2.6%, p = 0.016). Compared to their matched controls, CVD-IBD patients had a higher frequency of G3 acute complications (27.7 vs. 2.6%, p = 0.002). There was no difference between AD patients (7.9%) and controls (2.6%) experiencing late G3 toxicity (p = 0.33). The 2 years disease-free survival was lower in AD patients than in controls (74% vs. 91%, p = 0.01), although the differences in terms of survival were not significant. CONCLUSIONS G3 acute toxicity was more frequently reported in AD patients after PT or CIRT. Since no severe G4-G5 events were reported and in consideration of the benefit of particle therapy for selected cancers, we conclude that particle therapy should be not discouraged for patients with ADs. Further prospective studies are warranted to gain insight into toxicity in cancer patients with ADs enrolled for particle therapy.
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Affiliation(s)
- Giulia Riva
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (B.V.); (S.R.); (A.B.); (M.B.); (A.C.); (R.I.); (V.V.); (M.R.F.); (A.I.); (E.O.)
- Correspondence: ; Tel.: +39-0382-078-501
| | - Barbara Vischioni
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (B.V.); (S.R.); (A.B.); (M.B.); (A.C.); (R.I.); (V.V.); (M.R.F.); (A.I.); (E.O.)
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology (IEO), IRCCS, 20139 Milan, Italy;
| | - Stefano Cavalieri
- Head and Neck Cancer Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Sara Ronchi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (B.V.); (S.R.); (A.B.); (M.B.); (A.C.); (R.I.); (V.V.); (M.R.F.); (A.I.); (E.O.)
| | - Amelia Barcellini
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (B.V.); (S.R.); (A.B.); (M.B.); (A.C.); (R.I.); (V.V.); (M.R.F.); (A.I.); (E.O.)
| | - Maria Bonora
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (B.V.); (S.R.); (A.B.); (M.B.); (A.C.); (R.I.); (V.V.); (M.R.F.); (A.I.); (E.O.)
| | - Agnieszka Chalaszczyk
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (B.V.); (S.R.); (A.B.); (M.B.); (A.C.); (R.I.); (V.V.); (M.R.F.); (A.I.); (E.O.)
| | - Rossana Ingargiola
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (B.V.); (S.R.); (A.B.); (M.B.); (A.C.); (R.I.); (V.V.); (M.R.F.); (A.I.); (E.O.)
| | - Viviana Vitolo
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (B.V.); (S.R.); (A.B.); (M.B.); (A.C.); (R.I.); (V.V.); (M.R.F.); (A.I.); (E.O.)
| | - Maria Rosaria Fiore
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (B.V.); (S.R.); (A.B.); (M.B.); (A.C.); (R.I.); (V.V.); (M.R.F.); (A.I.); (E.O.)
| | - Alberto Iannalfi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (B.V.); (S.R.); (A.B.); (M.B.); (A.C.); (R.I.); (V.V.); (M.R.F.); (A.I.); (E.O.)
| | - Ester Orlandi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (B.V.); (S.R.); (A.B.); (M.B.); (A.C.); (R.I.); (V.V.); (M.R.F.); (A.I.); (E.O.)
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Riva G, Imparato S, Savietto G, Pecorilla M, Iannalfi A, Barcellini A, Ronchi S, Fiore MR, Paganelli C, Buizza G, Ciocca M, Baroni G, Preda L, Orlandi E. Potential role of functional imaging in predicting outcome for patients treated with carbon ion therapy: a review. Br J Radiol 2021; 94:20210524. [PMID: 34520670 DOI: 10.1259/bjr.20210524] [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: 11/05/2022] Open
Abstract
OBJECTIVE Carbon ion radiation therapy (CIRT) is an emerging radiation technique with advantageous physical and radiobiologic properties compared to conventional radiotherapy (RT) providing better response in case of radioresistant and hypoxic tumors. Our aim is to critically review if functional imaging techniques could play a role in predicting outcome of CIRT-treated tumors, as already proven for conventional RT. METHODS 14 studies, concerning Magnetic resonance imaging (MRI) and Positron Emission Tomography (PET), were selected after a comprehensive search on multiple electronic databases from January 2000 to March 2020. RESULTS MRI studies (n = 5) focused on diffusion-weighted MRI and, even though quantitative parameters were the same in all studies (apparent diffusion coefficient, ADC), results were not univocal, probably due to different imaging acquisition protocols and tumoral histology. For PET studies (n = 9), different tracers were used such as [18F]FDG and other uncommon tracers ([11C]MET, [18F]FLT), with a relevant heterogeneity regarding parameters used for outcome assessment. CONCLUSION No conclusion can be drawn on the predictive value of functional imaging in CIRT-treated tumors. A standardization of image acquisition, multi-institutional large trials and external validations are needed in order to establish the prognostic value of functional imaging in CIRT and to guide clinical practice. ADVANCES IN KNOWLEDGE Emerging studies focused on functional imaging's role in predicting CIRT outcome. Due to the heterogeneity of images acquisition and studies, results are conflicting and prospective large studies with imaging standardized protocol are needed.
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Affiliation(s)
- Giulia Riva
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Imparato
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Giovanni Savietto
- Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Mattia Pecorilla
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Alberto Iannalfi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Amelia Barcellini
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Ronchi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Maria Rosaria Fiore
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milano, Italy
| | - Giulia Buizza
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milano, Italy
| | - Mario Ciocca
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milano, Italy
| | - Lorenzo Preda
- Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy.,Department of Radiology, I.R.C.C.S. Policlinico San Matteo Foundation, Pavia, Italy
| | - Ester Orlandi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
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Buizza G, Zampini M, Sablone G, Fontana G, Imparato S, Riva G, Iannalfi A, Orlandi E, Paganelli C, Baroni G. PH-0212 Optimization of intravoxel incoherent motion diffusion MRI for brain tumours biomarkers estimation. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07264-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Iannalfi A, D'Ippolito E, Riva G, Molinelli S, Gandini S, Viselner G, Fiore MR, Vischioni B, Vitolo V, Bonora M, Ronchi S, Petrucci R, Barcellini A, Mirandola A, Russo S, Vai A, Mastella E, Magro G, Maestri D, Ciocca M, Preda L, Valvo F, Orecchia R. Proton and carbon ion radiotherapy in skull base chordomas: a prospective study based on a dual particle and a patient-customized treatment strategy. Neuro Oncol 2021; 22:1348-1358. [PMID: 32193546 DOI: 10.1093/neuonc/noaa067] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The aim of this study is to evaluate results in terms of local control (LC), overall survival (OS), and toxicity profile and to better identify factors influencing clinical outcome of skull base chordoma treated with proton therapy (PT) and carbon ion radiotherapy (CIRT). METHODS We prospectively collected and analyzed data of 135 patients treated between November 2011 and December 2018. Total prescription dose in the PT group (70 patients) and CIRT group (65 patients) was 74 Gy relative biological effectiveness (RBE) delivered in 37 fractions and 70.4 Gy(RBE) delivered in 16 fractions, respectively (CIRT in unfavorable patients). LC and OS were evaluated using the Kaplan-Meier method. Univariate and multivariate analyses were performed, to identify prognostic factors on clinical outcomes. RESULTS After a median follow-up of 44 (range, 6-87) months, 14 (21%) and 8 (11%) local failures were observed in CIRT and PT group, respectively. Five-year LC rate was 71% in CIRT cohort and 84% in PT cohort. The estimated 5-year OS rate in the CIRT and PT group was 82% and 83%, respectively. On multivariate analysis, gross tumor volume (GTV), optic pathways, and/or brainstem compression and dose coverage are independent prognostic factors of local failure risk. High rate toxicity grade ≥3 was reported in 11% of patients. CONCLUSIONS Particle radiotherapy is an effective treatment for skull base chordoma with acceptable late toxicity. GTV, optic pathways, and/or brainstem compression and target coverage were independent prognostic factors for LC. KEY POINTS • Proton and carbon ion therapy are effective and safe in skull base chordoma.• Prognostic factors are GTV, organs at risk compression, and dose coverage.• Dual particle therapy and customized strategy was adopted.
