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Bellardita L, Colciago RR, Frasca S, De Santis MC, Gay S, Palorini F, La Rocca E, Valdagni R, Rancati T, Lozza L. Breast cancer patient perspective on opportunities and challenges of a genetic test aimed to predict radio-induced side effects before treatment: Analysis of the Italian branch of the REQUITE project. Radiol Med 2021; 126:1366-1373. [PMID: 34268681 DOI: 10.1007/s11547-021-01395-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/29/2021] [Indexed: 02/06/2023]
Abstract
AIM To explore breast cancer patient's perspective on future genetic testing for prediction of toxicity after breast radiotherapy (RT). MATERIALS AND METHODS The study involved patient enrolled in the Italian branch of the REQUITE project conducted at the National Cancer Institute in Milan. Semi-structured interviews were conducted within one month from the end of radiotherapy treatment by two radiation oncologists and a radiotherapy technician previously trained by a clinical psychologist with experience in the oncology field. Semi-structured interviews are characterized by a set of pre-defined questions and developed ad hoc by researchers in Leicester within the REQUITE project. The interview questions investigated interest in undergoing the genetic test and expectations on its usefulness and disadvantages. RESULTS Eighteen interviews were conducted and analysed. Forty-five initial codes were combined into nine themes which were then clustered in two main macro-areas (i) Opportunities and (ii) Challenges. Overall, all patients understand the aim of the genetic test and considered its intrinsic opportunity to make the physician more confident with the treatment. Regarding side effects, most of patients felt prepared to RT but not without fear. Many women considered important to have the largest and reliable information, also about negative experiences. Prevailing emotions were anxiety and fear but not connected to genetic test's result. CONCLUSIONS A genetic test could be an opportunity because generate knowledge and give patients a dynamic role in the decision-making approach. Prediction of single patient radiosensitivity before RT could prompt suggestion to entail a more and more tailored radiation treatment in the era of personalized approach.
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Affiliation(s)
- Lara Bellardita
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | | | - Sarah Frasca
- Radiation Oncology 1 Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | | | - Simona Gay
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Federica Palorini
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Eliana La Rocca
- Radiation Oncology 1 Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Riccardo Valdagni
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Department of Radiotherapy, Università Degli Studi Di Milano Bicocca, Milan, Italy.,Radiation Oncology 1 Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Laura Lozza
- Radiation Oncology 1 Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
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A matched cohort study of radio-chemotherapy versus radiotherapy alone in soft tissue sarcoma patients. Radiol Med 2018; 124:301-308. [PMID: 30209796 DOI: 10.1007/s11547-018-0939-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 08/29/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE Adjuvant radiotherapy is the standard postoperative treatment after conservative surgery in high risk soft tissue sarcoma. The role of adjuvant chemotherapy is still debated. Therefore, a matched cohort analysis was performed in high risk soft tissue patients to analyse differences in terms of clinical outcome and toxicity between patients treated with concomitant radio-chemotherapy (RTCT) and radiotherapy (RT) alone. MATERIALS AND METHODS For each patient in RT group was selected a patient in the RTCT group matching for age, T stage and grading. Acute and late toxicity were recorded, overall survival, recurrence free survival and distant metastases free survival were analysed and compared between the two groups. RESULTS Ninety patients were selected, half of patients underwent radio-chemotherapy and half received radiotherapy alone. During the treatment Grade 3 dermatitis was recorded in 15 (16.7%) patients, 6 (6.7%) patients associated chemotherapy and during follow up 12 (13.3%) patients developed grade 2 late fibrosis, 3 (3.3%) joint stiffness and 1 (1.1%) patient experienced a bone fracture. There were no differences in the rate of acute and late toxicity between RTCT and RT alone group. Nineteen (21.1%) patients developed local recurrence, overall 5-year local relapse free survival was 83%. There were no differences between the two groups. 29 patients developed distant metastases, 14 (15.6%) patients in the RTCT group and 15 (16.7%) patients in the RT group. The 5-year distant metastases free survival was 67%. Age > 65 years was the only independent factor affecting distant recurrence (HR = 5.7, 95% CI 2.7-11.9; p = 0.001). At the time of analysis 15 (16.7%) patients were dead, 6 (6.7%) patients in the RTCT group and 9 (10%) patients in the RT group. 5-years overall survival was: 88%. At multivariate analysis age > 65 years was an independent prognostic factor of overall survival (HR = 3.7, 95% CI 1.2-12.1, p = 0.037). CONCLUSIONS Prospective randomized studies with large size population and with subgroup analysis for histological subtypes are necessary to clarify the role of adjuvant chemotherapy in soft tissue sarcoma patients. Tailored treatment has to be considered in elderly soft tissue patients to guarantee a better outcome in this high risk and fragile population.
