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Desideri I, Morelli I, Banini M, Greto D, Visani L, Nozzoli F, Caini S, Della Puppa A, Livi L, Perini Z, Zivelonghi E, Bulgarelli G, Pinzi V, Navarria P, Clerici E, Scorsetti M, Ascolese AM, Osti MF, Anselmo P, Amelio D, Minniti G, Scartoni D. Re-irradiation for recurrent intracranial meningiomas: Analysis of clinical outcomes and prognostic factors. Radiother Oncol 2024; 195:110271. [PMID: 38588920 DOI: 10.1016/j.radonc.2024.110271] [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: 01/14/2024] [Revised: 03/13/2024] [Accepted: 04/03/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Re-irradiation (re-RT) for recurrent intracranial meningiomas is hindered by the limited radiation tolerance of surrounding tissue and the risk of side effects. This study aimed at assessing outcomes, toxicities and prognostic factors in a cohort of patients with recurrent meningiomas re-treated with different RT modalities. MATERIALS AND METHODS A multi-institutional database from 8 Italian centers including intracranial recurrent meningioma (RM) patients who underwent re-RT with different modalities (SRS, SRT, PT, EBRT) was collected. Biologically Equivalent Dose in 2 Gy-fractions (EQD2) and Biological Effective Dose (BED) for normal tissue and tumor were estimated for each RT course (α/β = 2 for brain tissue and α/β = 4 for meningioma). Primary outcome was second progression-free survival (s-PFS). Secondary outcomes were overall survival (OS) and treatment-related toxicity. Kaplan-Meier curves and Cox regression models were used for analysis. RESULTS Between 2003 and 2021 181 patients (pts) were included. Median age at re-irradiation was 62 (range 20-89) and median Karnofsky Performance Status (KPS) was 90 (range 60-100). 78 pts were identified with WHO grade 1 disease, 65 pts had grade 2 disease and 10 pts had grade 3 disease. 28 pts who had no histologic sampling were grouped with grade 1 patients for further analysis. Seventy-five (41.4 %) patients received SRS, 63 (34.8 %) patients SRT, 31 (17.1 %) PT and 12 (6.7 %) EBRT. With a median follow-up of 4.6 years (interquartile range 1.7-6.8), 3-year s-PFS was 51.6 % and 3-year OS 72.5 %. At univariate analysis, SRT (HR 0.32, 95 % CI 0.19-0.55, p < 0.001), longer interval between the two courses of irradiation (HR 0.37, 95 % CI 0.21-0.67, p = 0.001), and higher tumor BED (HR 0.45 95 % CI 0.27-0.76, p = 0.003) were associated with longer s-PFS; in contrast, Ki67 > 5 % (HR 2.81, 95 % CI 1.48-5.34, p = 0.002) and WHO grade > 2 (HR 3.08, 95 % CI 1.80-5.28, p < 0.001) were negatively correlated with s-PFS. At multivariate analysis, SRT, time to re-RT and tumor BED maintained their statistically significant prognostic impact on s-PFS (HR 0.36, 95 % CI 0.21-0.64, p < 0.001; HR 0.38, 95 % CI 0.20-0.72, p = 0.003 and HR 0.31 95 % CI 0.13-0.76, p = 0.01, respectively). Acute and late adverse events (AEs) were reported in 38 (20.9 %) and 29 (16 %) patients. Larger tumor GTV (≥10 cc) was significantly associated with acute and late toxicity (p < 0.001 and p = 0.009, respectively). CONCLUSIONS In patients with recurrent meningiomas, reirradiation is a feasible treatment option associated with acceptable toxicity profile. Prognostic factors in the decision-making process have been identified and should be incorporated in daily practice.
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Affiliation(s)
- Isacco Desideri
- Department of Experimental and Clinical Biomedical sciences "Mario Serio", University of Florence, Florence, Italy
| | - Ilaria Morelli
- Department of Experimental and Clinical Biomedical sciences "Mario Serio", University of Florence, Florence, Italy.
| | - Marco Banini
- Department of Experimental and Clinical Biomedical sciences "Mario Serio", University of Florence, Florence, Italy
| | - Daniela Greto
- Radiation Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Luca Visani
- Radiation Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Filippo Nozzoli
- Histopathology and Molecular Diagnostics, Careggi University Hospital, Florence, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Alessandro Della Puppa
- Neurosurgical Clinical Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi University Hospital, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical sciences "Mario Serio", University of Florence, Florence, Italy
| | - Zeno Perini
- CyberKnife Unit, Ospedale S. Bortolo, Vicenza, Italy
| | - Emanuele Zivelonghi
- Unit of Stereotactic Neurosurgery, Department of Neurosciences, Hospital Trust of Verona, Verona, Italy; Physic Department, Department of Neurosciences, Hospital Trust of Verona, Italy
| | - Giorgia Bulgarelli
- Unit of Stereotactic Neurosurgery, Department of Neurosciences, Hospital Trust of Verona, Verona, Italy; Physic Department, Department of Neurosciences, Hospital Trust of Verona, Italy
| | - Valentina Pinzi
- Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Elena Clerici
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Anna Maria Ascolese
- Radiotherapy Department, St. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mattia Falchetto Osti
- Radiotherapy Department, St. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Paola Anselmo
- Radiotherapy Oncology Centre, Santa Maria Hospital, Terni, Italy
| | - Dante Amelio
- Proton Therapy Center, 'S. Chiara' Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Giuseppe Minniti
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Rome, Italy
| | - Daniele Scartoni
- Proton Therapy Center, 'S. Chiara' Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
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Desideri I, Scartoni D, Morelli I, Banini M, Visani L, Greto D, Detti B, Perini Z, Zivelonghi E, Bulgarelli G, Pinzi V, Pierina N, Clerici E, Ascolese AM, Anselmo P, Amelio D, Osti MF, Minniti G, Livi L. Clinical Outcomes and Dosimetric Predictive Factors in Patients Undergoing Reirradiation for Recurrent Meningiomas. Int J Radiat Oncol Biol Phys 2023; 117:e106-e107. [PMID: 37784638 DOI: 10.1016/j.ijrobp.2023.06.881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Re-irradiation (reRT) of intracranial meningiomas is often limited by radiation tolerance of the surrounding normal tissue and the risk of side effects. Aim of this retrospective study is to report outcomes, toxicity and prognostic factors of reRT in a large cohort of patients with recurrent meningiomas (RM) treated with different RT techniques. MATERIALS/METHODS A multi-institutional database of intracranial meningioma patients who recurred after prior radiation treatment was collected. Patients underwent reRT with one of the following techniques: radiosurgery (SRS), multi-fraction stereotactic radiotherapy (f-SRT), proton therapy (PT), Intensity-Modulated radiotherapy (IMRT) and External Beam radiotherapy (EBRT). Biologically Equivalent Doses in 2 Gy-fractions (EQD2) and Biological Effective Dose (BED) for surrounding normal tissue and tumor were estimated for each RT course, assuming an a/b = 2 for brain tissue and a/b = 4 for meningioma. Progression-free survival (PFS) was the primary outcome measure. Secondary outcomes were overall survival (OS) and treatment-related toxicity, according to Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v5.0). Kaplan-Meier curves were used to estimate the effect of several parameters on PFS and on OS; Cox regression models assessed predictors of PFS and OS. RESULTS Between 2003 and 2021, 181 patients (pts) were included. They were re-treated with SRS (n = 75; 41.4%), f-SRT (n = 63; 34.8%), PT (n = 31; 17.1%) and conventional radiotherapy (n = 12; 6.7%). 78 pts were identified with WHO Grade I disease, 65 pts with Grade II and 10 pts had Grade III disease. 28 pts without histologic sampling were included among Grade I patients for further analysis. Median age at re-irradiation was 62 (range 20-89) and median KPS 90 (range 60-100). After a median follow-up of 4.6 years (IQR 1.7-6.8), 3-year PFS was 51.6% and 3-year OS 72.5%. At univariate analysis Ki67 >5% (HR 2.81, 95% CI 1.48-5.34, p = 0.002) and WHO grade > I (HR 3.08, 95% CI 1.80-5.28, p< 0.001) were correlated with worse PFS, whereas f-SRT (HR 0.32, 95% CI 0.19-0.55, p<0.001), longer time to reRT (HR 0.37, 95% CI 0.21-0.67, p = 0.001) and higher tumor BED (HR 0.45 95% CI 0.27-0.76, p = 0.003) favorably correlated with PFS. At multivariate Cox analysis only f-SRT, time to reRT and tumor BED kept their statistically significant prognostic impact on PFS (HR 0.36, 95% CI 0.21-0.64, p<0.001; HR 0.38, 95% CI 0.20-0.72, p = 0.003 and HR 0.47 95% CI 0.26-0.83, p = 0.01, respectively). In addition, larger tumor GTV had a statistically significant higher risk of acute and late toxicity (p = .0.004 and p = 0.005, respectively). CONCLUSION Reirradiation of RM progressing after previous RT seems to be feasible, with encouraging outcomes and an acceptable toxicity profile. Prognostic factors in the treatment-algorithm have been identified and should be adopted in clinical daily practice.