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Affiliation(s)
- Alberto Iannalfi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Emma D'Ippolito
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Giulia Riva
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Silvia Molinelli
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Maria Rosaria Fiore
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Barbara Vischioni
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Viviana Vitolo
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Maria Bonora
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Ronchi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Rachele Petrucci
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Amelia Barcellini
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Alfredo Mirandola
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Stefania Russo
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Alessandro Vai
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Edoardo Mastella
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Giuseppe Magro
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Davide Maestri
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Mario Ciocca
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Lorenzo Preda
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Francesca Valvo
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Roberto Orecchia
- Scientific Directorate, European Institute of Oncology, IRCCS, Milan, Italy
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Buizza G, Zampini MA, Riva G, Molinelli S, Fontana G, Imparato S, Ciocca M, Iannalfi A, Orlandi E, Baroni G, Paganelli C. Investigating DWI changes in white matter of meningioma patients treated with proton therapy. Phys Med 2021; 84:72-79. [PMID: 33872972 DOI: 10.1016/j.ejmp.2021.03.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/30/2021] [Revised: 03/08/2021] [Accepted: 03/23/2021] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To evaluate changes in diffusion and perfusion-related properties of white matter (WM) induced by proton therapy, which is capable of a greater dose sparing to organs at risk with respect to conventional X-ray radiotherapy, and to eventually expose early manifestations of delayed neuro-toxicities. METHODS Apparent diffusion coefficient (ADC) and IVIM parameters (D, D* and f) were estimated from diffusion-weighted MRI (DWI) in 46 patients affected by meningioma and treated with proton therapy. The impact on changes in diffusion and perfusion-related WM properties of dose and time, as well as the influence of demographic and pre-treatment clinical information, were investigated through linear mixed-effects models. RESULTS Decreasing trends in ADC and D were found for WM regions hit by medium-high (30-40 Gy(RBE)) and high (>40 Gy(RBE)) doses, which are compatible with diffusion restriction due to radiation-induced cellular injury. Significant influence of dose and time on median ADC changes were observed. Also, D* showed a significant dependency on dose, whereas f consistently showed no dependency on dose and time. Age, gender and surgery extent were also found to affect changes in ADC. CONCLUSIONS These results overall agree with those from studies conducted on cohorts of mixed proton and X-ray radiotherapy patients. Future work should focus on relating our findings with clinical information of co-morbidities and thus exploiting such or more advanced imaging data to build normal tissue complication probability models to better integrate clinical and dose information.
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Affiliation(s)
- Giulia Buizza
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy.
| | - Marco Andrea Zampini
- MR Solutions Ltd., Ashbourne House, Old Portsmouth Rd., Guildford, United Kingdom.
| | - Giulia Riva
- Clinical Department, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi 53, 27100 Pavia, Italy.
| | - Silvia Molinelli
- Medical Physics Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi 53, 27100 Pavia, Italy.
| | - Giulia Fontana
- Clinical Bioengineering Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi 53, 27100 Pavia, Italy.
| | - Sara Imparato
- Radiology Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi 53, 27100 Pavia, Italy.
| | - Mario Ciocca
- Medical Physics Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi 53, 27100 Pavia, Italy.
| | - Alberto Iannalfi
- Clinical Department, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi 53, 27100 Pavia, Italy.
| | - Ester Orlandi
- Clinical Department, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi 53, 27100 Pavia, Italy.
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy; Clinical Bioengineering Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi 53, 27100 Pavia, Italy.
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy.
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Barcellini A, Vitolo V, Cobianchi L, Peloso A, Vanoli A, Mirandola A, Facoetti A, Fiore MR, Iannalfi A, Vischioni B, Cuccia F, Ronchi S, Bonora M, Riva G, Petrucci R, D'Ippolito E, Mas FD, Preda L, Valvo F. Re-irradiation With Carbon Ion Radiotherapy for Pelvic Rectal Cancer Recurrences in Patients Previously Irradiated to the Pelvis. In Vivo 2021; 34:1547-1553. [PMID: 32354961 DOI: 10.21873/invivo.11944] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND/AIM Re-irradiation of locally recurrent rectal cancer poses challenges due to the proximity of critical organs, such as the bowel. This study aimed at evaluating the safety and efficacy of re-irradiation with Carbon Ion Radiotherapy (CIRT) in rectal cancer patients with local recurrence. PATIENTS AND METHODS Between 2014 and 2018, 14 patients were treated at the National Center of Oncological Hadrontherapy (CNAO Foundation) with CIRT for locally recurrent rectal cancer. RESULTS All patients concluded the treatment. No G≥3 acute/late reaction nor pelvic infections were observed. The 1-year and 2-year local control rates were, 78% and 52%, respectively, and relapse occurred close to the bowel in 6 patients. The 1-year and 2-year overall survival rates were 100% and 76.2% each; while the 1-year and 2-year metastasis free survival rates were 64.3% and 43%. CONCLUSION CIRT as re-irradiation for locally recurrent rectal cancer emerges as a safe and valid treatment with an acceptable rate of morbidity of surrounding healthy tissue.
