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Valentini V, Alfieri S, Coco C, D'Ugo D, Crucitti A, Pacelli F, Persiani R, Sofo L, Picciocchi A, Doglietto GB, Barbaro B, Vecchio FM, Ricci R, Damiani A, Savino MC, Boldrini L, Cellini F, Meldolesi E, Romano A, Chiloiro G, Gambacorta MA. Four steps in the evolution of rectal cancer managements through 40 years of clinical practice: Pioneering, standardization, challenges and personalization. Radiother Oncol 2024; 194:110190. [PMID: 38438019 DOI: 10.1016/j.radonc.2024.110190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/26/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Sergio Alfieri
- Chirurgia Digestiva, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Claudio Coco
- U.O.C. Chirurgia Generale 2, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenico D'Ugo
- Unità di chirurgia generale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Fabio Pacelli
- Unità chirurgica del peritoneo e del retroperitoneo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberto Persiani
- Unità di chirurgia generale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luigi Sofo
- Divisione di Chirurgia Addominale, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Aurelio Picciocchi
- Dipartimento di Chirurgia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Battista Doglietto
- Chirurgia Digestiva, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Brunella Barbaro
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Fabio Maria Vecchio
- Dipartimento di Patologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Riccardo Ricci
- Dipartimento di Patologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Damiani
- Gemelli Generator Real World Data Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Savino
- Gemelli Generator Real World Data Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Cellini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Elisa Meldolesi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Angela Romano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giuditta Chiloiro
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Maria Antonietta Gambacorta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Moretto R, Germani MM, Borelli B, Conca V, Rossini D, Boraschi P, Donati F, Urbani L, Lonardi S, Bergamo F, Cerma K, Ramondo G, D'Amico FE, Salvatore L, Valente G, Barbaro B, Giuliante F, Di Maio M, Masi G, Cremolini C. Predicting early recurrence after resection of initially unresectable colorectal liver metastases: the role of baseline and pre-surgery clinical, radiological and molecular factors in a real-life multicentre experience. ESMO Open 2024; 9:102991. [PMID: 38631269 PMCID: PMC11027482 DOI: 10.1016/j.esmoop.2024.102991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Advances in surgical techniques and systemic treatments have increased the likelihood of achieving radical surgery and long-term survival in metastatic colorectal cancer (mCRC) patients with initially unresectable colorectal liver metastases (CRLMs). Nonetheless, roughly half of the patients resected after an upfront systemic therapy experience disease relapse within 6 months from surgery, thus leading to the question whether surgery is actually beneficial for these patients. MATERIALS AND METHODS A real-world dataset of mCRC patients with initially unresectable liver-limited disease treated with conversion chemotherapy followed by radical resection of CRLMs at three high-volume Italian institutions was retrospectively assessed with the aim of investigating the association of baseline and pre-surgical clinical, radiological and molecular factors with the risk of relapse within 6 or 12 months from surgery. RESULTS Overall, 268 patients were included in the analysis and 207 (77%) experienced recurrence. Ninety-six (46%) of them had disease relapse within 6 months after CRLM resection and in spite of several variables associated with early recurrence at univariate analyses, only primary tumour resection at diagnosis [odds ratio (OR) 0.53, 95% confidence interval (CI) 0.32-0.89, P = 0.02] remained significant in the multivariable model. Among patients with resected primary tumours, pN+ stage was associated with higher risk of disease relapse within 6 months (OR 3.02, 95% CI 1.23-7.41, P = 0.02). One hundred and forty-nine patients (72%) had disease relapse within 12 months after CRLMs resection but none of the analysed variables was independently associated with outcome. CONCLUSIONS Clinical, radiological and molecular factors assessed before and after conversion chemotherapy do not reliably predict early recurrence after secondary resection of initially unresectable CRLMs. While novel markers are needed to optimize the cost/efficacy balance of surgical procedures, CRLM resection should be offered as soon as metastases become resectable during first-line chemotherapy to all patients eligible for surgery.
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Affiliation(s)
- R Moretto
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa
| | - M M Germani
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa; Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa
| | - B Borelli
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa; Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa
| | - V Conca
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa; Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa
| | - D Rossini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa; Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Pisa
| | - P Boraschi
- Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa
| | - F Donati
- Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa
| | - L Urbani
- General Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa
| | - S Lonardi
- Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua
| | - F Bergamo
- Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua
| | - K Cerma
- Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua
| | - G Ramondo
- Radiology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua
| | - F E D'Amico
- General Surgery 2, Department of Surgical Oncological and Gastroenterological Sciences (DISCOG), University of Padua, Padua
| | - L Salvatore
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome; Medical Oncology Unit, Università Cattolica del Sacro Cuore, Rome
| | - G Valente
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome; Medical Oncology Unit, Università Cattolica del Sacro Cuore, Rome
| | - B Barbaro
- Diagnostic and General Interventional Radiology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome
| | - F Giuliante
- General and Hepatobiliary Surgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome
| | - M Di Maio
- Department of Oncology, Università degli Studi di Torino, Turin, Italy
| | - G Masi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa; Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa
| | - C Cremolini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa; Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa.
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Barbaro B, Carafa MRPI, Minordi LM, Testa P, Tatulli G, Carano D, Fiorillo C, Chiloiro G, Romano A, Valentini V, Gambacorta MA. Magnetic resonance imaging for assessment of rectal cancer nodes after chemoradiotherapy: A single center experience. Radiother Oncol 2024; 193:110124. [PMID: 38309586 DOI: 10.1016/j.radonc.2024.110124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/14/2024] [Accepted: 01/30/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Accurate nodal restaging is becoming clinically more important in patients with locally advanced rectal cancer (LARC) with the emergence of organ-preserving treatment after a good response to neoadjuvant chemoradiotherapy (nCRT). PURPOSE To evaluate the accuracy of MRI in identifying negative N status (ypN0 patients) in LARC after nCRT. MATERIAL AND METHODS 191 patients with LARC underwent MRI before and 6-8 weeks after nCRT and subsequent total mesorectal excision. Short-axis diameter of mesorectal lymph nodes was evaluated on the high resolution T2-weighted images to compare MRI restaging with histopathology.. RESULTS 146 and 45 patients had a negative N status (ypN0) and positive N status (ypN + ), respectively. On restaging MRI, the 70 % reduction in size of the largest node was associated with an area under the curve (AUC) of 0.818 to predict ypN0 stage, with a sensitivity of 93.3 % and a negative predictive value (NPV) of 95.4 %. No nodes were observed in 38 pts (37 pts ypN0 and 1 patient ypN + ), with sensitivity and NPV of nodes disappearance for ypN0 stage of 93.3 % and 92.5 % respectively. A 2.2 mm cut-off in short-axis diameter was associated with an AUC of 0.83 for the prediction of ypN0 nodal stage, with sensitivity and NPV of 79,5% and 91.1 % respectively. CONCLUSION A reduction in size of 70 % of the largest limph-node on MRI at rectal cancer restaging has high sensitivity and NPV for prediction of ypN0 stage after nCRT. The high NPV of node disappearance and of a ≤ 2.2 mm short-axis diameter is confirmed.