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Affiliation(s)
- I Desideri
- Azienda Ospedaliero-Universitaria Careggi, Radiation Oncology Unit, Florence, Italy; Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - D Scartoni
- Proton Therapy Center, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - I Morelli
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - M Banini
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - L Visani
- Azienda Ospedaliero-Universitaria Careggi, Radiation Oncology Unit, Florence, Italy; Istituto Fiorentino di Cura e Assistenza (IFCA), CyberKnife Center, Florence, Italy
| | - D Greto
- Azienda Ospedaliero-Universitaria Careggi, Radiation Oncology Unit, Florence, Italy
| | - B Detti
- Azienda Ospedaliero-Universitaria Careggi, Radiation Oncology Unit, Florence, Italy
| | - Z Perini
- CyberKnife Unit, Ospedale s. Bortolo, Vicenza, Italy
| | - E Zivelonghi
- Unit of Stereotactic Neurosurgery, Department of Neurosciences, Hospital Trust of Verona, Verona, Italy; Physic Department, Department of Neurosciences, Hospital Trust of Verona, Verona, Italy
| | - G Bulgarelli
- Unit of Stereotactic Neurosurgery, Department of Neurosciences, Hospital Trust of Verona, Verona, Italy; Physic Department, Department of Neurosciences, Hospital Trust of Verona, Verona, Italy
| | - V Pinzi
- Radiotherapy Department, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - N Pierina
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Milan, Italy
| | - E Clerici
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Milan, Italy
| | - A M Ascolese
- Radiotherapy Department, St. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - P Anselmo
- Radiotherapy Oncology Centre, Santa Maria Hospital, Terni, Italy
| | - D Amelio
- Proton Therapy Unit, APSS, Trento, Italy
| | - M F Osti
- Radiotherapy Department, St. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - G Minniti
- Radiation Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - L Livi
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
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Arcidiacono F, Anselmo P, Casale M, Trippa F. 18F-FDG-PET guided vs whole tumour radiotherapy dose escalation in patients with locally advanced non-small cell lung cancer (PET-Boost): Results from a randomised clinical trial: Should dose intensification be discontinued or should accelerated schemes remain an important area of clinical research? Radiother Oncol 2023; 185:109688. [PMID: 37164107 DOI: 10.1016/j.radonc.2023.109688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/26/2023] [Accepted: 04/24/2023] [Indexed: 05/12/2023]
Affiliation(s)
| | - Paola Anselmo
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy.
| | | | - Fabio Trippa
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
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Arcidiacono F, Trippa F, Maranzano E, Italiani M, Casale M, Anselmo P. 127P Stereotactic ablative radiotherapy and durvalumab: The backbone of unresectable locally advanced non-small cell lung cancer patients unfit to concurrent chemo-radiotherapy -Rib of START-NEW-ERA trial. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00382-9] [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: 04/03/2023]
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Arcidiacono F, Anselmo P, Casale M, Zannori C, Loreti F, Italiani M, Enrico B, Fabiani S, Marchetti G, Tassi V, Mancioli F, Muti M, Guida A, Bracarda S, Ragusa M, Maranzano E, Trippa F. 126P Chemotherapy and stereotactic ablative radiotherapy in newly diagnosed and recurrent locally advanced non-small cell lung cancer patients unfit for concurrent radiochemotherapy: Sub-analysis and update of START-NEW-ERA non-randomised phase II trial. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00381-7] [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: 04/03/2023]
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Arcidiacono F, Casale M, Maranzano E, Italiani M, Fabiani S, Zannori C, Enrico B, Guida A, Trippa F, Anselmo P. 128P Stereotactic ablative radiotherapy in locally-advanced non-small cell lung cancer patients: Little palliation or big cure? Sub-analysis of START-NEW-ERA phase II trial. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00383-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Arcidiacono F, Anselmo P, Casale M, Zannori C, Ragusa M, Mancioli F, Marchetti G, Loreti F, Italiani M, Bracarda S, Maranzano E, Trippa F. STereotactic Ablative RadioTherapy in NEWly Diagnosed and Recurrent Locally Advanced Non-Small Cell Lung Cancer Patients Unfit for ConcurrEnt RAdio-Chemotherapy: Early Analysis of the START-NEW-ERA Non-Randomised Phase II Trial. Int J Radiat Oncol Biol Phys 2023; 115:886-896. [PMID: 36288758 DOI: 10.1016/j.ijrobp.2022.10.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE This is a single arm phase 2 trial (Clinical trials.gov NCT05291780) to assess local control (LC) and safety of SAbR in patients with unresectable locally advanced non-small cell lung cancer (LA-NSCLC) unfit for concurrent chemo-radiation therapy (ChT-RT). METHODS Neoadjuvant ChT was prescribed in fit patients. The tumor volume included primary tumor and any regionally positive node/s. The coprimary study endpoints were LC and safety. RESULTS Between December 31, 2015, and December 31, 2020, 50 patients with LA-NSCLC were enrolled. Histology was squamous cell carcinoma and adenocarcinoma (ADC) in 52% and 48%, respectively. Forty (80%) patients had ultracentral tumor. Twenty-seven (54%) received neoadjuvant ChT and 7 (14%) adjuvant durvalumab. Median prescribed dose was 45 Gy (range, 35-55) and 40 Gy (35-45) in 5 daily fractions to tumor and node/s, respectively. After a median follow-up of 38 months (range, 12-80), 19 (38%) patients had experienced local recurrence (LR) at a median time of 13 months (range, 7-34). The median LR-free survival (FS) was not reached (95% confidence interval [CI], 28 to not reached). The 1-, 2-, and 3-year LR-FS rates were 86% ± 5%, 66% ± 7%, and 56% ± 8%, respectively. At last follow-up, 33 (66%) patients were alive. Median overall survival (OS) was 55 months (95% CI, 43-55 months). The 1-, 2-, and 3-year OS rates were 94% ± 3%, 79% ± 6%, and 72% ± 7%, respectively. No patients developed ≥ grade (G) 3 toxicity. ADC (hazard ratio [HR], 3.61; 95% CI, 1.15-11.35) was a significant predictor of better LC, while OS was significantly conditioned by smaller planning target volumes (HR, 1.004; 95% CI, 1.001-1.010) and tumor, node, and metastasis stage (HR, 4.8; 95% CI, 1.34-17). CONCLUSIONS Patients with LA-NSCLC treated with SABR had optimal LC and promising OS in absence of ≥G3 toxicity. Our early outcomes would suggest the feasibility of using this approach in patients with LA-NSCLC unfit for concurrent ChT-RT.
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Affiliation(s)
| | | | | | | | | | | | | | - Fabio Loreti
- Nuclear Medicine Service, "S. Maria" Hospital, Terni, Italy
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Ciabattoni A, Gregucci F, De Rose F, Falivene S, Fozza A, Daidone A, Morra A, Smaniotto D, Barbara R, Lozza L, Vidali C, Borghesi S, Palumbo I, Huscher A, Perrucci E, Baldissera A, Tolento G, Rovea P, Franco P, De Santis MC, Grazia AD, Marino L, Meduri B, Cucciarelli F, Aristei C, Bertoni F, Guenzi M, Leonardi MC, Livi L, Nardone L, De Felice F, Rosetto ME, Mazzuoli L, Anselmo P, Arcidiacono F, Barbarino R, Martinetti M, Pasinetti N, Desideri I, Marazzi F, Ivaldi G, Bonzano E, Cavallari M, Cerreta V, Fusco V, Sarno L, Bonanni A, Mangiacotti MG, Prisco A, Buonfrate G, Andrulli D, Fontana A, Bagnoli R, Marinelli L, Reverberi C, Scalabrino G, Corazzi F, Doino D, Di Genesio-Pagliuca M, Lazzari M, Mascioni F, Pace MP, Mazza M, Vitucci P, Spera A, Macchia G, Boccardi M, Evangelista G, Sola B, La Porta MR, Fiorentino A, Levra NG, Ippolito E, Silipigni S, Osti MF, Mignogna M, Alessandro M, Ursini LA, Nuzzo M, Meattini I, D’Ermo G. AIRO Breast Cancer Group Best Clinical Practice 2022 Update. Tumori 2022; 108:1-144. [DOI: 10.1177/03008916221088885] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Breast cancer is the most common tumor in women and represents the leading cause of cancer death. Radiation therapy plays a key-role in the treatment of all breast cancer stages. Therefore, the adoption of evidence-based treatments is warranted, to ensure equity of access and standardization of care in clinical practice. Method: This national document on the highest evidence-based available data was developed and endorsed by the Italian Association of Radiation and Clinical Oncology (AIRO) Breast Cancer Group. We analyzed literature data regarding breast radiation therapy, using the SIGN (Scottish Intercollegiate Guidelines Network) methodology ( www.sign.ac.uk ). Updated findings from the literature were examined, including the highest levels of evidence (meta-analyses, randomized trials, and international guidelines) with a significant impact on clinical practice. The document deals with the role of radiation therapy in the treatment of primary breast cancer, local relapse, and metastatic disease, with focus on diagnosis, staging, local and systemic therapies, and follow up. Information is given on indications, techniques, total doses, and fractionations. Results: An extensive literature review from 2013 to 2021 was performed. The work was organized according to a general index of different topics and most chapters included individual questions and, when possible, synoptic and summary tables. Indications for radiation therapy in breast cancer were examined and integrated with other oncological treatments. A total of 50 questions were analyzed and answered. Four large areas of interest were investigated: (1) general strategy (multidisciplinary approach, contraindications, preliminary assessments, staging and management of patients with electronic devices); (2) systemic therapy (primary, adjuvant, in metastatic setting); (3) clinical aspects (invasive, non-invasive and micro-invasive carcinoma; particular situations such as young and elderly patients, breast cancer in males and cancer during pregnancy; follow up with possible acute and late toxicities; loco-regional relapse and metastatic disease); (4) technical aspects (radiation after conservative surgery or mastectomy, indications for boost, lymph node radiotherapy and partial breast irradiation). Appendixes about tumor bed boost and breast and lymph nodes contouring were implemented, including a dedicated web application. The scientific work was reviewed and validated by an expert group of breast cancer key-opinion leaders. Conclusions: Optimal breast cancer management requires a multidisciplinary approach sharing therapeutic strategies with the other involved specialists and the patient, within a coordinated and dedicated clinical path. In recent years, the high-level quality radiation therapy has shown a significant impact on local control and survival of breast cancer patients. Therefore, it is necessary to offer and guarantee accurate treatments according to the best standards of evidence-based medicine.
