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Scrofani AR, Valvano M, Lancellotta V, Pezzulla D, Vinci A, Cornacchione P, Bonome P, Tagliaferri L, Iezzi R. Efficacy and safety of irreversible electroporation in unresectable perihilar cholangiocarcinoma: a systematic review and meta-analysis. Br J Radiol 2024; 97:1413-1422. [PMID: 38775716 PMCID: PMC11256912 DOI: 10.1093/bjr/tqae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/23/2024] [Accepted: 05/17/2024] [Indexed: 07/19/2024] Open
Abstract
OBJECTIVES The prognosis of patients with perihilar-cholangiocarcinoma (PHC) is poor, with the majority presenting with unresectable disease at diagnosis. Palliative chemotherapy (CHT) is the standard treatment for unresectable PHC. Irreversible electroporation (IRE) has been introduced as a novel ablation technique, working predominantly nonthermal. This review aims to analyse the efficacy and safety of IRE in treating unresectable PHC. METHODS This systematic review and meta-analysis was performed according to a specific protocol designed a priori, and reported according to the PRISMA. PubMed/MEDLINE, Scopus, and Cochrane CENTRAL were searched up to December 2023. Primary Outcome of interest of our meta-analysis was the mean Overall Survival (OS). Secondary outcomes were progression-free survival (PFS) and adverse event rate (AE). RESULTS The mean OS was estimated at 25.49 months (CI, 21.47-38.72, I2 81.37%), PFS 17.86 (CI, 13.00-22.72, I2 11.42%), with an AE incidence of 12% (CI, 7%-31%, I2 83.57%). High heterogeneity was found among studies, with no single study fully responsible for it, suggesting high variability among facilities/populations. CONCLUSION IRE is effective and relatively safe for unresectable PHC. However, the lack of prospective studies and randomized trials comparing chemotherapy or locoregional treatment with IRE prevents drawing sufficiently robust conclusions. ADVANCES IN KNOWLEDGE IRE appears a safe and effective technique for treating unresectable perihilar cholangiocarcinoma.
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Affiliation(s)
- Anna Rita Scrofani
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma 00168, Italy
| | - Marco Valvano
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila 67100, Italy
- Division of Gastroenterology, Galliera Hospital, Genoa 16128, Italy
| | - Valentina Lancellotta
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma 00168, Italy
| | - Donato Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso 86100, Italy
| | - Antonio Vinci
- Hospital Health Management Area, Local Health Authority “Roma 1”, Roma 00193, Italy
- Doctoral school in nursing sciences and Public Health, University of Rome “Tor Vergata”, Roma 00133, Italy
| | - Patrizia Cornacchione
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma 00168, Italy
| | - Paolo Bonome
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso 86100, Italy
| | - Luca Tagliaferri
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma 00168, Italy
| | - Roberto Iezzi
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma 00168, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Roma 00168, Italy
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Draghini L, Lancellotta V, Fionda B, De Angeli M, Cornacchione P, Massaccesi M, Trippa F, Kovács G, Morganti AG, Bussu F, Iezzi R, Tagliaferri L. Can interventional radiotherapy (brachytherapy) be an alternative to surgery in early-stage oral cavity cancer? A systematic review. Strahlenther Onkol 2024; 200:367-376. [PMID: 38108835 DOI: 10.1007/s00066-023-02184-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/12/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE Brachytherapy (BT), also known as interventional radiotherapy (IRT), has proven its utility in the treatment of localized tumors. The aim of this review was to examine the efficacy of modern BT in early-stage oral cavity cancer (OCC) in terms of local control (LC), overall survival (OS), disease-free survival (DFS), cancer-specific survival (CSS), and safety. METHODS The SPIDER framework was used, with sample (S), phenomena of interest (PI), design (D), evaluation (E), and research type (R) corresponding to early-stage oral cavity cancer (S); BT (PI); named types of qualitative data collection and analysis (D); LC, OS, DFS, CSS, and toxicity (E); qualitative method (R). Systematic research using PubMed and Scopus was performed to identify full articles evaluating the efficacy of BT in patients with early-stage OCC. The studies were identified using medical subject headings (MeSH). We also performed a PubMed search with the keywords "brachytherapy oral cavity cancer, surgery." The search was restricted to the English language. The timeframe 2002-2022 as year of publication was considered. We analyzed clinical studies of patients with OCC treated with BT alone only as full text; conference papers, surveys, letters, editorials, book chapters, and reviews were excluded. RESULTS The literature search resulted in 517 articles. After the selection process, 7 studies fulfilled the inclusion criteria and were included in this review, totaling 456 patients with early-stage node-negative OCC who were treated with BT alone (304 patients). Five-year LC, DFS, and OS for the BT group were 60-100%, 82-91%, and 50-84%, respectively. CONCLUSION In conclusion, our review suggests that BT is effective in the treatment of early-stage OCC, particularly for T1N0 of the lip, mobile tongue, and buccal mucosa cancers, with good functional and toxicity profiles.
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Affiliation(s)
- Lorena Draghini
- S.C. Radiation Oncology Centre, S.Maria Hospital, via T. Di Joannuccio 1, 05100, Terni, Italy.
| | - Valentina Lancellotta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Bruno Fionda
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Martina De Angeli
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Patrizia Cornacchione
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Mariangela Massaccesi
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Fabio Trippa
- S.C. Radiation Oncology Centre, S.Maria Hospital, via T. Di Joannuccio 1, 05100, Terni, Italy
| | - Gyoergy Kovács
- Gemelli-INTERACTS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alessio Giuseppe Morganti
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Settore Scientifico Disciplinare, Università di Bologna, Bologna, Italy
| | - Francesco Bussu
- Otolaryngology Division, Azienda Ospedaliero Universitaria, Sassari, Italy
- Department of Medical, Surgical and Experimental Science, University of Sassari, Sassari, Italy
| | - Roberto Iezzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia-U.O.C. Radiologia Diagnostica e Interventistica Generale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, L.go A.Gemelli 8, 00168, Roma, Italy
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
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3
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Milazzotto R, Lancellotta V, Posa A, Fionda B, Massaccesi M, Cornacchione P, Spatola C, Kovács G, Morganti AG, Bussu F, Valentini V, Iezzi R, Tagliaferri L. The role of interventional radiotherapy (brachytherapy) in nasopharynx tumors: A systematic review. J Contemp Brachytherapy 2023; 15:383-390. [PMID: 38026072 PMCID: PMC10669916 DOI: 10.5114/jcb.2023.132495] [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: 04/04/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Nasopharyngeal cancers (NPC) are very aggressive, and the recurrence rate after radical therapy is high. This study aimed to evaluate the efficacy of brachytherapy (BT) also called interventional radiotherapy (IRT) in primary NPC in comparison with external beam radiotherapy (EBRT) alone. Material and methods A systematic search was performed in Scopus, Cochrane, and PubMed databases. Clinical query based on PICO framework was as follows: In patients with NPC (P), is EBRT plus IRT (I) superior to EBRT alone (C) in terms of local control (LC) and toxicity (O)? Full articles evaluating the efficacy of IRT as a boost after EBRT in patients with NPC were considered. Results Eight papers, including 1,320 patients fulfilled the inclusion criteria. The median 5-year LC for IRT group and no-IRT group was 98% (range, 95.8-100%) and 86% (range, 80.2-91%), respectively; the median 5-year overall survival (OS) for IRT group and no-IRT group was 93.3% (range, 89.2-97.5%) and 82.9% (range, 74.8-91.1%), respectively; the median 5-year DFS for IRT group and no-IRT group was 94.2% (range, 92.5-96%) and 83.9% (range, 73.3-94.6%), respectively; the median 5-year cancer-specific survival (CSS) for IRT group and no-IRT group was 96% (range, 94.5-97.5%) and 88.2% (range, 83.4-93.1%), respectively. G1-2 and G3-4 toxicities were similar in some articles, or significantly lower in patients treated with IRT in other papers. Conclusions Data suggest that IRT may improve results of external beam radiotherapy in primary NPCs, especially when using new technologies.
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Affiliation(s)
- Roberto Milazzotto
- U.O. Radioterapia Oncologica, A.O.U. Policlinico “G. Rodolico-San Marco” Catania, Catania, Italy
| | - Valentina Lancellotta
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Alessandro Posa
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia-U.O.C. Radiologia Diagnostica e Interventistica Generale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Bruno Fionda
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Mariangela Massaccesi
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Patrizia Cornacchione
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Corrado Spatola
- U.O. Radioterapia Oncologica, A.O.U. Policlinico “G. Rodolico-San Marco” Catania, Catania, Italy
- Multidisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, Italy
- Department Scienze Mediche, Chirurgiche e Tecnologie Avanzate “G.F. Ingrassia”, Università di Catania, Italy
| | - György Kovács
- Università Cattolica del Sacro Cuore, Gemelli-INTERACTS, Rome, Italy
| | - Alessio Giuseppe Morganti
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Settore Scientifico Disciplinare, Università di Bologna, Bologna, Italy
| | | | - Vincenzo Valentini
- U.O. Radioterapia Oncologica, A.O.U. Policlinico “G. Rodolico-San Marco” Catania, Catania, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Roberto Iezzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia-U.O.C. Radiologia Diagnostica e Interventistica Generale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luca Tagliaferri
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
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Casà C, Corvari B, Cellini F, Cornacchione P, D'Aviero A, Reina S, Di Franco S, Salvati A, Colloca GF, Cesario A, Patarnello S, Balducci M, Morganti AG, Valentini V, Gambacorta MA, Tagliaferri L. KIT 1 (Keep in Touch) Project-Televisits for Cancer Patients during Italian Lockdown for COVID-19 Pandemic: The Real-World Experience of Establishing a Telemedicine System. Healthcare (Basel) 2023; 11:1950. [PMID: 37444784 DOI: 10.3390/healthcare11131950] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/09/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
To evaluate the adoption of an integrated eHealth platform for televisit/monitoring/consultation during the COVID-19 pandemic. METHODS During the lockdown imposed by the Italian government during the COVID19 pandemic spread, a dedicated multi-professional working group was set up in the Radiation Oncology Department with the primary aim of reducing patients' exposure to COVID-19 by adopting de-centralized/remote consultation methodologies. Each patient's clinical history was screened before the visit to assess if a traditional clinical visit would be recommended or if a remote evaluation was to be preferred. Real world data (RWD) in the form of patient-reported outcomes (PROMs) and patient reported experiences (PREMs) were collected from patients who underwent televisit/teleconsultation through the eHealth platform. RESULTS During the lockdown period (from 8 March to 4 May 2020) a total of 1956 visits were managed. A total of 983 (50.26%) of these visits were performed via email (to apply for and to upload of documents) and phone call management; 31 visits (1.58%) were performed using the eHealth system. Substantially, all patients found the eHealth platform useful and user-friendly, consistently indicating that this type of service would also be useful after the pandemic. CONCLUSIONS The rapid implementation of an eHealth system was feasible and well-accepted by the patients during the pandemic. However, we believe that further evidence is to be generated to further support large-scale adoption.