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Affiliation(s)
- Brunella Barbaro
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Maria Rachele PIa Carafa
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Maria Minordi
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Priscilla Testa
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Tatulli
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Davide Carano
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Fiorillo
- Digestive Surgery Unit, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Giuditta Chiloiro
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Angela Romano
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Maria Antonietta Gambacorta
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
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Minordi LM, Larosa L, Bevere A, D’Angelo FB, Pierro A, Cilla S, Del Ciello A, Scaldaferri F, Barbaro B. Imaging of Strictures in Crohn's Disease. Life (Basel) 2023; 13:2283. [PMID: 38137884 PMCID: PMC10745118 DOI: 10.3390/life13122283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
Crohn's disease (CD) is a chronic inflammation of the digestive tract, and it frequently affects young patients. It can involve any intestinal segment, even though it frequently affects the distal ileum. Up to 80% of patients with CD present with inflammatory behavior, and 5% to 28% develop stricturing disease. Based on the predominant mechanism causing them, strictures can be categorized as inflammatory, fibrotic, or mixed. Determining the relative amounts of inflammation and fibrosis in a stricture can influence treatment decisions. Imaging is an extremely useful tool in patients with small bowel stricturing CD to confirm the diagnosis and to evaluate disease characteristics, usually using CT or MRI. The aim of this paper is to describe how imaging can evaluate a patient with small bowel CD stricture.
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Affiliation(s)
- Laura Maria Minordi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy; (L.M.M.); (A.D.C.); (B.B.)
| | - Luigi Larosa
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy; (L.M.M.); (A.D.C.); (B.B.)
| | - Antonio Bevere
- Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy; (A.B.)
| | | | - Antonio Pierro
- Radiology Unit, San Timoteo Hospital, 86039 Termoli, Italy;
| | - Savino Cilla
- Medical Physics Unit, Responsible Research Hospital, 86100 Campobasso, Italy;
| | - Annemilia Del Ciello
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy; (L.M.M.); (A.D.C.); (B.B.)
| | - Franco Scaldaferri
- CEMAD Digestive Diseases Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy;
| | - Brunella Barbaro
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy; (L.M.M.); (A.D.C.); (B.B.)
- Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy; (A.B.)
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Minordi LM, Larosa L, Barbaro B, Angelino A, Broglia D, Cipri C, Scaldaferri F, Manfredi R, Natale L. How the Radiologist Must Reason for a Correct Diagnosis in Patients With Small Bowel Mural Thickening Studied by CT or MRI: A Pictorial Review. Curr Probl Diagn Radiol 2023; 52:393-411. [PMID: 37137738 DOI: 10.1067/j.cpradiol.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/06/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
Conditions that lead to small bowel mural thickening fall into a broad spectrum of diseases, including inflammatory, infectious, vascular or neoplastic. Computed tomography (CT) and Magnetic Resonance Imaging (MRI), especially CT-enterography and MR-enterography, permit evaluation of both entire small bowel and extraluminal structures. In CT/MR-enterography, the main prerequisite for the correct evaluation of small bowel is to obtain optimal intestinal distension. In fact, most errors are related to poor intestinal distension of the bowel which can lead to interpret as pathological a small bowel segment that is not very distended (false positive), or not to recognize presence of pathology in a collapsed segment (false negative). Once the examination has been performed, the images are analyzed in order to identify the presence of small bowel pathology. Pathology of the small bowel can manifest as endoluminal alteration and/or intestinal wall thickening. Once bowel wall thickening has been identified, the radiologist's first objective is trying to define benign or malignant nature of the alteration, using also patient's history and clinical features. Once the suspicion of benign or malignant pathology has been raised, the radiologist must try to formulate a diagnosis of nature. In this pictorial review we describe how the radiologist must reason for a correct diagnosis by answering a pattern of sequential questions in a patient with suspected small bowel disease studied by CT or MRI.
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Affiliation(s)
- Laura Maria Minordi
- Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Radiodiagnostica addominale, Roma, Italy.
| | - Luigi Larosa
- Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Radiodiagnostica addominale, Roma, Italy
| | - Brunella Barbaro
- Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Radiodiagnostica addominale, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | | | | | - Carla Cipri
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Franco Scaldaferri
- Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Area Medicina Interna, Gastroenterologia e Oncologia Medica, UOC di Medicina Interna e Gastroenterologia, CEMAD (Centro Malattie Apparato Digerente), Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Riccardo Manfredi
- Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Radiodiagnostica addominale, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luigi Natale
- Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Radiodiagnostica addominale, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
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Chiloiro G, Cusumano D, Romano A, Boldrini L, Nicolì G, Votta C, Tran HE, Barbaro B, Carano D, Valentini V, Gambacorta MA. Delta Radiomic Analysis of Mesorectum to Predict Treatment Response and Prognosis in Locally Advanced Rectal Cancer. Cancers (Basel) 2023; 15:3082. [PMID: 37370692 DOI: 10.3390/cancers15123082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The aim of this study is to evaluate the delta radiomics approach based on mesorectal radiomic features to develop a model for predicting pathological complete response (pCR) and 2-year disease-free survival (2yDFS) in locally advanced rectal cancer (LARC) patients undergoing neoadjuvant chemoradiotherapy (nCRT). METHODS Pre- and post-nCRT MRIs of LARC patients treated at a single institution from May 2008 to November 2016 were retrospectively collected. Radiomic features were extracted from the GTV and mesorectum. The Wilcoxon-Mann-Whitney test and area under the receiver operating characteristic curve (AUC) were used to evaluate the performance of the features in predicting pCR and 2yDFS. RESULTS Out of 203 LARC patients, a total of 565 variables were evaluated. The best performing pCR prediction model was based on two GTV features with an AUC of 0.80 in the training set and 0.69 in the validation set. The best performing 2yDFS prediction model was based on one GTV and two mesorectal features with an AUC of 0.79 in the training set and 0.70 in the validation set. CONCLUSIONS The results of this study suggest a possible role for delta radiomics based on mesorectal features in the prediction of 2yDFS in patients with LARC.