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Affiliation(s)
| | - Fabiana Gregucci
- UOC Radioterapia Oncologica, Ospedale Generale Regionale F. Miulli, Acquaviva delle Fonti (BA), Acquaviva delle Fonti, Italy
| | - Fiorenza De Rose
- UO Radioterapia Oncologica, Ospedale Santa Chiara, Trento, Italy
| | - Sara Falivene
- SC Radioterapia, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italy
| | - Alessandra Fozza
- UO Radioterapia Oncologica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Antonio Daidone
- UO Radioterapia Oncologica, Villa S.Teresa, Bagheria (PA), Palermo, Italy
| | - Anna Morra
- Divisione di Radioterapia Oncologica, Istituto Europeo di Oncologia, Milano, Italy
| | - Daniela Smaniotto
- UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
| | - Raffaele Barbara
- UOC Radioterapia Oncologica - Dipartimento Oncologico Internistico - ARNAS G.Brotzu - P. O. A Businco, Cagliari, Italy
| | - Laura Lozza
- SC Radioterapia 1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - Cristiana Vidali
- Radioterapia Oncologica, Radioterapia Oncologica, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Simona Borghesi
- UO Radioterapia Oncologica di Arezzo Valdarno, Azienda USL Toscana Sud Est, Arezzo, Italy
| | - Isabella Palumbo
- Sezione di Radioterapia Oncologica, Università degli Studi di Perugia e Azienda Ospedaliera di Perugia, Perugia, Italy
| | | | | | | | - Giorgio Tolento
- Radioterapia Oncologica, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paolo Rovea
- Radioterapia Oncologica, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Pierfrancesco Franco
- Dipartimento Medicina Traslazionale (DIMET), Università del Piemonte Orientale, Novara, Italy
| | | | - Alfio Di Grazia
- Radioterapia Humanitas, Istituto Clinico Catanese, Catania, Italy
| | - Lorenza Marino
- Radioterapia Humanitas, Istituto Clinico Catanese, Catania, Italy
| | - Bruno Meduri
- Dipartimento Radioterapia Oncologica, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Francesca Cucciarelli
- UO Radioterapia, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Cynthia Aristei
- Sezione di Radioterapia Oncologica, Università degli Studi di Perugia e Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Filippo Bertoni
- Radioterapia Oncologica, Associazione Italiana di Radioterapia ed Oncologia Clinica, Roma, Italy
| | - Marina Guenzi
- Radioterapia Oncologica, IRCCS Policlinico San Martino e Università, Genova, Italy
| | | | - Lorenzo Livi
- Dipartimento di Scienze Biomediche Sperimentali e Cliniche "M. Serio" - Università di Firenze, Firenze, e Radioterapia Oncologica, Dipartimento di Oncologia - Azienda Ospedaliero-Universitaria Careggi (AOUC), Italy
| | - Luigia Nardone
- UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
| | - Francesca De Felice
- Dipartimento Radioterapia, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza, Università di Roma, Roma, Italy
| | | | | | - Paola Anselmo
- SC Radioterapia Oncologica, Azienda Ospedaliera S. Maria, Terni, Italy
| | - Fabio Arcidiacono
- SC Radioterapia Oncologica, Azienda Ospedaliera S. Maria, Terni, Italy
| | | | | | - Nadia Pasinetti
- Servizio Radioterapia, ASST Valcamonica Esine e Università degli Studi di Brescia, Esine (BS), Italy
| | - Isacco Desideri
- Dipartimento di Scienze Biomediche Sperimentali e Cliniche "M. Serio" - Università di Firenze, Firenze, e Radioterapia Oncologica, Dipartimento di Oncologia - Azienda Ospedaliero-Universitaria Careggi (AOUC), Italy
| | - Fabio Marazzi
- UOC Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | - Elisabetta Bonzano
- PhD Medicina Sperimentale, Università degli Studi di Pavia, Pavia e Dipartimento di Radioterapia Oncologica, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | | | | | - Vincenzo Fusco
- UOC Radioterapia Oncologica, IRCCS-CROB Rionero in Vulture, Potenza, Italy
| | - Laura Sarno
- SC Radioterapia, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Alessio Bonanni
- UOC Radioterapia Oncologica, Ospedale S. Giovanni Calibita Fatebenefratelli - Isola Tiberina, Roma, Italy
| | | | - Agnese Prisco
- Dipartimento Radioterapia Oncologica, Azienda Ospedaliero Universitaria S. Maria della Misericordia, Udine, Italy
| | - Giovanna Buonfrate
- UOC Radioterapia, Ospedale della Misericordia, Azienda USL Toscana Sud Est, Grosseto, Italy
| | - Damiana Andrulli
- UOC Radioterapia, Oncologica Azienda Ospedaliera San Giovanni – Addolorata, Roma, Italy
| | - Antonella Fontana
- SC Radioterapia Oncologica, Ospedale S. Maria Goretti, Latina, Italy
| | - Rita Bagnoli
- SC Radioterapia, Area Omogenea Radioterapia, Ospedale San Luca, Azienda USL Toscana Nord Ovest, Lucca, Italy
| | - Luca Marinelli
- Radioterapia Oncologica, Fondazione Policlinico Universitario Campus Biomedico, Roma, Italy
| | - Chiara Reverberi
- Dipartimento Radioterapia Oncologica, Azienda Ospedaliero Universitaria S. Maria della Misericordia, Udine, Italy
| | - Giovanna Scalabrino
- UOC Radioterapia, Azienda Ospedaliero-Universitaria Policlinico Sant’Andrea, Sapienza, Università di Roma, Roma, Italy
| | - Francesca Corazzi
- SC Radioterapia Oncologica, Ospedale di Città di Castello, Città di Castello (PG), Italy
| | - Daniela Doino
- UO Radioterapia, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | | | - Francesca Mascioni
- UOC Radioterapia Oncologica, Ospedale Generale Provinciale di Macerata, Area Vasta 3, Macerata, Italy
| | - Maria Paola Pace
- UOC Radioterapia Oncologica, Ospedale Generale Provinciale di Macerata, Area Vasta 3, Macerata, Italy
| | - Mirko Mazza
- Azienda Ospedaliera San Salvatore Muraglia, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Pasquale Vitucci
- Département de Radiothérapie et Physique Médicale, CLCC “Henry Becquerel”, Rouen, France
| | | | - Gabriella Macchia
- UOC Radioterapia Oncologica-Gemelli Molise Hospital- Università Cattolica S. Cuore, Campobasso, Italy
| | - Mariangela Boccardi
- UOC Radioterapia Oncologica-Gemelli Molise Hospital- Università Cattolica S. Cuore, Campobasso, Italy
| | | | - Barbara Sola
- SS Radioterapia, Ospedale San Giovanni Antica Sede (SC Radioterapia U-AOU Città della Salute e della Scienza), Torino, Italy
| | | | - Alba Fiorentino
- UOC Radioterapia Oncologica, Ospedale Generale Regionale F. Miulli, Acquaviva delle Fonti (BA), Acquaviva delle Fonti, Italy
| | - Niccolò Giaj Levra
- Dipartimento di Radioterapia Oncologica Avanzata, IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar (VR), Italy
| | - Edy Ippolito
- Radioterapia Oncologica, Fondazione Policlinico Universitario Campus Biomedico, Roma, Italy
| | - Sonia Silipigni
- Radioterapia Oncologica, Fondazione Policlinico Universitario Campus Biomedico, Roma, Italy
| | - Mattia Falchetto Osti
- UOC Radioterapia, Azienda Ospedaliero-Universitaria Policlinico Sant’Andrea, Sapienza, Università di Roma, Roma, Italy
| | - Marcello Mignogna
- SC Radioterapia, Area Omogenea Radioterapia, Ospedale San Luca, Azienda USL Toscana Nord Ovest, Lucca, Italy
| | - Marina Alessandro
- SC Radioterapia Oncologica, Ospedale di Città di Castello, Città di Castello (PG), Italy
| | - Lucia Anna Ursini
- UOC Radioterapia Oncologica, Ospedale SS Annunziata, Università G d’Annunzio, Chieti, Italy
| | - Marianna Nuzzo
- UOC Radioterapia Oncologica, Ospedale SS Annunziata, Università G d’Annunzio, Chieti, Italy
| | - Icro Meattini
- Dipartimento di Scienze Biomediche Sperimentali e Cliniche "M. Serio" - Università di Firenze, Firenze, e Radioterapia Oncologica, Dipartimento di Oncologia - Azienda Ospedaliero-Universitaria Careggi (AOUC), Italy
| | - Giuseppe D’Ermo
- Dipartimento di Chirurgia P. Valdoni, Sapienza Università di Roma, Co-Coordinatore Task force per le Malattie del Seno LILT Sede Centrale, Italy
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9
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Arcidiacono F, Anselmo P, Casale M, Italiani M, Terenzi S, Di Marzo A, Fabiani S, Draghini L, Muti M, Trippa F, Maranzano E. PO-1269 SABR in locally-advanced non-small-cell lung cancer elderly patients: little palliation or big cure? Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03233-9] [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: 11/28/2022]
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10
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Arcidiacono F, Anselmo P, Casale M, Italiani M, Di Marzo A, Terenzi S, Draghini L, Muti M, Fabiani S, Maranzano E, Trippa F. PO-1244 Stereotactic Ablative Radiotherapy In Locally-Advanced Non-Small-Cell Lung Cancer: A Phase Ii Trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03208-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Lupattelli M, Tini P, Nardone V, Aristei C, Borghesi S, Maranzano E, Anselmo P, Ingrosso G, Deantonio L, di Monale E Bastia MB. Stereotactic radiotherapy for brain oligometastases. Rep Pract Oncol Radiother 2022; 27:15-22. [PMID: 35402029 PMCID: PMC8989457 DOI: 10.5603/rpor.a2021.0133] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/14/2021] [Indexed: 11/25/2022] Open
Abstract
Brain metastases, the most common metastases in adults, will develop in up to 40% of cancer patients, accounting for more than one-half of all intracranial tumors. They are most associated with breast and lung cancer, melanoma and, less frequently, colorectal and kidney carcinoma. Magnetic resonance imaging (MRI) is the gold standard for diagnosis. For the treatment plan, computed tomography (CT ) images are co-registered and fused with a gadolinium-enhanced T1-weighted MRI where tumor volume and organs at risk are contoured. Alternatively, plain and contrast-enhanced CT scans are co-registered. Single-fraction stereotactic radiotherapy (SRT ) is used to treat patients with good performance status and up to 4 lesions with a diameter of 30 mm or less that are distant from crucial brain function areas. Fractionated SRT (2–5 fractions) is used for larger lesions, in eloquent areas or in proximity to crucial or surgically inaccessible areas and to reduce treatment-related neurotoxicity. The single-fraction SRT dose, which depends on tumor diameter, impacts local control. Fractionated SRT may encompass different schedules. No randomized trial data compared the safety and efficacy of single and multiple fractions. Both single-fraction and fractionated SRT provide satisfactory local control rates, tolerance, a low risk of transient acute adverse events and of radiation necrosis the incidence of which correlated with the irradiated brain volume.
