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Nardangeli A, Autorino R, Boldrini L, Campitelli M, Reina S, Ferrandina G, Bizzarri N, Tagliaferri L, Macchia G, Valentini V, Gambacorta MA. Neoadjuvant Chemoradiotherapy With Simultaneous Integrated Boost in Locally Advanced Cervical Cancer: Long Term Results of a Single-Center Experience. Front Oncol 2022; 12:883965. [PMID: 35600370 PMCID: PMC9117618 DOI: 10.3389/fonc.2022.883965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/04/2022] [Indexed: 12/24/2022] Open
Abstract
Aim of this study was to analyze the efficacy and tolerability of simultaneous integrated boost volumetric modulated arc therapy (SIB-VMAT) associated with cisplatin-based chemotherapy in preoperative setting of patients with locally advanced cervical cancer (LACC). From June 2013 to September 2019, we analyzed patients with LACC who had undergone neoadjuvant chemoradiation (CRT). A radiation dose of 39.6 Gy, 1.8 Gy/fraction was delivered to the pelvis plus a radiation dose to the primary tumor delivered with SIB-VMAT strategy for a total of 50.6Gy, 2.3Gy/fraction in 25 fractions. Cisplatin-based chemotherapy was delivered combined with radiotherapy. Radical hysterectomy plus pelvic with or without aortic lymphadenectomy was performed within 7 to 8 weeks from CRT. One hundred forty-eight patients (median age: 49.5 years; FIGO stage IB2: 7, IIA: 8, IIB: 106, IIIA: 5; IIIB: 16; IVA: 5, IVB: 1; N0: 56, N1: 92) were analyzed. The treatment was well tolerated with good compliance: no grade 3/4 gastrointestinal or genitourinary toxicity was reported; grade 3 neutropenia was described in five cases. Pathological complete response (pCR) was documented in 68 cases (46%) and 32 patients (21.6%) had microscopic residual disease. Pathological nodal involvement was observed in 23 patients (15.5%). At median follow-up of 59 months (range: 27-100), the 3-year local control was 78.5%, whereas the 3-year metastasis-free survival was 70.5%. The 3-year overall survival rate was 89.0%. Neoadjuvant CRT with SIB-VMAT followed by radical surgery results in a high rate of pathologically assessed complete response and a very encouraging local control rate, with acceptable toxicity.
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Affiliation(s)
- Alessia Nardangeli
- UOC Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
- *Correspondence: Alessia Nardangeli,
| | - Rosa Autorino
- UOC Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Luca Boldrini
- UOC Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Maura Campitelli
- UOC Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Sara Reina
- Dipartimento Universitario di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Gabriella Ferrandina
- Dipartimento Universitario di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
- UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Vincenzo Valentini
- UOC Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
- Dipartimento Universitario di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Maria Antonietta Gambacorta
- UOC Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
- Dipartimento Universitario di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
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Macchia G, Ferrandina G, Patarnello S, Autorino R, Masciocchi C, Pisapia V, Calvani C, Iacomini C, Cesario A, Boldrini L, Gui B, Rufini V, Gambacorta MA, Scambia G, Valentini V. Multidisciplinary Tumor Board Smart Virtual Assistant in Locally Advanced Cervical Cancer: A Proof of Concept. Front Oncol 2022; 11:797454. [PMID: 35047408 PMCID: PMC8761664 DOI: 10.3389/fonc.2021.797454] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022] Open
Abstract
Aim The first prototype of the “Multidisciplinary Tumor Board Smart Virtual Assistant” is presented, aimed to (i) Automated classification of clinical stage starting from different free-text diagnostic reports; (ii) Resolution of inconsistencies by identifying controversial cases drawing the clinician’s attention to particular cases worthy for multi-disciplinary discussion; (iii) Support environment for education and knowledge transfer to junior staff; (iv) Integrated data-driven decision making and standardized language and interpretation. Patients and Method Data from patients affected by Locally Advanced Cervical Cancer (LACC), FIGO stage IB2-IVa, treated between 2015 and 2018 were extracted. Magnetic Resonance (MR), Gynecologic examination under general anesthesia (EAU), and Positron Emission Tomography–Computed Tomography (PET-CT) performed at the time