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Affiliation(s)
- Giuditta Chiloiro
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Davide Cusumano
- Mater Olbia Hospital, Strada Statale Orientale Sarda 125, 07026 Olbia, Italy
| | - Angela Romano
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Luca Boldrini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Giuseppe Nicolì
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Claudio Votta
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Huong Elena Tran
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Brunella Barbaro
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Davide Carano
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
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Pabst H, Gruber G, Picciotto R, Barbaro B, Giordan N. Efficacy and safety of Diclofenac sodium plaster in patients with acute pain of the limbs: a randomized, placebo and active-controlled, double-blind, parallel-group trial. Eur Rev Med Pharmacol Sci 2023; 27:3181-3190. [PMID: 37070921 DOI: 10.26355/eurrev_202304_31952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE The aim of the present study was to assess the safety and efficacy of Diclofenac sodium (DS) 140 mg medicated plaster vs. Diclofenac epolamine (DIEP) 180 mg medicated plaster and placebo plaster, for the treatment of painful disease due to traumatic events of the limbs. PATIENTS AND METHODS This was a multicenter, phase III study involving 214 patients, aged 18-65 years, affected by painful conditions due to soft tissue injuries. Patients were randomized to DS, DIEP or placebo arms and treated with once-daily application of the plaster for a total treatment period of 7 days. The primary objective was first to demonstrate the non-inferior efficacy of the DS treatment when compared to the reference DIEP treatment and second that both, test and reference treatments, were superior with respect to placebo. The secondary objectives included the evaluation of efficacy, adhesion, safety, and local tolerability of DS in comparison to both DIEP and placebo. RESULTS The mean visual analog scale (VAS) score decrease for pain at rest was higher in the DS (-17.65 mm) and the DIEP group (-17.5 mm) than in the placebo (-11.3 mm). Both active formulation plasters were associated with a statistically significant pain reduction compared to placebo. No statistically significant differences were observed between DIEP and DS plasters efficacy in relieving pain. Secondary endpoint evaluations supported the primary efficacy results. No serious adverse events (SAEs) were registered, and the most commonly detected adverse events were skin reactions at the application site. CONCLUSIONS The results showed that both the DS 140 mg plaster and the reference DIEP 180 mg plaster are effective in relieving pain and present a good safety profile.
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Affiliation(s)
- H Pabst
- Praxis Für Klinische Studien Dr. Med. Helmut Pabst, Gilching, Germany.
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Anghelone A, Bensi M, Barbaro B, Calegari MA, Cina C, Menghi R, Lorenzon L, Pozzo C, Basso M, Schietroma F, Valente G, Lococo F, Ardito F, Cellini F, Caira G, Trovato G, D'Ugo D, Giuliante F, Tortora G, Salvatore L. The impact of the multidisciplinary team (MDT) in the management of colorectal cancer (CRC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e13641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13641 Background: The management of CRC is complex, particularly in metastatic disease, where it is crucial the definition of disease burden, the assessment of radiological response and the identification of the right timing for potential radical surgery or loco-regional treatments. A correct CRC evaluation and the subsequent choice of the most appropriate treatment strategy, need, therefore, a MDT involving surgeons, oncologists, radiologists, radiation oncologists, endoscopists, gastroenterologists and pathologists. Based on such considerations, we investigated the impact of the MDT meeting in the management of CRC at our Institution. Methods: We retrospectively evaluated all the cases discussed at our MDT meeting between September 2019 and September 2021. We collected data, both pre- and post-MDT meeting, regarding radiology evaluation (disease control vs progression), surgical assessment (yes vs no) and radiotherapy evaluation (yes vs no). Primary endpoint was the overall rate of discrepancy in evaluation between pre- and post-MDT meeting. Results: Between September 2019 and September 2021, 696 cases were presented at our MDT meeting. The median age was 65 years (24-86), 391 (56%) patients were male and 553 (79%) patients had metastatic disease at diagnosis. After MDT meeting, a total of 214 decisions were modified, for an overall discrepancy rate of 31%. In particular, among 377 cases discussed for radiology evaluation, 110 decisions (29%) were modified after a central imaging review: 80 cases initially evaluated as progressed disease before MDT meeting were defined stable after MDT meeting, for a discrepancy rate of 73%. Regarding the 246 cases discussed for surgical assessment on primary tumor and/or metastatic sites, treatment strategy changed in 86 cases (35%). More specifically, 16 cases (19%), evaluated unresectable before MDT meeting, were then considered resectable after MDT meeting. Finally, among the 71 cases discussed for radiotherapy evaluation, treatment strategy changed in 18 cases (25%). Conclusions: Our analysis demonstrates a significant rate of discrepancy in radiology and/or surgical evaluation between pre- and post-MDT meeting. Our results show that a MDT allows a considerable modification in CRC management, maximizing the treatment strategy, in particular avoiding unnecessary changes in therapy and allowing surgery where possible.
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Affiliation(s)
- Annunziato Anghelone
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Bensi
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Brunella Barbaro
- Department of Bioimaging and Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Alessandra Calegari
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Caterina Cina
- Chirurgia Digestiva, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS. Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberta Menghi
- Chirurgia Digestiva, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS. Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Lorenzon
- Chirurgia Generale, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmelo Pozzo
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Michele Basso
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Rome, Italy
| | - Francesco Schietroma
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giustina Valente
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Lococo
- Chirurgia Toracica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ardito
- Chirurgia Epato-biliare, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Cellini
- Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia, Rome, Italy
| | - Giulia Caira
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Trovato
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico D'Ugo
- Chirurgia Generale, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Felice Giuliante
- Chirurgia Epato-biliare, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giampaolo Tortora
- Oncology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Catholic University of Rome, Rome, Italy
| | - Lisa Salvatore
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Chiloiro G, Di Dio C, Cusumano D, Catucci F, Boldrini L, Romano A, Meldolesi E, Marazzi F, Corvari B, Barbaro B, Manfredi R, Valentini V, Gambacorta M. PO-1327 Fractal-based radiomic approach to tailor the chemotherapy treatment in rectal cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03291-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ardito F, Coppola A, Rinninella E, Razionale F, Pulcini G, Carano D, Cintoni M, Mele MC, Barbaro B, Giuliante F. Preoperative Assessment of Skeletal Muscle Mass and Muscle Quality Using Computed Tomography: Incidence of Sarcopenia in Patients with Intrahepatic Cholangiocarcinoma Selected for Liver Resection. J Clin Med 2022; 11:jcm11061530. [PMID: 35329856 PMCID: PMC8956038 DOI: 10.3390/jcm11061530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 02/07/2023] Open
Abstract
Background: Sarcopenia is considered a predictor of poor postoperative and long-term results following liver resection for intrahepatic cholangiocarcinoma (ICC). The aim of our study was to assess the incidence of sarcopenia in patients resected for ICC and its relation to preoperative clinical factors. Methods: Patients resected for ICC in our unit, with available preoperative CT scans within one month before operation, were enrolled in the study. Skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD) were assessed for each patient. Results: Thirty patients matched all inclusion criteria. Low SMI values were documented in 15 patients (50.0%), and low SMD values were documented in 10 patients (33.3%). SMI was significantly greater in males (p < 0.001). In patients who were underweight, the incidence of low SMI was significantly higher than that of high SMI (p = 0.031). In patients who were overweight/obese, the incidence of high SMI was significantly higher than that of low SMI (p = 0.003) and the incidence of low SMD was significantly higher than that of high SMD (p = 0.038). In the univariate analysis, no preoperative factors (clinical and tumor-related factors), in particular BMI, were found to be independent predictors of low SMI. Conclusions: The incidence of sarcopenia was 50.0% in patients selected for liver resection for ICC and was not related to the preoperative clinical factors. A multidisciplinary evaluation of the nutritional status is fundamental before liver resection in patients.