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Affiliation(s)
- Marco Lupattelli
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
| | - Paolo Tini
- Unit of Radiation Oncology, University Hospital of Siena, Italy
| | - Valerio Nardone
- Unit of Radiation Oncology, Ospedale del Mare, Napoli, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
| | - Simona Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, Italy
| | | | - Paola Anselmo
- Radiation Oncology Centre, S. Maria Hospital, Terni, Italy
| | - Gianluca Ingrosso
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
| | - Letizia Deantonio
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona-Lugano, Switzerland
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12
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Di Marzo A, Trippa F, Anselmo P, Draghini L, Arcidiacono F, Terenzi S, Italiani M, Muti M, Casale M, Fabiani S, Maranzano E. PO-1340 Prostate cancer reirradiation with stereotactic V-MAT IGRT : interim analysis of a phase II trial. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07791-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Scoccianti S, Olmetto E, Pinzi V, Osti MF, Di Franco R, Caini S, Anselmo P, Matteucci P, Franceschini D, Mantovani C, Beltramo G, Pasqualetti F, Bruni A, Tini P, Giudice E, Ciammella P, Merlotti A, Pedretti S, Trignani M, Krengli M, Giaj-Levra N, Desideri I, Pecchioli G, Muto P, Maranzano E, Fariselli L, Navarria P, Ricardi U, Scotti V, Livi L. Immunotherapy in association with stereotactic radiotherapy for Non-Small Cell Lung Cancer brain metastases: results from a multicentric retrospective study on behalf of AIRO. Neuro Oncol 2021; 23:1750-1764. [PMID: 34050669 DOI: 10.1093/neuonc/noab129] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To define efficacy and toxicity of Immunotherapy (IT) with stereotactic radiotherapy (SRT) including radiosurgery (RS) or hypofractionated SRT (HFSRT) for brain metastases (BM) from Non-Small Cell Lung Cancer (NSCLC) in a multicentric retrospective study from AIRO (Italian Association of Radiotherapy and Clinical Oncology). METHODS NSCLC patients with BM receiving SRT+IT and treated in 19 Italian centers were analysed and compared with a control group of patients treated with exclusive SRT. RESULTS One hundred patients treated with SRT+IT and 50 patients treated with SRT-alone were included. Patients receiving SRT+IT had a longer intracranial Local Progression Free Survival (iLPFS) (propensity score-adjusted p=0.007). Among patients who, at the diagnosis of BM, received IT and had also extracranial progression (n=24), IT administration after SRT was shown to be related to a better overall survival (OS) (p=0.037). At multivariate analysis, non-adenocarcinoma histology, KPS =70 and use of HFSRT were associated with a significantly worse survival (p=0.019, p=0.017 and p=0.007 respectively). Time interval between SRT and IT ≤7 days (n=90) was shown to be related to a longer OS if compared to SRT-IT interval >7 days (n=10) (propensity score-adjusted p=0.008). The combined treatment was well tolerated. No significant difference in terms of radionecrosis between SRT+IT patients and SRT-alone patients was observed. Time interval between SRT and IT had no impact on toxicity rate. CONCLUSIONS Combined SRT+IT was a safe approach, associated with a better iLPFS if compared to exclusive SRT.
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Affiliation(s)
- Silvia Scoccianti
- Radiation Oncology Unit, Ospedale Santa Maria Annunziata, Department of Oncology, Bagno a Ripoli, Florence, Italy
| | - Emanuela Olmetto
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Florence, Italy
| | - Valentina Pinzi
- U.O Radioterapia, Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Neurosurgery, Milan, Italy
| | - Mattia Falchetto Osti
- U.O.C Radioterapia, A.O.U Sant'Andrea Facoltà Medicina e Psicologia Università Sapienza, Department of Medicine,Surgery and Translational Medicine,Rome, Italy
| | - Rossella Di Franco
- Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, Department of Radiotherapy, Naples, Italy
| | - Saverio Caini
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Cancer Risk Factors and Life-Style Epidemiology Unit, Florence, Italy
| | - Paola Anselmo
- Radiotherapy Oncology Center, S. Maria Hospital, Department of Oncology, Terni, Italy
| | - Paolo Matteucci
- Radioterapia Oncologica, Campus Biomedico, Department of Radiation Oncology, Rome, Italy
| | - Davide Franceschini
- Humanitas Research Hospital, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | | | - Giancarlo Beltramo
- Cyberknife Centro Diagnostico Italiano, Department of Radiology, Milan, Italy
| | - Francesco Pasqualetti
- Radiation Oncology, Azienda Ospedaliero Universitaria Pisana, Department of Translational Medicine, Pisa, Italy
| | - Alessio Bruni
- Radiotherapy Unit, University Hospital of Modena, Department of Oncology and Hematology, Modena, Italy
| | - Paolo Tini
- Radiotherapy Unit, University of Siena, Department of Radiotherapy and Oncology, Siena, Italy
| | - Emilia Giudice
- UOC di Radioterapia, Policlinico Universitario Tor Vergata, Department of Onco-Haematology, Rome, Italy
| | - Patrizia Ciammella
- Radioterapia Oncologica "G. Prodi", AO-IRCCS Arcispedale S. Maria Nuova, Department of Oncology and Advanced Technology, Reggio Emilia, Italy
| | - Anna Merlotti
- Radiation Oncology A.S.O. S.Croce e Carle, Department of Radiation Oncology, Cuneo, Italy
| | - Sara Pedretti
- U.O. Radioterapia oncologica, Department of Radiation Oncology, ASST Spedali Civili di Brescia e Università degli studi di Brescia, Brescia, Italy
| | - Marianna Trignani
- U.O.C. Radioterapia Oncologica, Ospedale Clinicizzato SS Annunziata- Università Chieti G. D'Annunzio, Department of Radiation Oncology, Chieti, Italy
| | - Marco Krengli
- Radiation Oncology, University Hospital Maggiore della Carità, Department of Translational Medicine, Novara, Italy
| | - Niccolò Giaj-Levra
- IRCCS Ospedale Sacro Cuore Don Calabria, Department of Advanced Radiation Oncology, Verona, Italy
| | - Isacco Desideri
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Florence, Italy
| | - Guido Pecchioli
- Neurosurgery Unit, Azienda Ospedaliero Universitaria Careggi, Department of Neurosurgery, Florence, Italy
| | - Paolo Muto
- Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, Department of Radiotherapy, Naples, Italy
| | - Ernesto Maranzano
- Radiotherapy Oncology Center, S. Maria Hospital, Department of Oncology, Terni, Italy
| | - Laura Fariselli
- U.O Radioterapia, Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Neurosurgery, Milan, Italy
| | - Piera Navarria
- Humanitas Research Hospital, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | | | - Vieri Scotti
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Florence, Italy
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14
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Arcidiacono F, Anselmo P, Trippa F, Casale M, Italiani M, Draghini L, Terenzi S, Fabiani S, Di Marzo A, Maranzano E. PO-1021: Stereotactic radiotherapy for unresectable locally advanced non small cell lung cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01038-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Navarria P, Clerici E, Comito T, Cozzi S, Pinzi V, Ciammella P, Scoccianti S, Borzillo V, Anselmo P, Maranzano E, Dell'acqua V, Jereczek-Fossa B, Levra NG, Minniti G, Podlesko A, Giudice E, di Monale e Bastia MB, Pedretti S, Bruni A, Zanetti IB, Borgesi S, Busato F, Scorsetti M. PO-0880: SRS in brain metastases from colorectalcancer. A Radiation Oncology Italian Association study. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00897-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Olmetto E, Scoccianti S, Di Franco R, Anselmo P, Beltramo G, Mantovani C, Osti M, Pinzi V, Giaj-Levra N, Bruni A, Matteucci P, Pedretti S, Giudice E, Tini P, Krengli M, Ciammella P, Pasqualetti F, Trignani M, Merlotti A, Borzillo V, Franceschini D, Maranzano E, Umberto R, Pierina N, Scotti V. PD-0175: TTIRS trial:a retrospective analysis of the association between TT or IT and RS for BM from NSCLC. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00199-7] [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: 11/29/2022]
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17
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Anselmo P, Pinzi V, Terenzi S, De Martin E, Trippa F, Gaviani P, Casale M, Fariselli L, Maranzano E. PH-0356: Long-term results after radiosurgery (SRS) of vestibular schwannomas (VS). A retrospective analysis. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00380-7] [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: 11/29/2022]
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18
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Navarria P, Minniti G, Clerici E, Comito T, Cozzi S, Pinzi V, Fariselli L, Ciammella P, Scoccianti S, Borzillo V, Anselmo P, Maranzano E, Dell'acqua V, Jereczek-Fossa B, Giaj Levra N, Podlesko AM, Giudice E, Buglione di Monale E Bastia M, Pedretti S, Bruni A, Bossi Zanetti I, Borghesi S, Busato F, Pasqualetti F, Paiar F, Scorsetti M. Brain metastases from primary colorectal cancer: is radiosurgery an effective treatment approach? Results of a multicenter study of the radiation and clinical oncology Italian association (AIRO). Br J Radiol 2020; 93:20200951. [PMID: 33035077 DOI: 10.1259/bjr.20200951] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES The prognosis of brain metastatic colorectal cancer patients (BMCRC) is poor. Several local treatments have been used, but the optimal treatment choice remains an unresolved issue. We evaluated the clinical outcomes of a large series of BMCRC patients treated in several Italian centers using stereotactic radiosurgery (SRS). METHODS 185 BMCRC patients for a total of 262 lesions treated were evaluated. Treatments included surgery followed by post-operative SRS to the resection cavity, and SRS, either single-fraction, then hypofractionated SRS (HSRS). Outcomes was measured in terms of local control (LC), toxicities, brain distant failure (BDF), and overall survival (OS). Prognostic factors influencing survival were assed too. RESULTS The median follow-up time was 33 months (range 3-183 months). Surgery plus SRS have been performed in 28 (10.7%) cases, SRS in 141 (53.8%), and HSRS in 93 (35.5%). 77 (41.6%) patients received systemic therapy. The main total dose and fractionation used were 24 Gy in single fraction or 24 Gy in three daily fractions. Local recurrence occurred in 32 (17.3%) patients. Median, 6 months,1-year-LC were 86 months (95%CI 36-86), 87.2% ± 2.8, 77.8% ± 4.1. Median,6 months,1-year-BDF were 23 months (95%CI 9-44), 66.4% ± 3.9, 55.3% ± 4.5. Median,6 months,1-year-OS were 7 months (95% CI 6-9), 52.7% ± 3.6, 33% ± 3.5. No severe neurological toxicity occurred. Stage at diagnosis, Karnofsky Performance Status (KPS), presence and number of extracranial metastases, and disease-specific-graded-prognostic-assessment (DS-GPA) score were observed as conditioning survival. CONCLUSION SRS/HSRS have proven to be an effective local treatment for BMCRC. A careful evaluation of prognostic factors as well as a multidisciplinary evaluation is a valid aid to manage the optimal therapeutic strategy for CTC patients with BMs. ADVANCES IN KNOWLEDGE The prognosis of BMCRC is poor. Several local treatments was used, but optimal treatment choice remains undefined. Radiosurgery has proven to be an effective local treatment for BMCRC. A careful evaluation of prognostic factors and a multidisciplinary evaluation needed.