of diagnosis were the items from the Electronic Health Records (eHRs) considered for analysis. An automated extraction of eHR that capture the patient’s data before the diagnosis and then, through Natural Language Processing (NLP), analysis and categorization of all data to transform source information into structured data has been performed. Results In the first round, the system has been used to retrieve all the eHR for the 96 patients with LACC. The system has been able to classify all patients belonging to the training set and - through the NLP procedures - the clinical features were analyzed and classified for each patient. A second important result was the setup of a predictive model to evaluate the patient’s staging (accuracy of 94%). Lastly, we created a user-oriented operational tool targeting the MTB who are confronted with the challenge of large volumes of patients to be diagnosed in the most accurate way. Conclusion This is the first proof of concept concerning the possibility of creating a smart virtual assistant for the MTB. A significant benefit could come from the integration of these automated methods in the collaborative, crucial decision stages.
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Affiliation(s)
- Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Gabriella Ferrandina
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.,Department of Woman, Child and Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Patarnello
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Rosa Autorino
- Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Carlotta Masciocchi
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Vincenzo Pisapia
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Cristina Calvani
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Chiara Iacomini
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Alfredo Cesario
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Luca Boldrini
- Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Benedetta Gui
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Vittoria Rufini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Maria Antonietta Gambacorta
- Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giovanni Scambia
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.,Department of Woman, Child and Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Vincenzo Valentini
- Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
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Jensen GL, Mezera MA, Hasan S, Hammonds KP, Swanson GP, El-Ghamry MN. Dose escalated simultaneous integrated boost of gross nodal disease in gynecologic cancers: a multi-institutional retrospective analysis and review of the literature. Radiat Oncol J 2021; 39:219-230. [PMID: 34610661 PMCID: PMC8497864 DOI: 10.3857/roj.2020.00948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 03/16/2021] [Indexed: 11/03/2022] Open
Abstract
PURPOSE Typical doses of 45-50.4 Gy used to treat regional nodes have demonstrated inadequate control of gross nodal disease (GND) in gynecologic cancer, and accelerated repopulation may limit the efficacy of a sequential boost. We reviewed outcomes of patients treated with a simultaneous integrated boost (SIB) at 2.25 Gy per fraction to positron emission tomography (PET) avid GND to evaluate toxicity and tumor control using this dose-escalated regimen. MATERIALS AND METHODS A total of 83 patients with gynecologic cancer and PET avid inguinal, pelvic, or para-aortic lymphadenopathy were treated using intensity-modulated radiation therapy (IMRT) with SIB. Primary cancers were mostly cervical (51%) and endometrial (34%), and included patients who received concurrent chemotherapy (59%) and/or brachytherapy boost (78%). RESULTS Median follow-up from radiation completion was 12.6 months (range, 2.7 to 92.9 months). Median dose to elective lymphatics was 50.4 Gy (range, 45 to 50.4 Gy) at 1.8 Gy/fraction. Median SIB dose and volume were 63 Gy (range, 56.3 to 63 Gy) and 72.8 mL (range, 6.8 to 1,134 mL) at 2-2.25 Gy/fraction. Nodal control was 97.6% in the SIB area while 90.4% in the low dose area (p = 0.013). SIB radiotherapy (RT) field failure-free, non-SIB RT field failure-free, and out of RT field failure-free survival at 4 years were 98%, 86%, and 51%, respectively. Acute and late grade ≥3 genitourinary toxicity rates were 0%. Acute and late grade ≥3 gastrointestinal toxicity rates were 7.2% and 12.0%, respectively. CONCLUSION Dose escalated SIB to PET avid adenopathy results in excellent local control with acceptable toxicity.
