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Franzese C, Navarria P, Clerici E, Comito T, Pessina F, Bello L, Reggiori G, Tomatis S, Scorsetti M. P05.50 Hypofractionated stereotactic radiation therapy (HSRT) in skull base meningiomas. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Clerici E, Navarria P, Franzese C, Carta GA, Mancosu P, Reggiori G, Picozzi P, Attuati L, Tomatis S, Scorsetti M. OS6.5 Randomized phase III trial comparing GAMMA KNIFE (GK) and LINAC based (EDGE) radiosurgery for brain metastases from solid tumors: results from the GADGET trial. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fogliata A, Stravato A, Reggiori G, Tomatis S, Würfel J, Scorsetti M, Cozzi L. Collimator scatter factor: Monte Carlo and in-air measurements approaches. Radiat Oncol 2018; 13:126. [PMID: 29996873 PMCID: PMC6042423 DOI: 10.1186/s13014-018-1070-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Linac output as a function of field sizes has a phantom and a head scatter component. This last term can be measured in-air with appropriate build-up ensuring a complete electron equilibrium and the absence of the contaminant electrons. Equilibrium conditions could be achieved using a build-up cap or a mini-phantom. Monte Carlo simulations in a virtual phantom mimicking a mini-phantom were analysed with the aim of better understanding the setup conditions for measuring the collimator scatter factor that is the head scatter component of the linac output factors. METHODS Beams of 6 and 15 MV from a TrueBeam, with size from 4 × 4 to 40 × 40 cm2 were simulated in cylindrical acrylic phantoms 20 cm long, of different diameters, from 0.5 to 4 cm, with the cylinder axis coincident with the beam central axis. The PRIMO package, based on PENELOPE Monte Carlo code, was used. The phase-space files for a Varian TrueBeam linac, provided by the linac vendor, were used for the linac head simulation. Depth dose curves were analysed, and collimator scatter factors estimated at different depth in the different phantom conditions. Additionally, in-air measurements using acyrilic and brass build-up caps, as well as acrylic mini-phantom were acquired for 6 and 18 MV beams from a Varian Clinac DHX. RESULTS The depth dose curves along the cylinders were compared, showing, in each phantom, very similar curves for all analysed field sizes, proving the correctness in estimating the collimator scatter factor in the mini-phantom, provided to position the detector to a sufficient depth to exclude electron contamination. The results were confirmed by the measurements, where the acrylic build-up cap showed to be inadequate to properly estimate the collimator scatter factors, while the mini-phantom and the brass caps gave reasonable measurements. CONCLUSION A better understanding of the beam characteristics inside a virtual mini-phantom through the analysis of depth dose curves, showed the critical points of using the acrylic build-up cap, and suggested the use of the mini-phantom for the collimator scatter factor measurements in the medium-large field size range.
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Fogliata A, De Rose F, Stravato A, Reggiori G, Tomatis S, Scorsetti M, Cozzi L. Evaluation of target dose inhomogeneity in breast cancer treatment due to tissue elemental differences. Radiat Oncol 2018; 13:92. [PMID: 29764450 PMCID: PMC5952506 DOI: 10.1186/s13014-018-1022-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Monte Carlo simulations were run to estimate the dose variations generated by thedifference arising from the chemical composition of the tissues. METHODS CT datasets of five breast cancer patients were selected. Mammary gland was delineated as clinical target volume CTV, as well as CTV_lob and CTV_fat, being the lobular and fat fractions of the entire mammary gland. Patients were planned for volumetric modulated arc therapy technique, optimized in the Varian Eclipse treatment planning system. CT, structures and plans were imported in PRIMO, based on Monte Carlo code Penelope, to run three simulations: AdiMus, where the adipose and muscle tissues were automatically assigned to fat and lobular fractions of the breast; Adi and Mus, where adipose and muscle, respectively were assigned to the whole mammary gland. The specific tissue density was kept identical from the CT dataset. Differences in mean doses in the CTV_lob and CTV_fat structures were evaluated for the different tissue assignments. Differences generated by the tissue composition and estimated by Acuros dose calculations in Eclipse were also analysed. RESULTS From Monte Carlo simulations, the dose in the lobular fraction of the breast, when adipose tissue is assigned in place of muscle, is overestimated by 1.25 ± 0.45%; the dose in the fat fraction of the breast with muscle tissue assignment is underestimated by 1.14 ± 0.51%. Acuros showed an overestimation of 0.98 ± 0.06% and an underestimation of 0.21 ± 0.14% in the lobular and fat portions, respectively. Reason of this dissimilarity resides in the fact that the two calculations, Monte Carlo and Acuros, differently manage the range of CT numbers and the material assignments, having Acuros an overlapping range, where two tissues are both present in defined proportions. CONCLUSION Although not clinically significant, the dose deposition difference in the lobular and connective fat fraction of the breast tissue lead to an improved knowledge of the possible dose distribution and homogeneity in the breast radiation treatment.