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Affiliation(s)
- Pierina Navarria
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy
| | | | - Elena Clerici
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy
| | - Tiziana Comito
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy
| | - Salvatore Cozzi
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy
| | - Valentina Pinzi
- Radiotherapy Unit, Istituto Neurologico Fondazione "Carlo Besta", Milan, Italy
| | - Laura Fariselli
- Radiotherapy Unit, Istituto Neurologico Fondazione "Carlo Besta", Milan, Italy
| | - Patrizia Ciammella
- Radiation Therapy Unit, Department of Oncology and Advanced Technology, Azienda Ospedaliera Arcispedale S Maria Nuova, Reggio Emilia, Italy
| | - Silvia Scoccianti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Valentina Borzillo
- UOC Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione "Giovanni Pascale", Milan, Italy
| | - Paola Anselmo
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | | | - Veronica Dell'acqua
- Department of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Barbara Jereczek-Fossa
- Department of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Niccolò Giaj Levra
- Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | | | - Emilia Giudice
- Radiation Therapy unit, Policlinico Universitario Tor Vergata, Roma, Italy
| | | | - Sara Pedretti
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | | | | | | | | | - Francesco Pasqualetti
- Department of Radiation Oncology, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Fabiola Paiar
- Department of Radiation Oncology, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Anselmo P, Maranzano E, Selimi A, Lupattelli M, Palumbo I, Bini V, Casale M, Trippa F, Bufi A, Arcidiacono F, Aristei C. Clinical characterization of glioblastoma patients living longer than 2 years: A retrospective analysis of two Italian institutions. Asia Pac J Clin Oncol 2020; 17:273-279. [PMID: 33078909 DOI: 10.1111/ajco.13457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/12/2020] [Indexed: 11/28/2022]
Abstract
AIM Despite the advances in surgery and radio-chemotherapy, the prognosis of glioblastoma (GBM) remains poor with about 13% of patients alive at 24 months. METHODS A total of 75 long-term survivors (LTS), defined as alive at least 24 months from diagnosis, were retrospectively analyzed. Overall survival (OS) and recurrence-free-survival (RFS) were calculated and related to patient characteristics and treatment received. RESULTS Median age and Karnofsky performance status (KPS) were 56 years and 100%, respectively. After surgery (gross tumor resection-GTR in 62, 83% patients), all LTS received concomitant temozolomide (TMZ) with radiotherapy and 70 (93%) adjuvant TMZ. Of these, 10 (13%) discontinued TMZ prior the completion of 6 cycles, 37 (49%) received 6 cycles and 23 (31%) >6 cycles. Sixty-nine (92%) patients experienced a first tumor recurrence at a median time of 21 months. Of these, 32 (46%) were submitted to a second surgery, 34 (49%) to other no-surgical treatments and 3 (5%) only supportive care. At multivariate analysis, OS was significantly improved by second surgery after first recurrence (P = 0.0032) and by cycles of adjuvant TMZ > 6 versus ≤6 (P = 0.05). More than six cycles of TMZ significantly conditioned also first RFS (P = 0.011) and second RFS (P = 0.033). CONCLUSION The large majority of LTS had <65 years, had a high KPS and received GTR. OS and RFS resulted significantly related to an extended administration of adjuvant TMZ (>6 cycles) and a second surgery in case of recurrence.
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Affiliation(s)
- Paola Anselmo
- Radiotherapy Oncology Centre, "Santa Maria" Hospital, Terni, Italy
| | | | - Adelina Selimi
- Department of Surgical and Biomedical Science, Radiotherapy Oncology Centre, University of Perugia and "Santa Maria della Misericordia" Hospital, Perugia, Italy
| | - Marco Lupattelli
- Radiotherapy Oncology Centre, "Santa Maria della Misericordia" Hospital, Perugia, Italy
| | - Isabella Palumbo
- Department of Surgical and Biomedical Science, Radiotherapy Oncology Centre, University of Perugia and "Santa Maria della Misericordia" Hospital, Perugia, Italy
| | - Vittorio Bini
- Internal Medicine, Endocrinology & Metabolism, University of Perugia and "Santa Maria della Misericordia" Hospital, Perugia, Italy
| | - Michelina Casale
- Radiotherapy Oncology Centre, "Santa Maria" Hospital, Terni, Italy
| | - Fabio Trippa
- Radiotherapy Oncology Centre, "Santa Maria" Hospital, Terni, Italy
| | - Alessandro Bufi
- Department of Surgical and Biomedical Science, Radiotherapy Oncology Centre, University of Perugia and "Santa Maria della Misericordia" Hospital, Perugia, Italy
| | | | - Cynthia Aristei
- Department of Surgical and Biomedical Science, Radiotherapy Oncology Centre, University of Perugia and "Santa Maria della Misericordia" Hospital, Perugia, Italy
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Trippa F, Draghini L, di Marzo A, Anselmo P, Arcidiacono F, Terenzi S, Sivolella S, Bassetti A, Sdrobolini A, Maranzano E. Long-term palliation of lymph node oligometastatic ovarian carcinoma after repeated stereotactic body radiotherapy: case report. Tumori 2020; 106:NP63-NP66. [PMID: 32912066 DOI: 10.1177/0300891620952852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Oligometastatic disease has emerged as an intermediate state between localized and systemic cancer. Improvements in diagnostic modalities such as functional imaging allow a greater frequency of oligometastases diagnosis. Patients with selected oligometastatic epithelial ovarian carcinoma (EOC) may be treated with metastasis-directed stereotactic body radiotherapy (SBRT) rather than chemotherapy. CASE DESCRIPTION We describe a 58-year-old woman who underwent surgery and chemotherapy for an EOC. The patient underwent 3 chemotherapy lines for recurrence of disease, but had allergic reactions and serious hematologic toxicity. During follow-up, lymph node oligometastases were diagnosed and treated with repeated SBRT because the patient refused further chemotherapy. No side effects were observed after each course of SBRT and the patient obtained complete response of all irradiated sites. CONCLUSIONS SBRT is a promising treatment approach for recurrent oligometastatic EOC with a high control rate and irrelevant iatrogenic toxicity. The possibility to repeat SBRT courses when new oligometastases are encountered in other sites resulted in an adequate long-term palliation approach.
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Affiliation(s)
- Fabio Trippa
- Radiotherapy Oncology Centre, "Santa Maria" Hospital, Terni, Italy
| | - Lorena Draghini
- Radiotherapy Oncology Centre, "Santa Maria" Hospital, Terni, Italy
| | | | - Paola Anselmo
- Radiotherapy Oncology Centre, "Santa Maria" Hospital, Terni, Italy
| | | | - Sara Terenzi
- Radiotherapy Oncology Centre, "Santa Maria" Hospital, Terni, Italy
| | - Silvio Sivolella
- Nuclear Medicine Centre, "San Giovanni Battista" Hospital, Foligno, Italy
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Arcidiacono F, Aristei C, Marchionni A, Italiani M, Fulcheri CPL, Saldi S, Casale M, Ingrosso G, Anselmo P, Maranzano E. Stereotactic body radiotherapy for adrenal oligometastasis in lung cancer patients. Br J Radiol 2020; 93:20200645. [PMID: 32822540 DOI: 10.1259/bjr.20200645] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To report our experience on stereotactic body radiotherapy (SBRT) in adrenal metastases from lung cancer. METHODS 37 oligometastatic lung cancer patients with 38 adrenal metastases submitted to SBRT were retrospectively analyzed. SBRT was delivered by volumetric modulated arc therapy (VMAT) or helical tomotherapy (HT). Primary study end point was local recurrence-free survival (LR-FS) and secondary end points were distant-progression free survival (d-PFS) and overall survival (OS). RESULTS Median age was 67 years and primary tumor was non-small-cell lung cancer in 27 (73%) and small-cell lung cancer in 10 (27%) patients. Adrenal metastases were in the left side in 66% cases. Median prescribed dose was 30 Gy in 5 fractions for a median biologically equivalent dose (α/β ratio 10 Gy, BED10) of 48 Gy. Most patients (62%) were submitted to SBRT alone, while the others (38%) received chemo-, immune- or target- therapies. Median follow-up was 10.5 months, median OS 16 months and median d-PFS 3 months. 27 (70%) patients obtained a local control with a median LR-FS of 32 months. LR-FS was significantly related to BED10 with a better LC with BED10 ≥72 Gy, 1- and 2 year LR-FS rates were 54.1±11.6% and 45±12.7% vs 100 and 100% for BED ≤59.5 Gy and BED ≥72 Gy, respectively (p = 0.05). There was no severe toxicity. CONCLUSION SBRT was effective and safe in lung cancer adrenal metastases. A dose-response relationship was found between BED10 >72 Gy and better local control. No significant toxicity was registered thanks to the respect of dose constraints and suspension of chemo- and target-therapies. ADVANCES IN KNOWLEDGE SBRT with a BED10 >72 Gy is an effective treatment for adrenal oligometastatic lung cancer patients.
