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Ferrigno I, Verzellesi L, Ottone M, Bonacini M, Rossi A, Besutti G, Bonelli E, Colla R, Facciolongo N, Teopompi E, Massari M, Mancuso P, Ferrari AM, Pattacini P, Trojani V, Bertolini M, Botti A, Zerbini A, Giorgi Rossi P, Iori M, Salvarani C, Croci S. CCL18, CHI3L1, ANG2, IL-6 systemic levels are associated with the extent of lung damage and radiomic features in SARS-CoV-2 infection. Inflamm Res 2024:10.1007/s00011-024-01852-1. [PMID: 38308760 DOI: 10.1007/s00011-024-01852-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVE AND DESIGN We aimed to identify cytokines whose concentrations are related to lung damage, radiomic features, and clinical outcomes in COVID-19 patients. MATERIAL OR SUBJECTS Two hundred twenty-six patients with SARS-CoV-2 infection and chest computed tomography (CT) images were enrolled. METHODS CCL18, CHI3L1/YKL-40, GAL3, ANG2, IP-10, IL-10, TNFα, IL-6, soluble gp130, soluble IL-6R were quantified in plasma samples using Luminex assays. The Mann-Whitney U test, the Kruskal-Wallis test, correlation and regression analyses were performed. Mediation analyses were used to investigate the possible causal relationships between cytokines, lung damage, and outcomes. AVIEW lung cancer screening software, pyradiomics, and XGBoost classifier were used for radiomic feature analyses. RESULTS CCL18, CHI3L1, and ANG2 systemic levels mainly reflected the extent of lung injury. Increased levels of every cytokine, but particularly of IL-6, were associated with the three outcomes: hospitalization, mechanical ventilation, and death. Soluble IL-6R showed a slight protective effect on death. The effect of age on COVID-19 outcomes was partially mediated by cytokine levels, while CT scores considerably mediated the effect of cytokine levels on outcomes. Radiomic-feature-based models confirmed the association between lung imaging characteristics and CCL18 and CHI3L1. CONCLUSION Data suggest a causal link between cytokines (risk factor), lung damage (mediator), and COVID-19 outcomes.
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Affiliation(s)
- Ilaria Ferrigno
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Verzellesi
- Unit of Medical Physics, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marta Ottone
- Unit of Epidemiology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Martina Bonacini
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandro Rossi
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giulia Besutti
- Unit of Radiology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences With Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Efrem Bonelli
- Unit of Radiology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Clinical Chemistry and Endocrinology Laboratory, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rossana Colla
- Clinical Chemistry and Endocrinology Laboratory, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Nicola Facciolongo
- Unit of Respiratory Diseases, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisabetta Teopompi
- Multidisciplinary Internal Medicine Unit, Guastalla Hospital, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Massari
- Unit of Infectious Diseases, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pamela Mancuso
- Unit of Epidemiology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Anna Maria Ferrari
- Department of Emergency, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pierpaolo Pattacini
- Unit of Radiology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Valeria Trojani
- Unit of Medical Physics, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Bertolini
- Unit of Medical Physics, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Botti
- Unit of Medical Physics, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandro Zerbini
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Unit of Epidemiology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mauro Iori
- Unit of Medical Physics, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carlo Salvarani
- Department of Surgery, Medicine, Dentistry and Morphological Sciences With Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Rheumatology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefania Croci
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
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Ciammella P, Cozzi S, Borghetti P, Galaverni M, Nardone V, Ruggieri MP, Sepulcri M, Scotti V, Bruni A, Zanelli F, Piro R, Tagliavini E, Botti A, Iori F, Alì E, Bennati C, Tiseo M. Redetermination of PD-L1 expression after chemio-radiation in locally advanced PDL1 negative NSCLC patients: retrospective multicentric analysis. Front Oncol 2024; 14:1325249. [PMID: 38357196 PMCID: PMC10866304 DOI: 10.3389/fonc.2024.1325249] [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: 10/20/2023] [Accepted: 01/02/2024] [Indexed: 02/16/2024] Open
Abstract
Background Chemoradiation therapy (CRT) is the treatment of choice for locally advanced non-small cell lung cancer (LA-NSCLC). Several clinical trials that combine programmed cell death 1 (PD1) axis inhibitors with radiotherapy are in development for patients with LA-NSCLC. However, the effect of CRT on tumor cells programmed cell death ligand-1 (PD-L1) expression is unknown. Methods In this multicentric retrospective study, we analyzed paired NSCLC specimens that had been obtained pre- and post-CRT. PD-L1 expression on tumor cells was studied by immunohistochemistry. The purpose of this study was to evaluate the feasibility, risk of complications, and clinical relevance of performing re-biopsy after CRT in patients with PD-L1 negative LA-NSCLC. Results Overall, 31 patients from 6 centers with PD-L1 negative LA-NSCLC were analyzed. The percentage of tumor cells with PD-L1 expression significantly increased between pre- and post-CRT specimens in 14 patients (45%). Nine patients had unchanged PD-L1 expression after CRT, in five patients the rebiopsy material was insufficient for PD-L1 analysis and in two patients no tumor cells at rebiopsy were found. The post-rebiopsy complication rate was very low (6%). All patients with positive PD-L1 re-biopsy received Durvalumab maintenance after CRT, except one patient who had a long hospitalization for tuberculosis reactivation. Median PFS of patients with unchanged or increased PD-L1 expression was 10 and 16.9 months, respectively. Conclusion CRT administration can induce PD-L1 expression in a considerable fraction of PD-L1 negative patients at baseline, allowing them receiving the maintenance Durvalumab in Europe. Hence, after a definitive CRT, PD-L1 redetermination should be considered in patients with LA-NSCLC PD-L1 negative, to have a better selection of maintenance Durvalumab candidates.
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Affiliation(s)
- Patrizia Ciammella
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Salvatore Cozzi
- Radiation Oncology Department, Centre Lèon Bèrard, Lyon, France
| | - Paolo Borghetti
- Dipartimento di Radioterapia Oncologica, Università e ASST Spedali Civili di Brescia, Brescia, Italy
| | - Marco Galaverni
- Radiation Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Valerio Nardone
- Dipartimento di Medicina di Precisione, Università degli Studi della Campania “L. Vanvitelli, Napoli, Italy
| | - Maria Paola Ruggieri
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Matteo Sepulcri
- Radiation Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Vieri Scotti
- Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Alessio Bruni
- Radiation Therapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Francesca Zanelli
- Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Roberto Piro
- Pulmonology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elena Tagliavini
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Botti
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federico Iori
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Emanuele Alì
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Chiara Bennati
- Department of Hematology-Onco, S Maria delle Croci Hospital, Ravenna, Italy
| | - Marcello Tiseo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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Iori M, Grassi E, Piergallini L, Meglioli G, Botti A, Sceni G, Cucurachi N, Verzellesi L, Finocchiaro D, Versari A, Fraboni B, Fioroni F. Safety injections of nuclear medicine radiotracers: towards a new modality for a real-time detection of extravasation events and 18F-FDG SUV data correction. EJNMMI Phys 2023; 10:31. [PMID: 37221434 DOI: 10.1186/s40658-023-00556-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 05/15/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND 18F-FDG PET/CT imaging allows to study oncological patients and their relative diagnosis through the standardised uptake value (SUV) evaluation. During radiopharmaceutical injection, an extravasation event may occur, making the SUV value less accurate and possibly leading to severe tissue damage. The study aimed to propose a new technique to monitor and manage these events, to provide an early evaluation and correction to the estimated SUV value through a SUV correction coefficient. METHODS A cohort of 70 patients undergoing 18F- FDG PET/CT examinations was enrolled. Two portable detectors were secured on the patients' arms. The dose-rate (DR) time curves on the injected DRin and contralateral DRcon arm were acquired during the first 10 min of injection. Such data were processed to calculate the parameters ΔpinNOR = (DRinmax- DRinmean)/DRinmax and ΔRt = (DRin(t) - DRcon(t)), where DRinmax is the maximum DR value, DRinmean is the average DR value in the injected arm. OLINDA software allowed dosimetric estimation of the dose in the extravasation region. The estimated residual activity in the extravasation site allowed the evaluation of the SUV's correction value and to define an SUV correction coefficient. RESULTS Four cases of extravasations were identified for which ΔRt [(390 ± 26) µSv/h], while ΔRt [(150 ± 22) µSv/h] for abnormal and ΔRt [(24 ± 11) µSv/h] for normal cases. The ΔpinNOR showed an average value of (0.44 ± 0.05) for extravasation cases and an average value of (0.91 ± 0.06) and (0.77 ± 0.23) in normal and abnormal classes, respectively. The percentage of SUV reduction (SUV%CR) ranges between 0.3% and 6%. The calculated self-tissue dose values range from 0.027 to 0.573 Gy, according to the segmentation modality. A similar correlation between the inverse of ΔpinNOR and the normalised ΔRt with the SUV correction coefficient was found. CONCLUSIONS The proposed metrics allowed to characterised the extravasation events in the first few minutes after the injection, providing an early SUV correction when necessary. We also assume that the characterisation of the DR-time curve of the injection arm is sufficient for the detection of extravasation events. Further validation of these hypotheses and key metrics is recommended in larger cohorts.
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Affiliation(s)
- Mauro Iori
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Elisa Grassi
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Lorenzo Piergallini
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Greta Meglioli
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Andrea Botti
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Giada Sceni
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
- Department of Physics, University of Bologna, Bologna, Italy
| | - Noemi Cucurachi
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy.
- Department of Physics, University of Padova, Padua, Italy.
| | - Laura Verzellesi
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
- Department of Physics, University of Bologna, Bologna, Italy
| | - Domenico Finocchiaro
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
- Department of Physics, University of Bologna, Bologna, Italy
| | - Annibale Versari
- Nuclear Medicine Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Federica Fioroni
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
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Cozzi S, Ruggieri MP, Bardoscia L, Najafi M, Blandino G, Giaccherini L, Manicone M, Ramundo D, Rosca A, Solla DS, Botti A, Lambertini D, Ciammella P, Iotti C. Good clinical practice and the use of hypofractionation radiation schedules as weapons to reduce the risk of COVID-19 infections in radiation oncology unit: A mono-institutional experience. J Cancer Res Ther 2023; 19:644-649. [PMID: 37470588 DOI: 10.4103/jcrt.jcrt_529_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND After coronavirus disease outbreak emerged in 2019, radiotherapy departments had to adapt quickly their health system and establish new organizations and priorities. The purpose of this work is to report our experience in dealing with COVID-19 emergency, how we have reorganized our clinical activity, changed our priorities, and stressed the use of hypofractionation in the treatment of oncological diseases. MATERIALS AND METHODS The patients' circuit of first medical examinations and follow-up was reorganized; a more extensive use of hypofractionated schedules was applied; a daily triage of the patients and staff, use of personal protective equipment, hand washing, environment sanitization, social distancing and limitations for the patients' caregivers in the department, unless absolutely essential, were performed; patients with suspected or confirmed COVID-19 were treated at the end of the day. In addition, the total number of radiotherapy treatment courses, patients and sessions, in the period from February 15 to April 30, 2020, comparing the same time period in 2018 were retrospectively investigated. In particular, changes in hypofractionated schedules adopted for the treatment of breast and prostate cancer and palliative bone metastasis were analyzed. RESULTS Between February 15, and April 30, 2020, an increased number of treatments was carried out: Patients treated were overall 299 compared to 284 of the same period of 2018. Stressing the use of hypofractionation, 2036 RT sessions were performed, with a mean number of fractions per course of 6.8, compared to 3566 and 12.6, respectively, in 2018. For breast cancer, the schedule in 18 fractions has been abandoned and treatment course of 13 fractions has been introduced; a 27% reduction in the use of 40.5 Gy in 15 fractions, (67 treatments in 2018-49 in 2020) was reported. An increase of 13% of stereotactic body radiation therapy for prostate cancer was showed. The use of the 20 Gy in 4 or 5 sessions for the treatment of symptomatic bone metastasis decreased of 17.5% in favor of 8 Gy-single fraction. Three patients results COVID-19 positive swab: 1 during, 2 after treatment. Only one staff member developed an asymptomatic infection. CONCLUSIONS The careful application of triage, anti-contagion and protective measures, a more extensive use of hypofractionation allowed us to maintain an effective and continuous RT service with no delayed/deferred treatment as evidenced by the very low number of patients developing COVID-19 infection during or in the short period after radiotherapy. Our experience has shown how the reorganization of the ward priority, the identification of risk factors with the relative containment measures can guarantee the care of oncological patients, who are potentially at greater risk of contracting the infection.