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Affiliation(s)
- Amelia Barcellini
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Viviana Vitolo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Lorenzo Cobianchi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Peloso
- Division of Abdominal Surgery, Department of Surgery, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,HepatoPancreato-Biliary Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Alessandro Vanoli
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alfredo Mirandola
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Angelica Facoetti
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Maria Rosaria Fiore
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Alberto Iannalfi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Barbara Vischioni
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Francesco Cuccia
- School of Radiation Oncology, University of Palermo, Palermo, Italy
| | - Sara Ronchi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Maria Bonora
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Giulia Riva
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Rachele Petrucci
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Emma D'Ippolito
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Francesca Dal Mas
- Lincoln International Business School, University of Lincoln, Lincoln, U.K.,Department of Law and Economics of Productive Activities, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Preda
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
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20
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Buizza G, Paganelli C, Ballati F, Sacco S, Preda L, Iannalfi A, Alexander DC, Baroni G, Palombo M. Improving the characterization of meningioma microstructure in proton therapy from conventional apparent diffusion coefficient measurements using Monte Carlo simulations of diffusion MRI. Med Phys 2021; 48:1250-1261. [PMID: 33369744 DOI: 10.1002/mp.14689] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/08/2020] [Accepted: 12/17/2020] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Proton therapy could benefit from noninvasively gaining tumor microstructure information, at both planning and monitoring stages. The anatomical location of brain tumors, such as meningiomas, often hinders the recovery of such information from histopathology, and conventional noninvasive imaging biomarkers, like the apparent diffusion coefficient (ADC) from diffusion-weighted MRI (DW-MRI), are nonspecific. The aim of this study was to retrieve discriminative microstructural markers from conventional ADC for meningiomas treated with proton therapy. These markers were employed for tumor grading and tumor response assessment. METHODS DW-MRIs from patients affected by meningioma and enrolled in proton therapy were collected before (n = 35) and 3 months after (n = 25) treatment. For the latter group, the risk of an adverse outcome was inferred by their clinical history. Using Monte Carlo methods, DW-MRI signals were simulated from packings of synthetic cells built with well-defined geometrical and diffusion properties. Patients' ADC was modeled as a weighted sum of selected simulated signals. The weights that best described a patient's ADC were determined through an optimization procedure and used to estimate a set of markers of tumor microstructure: diffusion coefficient (D), volume fraction (vf), and radius (R). Apparent cellularity (ρapp ) was estimated from vf and R for an easier clinical interpretability. Differences between meningothelial and atypical subtypes, and low- and high-grade meningiomas were assessed with nonparametric statistical tests, whereas sensitivity and specificity with ROC analyses. Similar analyses were performed for patients showing low or high risk of an adverse outcome to preliminary evaluate response to treatment. RESULTS Significant (P < 0.05) differences in median ADC, D, vf, R, and ρapp values were found when comparing meningiomas' subtypes and grades. ROC analyses showed that estimated microstructural parameters reached higher specificity than ADC for subtyping (0.93 for D and vf vs 0.80 for ADC) and grading (0.75 for R vs 0.67 for ADC). High- and low-risk patients showed significant differences in ADC and microstructural parameters. The skewness of ρapp was the parameter with highest AUC (0.90) and sensitivity (0.75). CONCLUSIONS Matching measured with simulated ADC yielded a set of potential imaging markers for meningiomas grading and response monitoring in proton therapy, showing higher specificity than conventional ADC. These markers can provide discriminative information about spatial patterns of tumor microstructure implying important advantages for patient-specific proton therapy workflows.
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Affiliation(s)
- Giulia Buizza
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, 20133, Italy
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, 20133, Italy
| | - Francesco Ballati
- Diagnostic Radiology Residency School, University of Pavia, Pavia, 27100, Italy
| | - Simone Sacco
- Diagnostic Radiology Residency School, University of Pavia, Pavia, 27100, Italy
| | - Lorenzo Preda
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, 27100, Italy
| | - Alberto Iannalfi
- Clinical Department, National Center of Oncological Hadrontherapy (CNAO), Pavia, 27100, Italy
| | - Daniel C Alexander
- Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London (UCL), London, WC1V6LJ, UK
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, 20133, Italy.,Bioengineering Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, 27100, Italy
| | - Marco Palombo
- Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London (UCL), London, WC1V6LJ, UK
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21
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Buizza G, Paganelli C, D’Ippolito E, Fontana G, Molinelli S, Preda L, Riva G, Iannalfi A, Valvo F, Orlandi E, Baroni G. Radiomics and Dosiomics for Predicting Local Control after Carbon-Ion Radiotherapy in Skull-Base Chordoma. Cancers (Basel) 2021; 13:339. [PMID: 33477723 PMCID: PMC7832399 DOI: 10.3390/cancers13020339] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/05/2021] [Accepted: 01/14/2021] [Indexed: 02/08/2023] Open
Abstract
Skull-base chordoma (SBC) can be treated with carbon ion radiotherapy (CIRT) to improve local control (LC). The study aimed to explore the role of multi-parametric radiomic, dosiomic and clinical features as prognostic factors for LC in SBC patients undergoing CIRT. Before CIRT, 57 patients underwent MR and CT imaging, from which tumour contours and dose maps were obtained. MRI and CT-based radiomic, and dosiomic features were selected and fed to two survival models, singularly or by combining them with clinical factors. Adverse LC was given by in-field recurrence or tumour progression. The dataset was split in development and test sets and the models' performance evaluated using the concordance index (C-index). Patients were then assigned a low- or high-risk score. Survival curves were estimated, and risk groups compared through log-rank tests (after Bonferroni correction α = 0.0083). The best performing models were built on features describing tumour shape and dosiomic heterogeneity (median/interquartile range validation C-index: 0.80/024 and 0.79/0.26), followed by combined (0.73/0.30 and 0.75/0.27) and CT-based models (0.77/0.24 and 0.64/0.28). Dosiomic and combined models could consistently stratify patients in two significantly different groups. Dosiomic and multi-parametric radiomic features showed to be promising prognostic factors for LC in SBC treated with CIRT.
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Affiliation(s)
- Giulia Buizza
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy; (C.P.); (G.B.)
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy; (C.P.); (G.B.)
| | - Emma D’Ippolito
- Radiotherapists Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy; (E.D.); (G.R.); (A.I.); (F.V.); (E.O.)
| | - Giulia Fontana
- Clinical Bioengineering Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy;
| | - Silvia Molinelli
- Medical Physics Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy;
| | - Lorenzo Preda
- Radiology Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy;
- Unit of Radiology, Department of Intensive Medicine, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Giulia Riva
- Radiotherapists Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy; (E.D.); (G.R.); (A.I.); (F.V.); (E.O.)
| | - Alberto Iannalfi
- Radiotherapists Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy; (E.D.); (G.R.); (A.I.); (F.V.); (E.O.)
| | - Francesca Valvo
- Radiotherapists Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy; (E.D.); (G.R.); (A.I.); (F.V.); (E.O.)
| | - Ester Orlandi
- Radiotherapists Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy; (E.D.); (G.R.); (A.I.); (F.V.); (E.O.)