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Affiliation(s)
- Calogero Casà
- Fatebenefratelli Isola Tiberina-Gemelli Isola, Via di Ponte Quattro Capi 39, 00186 Rome, Italy
| | - Barbara Corvari
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Francesco Cellini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Patrizia Cornacchione
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Andrea D'Aviero
- Mater Olbia Hospital, SS 125 Orientale Sarda, 07026 Olbia, Italy
| | - Sara Reina
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Silvia Di Franco
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Alessandra Salvati
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | | | - Alfredo Cesario
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Stefano Patarnello
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Mario Balducci
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Alessio Giuseppe Morganti
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Via Zamboni 33, 40126 Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
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Mittal P, Chopra S, Kamrava M, Vashistha R, Konrad S, Senapati S, Pradhan S, Reddy VA, Sharma DN, Engineer R, Sarin R, Budrukkar A, Ghoshal S, Shrivastava SK, Agarwal JP, Sturdza AE. Brachytherapy training in India: Results from the GEC-ESTRO-India survey. Brachytherapy 2023; 22:562-569. [PMID: 37193616 DOI: 10.1016/j.brachy.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/30/2023] [Accepted: 04/07/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Brachytherapy (BT) is integral in treatment of gynecological malignancies and is also an option for many other cancers. Data on training and proficiency levels of early career oncologists is limited. Like other continents a survey was conducted for early career oncologists in India. METHODS AND MATERIALS An online survey was conducted from November 2019 to February 2020, through Association of Radiation Oncologists of India (AROI) for early career radiation oncologists expected to be within 6 years of training. The survey used a 22 item questionnaire that was also used for European survey. Responses to individual statements were recorded on a 1-5 Likert-type scale. Descriptive statistics were used to describe proportions. RESULTS One-hundred twenty-four (17%) of 700 recipients responded to the survey. Majority of the respondents (88%) stated that being able to perform BT at the end of their training was important. Two-thirds of the respondents (81/124) had performed >10 intracavitary procedure and 22.5% had performed >10 intracavitary-interstitial implants. Many respondents had not performed nongynecological procedure- breast (64%), prostate(82%), gastro-intestinal (47%). Respondents predicted that in next 10 years, the role of BT is likely to increase. Lack of dedicated curriculum and training was perceived as the greatest barriers to achieving independence in BT (58%). Respondents suggested that BT training should be prioritized during conferences (73%) and online teaching modules (56%), along with development of BT skills labs (65%). CONCLUSION This survey identified a lack of proficiency in gynecological intracavitary-interstitial brachytherapy and non-gynecological brachytherapy, despite BT training being regarded as highly important. Dedicated programs, including standardized curriculum and assessment need to be developed for training early- career radiation oncologists in BT.
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Affiliation(s)
- Prachi Mittal
- Department of Radiation Oncology and Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rajesh Vashistha
- Department of Radiation Oncology, Max Super-Specialty Hospital, Bathinda, India
| | - Stefan Konrad
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Surendra Senapati
- Department of Radiation Oncology, Acharya Harihara Regional Cancer Centre, Cuttack, Odisha, India
| | - Satyajit Pradhan
- Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi, India
| | - Vijay Anand Reddy
- Department of Radiation Oncology, Apollo Hospitals, Hyderabad, India
| | - Daya Nand Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Reena Engineer
- Department of Radiation Oncology and Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rajiv Sarin
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology and Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sushmita Ghoshal
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Jai Prakash Agarwal
- Department of Radiation Oncology and Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Alina Emiliana Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
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Swain M, Budrukkar A, Rembielak A, Kron T, Agarwal JP. Challenges in the Sustainability of Brachytherapy Service in Contemporary Radiotherapy. Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00205-4. [PMID: 37302881 DOI: 10.1016/j.clon.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Abstract
Brachytherapy has a long history of delivering a highly conformal radiation dose to the target volume with sparing of adjacent normal tissue and has an irreplaceable role in certain cancers, such as cervical and prostate cancers. There have been futile attempts to replace brachytherapy with other radiation techniques. Despite that there are multifaceted challenges in preserving this dying art, from establishment, to a trained workforce, to maintenance of the equipment and source replacement costs. Here we focus on the challenges to access brachytherapy, the availability and distribution of care across the globe and appropriate training leading to proper implementation of the procedure. Brachytherapy holds a significant place in the treatment armamentarium of most common cancers, such as cervical, prostate, head and neck and skin cancers. However, there is an uneven distribution of brachytherapy facilities, not only across the globe, but also at a national level, with a larger proportion of facilities concentrated in certain regions, more so in low and low-middle income countries. The regions with the highest incidence of cervical cancer have the least access to brachytherapy facilities. Attempts to bridge the gap are essential and should be focused on uniform distribution and access to care, improving training of the workforce through specialised training programmes, reducing the cost of care, planning to reduce the recurring cost, generating evidence and research guidelines, renewing interest in brachytherapy through rebranding, use of social media and building an attainable long-term roadmap.
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Affiliation(s)
- M Swain
- Department of Radiation Oncology, Tata Memorial Hospital, HomiBhabha National Institute (HBNI), Parel, Mumbai, India
| | - A Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, HomiBhabha National Institute (HBNI), Parel, Mumbai, India
| | - A Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - T Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, HomiBhabha National Institute (HBNI), Parel, Mumbai, India.
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Casà C, Dinapoli L, Marconi E, Chiesa S, Cornacchione P, Beghella Bartoli F, Bracci S, Salvati A, Scalise S, Colloca GF, Chieffo DPR, Gambacorta MA, Valentini V, Tagliaferri L. Integration of art and technology in personalized radiation oncology care: Experiences, evidence, and perspectives. Front Public Health 2023; 11:1056307. [PMID: 36755901 PMCID: PMC9901799 DOI: 10.3389/fpubh.2023.1056307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023] Open
Abstract
Cancer diagnoses expose patients to traumatic stress, sudden changes in daily life, changes in the body and autonomy, with even long-term consequences, and in some cases, to come to terms with the end-of-life. Furthermore, rising survival rates underline that the need for interventions for emotional wellbeing is in growing demand by patients and survivors. Cancer patients frequently have compliance problems, difficulties during treatment, stress, or challenges in implementing healthy behaviors. This scenario was highlighted during the COVID-19 emergency. These issues often do not reach the clinical attention of dedicated professionals and could also become a source of stress or burnout for professionals. So, these consequences are evident on individual, interpersonal, and health system levels. Oncology services have increasingly sought to provide value-based health care, considering resources invested, with implications for service delivery and related financing mechanisms. Value-based health care can improve patient outcomes, often revealed by patient outcome measures while seeking balance with economical budgets. The paper aims to show the Gemelli Advanced Radiation Therapy (ART) experience of personalizing the patients' care pathway through interventions based on technologies and art, the personalized approach to cancer patients and their role as "co-stars" in treatment care. The paper describes the vision, experiences, and evidence that have guided clinical choices involving patients and professionals in a co-constructed therapeutic pathway. We will explore this approach by describing: the various initiatives already implemented and prospects, with particular attention to the economic sustainability of the paths proposed to patients; the several pathways of personalized care, both from the patient's and healthcare professional perspective, that put the person's experience at the Gemelli ART Center. The patient's satisfaction with the treatment and economic outcomes have been considered. The experiences and future perspectives described in the manuscript will focus on the value of people's experiences and patient satisfaction indicators, patients, staff, and the healthcare organization.
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Affiliation(s)
- Calogero Casà
- UOC di Radioterapia Oncologica, Fatebenefratelli Isola Tiberina, Gemelli Isola, Rome, Italy
| | - Loredana Dinapoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,UOS di Psicologia Clinica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Elisa Marconi
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,UOS di Psicologia Clinica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,*Correspondence: Elisa Marconi ✉
| | - Silvia Chiesa
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Patrizia Cornacchione
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Beghella Bartoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Serena Bracci
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandra Salvati
- Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sara Scalise
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giuseppe Ferdinando Colloca
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniela Pia Rosaria Chieffo
- UOS di Psicologia Clinica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Scienze della Salute della Donna, del Bambino e di Sanità Pubblica Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Antonietta Gambacorta
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Tagliaferri
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
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8
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Caissie A, Mierzwa M, Fuller CD, Rajaraman M, Lin A, MacDonald A, Popple R, Xiao Y, VanDijk L, Balter P, Fong H, Xu H, Kovoor M, Lee J, Rao A, Martel M, Thompson R, Merz B, Yao J, Mayo C. Head and Neck Radiation Therapy Patterns of Practice Variability Identified as a Challenge to Real-World Big Data: Results From the Learning from Analysis of Multicentre Big Data Aggregation (LAMBDA) Consortium. Adv Radiat Oncol 2023; 8:100925. [PMID: 36711064 PMCID: PMC9873496 DOI: 10.1016/j.adro.2022.100925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 12/24/2021] [Indexed: 02/01/2023] Open
Abstract
Purpose Outside of randomized clinical trials, it is difficult to develop clinically relevant evidence-based recommendations for radiation therapy (RT) practice guidelines owing to lack of comprehensive real-world data. To address this knowledge gap, we formed the Learning from Analysis of Multicenter Big Data Aggregation consortium to cooperatively implement RT data standardization, develop software solutions for data analysis, and recommend clinical practice change based on real-world data analyzed. The first phase of this "Big Data" study aimed at characterizing variability in clinical practice patterns of dosimetric data for organs at risk (OARs) that would undermine subsequent use of large-scale, electronically aggregated data to characterize associations with outcomes. Evidence from this study was used as the basis for practical recommendations to improve data quality. Methods and Materials Dosimetric details of patients with head and neck cancer treated with radiation therapy between 2014 and 2019 were analyzed. Institutional patterns of practice were characterized, including structure nomenclature, volumes, and frequency of contouring. Dose volume histogram (DVH) distributions were characterized and compared with institutional constraints and literature values. Results Plans for 4664 patients treated to a mean plan dose of 64.4 ± 13.2 Gy in 32 ± 4 fractions were aggregated. Before implementation of TG-263 guidelines in each institution, there was variability in OAR nomenclature across institutions and structures. With evidence from this study, we identified a targeted and practical set of recommendations aimed at improving the quality of real-world data. Conclusions Quantifying similarities and differences among institutions for OAR structures and DVH metrics is the launching point for next steps to investigate potential relationships between DVH parameters and patient outcomes.
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Affiliation(s)
| | | | | | | | - Alex Lin
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Ying Xiao
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Helen Fong
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Heping Xu
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | - Arvind Rao
- University of Michigan, Ann Arbor, Michigan
| | | | - Reid Thompson
- University of Oregon Health Sciences Center, Portland, Oregon
| | - Brandon Merz
- University of Oregon Health Sciences Center, Portland, Oregon
| | - John Yao
- University of Michigan, Ann Arbor, Michigan
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9
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Tagliaferri L, Dinapoli L, Casà C, Colloca GF, Marazzi F, Cornacchione P, Mazzarella C, Masiello V, Chiesa S, Beghella Bartoli F, Marconi E, D'Oria M, Cesario A, Chieffo DPR, Valentini V, Gambacorta MA. Art and digital technologies to support resilience during the oncological journey: The Art4ART project. Tech Innov Patient Support Radiat Oncol 2022; 24:101-106. [PMID: 36387778 PMCID: PMC9641049 DOI: 10.1016/j.tipsro.2022.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/15/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
Digital technologies can be useful in welcoming patients using the beauty of art. Cancer patients typically need to be supported in their treatment pathway. Digital entertainment can become a resilience-enhancing strategy. Art4ART project offers an art-based digital supporting patients’ resilience. Art4ART offers a research platform about the role of humanities as cure.
Introduction New digital technologies can become a tool for welcoming the patient through the artistic dimension. Cancer patients, in particular, need support that accompanies and supports them throughout their treatment. Materials and methods The Art4ART project consist in the structural proposal to cancer patients of a web-based digital platform containing several forms of art as video-entertainments; a multimedia immersive room; an art-based welcoming of the patients with several original paintings; an environment with a peacefulness vertical garden; a reconceptualization of the chemotherapy-infusion seats. Data regarding patients’ preference and choices will be stored and analysed also using artificial intelligence (AI) algorithm to measure and predict impact indicators regarding clinical outcomes (survival and toxicity), psychological indicators. Moreover, the same digital platform will contribute to a better organization of the activities. Discussion Through the systematic acquisition of patient preferences and through integration with other clinical parameters, it will be possible to measure the clinical, psychological, organisational, and social impact of the newly implemented Art4ART project. The use of digital technology leads us to apply the reversal of viewpoint from therapeutic acts to patient-centred care.