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Affiliation(s)
- Garrett Lee Jensen
- Department of Radiation Oncology, Baylor Scott & White Health, Temple, TX, USA
| | - Megan Ann Mezera
- Department of Radiation Oncology, MD Anderson Cancer Center at Cooper University Hospital, Camden, NJ, USA
| | - Salman Hasan
- Department of Radiation Oncology, Ascension Via Christi Cancer Center, Wichita, KS, USA
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Gui B, Autorino R, Miccò M, Nardangeli A, Pesce A, Lenkowicz J, Cusumano D, Russo L, Persiani S, Boldrini L, Dinapoli N, Macchia G, Sallustio G, Gambacorta MA, Ferrandina G, Manfredi R, Valentini V, Scambia G. Pretreatment MRI Radiomics Based Response Prediction Model in Locally Advanced Cervical Cancer. Diagnostics (Basel) 2021; 11:diagnostics11040631. [PMID: 33807494 PMCID: PMC8066099 DOI: 10.3390/diagnostics11040631] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to create a radiomics model for Locally Advanced Cervical Cancer (LACC) patients to predict pathological complete response (pCR) after neoadjuvant chemoradiotherapy (NACRT) analysing T2-weighted 1.5 T magnetic resonance imaging (MRI) acquired before treatment start. Patients with LACC and an International Federation of Gynecology and Obstetrics stage from IB2 to IVA at diagnosis were retrospectively enrolled for this study. All patients underwent NACRT, followed by radical surgery; pCR―assessed on surgical specimen―was defined as absence of any residual tumour. Finally, 1889 features were extracted from MR images; features showing statistical significance in predicting pCR at the univariate analysis were selected following an iterative method, which was ad-hoc developed for this study. Based on this method, 15 different classifiers were trained considering the most significant features selected. Model selection was carried out using the area under the receiver operating characteristic curve (AUC) as target metrics. One hundred eighty-three patients from two institutions were analysed. The model, showing the highest performance with an AUC of 0.80, was the random forest method initialised with default parameters. Radiomics appeared to be a reliable tool in pCR prediction for LACC patients undergoing NACRT, supporting the identification of patient risk groups, which paves treatment pathways tailored according to the predicted outcome.
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Affiliation(s)
- Benedetta Gui
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
| | - Rosa Autorino
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
| | - Maura Miccò
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
| | - Alessia Nardangeli
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
- Correspondence:
| | - Adele Pesce
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
| | - Jacopo Lenkowicz
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
| | - Davide Cusumano
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
| | - Luca Russo
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
| | - Salvatore Persiani
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
| | - Luca Boldrini
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
| | - Nicola Dinapoli
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
| | - Gabriella Macchia
- Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy; (G.M.); (G.S.)
| | - Giuseppina Sallustio
- Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy; (G.M.); (G.S.)