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Affiliation(s)
| | - Cynthia Aristei
- Department of Surgical and Biomedical Science, Radiotherapy Oncology Centre, University of Perugia and "Santa Maria della Misericordia" Hospital, Perugia, Italy
| | - Alessandro Marchionni
- Department of Surgical and Biomedical Science, Radiotherapy Oncology Centre, University of Perugia and "Santa Maria della Misericordia" Hospital, Perugia, Italy
| | - Marco Italiani
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | | | - Simonetta Saldi
- Radiotherapy Oncology Centre, "Santa Maria della Misericordia" Hospital, Perugia, Italy
| | | | - Gianluca Ingrosso
- Department of Surgical and Biomedical Science, Radiotherapy Oncology Centre, University of Perugia and "Santa Maria della Misericordia" Hospital, Perugia, Italy
| | - Paola Anselmo
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
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Lupattelli M, Maranzano E, Bellavita R, Natalini G, Corgna E, Rossetti R, Trippa F, Mascioni F, Sidoni A, Anselmo P, Buzzi F, Brugia M, Latini P. Raltitrexed and Radiotherapy as Adjuvant Treatment for Stage II-III Rectal Cancer: A Feasibility Study. Tumori 2019; 91:498-504. [PMID: 16457149 DOI: 10.1177/030089160509100610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background Adjuvant 5-FU chemotherapy plus radiotherapy represents the standard treatment for radically resected rectal cancer at high risk of relapse according to the NIH Consensus Conference. The therapeutic gain was obtained with a high rate of severe treatment-related toxicity and a sub-optimal patient compliance with this regimen. Raltitrexed is a specific thymidylate synthase inhibitor with a convenient administration schedule, acceptable toxicity and radiosensitizing properties, as the published phase I trials in combination with radiotherapy have shown. The aim of this prospective multicenter phase II study was to evaluate the feasibility, gastrointestinal and hematological acute toxicity of raltitrexed in combination with radiotherapy in rectal cancer patients. Methods From September 2000 to June 2004, 50 patients with radically resected stage II-III rectal adenocarcinoma were treated. All patients were evaluable for compliance and acute toxicity. Within 45-60 days of surgery, each patient underwent concomitant adjuvant radiochemotherapy. Radiotherapy was administered to the pelvis (plus perineum after abdominoperineal resection) with photon beam energy exceeding 5 MV, 3-4 fields, 45 Gy/25 fractions/5 weeks plus a boost delivered to the site of resected disease with 3-4 fields, 9 Gy/5 fractions/1 week to a total dose of 54 Gy. The boost dose was administered after complete exclusion of the small bowel from the treatment volumes; if this was not possible a total dose of 50.4 Gy was given. Raltitrexed was administered intravenously at a dose of 3 mg/m2 as a bolus injection on days 1 and 22 of radiotherapy one hour before treatment, for a total of two cycles. Each patient underwent weekly clinical evaluation and laboratory tests. Toxicity was assessed by the WHO scale. Results Forty-five (90%) patients completed the established treatment. Acute severe toxicity included grade III proctitis in 4/50 (8%), grade III-IV diarrhea in 4/50 (8%), grade III perineal dermatitis in 4/50 (8%) and grade III leukopenia in 2/50 (4%) patients; five patients (10%) experienced a transient grade III increase in their liver biochemistry values. Conclusions Our data related to acute toxicity and patient compliance proved the feasibility of this adjuvant radiochemotherapy treatment. A longer follow-up is necessary to evaluate the effectiveness of this new regimen in terms of disease-free and overall survival.
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Affiliation(s)
- Marco Lupattelli
- Radiation Oncology Center, Policlinico Monteluce, Via B. Brunamonti, 06125 Perugia, Italy.
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Maranzano E, Arcidiacono F, Italiani M, Anselmo P, Casale M, Terenzi S, Di Marzo A, Fabiani S, Draghini L, Trippa F. Accelerated partial-breast irradiation with high-dose-rate brachytherapy: Mature results of a Phase II trial. Brachytherapy 2019; 18:627-634. [PMID: 31285131 DOI: 10.1016/j.brachy.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to report mature clinical and cosmetic results of accelerated partial-breast irradiation with interstitial multicatheter high-dose-rate brachytherapy (HDR-BRT) in patients with early breast cancer. METHODS AND MATERIALS 133 patients were recruited in a Phase II trial of exclusive HDR-BRT. Inclusion criteria were age ≥40 years, PS 0-2, unifocal invasive ductal cancer, intraductal cancer component <25%, negative axillary nodes, and tumor size ≤2.5 cm. Treatment schedule was 4 Gy twice a day up to a total dose of 32 Gy in eight fractions. RESULTS Median age was 67 years (range, 42-85). There were 7 (5%) pT1a, 48 (36%) pT1b, 72 (54%) pT1c, and 6 (5%) pT2. Estrogen and progesterone receptors were positive in 119 (89%) and 93 (70%) patients, respectively. The median followup was 110 months (range, 12-163). After HDR-BRT, there were 3 (2%) in-field breast recurrences and 1 (1%) out-field breast recurrence. 5 (4%) patients developed contralateral breast cancer, another one (1%) isolated regional relapse in axillary node and 3 (2%) distant progression of disease. 19 (14%) patients reported a second primary cancer. 5-, 10-, and 13-year overall survival and cancer-specific survival were 95% and 100%, 84.5% and 100%, and 81.4% and 100%, respectively. Cosmetic outcome was excellent in 80% of cases. Late toxicity was significantly related to the skin administered doses (≤55% vs. > 55% of the prescribed dose, p < 0.05). CONCLUSIONS Accelerated partial-breast irradiation delivered with HDR-BRT in selected patients with breast cancer was associated to high local control and survival with excellent cosmetic outcomes overall when skin dose was ≤55%.
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Affiliation(s)
| | | | - Marco Italiani
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | - Paola Anselmo
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | | | - Sara Terenzi
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | | | | | - Lorena Draghini
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | - Fabio Trippa
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
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Maranzano E, Terenzi S, Anselmo P, Casale M, Arcidiacono F, Loreti F, Di Marzo A, Draghini L, Italiani M, Trippa F. A prospective phase II trial on reirradiation of brain metastases with radiosurgery. Clin Transl Radiat Oncol 2019; 17:1-6. [PMID: 31061900 PMCID: PMC6487370 DOI: 10.1016/j.ctro.2019.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/01/2019] [Accepted: 04/05/2019] [Indexed: 11/30/2022] Open
Abstract
Reirradiation with radiosurgery of brain metastases is feasible and safe. Good KPS and controlled systemic disease are most important selection criteria. An accurate patient selection is essential to avoid brain toxicity. If diameter is ≤ 2 cm and dose ≤ 20 Gy local control is high without late toxicity.
Purpose In our previous published trial on radiosurgery (SRS) of recurrent brain metastases (BM) after whole brain radiotherapy (WBRT), Karnofsky performance status (KPS) and administered dose conditioned outcome and late toxicity, respectively. Brain radionecrosis was registered in 6% of patients. With the aim to obtain similar satisfactory outcomes and limit toxicity, we started a phase II trial in which reirradiation of BM with SRS were done using a tighter patient selection. Materials and methods Patients with BM recurring after WBRT were recruited for reirradiation with SRS. Only patients with good KPS (≥70), good neurologic functional score (NFS 0-1) and lesions with a diameter ≤20 mm were considered eligible for retreatment. Dose exceeding 20 Gy was never administered. Results The 59 patients reirradiated had 109 BM with a diameter range of 6–20 mm. Median interval between prior WBRT and SRS was 15 months and median SRS administered dose was 18 Gy (range 10–20 Gy). Complete and partial response (CR, PR) was obtained in 42% of patients with 2 years of control rate of 81%. Median overall survival (OS) after reirradiation was 14 months. No radionecrosis was detected. Conclusions Analysis of our current trial compared with results of our previous data suggests that a tighter patient selection (KPS ≥ 70; NFS 0-1, BM with ≤20 mm of diameter) and SRS dose ≤20 Gy allowed a high OS rate, a good percentage of CR and PR which last for >2 years, and no brain radionecrosis.
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Affiliation(s)
| | - Sara Terenzi
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | - Paola Anselmo
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | | | | | - Fabio Loreti
- Nuclear Medicine Service, "S. Maria" Hospital, Terni, Italy
| | | | - Lorena Draghini
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | - Marco Italiani
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | - Fabio Trippa
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
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Anselmo P, Casale M, Trippa F, Arcidiacono F, Fabiani S, Di Marzo A, Draghini L, Terenzi S, Maranzano E. PO-0747 Results at long-term after linac-based radiosurgery of vestibular schwannomas. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31167-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Di Marzo A, Trippa F, Anselmo P, Arcidiacono F, Terenzi S, Draghini L, Italiani M, Casale M, Muti M, Fabiani S, Maranzano E. EP-1207 Fractionated stereotactic radiation therapy for resected brain metastases: a preliminary report. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31627-5] [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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Arcidiacono F, Casale M, Anselmo P, Trippa F, Draghini L, Terenzi S, Di Marzo A, Italiani M, Fabiani S, Maranzano E. EP-1381 Stereotactic Body Radiotherapy for Unresectable Locally-Advanced Non Small Cell Lung Cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31801-8] [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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Arcidiacono F, Trippa F, Anselmo P, Italiani M, Casale M, Draghini L, Fabiani S, Di Marzo A, Terenzi S, Maranzano E. OC-0318 10-year clinical and cosmetic outcomes of high-dose-rate brachytherapy for early breast cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30738-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Maranzano E, Anselmo P, Casale M, Trippa F, Carletti S, Principi M, Loreti F, Italiani M, Caserta C, Giorgi C. Treatment of Recurrent Glioblastoma with Stereotactic Radiotherapy: Long-Term Results of a Mono-Institutional Trial. Tumori 2018; 97:56-61. [DOI: 10.1177/030089161109700111] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background Few clinical data exist concerning normal brain tissue tolerance to re-irradiation. The present study evaluated long-term outcome of 22 recurrent glioblastoma patients re-irradiated with radiosurgery or fractionated stereotactic radiotherapy. Methods Twenty-two patients were treated with radiosurgery (13, 59%) or fractionated stereotactic radiotherapy (9, 41%) for 24 lesions of recurrent glioblastoma. The male/female ratio was 14: 8, median age 55 years (range, 27–81), and median Karnofsky performance status 90 (range, 70–100). The majority of the cases (77%) was in recursive partitioning analysis classes III or IV. Radiosurgery or fractionated stereotactic radiotherapy was chosen according to lesion size and location. Results Median time between primary radiotherapy and re-irradiation was 9 months. Median doses were 17 Gy and 30 Gy, whereas median cumulative normalized total dose was 141 Gy and 98 Gy for radiosurgery and fractionated stereotactic radiotherapy, respectively. All patients submitted to radiosurgery had a cumulative normalized total dose of more than 100 Gy, whereas only a few (44%) of fractionated stereotactic radiotherapy patients had a cumulative normalized total dose exceeding 100 Gy. Median follow-up from re-irradiation was 54 months. At the time of analysis, all patients had died. After re-irradiation, 1 (4%) lesion was in partial remission, 16 (67%) lesions were stable, and the remaining 7 (29%) were in progression. Median duration of response was 6 months, and median survival from re-irradiation 11 months. Three of 13 (23%) patients submitted to radiosurgery developed asymptomatic brain radionecrosis. The cumulative normalized total dose for the 3 patients was 122 Gy, 124 Gy, and 141 Gy, respectively. In one case, the volume of the lesion was large (14 cc), and in the other 2 the interval between the first and second cycle of radiotherapy was short (5 months). Conclusions Re-irradiation with radiosurgery and fractionated stereotactic radiotherapy is feasible and effective in recurrent glioblastoma patients. Apart from the importance of an accurate patient selection, cumulative radiotherapy dose and a correct indication for radiosurgery or fractionated stereotactic radiotherapy must be taken into account to avoid brain toxicity. Free full text available at www.tumorionline.it
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Arcidiacono F, Chirico L, Italiani M, Anselmo P, Casale M, Draghini L, Trippa F, Fabiani S, Basagni M, Maranzano E. OC-0181: Long-term clinical and cosmetic outcomes of high-dose-rate brachytherapy for early breast cancer. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30624-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Draghini L, Trippa F, Casale M, Anselmo P, Arcidiacono F, Fabiani S, Italiani M, Maranzano E. EP-1779: High-dose rate brachytherapy for inoperable endometrial cancer: definitive results. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)32141-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Maranzano E, Casale M, Rispoli R, Trippa F, Draghini L, Arcidiacono F, Carletti S, Anselmo P. LINAC-based radiosurgery for melanoma, sarcoma and renal cell carcinoma brain metastases. J Neurosurg Sci 2016; 64:37-43. [PMID: 27603406 DOI: 10.23736/s0390-5616.16.03745-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to report response, overall survival (OS) and toxicity in patients with radioresistant brain metastases (BM) treated with stereotactic radiosurgery (SRS). METHODS Patients with renal cell carcinoma, melanoma and sarcoma with one to four brain metastases received SRS without whole brain radiotherapy. RESULTS Fifty patients with 77 BM were treated. 46 (92%) patients with 71 BM were evaluable. Median follow-up was 67 months and median OS 11.8 months. At the time of analysis all patients had died. Brain control was conditioned by response to SRS (P<0.0001), while OS by histology (renal cell carcinoma versus melanoma and sarcoma) (P=0.04) and status of the tumour outside the brain (P=0.05). Treatment was well tolerated without more than grade 2 acute toxicity. CONCLUSIONS Treatment of BM from radioresistant tumors with SRS assures good brain control and OS with low toxicity. Our data suggest a better prognosis associated to renal cell carcinoma histology.