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10
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Macchia G, Casà C, Ferioli M, Lancellotta V, Pezzulla D, Pappalardi B, Laliscia C, Ippolito E, Di Muzio J, Huscher A, Tortoreto F, Boccardi M, Lazzari R, De Iaco P, Raspagliesi F, Gadducci A, Garganese G, Ferrandina G, Morganti AG, Tagliaferri L. Observational multicenter Italian study on vulvar cancer adjuvant radiotherapy (OLDLADY 1.2): a cooperation among AIRO Gyn, MITO and MaNGO groups. Radiol Med 2022; 127:1292-1302. [DOI: 10.1007/s11547-022-01538-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/28/2022] [Indexed: 12/01/2022]
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11
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Gonzalez-Perez V, Rembielak A, Luis Guinot J, Jaberi R, Lancellotta V, Walter R, Zuchora A, Budrukkar A, Kovács G, Jürgenliemk-Schulz I, Siebert FA, Tagliaferri L. H&N and Skin (HNS) GEC-ESTRO Working Group critical review of recommendations regarding prescription depth, bolus thickness and maximum dose in skin superficial brachytherapy with flaps and customized moulds. Radiother Oncol 2022; 175:122-132. [PMID: 36030932 DOI: 10.1016/j.radonc.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/26/2022] [Accepted: 08/21/2022] [Indexed: 11/26/2022]
Abstract
The aim of this publication is the assessment of the existing guidelines for non-melanoma skin cancer (NMSC) superficial brachytherapy (BT) and make a critical review based on the existing literature about the maximum dose prescription depth, bolus thickness and maximum skin surface dose (Dmax) of the published clinical practice. A systematic review of NMSC superficial BT published articles was carried out by the GEC-ESTRO Head & Neck and Skin (HNS) Working Group (WG). 10 members and 2 external reviewers compared the published clinical procedures with the recommendations in the current guidelines and examined the grade of evidence. Our review verified that there is a large variation among centres with regards to clinical practice in superficial BT and identified studies where published parameters such as maximum dose prescription depth, bolus thickness and Dmax exceed the constraints recommended in the guidelines, while showing excellent results in terms of local control, toxicity and cosmesis. This review confirmed that current recommendations on skin superficial BT do not include published experience on tumours treated with superficial BT that require dose prescription depth beyond the recommended 5mm under the skin surface and that the existing literature does not provide sufficient evidence to relate dosimetry of superficial BT to patient reported outcome measures. The GEC-ESTRO HNS WG considers acceptable to prescribe superficial BT dose at a depth above 5mm beyond the skin surface, and modify the bolus thickness to optimize the treatment plan and adjust the acceptable maximum dose on the skin surface, all pending clinical situation.
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Affiliation(s)
- Victor Gonzalez-Perez
- Department of Medical Physics, Fundación Instituto Valenciano de Oncología (F.I.V.O.). Beltran Baguena 8, 46009. Valencia, Spain.
| | - Agata Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust. 550 Wilmslow Road, Manchester M20 4BX Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, M13 9PL Oxford Road, Manchester, United Kingdom.
| | - Jose Luis Guinot
- Department of Radiation Oncology, Fundación Instituto Valenciano de Oncología (F.I.V.O.). Beltran Baguena 8, 46009. Valencia, Spain.
| | - Ramin Jaberi
- Radiation Oncology Research Centre (RORC), Cancer Institute, Tehran University of Medical Sciences. Keshavarz Blvd, Qods Street, 1417863181.Tehran, Iran.
| | - Valentina Lancellotta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168. Rome, Italy.
| | - Renate Walter
- Department of Medical Physics. Universitätsklinikum Augsburg. Stenglinstr 2, 86156 Augsburg, Deutschland. Renate.
| | - Anysja Zuchora
- Department of Medical Physics and Clinical Engineering. University Hospital Galway, Newcastle Road, Galway H91 YR71, Ireland.
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital Homi Bhabha National Institute, Ernest Borges Marg, Parel. Mumbai, India 400012.
| | - György Kovács
- Università Cattolica del Sacro Cuore, Gemelli - Interacts. Rome, Italy.
| | - Ina Jürgenliemk-Schulz
- Department of Radiation Oncology, University Medical Centre Utrecht. Lundlaan, 3584. Utrecht, The Netherlands.
| | - Frank-André Siebert
- Clinic of Radiotherapy, University Hospital of Schleswig-Holstein, Arnold-Heller-Straße 3, Haus L, 24105. Kiel, Germany.
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168. Rome, Italy.
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12
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Fionda B, Pagliara MM, Lancellotta V, Sammarco MG, Casà C, Savino G, Deodato F, Morganti AG, Gambacorta MA, Tagliaferri L, Blasi MA. The Role of Radiotherapy in Orbital Pseudotumor: A Systematic Review of Literature. Ocul Immunol Inflamm 2022; 30:1162-1167. [PMID: 33561371 DOI: 10.1080/09273948.2020.1871493] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Orbital pseudotumor (or pseudotumor orbitae) is a benign entity, also known as idiopathic orbital inflammatory syndrome (IOIS), which encompasses a wide range of non-tumoral, space occupying lesions of the orbit. In selected cases of refractory disease or presence of side effects or even comorbidities that limit systemic therapies, radiotherapy could play a role in the management because it has been demonstrated that irradiation is effective in suppressing the inflammatory process. METHODS A systematic review of the literature about the main scientific databases was launched and the time interval included all published articles present in the databases from their inception until September 2020. RESULTS We were able to identify 19 studies eligible for inclusion in this review from 1978 to 2018. Overall the data of 241 patients were collected and are presented in this systematic review. The response rate varied between 74% and 100% with a median recurrence rate of 10%. The median total dose was 20 Gy whereas the mean total dose was 21 Gy with a range from 4 to 36 Gy. Regarding the fractionation, 2 Gy/fraction daily was the most widely used. CONCLUSIONS Radiotherapy seemed to achieve good response rates however, in most of the studies, inclusion criteria and outcome parameters are not uniform and therefore the results are difficult to compare. Often important parameters such as chronic pain and permanent functional deficits are not assessed in the outcome. Therefore, prospective studies, with good cohort characteristics and a clear definition of the outcome, are required.
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Affiliation(s)
- Bruno Fionda
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Monica Maria Pagliara
- U.O.C. Oncologia Oculare, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valentina Lancellotta
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Grazia Sammarco
- U.O.C. Oncologia Oculare, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Calogero Casà
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gustavo Savino
- U.O.C. Oncologia Oculare, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Deodato
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
- Radiotherapy Unit, Gemelli Molise Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Campobasso, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Maria Antonietta Gambacorta
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Tagliaferri
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Antonietta Blasi
- U.O.C. Oncologia Oculare, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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13
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Miccichè F, Chiloiro G, Longo S, Autorino R, Massaccesi M, Lenkowicz J, Bonomo P, Desideri I, Belgioia L, Bacigalupo A, D’Angelo E, Bertolini F, Merlotti A, Denaro N, Franco P, Bussu F, Paludetti G, Ricardi U, Valentini V. Development of a prognostic model of overall survival in oropharyngeal cancer from real-world data: PRO.M.E.THE.O. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:205-214. [PMID: 35396587 PMCID: PMC9330744 DOI: 10.14639/0392-100x-n1672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/11/2021] [Indexed: 11/23/2022]
Abstract
Objective The PRO.M.E.THE.O. study (PredictiOn Models in Ent cancer for anti-EGFR based THErapy Optimization) aimed to develop a predictive model (PM) of overall survival (OS) for patients with locally advanced oropharyngeal cancer (LAOC) treated with radiotherapy (RT) and cetuximab (Cet) from an Italian dataset. Methods We enrolled patients with LAOC from 6 centres treated with RT-Cet. Clinical and treatment variables were collected. Patients were randomly divided into training (TS) (80%) and validation (VS) (20%) sets. A binary logistic regression model was used on the TS with stepwise feature selection and then on VS. Timepoints of 2, 3 and 5 years were considered. The area under the curve (AUC) of receiver operating characteristic of 2, 3 and 5 year and confusion matrix statistics at 5-threshold were used as performance criteria. Results Overall, 218 patients were enrolled and 174 (79.8%) were analysed. Age at diagnosis, gender, ECOG performance, clinical stage, dose to high-risk volume, overall treatment time and day of RT interruption were considered in the final PMs. The PMs were developed and represented by nomograms with AUC of 0.75, 0.73 and 0.73 for TS and 0.713, 0.713, 0.775 for VS at 2, 3 and 5 years, respectively. Conclusions PRO.M.E.THE.O. allows the creation of a PM for OS in patients with LAOC treated with RT-Cet.
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14
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Silva MC, Eugénio P, Faria D, Pesquita C. Ontologies and Knowledge Graphs in Oncology Research. Cancers (Basel) 2022; 14:cancers14081906. [PMID: 35454813 PMCID: PMC9029532 DOI: 10.3390/cancers14081906] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/25/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022] Open
Abstract
The complexity of cancer research stems from leaning on several biomedical disciplines for relevant sources of data, many of which are complex in their own right. A holistic view of cancer—which is critical for precision medicine approaches—hinges on integrating a variety of heterogeneous data sources under a cohesive knowledge model, a role which biomedical ontologies can fill. This study reviews the application of ontologies and knowledge graphs in cancer research. In total, our review encompasses 141 published works, which we categorized under 14 hierarchical categories according to their usage of ontologies and knowledge graphs. We also review the most commonly used ontologies and newly developed ones. Our review highlights the growing traction of ontologies in biomedical research in general, and cancer research in particular. Ontologies enable data accessibility, interoperability and integration, support data analysis, facilitate data interpretation and data mining, and more recently, with the emergence of the knowledge graph paradigm, support the application of Artificial Intelligence methods to unlock new knowledge from a holistic view of the available large volumes of heterogeneous data.
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15
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Lancellotta V, D'Aviero A, Fionda B, Casà C, Esposito I, Preziosi F, Acampora A, Marazzi F, Kovács G, Jereczek-Fossa BA, Morganti AG, Valentini V, Gambacorta MA, Romagnoli J, Tagliaferri L. Immunosuppressive treatment and radiotherapy in kidney transplant patients: A systematic review. World J Radiol 2022; 14:60-69. [PMID: 35432777 PMCID: PMC8966497 DOI: 10.4329/wjr.v14.i3.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/20/2021] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Immunosuppression (IS) therapy may contribute to cancer development. Some authors have proposed to reduce immunosuppression drugs dose in case of viral infections, in immunosuppression-related diseases, and in patients undergoing radiotherapy. The present analysis reports the results of a systematic review on kidney transplant recipients undergoing immunosuppression and radiotherapy.
AIM To define if it is necessary reduce immunosuppression drugs during radiotherapy.
METHODS The literature search was based on three electronic databases (Pubmed, Scopus, and Web of Science) using selected keywords linked through the "AND" and "OR" Boolean operators to build specific strings for each electronic search engine. Two researchers independently screened the citations, and disagreement was resolved by discussion or through the intervention of a third author. The review was conducted and reported according to the PRISMA statement. Extracted data were narratively synthesized, and, where possible, frequencies, percentages, and ranges were calculated.
RESULTS The literature search resulted in 147 citations. After abstracts screening, 21 records were selected for full-text evaluation. Fifteen of these were excluded, leaving six papers considered suitable for analysis. There is still no clear evidence that withdrawing antimetabolites and/or calcineurin inhibitors and/or mammalian target of rapamycin-inhibitors, as opposed to continuing maintenance IS, improves patient survival in kidney transplant recipients with cancer undergoing radiotherapy. Only few retrospective studies on small cancer patient cohorts are available in this setting, but without comparison of different immunosuppression treatments. Even where immunosuppression therapy was described, patient survival seemed to be correlated only with cancer stage and type.
CONCLUSION The results of this systematic review do not support the reduction of immunosuppression dose in patients undergoing radiotherapy.