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Affiliation(s)
- Salvatore Cozzi
- Radiation Therapy Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Maria Paola Ruggieri
- Radiation Therapy Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Lilia Bardoscia
- Radiation Therapy Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Masoumeh Najafi
- Department of Radiation Oncology Shohadaye Haft-e-Tir Hospital, Iran University of Medical Science, Teheran, Iran
| | - Gladys Blandino
- Radiation Therapy Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Lucia Giaccherini
- Radiation Therapy Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Moana Manicone
- Radiation Therapy Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Dafne Ramundo
- Radiation Therapy Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Ala Rosca
- Radiation Therapy Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Dario Salvatore Solla
- Radiation Therapy Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Andrea Botti
- Medical Physics Unit, Department of Oncology and Advanced technology, AUSL-IRCCS di Reggio Emilia, Italy
| | - Daniele Lambertini
- Medical Physics Unit, Department of Oncology and Advanced technology, AUSL-IRCCS di Reggio Emilia, Italy
| | - Patrizia Ciammella
- Radiation Therapy Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Cinzia Iotti
- Radiation Therapy Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
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Cozzi S, Ruggieri MP, Alì E, Ghersi SF, Vigo F, Augugliaro M, Giaccherini L, Iori F, Najafi M, Bardoscia L, Botti A, Trojani V, Ciammella P, Iotti C. Moderately Hypofractionated Helical Tomotherapy for Prostate Cancer: Ten-year Experience of a Mono-institutional Series of 415 Patients. In Vivo 2023; 37:777-785. [PMID: 36881094 PMCID: PMC10026640 DOI: 10.21873/invivo.13141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND/AIM Radiotherapy represents an important therapeutic option in the management of prostate cancer (PCa). As helical tomotherapy may improve toxicity outcomes, we aimed to evaluate and report the toxicity and clinical outcomes of localized PCa patients treated with moderately hypofractionated helical tomotherapy. PATIENTS AND METHODS We retrospectively analyzed 415 patients affected by localized PCa and treated with moderately hypofractionated helical tomotherapy in our department from January 2008 to December 2020. All patients were stratified according to the D'Amico risk classification: low-risk 21%, favorable intermediate-risk 16%, unfavorable intermediate-risk 30.4%, and high-risk 32.6%. The dose prescription for high-risk patients was 72.8 Gy to the prostate (planning tumor volume-PTV1), 61.6 Gy to the seminal vesicles (PTV2), and 50.4 Gy to the pelvic lymph nodes (PTV3) in 28 fractions; for low- and intermediate-risk patients 70 Gy for PTV1, 56 Gy for PTV2, and 50.4 Gy for PTV3 in 28 fractions. Image-guided radiation therapy was performed daily in all patients by mega-voltage computed tomography. Forty-one percent of patients received androgen deprivation therapy (ADT). Acute and late toxicity was assessed according to the National Cancer Institute's Common Terminology Criteria for Adverse Events v.5.0 (CTCAE). RESULTS Median follow-up was 82.7 months (range=12-157 months) and the median age of patients at diagnosis was 72.5 years (range=49-84 years). The 3, 5, and 7 yr overall survival (OS) rates were 95%, 90%, and 84%, respectively, while 3, 5, and 7 yr disease-free survival (DFS) were 96%, 90%, and 87%, respectively. Acute toxicity was as follows: genitourinary (GU) G1 and G2 in 35.9% and 24%; gastrointestinal (GI) in 13.7% and 8%, with G3 or more acute toxicities less than 1%. The late GI toxicity G2 and G3 were 5.3% and 1%, respectively, and the late GU toxicity G2 and G3 were 4.8% and 2.1%, respectively, and only three patients had a G4 toxicity. CONCLUSION Hypofractionated helical tomotherapy for PCa treatment appeared to be safe and reliable, with favorable acute and late toxicity rates and encouraging results in terms of disease control.
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Affiliation(s)
- Salvatore Cozzi
- Radiation Therapy Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy;
- Radiation Oncology Department, Centre Lèon Bèrard, Lyon, France
| | - Maria Paola Ruggieri
- Radiation Therapy Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Emanuele Alì
- Radiation Therapy Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | - Federica Vigo
- Radiation Therapy Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Matteo Augugliaro
- Radiation Therapy Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Lucia Giaccherini
- Radiation Therapy Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Federico Iori
- Radiation Therapy Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Masoumeh Najafi
- Skull Base Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Lilia Bardoscia
- Radiation Oncology Unit, San Luca Hospital, USL Toscana Nord Ovest, Lucca, Italy
| | - Andrea Botti
- Medical Physics Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Valeria Trojani
- Medical Physics Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Patrizia Ciammella
- Radiation Therapy Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Cinzia Iotti
- Radiation Therapy Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
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Cozzi S, Finocchi Ghersi S, Bardoscia L, Najafi M, Blandino G, Alì E, Augugliaro M, Vigo F, Ruggieri MP, Cardano R, Giaccherini L, Iori F, Botti A, Trojani V, Ciammella P, Iotti C. Linac-based stereotactic salvage reirradiation for intraprostatic prostate cancer recurrence: toxicity and outcomes. Strahlenther Onkol 2023; 199:554-564. [PMID: 36732443 DOI: 10.1007/s00066-023-02043-3] [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: 09/02/2022] [Accepted: 01/04/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND The rates of local failure after curative radiotherapy for prostate cancer (PC) remain high despite more accurate locoregional treatments available, with one third of patients experiencing biochemical failure and clinical relapse occurring in 30-47% of cases. Today, androgen deprivation therapy (ADT) is the treatment of choice in this setting, but with not negligible toxicity and low effects on local disease. Therefore, the treatment of intraprostatic PC recurrence represents a challenge for radiation oncologists. Prostate reirradiation (Re-I) might be a therapeutic possibility. We present our series of patients treated with salvage stereotactic Re‑I for intraprostatic recurrence of PC after radical radiotherapy, with the aim of evaluating feasibility and safety of linac-based prostate Re‑I. MATERIALS AND METHODS We retrospectively evaluated toxicities and outcomes of patients who underwent salvage reirradiation using volumetric modulated arc therapy (VMAT) for intraprostatic PC recurrence. Inclusion criteria were age ≥ 18 years, histologically proven diagnosis of PC, salvage Re‑I for intraprostatic recurrence after primary radiotherapy for PC with curative intent, concurrent/adjuvant ADT with stereotactic body radiation therapy (SBRT) allowed, performance status ECOG 0-2, restaging choline/PSMA-PET/TC and prostate MRI after biochemical recurrence, and signed informed consent. RESULTS From January 2019 to April 2022, 20 patients were recruited. Median follow-up was 26.7 months (range 7-50). After SBRT, no patients were lost at follow-up and all are still alive. One- and 2‑year progression free survival (PFS) was 100% and 81.5%, respectively, while 2‑year biochemical progression-free survival (bFFS) was 88.9%. Four patients (20%) experienced locoregional lymph node progression and were treated with a further course of SBRT. Prostate reirradiation allowed the ADT start to be postponed for 12-39 months. Re‑I was well tolerated by all patients and none discontinued the treatment. No cases of ≥ G3 genitourinary (GU) or gastrointestinal (GI) toxicity were reported. Seven (35%) and 2 (10%) patients experienced acute G1 and G2 GU toxicity, respectively. Late GU toxicity was recorded in 10 (50%) patients, including 8 (40%) G1 and 2 (10%) G2. ADT-related side effects were found in 7 patients (hot flashes and asthenia). CONCLUSION Linac-based SBRT is a safe technique for performing Re‑I for intraprostatic recurrence after primary curative radiotherapy for PC. Future prospective, randomized studies are desirable to better understand the effectiveness of reirradiation and the still open questions in this field.
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Affiliation(s)
- Salvatore Cozzi
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy. .,Radiation Oncology Department, Centre Lèon Bèrard, Lyon, France.
| | - Sebastiano Finocchi Ghersi
- Radiation Oncolgy Unit, AOU Sant'Andrea, Facoltà di Medicina e Psicologia, Università La Sapienza, 00185, Rome, Italy
| | - Lilia Bardoscia
- Radiation Oncology Unit, S. Luca Hospital, Healthcare Company Tuscany Nord Ovest, 55100, Lucca, Italy
| | - Masoumeh Najafi
- Skull Base Research Center, Iran University of Medical Science, 1997667665, Tehran, Iran
| | - Gladys Blandino
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Emanuele Alì
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Matteo Augugliaro
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Federica Vigo
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Maria Paola Ruggieri
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Raffaele Cardano
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Lucia Giaccherini
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Federico Iori
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Andrea Botti
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Valeria Trojani
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Patrizia Ciammella
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Cinzia Iotti
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
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Gaibazzi N, Rigo F, Lorenzoni V, Pasqualetto C, Foà A, Cagliari E, Cavasin N, Botti A, Martini C, Tuttolomondo D. Association of Coronary Computed Tomography Angiography and Stress Echocardiography with Long-Term Cardiac Outcome: A Comparison Study. J Clin Med 2023; 12:903. [PMID: 36769550 PMCID: PMC9917407 DOI: 10.3390/jcm12030903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 01/25/2023] Open
Abstract
AIMS This study aimed to assess which variables on coronary computed tomography angiography (CTA) and vasodilator stress-echocardiography (SE) are best associated with long-term cardiac outcome in patients presenting for suspected chronic coronary syndrome (CCS) who performed both tests. METHODS We identified 397 patients with suspected CCS who, between 2007 and 2019, underwent both SE and CTA within 30 days. Coronary artery calcium score (CACS) and the number of coronary arteries with diameter stenosis >50% were assessed on CTA. The presence of reversible regional wall motion abnormalities (RWMA) and reduced Doppler coronary flow velocity reserve in the left-anterior descending coronary artery (CFVR) were assessed on SE. The association of SE and CTA variables with cardiac outcome (cardiac death or myocardial infarction) was evaluated using Fine and Gray competing risk models. RESULTS During a median follow-up of 10 years, 38 (9.6%) patients experienced a nonfatal myocardial infarction and 19 (4.8%) died from a cardiac cause. RWMA (HR 7.189, p < 0.001) and a lower CFVR (HR 0.034, p < 0.001) on SE, along with CACS (HR 1.004, p < 0.001) and the number of >50% stenosed coronary vessels (HR 1.975, p < 0.001) on CTA, were each associated with cardiac events. After adjusting for covariates, only CACS and CFVR remained associated (both p < 0.001) with cardiac outcome. CONCLUSION Our data suggest that only CFVR on vasodilatory SE and CACS on CTA are independently and strongly associated with long-term cardiac outcome, unlike RWMA or the number of stenosed coronary arteries, usually considered the hallmarks of coronary artery disease on each test.
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Affiliation(s)
- Nicola Gaibazzi
- Department of Cardiology, Parma University Hospital, 43126 Parma, Italy
| | - Fausto Rigo
- Division of Cardiology, Villa Salus Hospital Foundation/IRCCS San Camillo, 30126 Venice, Italy
| | | | - Cristina Pasqualetto
- Department of Cardiology, Ospedale Civile di Dolo, ULSS 3 Serenissima, 30174 Venice, Italy
| | - Alberto Foà
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine—DIMES, University of Bologna, 40126 Bologna, Italy
| | - Enrico Cagliari
- Neuroradiology Department, Mestre Hospital, ULSS3 Serenissima, 30174 Mestre, Italy
| | - Nicola Cavasin
- Neuroradiology Department, Mestre Hospital, ULSS3 Serenissima, 30174 Mestre, Italy
| | - Andrea Botti
- Department of Cardiology, Parma University Hospital, 43126 Parma, Italy
| | - Chiara Martini
- Department Diagnostic, Parma University Hospital, 43126 Parma, Italy
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
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8
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Cozzi S, Bruni A, Ruggieri MP, Borghetti P, Scotti V, Franceschini D, Fiore M, Taraborrelli M, Salvi F, Galaverni M, Savoldi L, Braglia L, Botti A, Finocchi Ghersi S, Niccolò GL, Lohr F, Iotti C, Ciammella P. Thoracic Radiotherapy in Extensive Disease Small Cell Lung Cancer: Multicenter Prospective Observational TRENDS Study. Cancers (Basel) 2023; 15:cancers15020434. [PMID: 36672383 PMCID: PMC9857193 DOI: 10.3390/cancers15020434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/19/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
(1) Introduction: Small cell lung cancer (SCLC) is an aggressive tumor type, accounting for about 15% of all lung cancers. Radiotherapy (RT) plays a fundamental role in both early and advanced stages. Currently, in advanced disease, the use of consolidative chest RT should be recommended for patients with good response to platinum-based first-line chemotherapy, but its use has not yet been standardized. The present prospective study aims to evaluate the pattern of care of consolidative chest RT in patients with advanced stage SCLC, and its effectiveness in terms of disease control and tolerability. (2) Materials and methods: This study was a multicenter prospective observational trial, proposed and conducted within the AIRO lung study group to evaluate the pattern of care of consolidative chest RT after first-line chemotherapy in patients with advanced SCLC. The patient and tumor characteristics, doses, fractionation and volumes of thoracic RT and prophylactic cranial irradiation (PCI), as well as the thoracic and extrathoracic response to the treatment, toxicity and clinical outcomes, were collected and analyzed. (3) Results: From January 2017 to December 2019, sixty-four patients were enrolled. Median follow-up was 33 months. The median age was 68 years (range 42-81); 38 patients (59%) were male and 26 (41%) female. Carboplatin + etoposide for 6 cycles was the most commonly used first-line therapeutic scheme (42%). With regard to consolidative chest RT, 56% of patients (35) received 30 Gy in 10 factions and 16 patients (26%) received 45 Gy in 15 sessions. The modulated intensity technique was used in 84.5% of cases, and post-chemotherapy macroscopic residual disease was the target volume in 87.5% of patients. Forty-four patients (69%) also underwent PCI. At the last follow-up, over 60% of patients did not experience chest disease progression, while 67% showed extrathoracic progression. At the first radiological evaluation after RT, complete response and stable disease were recorded in 6% and 46% of the cases, respectively. Two patients had a long-term complete response to the combined treatment. The brain was the first site of extrathoracic progression in 28%. 1y and 2y OS and PFS were 67%, 19%, 28% and 6%, respectively. Consolidative chest RT was well-tolerated in the majority of patients; it was interrupted in three cases (due to G2 pulmonary toxicity, disease progression and clinical decay, respectively). Only 1 patient developed G3 asthenia. (4) Conclusions: Consolidative chest RT has been shown to be useful in reducing the risk of thoracic disease progression and is absolutely well-tolerated in patients with advanced stage SCLC with good response after first-line chemotherapy. Among the Italian centers that participated in this study, there is still variability in the choice of fractionation and target volumes, although the guidelines contain clear recommendations. The aim of future research should be to clarify the role and modalities of chest RT in the era of immunotherapy in advanced-stage SCLC.