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Reggiori G, Stravato A, Mancosu P, Lobefalo F, Paganini L, Zucconi F, Palumbo V, Gaudino A, Scorsetti M, Tomatis S. Small field characterization of a Nanochamber prototype under flattening filter free photon beams. Phys Med 2018; 49:139-146. [DOI: 10.1016/j.ejmp.2017.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/04/2017] [Accepted: 08/16/2017] [Indexed: 11/28/2022] Open
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Tomatis S, Bono A, Bartoli C, Tragni G, Farina B, Marchesini R. Image Analysis in the RGB and HS Colour Planes for a Computer-Assisted Diagnosis of Cutaneous Pigmented Lesions. TUMORI JOURNAL 2018; 84:29-32. [PMID: 9619710 DOI: 10.1177/030089169808400106] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background A study was carried out to evaluate the effectiveness of image analysis performed by the two color representation models when a computer-assisted diagnosis of melanoma is involved. Methods Color images of 40 skin pigmented lesions, which included 12 melanomas, were acquired by a standard color RGB video camera and stored in a PC for off-line processing. Image analysis was performed in the red green and blue color representation model and using hue and saturation color components. To describe shape and color characteristics of each lesion, including area, roundness and color variegation, 16 parameters were derived from red, green, blue, hue and saturation color planes and tested as possible variables useful to differentiate melanomas from benign nevi. Results The test gave a result of significance for six of the 16 derived image descriptors. The general trend of our data was in agreement with clinical observations according to which melanoma is usually darker, more variegated and less round than a benign nevus, whereas lesion dimension of melanomas and benign lesions was not significantly different. Conclusions Our preliminary results suggested that image analysis performed on hue and saturation-derived and red green and blue-derived data could better discriminate melanoma from nevi than separately using the two color representation models.
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De Rose F, Franceschini D, Iftode C, Comito T, Tozzi A, Franzese C, Di Brina L, Clerici E, D'Agostino G, Navarria P, Tomatis S, Scorsetti M. EP-1270: Randomized phase II study of hypofractionated WBI versus APBI using VMAT: early toxicity results. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31580-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Franzese C, Tomatis S, Bossi P, Franco P, Bonomo P, Beltramo G, Bossi Zanetti I, Cante D, Argenone A, Musio D, Furlan C, Scorsetti M, Fallai C, Orlandi E. EP-1175: Role of Radiotherapy in the management of metastases from salivary gland carcinoma. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31485-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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D'Agostino G, Di Brina L, Franzese C, Franceschini D, Clerici E, Tomatis S, Iftode C, Tozzi A, Navarria P, De Rose F, Comito T, Scorsetti M. EP-1589: VMAT SBRT For Localized Prostate Cancer: 4-Year Follow-Up And Correlation With WHO2016 Grade Groups. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31898-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Palumbo V, Navarria P, Tomatis S, Clerici E, Carta G, Picozzi P, Mancosu P, Scorsetti M. OC-0591: Phase III randomized trial comparing two modalities of RS for brain metastases: Gammaknife vs Linac. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30901-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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De Rose F, Franceschini D, Iftode C, Reggiori G, Masci G, Torrisi R, Testori A, Tinterri C, Tomatis S, Scorsetti M. Adjuvant chemotherapy and hypofractionated VMAT treatment with SIB for early stage breast cancer: A prospective evaluation of acute toxicity and cosmetic results. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30403-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Stravato A, Palumbo V, Fogliata A, Reggiori G, Mancosu P, Paganini L, De Rose F, Franceschini D, Tomatis S, Scorsetti M. EP-1967: VMAT technique on left sided breast focusing on the dose to the heart. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32276-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mancosu P, Nicolini G, Goretti G, De Rose F, Franceschini D, Ferrari C, Tomatis S, Scorsetti M. EP-2154: Lean-six-sigma methodology for improving quality in RT: the breast daily repositioning case. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32463-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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De Rose F, Franceschini D, Reggiori G, Stravato A, Navarria P, Ascolese AM, Tomatis S, Mancosu P, Scorsetti M. Organs at risk in lung SBRT. Phys Med 2017; 44:131-138. [PMID: 28433508 DOI: 10.1016/j.ejmp.2017.04.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 03/24/2017] [Accepted: 04/09/2017] [Indexed: 12/23/2022] Open
Abstract
Lung stereotactic body radiotherapy (SBRT) is an accurate and precise technique to treat lung tumors with high 'ablative' doses. Given the encouraging data in terms of local control and toxicity profile, SBRT has currently become a treatment option for both early stage lung cancer and lung oligometastatic disease in patients who are medically inoperable or refuse surgical resection. Dose-adapted fractionation schedules and ongoing prospective trials should provide further evidence of SBRT safety trying to reduce toxicities and complications. In this heterogeneous scenario, a non-systematic review of dose constraints for lung SBRT was performed, including the main organs at risk in the thorax.
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Comito T, Cozzi L, Clerici E, Franzese C, Tozzi A, Iftode C, Navarria P, D’Agostino G, Rimassa L, Carnaghi C, Personeni N, Tronconi MC, De Rose F, Franceschini D, Ascolese AM, Fogliata A, Tomatis S, Santoro A, Zerbi A, Scorsetti M. Can Stereotactic Body Radiation Therapy Be a Viable and Efficient Therapeutic Option for Unresectable Locally Advanced Pancreatic Adenocarcinoma? Results of a Phase 2 Study. Technol Cancer Res Treat 2017; 16:295-301. [PMID: 27311310 PMCID: PMC5616043 DOI: 10.1177/1533034616650778] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/14/2016] [Accepted: 04/22/2016] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To assess the efficacy of stereotactic body radiotherapy in patients with unresectable locally advanced pancreatic cancer. MATERIALS AND METHODS All patients received a prescription dose of 45 Gy in 6 fractions. Primary end point was freedom from local progression. Secondary end points were overall survival, progression-free survival, and toxicity. Actuarial survival analysis and univariate or multivariate analysis were investigated. RESULTS Forty-five patients were enrolled in a phase 2 trial. Median follow-up was 13.5 months. Freedom from local progression was 90% at 2 years. On univariate ( P < .03) and multivariate analyses ( P < .001), lesion size was statistically significant for freedom from local progression. Median progression-free survival and overall survival were 8 and 13 months, respectively. On multivariate analysis, tumor size ( P < .001) and freedom from local progression ( P < .002) were significantly correlated with overall survival. Thirty-two (71%) patients with locally advanced pancreatic cancer received chemotherapy before stereotactic body radiotherapy. Median overall survival from diagnosis was 19 months. Multivariate analysis showed that freedom from local progression ( P < .035), tumor diameter ( P < .002), and computed tomography before stereotactic body radiotherapy ( P < .001) were significantly correlated with overall survival from diagnosis. CONCLUSION Stereotactic body radiotherapy is a safe and effective treatment for patients with locally advanced pancreatic cancer with no G3 toxicity or greater and could be a promising therapeutic option in multimodality treatment regimen.