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Affiliation(s)
- Valentina Lancellotta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Andrea D'Aviero
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Bruno Fionda
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Calogero Casà
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Ilaria Esposito
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Francesco Preziosi
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Anna Acampora
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome 00168, Rome, Italy
| | - Fabio Marazzi
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - György Kovács
- Università Cattolica del Sacro Cuore, Gemelli-INTERACTS, Rome, 00168 Rome, Italy
| | | | | | - Vincenzo Valentini
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Maria Antonietta Gambacorta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Jacopo Romagnoli
- Renal Transplant Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Luca Tagliaferri
- Renal Transplant Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
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16
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Tang Y, Yang CM, Su S, Wang WJ, Fan LP, Shu J. Machine learning-based Radiomics analysis for differentiation degree and lymphatic node metastasis of extrahepatic cholangiocarcinoma. BMC Cancer 2021; 21:1268. [PMID: 34819043 PMCID: PMC8611922 DOI: 10.1186/s12885-021-08947-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/01/2021] [Indexed: 12/15/2022] Open
Abstract
Background Radiomics may provide more objective and accurate predictions for extrahepatic cholangiocarcinoma (ECC). In this study, we developed radiomics models based on magnetic resonance imaging (MRI) and machine learning to preoperatively predict differentiation degree (DD) and lymph node metastasis (LNM) of ECC. Methods A group of 100 patients diagnosed with ECC was included. The ECC status of all patients was confirmed by pathology. A total of 1200 radiomics features were extracted from axial T1 weighted imaging (T1WI), T2-weighted imaging (T2WI), diffusion weighted imaging (DWI), and apparent diffusion coefficient (ADC) images. A systematical framework considering combinations of five feature selection methods and ten machine learning classification algorithms (classifiers) was developed and investigated. The predictive capabilities for DD and LNM were evaluated in terms of area under precision recall curve (AUPRC), area under the receiver operating characteristic (ROC) curve (AUC), negative predictive value (NPV), accuracy (ACC), sensitivity, and specificity. The prediction performance among models was statistically compared using DeLong test. Results For DD prediction, the feature selection method joint mutual information (JMI) and Bagging Classifier achieved the best performance (AUPRC = 0.65, AUC = 0.90 (95% CI 0.75–1.00), ACC = 0.85 (95% CI 0.69–1.00), sensitivity = 0.75 (95% CI 0.30–0.95), and specificity = 0.88 (95% CI 0.64–0.97)), and the radiomics signature was composed of 5 selected features. For LNM prediction, the feature selection method minimum redundancy maximum relevance and classifier eXtreme Gradient Boosting achieved the best performance (AUPRC = 0.95, AUC = 0.98 (95% CI 0.94–1.00), ACC = 0.90 (95% CI 0.77–1.00), sensitivity = 0.75 (95% CI 0.30–0.95), and specificity = 0.94 (95% CI 0.72–0.99)), and the radiomics signature was composed of 30 selected features. However, these two chosen models were not significantly different to other models of higher AUC values in DeLong test, though they were significantly different to most of all models. Conclusion MRI radiomics analysis based on machine learning demonstrated good predictive accuracies for DD and LNM of ECC. This shed new light on the noninvasive diagnosis of ECC.
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Affiliation(s)
- Yong Tang
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, No. 4, Section 2, North Jianshe Road, Chengdu, 610054, Sichuan, China
| | - Chun Mei Yang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, and Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, Sichuan, China
| | - Song Su
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, 646000, Sichuan, China
| | - Wei Jia Wang
- School of Information and Software Engineering, University of Electronic Science and Technology of China, No. 4, Section 2, North Jianshe Road, Chengdu, 610054, Sichuan, China
| | - Li Ping Fan
- Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, 646000, Sichuan, China.
| | - Jian Shu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, and Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, Sichuan, China.
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17
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Lancellotta V, Macchia G, Garganese G, Fionda B, Fragomeni SM, D'Aviero A, Casà C, Gui B, Gentileschi S, Corrado G, Inzani F, Rovirosa A, Morganti AG, Gambacorta MA, Tagliaferri L. The role of brachytherapy (interventional radiotherapy) for primary and/or recurrent vulvar cancer: a Gemelli Vul.Can multidisciplinary team systematic review. Clin Transl Oncol 2021; 23:1611-1619. [PMID: 33650029 DOI: 10.1007/s12094-021-02557-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/19/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of our systematic review was to assess the role of interventional radiotherapy (IRT, brachytherapy) in the management of primary and/or recurrent vulvar carcinoma. EVIDENCE ACQUISITION A systematic research using PubMed, Scopus and Cochrane library was performed. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews. Only full-text English-language articles related to IRT for treatment of primary or recurrent VC were identified and reviewed. Conference paper, survey, letter, editorial, book chapter and review were excluded. Time restriction (1990-2018) as concerns the years of the publication was considered. EVIDENCE SYNTHESIS Primary disease: the median 5-year LC was 43.5% (range 19-68%); the median 5-year DFS was 44.5% (range 44-81%); the median 5-year OS was 50.5% (range 27-85%). Recurrent disease: the median 5-year DFS was 64% (range 56-72%) and the median 5-year OS was 45% (range 33%-57%). Acute ≥ grade 2 toxicity was reported in three patients (1.6%). The severe late toxicity rates (grade 3-4) ranged from 0% to 14.3% (median 7.7%). CONCLUSION IRT as part of primary treatment for primary and/or recurrent vulvar cancer is associated with promising clinical outcomes.
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Affiliation(s)
- V Lancellotta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Roma, Italy
| | - G Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy.
| | - G Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - B Fionda
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Roma, Italy
| | - S M Fragomeni
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A D'Aviero
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Roma, Italy
| | - C Casà
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Roma, Italy
| | - B Gui
- Radiologia Diagnostica e Interventistica Generale, Area Diagnostica per Immagini, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - S Gentileschi
- UOC Chirurgia Plastica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Corrado
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F Inzani
- Unità di Gineco-Patologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Rovirosa
- Department of Radiation Oncology, Hospital Clinic I Universitari, Fonaments Clinics Department, University of Barcelona, Barcelona, Spain
| | - A G Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - M A Gambacorta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Roma, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Roma, Italy
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18
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Marazzi F, Tagliaferri L, Masiello V, Moschella F, Colloca GF, Corvari B, Sanchez AM, Capocchiano ND, Pastorino R, Iacomini C, Lenkowicz J, Masciocchi C, Patarnello S, Franceschini G, Gambacorta MA, Masetti R, Valentini V. GENERATOR Breast DataMart-The Novel Breast Cancer Data Discovery System for Research and Monitoring: Preliminary Results and Future Perspectives. J Pers Med 2021; 11:jpm11020065. [PMID: 33498985 PMCID: PMC7911086 DOI: 10.3390/jpm11020065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 02/07/2023] Open
Abstract
Background: Artificial Intelligence (AI) is increasingly used for process management in daily life. In the medical field AI is becoming part of computerized systems to manage information and encourage the generation of evidence. Here we present the development of the application of AI to IT systems present in the hospital, for the creation of a DataMart for the management of clinical and research processes in the field of breast cancer. Materials and methods: A multidisciplinary team of radiation oncologists, epidemiologists, medical oncologists, breast surgeons, data scientists, and data management experts worked together to identify relevant data and sources located inside the hospital system. Combinations of open-source data science packages and industry solutions were used to design the target framework. To validate the DataMart directly on real-life cases, the working team defined tumoral pathology and clinical purposes of proof of concepts (PoCs). Results: Data were classified into “Not organized, not ‘ontologized’ data”, “Organized, not ‘ontologized’ data”, and “Organized and ‘ontologized’ data”. Archives of real-world data (RWD) identified were platform based on ontology, hospital data warehouse, PDF documents, and electronic reports. Data extraction was performed by direct connection with structured data or text-mining technology. Two PoCs were performed, by which waiting time interval for radiotherapy and performance index of breast unit were tested and resulted available. Conclusions: GENERATOR Breast DataMart was created for supporting breast cancer pathways of care. An AI-based process automatically extracts data from different sources and uses them for generating trend studies and clinical evidence. Further studies and more proof of concepts are needed to exploit all the potentials of this system.
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Affiliation(s)
- Fabio Marazzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00186 Rome, Italy; (F.M.); (L.T.); (G.F.C.); (B.C.); (M.A.G.); (V.V.)
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00186 Rome, Italy; (F.M.); (L.T.); (G.F.C.); (B.C.); (M.A.G.); (V.V.)
| | - Valeria Masiello
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00186 Rome, Italy; (F.M.); (L.T.); (G.F.C.); (B.C.); (M.A.G.); (V.V.)
- Correspondence:
| | - Francesca Moschella
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, UOC di Chirurgia Senologica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00186 Roma, Italy; (F.M.); (A.M.S.); (G.F.); (R.M.)
| | - Giuseppe Ferdinando Colloca
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00186 Rome, Italy; (F.M.); (L.T.); (G.F.C.); (B.C.); (M.A.G.); (V.V.)
| | - Barbara Corvari
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00186 Rome, Italy; (F.M.); (L.T.); (G.F.C.); (B.C.); (M.A.G.); (V.V.)
| | - Alejandro Martin Sanchez
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, UOC di Chirurgia Senologica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00186 Roma, Italy; (F.M.); (A.M.S.); (G.F.); (R.M.)
| | - Nikola Dino Capocchiano
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00186 Rome, Italy; (N.D.C.); (J.L.)
| | - Roberta Pastorino
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00186 Roma, Italy; (R.P.); (C.I.); (C.M.); (S.P.)
| | - Chiara Iacomini
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00186 Roma, Italy; (R.P.); (C.I.); (C.M.); (S.P.)
| | - Jacopo Lenkowicz
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00186 Rome, Italy; (N.D.C.); (J.L.)
| | - Carlotta Masciocchi
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00186 Roma, Italy; (R.P.); (C.I.); (C.M.); (S.P.)
| | - Stefano Patarnello
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00186 Roma, Italy; (R.P.); (C.I.); (C.M.); (S.P.)
| | - Gianluca Franceschini
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, UOC di Chirurgia Senologica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00186 Roma, Italy; (F.M.); (A.M.S.); (G.F.); (R.M.)
- Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, 00186 Rome, Italy
| | - Maria Antonietta Gambacorta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00186 Rome, Italy; (F.M.); (L.T.); (G.F.C.); (B.C.); (M.A.G.); (V.V.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00186 Rome, Italy; (N.D.C.); (J.L.)
| | - Riccardo Masetti
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, UOC di Chirurgia Senologica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00186 Roma, Italy; (F.M.); (A.M.S.); (G.F.); (R.M.)
- Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, 00186 Rome, Italy
| | - Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00186 Rome, Italy; (F.M.); (L.T.); (G.F.C.); (B.C.); (M.A.G.); (V.V.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00186 Rome, Italy; (N.D.C.); (J.L.)
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19
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Tagliaferri L, Carra N, Lancellotta V, Rizzo D, Casà C, Mattiucci G, Parrilla C, Fionda B, Deodato F, Cornacchione P, Gambacorta MA, Paludetti G, Valentini V, Bussu F. Interventional radiotherapy as exclusive treatment for primary nasal vestibule cancer: single-institution experience. J Contemp Brachytherapy 2020; 12:413-419. [PMID: 33299429 PMCID: PMC7701927 DOI: 10.5114/jcb.2020.100373] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 08/12/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The aim of this paper was to evaluate treatment outcomes following interventional radiotherapy (brachytherapy - BT) for nasal vestibule cancer. MATERIAL AND METHODS Considering histological diagnosis and staging, a multidisciplinary tumor board indicated an exclusive interventional radiotherapy for all patients. Plastic tubes were placed mainly with interstitial approach. The total dose was 44 Gy in 14 fractions, 3 Gy/fraction (except for the first and last fractions, 4 Gy), 2 fractions per day (b.i.d.), 5 days a week. Inclusion criteria for this analysis were: patients affected by squamous cell carcinoma with follow-up more than 6 months. RESULTS 20 patients with primary nasal vestibule cancer were treated with IRT from May 2012 to June 2019. We excluded 4 patients due to follow-up less than 6 months and 2 patients affected by basal cell carcinoma. In total, 14 consecutive previously untreated patients were considered for definitive analysis, median age was 67.5 (range, 51-83) years, median follow-up was 53 (range, 6-84) months. All patients followed the protocol except one, who received a total dose of 42 Gy in 12 fractions, 3 Gy per 6 fractions, and 4 Gy per 6 fractions. Local control at 12, 24, and 36 months was 85.7%. Overall survival at 12 months was 92.3%, at 24 months was 76.9%, and at 36 months was 69.2%. Staging system proposed by Wang was statistically significant on local control (LC), disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS). Excellent cosmetic results were observed. CONCLUSIONS This study confirms that interventional radiotherapy could be considered as a definitive treatment in nasal vestibule cancer with excellent oncological and cosmetic outcomes.