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Affiliation(s)
- Salvatore Cozzi
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Radiation Oncology Department, Centre Lèon Bèrard, 693736 Lyon, France
- Correspondence:
| | - Alessio Bruni
- Radiation Therapy Unit, Department of Oncology and Hematology, University Hospital of Modena, 41125 Modena, Italy
| | - Maria Paola Ruggieri
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Paolo Borghetti
- Radiation Oncology Department, ASST Spedali Civili and University of Brescia, 25123 Brescia, Italy
| | - Vieri Scotti
- Radiation Oncology Unit, Oncology Department AOU Careggi Firenze, 50134 Florence, Italy
| | | | - Michele Fiore
- Radiation Oncology, Campus Bio-Medico University, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Maria Taraborrelli
- Radiation Oncology Unit, “SS Annunziata” Hospital, “G. D’Annunzio” University, 66100 Chieti, Italy
| | - Fabrizio Salvi
- Radiation Oncology Unit, Bellaria Hospital, 40139 Bologna, Italy
| | - Marco Galaverni
- Radiotherapy Unit, Azienda Ospedaliera Universitaria, 43126 Parma, Italy
| | - Luisa Savoldi
- Research and Statistics Infrastructure, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Luca Braglia
- Research and Statistics Infrastructure, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Andrea Botti
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Sebastiano Finocchi Ghersi
- Radiation Oncolgy Unit, AOU Sant’Andrea, Facoltà di Medicina e Psicologia, Università La Sapienza, 00185 Rome, Italy
| | - Giaj-Levra Niccolò
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, 37024 Verona, Italy
| | - Frank Lohr
- Radiation Oncology Department, Centre Lèon Bèrard, 693736 Lyon, France
- Department of Medical and Surgical Science, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Cinzia Iotti
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Patrizia Ciammella
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
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Grehn M, Balgobind BV, Trojani V, Visser J, Botti A, Dolla L, van Elmpt W, Hurkmans C, Schweikard A, Fast M, Mandija S, Both M, Zeppenfeld K, Postema PG, Andratschke N, Miszczyk M, Pruvot E, Verhoeff J, Iori M, Blanck O. PATTERN-OF-PRACTISE, MULTI-CENTRE BENCHMARKS AND CREDENTIALING WORKFLOW FOR CONTOURING, TREATMENT PLANNING AND DELIVERY OF STEREOTACTIC ARRHYTHMIA RADIOABLATION FROM THE STOPSTORM.EU CONSORTIUM. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)02137-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Iori F, Botti A, Ciammella P, Cozzi S, Orlandi M, Iori M, Iotti C. How a very large sarcomatoid lung cancer was efficiently managed with lattice radiation therapy: a case report. Ann Palliat Med 2022; 11:3555-3561. [PMID: 35871277 DOI: 10.21037/apm-22-246] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/07/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND The management of large tumors represent a concerning issue in the palliative setting. Since a surgical approach is excluded and systemic therapy has reported limited efficacy, the patients are commonly referred for radiation therapy as last resort. However, to improve quality of life and to avoid excessive toxicity, low doses of palliative radiotherapy (RT) are delivered. In these cases, with limited and short response. Lattice radiation therapy (LRT) represents an innovative technique aiming to increase tumor response without enhancing adjacent organs at risk (OAR) toxicity, by administering inhomogeneous doses with ablative high dose areas inside the tumor and low doses near the OAR. CASE DESCRIPTION A 69-year-old male patient was admitted to our hospital complaining of sacral pain and mild dyspnea. After a suspicious opacity on X-ray, the chest computed tomography (CT), the positron emission tomography/CT (PET/CT) and the endobronchial ultra sound-guided transbronchial needle aspiration confirmed the diagnosis of a bulky sarcomatoid lung cancer (stage IV: cT4N3M1c). After an effective antalgic RT on the sacral metastasis and three lines of systemic therapy without response, the patient started to have a disabling dyspnea. Thus, we administered LRT on the bulky lesion. The patients experienced no significant toxicity, with a marked lesion response on the 3 month-follow CT and a significant improvement in symptoms and in his daily life. CONCLUSIONS This is the first LRT treatment done in our Center and it provides another evidence in the efficacy of LRT planning. It shows how LRT could represent an innovative technique to provide durable response in large tumors, without increasing treatment-related toxicity.
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Affiliation(s)
- Federico Iori
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Botti
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Patrizia Ciammella
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Salvatore Cozzi
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Matteo Orlandi
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mauro Iori
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cinzia Iotti
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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11
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Cozzi S, Bottoni N, Botti A, Trojani V, Alì E, Finocchi Ghersi S, Cremaschi F, Iori F, Ciammella P, Iori M, Iotti C. The Use of Cardiac Stereotactic Radiation Therapy (SBRT) to Manage Ventricular Tachycardia: A Case Report, Review of the Literature and Technical Notes. J Pers Med 2022; 12:jpm12111783. [PMID: 36579492 PMCID: PMC9694192 DOI: 10.3390/jpm12111783] [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: 09/27/2022] [Revised: 10/11/2022] [Accepted: 10/24/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND among cardiac arrhythmias, ventricular tachycardia (VT) is one that can lead to cardiac death, although significant progress has been made in its treatment, including the use of implantable cardioverter-defibrillators (ICD) and radiofrequency catheter ablation. Nevertheless, long-term recurrence rates remain in about half of patients and drastically impact the patient's quality of life. Moreover, recurrent ICD shocks are painful and are associated with higher mortality and worsening of heart failure. Recently, more and more experiences are demonstrating potential efficacy in the use of stereotactic body radiotherapy (SBRT) (also called cardiac radio-ablation) to treat this condition. In this paper, we report our experience in the use of cardiac radio-ablation for the treatment of refractory ventricular tachycardia with a focus on the technique used, along with a review of the literature and technical notes. CASE PRESENTATION an 81-year-old male patient with a long history of non-ischemic dilated cardiomyopathy and mechanical mitral prosthesis underwent a biventricular cardioverter defibrillator implant after atrial ventricular node ablation. At the end of 2021, the number of tachycardias increased significantly to about 10 episodes per day. After failure of medical treatment and conventional RT catheter ablation, the patient was treated with SBRT for a total dose of 25 Gy in a single session at the site of the ectopic focus. No acute toxicity was recorded. After SBRT (follow-up 7 months) no other VT episodes were recorded. CONCLUSION SBRT appears to be safe and leads to a rapid reduction in arrhythmic storms as treatment for VT without acute toxicity, representing one of the most promising methods for treating VT storms.
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Affiliation(s)
- Salvatore Cozzi
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Nicola Bottoni
- Department of Cardiology, Arrhythmology Center, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Andrea Botti
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Correspondence:
| | - Valeria Trojani
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Emanuele Alì
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Sebastiano Finocchi Ghersi
- Radiation Oncolgy Unit, AOU Sant’Andrea, Facoltà di Medicina e Psicologia, Università La Sapienza, 00185 Rome, Italy
| | - Federica Cremaschi
- Engineer Clinical Specialist, Biosense Webster, Pratica di Mare, Pomezia, 00071 Rome, Italy
| | - Federico Iori
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Patrizia Ciammella
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Mauro Iori
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Cinzia Iotti
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
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Ciammella P, Cozzi S, Botti A, Giaccherini L, Sghedoni R, Orlandi M, Napoli M, Pascarella R, Pisanello A, Russo M, Cavallieri F, Ruggieri MP, Cavuto S, Savoldi L, Iotti C, Iori M. Safety of Inhomogeneous Dose Distribution IMRT for High-Grade Glioma Reirradiation: A Prospective Phase I/II Trial (GLIORAD TRIAL). Cancers (Basel) 2022; 14:cancers14194604. [PMID: 36230525 PMCID: PMC9562035 DOI: 10.3390/cancers14194604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Glioblastoma multiforme (GBM) is the most frequent primary malignant brain tumor, and despite advances in imaging techniques and treatment options, the outcome remains poor and recurrence is inevitable. Salvage therapy presents a challenge, and re-irradiation can be a therapeutic option in recurrent GBM. The decision-making process for re-irradiation is a challenge for radiation oncologists due to the expected toxicity of a second course of radiotherapy and the limited radiation tolerance of normal tissue; nevertheless, it is being increasingly used, as several studies have demonstrated its feasibility. The current study aimed to investigate the safety of moderate–high-voxel-based dose escalation radiotherapy in recurrent GBM patients after conventional concurrent chemoradiation. Twelve patients were enrolled in this prospective single-center study. Retreatment consisted of re-irradiation with a total dose range of 30–50 Gy over 5 days using the IMRT (arc VMAT) technique using dose painting planning. The treatment was well tolerated. No toxicities greater than 3 were recorded; only one patient had severe G3 acute toxicity, characterized by muscle weakness and fatigue. Median overall survival (OS2) and progression-free survival (PFS2) from the time of re-irradiation were 10.4 months and 5.7 months, respectively. Our phase I study demonstrated an acceptable tolerance profile of this approach, and the future prospective phase II study will analyze the efficacy in terms of PFS and OS. Abstract Glioblastoma multiforme (GBM) is the most aggressive astrocytic primary brain tumor, and concurrent temozolomide (TMZ) and radiotherapy (RT) followed by maintenance of adjuvant TMZ is the current standard of care. Despite advances in imaging techniques and multi-modal treatment options, the median overall survival (OS) remains poor. As an alternative to surgery, re-irradiation (re-RT) can be a therapeutic option in recurrent GBM. Re-irradiation for brain tumors is increasingly used today, and several studies have demonstrated its feasibility. Besides differing techniques, the published data include a wide range of doses, emphasizing that no standard approach exists. The current study aimed to investigate the safety of moderate–high-voxel-based dose escalation in recurrent GBM. From 2016 to 2019, 12 patients met the inclusion criteria and were enrolled in this prospective single-center study. Retreatment consisted of re-irradiation with a total dose of 30 Gy (up to 50 Gy) over 5 days using the IMRT (arc VMAT) technique. A dose painting by numbers (DPBN)/dose escalation plan were performed, and a continuous relation between the voxel intensity of the functional image set and the risk of recurrence in that voxel were used to define target and dose distribution. Re-irradiation was well tolerated in all treated patients. No toxicities greater than G3 were recorded; only one patient had severe G3 acute toxicity, characterized by muscle weakness and fatigue. Median overall survival (OS2) and progression-free survival (PFS2) from the time of re-irradiation were 10.4 months and 5.7 months, respectively; 3-, 6-, and 12-month OS2 were 92%, 75%, and 42%, respectively; and 3-, 6-, and 12-month PFS2 were 83%, 42%, and 8%, respectively. Our work demonstrated a tolerable tolerance profile of this approach, and the future prospective phase II study will analyze the efficacy in terms of PFS and OS.
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Affiliation(s)
- Patrizia Ciammella
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Salvatore Cozzi
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Correspondence: ; Tel.: +39-3297317608
| | - Andrea Botti
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Lucia Giaccherini
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Roberto Sghedoni
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Matteo Orlandi
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Manuela Napoli
- Neuroradiology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Rosario Pascarella
- Neuroradiology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Anna Pisanello
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Marco Russo
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Francesco Cavallieri
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Maria Paola Ruggieri
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Silvio Cavuto
- Clinical Trials and Statistics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Luisa Savoldi
- Clinical Trials and Statistics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Cinzia Iotti
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Mauro Iori
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
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Ardissino M, Nelson AJ, Maglietta G, Malagoli Tagliazucchi G, Disisto C, Celli P, Ferrario M, Canosi U, Cernetti C, Negri F, Merlini PA, Tubaro M, Berzuini C, Manzalini C, Ignone G, Campana C, Moschini L, Ponte E, Pozzi R, Fetiveau R, Buratti S, Paraboschi EM, Asselta R, Botti A, Tuttolomondo D, Barocelli F, Bricoli S, Biagi A, Bonura R, Moccetti T, Crocamo A, Benatti G, Paoli G, Solinas E, Notarangelo MF, Moscarella E, Calabrò P, Duga S, Magnani G, Ardissino D. Sex-Related Differences in Long-Term Outcomes After Early-Onset Myocardial Infarction. Front Cardiovasc Med 2022; 9:863811. [PMID: 35859592 PMCID: PMC9289186 DOI: 10.3389/fcvm.2022.863811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022] Open
Abstract
Importance There is growing awareness of sex-related differences in cardiovascular risk profiles, but less is known about whether these extend to pre-menopausal females experiencing an early-onset myocardial infarction (MI), who may benefit from the protective effects of estrogen exposure. Methods A nationwide study involving 125 Italian Coronary Care Units recruited 2,000 patients between 1998 and 2002 hospitalized for a type I myocardial infarction before the age of 45 years (male, n = 1,778 (88.9%). Patients were followed up for a median of 19.9 years (IQR 18.1–22.6). The primary composite endpoint was the occurrence of cardiovascular death, non-fatal myocardial re-infarction or non-fatal stroke, and the secondary endpoint of hospitalization for revascularisation by means of a percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). Results ST-elevation MI was the most frequent presentation among both men and women (85.1 vs. 87.4%, p = ns), but the men had a greater baseline coronary atherosclerotic burden (median Duke Coronary Artery Disease Index: 48 vs. 23; median Syntax score 9 vs. 7; both p < 0.001). The primary composite endpoint occurred less frequently among women (25.7% vs. 37.0%; adjusted hazard ratio: 0.69, 95% CI 0.52–0.91; p = 0.01) despite being less likely to receive treatment with most secondary prevention medications during follow up. Conclusions There are significant sex-related differences in baseline risk factors and outcomes among patients with early-onset MI: women present with a lower atherosclerotic disease burden and, although they are less frequently prescribed secondary prevention measures, experience better long-term outcomes. Trial Registration 4272/98 Ospedale Niguarda, Ca' Granda 03/09/1998.