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Affiliation(s)
- Francesco Ardito
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.A.); (F.R.); (F.G.)
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (E.R.); (M.C.M.)
| | - Alessandro Coppola
- General Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Correspondence:
| | - Emanuele Rinninella
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (E.R.); (M.C.M.)
- Clinical Nutrition Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (M.C.)
| | - Francesco Razionale
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.A.); (F.R.); (F.G.)
| | - Gabriele Pulcini
- Clinical Nutrition Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (M.C.)
| | - Davide Carano
- Department of Bioimaging and Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (B.B.)
| | - Marco Cintoni
- Clinical Nutrition Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (M.C.)
| | - Maria Cristina Mele
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (E.R.); (M.C.M.)
- Clinical Nutrition Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (M.C.)
| | - Brunella Barbaro
- Department of Bioimaging and Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (B.B.)
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.A.); (F.R.); (F.G.)
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (E.R.); (M.C.M.)
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11
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Chiloiro G, Meldolesi E, Corvari B, Romano A, Barbaro B, Coco C, Crucitti A, Genovesi D, Lupattelli M, Mantello G, Menghi R, Falchetto Osti M, Persiani R, Petruzziello L, Ricci R, Sofo L, Valentini C, De Paoli A, Valentini V, Antonietta Gambacorta M. BRIDGE -1 TRIAL: BReak Interval Delayed surgery for Gastrointestinal Extraperitoneal rectal cancer, a multicentric phase III randomized trial. Clin Transl Radiat Oncol 2022; 34:30-36. [PMID: 35340685 PMCID: PMC8943334 DOI: 10.1016/j.ctro.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/04/2022] [Accepted: 03/05/2022] [Indexed: 12/01/2022] Open
Abstract
The lengthening of the surgical interval has a positive impact on pathological complete response (pCR) rate. Lengthening the surgical interval from the end of preoperative chemoradiation is not detrimental to survival outcomes in locally advanced rectal cancer. Prospective validation of the impact of surgical interval lengthening on complete response and survival outcomes in a randomized trial.
Design Methods Conclusions
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Affiliation(s)
- Giuditta Chiloiro
- Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Elisa Meldolesi
- Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Barbara Corvari
- Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Angela Romano
- Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
- Corresponding author at: Department of Diagnostic Imaging, Radiation Oncology and Haematology Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy.
| | - Brunella Barbaro
- Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Claudio Coco
- Department of Surgical Sciences, Catholic University of Rome, Rome, Italy
| | - Antonio Crucitti
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Genovesi
- Department of Radiotherapy, “SS Annunziata” Hospital “G. D’Annunzio” University, Chieti, Italy
| | | | - Giovanna Mantello
- Department of Oncology and Radiotherapy, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Roberta Menghi
- Gemelli Pancreatic Center, CRMPG (Advanced Pancreatic Research Center) Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Mattia Falchetto Osti
- Department of Radiation Oncology, “Sapienza” University, Sant'Andrea Hospital, Rome, Italy
| | - Roberto Persiani
- Department of General Surgery, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lucio Petruzziello
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Riccardo Ricci
- Department of Pathology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Luigi Sofo
- Department of Gastroenterological, Endocrino-Metabolic and Nephro-Urological Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara Valentini
- Klinik für Radioonkologie-OncoRay Universitätsklinikum C.G. Carus an der TU, Dresden, Germany
| | - Antonino De Paoli
- Department of Radiation Oncology, Centro di Riferimento Oncologico, Aviano, Italy
| | - Vincenzo Valentini
- Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Maria Antonietta Gambacorta
- Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
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12
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Chiloiro G, Cusumano D, Boldrini L, Romano A, Placidi L, Nardini M, Meldolesi E, Barbaro B, Coco C, Crucitti A, Persiani R, Petruzziello L, Ricci R, Salvatore L, Sofo L, Alfieri S, Manfredi R, Valentini V, Gambacorta MA. THUNDER 2: THeragnostic Utilities for Neoplastic DisEases of the Rectum by MRI guided radiotherapy. BMC Cancer 2022; 22:67. [PMID: 35033008 PMCID: PMC8760695 DOI: 10.1186/s12885-021-09158-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/24/2021] [Indexed: 02/07/2023] Open
Abstract
Background Neoadjuvant chemoradiation therapy (nCRT) is the standard treatment modality in locally advanced rectal cancer (LARC). Since response to radiotherapy (RT) is dose dependent in rectal cancer, dose escalation may lead to higher complete response rates. The possibility to predict patients who will achieve complete response (CR) is fundamental. Recently, an early tumour regression index (ERI) was introduced to predict pathological CR (pCR) after nCRT in LARC patients. The primary endpoints will be the increase of CR rate and the evaluation of feasibility of delta radiomics-based predictive MRI guided Radiotherapy (MRgRT) model. Methods Patients affected by LARC cT2-3, N0-2 or cT4 for anal sphincter involvement N0-2a, M0 without high risk features will be enrolled in the trial. Neoadjuvant CRT will be administered using MRgRT. The initial RT treatment will consist in delivering 55 Gy in 25 fractions on Gross Tumor Volume (GTV) plus the corresponding mesorectum and 45 Gy in 25 fractions on the drainage nodes. Chemotherapy with 5-fluoracil (5-FU) or oral capecitabine will be administered continuously. A 0.35 Tesla MRI will be acquired at simulation and every day during MRgRT. At fraction 10, ERI will be calculated: if ERI will be inferior than 13.1, the patient will continue the original treatment; if ERI will be higher than 13.1 the treatment plan will be reoptimized, intensifying the dose to the residual tumor at the 11th fraction to reach 60.1 Gy. At the end of nCRT instrumental examinations are to be performed in order to restage patients. In case of stable disease or progression, the patient will undergo surgery. In case of major or complete clinical response, conservative approaches may be chosen. Patients will be followed up to evaluate toxicity and quality of life. The number of cases to be enrolled will be 63: all the patients will be treated at Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome. Discussion This clinical trial investigates the impact of RT dose escalation in poor responder LARC patients identified using ERI, with the aim of increasing the probability of CR and consequently an organ preservation benefit in this group of patients. Trial registration ClinicalTrials.gov Identifier: NCT04815694 (25/03/2021).