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy; (C.P.); (G.B.)
- Clinical Bioengineering Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy;
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22
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Ronchi S, Vischioni B, Bonora M, Vitolo V, Fiore M, Iannalfi A, Barcellini A, Molinelli S, Russo S, Maestri D, Ciocca M, Preda L, Valvo F. PO-0850: Proton Beam Reirradiation In Head And Neck Patients at CNAO: preliminary results. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00867-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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23
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Mancin A, Villani E, Montana S, Tampellini S, Iannalfi A, Valvo F, Gandola L. PO-1925: “The journey of the superhero MeV”: the CNAO's pediatric project. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01942-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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24
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Barcellini A, Vitolo V, Cobianchi L, Valvo F, Vischioni B, Bonora M, Fiore MR, Iannalfi A, Riva G, Ronchi S, Tornari E, Orlandi E. Pancreatic cancer: Does a short course of carbon ion radiotherapy worth during COVID-19 outbreak? Pancreatology 2020; 20:1004-1005. [PMID: 32418757 PMCID: PMC7217079 DOI: 10.1016/j.pan.2020.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | - Viviana Vitolo
- Corresponding author. National Center of Oncological Hadrontherapy (Fondazione CNAO), Strada Campeggi 53, Pavia, Italy
| | - Lorenzo Cobianchi
- General Surgery Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Barbara Vischioni
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Maria Bonora
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Maria Rosaria Fiore
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Alberto Iannalfi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Giulia Riva
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Sara Ronchi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Elena Tornari
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Ester Orlandi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
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25
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Sacco S, Ballati F, Gaetani C, Lomoro P, Farina LM, Bacila A, Imparato S, Paganelli C, Buizza G, Iannalfi A, Baroni G, Valvo F, Bastianello S, Preda L. Multi-parametric qualitative and quantitative MRI assessment as predictor of histological grading in previously treated meningiomas. Neuroradiology 2020; 62:1441-1449. [PMID: 32583368 DOI: 10.1007/s00234-020-02476-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/10/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Meningiomas are mainly benign tumors, though a considerable proportion shows aggressive behaviors histologically consistent with atypia/anaplasia. Histopathological grading is usually assessed through invasive procedures, which is not always feasible due to the inaccessibility of the lesion or to treatment contraindications. Therefore, we propose a multi-parametric MRI assessment as a predictor of meningioma histopathological grading. METHODS Seventy-three patients with 74 histologically proven and previously treated meningiomas were retrospectively enrolled (42 WHO I, 24 WHO II, 8 WHO III) and studied with MRI including T2 TSE, FLAIR, Gradient Echo, DWI, and pre- and post-contrast T1 sequences. Lesion masks were segmented on post-contrast T1 sequences and rigidly registered to ADC maps to extract quantitative parameters from conventional DWI and intravoxel incoherent motion model assessing tumor perfusion. Two expert neuroradiologists assessed morphological features of meningiomas with semi-quantitative scores. RESULTS Univariate analysis showed different distributions (p < 0.05) of quantitative diffusion parameters (Wilcoxon rank-sum test) and morphological features (Pearson's chi-square; Fisher's exact test) among meningiomas grouped in low-grade (WHO I) and higher grade forms (WHO II/III); the only exception consisted of the tumor-brain interface. A multivariate logistic regression, combining all parameters showing statistical significance in the univariate analysis, allowed discrimination between the groups of meningiomas with high sensitivity (0.968) and specificity (0.925). Heterogeneous contrast enhancement and low ADC were the best independent predictors of atypia and anaplasia. CONCLUSION Our multi-parametric MRI assessment showed high sensitivity and specificity in predicting histological grading of meningiomas. Such an assessment may be clinically useful in characterizing lesions without histological diagnosis. Key points • When surgery and biopsy are not feasible, parameters obtained from both conventional and diffusion-weighted MRI can predict atypia and anaplasia in meningiomas with high sensitivity and specificity. • Low ADC values and heterogeneous contrast enhancement are the best predictors of higher grade meningioma.
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Affiliation(s)
- Simone Sacco
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Francesco Ballati
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Clara Gaetani
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Pascal Lomoro
- Department of Radiology, Valduce Hospital, Como, Italy
| | | | - Ana Bacila
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Sara Imparato
- Diagnostic Imaging Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100, Pavia, PV, Italy
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Giulia Buizza
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Alberto Iannalfi
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- Bioengineering Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Francesca Valvo
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Stefano Bastianello
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Lorenzo Preda
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
- Diagnostic Imaging Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100, Pavia, PV, Italy.
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26
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Cuccia F, Fiore MR, Barcellini A, Iannalfi A, Vischioni B, Ronchi S, Bonora M, Riva G, Vai A, Facoetti A, Preda L, Valvo F, Vitolo V. Outcome and Toxicity of Carbon Ion Radiotherapy for Axial Bone and Soft Tissue Sarcomas. Anticancer Res 2020; 40:2853-2859. [PMID: 32366434 DOI: 10.21873/anticanres.14260] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 03/25/2020] [Accepted: 03/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Definitive radiotherapy for bone and soft tissues sarcomas benefits patients deemed unfit for surgery; poor outcomes have been reported with conventional photons, while interesting preliminary results have been described with particle in single-Institution experiences. The aim of the study was to retrospectively evaluate preliminary results of carbon ion radiotherapy (CIRT) in patients with axial bone and soft tissue sarcomas (BSTS) treated with curative intent at the National Center for Oncological Hadrontherapy (CNAO). PATIENTS AND METHODS From January 2013 to September 2018, 54 patients with axial BSTS were treated with CIRT at CNAO. Their median age was 50 years (range=19-79 years), males/females=1.4:1. Tumor site was the pelvis in 50% of cases (n=27), thoracic region in 24% (n=13), cervical spine in 15% (n=8) and lumbar in 11% (n=6). A total of 76% (n=41) of patients had primary disease, while 24% (n=13) had recurrent disease. Before CIRT, surgery was performed in 47% of cases, including positive margins (R1) in 8 patients, and macroscopic residual disease (R2) in 17. Histological subtypes were mainly represented by chondrosarcomas in 39% (n=21) of patients and osteosarcomas in 24% (n=13). Pre-treatment chemotherapy was administered in 40% of cases (n=22); no patient received previous radiotherapy. All treatments were performed with active scanning CIRT for a median total dose of 73.6 Gy (range=70.4-76.8 Gy), in 16 fractions (4 fractions per week). RESULTS Median follow-up was 24 months (range=4-61 months). Four patients were lost to follow-up. Acute toxicities were mild, no >G2 event was reported and no treatment interruption was required. For late toxicity, only G3 neuropathy was detected in 4% of cases (n=2). With a median time to local progression of 13 months (3-35), 15 local failures were observed, resulting in 2- and 3-year local control rates of 67.4% for both. Distant progression occurred in 12 patients, with 1-year progression-free survival (PFS) rate of 97.5%; 2- and 3-year rates were 92.2%. Fifteen patients died resulting in 1- 2- and 3-years overall survival (OS) rates of 87.1%, 75.4% and 64%, respectively. At log-rank test, gross total volume (GTV) >1,000 ml was found to be predictive of local failure (p=0.04), pre-treatment chemotherapy was found to be significantly related to PFS and OS (p=0.02 and p=0.016); also, recurrent disease and distant progression were significantly related to OS (p=0.019 and p=0.0013). Cox proportional-hazards model confirmed that GTV >1,000 ml was related to worse local control (p=0.0010). CONCLUSION CIRT for axial BSTS resulted in mild toxicity, showing promising results in terms of clinical outcomes. A longer follow-up is warranted.