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Affiliation(s)
- Luca Tagliaferri
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy,
| | - Nadia Carra
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy,
- Address for correspondence: Nadia Carra, MD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS – Università Cattolica del Sacro Cuore, Istituto di Radiologia, Largo Agostino Gemelli 8, Roma, Italy, phone: +39-34-76974405, ) e-mail:
| | - Valentina Lancellotta
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy,
| | - Davide Rizzo
- Divisione di Otorinolaringoiatria, Azienda Ospedaliero Universitaria, Sassari, Italy,
| | - Calogero Casà
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy,
| | - Giancarlo Mattiucci
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy,
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy,
| | - Claudio Parrilla
- U.O.C. Otorinolaringoiatria, Dipartimento Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della testa collo, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy,
| | - Bruno Fionda
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy,
| | - Francesco Deodato
- Dipartimento di Radioterapia, Fondazione Ricerca e Cura Giovanni Paolo II, Università Cattolica del Sacro Cuore, Campobasso, Italy,
| | - Patrizia Cornacchione
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy,
| | - Maria Antonietta Gambacorta
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy,
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy,
| | - Gaetano Paludetti
- U.O.C. Otorinolaringoiatria, Dipartimento Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della testa collo, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy,
- Istituto di Otorinolaringoiatria, Università Cattolica del Sacro Cuore, Roma, Italy,
| | - Vincenzo Valentini
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy,
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy,
| | - Francesco Bussu
- Divisione di Otorinolaringoiatria, Azienda Ospedaliero Universitaria, Sassari, Italy,
- Otorinolaringoiatria, Università degli studi di Sassari, Sassari, Italy
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20
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García-Consuegra A, Gimeno Morales M, Cambeiro M, Tagliaferri L, Kovacs G, Van Limbergen E, Ramos LI, Manuel Arnaiz J, Alcalde J, Lecanda F, Martinez-Monge R. Dose volume histogram constraints in patients with head and neck cancer treated with surgery and adjuvant HDR brachytherapy: A proposal of the head and neck and skin GEC ESTRO Working group. Radiother Oncol 2020; 154:128-134. [PMID: 32941955 DOI: 10.1016/j.radonc.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Head and Neck and Skin (HNS) Working group of the GEC-ESTRO acknowledges the lack of widely accepted Dose Volume Histogram (DVH) constraints in adjuvant head and neck brachytherapy and issues recommendations to minimize mandibular Osteoradionecrosis (ORN) and Soft Tissue Necrosis (STN). METHODS A total of 227 patients with the diagnosis of head and neck cancer treated with surgery and adjuvant HDR brachytherapy alone or combined with other treatment modalities during the period 2000-2018 were analyzed. RESULTS STN was observed in 28 out of 227 cases (12.3%) with an average time to appearance of 4.0 months. In previously unirradiated cases, there was a positive correlation between CTV size and STN (p = 0.017) and a trend towards significance between Total EQD2-DVH TV100 dose and STN (p = 0.06). The risk of STN in the absence of both factors (i.e, CTV < 15 cm3 and Total EQD2-DVH TV100 dose < 87 Gy) was 2%, with one factor present 15.7% and with both factors 66.7% (p = 0.001). ORN was observed in 13 out of 227 cases (5.7%) with an average time to appearance of 26.2 months. In unirradiated cases, ORN correlated with Total Physical Dose to Mandible2cm3 (p = 0.027). Patients receiving Total Physical Doses greater than 61 Gy had a 20-fold increased risk of ORN. CONCLUSIONS In Unirradiated patients the panel recommends to avoid implantation of postoperative CTVs exceeding 15 cm3 at Total EQD2-DVH TV100 doses in excess of 87 Gy as well as to limit the irradiation of the Mandible2cm3 to 61 Gy. In previously irradiated patients the panel cannot make a recommendation based on the available results.
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Affiliation(s)
| | | | | | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia, Dipartimento di Diagnostica per Immagini, Roma, Italy
| | - Gyoergy Kovacs
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia, Dipartimento di Diagnostica per Immagini, Roma, Italy
| | | | - Luis I Ramos
- Departments of Oncology, University of Navarra, Pamplona, Spain
| | - José Manuel Arnaiz
- Department of Radiation Oncology, Hospital Gregorio Marañón, Madrid, Spain
| | - Juan Alcalde
- Head and Neck Surgery, University of Navarra, Pamplona, Spain
| | - Fernando Lecanda
- Clínica Universidad de Navarra and Department of Solid Tumors and Biomarkers, University of Navarra, Pamplona, Spain
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21
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A new standardized data collection system for brain stereotactic external radiotherapy: the PRE.M.I.S.E project. Future Sci OA 2020; 6:FSO596. [PMID: 32802398 PMCID: PMC7421993 DOI: 10.2144/fsoa-2020-0015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: In recent years, novel radiation therapy techniques have moved clinical practice toward tailored medicine. An essential role is played by the decision support system, which requires a standardization of data collection. The Aim of the Prediction Models In Stereotactic External radiotherapy (PRE.M.I.S.E.) project is the implementation of systems that analyze heterogeneous datasets. This article presents the project design, focusing on brain stereotactic radiotherapy (SRT). Materials & methods: First, raw ontology was defined by exploiting semiformal languages (block and entity relationship diagrams) and the natural language; then, it was transposed in a Case Report Form, creating a storage system. Results: More than 130 brain SRT’s variables were selected. The dedicated software Beyond Ontology Awareness (BOA-Web) was set and data collection is ongoing. Conclusion: The PRE.M.I.S.E. project provides standardized data collection for a specific radiation therapy technique, such as SRT. Future aims are: including other centers and validating an extracranial SRT ontology. Radiotherapy moves clinical practice toward tailored medicine, where a decision support system is essential. The Prediction Models In Stereotactic External radiotherapy (PRE.M.I.S.E) project aims to implement a system that can analyze heterogeneous datasets. This article presents the project design for brain stereotactic radiotherapy (SRT). First, a raw ontology, which is a classification system where uniform and nonambiguous definitions represent each variable and all their relationships, was defined by exploiting semiformal and natural language. It was then it was transposed in a case report form, setting a storage system. More than 130 brain SRT’s variables were selected. The dedicated software BOA-Web (Beyond Ontology Awareness) was set. PRE.M.I.S.E. provides standardized data collection for SRT. Future aims are: including other centers and validating an extracranial SRT ontology.
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Tagliaferri L, Vavassori A, Lancellotta V, Sanctis VD, Vidali C, Casà C, Aristei C, Genovesi D, Jereczek-Fossa BA, Morganti AG, Kovács G, Guinot JL, Rembielak A, Greto D, Gambacorta MA, Valentini V, Donato V, Corvò R, Magrini SM, Livi L. INTERACTS (INTErventional Radiotherapy ACtive Teaching School) consensus conference on sarcoma interventional radiotherapy (brachytherapy) endorsed by AIRO (Italian Association of Radiotherapy and Clinical Oncology). J Contemp Brachytherapy 2020; 12:397-404. [PMID: 33293980 PMCID: PMC7690224 DOI: 10.5114/jcb.2020.98120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To report the results of INTERACTS (INTErventional Radiotherapy ACtive Teaching School) consensus conference on sarcoma interventional radiotherapy (brachytherapy). MATERIAL AND METHODS An international board of multidisciplinary experts was invited to a consensus conference on the state-of-the-art of sarcoma interventional oncology during the 9th Rome INTER-MEETING (INTERventional Radiotherapy Multidisciplinary Meeting), proposing 3 statements for each one speech. At the end of each lecture, the entire group of experts was invited to vote with an electronic device. The preliminary results were presented and discussed at the end of the meeting, during a dedicated session. After the meeting, a survey was distributed within the consensus conference board to share and definitively vote the statements. RESULTS All the invited authors of the consensus conference board completed the final survey. All the 38 statements received more than 70% of agreement, 31 statements (82%) obtained an agreement of level higher or equal to 90%, 6 statements (15.8%) received an agreement level between 80% and 90%, and 1 statement (2.6%) had less than 80% of agreement. CONCLUSIONS The consensus conference demonstrated that interventional radiotherapy must be considered by a multidisciplinary management of patients affected by sarcoma.
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Affiliation(s)
- Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,
| | - Andrea Vavassori
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy,
| | - Valentina Lancellotta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,
- Address for correspondence: Valentina Lancellotta, MD, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy, e-mail:
| | - Vitaliana De Sanctis
- Department of Radiation Oncology, Faculty of Medicina e Psicologia, Sant’Andrea Hospital, University of Rome “La Sapienza”, Rome, Italy,
| | - Cristiana Vidali
- Former Deputy Chair of Interventional Radiotherapy AIRO working Group – IntraOperative RadioTherapy, Trieste, Italy,
| | | | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgery and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy,
| | - Domenico Genovesi
- Department of Radiation Oncology, Santissima Annunziata Hospital, Gabriele D’Annunzio University of Chieti-Pescara, Chieti, Italy,
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy,
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy,
| | - Alessio Giuseppe Morganti
- Department of Experimental, Diagnostic and Specialty Medicine – DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy,
| | | | - Jose Luis Guinot
- Foundation Instituto Valenciano de Oncologia (I.V.O.), Valencia, Spain,
| | - Agata Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester and Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom,
| | - Daniela Greto
- Radiotherapy Department, University of Florence, Florence, Italy,
| | - Maria Antonietta Gambacorta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,
- Università Cattolica del Sacro Cuore, Rome, Italy,
| | - Vincenzo Valentini
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,
- Università Cattolica del Sacro Cuore, Rome, Italy,
| | - Vittorio Donato
- Radiation Oncology Department, Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy,
| | - Renzo Corvò
- Radiation Oncology, IRCCS Ospedale Policlinico San Martino and Department of Health Science, University of Genoa, Italy,
| | - Stefano Maria Magrini
- Radiation Oncology Department, Ospedali Civili Hospital and Brescia University, Brescia, Italy
| | - Lorenzo Livi
- Radiotherapy Department, University of Florence, Florence, Italy,
| | - Consensus Conference Board
- Consensus Conference Board: Rosa Autorino (radiation oncologist, Rome), Carmelo Caldarella (nuclear medicine physician, Rome), Annamaria Cerrotta (radiation oncologist, Milan), Antonino De Paoli (radiation oncologist, Aviano), Vitaliana De Sanctis (radiation oncologist, Rome), Nicola Dinapoli (radiation oncologist, Rome), Vittorio Donato (radiation oncologist, Rome), Martina Ferioli (radiation oncologist, Bologna), Vincenzo Fusco (radiation oncologist, Rionero in Vulture), Maria Antonietta Gambacorta (radiation oncologist, Rome), Domenico Genovesi (radiation oncologist, Chieti), Daniela Greto (radiation oncologist, Florence), Jose Luis Guinot (radiation oncologist, València), Roberto Iezzi (interventional radiologist, Rome), Barbara Alicja Jereczek-Fossa (radiation oncologist, Milan), György Kovács (radiation oncologist, Rome and Lübeck), Valentina Lancellotta (radiation oncologist, Rome), Antonio Leone (radiologist, Rome), Giulio Maccauro (orthopedic surgeon, Rome), Stefano Maria Magrini (radiation oncologist, Brescia), Alessio Giuseppe Morganti (radiation oncologist, Bologna), Michela Quirino (medical oncologist, Rome), Agata Rembielak (clinical and radiation oncologist, Manchester), Umberto Ricardi (radiation oncologist, Turin), Vittoria Rufini (nuclear medicine physician, Rome), Giuseppe Sanguineti (radiation oncologist, Rome), Luca Tagliaferri (radiation oncologist, Rome), Andrea Vavassori (radiation oncologist, Milan), Cristiana Vidali (radiation oncologist, Trieste)
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23
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Di Stefani A, Tagliaferri L, Lancellotta V, Fionda B, Fossati B, Balducci M, Federico F, Hohaus S, De Simone C, Gambacorta MA, Peris K. The Safety of Radiotherapy in the Treatment of Primary Cutaneous B-Cell Lymphoma: A Multidisciplinary Systematic Review. Front Oncol 2020; 10:1133. [PMID: 32760672 PMCID: PMC7372591 DOI: 10.3389/fonc.2020.01133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/05/2020] [Indexed: 12/22/2022] Open
Abstract
Primary cutaneous B-cell lymphomas (PCBCL) are rare types of extranodal non-Hodgkin's lymphoma. The choice of treatment usually depends on the variant of PCBCL, number, size, and location of the lesions, involved body surface area as well as patient's age and health condition. The efficacy of radiotherapy (RT) in the treatment of PCBCL has been widely reported conversely, data about the acute and late skin toxicity, patient's treatment satisfaction and quality of life are scarce. A systematic search using PubMed, Scopus, and Cochrane library was performed to identify full original articles analyzing the safety of RT in patients with PCBCL with the primary outcome to assess the acute and late skin toxicity. Secondary outcomes were complete remission, disease free survival, and overall survival. The literature search resulted in 276 articles including eight studies assessing the safety of RT for the treatment of PCBCL. Most patients (median 73%, range 11.9-99.9%) were recorded as having acute skin toxicity of grade 1-2, while acute grade 3-4 toxicity occurred in a median of 8% (range 4-23%) of patients. A median of 20% (range 4-54%) of patients had late skin toxicity of grade 1-2. No late grade 3-4 toxicity was reported. Only one study evaluated patient's satisfaction showing that the 97% of patients were satisfied with radiation therapy. This systematic review confirms the safety of RT in the treatment of PCBCL. Patients with a PCBCL should be managed in highly specialized centers in the context of a multidisciplinary team including dermatologist, hematologist, pathologist, and radiation oncologist.