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Affiliation(s)
| | - Adam J. Nelson
- Duke Clinical Research Institute, Durham, NC, United States
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Giuseppe Maglietta
- Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Caterina Disisto
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Patrizia Celli
- Division of Cardiology, Ospedale San Camillo, Rome, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | - Umberto Canosi
- Division of Cardiology, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
- Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy
| | - Carlo Cernetti
- Cardiothoracic Department, University Hospital “Santa Maria della Miserciordia”, Udine, Italy
| | - Francesco Negri
- Cardiothoracic Department, University Hospital “Santa Maria della Miserciordia”, Udine, Italy
| | - Piera Angelica Merlini
- Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy
- Division of Cardiology, Azienda Ospedaliera, Ospedale Niguarda Cà Granda, Milan, Italy
| | - Marco Tubaro
- ICCU, Intensive and Interventional Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Carlo Berzuini
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Chiara Manzalini
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Gianfranco Ignone
- Department of Cardiology, Antonio Perrino Hospital, Azienda Sanitaria Locale di Brindisi, Brindisi, Italy
| | - Carlo Campana
- Department of Cardiology, Sant'Anna Hospital, Como, Italy
| | - Luigi Moschini
- Division of Cardiology, Istituti Ospitalieri, Cremona, Italy
| | - Elisabetta Ponte
- Hospital Universitario de Toledo, Servizio di Radiologia, Toledo, Spain
| | - Roberto Pozzi
- Division of Cardiology, San Luigi Gonzaga University Hospital, Turin, Italy
| | | | - Silvia Buratti
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Elvezia Maria Paraboschi
- Department of Biomedical Sciences, Humanitas Clinical and Research Center IRCCS, Humanitas University, Milan, Italy
| | - Rosanna Asselta
- Department of Biomedical Sciences, Humanitas Clinical and Research Center IRCCS, Humanitas University, Milan, Italy
| | - Andrea Botti
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Federico Barocelli
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Serena Bricoli
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Andrea Biagi
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Rosario Bonura
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Tiziano Moccetti
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Antonio Crocamo
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Giorgio Benatti
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Giorgia Paoli
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Emilia Solinas
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Elisabetta Moscarella
- University Division of Clinical Cardiology, AORN Sant'Anna e San Sebastiano, Caserta, Department of Translational Medical Sciences, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Paolo Calabrò
- University Division of Clinical Cardiology, AORN Sant'Anna e San Sebastiano, Caserta, Department of Translational Medical Sciences, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Stefano Duga
- Department of Biomedical Sciences, Humanitas Clinical and Research Center IRCCS, Humanitas University, Milan, Italy
| | - Giulia Magnani
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
- *Correspondence: Giulia Magnani ;
| | - Diego Ardissino
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
- Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy
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14
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Cozzi S, Augugliaro M, Ciammella P, Botti A, Trojani V, Najafi M, Blandino G, Ruggieri MP, Giaccherini L, Alì E, Iori F, Sardaro A, Finocchi Ghersi S, Deantonio L, Gutierrez Miguelez C, Iotti C, Bardoscia L. The Role of Interstitial Brachytherapy for Breast Cancer Treatment: An Overview of Indications, Applications, and Technical Notes. Cancers (Basel) 2022; 14:cancers14102564. [PMID: 35626168 PMCID: PMC9139312 DOI: 10.3390/cancers14102564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Breast cancer is the most common cancer in the female population. Adjuvant radiotherapy has become increasingly important as conservative treatment. Muticatheter interstitial brachytherapy is a type of radiation technique wherein the radioactive sources are directly implanted into or close to the target tissue and may be considered an extremely precise, versatile, and variable radiation technique. Literature data support muticatheter interstitial brachytherapy as the only method with strong scientific evidence to perform partial breast irradiation and reirradiation after previous conservative surgery and external beam radiotherapy. The aim of our work is to provide a comprehensive view of the use of interstitial brachytherapy, with particular focus on the implant description, limits, and advantages of the technique. Abstract Breast cancer represents the second leading cause of cancer-related death in the female population, despite continuing advances in treatment options that have significantly accelerated in recent years. Conservative treatments have radically changed the concept of healing, also focusing on the psychological aspect of oncological treatments. In this scenario, radiotherapy plays a key role. Brachytherapy is an extremely versatile radiation technique that can be used in various settings for breast cancer treatment. Although it is invasive, technically complex, and requires a long learning curve, the dosimetric advantages and sparing of organs at risk are unequivocal. Literature data support muticatheter interstitial brachytherapy as the only method with strong scientific evidence to perform partial breast irradiation and reirradiation after previous conservative surgery and external beam radiotherapy, with longer follow-up than new, emerging radiation techniques, whose effectiveness is proven by over 20 years of experience. The aim of our work is to provide a comprehensive view of the use of interstitial brachytherapy to perform breast lumpectomy boost, breast-conserving accelerated partial breast irradiation, and salvage reirradiation for ipsilateral breast recurrence, with particular focus on the implant description, limits, and advantages of the technique.
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Affiliation(s)
- Salvatore Cozzi
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
- Correspondence: ; Tel.: +39-329-731-7608
| | - Matteo Augugliaro
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Patrizia Ciammella
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Andrea Botti
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.B.); (V.T.)
| | - Valeria Trojani
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.B.); (V.T.)
| | - Masoumeh Najafi
- Department of Radiation Oncology, Shohadaye Haft-e-Tir Hospital, Iran University of Medical Science, Teheran 1997667665, Iran;
| | - Gladys Blandino
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Maria Paola Ruggieri
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Lucia Giaccherini
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Emanuele Alì
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Federico Iori
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Angela Sardaro
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Sebastiano Finocchi Ghersi
- Radiation Oncolgy Unit, AOU Sant’Andrea, Facoltà di Medicina e Psicologia, Università La Sapienza, 00185 Rome, Italy;
| | - Letizia Deantonio
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland (IOSI), Bellinzona, 6500 Lugano, Switzerland;
| | - Cristina Gutierrez Miguelez
- Brachytherapy Unit, Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, L’Hospitalet de Llobregat, 08908 Barcelona, Spain;
| | - Cinzia Iotti
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Lilia Bardoscia
- Radiation Oncology Unit, S. Luca Hospital, Healthcare Company Tuscany Nord Ovest, 55100 Lucca, Italy;
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15
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Trojani V, Botti A, Grehn M, Balgobind B, Savini A, Pruvot E, Verhoeff J, Iori M, Blanck O. Stereotactic arrhythmia radioablation in europe: treatment planning benchmark results of the STOPSTORM consortium. Europace 2022. [DOI: 10.1093/europace/euac053.371] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EU
Background
In patients with refractory ventricular tachycardia (VT), STereotactic Arrhythmia Radioablation (STAR) showed promising results for otherwise untreatable patients [1]. The STOPSTORM.eu project coordinates European efforts to clinically validate STAR and to refine protocols and guidelines to ensure treatment harmonization.
Purpose
The aim of this work is to present the current clinical STAR practise in Europe based on three examples as baseline for further optimization.
Methods
Target Volumes (TV) and Organs-at-Risk (OAR) were generated from previous consortium benchmarks and consensus definitions for three well-selected STAR cases [1]. Planning Target Volumes (PTV) were generated based on three different compensation strategies for cardiac and respiratory motion [2] and overlapped close OAR like coronary arteries or stomach in some areas. The STOPSTORM.eu members were asked to generate single fraction treatment plans with 25 Gy dose prescription based on ICRU report 91 for each case based on their clinical practise and preferences for STAR including multi-disciplinary discussion and plan approval. Resulting dose distributions were analysed independently using a customized platform for multi-center treatment planning studies [3].
Results
Twenty centers submitted 22, 23 and 22 treatment plans for case 1, 2 and 3, respectively, mostly (75% of all plans) using Intensity Modulated Arc Therapy (IMAT) with 6 MeV FFF beams (73% of the IMAT plans) among other commonly used techniques for stereotactic radiotherapy. At this current stage, used guidelines for STAR treatment planning and OAR dose limits vary greatly and are mostly based on the AAPM TG-101 report or the RAVENTA trial publication [4]. As a major finding, 73% of all plans submitted preferred close OAR sparing over achieving high PTV coverage arguing that lower doses down to 20 Gy may also result in clinical efficiency as recently suggested [5]. As a minor finding, 80% of the centers chose to override strong artifact regions originating from e.g. left ventricular assist devices.
Conclusion
From this first STOPSTORM.eu multi-center multi-platform treatment planning benchmark study we obtained important information concerning current clinical preference and practise from major European centers performing STereotactic Arrhythmia Radioablation for VT. Using the individual and strongly varying approaches of the centers, the key task for the STOPSTORM.eu project is now to find consensus in order to harmonize and optimize STAR practise in Europe.
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Affiliation(s)
- V Trojani
- AUSL-IRCCS Reggio Emilia, Medical Physics, Reggio Emilia, Italy
| | - A Botti
- AUSL-IRCCS Reggio Emilia, Medical Physics, Reggio Emilia, Italy
| | - M Grehn
- University Medical Center of Schleswig-Holstein, Radiotherapy, Kiel, Germany
| | - B Balgobind
- Amsterdam UMC, Radiotherapy, Amsterdam, Netherlands (The)
| | - A Savini
- G. Mazzini Hospital, Medical Physics, Teramo, Italy
| | - E Pruvot
- Lausanne university hospital, Heart and Vessel Department, Lausanne, Switzerland
| | - J Verhoeff
- University Medical Center Utrecht, Radiotherapy, Utrecht, Netherlands (The)
| | - M Iori
- AUSL-IRCCS Reggio Emilia, Medical Physics, Reggio Emilia, Italy
| | - O Blanck
- University Medical Center of Schleswig-Holstein, Radiotherapy, Kiel, Germany
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16
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Tuttolomondo D, Suma S, Botti A, Gaibazzi N. P109 CORONARY FLOW VELOCITY RESERVE REDUCTION IS ASSOCIATED WITH CARDIOVASCULAR, CANCER, AND NONCANCER, NONCARDIOVASCULAR MORTALITY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.106] [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: 11/14/2022]
Abstract
Abstract
Background
Coronary flow velocity reserve (CFVR) measured in the left anterior descending artery during high–dose vasodilator stress echocardiography interrogates both epicardial and microcirculatory coronary function and has been inversely associated with chronic inflammation and microvascular dysfunction, as well as with the presence of obstructive coronary artery disease. Microvascular dysfunction and chronic inflammation are common mechanisms of disease in cardiovascular (CV) and non–CV conditions. We aimed to assess whether CFVR is associated with all–cause death, but more specifically with CV, cancer, and non–CV and noncancer (NCVNC) mortality, independently and increasingly over other demographic, clinical, and echocardiography variables.
Methods
One thousand two patients who underwent stress echocardiography were followed for a median of 8.2 years, with clinical, regional wall motion abnormalities (RWMAs), and CFVR data. The independent prognostic value of RWMA and CFVR regarding CV, cancer, or NCVNC mortality was evaluated adjusting for clinical variables. A prespecified subgroup of subjects with no RWMA or revascularization procedures during follow–up was also analyzed (n = 752), to exclude most participants with possible coronary artery disease and remove such confounding from the assessment of the potential association of CFVR and mortality.
Results
A total of 161 patients (16%) died, 63 deaths being CV (39%), 52 from cancer (32%), and 46 (29%) from NCVNC causes. In comparison to CV mortality, cancer and NCVNC mortality were not associated with an ischemic RWMA at univariable analysis, while a CFVR < 2 was significantly associated with each category of cause–specific mortality. A CFVR < 2 or ≥ 2 separated a group of patients with 8–year 14.6% versus 1.2% CV mortality, 10.3% versus 0.4% cancer mortality, and 9.5% versus 1.5% NCVNC mortality.
Conclusions
The reduction of CFVR is independently associated with CV, cancer, and NCVNC death in a population clinically referred for suspected/known coronary artery disease. CFVR can act as a marker or a mechanism preceding and predicting mortality from a wide variety of diseases.
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Affiliation(s)
- D Tuttolomondo
- UOC CARDIOLOGIA, AZIENDA OSPEDALIERO UNIVERISTARIA MAGGIORE DI PARMA, PARMA; RESPONSABILE COORDINAMENTO IMAGING CARDIOVASCOLARE AVANZATO, UOC CARDIOLOGIA, AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DI PARMA, PARMA
| | - S Suma
- UOC CARDIOLOGIA, AZIENDA OSPEDALIERO UNIVERISTARIA MAGGIORE DI PARMA, PARMA; RESPONSABILE COORDINAMENTO IMAGING CARDIOVASCOLARE AVANZATO, UOC CARDIOLOGIA, AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DI PARMA, PARMA
| | - A Botti
- UOC CARDIOLOGIA, AZIENDA OSPEDALIERO UNIVERISTARIA MAGGIORE DI PARMA, PARMA; RESPONSABILE COORDINAMENTO IMAGING CARDIOVASCOLARE AVANZATO, UOC CARDIOLOGIA, AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DI PARMA, PARMA
| | - N Gaibazzi
- UOC CARDIOLOGIA, AZIENDA OSPEDALIERO UNIVERISTARIA MAGGIORE DI PARMA, PARMA; RESPONSABILE COORDINAMENTO IMAGING CARDIOVASCOLARE AVANZATO, UOC CARDIOLOGIA, AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DI PARMA, PARMA
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17
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Botti A, Bertolini M, Trojani V, Cucurachi N, Iori M, Galaverni M, Iotti C, Borghetti P, La Mattina S, Giaj Levra N, Sepulcri M, Iori F, Ciammella P. PO-1773 Feasibility of a novel harmonization method for NSCLC multi-centric radiomic studies. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03737-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Cozzi S, Bardoscia L, Najafi M, Botti A, Blandino G, Augugliaro M, Manicone M, Iori F, Giaccherini L, Sardaro A, Iotti C, Ciammella P. Adenoid Cystic Carcinoma/Basal Cell Carcinoma of the Prostate: Overview and Update on Rare Prostate Cancer Subtypes. Curr Oncol 2022; 29:1866-1876. [PMID: 35323352 PMCID: PMC8947681 DOI: 10.3390/curroncol29030152] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
Adenoid cystic carcinoma/basaloid cell carcinoma of the prostate (ACC/BCC) is a very rare variant of prostate cancer with uncertain behavior. Few cases are reported in the literature. Data on treatment options are scarce. The aim of our work was to retrospectively review the published reports. Thirty-three case reports or case series were analyzed (106 patients in total). Pathological features, management, and follow-up information were evaluated. Despite the relatively low level of evidence given the unavoidable lack of prospective trials for such a rare prostate tumor, the following considerations were made: prostate ACC/BCC is an aggressive tumor often presenting with locally advanced disease and incidental diagnosis occurs during transurethral resection of the prostate for urinary obstructive symptoms. Prostate-specific antigen was not a reliable marker for diagnosis nor follow-up. Adequate staging with Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI) should be performed before treatment and during follow-up, while there is no evidence for the use of Positron Emission Tomography (PET). Radical surgery with negative margins and possibly adjuvant radiotherapy appear to be the treatments of choice. The response to androgen deprivation therapy was poor. Currently, there is no evidence of the use of truly effective systemic therapies.