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Affiliation(s)
- Francesco Cuccia
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy.,Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Maria Rosaria Fiore
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Amelia Barcellini
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Alberto Iannalfi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Barbara Vischioni
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Sara Ronchi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Maria Bonora
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Giulia Riva
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Alessandro Vai
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Angelica Facoetti
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Lorenzo Preda
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Viviana Vitolo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
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27
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Vitolo V, Barcellini A, Mirandola A, Facoetti A, Iannalfi A, Vischioni B, Fiore MR, Brugnatelli S, Secondino S, Ronchi S, Bonora M, Preda L, Valvo F. Is Proton Beam Radiotherapy Worthwhile in the Management of Angiosarcoma of the Scalp? Anticancer Res 2020; 40:1645-1649. [PMID: 32132069 DOI: 10.21873/anticanres.14114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/06/2020] [Accepted: 02/13/2020] [Indexed: 11/10/2022]
Abstract
In inoperable patients, the management of angiosarcoma of the scalp is challenging. Due to intrinsic, dosimetric and radiobiological properties, proton beam radiotherapy may be an effective and safe option to offer to these difficult-to-cure patients. Here, we report a case of angiosarcoma of the scalp treated successfully with proton beam radiotherapy. Angiosarcoma is a rare malignancy concerning around 2% of soft-tissue sarcomas and 5% of cutaneous soft-tissue sarcomas. Cutaneous angiosarcomas can occur in any part of the body, but the head and neck region is a common primary site and the scalp is a frequent site in elderly patients.
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Affiliation(s)
- Viviana Vitolo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Amelia Barcellini
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Alfredo Mirandola
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Angelica Facoetti
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Alberto Iannalfi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Barbara Vischioni
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Maria Rosaria Fiore
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Silvia Brugnatelli
- Department of Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simona Secondino
- Department of Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Ronchi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Maria Bonora
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Lorenzo Preda
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy.,Department of Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
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Zoia C, Lombardi F, Fiore MR, Montalbetti A, Iannalfi A, Sansone M, Bongetta D, Valvo F, Del Maestro M, Luzzi S, Galzio RJ. Sacral solitary fibrous tumour: surgery and hadrontherapy, a combined treatment strategy. Rep Pract Oncol Radiother 2020; 25:241-244. [PMID: 32025222 DOI: 10.1016/j.rpor.2020.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 10/24/2019] [Accepted: 01/24/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Cesare Zoia
- Neurosurgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Francesco Lombardi
- Neurosurgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Maria Rosaria Fiore
- National Center of Oncological Hadrontherapy (CNAO) Clinical Radiotherapy Unit, Pavia, Italy
| | - Andrea Montalbetti
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alberto Iannalfi
- National Center of Oncological Hadrontherapy (CNAO) Clinical Radiotherapy Unit, Pavia, Italy
| | - Mattia Sansone
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Daniele Bongetta
- Neurosurgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy (CNAO) Clinical Radiotherapy Unit, Pavia, Italy
| | - Mattia Del Maestro
- Neurosurgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Renato Juan Galzio
- Neurosurgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
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Zoia C, Lombardi F, Custodi VM, Lovati E, Lucotti P, Iannalfi A, D'ippolito E, Valvo F, Bongetta D. Evaluation of the early endocrinological sequelae after hadron therapy on anterior skull base lesions in the adult population. MINERVA ENDOCRINOL 2019; 45:162-164. [PMID: 31738035 DOI: 10.23736/s0391-1977.19.03071-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, IRCCS San Matteo Polyclinic Hospital and Foundation, Pavia, Italy -
| | - Francesco Lombardi
- Neurosurgery Unit, IRCCS San Matteo Polyclinic Hospital and Foundation, Pavia, Italy
| | - Viola M Custodi
- Neurosurgery Unit, IRCCS San Matteo Polyclinic Hospital and Foundation, Pavia, Italy
| | - Elisabetta Lovati
- Endocrinology Unit, Internal Medicine I, IRCCS San Matteo Polyclinic Hospital and Foundation, Pavia, Italy
| | - Pietro Lucotti
- Endocrinology Unit, Internal Medicine I, IRCCS San Matteo Polyclinic Hospital and Foundation, Pavia, Italy
| | - Alberto Iannalfi
- Clinical Radiotherapy Unit, National Center of Oncological Hadron Therapy (CNAO), Pavia, Italy
| | - Emma D'ippolito
- Clinical Radiotherapy Unit, National Center of Oncological Hadron Therapy (CNAO), Pavia, Italy
| | - Francesca Valvo
- Clinical Radiotherapy Unit, National Center of Oncological Hadron Therapy (CNAO), Pavia, Italy
| | - Daniele Bongetta
- Neurosurgery Unit, Ospedale Fatebenefratelli e Oftalmico, ASST Fatebenefratelli Sacco, Milan, Italy
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Viselner G, Farina L, Lucev F, Turpini E, Lungarotti L, Bacila A, Iannalfi A, D'Ippolito E, Vischioni B, Ronchi S, Marchioni E, Valvo F, Bastianello S, Preda L. Brain MR findings in patients treated with particle therapy for skull base tumors. Insights Imaging 2019; 10:94. [PMID: 31549243 PMCID: PMC6757093 DOI: 10.1186/s13244-019-0784-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/19/2019] [Indexed: 12/27/2022] Open
Abstract
Nowadays, hadrontherapy is increasingly used for the treatment of various tumors, in particular of those resistant to conventional radiotherapy. Proton and carbon ions are characterized by physical and biological features that allow a high radiation dose to tumors, minimizing irradiation to adjacent normal tissues. For this reason, radioresistant tumors and tumors located near highly radiosensitive critical organs, such as skull base tumors, represent the best target for this kind of therapy. However, also hadrontherapy can be associated with radiation adverse effects, generally referred as acute, early-delayed and late-delayed. Among late-delayed effects, the most severe form of injury is radiation necrosis. There are various underlying mechanisms involved in the development of radiation necrosis, as well as different clinical presentations requiring specific treatments. In most cases, radiation necrosis presents as a single focal lesion, but it can be multifocal and involve a single or multiple lobes simulating brain metastasis, or it can also involve both cerebral hemispheres. In every case, radiation necrosis results always related to the extension of radiation delivery field. Multiple MRI techniques, including diffusion, perfusion imaging, and spectroscopy, are important tools for the radiologist to formulate the correct diagnosis. The aim of this paper is to illustrate the possible different radiologic patterns of radiation necrosis that can be observed in different MRI techniques in patients treated with hadrontherapy for tumors involving the skull base. The images of exemplary cases of radiation necrosis are also presented.