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Affiliation(s)
- Giuditta Chiloiro
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Davide Cusumano
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Luca Boldrini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Angela Romano
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Matteo Nardini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Elisa Meldolesi
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Brunella Barbaro
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Claudio Coco
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Antonio Crucitti
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Roberto Persiani
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Lucio Petruzziello
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Riccardo Ricci
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Lisa Salvatore
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Luigi Sofo
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Sergio Alfieri
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Riccardo Manfredi
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
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Tringali A, Milluzzo SM, Ardito F, Laurenzi A, Ettorre GM, Barbaro B, Ricci R, Giuliante F, Boškoski I, Costamagna G. Peroral-cholangioscopy to plan surgery for protruding biliary lesions: report of four cases. Ther Adv Gastrointest Endosc 2022; 15:26317745221139735. [PMID: 36465430 PMCID: PMC9709184 DOI: 10.1177/26317745221139735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/17/2022] [Indexed: 01/11/2024] Open
Abstract
Intraductal biliary lesions can involve the main hepatic confluence. Assessment of the extension of pedunculated biliary lesions during per-oral cholangioscopy (POCS) can optimize and personalize the surgical strategy. Four consecutive cases of pedunculated biliary lesions were analysed. Cholangioscopy was performed with a disposable single-operator cholangioscope. POSC was successfully performed in four patients (three female, mean age 50 years), showing involvement of the main biliary confluence in three of four pedunculated biliary lesions; direct biopsy sampling was diagnostic in two of three cases (in one patient, biopsy were not performed due to the smooth appearance of the intrabiliary lesion). No adverse events occurred after POCS. Surgery required excision of the main hepatic confluence in two of three cases (one patient was not resectable). POCS can diagnose intrabiliary extension of protruding biliary lesions, providing important information to plan the surgical intervention.
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Affiliation(s)
- Andrea Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy Centre for Endoscopic Research Therapeutics and Training (CERTT), Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Rome, Italy
| | - Sebastian Manuel Milluzzo
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Francesco Ardito
- Hepato-Biliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli” IRCCS, Rome, Italy
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Laurenzi
- General Surgery and Transplantation Unit San Camillo-Forlanini Hospital and National Institute of Infectious Disease ‘Lazzaro Spallanzani’ IRCCS, Rome, Italy
| | - Giuseppe Maria Ettorre
- General Surgery and Transplantation Unit San Camillo-Forlanini Hospital and National Institute of Infectious Disease ‘Lazzaro Spallanzani’ IRCCS, Rome, Italy
| | - Brunella Barbaro
- 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
| | - Riccardo Ricci
- UOC di Anatomia Patologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Pathology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Felice Giuliante
- Hepato-Biliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli” IRCCS, Rome, Italy
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
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14
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Di Dio C, Chiloiro G, Cusumano D, Catucci F, Boldrini L, Romano A, Meldolesi E, Marazzi F, Corvari B, Barbaro B, Manfredi R, Valentini V, Gambacorta MA. Fractal-Based Radiomic Approach to Tailor the Chemotherapy Treatment in Rectal Cancer: A Generating Hypothesis Study. Front Oncol 2021; 11:774413. [PMID: 34956893 PMCID: PMC8695680 DOI: 10.3389/fonc.2021.774413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/18/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction The aim of this study was to create a radiomic model able to calculate the probability of 5-year disease-free survival (5yDFS) when oxaliplatin (OXA) is or not administered in patients with locally advanced rectal cancer (LARC) and treated with neoadjuvant chemoradiotherapy (nCRT), allowing physicians to choose the best chemotherapy (CT) regimen. Methods LARC patients with cT3–4 cN0 or cT1–4 cN1–2 were treated according to an nCRT protocol that included concomitant CT schedules with or without OXA and radiotherapy dose of 55 Gy in 25 fractions. Radiomic analysis was performed on the T2-weighted (T2-w) MR images acquired during the initial tumor staging. Statistical analysis was performed separately for the cohort of patients treated with and without OXA. The ability of every single radiomic feature in predicting 5yDFS as a univariate analysis was assessed using the Wilcoxon–Mann–Whitney (WMW) test or t-test. Two logistic models (one for each cohort) were calculated, and their performance was assessed using the area under the receiver operating characteristic (ROC) curve (AUC). Results A total of 176 image features belonging to four families (morphological, statistical, textural, and fractal) were calculated for each patient. At the univariate analysis, the only feature showing significance in predicting 5yDFS was the maximum fractal dimension of the subpopulation identified considering 30% and 50% as threshold levels (maxFD30–50). Once the models were developed using this feature, an AUC of 0.67 (0.57–0.77) and 0.75 (0.56–0.95) was obtained for patients treated with and without OXA, respectively. A maxFD30–50 >1.6 was correlated to a higher 5yDFS probability in patients treated with OXA. Conclusion This study suggests that radiomic analysis of MR T2-w images can be used to define the optimal concomitant CT regimen for stage III LARC cancer patients. In particular, by providing an indication of the gross tumor volume (GTV) spatial heterogeneity at initial staging, maxFD30–50 seems to be able to predict the probability of 5yDFS. New studies including a larger cohort of patients and external validation sets are recommended to verify the results of this hypothesis-generating study.
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Affiliation(s)
- Carmela Di Dio
- UOC Radioterapia Oncologica, Mater Olbia Hospital, Olbia, Italy
| | - Giuditta Chiloiro
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Davide Cusumano
- UOC Radioterapia Oncologica, Mater Olbia Hospital, Olbia, Italy.,Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Luca Boldrini
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Angela Romano
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Elisa Meldolesi
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Fabio Marazzi
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Barbara Corvari
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Brunella Barbaro
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Riccardo Manfredi
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Vincenzo Valentini
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Antonietta Gambacorta
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Chiloiro G, Cusumano D, de Franco P, Lenkowicz J, Boldrini L, Carano D, Barbaro B, Corvari B, Dinapoli N, Giraffa M, Meldolesi E, Manfredi R, Valentini V, Gambacorta MA. Does restaging MRI radiomics analysis improve pathological complete response prediction in rectal cancer patients? A prognostic model development. Radiol Med 2021; 127:11-20. [PMID: 34725772 DOI: 10.1007/s11547-021-01421-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 10/14/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE Our study investigated the contribution that the application of radiomics analysis on post-treatment magnetic resonance imaging can add to the assessments performed by an experienced disease-specific multidisciplinary tumor board (MTB) for the prediction of pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC). MATERIALS AND METHODS This analysis included consecutively retrospective LARC patients who obtained a complete or near-complete response after nCRT and/or a pCR after surgery between January 2010 and September 2019. A three-step radiomics features selection was performed and three models were generated: a radiomics model (rRM), a multidisciplinary tumor board model (yMTB) and a combined model (CM). The predictive performance of models was quantified using the receiver operating characteristic (ROC) curve, evaluating the area under curve (AUC). RESULTS The analysis involved 144 LARC patients; a total of 232 radiomics features were extracted from the MR images acquired post-nCRT. The yMTB, rRM and CM predicted pCR with an AUC of 0.82, 0.73 and 0.84, respectively. ROC comparison was not significant (p = 0.6) between yMTB and CM. CONCLUSION Radiomics analysis showed good performance in identifying complete responders, which increased when combined with standard clinical evaluation; this increase was not statistically significant but did improve the prediction of clinical response.