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Affiliation(s)
- Alessandro Di Stefani
- Institute of Dermatology, Università Cattolica, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valentina Lancellotta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Bruno Fionda
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Barbara Fossati
- Institute of Dermatology, Università Cattolica, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mario Balducci
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Federico
- Institute of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Pathology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefan Hohaus
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.,Area di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Clara De Simone
- Institute of Dermatology, Università Cattolica, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ketty Peris
- Institute of Dermatology, Università Cattolica, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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24
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Tagliaferri L, Garganese G, D'Aviero A, Lancellotta V, Fragomeni SM, Fionda B, Casà C, Gui B, Perotti G, Gentileschi S, Inzani F, Corrado G, Buwenge M, Morganti AG, Valentini V, Scambia G, Gambacorta MA, Macchia G. Multidisciplinary personalized approach in the management of vulvar cancer - the Vul.Can Team experience. Int J Gynecol Cancer 2020; 30:932-938. [PMID: 32474446 DOI: 10.1136/ijgc-2020-001465] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Multidisciplinary treatment strategy involving adjuvant radiotherapy for advanced vulvar cancer could be useful in offering the best personalized clinical approach. In 2013, the VULvar CANcer Multi-Disciplinary Team (Vul.Can MDT) was set up in our institution, in order to share knowledge and expertise, high-quality diagnosis, and evidence-based decision making in the context of personalized medicine. The aim of this observational study was to report on our series of vulvar cancer patients managed postoperatively with radiotherapy within the framework of a formal multidisciplinary tumor board. METHODS Coupling surgical and oncological international guidelines with "case-by-case" discussions, a multi-specialist consensus was progressively reached and internal recommendations were developed and introduced in the daily routine. Data from vulvar cancer patients who underwent primary surgery and adjuvant radiotherapy throughout a 5-year period were retrospectively collected. Actuarial local control was the primary endpoint, while secondary end-points were acute and late toxicities, disease-free survival, and overall survival. Toxicity was evaluated according to the Common Toxicity Criteria Adverse Event v 4.0 scale. RESULTS The analysis included 35 patients with squamous vulvar cancer treated with adjuvant radiotherapy±chemotherapy, from April 2013 to September 2017. Median age was 70 years (range 18-87), all patients underwent surgery followed by concomitant chemoradiation (45.7%) or radiotherapy alone (54.3%). The median prophylactic dose on lymphatic drainage was 45 Gy, while positive nodes and perineal area received 51.2 Gy and 52.6 Gy, respectively. Chemotherapy involved the cisplatin-based regimen (45.7%)±5-fluorouracil (37.1%). Median follow-up was 32 months (range 6-72): the 24-months local control, disease-free survival, and actuarial overall survival rates were 88.6%, 82.0%, and 91.0%, respectively. Low rates of severe acute (12%) and late (3%) toxicities occurred. DISCUSSION The outcomes of this series support the benefit of a multidisciplinary personalized approach in the management of vulvar cancer.
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Affiliation(s)
- Luca Tagliaferri
- Unità Operativa Complessa di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Lazio, Italy
| | - Giorgia Garganese
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Lazio, Italy
| | | | - Valentina Lancellotta
- Unità Operativa Complessa di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Lazio, Italy
| | - Simona Maria Fragomeni
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Lazio, Italy
| | - Bruno Fionda
- Unità Operativa Complessa di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Lazio, Italy
| | - Calogero Casà
- Università Cattolica del Sacro Cuore, Roma, Lazio, Italy
| | - Benedetta Gui
- Unità Operativa Complessa di Radiologia Diagnostica e Interventistica Generale, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Lazio, Italy
| | - Germano Perotti
- Unità Operativa Complessa di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Lazio, Italy
| | - Stefano Gentileschi
- Unità Operativa Complessa di Chirurgia Plastica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Lazio, Italy
| | - Frediano Inzani
- Unità Operativa Semplice di Gineco-patologia e Patologia Mammaria, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Lazio, Italy
| | - Giacomo Corrado
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Lazio, Italy
| | - Milly Buwenge
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Emilia Romagna, Italy
| | - Alessio Giuseppe Morganti
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Emilia Romagna, Italy
| | - Vincenzo Valentini
- Unità Operativa Complessa di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Lazio, Italy
- Università Cattolica del Sacro Cuore, Roma, Lazio, Italy
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Lazio, Italy
- Università Cattolica del Sacro Cuore, Roma, Lazio, Italy
| | - Maria Antonietta Gambacorta
- Unità Operativa Complessa di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Lazio, Italy
- Università Cattolica del Sacro Cuore, Roma, Lazio, Italy
| | - Gabriella Macchia
- Unità Operativa di Radioterapia, Gemelli Molise Hospital, Campobasso, Molise, Italy
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Kowalchuk RO, Waters MR, Richardson KM, Spencer K, Larner JM, Irvin WP, Kersh CR. Stereotactic body radiation therapy in the treatment of ovarian cancer. Radiat Oncol 2020; 15:108. [PMID: 32404167 PMCID: PMC7222303 DOI: 10.1186/s13014-020-01564-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study evaluates the outcomes and toxicity of stereotactic body radiation therapy (SBRT) in ovarian cancer. METHODS This retrospective analysis considered all patients treated with SBRT from 2009 to 2018 with a primary ovarian tumor. Follow-up included PET-CT and CT scans at 2-3 month intervals. Statistical analysis primarily consisted of univariate analysis, Cox proportional hazards analysis, and the Kaplan-Meier method. RESULTS The study included 35 patients with 98 treatments for lymph nodes (51), local recurrence (21), and de novo solid metastases (26). Median biologically effective dose (BED), gross tumor volume, and planning target volume were 38.40 Gy, 10.41 cc, and 25.21 cc, respectively. 52 lesions showed complete radiographic response, and two-year local control was 80%. Median overall survival (OS) was 35.2 months, and two-year progression-free survival (PFS) was 12%. On univariate analysis, Eastern Cooperative Oncology Group performance status > 0 was predictive of decreased OS (p = 0.0024) and PFS (p = 0.044). Factors predictive of local failure included lower BED (p = 0.016), treatment for recurrence (p = 0.029), and higher pre-treatment SUV (p = 0.026). Kaplan-Meier analysis showed BED ≤35 Gy (p < 0.005) and treatment for recurrence (p = 0.01) to be predictive of local failure. On Cox proportional hazards analysis, treatment of lymph nodes was predictive of complete radiographic response (hazard ratio (HR) = 4.95), as was higher BED (HR = 1.03). Toxicity included 27 cases of grade < 3 toxicity, and one grade 5 late toxicity of GI bleed from a radiation therapy-induced duodenal ulcer. CONCLUSIONS SBRT provides durable local control with minimal toxicity in ovarian cancer, especially with BED > 35 Gy and treatment for lymph nodes.
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Affiliation(s)
- Roman O Kowalchuk
- University of Virginia / Riverside, Radiosurgery Center, Newport News, VA, USA.
| | - Michael R Waters
- University of Virginia / Riverside, Radiosurgery Center, Newport News, VA, USA
| | - K Martin Richardson
- University of Virginia / Riverside, Radiosurgery Center, Newport News, VA, USA
| | - Kelly Spencer
- University of Virginia / Riverside, Radiosurgery Center, Newport News, VA, USA
| | - James M Larner
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA
| | - William P Irvin
- Department of Gynecologic Oncology, Riverside Regional Medical Center, Newport News, USA
| | - Charles R Kersh
- University of Virginia / Riverside, Radiosurgery Center, Newport News, VA, USA
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Alitto AR, Tagliaferri L, Lancellotta V, D'Aviero A, Piras A, Frascino V, Catucci F, Fionda B, Staackmann C, Saldi S, Valentini V, Kovacs G, Aristei C, Mantini G. BIT-ART: Multicentric Comparison of HDR-brachytherapy, Intensity-modulated Radiotherapy and Tomotherapy for Advanced Radiotherapy in Prostate Cancer. In Vivo 2020; 34:1297-1305. [PMID: 32354922 PMCID: PMC7279807 DOI: 10.21873/invivo.11905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 01/28/2020] [Accepted: 02/03/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIM The aim of the study was to evaluate acute and late genitourinary (GU) and gastrointestinal (GI) toxicity in patients with high- or intermediate-risk prostate cancer. PATIENTS AND METHODS We evaluated data of patients from three Radiation Oncology Departments (Rome, Lübeck and Perugia). Patients treated in Rome underwent exclusive intensity-modulated-radiotherapy (IMRT) or IMRT plus high-dose-rate interventional radiotherapy (HDR-IRT). IMRT plus two fractions HDR-IRT was performed in Lübeck, while in Perugia Helical Tomotherapy was performed. The Common Toxicity Criteria for Adverse Event (Version 4.03) scale was used to describe acute and late toxicity. RESULTS At a median follow-up of 28 months, all 51 patients were alive and disease-free. Patients treated by HDR-IRT plus VMAT showed only G1-2 genitourinary- gastrointestinal (GU-GI) acute and late toxicity. Univariate analysis showed a lower risk of acute GU toxicity (p=0.048) in IMRT+HDR-IRT. CONCLUSION Low grade and less acute GU toxicity was observed in patients undergoing HDR-IRT boost.
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Affiliation(s)
- Anna Rita Alitto
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | | | | | | | - Vincenzo Frascino
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Francesco Catucci
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Bruno Fionda
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Christian Staackmann
- Interdisciplinary Brachytherapy Unit, University of Lübeck - University Hospital S-H, Campus Lübeck, Lübeck, Germany
| | - Simonetta Saldi
- Radiation Oncology Section, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gyorgy Kovacs
- Interdisciplinary Brachytherapy Unit, University of Lübeck - University Hospital S-H, Campus Lübeck, Lübeck, Germany
- Università Cattolica del Sacro Cuore, Educational Program Director Gemelli-INTERACTS, Rome, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Giovanna Mantini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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SKIN-COBRA (Consortium for Brachytherapy data Analysis) ontology: The first step towards interdisciplinary standardized data collection for personalized oncology in skin cancer. J Contemp Brachytherapy 2020; 12:105-110. [PMID: 32395133 PMCID: PMC7207239 DOI: 10.5114/jcb.2020.94579] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/17/2020] [Indexed: 01/21/2023] Open
Abstract
Purpose The primary objective of the SKIN-COBRA (Consortium for Brachytherapy data Analysis) ontology is to define a specific terminological system to standardize data collection for non-melanoma skin cancer patients treated with brachytherapy (BT, interventional radiotherapy). Through ontological characterization of information, it is possible to find, isolate, organize, and integrate its meaning. Material and methods SKIN-COBRA is a standardized data collection consortium for non-melanoma skin patients treated with BT, including 8 cancer centers. Its ontology was firstly defined by a multicentric and multidisciplinary working group and evaluated by the consortium, followed by a multi-professional technical commission involving a mathematician, an engineer, a physician with experience in data storage, a programmer, and a software expert. Results Two hundred and ninety variables were defined in 10 input forms. There are 3 levels, with each offering a specific type of analysis: 1. Registry level (epidemiology analysis); 2. Procedures level (standard oncology analysis); 3. Research level (radiomics analysis). The ontology was approved by the technical commission and consortium, and an ad-hoc software system was defined to be implemented in the SKIN-COBRA consortium. Conclusions Large databases are natural extension of traditional statistical approaches, a valuable and increasingly necessary tool for modern healthcare system. Future analysis of the collected multinational and multicenter data will show whether the use of the system can produce high-quality evidence to support multidisciplinary management of non-melanoma skin cancer and utilizing this information for personalized treatment decisions.