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
| | - Gabriella Ferrandina
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
| | - Riccardo Manfredi
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
| | - Giovanni Scambia
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
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Boldrini L, Piras A, Chiloiro G, Autorino R, Cellini F, Cusumano D, Fionda B, D'Aviero A, Campitelli M, Marazzi F, Balducci M, Valentini V, Gambacorta MA. Low Tesla magnetic resonance guided radiotherapy for locally advanced cervical cancer: first clinical experience. TUMORI JOURNAL 2020; 106:497-505. [PMID: 32066345 DOI: 10.1177/0300891620901752] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Magnetic resonance-guided radiotherapy (MRgRT) represents an innovative approach for personalized radiotherapy treatments and its applications are being explored in various anatomical sites to fully understand its potential advantages. This study describes the first clinical experience of MRgRT application in patients with locally advanced cervical cancer (LACC) undergoing neoadjuvant chemoradiotherapy. The feasibility of the technique is evaluated and its toxicity profile and clinical outcomes are reported. METHODS Patients with LACC (International Federation of Gynecology and Obstetrics stage IIA-IVA) undergoing neoadjuvant chemoradiotherapy (CRT) on a 0.35T Tri-60-Co hybrid unit (ViewRay) were retrospectively compared with randomly selected patients treated with a standard linear accelerator. Total prescribed dose was 50.6 Gy (2.3 Gy/fraction) to planning target volume 1 (PTV1) and 39.6 Gy (1.8 Gy/fraction) to PTV2, delivered using a simultaneous integrated boost. Surgery was performed 8 weeks after the end of CRT. The effect of magnetic resonance guidance on replanning approaches, treatment-related toxicities, and pathologic response were assessed for each patient. Patient outcomes were noted and dosimetric comparisons performed between the 2 arms. RESULTS Nine patients with LACC treated from May 2018 to November 2018 were retrospectively enrolled and their records compared with the records of an equivalent cohort of randomly selected patients. Five replanning cases were performed in the MRgRT group and 0 in the linear accelerator group. Acute G1-G2 gastrointestinal toxicities were observed in 33.3% of MRgRT patients and in 55.5% of linear accelerator patients; acute G1-G2 genitourinary toxicities in 22.2% and 33.3%, respectively. No G3 toxicity was found except for neutropenia in 2 patients. No differences were observed in pathologic response between the 2 groups. CONCLUSIONS Despite the retrospective nature of the observations and the low number of enrolled patients, the application of MRgRT in LACC appears to be safe and feasible with a favorable toxicity profile and response rates comparable to gold standard, supporting the setup of larger prospective studies to investigate the potentialities of this new technology.
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Affiliation(s)
- Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - Antonio Piras
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuditta Chiloiro
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - Rosa Autorino
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - Francesco Cellini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - Davide Cusumano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Fisica Sanitaria, Rome, Italy
| | - Bruno Fionda
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - Andrea D'Aviero
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maura Campitelli
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - Fabio Marazzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - Mario Balducci
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Rome, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Rome, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Antonietta Gambacorta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Rome, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
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Draghini L, Costantini S, Vicenzi L, Italiani M, Loreti F, Trippa F, Arcidiacono F, Casale M, Mantello G, Maranzano E. Positron emission tomography for staging locally advanced cervical cancer and assessing intensity modulated radiotherapy approach. Radiol Med 2019; 124:819-825. [PMID: 30904982 DOI: 10.1007/s11547-019-01023-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 03/11/2019] [Indexed: 12/13/2022]
Abstract
AIMS To evaluate toxicity and outcome of concomitant chemotherapy and intensity modulated radiotherapy (IMRT) with 18-fluorodeoxyglucose positron emission tomography/computed tomography (18FDG-PET/CT) based simultaneous integrated boost (SIB) of locally advanced cervical cancer (LACC). METHODS Patients with LACC underwent chemo-radiation with IMRT and SIB. Staging and follow-up were performed with clinical evaluation and CT, MRI, 18FDG-PET/CT. SIB was done on positive nodes with 18FDG-PET/CT based planning. CT-based planning high-dose-rate brachytherapy (HDR-BT) was delivered as subsequent boost to the primary tumor. Cisplatin concomitant chemotherapy was administered during IMRT. RESULTS Fourteen patients with cervical cancer were prospectively recruited between August 2014 and June 2017, 13 (93%) had a LACC, one (7%) patient was not evaluable because 18FDG-PET/CT evidenced metastases to the liver undetected by previous CT/MRI. Patients had a median age of 59 years, a median Karnofsky performance status of 100%, and a prevalence of squamous cell carcinoma histology (85%). SIB was delivered on 23 positive lymph nodes. IMRT median dose to the pelvis was 48.6 Gy in 27 fractions, SIB median dose 54 Gy in 27 fractions, HDR-BT boost median dose 21 Gy in 3 fractions. After a median follow-up of 30 months, 2-year local control and distant control were 86% and 86%, respectively. There were no grade 4 acute and/or late toxicities. CONCLUSIONS The 18FDG-PET/CT influenced stage assessment and RT treatment planning due to its high specificity in distant metastases and nodal involvement detection. The IMRT with SIB for positive nodes was an effective therapy with acceptable toxicity in LACC.