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Affiliation(s)
- Salvatore Cozzi
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy or (S.C.); (G.B.); (M.A.); (M.M.); (F.I.); (L.G.); (C.I.); (P.C.)
| | - Lilia Bardoscia
- Radiation Oncology Unit, S. Luca Hospital, Healthcare Company Tuscany Nord Ovest, 55100 Lucca, Italy
- Correspondence:
| | - Masoumeh Najafi
- Department of Radiation Oncology Shohadaye Haft-e-Tir Hospital, Iran University of Medical Science, Teheran 1449614535, Iran;
| | - Andrea Botti
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Gladys Blandino
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy or (S.C.); (G.B.); (M.A.); (M.M.); (F.I.); (L.G.); (C.I.); (P.C.)
| | - Matteo Augugliaro
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy or (S.C.); (G.B.); (M.A.); (M.M.); (F.I.); (L.G.); (C.I.); (P.C.)
| | - Moana Manicone
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy or (S.C.); (G.B.); (M.A.); (M.M.); (F.I.); (L.G.); (C.I.); (P.C.)
| | - Federico Iori
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy or (S.C.); (G.B.); (M.A.); (M.M.); (F.I.); (L.G.); (C.I.); (P.C.)
| | - Lucia Giaccherini
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy or (S.C.); (G.B.); (M.A.); (M.M.); (F.I.); (L.G.); (C.I.); (P.C.)
| | - Angela Sardaro
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari Aldo Moro, 70124 Bari, Italy;
| | - Cinzia Iotti
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy or (S.C.); (G.B.); (M.A.); (M.M.); (F.I.); (L.G.); (C.I.); (P.C.)
| | - Patrizia Ciammella
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy or (S.C.); (G.B.); (M.A.); (M.M.); (F.I.); (L.G.); (C.I.); (P.C.)
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19
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Magnani G, Bricoli S, Ardissino M, Maglietta G, Nelson A, Tagliazucchi GM, Disisto C, Celli P, Ferrario M, Canosi U, Cernetti C, Negri F, Merlini PA, Tubaro M, Berzuini C, Manzalini C, Ignone G, Campana C, Moschini L, Ponte E, Pozzi R, Fetiveau R, Buratti S, Paraboschi E, Asselta R, Botti A, Tuttolomondo D, Barocelli F, Biagi A, Bonura R, Moccetti T, Crocamo A, Benatti G, Paoli G, Solinas E, Notarangelo MF, Moscarella E, Calabrò P, Duga S, Niccoli G, Ardissino D. Long-term outcomes of early-onset myocardial infarction with non-obstructive coronary artery disease (MINOCA). Int J Cardiol 2022; 354:7-13. [PMID: 35176406 DOI: 10.1016/j.ijcard.2022.02.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Acute myocardial infarction with non-obstructive coronary artery disease (MINOCA) is frequent in patients experiencing an early-onset MI, but data concerning its long-term prognosis are limited and conflicting. METHODS The Italian Genetic Study on Early-onset MI enrolled 2000 patients experiencing a first MI before the age of 45 years, and had a median follow-up of 19.9 years. The composite primary endpoint was cardiovascular (CV) death, non-fatal MI, and non-fatal stroke (MACE); the secondary endpoint was rehospitalisation for coronary revascularisation. RESULTS MINOCA occurred in 317 patients (15.9%) and, during the follow-up, there was no significant difference in MACE rates between them and the patients with obstructive coronary artery disease (MICAD: 27.8% vs 37.5%; adjusted hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.57-1.09;p = 0.15). The CV death rate was lower in the MINOCA group (4.2% vs 8.4%, HR 0.26, 95%CI 0.08-0.86;p = 0.03), whereas the rates of non-fatal reinfarction (17.3% vs 25.4%; HR 0.76, 95%CI 0.52-1.13;p = 0.18), non-fatal ischemic stroke (9.5% vs 3.7%; HR 1.79, 95%CI 0.87-3.70;p = 0.12), and all-cause mortality (14.1% vs 20.7%, HR 0.73, 95%CI 0.43-1.25;p = 0.26) were not significantly different in the two groups. The rate of rehospitalisation for coronary revascularisation was lower among the MINOCA patients (6.7% vs 27.7%; HR 0.27, 95% CI 0.15-0.47;p < 0.001). CONCLUSIONS MINOCA is frequent and not benign in patients with early-onset MI. Although there is a lower likelihood of CV death,the long-term risk of MACE and overall mortality is not significantly different from that of MICAD patients.
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Affiliation(s)
- Giulia Magnani
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Serena Bricoli
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Giuseppe Maglietta
- Division of Research and Innovation, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Statistics, Computer Science, Applications, University of Florence, Florence, Italy
| | - Adam Nelson
- Duke Clinical Research Institute, Durham, NC, USA; South Australian Health & Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | | | - Caterina Disisto
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Patrizia Celli
- Division of Cardiology, Ospedale San Camillo, Rome, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | - Umberto Canosi
- Division of Cardiology, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy; Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy
| | - Carlo Cernetti
- Cardio-neurovascular Department, Cà Foncello and San Giacomo Hospital Azienda No. 2, Marca Trevigiana Treviso, Treviso, Italy
| | - Francesco Negri
- Cardio-neurovascular Department, Cà Foncello and San Giacomo Hospital Azienda No. 2, Marca Trevigiana Treviso, Treviso, Italy
| | - Piera Angelica Merlini
- Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy; Division of Cardiology, Azienda Ospedaliera, Ospedale Niguarda Cà Granda, Milan, Italy
| | - Marco Tubaro
- Division of Cardiology, San Filippo Neri Hospital, ASL, Roma 1, Rome, Italy
| | - Carlo Berzuini
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Chiara Manzalini
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Giancarlo Ignone
- Department of Cardiology, Antonio Perrino Hospital, Azienda Sanitaria Locale di Brindisi, Brindisi, Italy
| | - Carlo Campana
- Department of Cardiology, Sant'Anna Hospital, Como, Italy
| | - Luigi Moschini
- Division of Cardiology, Istituti Ospitalieri, Cremona, Italy
| | | | - Roberto Pozzi
- Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | | | - Silvia Buratti
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Elvezia Paraboschi
- Department of Biomedical Sciences, Humanitas University, and Humanitas Clinical and Research Center IRCCS, Milan, Italy
| | - Rosanna Asselta
- Department of Biomedical Sciences, Humanitas University, and Humanitas Clinical and Research Center IRCCS, Milan, Italy
| | - Andrea Botti
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Federico Barocelli
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Andrea Biagi
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Rosario Bonura
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Tiziano Moccetti
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Antonio Crocamo
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Giorgio Benatti
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Giorgia Paoli
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Emilia Solinas
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Elisabetta Moscarella
- University Division of Clinical Cardiology, AORN Sant'Anna e San Sebastiano, Caserta, and Department of Translational Medical Sciences, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Paolo Calabrò
- University Division of Clinical Cardiology, AORN Sant'Anna e San Sebastiano, Caserta, and Department of Translational Medical Sciences, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Stefano Duga
- Department of Biomedical Sciences, Humanitas University, and Humanitas Clinical and Research Center IRCCS, Milan, Italy
| | - Giampaolo Niccoli
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Diego Ardissino
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy
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Magnani G, Bricoli S, Ardissino M, Maglietta G, Nelson A, Tagliazzuccchi GM, Disisto C, Celli P, Ferrario M, Canosi U, Cernetti C, Negri F, Merlini PA, Tubaro M, Berzuini C, Manzalini C, Ignone G, Campana C, Moschini L, Ponte E, Pozzi R, Fetiveau R, Buratti S, Paraboschi E, Asselta R, Botti A, Tuttolomondo D, Barocelli F, Biagi A, Bonura R, Moccetti T, Crocamo A, Benatti G, Paoli G, Solinas E, Notarangelo MF, Moscarella E, Calabrò P, Duga S, Niccoli G, Ardissino D. 189 Long-term outcomes of early-onset myocardial infarction with non-obstructive coronary artery disease. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab140.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Data regarding long-term prognosis of MINOCA are very limited and conflicting.
Methods and results
The Italian Genetic Study on early-onset MI enrolled 2000 patients who had a first MI before they were 45. The median follow-up was 19.9 years, the equivalent of 39 535 person-years. The composite primary endpoint was cardiovascular (CV) death, non-fatal MI, and non-fatal stroke (MACE); the secondary endpoint was rehospitalization for coronary revascularization. MINOCA was experienced by 317 patients (15.9%). The risk of MACE was not significantly different between MINOCA patients and those with obstructive coronary artery disease (MICAD, 27.8% vs. 37.5%; adj. HR: 0.79, 95% CI: 0.57–1.09; P = 0.15, Figure 1). There was no between-group difference in the rate of non-fatal MI (17.3% vs. 25.4%; adj. HR: 0.76, 95% CI: 0.52–1.13; P = 0.18), non-fatal ischaemic stroke (9.5% vs. 3.7%; adj. HR: 1.79, 95% CI: 0.87–3.70; P = 0.12), or all-cause mortality (14.1% vs. 20.7%; adj. HR: 0.73, 95% CI: 0.43–1.25; P = 0.26), but the rates of CV death (6.2% vs. 8.4%; adj. HR: 0.26, 95% CI: 0.08–0.86; P = 0.03) and coronary revascularization (6.7% vs. 27.7%; HR: 0.27, 95% CI: 0.15–0.47; P < 0.001) were lower in the MINOCA group.
Conclusions
MINOCA is frequent in early-onset MI patients and is not benign with a long-term risk of MACE and overall mortality not significantly different from that of the MICAD patients.
189 Figure 1 Composite primary endpoint of CV death, non-fatal MI, and non-fatal stroke
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Giancarlo Ignone
- Antonio Perrino Hospital, Azienda Sanitaria Locale di Brindisi, Italy
| | | | | | | | | | | | | | - Elvezia Paraboschi
- Humanitas University and Humanitas Clinical and Research Center IRCCS, Italy
| | - Rosanna Asselta
- Humanitas University and Humanitas Clinical and Research Center IRCCS, Italy
| | - Andrea Botti
- Azienda Ospedaliero Universitaria di Parma, Italy
| | | | | | - Andrea Biagi
- Azienda Ospedaliero Universitaria di Parma, Italy
| | | | | | | | | | | | | | | | | | - Paolo Calabrò
- AORN Sant’Anna e San Sebastiano Caserta, University of Campania, Italy
| | - Stefano Duga
- Humanitas University and Humanitas Clinical and Research Center IRCCS, Italy
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Trojani V, Galaverni M, Ciammella P, Chendi A, Botti A, Nitrosi A, Fioroni F, Iori M, Bertolini M. Radiomic features characterization in healthy and NSCLC tissues. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00400-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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22
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Cozzi S, Najafi M, Bardoscia L, Ruggieri MP, Giaccherini L, Blandino G, Botti A, Ciammella P, Iotti C. Radiation-induced breast angiosarcoma: report of two patients after accelerated partial breast irradiation (APBI) and review of the literature. Rep Pract Oncol Radiother 2021; 26:827-832. [PMID: 34760317 DOI: 10.5603/rpor.a2021.0080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/27/2021] [Indexed: 12/23/2022] Open
Abstract
Background Angiosarcoma may rarely complicate radiotherapy of breast cancer. This so-called radiation-induced angiosarcoma (RIAS) occurs in less than 0.3% of patients that underwent breast conservation surgeries, usually years after completion of radiotherapy. Case presentation we introduce two cases of invasive ductal carcinoma who underwent lumpectomy and accelerated partial breast irradiation (APBI) as an alternative protocol to whole breast irradiation (WBI). They received adjuvant partial breast radiotherapy on tumor cavity for a total dose of 38.5 Gy in 10 fractions in 5 days using 3D-external-beam RT. In both cases, RIAS occurred eight years after radiotherapy, in the sub-cicatricial area in one patient and outside the irradiated area in the other one. They both underwent radical surgery and chemotherapy was performed in one patient. Discussion The underlying mechanism for development of RIAS is not well known, but its incidence seems to be increasing. RIAS after partial breast irradiation is very rare and has been reported in two cases so far. As it may be suggested in case 2, it is still a matter of debate if the risk of radiation-induced sarcoma is radiation-dose dependent. Although mastectomy is considered as a standard treatment, choice of treatment should be made according to the patient's specifications. Conclusion There are very few studies in the literature that report RIAS after APBI. Present study is the only one reporting two cases after the external 3D technique APBI. Prognosis of RIAS remains poor. Only a careful evaluation in a multidisciplinary context can offer to the patients the best result in terms of local control and survival.