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Affiliation(s)
| | | | - Rossella Rispoli
- Radiotherapy Oncology Center, S. Maria Hospital, Terni, Italy.,Neurosurgery Center, S. Maria Hospital, Terni, Italy
| | - Fabio Trippa
- Radiotherapy Oncology Center, S. Maria Hospital, Terni, Italy
| | - Lorena Draghini
- Radiotherapy Oncology Center, S. Maria Hospital, Terni, Italy
| | | | - Sandro Carletti
- Radiotherapy Oncology Center, S. Maria Hospital, Terni, Italy.,Neurosurgery Center, S. Maria Hospital, Terni, Italy
| | - Paola Anselmo
- Radiotherapy Oncology Center, S. Maria Hospital, Terni, Italy
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Anselmo P, Chirico L, Muti M, Basagni M, Trippa F, Rossi R, Draghini L, Arcidiacono F, Italiani M, Casale M, Fabiani S, Giorgi C, Maranzano E. PO-0642: Radiosurgery without whole brain radiotherapy in brain metastases from non-small cell lung cancer. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31892-8] [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: 11/29/2022]
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Maranzano E, Draghini L, Anselmo P, Casale M, Arcidiacono F, Chirico L, Italiani M, Trippa F. Lung reirradiation with stereotactic body radiotherapy. J Radiosurg SBRT 2016; 4:61-68. [PMID: 29296427 PMCID: PMC5658839] [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] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/28/2015] [Indexed: 06/07/2023]
Abstract
PURPOSE We examined safety and efficacy of stereotactic body radiotherapy (SBRT) in reirradiation for lung recurrent lesions (LRLs). MATERIALS AND METHODS Eighteen patients, 4 with lung local failure from primary non-small cell lung carcinomas and 14 with lung metastases, were reirradiated with SBRT for 29 LRLs. Doses were recalculated to an Equivalent Dose of 2 Gy per fraction (EQD2) and α/β ratio was assumed to be Gy10 for primary and metastatic lung tumors and Gy3 for organ at risk. Cumulative administered doses were calculated adding doses of prior radiotherapy and reirradiation. RESULTS Peripherally located lesions received 5 fractions of 8-10 Gy, while centrally ones lower doses (5 fractions of 5-8 Gy). Cumulative EQD2 did not exceed 198 Gy10 and reirradiated volumes were rather small (median 18 cc). Local control was obtained for all patients except one and lasted medially 43 months. Median overall survival was 40 months from reirradiation. Only acute grade 1 toxicity was recorded. CONCLUSIONS Reirradiation of LRLs with SBRT was feasible and effective. It is important to appropriately select patient and to adopt organ at risk constrains considering cumulative doses.
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Affiliation(s)
- Ernesto Maranzano
- Radiotherapy Oncology Centre, “S. Maria” Hospital, Via T. di Joannuccio, 1, I-05100 Terni, Italy
| | - Lorena Draghini
- Radiotherapy Oncology Centre, “S. Maria” Hospital, Via T. di Joannuccio, 1, I-05100 Terni, Italy
| | - Paola Anselmo
- Radiotherapy Oncology Centre, “S. Maria” Hospital, Via T. di Joannuccio, 1, I-05100 Terni, Italy
| | - Michelina Casale
- Radiotherapy Oncology Centre, “S. Maria” Hospital, Via T. di Joannuccio, 1, I-05100 Terni, Italy
| | - Fabio Arcidiacono
- Radiotherapy Oncology Centre, “S. Maria” Hospital, Via T. di Joannuccio, 1, I-05100 Terni, Italy
| | - Luigia Chirico
- Radiotherapy Oncology Centre, “S. Maria” Hospital, Via T. di Joannuccio, 1, I-05100 Terni, Italy
| | - Marco Italiani
- Radiotherapy Oncology Centre, “S. Maria” Hospital, Via T. di Joannuccio, 1, I-05100 Terni, Italy
| | - Fabio Trippa
- Radiotherapy Oncology Centre, “S. Maria” Hospital, Via T. di Joannuccio, 1, I-05100 Terni, Italy
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Maranzano E, Draghini L, Casale M, Arcidiacono F, Anselmo P, Trippa F, Giorgi C. Long-term outcome of moderate hypofractionated stereotactic radiotherapy for meningiomas. Strahlenther Onkol 2015; 191:953-60. [PMID: 26490452 DOI: 10.1007/s00066-015-0915-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 10/07/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this work was to evaluate long-term results of moderate hypofractionated stereotactic radiotherapy (hFSRT) for intracranial meningiomas. PATIENTS AND METHODS In all, 77 consecutive patients with 80 lesions were included. Median age was 65 years (range 23-82 years), male/female ratio was 21/56, and the median Karnofsky performance status was 90 (range 60-100). In 31 lesions (39 %), diagnosis was based upon clinical and radiological data; 37 lesions were histologically proven as World Health Organization (WHO) grade I and 12 grade II meningiomas. Median treatment volume was 23 cc. Prescribed doses were 45 Gy in 15 fractions of 3 Gy (15 × 3 Gy) or 42 Gy in 14 fractions of 3 Gy (14 × 3 Gy). RESULTS After a median follow-up of 56 months, 49 (61 %) lesions received 14 × 3 Gy and 31 (39 %) 15 × 3 Gy. Local control (LC) rate remained unchanged at 84 % at 5 and 10 years. Overall survival and disease-specific survival (DSS) were 76 and 93 % at 5 years, 72 and 89 % at 10 years, respectively. With univariate analysis, previous surgery and WHO grade II tumor were negative prognostic factors for LC and DSS. With multivariate analysis only tumor grade was an independent prognostic factor for LC. No clinically significant acute and/or late toxicities were observed. CONCLUSION Moderate hFSRT was effective and safe with an excellent tolerance profile. It can be an alternative treatment option for patients with recurrent or inoperable large meningiomas. The low number of fractions administered with hFSRT led to reduce treatment-related discomfort for patients. Grade II tumor and previous surgery were negative prognosis factors.
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Affiliation(s)
- Ernesto Maranzano
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Via T. di Joannuccio, 1, 05100, Terni, Italy.
| | - Lorena Draghini
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Via T. di Joannuccio, 1, 05100, Terni, Italy
| | - Michelina Casale
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Via T. di Joannuccio, 1, 05100, Terni, Italy
| | - Fabio Arcidiacono
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Via T. di Joannuccio, 1, 05100, Terni, Italy
| | - Paola Anselmo
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Via T. di Joannuccio, 1, 05100, Terni, Italy
| | - Fabio Trippa
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Via T. di Joannuccio, 1, 05100, Terni, Italy
| | - Cesare Giorgi
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Via T. di Joannuccio, 1, 05100, Terni, Italy
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Lancellotta V, Chirico L, Palumbo I, Anselmo P, Zucchetti C, Italiani M, Bini V, Maranzano E, Aristei C. OC-0041: PBI with interstitial high-dose-rate brachytherapy: results of a phase II prospective study. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40041-6] [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: 11/15/2022]
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Maranzano E, Trippa F, Casale M, Draghini L, Rossi R, Anselmo P, Chirico L, Basagni M, Italiani M, Giorgi C. EP-1297 FRACTIONATED STEREOTACTIC RADIOTHERAPY OR RADIOSURGERY FOR PITUITARY ADENOMAS. A MONOINSTITUTIONAL EXPERIENCE. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71630-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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38
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Maranzano E, Trippa F, Casale M, Anselmo P, Rossi R. Reirradiation of metastatic spinal cord compression: Definitive results of two randomized trials. Radiother Oncol 2011; 98:234-7. [DOI: 10.1016/j.radonc.2010.12.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 12/11/2010] [Accepted: 12/30/2010] [Indexed: 11/16/2022]
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Aristei C, Stracci F, Guerrieri P, Anselmo P, Armellini R, Rulli A, Barberini F, Latini P, Menghini AR. Frequency of sister chromatid exchanges and micronuclei monitored over time in patients with early-stage breast cancer: results of an observational study. ACTA ACUST UNITED AC 2009; 192:24-9. [PMID: 19480933 DOI: 10.1016/j.cancergencyto.2009.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 02/16/2009] [Accepted: 02/26/2009] [Indexed: 10/20/2022]
Abstract
Spontaneous chromosomal instability correlates with a high risk of cancer. The frequency of spontaneous sister chromatid exchanges (SCE) and micronuclei (MN) in peripheral blood lymphocytes was used for evaluation of spontaneous chromosomal instability in early-stage breast cancer patients to determine whether SCE and MN frequencies are biomarkers of damage from chemotherapy and radiotherapy. In 20 stage I-II breast cancer patients, SCE and MN were measured before surgery and at 4 weeks after. In patients who received adjuvant chemotherapy (CTx), they were also determined before starting radiotherapy (RTx). Other assessments were done 2, 6, and 12 months after RTx in almost all patients and at 18 months in 4 patients. Generalized estimating equations (GEE) were used to estimate population averaged effects at the different treatment and follow-up time points. Moreover, SCE and MN baseline values in patients were compared with those of a control group of 12 healthy women. A significant difference emerged between patients and healthy controls (P<0.0001 for SCE and P<0.0003 for MN; Mann-Whitney test); SCE increased significantly after CTx and MN increased significantly after RTx. In the GEE model, the smoking habit was associated with increased SCE in patients treated with CTx; age significantly affected MN frequencies. Both MN and SCE frequencies are increased in breast cancer patients and are indicators of CTx and RTx damage, respectively. The increased SCE levels in patients treated with CTx may be due to a synergic effect of smoking and chemotherapy.