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Affiliation(s)
- Lorena Draghini
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | - Sara Costantini
- Radiation Oncology Centre, Ospedali Riuniti Umberto I°, Ancona, Italy
| | - Lisa Vicenzi
- Radiation Oncology Centre, Ospedali Riuniti Umberto I°, Ancona, Italy
| | - Marco Italiani
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | - Fabio Loreti
- Nuclear Medicine Service, "S. Maria" Hospital, Terni, Italy
| | - Fabio Trippa
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | | | | | - Giovanna Mantello
- Radiation Oncology Centre, Ospedali Riuniti Umberto I°, Ancona, Italy
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Li C, Ni W, Wang X, Zhou Z, Deng W, Chang X, Chen D, Feng Q, Liang J, Wang X, Deng L, Wang W, Bi N, Zhang T, Xiao Z. A phase I/II radiation dose escalation trial using simultaneous integrated boost technique with elective nodal irradiation and concurrent chemotherapy for unresectable esophageal Cancer. Radiat Oncol 2019; 14:48. [PMID: 30876442 PMCID: PMC6420772 DOI: 10.1186/s13014-019-1249-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 03/04/2019] [Indexed: 12/22/2022] Open
Abstract
Background To investigate the safety and tolerability of simultaneous integrated boost (SIB) technique concurrent with elective nodal irradiation (ENI) and dual-drug chemotherapy for patients with unresectable esophageal cancer. Methods In phase I, the prophylactic PTV received a stable dose of 50.40Gy/1.80Gy/28f while the boost area was planned with 3 consecutive dose levels: the first dose level was 60.76Gy/2.17Gy/28f, and then escalated approximately every 2 Gy. ENI was incorporated in Clinical Target Volume (CTV), and paclitaxel and nedaplatin were given concurrently for at least 5 weeks. In phase II, enrolled patients were treated with Maximum Tolerated Dose (MTD) obtained in phase I and the compliance rate, survival results and toxicities were evaluated. Results From December 2014 to April 2017, 53 patients were enrolled. In phase I, 2 out of 6 patients developed Dose-Limiting Toxicity (DLT) at dose level 1. Due to excessive treatment-related toxicities, the escalation process was suspended and de-escalated to 59.92Gy /2.14Gy /28 f. Three patients were treated at this dose level, all of whom completed at least 5 weeks of chemotherapy and none of whom reached a DLT, determining the newly added dose level to be the MTD. In phase II, 44 patients were treated with MTD, 31 of them (70.0%) completed at least 5 weeks of chemotherapy. The most common Grade 3 or 4 toxicities in phase II included leukopenia (21%) and esophagitis (15%). With a median follow-up time of 16.9 months, 1-y OS, DFS and local failure-free survival were 76.9, 63.6 and 78.8% respectively. Conclusion The SIB technique was feasible and safe at the MTD (95% PGTV/PTV 59.92/50.40Gy/28f) concurrent with ENI and dual-drug chemotherapy for patients with unresectable esophageal cancer. Trial registration clinicaltrials.govNCT02429622. Retrospectively registered on April 24, 2015. Electronic supplementary material The online version of this article (10.1186/s13014-019-1249-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chen Li
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Beijing, 100021, China
| | - Wenjie Ni
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Beijing, 100021, China
| | - Xin Wang
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Beijing, 100021, China
| | - Zongmei Zhou
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Beijing, 100021, China
| | - Wei Deng
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Beijing, 100021, China
| | - Xiao Chang
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Beijing, 100021, China
| | - Dongfu Chen
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Beijing, 100021, China
| | - Qinfu Feng
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Beijing, 100021, China
| | - Jun Liang
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Beijing, 100021, China
| | - Xiaozhen Wang
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Beijing, 100021, China
| | - Lei Deng
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Beijing, 100021, China
| | - Wenqing Wang
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Beijing, 100021, China
| | - Nan Bi
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Beijing, 100021, China
| | - Tao Zhang
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Beijing, 100021, China
| | - Zefen Xiao
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Beijing, 100021, China.