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Affiliation(s)
- Salvatore Cozzi
- Radiation Therapy Unit, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Masoumeh Najafi
- Department of Radiation Oncology Shohadaye Haft-e-Tir Hospital, Iran University of Medical Science, Teheran, Iran
| | - Lilia Bardoscia
- Radiation Therapy Unit, Azienda USL-IRCCS di Reggio Emilia, Italy
| | | | | | - Gladys Blandino
- Radiation Therapy Unit, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Andrea Botti
- Medical Physics Unit, Department of Oncology and Advanced Technology, AUSL-IRCCS, Reggio Emilia, Italy
| | | | - Cinzia Iotti
- Radiation Therapy Unit, Azienda USL-IRCCS di Reggio Emilia, Italy
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23
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Cozzi S, Botti A, Timon G, Blandino G, Najafi M, Manicone M, Bardoscia L, Ruggieri MP, Ciammella P, Iotti C. Prognostic factors, efficacy, and toxicity of involved-node stereotactic body radiation therapy for lymph node oligorecurrent prostate cancer : An investigation of 117 pelvic lymph nodes. Strahlenther Onkol 2021; 198:700-709. [PMID: 34757443 DOI: 10.1007/s00066-021-01871-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/21/2021] [Accepted: 10/17/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND The optimal radiotherapy regimen is not yet defined in the setting of oligorecurrent prostate cancer (oligorPC). There is evidence of high variability in treatment protocols among different centers worldwide, and no international consensus guidelines on treatment volumes, radiation schedules, and techniques. The purpose of the present retrospective study is to evaluate the efficacy and safety of involved-pelvic-node stereotactic body radiotherapy (SBRT) for oligorPC. MATERIALS AND METHODS Patients with pelvic node oligorPC following primary surgery, radical radiotherapy, or salvage radiotherapy for biochemical or local relapse of prostate cancer who underwent involved-node SBRT with biological effective dose (BED) > 100 Gy, with or without concurrent and adjuvant androgen deprivation therapy (ADT), were retrospectively evaluated. Biochemical progression-free survival (bPFS), distant progression-free survival (DPFS), overall survival (OS), possible prognostic factors, and toxicity outcomes were investigated. RESULTS From November 2012 to December 2019, 74 patients fitted the selection criteria. A total of 117 lesions were treated. Median follow-up was 31 months (range 6-89). Concurrent ADT was administered in 58.1% of patients. The 1‑year, 2‑year, and 3‑year DPFS was 77%, 37%, and 19%, respectively; the 1‑year, 2‑year, and 3‑year OS was 98%, 98%, and 95%, respectively. The presence of a single target lesion was associated with a statistically significant impact on OS. No in-field recurrence occurred. Patients who reached early prostate-specific antigen (PSA) nadir (< 3 months after SBRT) had a lower 3‑year survival (p = 0.004). The value of PSA nadir after SBRT and the time between primary treatment and SBRT had an impact on bPFS. Concomitant ADT was associated with improved DPFS. No acute or early late (> 6 months) genitourinary and gastrointestinal adverse events of any grade were reported, albeit with relatively short median follow-up. CONCLUSION SBRT is a safe and effective treatment for oligorPC, with a 100% local control rate in our series. It is not possible to clearly assess the opportunity to postpone ADT prescription in patients with two or more nodal metastases. The number of secondary lesions, time-to-nadir PSA, PSA nadir value, and the time interval between primary treatment and SBRT were identified as prognostic factors. Future prospective randomized studies are desirable to better understand the still open questions regarding the oligorecurrent prostate cancer state.
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Affiliation(s)
- Salvatore Cozzi
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Andrea Botti
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giorgia Timon
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gladys Blandino
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Masoumeh Najafi
- Department of Radiation Oncology Shohadaye Haft-e-Tir Hospital, Iran University of Medical Science, Teheran, Iran
| | - Moana Manicone
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lilia Bardoscia
- Radiation Oncology Unit, S. Luca Hospital, Healtcare Company Tuscany Nord Ovest, Lucca, Italy
| | - Maria Paola Ruggieri
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Patrizia Ciammella
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cinzia Iotti
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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24
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Cagni E, Botti A, Rossi L, Iotti C, Iori M, Cozzi S, Galaverni M, Rosca A, Sghedoni R, Timon G, Spezi E, Heijmen B. Variations in Head and Neck Treatment Plan Quality Assessment Among Radiation Oncologists and Medical Physicists in a Single Radiotherapy Department. Front Oncol 2021; 11:706034. [PMID: 34712606 PMCID: PMC8545894 DOI: 10.3389/fonc.2021.706034] [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: 05/06/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background Agreement between planners and treating radiation oncologists (ROs) on plan quality criteria is essential for consistent planning. Differences between ROs and planning medical physicists (MPs) in perceived quality of head and neck cancer plans were assessed. Materials and Methods Five ROs and four MPs scored 65 plans for in total 15 patients. For each patient, the clinical (CLIN) plan and two or four alternative plans, generated with automated multi-criteria optimization (MCO), were included. There was always one MCO plan aiming at maximally adhering to clinical plan requirements, while the other MCO plans had a lower aimed quality. Scores were given as follows: 1-7 and 1-2, not acceptable; 3-5, acceptable if further planning would not resolve perceived weaknesses; and 6-7, straightway acceptable. One MP and one RO repeated plan scoring for intra-observer variation assessment. Results For the 36 unique observer pairs, the median percentage of plans for which the two observers agreed on a plan score (100% = 65 plans) was 27.7% [6.2, 40.0]. In the repeat scoring, agreements between first and second scoring were 52.3% and 40.0%, respectively. With a binary division between unacceptable (scores 1 and 2) and acceptable (3-7) plans, the median inter-observer agreement percentage was 78.5% [63.1, 86.2], while intra-observer agreements were 96.9% and 86.2%. There were no differences in observed agreements between RO-RO, MP-MP, and RO-MP pairs. Agreements for the highest-quality, automatically generated MCO plans were higher than for the CLIN plans. Conclusions Inter-observer differences in plan quality scores were substantial and could result in inconsistencies in generated treatment plans. Agreements among ROs were not better than between ROs and MPs, despite large differences in training and clinical role. High-quality automatically generated plans showed the best score agreements.
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Affiliation(s)
- Elisabetta Cagni
- Medical Physics Unit, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico (USL-IRCCS) di Reggio Emilia, Reggio Emilia, Italy.,School of Engineering, Cardiff University, Cardiff, United Kingdom
| | - Andrea Botti
- Medical Physics Unit, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico (USL-IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Linda Rossi
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Cinzia Iotti
- Radiotherapy Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mauro Iori
- Medical Physics Unit, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico (USL-IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Salvatore Cozzi
- Radiotherapy Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Galaverni
- Radiotherapy Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ala Rosca
- Radiotherapy Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Roberto Sghedoni
- Medical Physics Unit, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico (USL-IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Giorgia Timon
- Radiotherapy Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Emiliano Spezi
- School of Engineering, Cardiff University, Cardiff, United Kingdom
| | - Ben Heijmen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
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BARDOSCIA L, Ciammella P, Besutti G, Bonelli E, Botti A, Pellegrini M, Vigo F, Rosca A, Timon G, Cozzi S, Ruggieri M, Iotti C. PO-0991 Impact of low muscle quality in patients with head and neck cancer undergoing chemoradiation. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07442-9] [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: 11/25/2022]
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26
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Cagni E, Botti A, Chendi A, Iori M, Spezi E. Use of knowledge based DVH predictions to enhance automated re-planning strategies in head and neck adaptive radiotherapy. Phys Med Biol 2021; 66. [PMID: 34098549 DOI: 10.1088/1361-6560/ac08b0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/07/2021] [Indexed: 11/12/2022]
Abstract
This study aimed to investigate if a commercial, knowledge-based tool for radiotherapy planning could be used to estimate the amount of sparing in organs at risk (OARs) in the re-planning strategy for adaptive radiotherapy (ART). Eighty head and neck (HN) VMAT Pareto plans from our institute's database were used to train a knowledge-based planning (KBP) model. An evaluation set of another 20 HN patients was randomly selected. For each patient in the evaluation set, the planning computed tomography (CT) and 2 sets of on-board cone-beam CT, corresponding to the middle and second half of the radiotherapy treatment course, were extracted. The original plan was re-calculated on a daily deformed CT (delivered dose-volume histogram (DVH)) and compared with the KBP DVH predictions and with the final KBP DVH after optimisation of the plan, which was performed on the same image sets. To evaluate the feasibility of this method, the range of KBP DVH uncertainties was compared with the gains obtained from re-planning. DVH differences and receiver operating characteristic (ROC) curve analysis were used for this purpose. On average, final KBP uncertainties were smaller than the gain in re-planning. Statistical tests confirmed significant differences between the two groups. ROC analysis showed KBP performance in terms of area under the curve values higher than 0.7, which confirmed a good accuracy in predicted values. Overall, for 48% of cases, KBP predicted a desirable outcome from re-planning, and the final dose confirmed an effective gain in 47% of cases. We have established a systematic workflow to identify effective OAR sparing in re-planning based on KBP predictions that can be implemented in an on-line, ART process.
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Affiliation(s)
- Elisabetta Cagni
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,School of Engineering, Cardiff University, Cardiff, United Kingdom
| | - Andrea Botti
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Agnese Chendi
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Medical Physics, Alma Mater Studiorum Bologna University, Bologna, Italy
| | - Mauro Iori
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Emiliano Spezi
- School of Engineering, Cardiff University, Cardiff, United Kingdom
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27
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Halasz G, Sperti M, Villani M, Michelucci U, Agostoni P, Biagi A, Rossi L, Botti A, Mari C, Maccarini M, Pura F, Roveda L, Nardecchia A, Mottola E, Nolli M, Salvioni E, Mapelli M, Deriu MA, Piga D, Piepoli M. A Machine Learning Approach for Mortality Prediction in COVID-19 Pneumonia: Development and Evaluation of the Piacenza Score. J Med Internet Res 2021; 23:e29058. [PMID: 33999838 PMCID: PMC8168638 DOI: 10.2196/29058] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/15/2021] [Accepted: 05/16/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Several models have been developed to predict mortality in patients with COVID-19 pneumonia, but only a few have demonstrated enough discriminatory capacity. Machine learning algorithms represent a novel approach for the data-driven prediction of clinical outcomes with advantages over statistical modeling. OBJECTIVE We aimed to develop a machine learning-based score-the Piacenza score-for 30-day mortality prediction in patients with COVID-19 pneumonia. METHODS The study comprised 852 patients with COVID-19 pneumonia, admitted to the Guglielmo da Saliceto Hospital in Italy from February to November 2020. Patients' medical history, demographics, and clinical data were collected using an electronic health record. The overall patient data set was randomly split into derivation and test cohorts. The score was obtained through the naïve Bayes classifier and externally validated on 86 patients admitted to Centro Cardiologico Monzino (Italy) in February 2020. Using a forward-search algorithm, 6 features were identified: age, mean corpuscular hemoglobin concentration, PaO2/FiO2 ratio, temperature, previous stroke, and gender. The Brier index was used to evaluate the ability of the machine learning model to stratify and predict the observed outcomes. A user-friendly website was designed and developed to enable fast and easy use of the tool by physicians. Regarding the customization properties of the Piacenza score, we added a tailored version of the algorithm to the website, which enables an optimized computation of the mortality risk score for a patient when some of the variables used by the Piacenza score are not available. In this case, the naïve Bayes classifier is retrained over the same derivation cohort but using a different set of patient characteristics. We also compared the Piacenza score with the 4C score and with a naïve Bayes algorithm with 14 features chosen a priori. RESULTS The Piacenza score exhibited an area under the receiver operating characteristic curve (AUC) of 0.78 (95% CI 0.74-0.84, Brier score=0.19) in the internal validation cohort and 0.79 (95% CI 0.68-0.89, Brier score=0.16) in the external validation cohort, showing a comparable accuracy with respect to the 4C score and to the naïve Bayes model with a priori chosen features; this achieved an AUC of 0.78 (95% CI 0.73-0.83, Brier score=0.26) and 0.80 (95% CI 0.75-0.86, Brier score=0.17), respectively. CONCLUSIONS Our findings demonstrated that a customizable machine learning-based score with a purely data-driven selection of features is feasible and effective for the prediction of mortality among patients with COVID-19 pneumonia.