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Affiliation(s)
- Giuditta Chiloiro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Davide Cusumano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Paola de Franco
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy.
| | - Jacopo Lenkowicz
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Luca Boldrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Davide Carano
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Brunella Barbaro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Barbara Corvari
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Nicola Dinapoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Martina Giraffa
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Elisa Meldolesi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Riccardo Manfredi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
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Salvatore L, Bensi M, Corallo S, Bergamo F, Pellegrini I, Rasola C, Borelli B, Tamburini E, Randon G, Galuppo S, Boccaccino A, Viola M, Auriemma A, Fea E, Barbara C, Corvari B, Bustreo S, Smiroldo V, Barbaro B, Tortora G. O-12 Phase II study of preoperative chemoradiotherapy plus avelumab in patients with locally advanced rectal cancer: The AVANA study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Salvatore L, Bensi M, Corallo S, Bergamo F, Pellegrini I, Rasola C, Borelli B, Tamburini E, Randon G, Galuppo S, Boccaccino A, Viola MG, Auriemma A, Fea E, Barbara C, Bustreo S, Smiroldo V, Barbaro B, Gambacorta MA, Tortora G. Phase II study of preoperative (PREOP) chemoradiotherapy (CTRT) plus avelumab (AVE) in patients (PTS) with locally advanced rectal cancer (LARC): The AVANA study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.3511] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3511 Background: Preop CTRT is considered the standard of care in the management of LARC. RT can induce antigen release from a low neoantigen-burden tumor (such as a mismatch repair proficient colorectal cancer) and activate dendritic cells leading to a CD8+ T lymphocyte-mediated anticancer immune response. In LARC patients, neoadjuvant CTRT increases PD-L1 expression in tumor cells, strongly suggesting a neoadjuvant combinatory strategy with RT and PD-1/PD-L1 pathway blockade. Based on such considerations, we have designed the AVANA study to investigate the role of Ave in combination with preop CTRT in LARC. Methods: This is an Italian multi-center, phase II study. Pts with resectable LARC, defined by the presence of at least one of the following features: cN+, cT4, high risk cT3, received standard preop CTRT (capecitabine 825 mg/sqm/bid 5 days/week+ 50.4 Gy in 28 fractions over 5.5 weeks) plus 6 cycles of Ave 10 mg/Kg every 2 weeks. Surgery with total mesorectal excision was performed at 8-10 weeks after the end of CTRT. The primary end-point was the pCR rate, defined as complete histological regression with no available tumor cells ypT0N0. Secondary end-points were R0 resection rate, tumor downstaging, local recurrence, sphincter preservation rate, progression-free survival, overall survival, safety profile, and the evaluation of exploratory predictive and/or prognostic biomarkers. Assuming as null hypothesis p0 a pCR rate of 15%, a significance level of 5% (one-side), and a power of 80%, a sample size of 101 pts was needed to detect an absolute increment of 10% in pCR rate (from 15% to 25%). The experimental regimen is considered for further studies if, in at least 22 pts, we observe a pCR. Results: From April 2019 to November 2020, a total of 101 resectable LARC pts were enrolled in 10 Italian Centers. The median age was 63 years (23-82), 62 (61.4%) pts were male, 93 (92%) had ECOG PS 0. At baseline, 94 (93%) and 16 (16%) pts had cN+ and cT4 LARC, respectively. All pts completed the induction phase. Out of 96 pts evaluable for pathological response, 22 (23%) pts achieved a pCR and 59 (61.5%) pts a major pathological response (a central review is ongoing). At this time, microsatellite status is available only in 39 pts, of which only one was instable. The rate of grade 3-4 non-immune and immune-related adverse events was 8% and 4%, respectively. Avelumab was early interrupted in 9 pts out 101, mainly due to toxicity. Conclusions: The combination of preop CTRT plus Ave showed a promising activity and a feasible safety profile. According to our statistical considerations, the experimental regimen will be considered for further studies. Updated results will be presented during the Congress. Sponsored by GONO and partially supported by Merck. EUDRACT 2017-003582-10. Clinical trial information: NCT03854799.
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Affiliation(s)
- Lisa Salvatore
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Bensi
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Salvatore Corallo
- Dipartimento di Oncologia Medica Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Francesca Bergamo
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Ilaria Pellegrini
- Dipartimento di Oncologia Medica Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Cosimo Rasola
- Unit of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Beatrice Borelli
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Giovanni Randon
- Dipartimento di Oncologia Medica Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Galuppo
- Radiation Oncology Dept-IOV-IRCCS Padova, Padua, Italy
| | - Alessandra Boccaccino
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | | | - Elena Fea
- S.Croce & Carle Teaching Hospital, Cuneo, Italy
| | - Cecilia Barbara
- Department of Oncology; Division of Medical Oncology, Livorno Hospital, Azienda USL Toscana Nord Ovest, Livorno, Italy
| | - Sara Bustreo
- SSD ColoRectal Cancer Unit Dipartimento di Oncologia AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Valeria Smiroldo
- Medical Oncology Unit IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Brunella Barbaro
- Department of Bioimaging and Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Antonietta Gambacorta
- Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giampaolo Tortora
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Cusumano D, Meijer G, Lenkowicz J, Chiloiro G, Boldrini L, Masciocchi C, Dinapoli N, Gatta R, Casà C, Damiani A, Barbaro B, Gambacorta MA, Azario L, De Spirito M, Intven M, Valentini V. A field strength independent MR radiomics model to predict pathological complete response in locally advanced rectal cancer. Radiol Med 2021; 126:421-429. [PMID: 32833198 PMCID: PMC7937600 DOI: 10.1007/s11547-020-01266-z] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Aim of this study was to develop a generalised radiomics model for predicting pathological complete response after neoadjuvant chemo-radiotherapy in locally advanced rectal cancer patients using pre-CRT T2-weighted images acquired at a 1.5 T and a 3 T scanner. METHODS In two institutions, 195 patients were scanned: 136 patients were scanned on a 1.5 T MR scanner, 59 patients on a 3 T MR scanner. Gross tumour volumes were delineated on the MR images and 496 radiomic features were extracted, applying the intensity-based (IB) filter. Features were standardised with Z-score normalisation and an initial feature selection was carried out using Wilcoxon-Mann-Whitney test: The most significant features at 1.5 T and 3 T were selected as main features. Several logistic regression models combining the main features with a third one selected by those resulting significant were elaborated and evaluated in terms of area under curve (AUC). A tenfold cross-validation was repeated 300 times to evaluate the model robustness. RESULTS Three features were selected: maximum fractal dimension with IB = 0-50, energy and grey-level non-uniformity calculated on the run-length matrix with IB = 0-50. The AUC of the model applied to the whole dataset after cross-validation was 0.72, while values of 0.70 and 0.83 were obtained when 1.5 T and 3 T patients were considered, respectively. CONCLUSIONS The model elaborated showed good performance, even when data from patients scanned on 1.5 T and 3 T were merged. This shows that magnetic field intensity variability can be overcome by means of selecting appropriate image features.