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Affiliation(s)
- Cynthia Aristei
- Department of Radiation Oncology, University of Perugia, Policlinico Monteluce, Perugia, Italy.
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Gobbi PG, Broglia C, Di Giulio G, Mantelli M, Anselmo P, Merli F, Zinzani PL, Rossi G, Callea V, Iannitto E, Paulli M, Garioni L, Ascari E. The clinical value of tumor burden at diagnosis in Hodgkin lymphoma. Cancer 2004; 101:1824-34. [PMID: 15372482 DOI: 10.1002/cncr.20568] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The authors investigated the clinical role of tumor burden (TB) in patients with Hodgkin lymphoma, relating this parameter to most of the current clinical and prognostic factors and to the best predictive multifactorial models. METHODS The volume of TB at diagnosis was measured directly from the initial staging computed tomography scans in 351 patients who were treated on standard protocols. The mean patient age was 34.0 years +/- 16.4 years. Forty-six patients had clinical Stage I disease, 201 patients had Stage II disease, 64 patients had Stage III disease, and 40 patients had Stage IV disease. There were 146 symptomatic patients. Overall survival (OS), disease-free survival (DFS), and time to treatment failure (TTF) were the time parameters evaluated in the multivariate analysis. Logistic regression was applied according to those who achieved or failed complete remission. RESULTS The mean TB normalized to body surface area (rTB) was 137.8 cm(3)/m(2) +/- 124.7 cm(3)/m(2) (range, 1.9-694.5 cm(3)/m(2)). In multivariate analysis, rTB was the best predictor of TTF, DFS, and complete remission; the second best predictor of OS after patient age; and largely superior to all prognostic models analyzed. For the same stage and treatment, patients who were destined to clinical failure had an initial rTB 60-108% higher compared with the initial rTB in patients who achieved a cure, whereas differences in drug dose intensity were not significant. CONCLUSIONS In the current study, it was found that the rTB, as a prognostic factor, was more effective than and was independent of hitherto used factors and scores. The rTB may be a tool for evaluating the curative potential of treatment combinations, allowing physicians and patients to make better therapeutic choices earlier.
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Affiliation(s)
- Paolo G Gobbi
- Medicina Interna e Oncologia Medica, Universitá di Pavia, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S. Matteo, Pavia, Italy.
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Perrucci E, Aristei C, De Angelis V, Anselmo P, Mascioni F, Gori S, Frattegiani A, Latini P. T1-T2 Breast Cancer with Four or More Positive Axillary Lymph Nodes: Adjuvant Locoregional Radiotherapy with High-Dose or Standard-Dose Chemotherapy. Results of an Observational Study. Tumori 2004; 90:379-86. [PMID: 15510979 DOI: 10.1177/030089160409000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim and background The aim of this study was to investigate the efficacy of postoperative locoregional radiotherapy in patients with T1-T2 breast cancer and four or more positive axillary lymph nodes submitted to mastectomy or breast-conserving surgery followed by standard-dose or high-dose adjuvant chemotherapy. The incidence of locoregional relapses and the survival correlated with the number of positive nodes were recorded for each treatment arm. Patients and methods From August 1992 to August 1999 86 breast cancer patients (median age, 54 years, T1-T2, N+ >4) submitted to surgery were treated. Sixty-three patients received standard-dose chemotherapy while 23 patients with 10 or more positive nodes received high-dose chemotherapy. After four courses of standard-dose anthracycline-based chemotherapy peripheral blood stem cells were mobilized with cyclophosphamide (7g/m2) and G-CSF (10-16 μg/kg/day/sc). High-dose chemotherapy consisted of etoposide 1000 mg/m2, thiotepa 500 mg/m2 and carboplatin 800 mg/m2. Hormone receptor-positive patients underwent hormone therapy. Following chemotherapy all 86 patients were given conventional radiotherapy to the breast or the chest wall and the supraclavicular fossa. The high-dose subgroup received radiotherapy to the internal mammary nodes ± axilla. Results: The median follow-up from the start of radiotherapy was 36.5 months. Locoregional relapses occurred in nine patients (10.4%); in four of them they were isolated (4.6%). Local relapses were four (4.6%) and regional relapses six (6.9%). Twenty-five patients (29%) had distant metastases. The five-year and eight-year overall actuarial survival rates were 82.6% ± 4.8 and 60.1% ± 8.8, respectively. No statistical differences were found when the number of positive nodes or the type of treatment of N+ 10 patients was included in the analysis. Conclusions Breast cancer patients with four or more positive axillary lymph nodes are at high risk of developing locoregional and distant relapses. The results reported here demonstrate the efficacy of radiotherapy in the reduction of locoregional failure; no differences in survival and locoregional control in relation to treatment arm and number of positive nodes were found.
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Affiliation(s)
- Elisabetta Perrucci
- Radiotherapy Oncology, Policlinico Hospital and University of Perugia, Italy.
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Aristei C, Guerrieri P, Anselmo P, Armellini R, Tarducci R, Rulli A, Latini P, Menghini A. Sister chromatid exchange and micronuclei frequency in early-stage breast cancer patients: preliminary results of a prospective observational study. EJC Suppl 2004. [DOI: 10.1016/s1359-6349(04)91039-7] [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: 10/26/2022] Open
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Di Cesare E, Cerone G, Enrici RM, Tombolini V, Anselmo P, Masciocchi C. MRI characterization of residual mediastinal masses in Hodgkin's disease: long-term follow-up. Magn Reson Imaging 2004; 22:31-8. [PMID: 14972392 DOI: 10.1016/j.mri.2003.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2003] [Revised: 08/14/2003] [Accepted: 08/15/2003] [Indexed: 11/17/2022]
Abstract
Our purpose was to evaluate the role of MRI in distinguishing fibrous from active residual masses in treated Hodgkin's disease. Forty patients with residual mediastinal mass larger than 1.5 cm underwent MRI 1, 3, 6, and 12 months after the end of cycles of prescribed chemotherapy or combined chemoradiotherapy. The MRI examinations were performed on a 0.5 and a 1.5 T systems, using T(1) before and after gadolinium injection and T(2)-weighted sequences. Each time the residual mass was evaluated in size and signal intensity on spin echo (SE) T(2)-weighted images and on SE T(1)-weighted images after contrast medium. Low signal intensity and low contrast enhancement were considered signs of inactive residues; homogeneous high signal intensity and high contrast enhancement were indicative of active residual disease; heterogeneous signal intensity and heterogeneous contrast enhancement were indicative of partial remission or necrotic/inflammatory phenomena. MR showed high diagnostic accuracy in the evaluation of Hodgkin's mediastinal residues after treatment, if performed at least 6 months after the end of therapy, reaching the highest sensitivity and specificity values at 12 month follow-up (considering the three parameters-T(2) signal intensity, contrast-enhancement, and size-all together). If we consider the single parameters individually, we can observe that size variation remains the more valuable parameter to predict or to exclude a relapse. MR diagnostic accuracy at the 6-month follow-up was lower due to the higher incidence of inhomogeneous pattern. The accuracy of MR performed at 1 and at 3 months after the end of therapy was not satisfying. This represents a clinical problem because the most important clinical decisions have to be taken just in this early post-treatment phase.
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Donato V, Zurlo A, Banelli E, Santarelli M, Anselmo P, Martelli M, Enrici R, Biagini C. Local hyperthermia and radiation therapy in the treatment of superficially located lymphomas and recurrent Hodgkin's disease. Oncol Rep 1996; 3:1043-7. [DOI: 10.3892/or.3.6.1043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Gaidano G, Angeli A, Rovero E, Rolfo E, Rosatti P, Anselmo P. Plasma bile pigment conjugation modalities in icterus syndromes of various origin. Ric Clin Lab 1979; 9:379-86. [PMID: 545646 DOI: 10.1007/bf02904574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Plasma azopigments derived from conjugated bilirubin were analyzed by thin-layer chromatography according to HEIRWEGH et al. in 14 cases of obstructive jaundice and in 11 of acute hepatitis. The chromatographic patterns were compared with those obtained from azopigments derived from 8 normal bile samples. The plasma pigment patterns did not differ from those of the bile in number and chromatographic mobility of the spots. However, the quantitative percentages of the plasma azopigments were significantly modified: the alpha 0 fraction (free azodipyrrolic pigment) increased in both icteric syndromes, while the delta fraction (mainly glucuronide azopigment) decreased. Moreover, the behavior of two closed components of the delta group showed significant differences in both icteric syndromes. It can be postulated that the synthesis of bilirubin diconjugates decreases both in hepatocellular and cholestatic jaundice, while monoglucuronidated as well as saccharide and glucoside conjugates increase. In cholestatic jaundice the conjugation with glucuronic acid mainly takes place in the normal way, whereas compounds with different features are formed in hepatitis.
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Mandelli F, Anselmo P, Cesaria R, Criscuolo D, Granati L. Clinical evaluation of corticoid therapy in haematology. Chronobiologia 1974; 1 Suppl 1:443-8. [PMID: 4471283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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