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Affiliation(s)
- Gisela Viselner
- Diagnostic Imaging Unit, National Center of Oncological Hadrontherapy (CNAO), 27100, Pavia, Italy
| | - Lisa Farina
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Federica Lucev
- Diagnostic Radiology Residency School, University of Pavia, Pavia, Italy
| | - Elena Turpini
- Diagnostic Radiology Residency School, University of Pavia, Pavia, Italy
| | - Luca Lungarotti
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ana Bacila
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Alberto Iannalfi
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Emma D'Ippolito
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Barbara Vischioni
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Ronchi
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | | | - Francesca Valvo
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Stefano Bastianello
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Lorenzo Preda
- Diagnostic Imaging Unit, National Center of Oncological Hadrontherapy (CNAO), 27100, Pavia, Italy. .,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
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Facoetti A, Aprile C, Cavagnini M, Ciocca M, Iannalfi A, Lodola L, Marenco M, Nano R, Pasi F, Persico M, Valvo F, Orecchia R. EP-2159 Influence of L-Dopa pretreatment on cellular features in T98G cells. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32579-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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32
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Vischioni B, Dhanireddy B, Bonora M, Ronchi S, Vitolo V, Fiore M, D’Ippolito E, Petrucci R, Severo C, Ciurlia E, Hasegawa A, Iannalfi A, Valvo F, Orecchia R. PO-0728 reirradiation of salivary gland tumors with carbon ion radiotherapy (CIRT) at CNAO. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31148-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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D’Ippolito E, Iannalfi A, Bonora M, Vischioni B, Fiore M, Ronchi S, Vitolo V, Barcellini A, Petrucci R, Mirandola A, Maestri D, Magro G, Facoetti A, Viselner G, Ciocca M, Preda L, Valvo F, Orecchia R. PO-0741 Active spot-scanning proton therapy for intracranial meningiomas: CNAO experience. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31161-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Barcellini A, Vitolo V, Fiore M, Iannalfi A, Vischioni B, Fossati P, Ronchi S, Bonora M, D'Ippolito E, Petrucci R, Facoetti A, Mirandola A, Vai A, Molinelli S, Mastella E, Russo S, Viselner G, Preda L, Ciocca M, Valvo F, Orecchia R. EP-1496 Feasibility of carbon ion radiotherapy for the melanoma of the lower genital tract. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31916-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Buizza G, Paganelli C, Fontana G, Franconeri A, Raciti M, Pella A, Anemoni L, Iannalfi A, Preda L, Valvo F, Baroni G. EP-2051 A comparative analysis of MR signal normalization methods during proton therapy treatment. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32471-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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D’Ippolito E, Iannalfi A, Vischioni B, Vitolo V, Fiore M, Ronchi S, Bonora M, Barcellini A, Petrucci R, Mirandola A, Vai A, Mastella E, Viselner G, Ciocca M, Preda L, Valvo F, Orecchia R. EP-1147 Local control rate in patients with skull-base chondrosarcoma treated with particle therapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31567-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ronchi S, Vischioni B, Vitolo V, Bonora M, Hasegawa A, Fiore M, Iannalfi A, D’Ippolito E, Petrucci R, Barcellini A, Molinelli S, Maestri D, Viselner G, Facoetti A, Ciocca M, Preda L, Valvo F, Orecchia R. EP-1188 Carbon ion radiotherapy for recurrent pleomorphic adenoma at CNAO: preliminary results. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31608-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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38
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Iannalfi A, D’Ippolito E, Vitolo V, Vischioni B, Fiore M, Bonora M, Ronchi S, Barcellini A, Petrucci R, Molinelli S, Mirandola A, Russo S, Facoetti A, Vai A, Mastella E, Viselner G, Magro G, Ciocca M, Preda L, Valvo F, Orecchia R. PO-0716 Skull-base chordoma treated with proton and carbon ion radiotherapy : CNAO clinical experience. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31136-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vitolo V, Barcellini A, Fossati P, Fiore MR, Vischioni B, Iannalfi A, Facoetti A, Bonora M, Ronchi S, D'Ippolito E, Petrucci R, Viselner G, Preda L, Ciocca M, Valvo F, Orecchia R. Carbon Ion Radiotherapy in the Management of Unusual Liposarcomas: A Case Report. In Vivo 2019; 33:529-533. [PMID: 30804137 PMCID: PMC6506314 DOI: 10.21873/invivo.11506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/29/2018] [Revised: 12/07/2018] [Accepted: 12/11/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Liposarcomas are the most common soft-tissue sarcomas in adulthood. Orbital and spermatic cord liposarcomas are uncommon and there is no consensus on their management. The treatment of choice is wide excision, which may be destructive and lead to unacceptable morbidity. When surgery is declined by patients and in recurrent disease, management can be challenging. We report two cases of liposarcoma treated with carbon ion radiotherapy at the National Center for Oncological Hadrontherapy (Fondazione CNAO) in Italy. CASE REPORT A woman with orbital liposarcoma and a man with spermatic cord liposarcoma were referred to our Center and accepted for carbon ion radiotherapy. The treatment was well tolerated and late toxicities were mild. Good local control was achieved in patients. CONCLUSION In our experience, carbon ion radiotherapy is an effective and safe option, especially in cases of tumor at high risk for local relapse, in patients with multiple local recurrences, and in patients who refuse destructive surgery.