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Affiliation(s)
- Davide Cusumano
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Gert Meijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jacopo Lenkowicz
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giuditta Chiloiro
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Luca Boldrini
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Carlotta Masciocchi
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Nicola Dinapoli
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Roberto Gatta
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Calogero Casà
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Andrea Damiani
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Brunella Barbaro
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | | | - Luigi Azario
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Marco De Spirito
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Martijn Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
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Chiloiro G, Meldolesi E, Giraffa M, Capocchiano ND, Barbaro B, Coco C, Corvari B, De Franco P, D'Ugo D, Alfieri S, Manfredi R, Valentini V, Gambacorta MA. Could the conservative approach be considered safe in the treatment of locally advanced rectal cancer in case of a clinical near-complete or complete response? A retrospective analysis. Clin Transl Radiat Oncol 2021; 28:1-9. [PMID: 33732909 PMCID: PMC7937531 DOI: 10.1016/j.ctro.2021.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 01/06/2023] Open
Abstract
Background Conservative approach has emerged as an option for the management of rectal cancer (RC) patients with a near or complete clinical response after neoadjuvant chemoradiotherapy (nCRT). The aim of this study is to assess the impact of the conservative approach by comparing patients’ survival outcomes and quality of life with those who had surgical resection. Methods A single-institution and retrospective study including RC patients who reached a near complete or complete clinical response after nCRT from January 2010 to September 2019. Conservative approaches included local excision or watch and wait strategy; surgery approaches included anterior resection or abdominal-perineal resection. Local regrowth (LR), overall survival, disease free survival, metastasis free survival and colostomy free survival were evaluated through Kaplan-Meier curves and compared trough log-rank tests. Quality of life was measured by the following validated questionnaires: EORTC QLC30, EORTC QLQ – CR29 and Fecal Incontinence Quality of Life scale. Results Overall 157 patients were analyzed: 105 (66,9%) underwent radical surgery and 52 (33,1%) had a conservative approach. With a median follow-up of 51 months, 2 patients in the surgical group had a local recurrence and 8 in the conservative group had a LR, respectively. Distance metastasis occurred in 7 and 1 patients of surgical and conservative group, respectively. No differences were detected in terms of survival outcomes except for colostomy free survival (p: 0,01). The conservative group showed better intestinal (p < 0.01) and sexual (p: 0,04) function and emotional status (p: 0,02). Conclusions Conservative approach seems to be safe in terms of survival outcomes with a significant advantage on quality of life in RC patients who achieved clinical complete response after nCRT.
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Affiliation(s)
- Giuditta Chiloiro
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia, Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Elisa Meldolesi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia, Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | | | - Nikola Dino Capocchiano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia, Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Brunella Barbaro
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia, Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Claudio Coco
- Dipartimento di Chirurgia Generale, Fondazione Policlinico Universitario "A.Gemelli" IRCSS, Roma, Italy
| | - Barbara Corvari
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia, Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | | | - Domenico D'Ugo
- Università Cattolica del Sacro Cuore, Roma, Italy.,Dipartimento di Chirurgia Generale, Fondazione Policlinico Universitario "A.Gemelli" IRCSS, Roma, Italy
| | - Sergio Alfieri
- Università Cattolica del Sacro Cuore, Roma, Italy.,Unità di Chirurgia Digestiva, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Riccardo Manfredi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia, Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia, Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Maria Antonietta Gambacorta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia, Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
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Chiloiro G, Rodriguez-Carnero P, Lenkowicz J, Casà C, Masciocchi C, Boldrini L, Cusumano D, Dinapoli N, Meldolesi E, Carano D, Damiani A, Barbaro B, Manfredi R, Valentini V, Gambacorta MA. Delta Radiomics Can Predict Distant Metastasis in Locally Advanced Rectal Cancer: The Challenge to Personalize the Cure. Front Oncol 2020; 10:595012. [PMID: 33344243 PMCID: PMC7744725 DOI: 10.3389/fonc.2020.595012] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/02/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Distant metastases are currently the main cause of treatment failure in locally advanced rectal cancer (LARC) patients. The aim of this research is to investigate a correlation between the variation of radiomics features using pre- and post-neoadjuvant chemoradiation (nCRT) magnetic resonance imaging (MRI) with 2 years distant metastasis (2yDM) rate in LARC patients. METHODS AND MATERIALS Diagnostic pre- and post- nCRT MRI of LARC patients, treated in a single institution from May 2008 to June 2015 with an adequate follow-up time, were retrospectively collected. Gross tumor volumes (GTV) were contoured by an abdominal radiologist and blindly reviewed by a radiation oncologist expert in rectal cancer. The dataset was firstly randomly split into 90% training data, for features selection, and 10% testing data, for the validation. The final set of features after the selection was used to train 15 different classifiers using accuracy as target metric. The models' performance was then assessed on the testing data and the best performing classifier was then selected, maximising the confusion matrix balanced accuracy (BA). RESULTS Data regarding 213 LARC patients (36% female, 64% male) were collected. Overall 2yDM was 17%. A total of 2,606 features extracted from the pre- and post- nCRT GTV were tested and 4 features were selected after features selection process. Among the 15 tested classifiers, logistic regression proved to be the best performing one with a testing set BA, sensitivity and specificity of 78.5%, 71.4% and 85.7%, respectively. CONCLUSIONS This study supports a possible role of delta radiomics in predicting following occurrence of distant metastasis. Further studies including a consistent external validation are needed to confirm these results and allows to translate radiomics model in clinical practice. Future integration with clinical and molecular data will be mandatory to fully personalized treatment and follow-up approaches.