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Can brachytherapy be properly considered in the clinical practice? Trilogy project: The vision of the AIRO (Italian Association of Radiotherapy and Clinical Oncology) Interventional Radiotherapy study group. J Contemp Brachytherapy 2020; 12:84-89. [PMID: 32190074 PMCID: PMC7073336 DOI: 10.5114/jcb.2020.92765] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/20/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose Brachytherapy (BT, interventional radiotherapy - IRT) is a kind of radiation therapy, in which the radioactive source is placed nearby or even inside the cancer itself. Even though this kind of radiation therapy appears effective and valuable, BT has been facing a slow but progressive decline over the past decades in Europe, particularly in Italy. Aims of this study were to identify the practical and theoretical reasons why BT is facing a slow decline in Italy, and to define a vision of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) and a strategy about this emerged issues. Material and methods A programmatic path divided into three steps like a trilogy was launched by AIRO Interventional Radiotherapy study group. The study group performed an initial data collection to highlight both the clinical and the educational topics and problems through specific surveys. After having analyzed the results of the surveys and shared a vision about the emerged issues, a specific strategy was adopted. Results Four relevant domains were identified and for each ones, a strategy has been discussed and defined. This manuscript shows in detail the individual actions defined (accomplished or in progress). Conclusions The AIRO vision implies that specific strategic interventions must be carried out in the field of national guidelines, education, research, and communication with patients and colleagues of other specialties in an interdisciplinary setting.
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The role of vaginal brachytherapy in stage I endometrial serous cancer: a systematic review. J Contemp Brachytherapy 2020; 12:61-66. [PMID: 32190072 PMCID: PMC7073340 DOI: 10.5114/jcb.2020.92698] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/15/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose Serous adenocarcinoma (uterine serous carcinoma – USC) is a rare and aggressive histologic subtype of endometrial cancer, with a high-rate of recurrence and poor prognosis. The adjuvant treatment for stage I patients is unclear. The purpose of this study was to evaluate the outcomes of stage I USC treated exclusively with chemotherapy plus vaginal brachytherapy (VBT). Material and methods A systematic research using PubMed, Scopus, and Cochrane library was conducted to identify full articles evaluating the efficacy of VBT in patients with stage I USC. A search in ClinicalTrials.gov was performed in order to detect ongoing or recently completed trials, and in PROSPERO for searching ongoing or recently completed systematic reviews. Results All studies were retrospective and 364 of evaluated patients were found. The average local control was 97.5% (range, 91-100%), the disease free-survival was 88% (range, 82-94%), the overall survival was 93% (range, 72-100%), the specific cancer survival was 89.4% (range, 84.8-94%), and the G3-G4 toxicity was 0-8%. Conclusions These data support the concept that in adequately selected patients, VBT alone may be a suitable radiotherapy technique in women with stage I USC who underwent surgical staging and received adjuvant chemotherapy.
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Could a Personalized Strategy Using Accelerated Partial Breast Irradiation be an Advantage for Elderly Patients? A Systematic Review of the Literature and Multidisciplinary Opinion. JOURNAL OF ONCOLOGY 2020; 2020:3928976. [PMID: 32190051 PMCID: PMC7064828 DOI: 10.1155/2020/3928976] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/27/2019] [Indexed: 12/12/2022]
Abstract
Introduction. Elderly patients are underrepresented from a majority of clinical trials and the choice of the best treatment becomes a challenge. The optimal treatment should be personalized and based on a multidisciplinary approach that includes radiation oncologists, surgeons, geriatricians, medical oncologists, social workers, and support services. The global evaluation of the patients and the creation of nomograms may facilitate the definition of long-term treatment benefits minimizing the use of unnecessary therapy. Material and Method. A systematic research using PubMed, Scopus, and Cochrane library was performed to identify full articles analyzing the efficacy of APBI in elderly patients with breast cancer. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews.
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Pagliara MM, Tagliaferri L, Lenkowicz J, Azario L, Giattini D, Fionda B, Sammarco MG, Lancellotta V, Gambacorta MA, Blasi MA. AVATAR: Analysis for Visual Acuity Prediction After Eye Interventional Radiotherapy. In Vivo 2020; 34:381-387. [PMID: 31882502 PMCID: PMC6984081 DOI: 10.21873/invivo.11784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/02/2019] [Accepted: 10/07/2019] [Indexed: 12/26/2022]
Abstract
AIM The aim of this study was to detect clinical factors predictive of loss of visual acuity after treatment in order to develop a predictive model to help identify patients at risk of visual loss. PATIENTS AND METHODS This was a retrospective review of patients who underwent interventional radiotherapy (brachytherapy) with 106Ru plaque for primary uveal melanoma. A predictive nomogram for visual acuity loss at 3 years from treatment was developed. RESULTS A total of 152 patients were selected for the study. The actuarial probability of conservation of 20/40 vision or better was 0.74 at 1 year, 0.59 at 3 years, and 0.54 at 5 years after treatment. Factors positively correlated with loss of visual acuity included: age at start of treatment (p=0.004) and longitudinal basal diameter (p=0.057), while distance of the posterior margin of the tumor from the foveola was inversely correlated (p=0.0007). CONCLUSION We identified risk factors affecting visual function and developed a predictive model and decision support tool (AVATAR nomogram).
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Affiliation(s)
- Monica Maria Pagliara
- U.O.C. Oncologia Oculare, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Tagliaferri
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jacopo Lenkowicz
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Azario
- U.O.C. Fisica Sanitaria, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Fisica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dario Giattini
- Ophthalmology Clinic, Department of Medicine and Aging Science, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Bruno Fionda
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Grazia Sammarco
- U.O.C. Oncologia Oculare, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valentina Lancellotta
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Antonietta Gambacorta
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Antonietta Blasi
- U.O.C. Oncologia Oculare, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Oftalmologia, Università Cattolica del Sacro Cuore, Rome, Italy
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Critical review of multidisciplinary non-surgical local interventional ablation techniques in primary or secondary liver malignancies. J Contemp Brachytherapy 2019; 11:589-600. [PMID: 31969919 PMCID: PMC6964346 DOI: 10.5114/jcb.2019.90466] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/15/2019] [Indexed: 12/21/2022] Open
Abstract
Local non-surgical interventional percutaneous ablation represents nowadays an important part of the potential treatment strategies. Although surgical ablation represents the gold standard, in the past decade there was an expansion in the use of non-surgical ablative techniques: radiofrequency, microwave, laser, cryoablation, irreversible electroporation, and interventional radiotherapy (brachytherapy) in primary as well as secondary liver cancers. With the growing experience in the field, there was implemented a new pillar for cancer treatment, together with surgery, chemotherapy as well as radiotherapy, so-called interventional oncology (IO). To date, there are no published papers regarding a comparative interdisciplinary evaluation of all these non-surgical interventional local ablation therapies. Our paper offers a critical interdisciplinary overview of the treatments in both primary and secondary liver tumors, including from a cost-effective point of view. Furthermore, the present status of education in IO and a comparison of actual economic aspects of the treatments are also provided.
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Leccisotti L, Manfrida S, Barone R, Ripani D, Tagliaferri L, Masiello V, Privitera V, Gambacorta MA, Rufini V, Valentini V, Giordano A. The prognostic role of FDG PET/CT before combined radio-chemotherapy in anal cancer patients. Ann Nucl Med 2019; 34:65-73. [DOI: 10.1007/s12149-019-01416-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/23/2019] [Indexed: 01/20/2023]
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Clinical evidence of abscopal effect in cutaneous squamous cell carcinoma treated with diffusing alpha emitters radiation therapy: a case report. J Contemp Brachytherapy 2019; 11:449-457. [PMID: 31749854 PMCID: PMC6854861 DOI: 10.5114/jcb.2019.88138] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/25/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose Alpha particle treatments could enhance the probability of an immune response, which can lead to abscopal effects (AE). We report a case of a patient affected by multiple cutaneous squamous cell carcinoma (cSCC). After the treatment with diffusing alpha emitters radiation therapy (DaRT) of one lesion, an AE was observed on at least two distant ones. Material and methods We investigated a case of a 65-year-old female patient with multiple synchronous lesions of the skin of lower limbs confirmed by a biopsy. Patient was enrolled in a clinical trial N.CTP-SCC-00 (NCT03015883), with the objective to assess effectiveness of DaRT technique. DaRT is based on the insertion of locally 224Ra-loaded seeds in a clinical target volume (CTV). Treatment plan with positron emission tomography/computed tomography (PET/CT) was used to entirely cover the CTV. Follow-up and biopsy evaluations were employed to outline the patient outcome. Results We performed seeds implantation according to the Paris system. At 28th day, an evident lesion shrinkage with a persistent minimal area of hyperkeratosis was noted. 76 days after implantation, a complete remission of the treated lesion was observed and an evident reduction of the area with two more distant lesion, which could be associated to an immune-mediated response. One year after the treatment, a complete remission of treated lesion was observed as well as spontaneous regression of untreated distant ones. Conclusions In this study, we reported evidences of an AE in cSCC stimulated by radiation and possibly mediated by immune system. In the next DaRT treatments, our intent is to monitor T-lymphocytes variations in peripheral blood in order to demonstrate indirect activation of the immune system mediated by radiation also in patients with solitary lesions, in which, by definition, an AE cannot be observed.
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Lancellotta V, Cellini F, Fionda B, De Sanctis V, Vidali C, Fusco V, Barbera F, Gambacorta MA, Corvò R, Magrini SM, Tagliaferri L. The role of palliative interventional radiotherapy (brachytherapy) in esophageal cancer: An AIRO (Italian Association of Radiotherapy and Clinical Oncology) systematic review focused on dysphagia-free survival. Brachytherapy 2019; 19:104-110. [PMID: 31636025 DOI: 10.1016/j.brachy.2019.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/16/2019] [Accepted: 09/09/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE The aim of this review was to examine efficacy of palliative interventional radiotherapy (IRT) in esophageal cancer compared with other treatment in terms of dysphagia-free survival (DyFS) and safety. METHODS AND MATERIAL A systematic research using PubMed, Scopus, and Cochrane library was performed to identify full articles evaluating the efficacy of IRT as palliation in patients with esophageal cancer. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews. We analyzed only clinical study as full text of patients with symptomatic esophageal cancer treated with IRT alone or in combination with other treatment. Conference paper, survey, letter, editorial, book chapter, and review were excluded. Time restriction (1990-2018) as concerns the years of the publication was considered. The primary outcome was the duration of dysphagia relief (DyFS) after brachytherapy vs. other treatment (external-beam radiotherapy, photodynamic therapy, argon plasma coagulation, stent, and laser) during followup. Secondary outcomes included overall survival and adverse event rates. RESULTS The literature search resulted in 554 articles. Sixty-six articles were assessed via full text for eligibility. Of these, 59 articles were excluded for various reasons, leaving seven randomized studies. The number of evaluated patients was 905 patients, and median age was 70.5 years. In the IRT group, the median DyFS was 99 days, the most relevant G3-G4 toxicity were fistula development and stenosis reported, respectively, in 8.3% and 12.2%; the overall median survival was 175.5 days. CONCLUSION In conclusion, we provided evidence-based support that IRT is an effective and safe treatment option; therefore, its underuse is no longer justified.