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Affiliation(s)
- Viviana Vitolo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Amelia Barcellini
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Piero Fossati
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Maria Rosaria Fiore
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Barbara Vischioni
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Alberto Iannalfi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Angelica Facoetti
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Maria Bonora
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Sara Ronchi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Emma D'Ippolito
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Rachele Petrucci
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Gisela Viselner
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Lorenzo Preda
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Mario Ciocca
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Roberto Orecchia
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
- European Institute of Oncology, Milan, Italy
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Barcellini A, Vitolo V, Facoetti A, Fossati P, Preda L, Fiore MR, Vischioni B, Iannalfi A, Bonora M, Ronchi S, D'Ippolito E, Petrucci R, Viselner G, Ciocca M, Valvo F, Orecchia R. Feasibility of Carbon Ion Radiotherapy in the Treatment of Gynecological Melanoma. In Vivo 2019; 33:473-476. [PMID: 30804128 PMCID: PMC6506293 DOI: 10.21873/invivo.11497] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 12/14/2018] [Revised: 12/28/2018] [Accepted: 01/07/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Malignant melanoma of the lower genital tract is a rare disease known to have a poor prognosis. Because of the high rate of distant metastasis and unsatisfactory survival benefit, a more conservative treatment approach, instead of extensive surgery, may be warranted. Gynecological melanoma is a radioresistant tumor, an ideal disease to test the biological efficacy of carbon ion radiotherapy (CIRT). AIM To report our preliminary experience with CIRT in the treatment of gynecological melanoma at the National Center of Oncological Hadrontherapy (CNAO). PATIENTS AND METHODS Between January 2016 and February 2017, four patients were admitted for CIRT at CNAO. A case of cervical melanoma was treated with palliative aim because of large volume macroscopic disease, while three cases of vaginal melanoma were irradiated with a total dose of 68.8 Gy (relative biological effectiveness) in 16 fractions delivered over 4 weeks (4 days a week). RESULTS The age of women ranged between 49 and 72 (median=60.5 years) years. Treatment was well tolerated in all patients and all women completed the scheduled treatment course. During CIRT, toxicity was mild. For patients with vaginal disease, local control was 10.23 and 12.6 months, while that for cervical malignant melanoma was 7.3 months. All patients experienced systemic progression, with median distant metastasis-free survival of 11.7 months. The median overall survival for the whole patient group was 11.41 months. CONCLUSION In our first experiences, CIRT appears to be a safe non-invasive option for malignant melanoma of the lower genital tract, but more data and longer follow-up are necessary in order to evaluate the effectiveness and late effects.
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Affiliation(s)
| | - Viviana Vitolo
- National Center of Oncological Hadrontherapy, Pavia, Italy
| | | | - Piero Fossati
- National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Lorenzo Preda
- National Center of Oncological Hadrontherapy, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | | | | | | | - Maria Bonora
- National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Sara Ronchi
- National Center of Oncological Hadrontherapy, Pavia, Italy
| | | | | | | | - Mario Ciocca
- National Center of Oncological Hadrontherapy, Pavia, Italy
| | | | - Roberto Orecchia
- National Center of Oncological Hadrontherapy, Pavia, Italy
- European Institute of Oncology, Milan, Italy
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41
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Vitolo V, Fiore MR, Barcellini A, Vischioni B, Iannalfi A, Facoetti A, Fossati P, Bonora M, Ronchi S, D'Ippolito E, Petrucci R, Viselner G, Ciocca M, Preda L, Valvo F, Orecchia R. Carbon Ion Radiotherapy in the Management of the Tumors of the Peripheral Nervous System. Anticancer Res 2019; 39:909-913. [PMID: 30711975 DOI: 10.21873/anticanres.13193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 12/13/2018] [Accepted: 12/17/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Malignant peripheral nerve sheaths tumors (MPNST) are rare, highly aggressive and radioresistant tumors of soft tissue. Carbon ion radiotherapy (CIRT) seems to be an attractive treatment option when surgery is not possible or refused by the patient. The aim of this study was to report our preliminary results (outcomes and toxicity) of CIRT in the treatment of MPNSTs. PATIENTS AND METHODS Our study retrospectively analyzed 13 patients (median age=54 years; range=23-72 years) with MPNST treated with CIRT for a median total dose of 73.6 Gy (relative biological effectiveness) (range=70.4-76.8 Gy) between 2013 and 2016. RESULTS Six local progressions were recorded, with a median local progression-free survival of 23.2 months (range=2.2-45.4 months). Acute toxicities were mild. Late toxicity of grade 2 or more was noted in two patients. CONCLUSION CIRT yielded good local control with a low rate of acute and late toxicities.
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Affiliation(s)
- Viviana Vitolo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Maria Rosaria Fiore
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Amelia Barcellini
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Barbara Vischioni
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Alberto Iannalfi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Angelica Facoetti
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Piero Fossati
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Maria Bonora
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Sara Ronchi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Emma D'Ippolito
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Rachele Petrucci
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Gisela Viselner
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Mario Ciocca
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Lorenzo Preda
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Roberto Orecchia
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy.,IEO European Institute of Oncology IRCCS, Milan, Italy
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Garibaldi C, Ferrari M, Colandrea M, Cascio A, Ciocca M, Iannalfi A, D’Ippolito E, Pesente S, Grana C, Jereczek-Fossa B, Cremonesi M. 244. Target volume definition with MRI and 68 Ga-DOTATOC-PET/CT for patients with meningiomas. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Picca A, Berzero G, Diamanti L, Bini P, Bacila A, Farina L, Bernini S, D’Ippolito E, Preda L, Iannalfi A. P05.84 Clinical and radiological patterns of brain radiation necrosis after ion beam radiotherapy for head and neck tumors. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.410] [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)
- A Picca
- Department of Neuro-oncology, Mondino Foundation IRCCS, Pavia, Italy
- Neuroscience Consortium, Mondino Foundation IRCSS, Monza Policlinico and Pavia University, Pavia, Italy
| | - G Berzero
- Department of Neuro-oncology, Mondino Foundation IRCCS, Pavia, Italy
| | - L Diamanti
- Department of Neuro-oncology, Mondino Foundation IRCCS, Pavia, Italy
| | - P Bini