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Lu H, Wu Y, Liu X, Jiang H, Pang Q, Peng L, Cheng J, Deng S, Gu J, Zhao R, Hu X, Chen C, Yu J. A prospective study on neoadjuvant chemoradiotherapy plus anti-EGFR monoclonal antibody followed by surgery for locally advanced cervical cancer. Onco Targets Ther 2018; 11:3785-3792. [PMID: 29997439 PMCID: PMC6033113 DOI: 10.2147/ott.s164071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background To investigate the efficacy and safety of neoadjuvant chemoradiotherapy plus anti-epidermal growth factor receptor monoclonal antibody followed by surgery for locally advanced cervical cancer (LACC). Patients and methods Patients with histologically proven LACC were enrolled into this prospective study. All patients received intensity-modulated radiation therapy with conventional fractionation. Weekly cisplatin or nedaplatin was administered concurrently with intensity-modulated radiation therapy. Nimotuzumab, a humanized anti-epidermal growth factor receptor monoclonal antibody, was given at a dose of 200 mg per week for 6 cycles. Approximately 1 month after the completion of neoadjuvant treatment, the patients were assessed for clinical tumor response and operability based on MRI and gynecological examination. For those who were considered to be candidates for surgery, radical hysterectomy, and pelvic lymph node dissection were performed 5–6 weeks after the completion of neoadjuvant therapy. Results Twenty-eight patients were enrolled. Clinical complete response and partial response were found in 8 (28.5%) and 20 (71.5%) patients, respectively. Four patients were not eligible for surgery and 2 patients refused surgery although they were assessed as surgical candidates. They were not included in this analysis. Radical hysterectomy and pelvic lymph node dissection were performed for the remaining 22 patients. Among them, 8 (36.4%) had complete pathology response, 9 (40.9%) presented with persistent atypical cells or cervical intraepithelial neoplasia, and 5 (22.7%) presented with macroscopic and/or microscopic residual disease, according to the pathological evaluation. Median follow-up time was 22 months (range, 5–39 months). The 2-year locoregional control rate, progression-free survival rate, distant metastasis-free survival rate, and overall survival rate were 95.0%, 85.2%, 84.0%, and 90.0%, respectively. Acute toxicities were mild in general and easily manageable. Chronic toxicities were mainly limited to grade 1. No severe late toxicities were observed. Conclusion Concurrent chemoradiotherapy plus nimotuzumab followed by surgery is highly effective and safe in LACC. Further studies are warranted to confirm the findings.
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Affiliation(s)
- Heming Lu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China, .,Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yuying Wu
- Department of Gynecology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xu Liu
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Hailan Jiang
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Qiang Pang
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Luxing Peng
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jinjian Cheng
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Shan Deng
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Junzhao Gu
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Renfeng Zhao
- Department of Gynecology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xiaoxia Hu
- Department of Gynecology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Changyi Chen
- Department of Gynecology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China,
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Vergalasova I, Light K, Chino J, Craciunescu O. Simultaneous integrated boost (SIB) for treatment of gynecologic carcinoma: Intensity-modulated radiation therapy (IMRT) vs volumetric-modulated arc therapy (VMAT) radiotherapy. Med Dosim 2017; 42:230-237. [DOI: 10.1016/j.meddos.2017.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 04/26/2017] [Accepted: 05/18/2017] [Indexed: 01/13/2023]
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