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Stravato A, Reggiori G, Mancosu P, Lobefalo F, Paganini L, Zucconi F, Palumbo V, Tomatis S, Scorsetti M. EP-1439: Small field dosimetry: preliminary characterization of a nano-chamber with a focus on stem effect. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31874-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Iftode C, Tozzi A, Clerici E, Di Brina L, D'Agostino G, Ascolese A, Comito T, Franceschini D, Franzese C, De Rose F, Tomatis S, Mancosu P, Navarria P, Scorsetti M. EP-1296: Adjuvant radiotherapy in endometrial cancer: Volumetric Modulated Intensity Arc Therapy vs 3DRT. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31731-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mancosu P, Nicollini G, De Rose F, Lobefalo F, Franceschini D, Scorsetti M, Tomatis S. EP-1637: Critical appraisal of deep inspiration breath hold CBCT for left breast using VMAT. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)32072-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ascolese A, Navarria P, Mancosu P, Tomatis S, Fogliata A, Colombo P, De Sanctis R, Marrari A, Franceschini D, D'Agostino G, Santoro A, Quagliuolo V, Scorsetti M. EP-1375: Volumetric-modulated-arc-therapy versus 3D-conformal-radiotherapy for sarcoma of extremities. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31810-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Clerici E, Navarria P, Ascolese A, Pessina F, Tomatis S, Cozzi L, Simonelli M, Santoro A, Franzese C, Bello L, Scorsetti M. EP-1409: Prospective study of hypofractionated radiotherapy for elderly patients with High Grade Glioma. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31844-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Fogliata A, Reggiori G, Stravato A, Lobefalo F, Franzese C, Franceschini D, Tomatis S, Mancosu P, Scorsetti M, Cozzi L. RapidPlan head and neck model: the objectives and possible clinical benefit. Radiat Oncol 2017; 12:73. [PMID: 28449704 PMCID: PMC5408433 DOI: 10.1186/s13014-017-0808-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 04/14/2017] [Indexed: 11/27/2022] Open
Abstract
Background To evaluate a knowledge based planning model for RapidPlan (RP) generated for advanced head and neck cancer (HNC) patient treatments, as well its ability to possibly improve the clinical plan quality. The stability of the model was assessed also for a different beam geometry, different dose fractionation and different management of bilateral structures (parotids). Methods Dosimetric and geometric data from plans of 83 patients presenting HNC were selected for the model training. All the plans used volumetric modulated arc therapy (VMAT, RapidArc) to treat two targets at dose levels of 69.96 and 54.45 Gy in 33 fractions with simultaneous integrated boost. Two models were generated, the first separating the ipsi- and contra-lateral parotids, while the second associating the two parotids to a single structure for training. The optimization objectives were adjusted to the final model to better translate the institutional planning and dosimetric strategies and trade-offs. The models were validated on 20 HNC patients, comparing the RP generated plans and the clinical plans. RP generated plans were also compared between the clinical beam arrangement and a simpler geometry, as well as for a different fractionation scheme. Results RP improved significantly the clinical plan quality, with a reduction of 2 Gy, 5 Gy, and 10 Gy of the mean parotid, oral cavity and laryngeal doses, respectively. A simpler beam geometry was deteriorating the plan quality, but in a small amount, keeping a significant improvement relative to the clinical plan. The two models, with one or two parotid structures, showed very similar results. NTCP evaluations indicated the possibility of improving (NTCP decreasing of about 7%) the toxicity profile when using the RP solution. Conclusions The HNC RP model showed improved plan quality and planning stability for beam geometry and fractionation. An adequate choice of the objectives in the model is necessary for the trade-offs strategies.
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Navarria P, Pessina F, Tomatis S, Simonelli M, Santoro A, Ascolese A, Clerici E, Rossi M, Bello L, Scorsetti M. P09.36 A new therapeutic strategy for newly diagnosed glioblastoma patients: hypofractionated stereotactic radiation therapy (HSRT) delivered in 15 fractions respect to standard fractionation in 30 fractions, with concomitant temozolomide chemotherapy - A phase II study. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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De Rose F, Franceschini D, Cozzi L, Comito T, D'Agostino G, Navarria P, Ascolese A, Tozzi A, Iftode C, Franzese C, Clerici E, Tomatis S, Fogliata A, Scorsetti M. Is There a Role for Stereotactic Body Radiation Therapy (SBRT) in Oligometastatic Breast Cancer? Results From an Observational Study. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pessina F, Navarria P, Ascolese A, Cozzi L, Tomatis S, Riva M, Rossi M, Scorsetti M, Bello L. P08.27 The role of supramarginal resection for single large brain metastases: feasibility, morbidity and local control evaluation. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Navarria P, Ascolese A, Cozzi L, Tomatis S, Picozzi P, Pecchioli G, Attuati L, Clerici E, Maggi G, Scorsetti M. P19.03 Randomized double arm phase III study to evaluate feasibility and safety of Gamma Knife radiosurgery versus Linac Based (Edge) radiosurgery in brain metastatic patients. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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