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Affiliation(s)
- Geza Halasz
- Department of Cardiology, Guglielmo Da Saliceto Hospital, Piacenza, Italy
| | - Michela Sperti
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Matteo Villani
- Anesthesiology and ICU Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | - Piergiuseppe Agostoni
- Department of Clinical Sciences and Community Health, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Italy
| | - Andrea Biagi
- Department of Cardiology, Guglielmo Da Saliceto Hospital, Piacenza, Italy
| | - Luca Rossi
- Department of Cardiology, Guglielmo Da Saliceto Hospital, Piacenza, Italy
| | - Andrea Botti
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Chiara Mari
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Marco Maccarini
- Dalle Molle Institute for Artificial Intelligence, Università della Svizzera italiana/Scuola universitaria professionale della Svizzera italiana, Lugano, Switzerland
| | - Filippo Pura
- Dalle Molle Institute for Artificial Intelligence, Università della Svizzera italiana/Scuola universitaria professionale della Svizzera italiana, Lugano, Switzerland
| | - Loris Roveda
- Dalle Molle Institute for Artificial Intelligence, Università della Svizzera italiana/Scuola universitaria professionale della Svizzera italiana, Lugano, Switzerland
| | | | | | - Massimo Nolli
- Anesthesiology and ICU Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Elisabetta Salvioni
- Department of Clinical Sciences and Community Health, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Italy
| | - Massimo Mapelli
- Department of Clinical Sciences and Community Health, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Italy
| | - Marco Agostino Deriu
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Dario Piga
- Dalle Molle Institute for Artificial Intelligence, Università della Svizzera italiana/Scuola universitaria professionale della Svizzera italiana, Lugano, Switzerland
| | - Massimo Piepoli
- Department of Cardiology, Guglielmo Da Saliceto Hospital, Piacenza, Italy
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Chendi A, Botti A, Orlandi M, Sghedoni R, Iori M, Cagni E. EPID-based 3D dosimetry for pre-treatment FFF VMAT stereotactic body radiotherapy plan verification using dosimetry Check TM. Phys Med 2021; 81:227-236. [PMID: 33485140 DOI: 10.1016/j.ejmp.2020.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The software Dosimetry Check (DC) reconstructs the 3D dose distribution on CT images data set by using EPID measured signal. This study aimed to evaluate DC for stereotactic body radiotherapy (SBRT) with unflattened photon beams (FFF) for dosimetric independent plan verification in pre-treatment modality. METHODS DC v.4.1 was configured for Varian TrueBeam STx FFF beams equipped with EPID aS-1200. The DC FFF models were tested using arc open fields (from 1×1 cm2 to 15×15 cm2) and VMAT (Volumetric Modulated Arc Therapy) SBRT plans on phantom and patient CTs. DC dose distributions (DDC) were compared with that calculated by Eclipse with Acuros XB algorithm (DAXB) and one measured by Octavius 1000 SRS detector (DOCT). All differences were quantified in terms of the local 3D gamma passing rate (%GP), DVH and point dose differences. RESULTS DC was configured for FFF VMAT using an appropriate correction procedure. %GP2%2mm (mean±standard deviation) of DOCT-DDC was 96.3±2.7% for open fields whereas it was 90.1±5.9% for plans on homogeneous phantom CT. However, average %GP3%3mm of DAXB-DDC was 95.0±4.1 for treatments on patient CT. The fraction of plans passing the %GP3%3mm DQA tolerance level [10% (50%) of maximum dose threshold] were 20/20 (14/20) and 18/20 (16/20) for OCT on phantom CT and DC on patient CT, respectively. CONCLUSIONS DC characterization for FFF beams was performed. For stereotactic VMAT plan verifications DC showed good agreement with TPS whereas underlined discrepancies with Octavius in the high dose regions. A customized tolerance level is required for EPID-based VMAT FFF pre-treatment verification when DC system is applied.
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Affiliation(s)
- Agnese Chendi
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Postgraduate School in Medical Physics, University of Bologna, Bologna, Italy.
| | - Andrea Botti
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Matteo Orlandi
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Roberto Sghedoni
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mauro Iori
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisabetta Cagni
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; School of Engineering, Cardiff University, Cardiff, UK
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Galaverni M, Chendi A, Trojani V, Bertolini M, Botti A, Ciammella P, Ruggieri M, Giaccherini L, Blandino G, Manicone M, Rossi R, Timon G, Cozzi S, Bardoscia L, Solla S, Orlandi M, Fioroni F, Spaggiari L, Iori M, Iotti C. Radiomics Analysis of Stereotactic Body Radiation Therapy Patients with Lung Cancer as a Toxicity Biomarker. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1338] [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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Cagni E, Rossi L, Botti A, Iori M, Sghedoni R, Iotti C, Rosca A, Timon G, Cozzi S, Galaverni M, Orlandi M, Spezi E, Heijmen B. OC-0105: Inter-observer variability in quality scores of Pareto optimal plans. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00131-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ardissino M, Nelson AJ, Maglietta G, Tagliazucchi GM, Disisto C, Canosi U, Cernetti C, Merlini PA, Berzuini C, Ponte E, Fetiveau R, Buratti S, Paraboschi E, Duga S, Tuttolomondo D, Crocamo A, Barocelli F, Bricoli S, Botti A, Bonura R, Magnani G, Biagi A, Paoli G, Solinas E, Ardissino D. SEX-BASED DIFFERENCES IN LONG-TERM OUTCOMES AFTER EARLY-ONSET MYOCARDIAL INFARCTION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30833-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gaibazzi N, Martini C, Botti A, Pinazzi A, Bottazzi B, Rendina R, Palumbo AA. 1176 Coronary inflammation by CT peri-coronary fat attenuation in MINOCA and Tako-Tsubo syndrome. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.675] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Nothing to declare
OnBehalf
None
Background
Peri-coronary fat attenuation index (pFAI) has emerged as a clinical marker of coronary
inflammation, which is measurable from standard coronary CT angiography (CCTA). It compares
well with gold-standard methods for the assessment of coronary inflammation and can predict future
cardiovascular events. pFAI could prove invaluable to differentiate an inflammatory from noninflammatory coronary artery status, helping unravel the mechanisms subtending an event classified as myocardial infarction with nonobstructive coronary arteries (MINOCA) or Tako-Tsubo syndrome (TTs).
Methods and Results
Patients admitted with MINOCA and TTs diagnosis between 2011 and 2018,
who had both CCTA and CMR performed during or shortly after the acute phase, were selected and
pFAI measured in their index CCTA. pFAI was also measured in a control subjects who had CCTA
for atypical chest pain work-up, no obstructive coronary artery disease found in their CCTA and no
cardiac events at a minimum 2-year follow-up.
In the n = 106 MINOCA/TTs patients selected, mean pFAI averaged for the 3 coronary arteries was -68.37 ± 8.29 vs -78.03 ± 6.20 in the n = 106 controls (p < 0.0001) and the statistical difference was
confirmed also when comparing mean pFAI in each single coronary artery between MINOCA/TTs
and controls (p < 0.0001). Non-obstructive coronary plaques at CCTA, and high-risk plaques in
particular, were also more frequently found (p < 0.01) in the MINOCA/TTs group compared with
controls.
Conclusions
In MINOCA and TTs patients, CCTA is not only able to detect otherwise angiographically invisible atherosclerotic plaques, but its diagnostic yield can be further expanded using the simple off-line measurement of pFAI for the characterization of peri-coronary fat tissue. In MINOCA/TTs mean pFAI clearly demonstrates higher values in comparison with controls, a finding which has been previously associated with coronary artery inflammation. We speculate that this newly-available diagnostic tool in the future may help select patients for new therapies, for example therapies targeting coronary inflammation.
I was able to build a table.
Abstract 1176 Figure.
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Affiliation(s)
- N Gaibazzi
- University Hospital of Parma, Cardiology, Parma, Italy
| | - C Martini
- University Hospital of Parma, Diagnostic, Parma, Italy
| | - A Botti
- University of Parma, Medicine and Surgery, Parma, Italy
| | - A Pinazzi
- University of Parma, Medicine and Surgery, Parma, Italy
| | - B Bottazzi
- University of Parma, Medicine and Surgery, Parma, Italy
| | - R Rendina
- University of Parma, Medicine and Surgery, Parma, Italy
| | - A A Palumbo
- University Hospital of Parma, Diagnostic, Parma, Italy
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Suma S, Coli S, Serra W, Spaggiari I, Botti A, Cozza F, Garibaldi S, Gaibazzi N. P1304 Is antibiotic profilaxis really not needed in mitral valve prolapse? Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.748] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Patient Presentation
A 54 years old woman with dyslipidemia was admitted to the hospital due to the onset of persistent fever. She had no significant comorbidities and she had a known mitral valve prolapse, which was in clinical and echocardiographic follow-up since more than 15 years before.
Two months before the hospitalization she underwent dental hygiene procedure without taking any antibiotic before. The procedure included scaling and polishing of the teeth, and she referred just a mild bleeding. After few days she reported the onset of fever and therefore she started to take amoxicilline/clavulanic acid but without any significant improvement of symptoms.
Initial work up
At the blood chemistry she had a mild leucocytosis with neutrophilia and a rise in inflammatory indices. The Chest x-ray was normal. A systolic murmur was evident at the physical examination. Therefore, Transthoracic Echocardiogram was performed, followed by Transesophageal Echocardiogram (see Figure). At the Echo there was a significant endocarditic involvement of the mitral valve with multiple vegetations, two on the posterior leaflet (scallop P1 and P3) and one on the anterior one (scallop A3); moreover, there was a flail of the posterior leaflet (scallop P1) with subsequent moderate to severe eccentric valve regurgitation.
Diagnosis and management
Diagnosis of Endocarditis was made and, thus, antibiotic therapy was started with gentamicin and daptomycin, then switched to ampicillin and ceftriaxone after the isolation at the blood culture of Enterococcus Faecalis sensitive to them. Cerebral CT was performed with no evidence of embolization. Finally, owing to the significant endocarditis of the mitral valve with associate moderate to severe regurgitation, the patient underwent surgical intervention with mitral valve replacement with bioprosthesis.
Follow-up
The post-operative period was regular with no significant complications. She had no more fever and the antibiotics were stopped after six weeks.
Conclusion
We reported the case of a severe endocarditic involvement of the mitral valve in a patient with known valvular prolapse, who did not take any antibiotic before a minor dental procedure.
2015 ESC guidelines on Endocarditis recommend to not perform antibiotic prophylaxis in patient with no valvular prosthesis but with other form of valvular disease, including mitral valve prolapse (Class III, level of evidence C). Most of the time, patients with other form of valvular disease (e.g. mitral valve prolapse, bicuspid aortic valve, calcific aortic stenosis) do not experience endocarditis, neither after dental procedures. However, this case shows that sometimes it can happen due to the abnormal conformation of the native valve and, hence, it makes us wonder whether the antibiotic therapy should be indicated before dental procedures in those kind of patients.
Abstract P1304 Figure.
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Affiliation(s)
- S Suma
- University Hospital of Parma, Parma, Italy
| | - S Coli
- University Hospital of Parma, Parma, Italy
| | - W Serra
- University Hospital of Parma, Parma, Italy
| | | | - A Botti
- University Hospital of Parma, Parma, Italy
| | - F Cozza
- University Hospital of Parma, Parma, Italy
| | | | - N Gaibazzi
- University Hospital of Parma, Parma, Italy
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Bruni A, Giaj-Levra N, Ciammella P, Maragna V, Ferrari K, Bonti V, Grossi F, Greco S, Greco C, Borghetti P, Franceschini D, Capelletto E, Perna M, Banna G, Vagge S, Baldini E, Bria E, Botti A, Tiseo M, Paci M, Taraborrelli M, Poletti V, Granone P, Ricardi U, Novello S, Scotti V. Management of locally advanced non-small cell lung cancer in the modern era: A national Italian survey on diagnosis, treatment and multidisciplinary approach. PLoS One 2019; 14:e0224027. [PMID: 31721773 PMCID: PMC6853329 DOI: 10.1371/journal.pone.0224027] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/03/2019] [Indexed: 12/13/2022] Open
Abstract
Concurrent chemotherapy and radiotherapy (cCRT) is considered the standard treatment of locally advanced non-small cell lung cancer (LA-NSCLC). Unfortunately, management is still heterogeneous across different specialists. A multidisciplinary approach is needed in this setting due to recent, promising results obtained by consolidative immunotherapy. The aim of this survey is to assess current LA-NSCLC management in Italy. From January to April 2018, a 15-question survey focusing on diagnostic/therapeutic LA-NSCLC management was sent to 1,478 e-mail addresses that belonged to pneumologists, thoracic surgeons, and radiation and medical oncologists. 421 answers were analyzed: 176 radiation oncologists, 86 medical oncologists, 92 pneumologists, 64 thoracic surgeons and 3 other specialists. More than a half of the respondents had been practicing for >10 years after completing residency training. Some discrepancies were observed in clinical LA-NSCLC management: the lack of a regularly planned multidisciplinary tumor board, the use of upfront surgery in multistation stage IIIA, and territorial diffusion of cCRT in unresectable LA-NSCLC. Our analysis demonstrated good compliance with international guidelines in the diagnostic workup of LA-NSCLC. We observed a relationship between high clinical experience and good clinical practice. A multidisciplinary approach is mandatory for managing LA-NSCLC.