- Department of Neuro-oncology, Mondino Foundation IRCCS, Pavia, Italy
| | - A Bacila
- Department of Neuroradiology, Mondino Foundation IRCCS, Pavia, Italy
| | - L Farina
- Department of Neuroradiology, Mondino Foundation IRCCS, Pavia, Italy
| | - S Bernini
- Laboratory of Neuropsychology, Mondino Foundation IRCCS, Pavia, Italy
| | - E D’Ippolito
- Radiotherapy Unit, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - L Preda
- Diagnostic Imaging Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - A Iannalfi
- Radiotherapy Unit, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
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Iannalfi A, D’Ippolito E, Vitolo V, Vischioni B, Fiore M, Bonora M, Ronchi S, Caivano D, Barcellini A, Mirandola A, Molinelli S, Russo S, Facoetti A, Vai A, Mastella E, Viselner G, Raciti M, Fanizza M, Magro G, Maestri D, Ciocca M, Preda L, Valvo F, Orecchia R. P05.39 Skull-base chordoma treated with proton and carbon ion radiotherapy: C.N.A.O. clinical experience. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.365] [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
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - M Raciti
- Università degli Studi di Pavia, Pavia, Italy
| | - M Fanizza
- Università degli Studi di Pavia, Pavia, Italy
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Buizza G, Paganelli C, Fontana G, Franconeri A, Raciti MV, Viselner G, Anemoni L, Iannalfi A, Preda L, Baroni G. [OA044] Quantitative DW-MRI for treatment evaluation in particle therapy: ROLE of ADC maps estimation. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.06.116] [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: 10/28/2022] Open
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Preda L, Stoppa D, Fiore MR, Fontana G, Camisa S, Sacchi R, Ghitti M, Viselner G, Fossati P, Valvo F, Vitolo V, Bonora M, Iannalfi A, Vischioni B, Vai A, Mastella E, Baroni G, Orecchia R. MRI evaluation of sacral chordoma treated with carbon ion radiotherapy alone. Radiother Oncol 2018; 128:203-208. [DOI: 10.1016/j.radonc.2017.11.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/20/2017] [Accepted: 11/30/2017] [Indexed: 11/16/2022]
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Garibaldi C, Ferrari M, Colandrea M, Cascio A, Ciocca M, Iannalfi A, D'Ippolito E, Pesente S, Grana C, Cremonesi M. EP-2110: Target volume definition with MRI and 68Ga-DOTATOC-PET/CT for patients with meningiomas. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32419-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Caivano D, Vitolo V, Fiore M, Iannalfi A, Vischioni B, Bonora M, D'ippolito E, Ronchi S, Molinelli S, Ciocca M, Valvo F, Orecchia R. EP-1421: Carbon Ions In The Treatment Of Pancreatic Disease. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31730-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Scoccianti S, Detti B, Meattini I, Iannalfi A, Sardaro A, Leonulli BG, Martinelli F, Bordi L, Pellicanò G, Biti G. Symptomatic Leptomeningeal and Intramedullary Metastases from Intracranial Glioblastoma Multiforme: A Case Report. Tumori 2018; 94:877-81. [DOI: 10.1177/030089160809400620] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Glioblastoma multiforme infrequently metastasizes to the leptomeninges and even more rarely to the spinal cord. Moreover, very few patients with intracranial glioblastoma develop symptoms from spinal dissemination, with most patients not surviving long enough for spinal disease to become clinically evident. Case Report We present a rare case of symptomatic diffuse spinal leptomeningeal metastases simultaneously to an intramedullary lesion from an intracranial glioblastoma multiforme. After the diagnosis of spinal metastases the patient was treated with limited-field spinal radiotherapy (30 Gy in 3-Gy fractions). Results Radiotherapy on the main spinal lesions provided either relief from pain or mild improvement of neurological deficits. The patient died due to intracranial progression 4 months after diagnosis of spinal seeding and 17 months after diagnosis of the primary disease. We analyzed leptomeningeal and spinal metastases from glioblastoma multiforme with reference to the literature. Conclusions Radiotherapy for spinal disease may provide important symptom relief but the prognosis of these patients remains dramatically poor. As the local control of primary glioblastoma multiforme has improved with recent therapeutic advances, distant metastasis from high-grade gliomas is likely to become a more common clinical problem and such patients need to be included in clinical trials to evaluate new therapeutic approaches.
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Affiliation(s)
| | - Beatrice Detti
- Department of Radiotherapy, University of Florence, Florence
| | - Icro Meattini
- Department of Radiotherapy, University of Florence, Florence
| | | | - Angela Sardaro
- Department of Internal Medicine, Institute of Radiology, University of Bari, Bari
| | | | | | - Lorenzo Bordi
- Department of Neurological Surgery, Careggi Hospital, Florence, Italy
| | | | - Giampaolo Biti
- Department of Radiotherapy, University of Florence, Florence
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Cobianchi L, Peloso A, Vischioni B, Panizza D, Fiore MR, Fossati P, Vitolo V, Iannalfi A, Ciocca M, Brugnatelli S, Dominioni T, Bugada D, Maestri M, Alessiani M, Valvo F, Orecchia R, Dionigi P. Erratum to: Surgical spacer placement prior carbon ion radiotherapy (CIRT): an effective feasible strategy to improve the treatment for sacral chordoma. World J Surg Oncol 2016; 14:262. [PMID: 27733205 PMCID: PMC5062855 DOI: 10.1186/s12957-016-1020-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 10/04/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Lorenzo Cobianchi
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy. .,IRCCS Policlinico San Matteo Foundation, General Surgery 1, Pavia, Italy. .,Department of General Surgery, IRCCS San Matteo Foundation, University of Pavia, Piazzale Golgi, Pavia, 27100, Italy.
| | - Andrea Peloso
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.,IRCCS Policlinico San Matteo Foundation, General Surgery 1, Pavia, Italy
| | - Barbara Vischioni
- Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy
| | - Denis Panizza
- Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy
| | - Maria Rosaria Fiore
- Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy
| | - Piero Fossati
- Department of Radiation Oncology, European Institute of Oncology (IEO), Milan, Italy
| | - Viviana Vitolo
- Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy
| | - Alberto Iannalfi
- Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy
| | - Mario Ciocca
- Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy
| | - Silvia Brugnatelli
- IRCCS Policlinico San Matteo Foundation, Department of Onco-Hematology, Oncology Section, Pavia, Italy
| | - Tommaso Dominioni
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.,IRCCS Policlinico San Matteo Foundation, General Surgery 1, Pavia, Italy
| | - Dario Bugada
- Department of Surgical Science, University of Parma, Parma, Italy
| | - Marcello Maestri
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.,IRCCS Policlinico San Matteo Foundation, General Surgery 1, Pavia, Italy
| | - Mario Alessiani
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.,IRCCS Policlinico San Matteo Foundation, General Surgery 1, Pavia, Italy
| | - Francesca Valvo
- Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy
| | - Roberto Orecchia
- Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy.,Department of Radiation Oncology, European Institute of Oncology (IEO), Milan, Italy
| | - Paolo Dionigi
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.,IRCCS Policlinico San Matteo Foundation, General Surgery 1, Pavia, Italy
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