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Greto D, Loi M, Saieva C, Muntoni C, Delli Paoli C, Becherini C, Ciabatti C, Perna M, Campanacci D, Terziani F, Beltrami G, Scoccianti G, Bonomo P, Meattini I, Desideri I, Simontacchi G, Mangoni M, Livi L. Safety of concurrent adjuvant radiotherapy and chemotherapy for locally advanced soft tissue sarcoma. TUMORI JOURNAL 2018; 104:322-329. [PMID: 29714662 DOI: 10.1177/0300891618765565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION: This retrospective study analyzes the safety and feasibility of concurrent chemoradiotherapy (CRT) in adjuvant treatment of soft tissue sarcoma (STS). METHODS: A total of 158 patients with STS were retrospectively analyzed. Anthracycline-based computed tomography was performed in high-risk patients. Acute radiotherapy toxicity and chemotherapy-related toxicity were assessed according to the Common Terminology Criteria for Adverse Events 4.0; late radiotherapy toxicity was recorded according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. RESULTS: Fifty-four (34.2%) patients received CRT. Mean follow up was 5.4 years (range .2-21.1 years). Local DFS-recurrence-free survival, distant DFS-relapse-free survival, and overall survival were 79.1%, 76.4%, and 64.6%, respectively, at last follow-up. Leukopenia occurred in 11.4% of patients. Skin acute toxicity developed in 60.1% of patients and determined interruption of radiotherapy treatment in 19 (12%) patients. Nineteen patients (12%) experienced moderate fibrosis (grade 2). Mild and moderate joint stiffness was recorded in 16 (10.1%) patients. Size ≥5 cm was the only predictor of local recurrence at multivariate analysis (hazard ratio [HR] 9.65, 95% confidence interval [CI] 1.28-72.83, p = .028). Age and stage resulted as independent distant relapse predictors (HR 4.77, 95% CI 1.81-12.58, p = .002 and HR 4.83, CI 1.41-16.57, p = .012, respectively). At Cox regression univariate analysis, Karnofsky Performance Status, size, and stage were significant survival predictors (HR 2.23, 95% CI 1.02-4.87, p = .045; HR 2.88, 95% CI 1.10-7.52, p = .031; HR 2.59, 95% CI 1.11-6.04, p = .028). CONCLUSIONS: Concurrent CRT is a well-tolerated treatment option with no additional toxicity compared to exclusive radiotherapy or sequential CRT.
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Affiliation(s)
- Daniela Greto
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Mauro Loi
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Calogero Saieva
- 2 Molecular and Nutritional Epidemiology Unit, ISPO (Cancer Research and Prevention Institute), Florence, Italy
| | - Cristina Muntoni
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Camilla Delli Paoli
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Carlotta Becherini
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Cinzia Ciabatti
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Marco Perna
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Domenico Campanacci
- 3 Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Francesca Terziani
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Giovanni Beltrami
- 3 Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Guido Scoccianti
- 3 Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Pierluigi Bonomo
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Icro Meattini
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Isacco Desideri
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Gabriele Simontacchi
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Monica Mangoni
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Lorenzo Livi
- 1 Department of Radiation-Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
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Lemanski C, Thariat J, Ampil FL, Bose S, Vock J, Davis R, Chi A, Dutta S, Woods W, Desai A, Godinez J, Karlsson U, Mills M, Nguyen NP, Vinh-Hung V. Image-guided radiotherapy for cardiac sparing in patients with left-sided breast cancer. Front Oncol 2014; 4:257. [PMID: 25295227 PMCID: PMC4172060 DOI: 10.3389/fonc.2014.00257] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/05/2014] [Indexed: 11/30/2022] Open
Abstract
Patients with left-sided breast cancer are at risk of cardiac toxicity because of cardiac irradiation during radiotherapy with the conventional 3-dimensional conformal radiotherapy technique. In addition, many patients may receive chemotherapy prior to radiation, which may damage the myocardium and may increase the potential for late cardiac complications. New radiotherapy techniques such as intensity-modulated radiotherapy (IMRT) may decrease the risk of cardiac toxicity because of the steep dose gradient limiting the volume of the heart irradiated to a high dose. Image-guided radiotherapy (IGRT) is a new technique of IMRT delivery with daily imaging, which may further reduce excessive cardiac irradiation. Preliminary results of IGRT for cardiac sparing in patients with left-sided breast cancer are promising and need to be investigated in future prospective clinical studies.
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Affiliation(s)
- Claire Lemanski
- Department of Radiation Oncology, Centre Val d'Aurelle , Montpellier , France
| | - Juliette Thariat
- Department of Radiation Oncology, University of Nice , Nice , France
| | - Federico L Ampil
- Department of Radiation Oncology, Louisiana State University , Shreveport, LA , USA
| | - Satya Bose
- Department of Radiation Oncology, Howard University , Washington, DC , USA
| | - Jacqueline Vock
- Department of Radiation Oncology, Lindenhofspital , Bern , Switzerland
| | - Rick Davis
- Michael D. Watchtel Cancer Center , Oshkosh, WI , USA
| | - Alexander Chi
- Department of Radiation Oncology, University of West Virginia , Morgantown, WV , USA
| | - Suresh Dutta
- Department of Radiation Oncology, Medicine and Radiation Oncology PA , San Antonio, TX , USA
| | - William Woods
- Department of Radiation Oncology, Richard A. Henson Institute , Salisbury, MD , USA
| | - Anand Desai
- Department of Radiation Oncology, Akron City Hospital , Akron, OH , USA
| | - Juan Godinez
- Florida Radiation Oncology Group, Department of Radiation Oncology , Jacksonville, FL , USA
| | - Ulf Karlsson
- Department of Radiation Oncology, Marshfield Clinic , Marshfield, WI , USA
| | - Melissa Mills
- Department of Radiation Oncology, University of Arizona , Tucson, AZ , USA
| | - Nam Phong Nguyen
- Department of Radiation Oncology, Howard University , Washington, DC , USA
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, University of Martinique Hospital , Martinique , France
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