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Affiliation(s)
- Valentina Lancellotta
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
| | - Francesco Cellini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
| | - Bruno Fionda
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy.
| | - Vitaliana De Sanctis
- Faculty of Medicina e Psicologia, Sant'Andrea Hospital, Department of Radiation Oncology, University of Rome "La Sapienza", Rome, Italy
| | - Cristiana Vidali
- Department of Radiation Oncology, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
| | - Vincenzo Fusco
- Department of Radiation Oncology, Centro di Riferimento Oncologico Regionale, Rionero in Vulture, Potenza, Italy
| | - Fernando Barbera
- Brachytherapy Section, Radiation Oncology Department, Ospedali Civili Hospital and Brescia University, Brescia, Italy
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italy
| | - Renzo Corvò
- Radiation Oncology, IRCCS Ospedale Policlinico San Martino and Department of Health Science, University of Genoa, Genoa, Italy
| | - Stefano Maria Magrini
- Radiation Oncology Department, Ospedali Civili Hospital and Brescia University, Brescia, Italy
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
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Tagliaferri L, Lancellotta V, Zinicola T, Gentileschi S, Sollena P, Garganese G, Guinot JL, Rembielak A, Soror T, Autorino R, Cammelli S, Gambacorta MA, Aristei C, Valentini V, Kovacs G. Cosmetic assessment in brachytherapy (interventional radiotherapy) for breast cancer: A multidisciplinary review. Brachytherapy 2019; 18:635-644. [PMID: 31171462 DOI: 10.1016/j.brachy.2019.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/18/2019] [Accepted: 03/25/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE This review was to focus on breast brachytherapy cosmetic assessment methods state of the art and to define the advantages and disadvantages related to. METHODS AND MATERIALS We conducted a literature review of the major experience on breast brachytherapy cosmetic assessment methods in several databases (PubMed, Scopus, and Google Scholar databases). To identify the relevant works, a task force screened citations at title and abstract level to identify potentially relevant paper. An expert board reviewed and approved the text. The assessment systems were classified into three main groups: (1) the Oncological Toxicity Scales, (2) the Independent Patients Perspective Measures, (3) the Patient-Related Outcome Measures. Each cosmetic assessment method was evaluated following six parameters: (1) anatomical site, (2) advantages, (3) disadvantages, (4) subjective/objective, (5) quantitative/qualitative, (6) computers or pictures needs. RESULTS Eleven assessment methods were selected. Three methods were classified as Oncological Toxicity Scale, six in the Independent Patients Perspective Measures classification, and two as Patient-Related Outcome Measures. Six methods are subjective, while eight are objective. Four systems are classified as quantitative, four as qualitative while three both. Five systems need informatics support. Moreover, each method was discussed individually reporting the main characteristics and peculiarities. CONCLUSIONS Cosmesis is one major end point for the patient who has a malignancy of low lethal potential. In modern personalized medicine, there is a need for standardized cosmetic outcome assessments to analyze and compare the results of treatments. No gold standard methods currently exist. The result of this review is to summarize the various cosmesis methods, defining the strengths and weaknesses of each one and giving a line in research and clinical practice.
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Affiliation(s)
- Luca Tagliaferri
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Valentina Lancellotta
- Department of Surgery and Biomedical Sciences, Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italia
| | - Tiziano Zinicola
- Università Cattolica del Sacro Cuore, Istituto di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia.
| | - Stefano Gentileschi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Chirurgia Plastica e Ricostruttiva, Centro di Trattamento Chirurgico del Linfedema, Roma, Italia
| | - Pietro Sollena
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Dermatologia, Roma, Italia
| | - Giorgia Garganese
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna e del Bambino, Roma, Italia
| | - José L Guinot
- Department of Radiation Oncology, Foundation Instituto Valenciano de Oncologia (I.V.O.), València, Spain
| | - Agata Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester and Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Tamer Soror
- Department of Clinical Radiation Oncology, Ernst von Bergmann Medical Center, Academic Teaching Hospital of Humboldt University Berlin (Charité), Berlin, Germany; National Cancer Institute (NCI), Radiation Oncology Department, Cairo University, Cairo, Egypt
| | - Rosa Autorino
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Silvia Cammelli
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italia
| | - Maria A Gambacorta
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia; Università Cattolica del Sacro Cuore, Istituto di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Cynthia Aristei
- Department of Surgery and Biomedical Sciences, Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italia
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia; Università Cattolica del Sacro Cuore, Istituto di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - György Kovacs
- Interdisciplinary Brachytherapy Unit, UKSH CL, Lübeck, Germany
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Adjuvant interstitial three-dimensional pulse-dose-rate-brachytherapy for lip squamous cell carcinoma after surgical resection. J Contemp Brachytherapy 2019; 11:116-121. [PMID: 31139219 PMCID: PMC6536141 DOI: 10.5114/jcb.2019.84687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/29/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose The purpose of this study was to report clinical outcomes of patients treated with pulse-dose-rate brachytherapy (PDR-BT) for lip cancer after insufficient surgery. Material and methods Twenty lip cancer patients were treated from January 2012 to September 2016. Primary treatment included surgery with or without reconstruction. All patients were diagnosed with squamous cell carcinoma, most of the tumors were pT1. Brachytherapy procedures were done after post-operative wound healing. Median of three plastic tubes were implanted using a free-hand technique. Two PDR-BT treatments were scheduled for every patient, with the gap of median 13 days. The planned dose was 0.8-1 Gy per pulse to the total dose of 50 Gy from two PDR-BT treatments. Patients were evaluated every 3-6 months. Follow-up time was counted from the last day of treatment to any event or last visit. Early and late toxicities were scored with RTOG scale. Results Average follow-up was 34.7 months (range, 12.7-67.6). Three- and five-year estimated disease-free survival was 95% and local control was 100%. One patient suffered from regional relapse in the submental region (IA lymph node group). Skin erythema or dry desquamation (grade 1) or wet desquamation (grade 2) was observed in 13 patients (65%) and one patient (5%), respectively. Six patients presented no acute toxicity. Moreover, there were no complications involving lip mucosa. All patients had grade 1 soft tissue fibrosis in the irradiated area, besides that, late toxicity included only skin complications. There were no significant factors associated with late toxicity ≥ grade 2. Conclusions PDR-BT in the adjuvant treatment of the lip cancer yields high local control with low toxicity. Even patients with close margins after surgery (< 5 mm) should be considered as candidates for PDR-BT.
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Personalized re-treatment strategy for uveal melanoma local recurrences after interventional radiotherapy (brachytherapy): single institution experience and systematic literature review. J Contemp Brachytherapy 2019; 11:54-60. [PMID: 30911311 PMCID: PMC6431104 DOI: 10.5114/jcb.2019.82888] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/01/2019] [Indexed: 12/30/2022] Open
Abstract
Purpose To report the results of a patient’s tailored therapeutic approach using a second course of interventional radiotherapy (brachytherapy) in patients with locally recurrent uveal melanoma. Material and methods Patients who had already undergone ocular brachytherapy treated at our IOC (Interventional Oncology Center) were considered. Five patients who has received a second course of treatment with a plaque after local recurrences were included in our study. Re-irradiation was performed with Ruthenium-106 (prescribed dose to the apex 100 Gy) or with Iodine-125 plaques (prescribed dose to the apex 85 Gy). Moreover, a systematic literature search was conducted through three electronic databases, including Medline/PubMed, Scopus, and Embase. Results All patients were initially treated with Ruthenium-106 plaque; the re-irradiation was performed with Ruthenium-106 plaque in three cases and with Iodine in two cases. Mean time between the first and the second plaque was 56.8 months (range, 25-93 months). Local tumor control rate was 100%, no patient underwent secondary enucleation owing to re-treatment failure. Distant metastasis occurred in 1 patient after 6 months from re-treatment. After a median follow-up of 44.2 months (range, 26-65 months) from re-treatment, all patients experienced worsening of the visual acuity (median visual acuity was 0.42 at time of recurrence and decline to 0.24 at the most recent follow-up); cataract occurred in two cases, no patient developed scleral necrosis. We considered 2 papers for a systematic review. Conclusions In selected cases, especially in presence of marginal local recurrence, a personalized re-treatment strategy with a plaque may offer high probability of tumor control and organ preservation but worsening of visual acuity.
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The role of personalized Interventional Radiotherapy (brachytherapy) in the management of older patients with non-melanoma skin cancer. J Geriatr Oncol 2018; 10:514-517. [PMID: 30314955 DOI: 10.1016/j.jgo.2018.09.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/05/2018] [Accepted: 09/26/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Non-melanoma skin cancer (NMSC) has been rapidly increasing in incidence over the past 30 years. Mainstays of treatment remain surgery and radiotherapy, particularly in older and/or frail patients (≥75 years old) that often require a personalized treatment strategy using innovative biotechnologies. High-dose-rate interventional radiotherapy (HDR-IRT) seems to be an excellent option for NMSC. MATERIAL AND METHODS Nineteen aged patients with advanced, biopsy proven NMSC were treated with exclusively HDR-IRT. A personalized double-layer mould of thermoplastic mask material was applied to the skin surface. Plastic tubes were fixed on the mould in appropriate geometry over the target area. Planning computed tomography (CT) images were acquired with 2.5 mm slice thickness and transmitted to the planning system. Treatment intention was to deliver ≥95% of the prescribed dose to the Planning Target Volume (PTV), accepting 90% as satisfactory. Toxicities were assessed using the Common Terminology Criteria for Adverse Events scale (CTCAE) v. 4.0. RESULTS Median age was 86 years. Acute toxicity: Grade 2 erythema appeared in all 19 patients. Towards the end of each treatment schedule, epidermolysis developed which was resolved within 6 weeks of completing HDR-IRT. Late toxicity: Grade 1 skin atrophy, pigmentation changes and alopecia in field were observed in all patients. At last follow-up, all patients were disease free. CONCLUSIONS Personalized HDR-IRT appears to be safe and effective for frail older patients and a valid alternative to supportive care for those with contraindication to surgery. Future investigations using also large database analysis seem to be advisory.
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Murakami N, Ueno T, Yatsuoka W, Okamoto H, Tselis N, Masui K, Yoshida K, Takahashi K, Inaba K, Okuma K, Igaki H, Nakayama Y, Itami J. Dose coverage comparison between "interstitial catheter-only" and "hybrid intracavitary-interstitial brachytherapy" for early stage squamous cell carcinoma of the buccal mucosa. J Contemp Brachytherapy 2018; 10:486-491. [PMID: 30479628 PMCID: PMC6251447 DOI: 10.5114/jcb.2018.79471] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 10/16/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE When squamous cell carcinoma of the buccal mucosa (BSCC) extends surrounding anatomical sites such as gingiva, retromolar triangle, or hard palate, it might be challenging to ensure adequate tumor coverage by sole interstitial brachytherapy due to the complexity of catheter implantation. By combining interstitial catheters with an enoral placed, individually assembled "oral spacer plus embedded catheters" device (hybrid of intracavitary-interstitial brachytherapy), it should be easier to deliver the necessary tumoricidal dose to irregular-shaped tumor volumes (clinical target volume - CTV) with improved conformity. The purpose of this analysis was to compare the dose distribution created by the hybrid of intracavitary-interstitial brachytherapy (HBT) with the dose distribution of an interstitial catheter only-approach, based on the interstitial catheters used for HBT (ISBT-only) by evaluating respective treatment plans (HBT plan vs. ISBT-only plan) for the treatment of early stage BSCC. MATERIAL AND METHODS A retrospective analysis was performed for patients with localized BSCC treated between April 2013 and October 2017. All patients received sole HBT without additional external beam radiation therapy or planned neck dissection. Dosimetric parameters taken into account for comparison between actual HBT and virtual ISBT-only were CTV D90, CTV V100, CTV V150, CTV V200, mandible D2cc, and mucosal surface D2cc. RESULTS Dosimetrically, HBT showed a trend toward better CTV D90 compared to ISBT-only. In addition, HBT demonstrated statistically better CTV V100 coverage compared to ISBT-only. There was no statistically significant difference with respect to CTV V150, CTV V200, and mucosal surface D2cc, while a trend was seen in better mandible D0.1cc between HBT and ISBT-only. CONCLUSIONS The HBT approach appears to enable improved dose coverage of irregular-shaped enoral tumor volumes compared to ISBT-only for patients with early stage BSCC.
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Affiliation(s)
- Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Takao Ueno
- Department of Oral Health and Diagnostic Sciences, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Wakako Yatsuoka
- Department of Oral Health and Diagnostic Sciences, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Hiroyuki Okamoto
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Nikolaos Tselis
- Department of Radiotherapy and Oncology, Goethe-University Hospital, Goethe-University Frankfurt, Germany
| | - Koji Masui
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ken Yoshida
- Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Kana Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Koji Inaba
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Kae Okuma
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Yuko Nakayama
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
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