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Affiliation(s)
- Alessio Bruni
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Niccolò Giaj-Levra
- Department of Advanced Radiation Oncology, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Patrizia Ciammella
- Radiation Therapy Unit, Department of Oncology and Advanced Technology, AUSL-IRCCS, Reggio Emilia, Italy
| | - Virginia Maragna
- Radiation Therapy Unit, Department of Oncology, Careggi University Hospital, Firenze, Italy
| | - Katia Ferrari
- Section of Respiratory Medicine, Careggi University Hospital, Firenze, Italy
| | - Viola Bonti
- Section of Respiratory Medicine, Careggi University Hospital, Firenze, Italy
| | - Francesco Grossi
- UOC Oncologia Medica Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Greco
- UOSD of Oncologic Pneumology, San Camillo Forlanini Hospital, Rome, Italy
| | - Carlo Greco
- Department of Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Paolo Borghetti
- Radiation Oncology Department University and Spedali Civili, Brescia, Italy
| | - Davide Franceschini
- Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - Enrica Capelletto
- Oncology Department, University of Turin, AOU San Luigi, Orbassano (TO), Italy
| | - Marco Perna
- Radiation Therapy Unit, Department of Oncology, Careggi University Hospital, Firenze, Italy
| | - Giuseppe Banna
- Oncology Department, Ospedale Cannizzaro, Catania, Italy
| | - Stefano Vagge
- Department of Radiation Oncology, Azienda Ospedaliera Universitaria San Martino di Genova-IST, Istituto Nazionale Ricerca sul Cancro, Genoa, Italy
| | | | - Emilio Bria
- U.O.C. Oncologia Medica, Comprehensive Cancer Center-Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Roma, Italy
| | - Andrea Botti
- Medical Physics Unit, Department of Oncology and Advanced Technology, AUSL-IRCCS, Reggio Emilia, Italy
| | - Marcello Tiseo
- Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Massimiliano Paci
- Division of Thoracic Surgery, Azienda USL-IRCCS of Reggio Emilia, Italy
| | - Maria Taraborrelli
- Radiotherapy Unit, SS Annunziata Hospital-G. D'annunzio University, Chieti, Italy
| | - Venerino Poletti
- Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì (I), Italy
- Department of Respiratory Diseases & Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Pierluigi Granone
- Department of General Thoracic Surgery, Catholic University, Rome, Italy
| | | | - Silvia Novello
- Oncology Department, University of Turin, AOU San Luigi, Orbassano (TO), Italy
| | - Vieri Scotti
- Radiation Therapy Unit, Department of Oncology, Careggi University Hospital, Firenze, Italy
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Giaccherini L, Galaverni M, Renna I, Timon G, Galeandro M, Pisanello A, Russo M, Botti A, Iotti C, Ciammella P. Role of multidimensional assessment of frailty in predicting outcomes in older patients with glioblastoma treated with adjuvant concurrent chemo-radiation. J Geriatr Oncol 2019; 10:770-778. [DOI: 10.1016/j.jgo.2019.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/30/2019] [Accepted: 03/13/2019] [Indexed: 12/13/2022]
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Gaibazzi N, Martini C, Botti A, Pinazzi A, Bottazzi B, Palumbo AA. Coronary Inflammation by Computed Tomography Pericoronary Fat Attenuation in MINOCA and Tako-Tsubo Syndrome. J Am Heart Assoc 2019; 8:e013235. [PMID: 31462127 PMCID: PMC6755824 DOI: 10.1161/jaha.119.013235] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The pericoronary fat attenuation index (pFAI) has emerged as a marker of coronary inflammation, which is measurable from standard coronary computed tomography angiography (CCTA). It compares well with gold‐standard methods for the assessment of coronary inflammation and can predict future cardiovascular events. pFAI could prove invaluable to differentiate an inflammatory from a noninflammatory coronary artery status, helping unravel the mechanisms subtending an event classified as myocardial infarction with nonobstructive coronary arteries (MINOCA) or Tako‐Tsubo syndrome (TTS). Methods and Results Patients admitted with MINOCA and TTS between 2011 and 2018, who had both CCTA and cardiac magnetic resonance during or shortly after the acute phase, were selected and pFAI measured in their CCTA; pFAI was also measured in control subjects who had CCTA for atypical chest pain workup, no obstructive coronary artery disease found in their CCTA, and no cardiac events at 2‐year follow‐up. In the n=106 MINOCA/TTS patients, mean pFAI was −68.37±8.29 versus −78.03±6.20 in the n=106 controls (P<0.0001), and the difference was confirmed also when comparing mean pFAI in each coronary artery between MINOCA/TTS and controls (P<0.0001). Nonobstructive coronary plaques at CCTA, high‐risk plaques in particular, were more frequently found (P<0.01) in the MINOCA/TTS group compared with controls. Conclusions In MINOCA and TTS patients, CCTA is not only able to detect angiographically invisible atherosclerotic plaques, but its diagnostic yield can be expanded using the simple measurement of pFAI to characterize pericoronary fat tissue; in MINOCA/TTS mean pFAI demonstrates higher values compared with controls, a finding that has been associated with coronary artery inflammation.
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Affiliation(s)
- Nicola Gaibazzi
- Cardiology and Radiology Departments Parma University Hospital Parma Italy
| | - Chiara Martini
- Cardiology and Radiology Departments Parma University Hospital Parma Italy
| | - Andrea Botti
- Cardiology and Radiology Departments Parma University Hospital Parma Italy
| | - Antonio Pinazzi
- Cardiology and Radiology Departments Parma University Hospital Parma Italy
| | - Barbara Bottazzi
- Cardiology and Radiology Departments Parma University Hospital Parma Italy
| | - Anselmo A Palumbo
- Cardiology and Radiology Departments Parma University Hospital Parma Italy
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Lange F, Botti A, Almeida J, Júnior JP, Omir F, Ribeiro F, Loureiro D, Vasques M. Maxillomandibular advancement treatment of obstructive sleep apnea syndrome: case report. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.847] [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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Demola P, Crocamo A, Ceriello L, Botti A, Cremonini I, Pattoneri P, Corradi D, Visioli F, Goldoni M, Pelà G. Hemodynamic and ECG responses to stress test in early adolescent athletes explain ethnicity-related cardiac differences. Int J Cardiol 2019; 289:125-130. [PMID: 31072636 DOI: 10.1016/j.ijcard.2019.04.084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/14/2019] [Revised: 04/10/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Ethnicity is an important determinant of athletes' cardiovascular adaptation. Black adolescent and adult athletes exhibit a left ventricular (LV) hypertrophy with a concentric remodelling higher than their Caucasian counterparts. Scant data, however, are available on race-related differences in hemodynamic response of adolescent athletes to exercise and its relation with heart remodelling. We evaluated if race-specific, sport-related structural and electrical remodelling in adolescent athletes of Caucasian and African ethnicity exclusively depends on race itself rather than on different cardiovascular responses to physical exercise. METHODS We examined 90 adolescent athletes, 60 Caucasian (WA) and 30 Black (BA). All participants underwent thorough clinical, echocardiographic and stress test evaluations. RESULTS BA had greater indexed LV mass (LVM/BSA) with increased relative wall thickness (RWT) implying a concentric remodelling. BA showed higher systolic blood pressure (SBP) compared to WA during the whole exercise test. ECG data showed that BA vs WA had a significant shorter QRS duration in each step considered with a significant greater QT dispersion. BA reached a higher relative pressure peak as compared to WA. RWT was strongly influenced by ethnicity and less by SBP at peak of exercise (PE), although LVM/BSA was significantly related to SBP at PE and just marginally to age and not significantly to race. CONCLUSIONS Black adolescent athletes showed higher SBP during all steps of exercise associated to a different trend. Ethnicity was the main determinant of RWT, suggesting that LV geometry is principally race-related rather than influenced by a different hemodynamic profile to physical activity.
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Affiliation(s)
- Pierluigi Demola
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy
| | - Antonio Crocamo
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy
| | - Laura Ceriello
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy
| | - Andrea Botti
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy
| | - Isabella Cremonini
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy
| | | | - Domenico Corradi
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy
| | - Francesco Visioli
- Department of Molecular Medicine, University of Padova, Italy; IMDEA-Food, CEI UAM+CSIC, Madrid, Spain
| | - Matteo Goldoni
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy
| | - Giovanna Pelà
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy.
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Giaccherini L, Ciammella P, Galaverni M, Manicone M, Renna I, Galeandro M, Timon G, Bellafiore F, Ramundo D, Vigo F, Rosca A, Palmieri T, Ruggieri M, Botti A, Sghedoni R, Cagni E, Orlandi M, Iori M, Russo M, Iotti C. EP-1650 Elderly glioblastoma patients:role of multidimensional assessment of frailty in predicting outcomes. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cagni E, Botti A, Orlandi M, Sghedoni R, Spezi E, Iori M. PO-0996 A knowledge-based tool to estimate the gain of re-planning strategy for Head and Neck (HN) ART. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31416-1] [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: 11/16/2022]
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Manicone M, Galaverni M, Renna I, Ciammella P, Giaccherini L, Bellafiore F, Timon G, Vigo F, Rosca A, Ramundo D, Galeandro M, Ruggieri M, Palmieri T, Botti A, Sghedoni R, Cagni E, Orlandi M, Russo M, Bonelli C, Pagano M, Iotti C. EP-1248 Stereotactic radiotherapy for brain metastasis and systemic therapies: a safe combination? Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31668-8] [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: 10/26/2022]
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Palorini F, Cicchetti A, Rancati T, Cozzarini C, Avuzzi B, Botti A, Cante D, Borca VC, Esposti CD, Garibaldi E, Girelli G, Iotti C, Maggio A, Munoz F, Palombarini M, Pierelli A, Pignoli E, Vavassori V, Valdagni R, Fiorino C. 47. Dependence from dose and fractionation of late severe urinary toxicities after radical radiotherapy for prostate cancer. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Cagni E, Botti A, Wang Y, Iori M, Petit SF, Heijmen BJM. Pareto-optimal plans as ground truth for validation of a commercial system for knowledge-based DVH-prediction. Phys Med 2018; 55:98-106. [PMID: 30471826 DOI: 10.1016/j.ejmp.2018.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/01/2018] [Accepted: 11/03/2018] [Indexed: 01/22/2023] Open
Affiliation(s)
- Elisabetta Cagni
- Medical Physics Unit, Department of Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; School of Engineering, Cardiff University, Cardiff, Wales, UK.
| | - Andrea Botti
- Medical Physics Unit, Department of Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Yibing Wang
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Mauro Iori
- Medical Physics Unit, Department of Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Steven F Petit
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Ben J M Heijmen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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Benatti G, Bosi D, Lazzeroni D, Botti A, Gaibazzi N. P1937The MyrhythmTM app for automatic detection of atrial fibrillation using commercial chest strap monitors: proof-of-concept accuracy testing in patients undergoing external electrical cardioversion. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1937] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Benatti
- University Hospital of Parma, Department of Cardiology, Parma, Italy
| | - D Bosi
- University Hospital of Parma, Department of Cardiology, Parma, Italy
| | - D Lazzeroni
- Don Carlo Gnocchi Foundation, Cardiovascular Prevention and Rehabilitation Unit, PARMA, Italy
| | - A Botti
- University Hospital of Parma, Department of Cardiology, Parma, Italy
| | - N Gaibazzi
- University Hospital of Parma, Department of Cardiology, Parma, Italy
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Palorini F, Cicchetti A, Rancati T, Cozzarini C, Avuzzi B, Botti A, Cante D, Casanova Borca V, Degli Esposti C, Garibaldi E, Girelli G, Iotti C, Maggio A, Munoz F, Palombarini M, Pierelli A, Pignoli E, Vavassori V, Valdagni R, Fiorino C. PV-0320: NTCP models of late severe urinary symptoms after radical IMRT for prostate cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30630-3] [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: 10/14/2022]
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Ciammella P, Galaverni M, Lattanzi E, Timon G, Renna I, Botti A, Orlandi M, Giaccherini L, Bellafiore F, Iotti C. EP-1365: F-FDG-PET/CT metabolic features as prognostic and predictive factors in lung tumors undergoing SBRT. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31674-8] [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: 11/30/2022]
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Iori M, Galeandro M, Botti A, Sghedoni R, Ciammella P, Orlandi M, Napoli M, Tanzi S, Pascarella R, Cavuto S, Pisanello A, Russo M, Cagni E, Chiari D, Campioli M, Iotti C. EP-1397: Dose painting guided by diffusion-weighted MRI applied to recurrent glioblastoma: a phase I protocol. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31832-7] [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: 10/19/2022]
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Cagni E, Botti A, Wang Y, Iori M, Petit S, Heijmen B. OC-0444: Pareto-optimal plans as ground truth to validate a commercial knowledge-based DVH-prediction system. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30886-1] [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: 11/30/2022]
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Cagni E, Botti A, Micera R, Galeandro M, Sghedoni R, Orlandi M, Iotti C, Cozzi L, Iori M. Knowledge-based treatment planning: An inter-technique and inter-system feasibility study for prostate cancer. Phys Med 2017; 36:38-45. [PMID: 28410684 DOI: 10.1016/j.ejmp.2017.03.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 09/27/2016] [Revised: 03/03/2017] [Accepted: 03/07/2017] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Helical Tomotherapy (HT) plans were used to create two RapidPlan knowledge-based (KB) models to generate plans with different techniques and to guide the optimization in a different treatment planning system for prostate plans. Feasibility and performance of these models were evaluated. MATERIAL AND METHODS two sets of 35 low risk (LR) and 30 intermediate risk (IR) prostate cancer cases who underwent HT treatments were selected to train RapidPlan models. The KB predicted constraints were used to perform new 20KB plans using RapidArc technique (KB-RA) (inter-technique validation), and to optimise 20 new HT (KB-HT) plans in the Tomoplan (inter-system validation). For each validation modality, KB plans were benchmarked with the manual plans created by an expert planner (EP). RESULTS RapidPlan was successfully configured using HT plans. The KB-RA plans fulfilled the clinical dose-volume requirements in 100% and 92% of cases for planning target volumes (PTVs) and organs at risk (OARs), respectively. For KB-HT plans these percentages were found to be a bit lower: 90% for PTVs and 86% for OARs. In comparison to EP plans, the KB-RA plans produced higher bladder doses for both LR and IR, and higher rectum doses for LR. KB-HT and EP plans produced similar results. CONCLUSION RapidPlan can be trained to create models by using plans of a different treatment modality. These models were suitable for generating clinically acceptable plans for inter-technique and inter-system applications. The use of KB models based on plans of consolidated technique could be useful with a new treatment modality.
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Affiliation(s)
- Elisabetta Cagni
- Medical Physics Unit, Department of Advanced Technology, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.
| | - Andrea Botti
- Medical Physics Unit, Department of Advanced Technology, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.
| | - Renato Micera
- Radiotherapy Unit, Department of Advanced Technology, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.
| | - Maria Galeandro
- Radiotherapy Unit, Department of Advanced Technology, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.
| | - Roberto Sghedoni
- Medical Physics Unit, Department of Advanced Technology, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.
| | - Matteo Orlandi
- Medical Physics Unit, Department of Advanced Technology, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.
| | - Cinzia Iotti
- Radiotherapy Unit, Department of Advanced Technology, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.
| | - Luca Cozzi
- Radiotherapy and Radiosurgery Department, Istituto Clinico Humanitas, Rozzano, Milan, Italy.
| | - Mauro Iori
- Medical Physics Unit, Department of Advanced Technology, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.
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