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Affiliation(s)
- Giuditta Chiloiro
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Jacopo Lenkowicz
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Calogero Casà
- Dipartimento Universitario di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlotta Masciocchi
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Boldrini
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Davide Cusumano
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Nicola Dinapoli
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Elisa Meldolesi
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Davide Carano
- Dipartimento Universitario di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Damiani
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Brunella Barbaro
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Riccardo Manfredi
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Vincenzo Valentini
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Antonietta Gambacorta
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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21
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Cusumano D, Boldrini L, Yadav P, Gao Y, Chiloiro G, Piras A, Broggi S, Lenkowicz J, Placidi L, Musunuru H, Dinapoli N, Barbaro B, Azario L, Gambacorta M, De Spirito M, Basetti M, Yang Y, Fiorino C, Valentini V. PH-0715: External validation of ERITCP as response predictor in rectal cancer using MR-guided Radiotherapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00737-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Giraffa M, Chiloiro G, Meldolesi E, Corvari B, Coco C, Persiani R, Sofo L, Alfieri S, Barbaro B, Valentini V, Gambacorta M. PO-1089: Major and complete response after neoadjuvant treatment in rectal cancer: a retrospective analysis. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Cusumano D, Boldrini L, Yadav P, Yu G, Musurunu B, Chiloiro G, Piras A, Lenkowicz J, Placidi L, Broggi S, Romano A, Mori M, Barbaro B, Azario L, Gambacorta MA, De Spirito M, Bassetti MF, Yang Y, Fiorino C, Valentini V. External Validation of Early Regression Index (ERI TCP) as Predictor of Pathologic Complete Response in Rectal Cancer Using Magnetic Resonance-Guided Radiation Therapy. Int J Radiat Oncol Biol Phys 2020; 108:1347-1356. [PMID: 32758641 DOI: 10.1016/j.ijrobp.2020.07.2323] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 07/08/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Tumor control probability (TCP)-based early regression index (ERITCP) is a radiobiological parameter that showed promising results in predicting pathologic complete response (pCR) on T2-weighted 1.5 T magnetic resonance (MR) images of patients with locally advanced rectal cancer. This study aims to validate the ERITCP in the context of low-tesla MR-guided radiation therapy, using images acquired with different magnetic field strength (0.35 T) and image contrast (T2/T1). Furthermore, the optimal timing for pCR prediction was estimated, calculating the ERI index at different biologically effective dose (BED) levels. METHODS AND MATERIALS Fifty-two patients with locally advanced rectal cancer treated with neoadjuvant chemoradiation therapy were enrolled in this multi-institutional retrospective study. For each patient, a 0.35 T T2/T1-weighted MR image was acquired during simulation and on each treatment day. Gross tumor volume was contoured according to International Commission on Radiation Units Report 83 guidelines. According to the original definition, ERITCP was calculated considering the residual tumor volume at BED = 25 Gy. ERI was also calculated in correspondence with several BED levels: 13, 21, 32, 40, 46, 54, 59, and 67. The predictive performance of the different ERI indices were evaluated in terms of receiver operating characteristic curve. The robustness of ERITCP with respect to the interobserver variability was also evaluated considering 2 operators and calculating the intraclass correlation index. RESULTS Fourteen patients showed pCR. ERITCP correctly 47 of 52 cases (accuracy = 90%), showing good results in terms of sensitivity (86%), specificity (92%), negative predictive value (95%), and positive predictive value (80%). The analysis at different BED levels shows that the best predictive performance is obtained when this parameter is calculated at BED = 25 Gy (area under the curve = 0.93). ERITCP results are robust with respect to interobserver variability (intraclass correlation index = 0.99). CONCLUSIONS This study confirmed the validity and the robustness of ERITCP as a pCR predictor in the context of low-tesla MR-guided radiation therapy and indicate 25 Gy as the best BED level to perform predictions.
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Affiliation(s)
- Davide Cusumano
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Luca Boldrini
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.
| | - Poonam Yadav
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Gao Yu
- Department of Radiological Sciences, University of California, Los Angeles, California
| | - Bindu Musurunu
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Giuditta Chiloiro
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Antonio Piras
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Jacopo Lenkowicz
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Sara Broggi
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Angela Romano
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Martina Mori
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Brunella Barbaro
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Luigi Azario
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | | | - Marco De Spirito
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Michael F Bassetti
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Yingli Yang
- Department of Radiological Sciences, University of California, Los Angeles, California
| | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
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24
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Basso M, Corallo S, Calegari MA, Zurlo IV, Ardito F, Vellone M, Marchesani S, Orlandi A, Dadduzio V, Fucà G, Di Dio C, Mele C, Barbaro B, Strippoli A, Coppola A, Cassano A, Bria E, Barone CA, Giuliante F. The impact of multidisciplinary team management on outcome of hepatic resection in liver-limited colorectal metastases. Sci Rep 2020; 10:10871. [PMID: 32616782 PMCID: PMC7331814 DOI: 10.1038/s41598-020-67676-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/19/2020] [Indexed: 12/28/2022] Open
Abstract
Hepatic resection is the gold standard treatment for patients affected by liver-limited colorectal metastases. Reports addressing the impact of multidisciplinary team (MDT) evaluation on survival are controversial. The aim of this study was to evaluate the benefit of MDT management in these patients in our Institution experience. The objective of the analysis was to compare survivals of patients managed within our MDT (MDT cohort) to those of patients referred to surgery from other hospitals without MDT discussion (non-MDT cohort). Of the 523 patients, 229 were included in the MDT cohort and 294 in the non-MDT cohort. No difference between the two groups was found in terms of median overall survival (52.5 vs 53.6 months; HR 1.13; 95% CI, 0.88-1.45; p = 0.344). In the MDT cohort there was a higher number of metastases (4.5 vs 2.7; p < 0.0001). The median duration of chemotherapy was lower in MDT patients (8 vs 10 cycles; p < 0.001). Post-operative morbidity was lower in the MDT cohort (6.2 vs 21.5%; p < 0.001). One hundred and ninety-seven patients in each group were matched by propensity score and no significant difference was observed between the two groups in terms of OS and DFS. Our study does not demonstrate a survival benefit from MDT management, but it allows surgery to patients with a more advanced disease. MDT assessment reduces the median duration of chemotherapy and post-operative morbidities.
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Affiliation(s)
- Michele Basso
- Oncologia Medica, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Salvatore Corallo
- Oncologia Medica, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Ina Valeria Zurlo
- Oncologia Medica, Università Cattolica del Sacro Cuore-IRCCS, Rome, Italy
| | - Francesco Ardito
- Chirurgia Epatobiliare, Università Cattolica del Sacro Cuore-IRCCS, Rome, Italy
| | - Maria Vellone
- Chirurgia Epatobiliare, Università Cattolica del Sacro Cuore-IRCCS, Rome, Italy
| | - Silvio Marchesani
- Oncologia Medica, Università Cattolica del Sacro Cuore-IRCCS, Rome, Italy
| | - Armando Orlandi
- Oncologia Medica, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | | | - Giovanni Fucà
- Oncologia Medica, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carmela Di Dio
- Oncologia Medica, Università Cattolica del Sacro Cuore-IRCCS, Rome, Italy
| | - Caterina Mele
- Chirurgia Epatobiliare, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy
| | - Brunella Barbaro
- Radiologia Diagnostica ed Interventistica Generale, Università Cattolica del Sacro Cuore - IRCCS, Rome, Italy
| | - Antonia Strippoli
- Oncologia Medica, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Alessandro Coppola
- Chirurgia Epatobiliare, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy
| | - Alessandra Cassano
- Oncologia Medica, Università Cattolica del Sacro Cuore-IRCCS, Rome, Italy
| | - Emilio Bria
- Oncologia Medica, Università Cattolica del Sacro Cuore-IRCCS, Rome, Italy
| | - Carlo Antonio Barone
- Oncologia Medica, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy.
| | - Felice Giuliante
- Chirurgia Epatobiliare, Università Cattolica del Sacro Cuore-IRCCS, Rome, Italy
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25
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Boldrini L, Chiloiro G, Casà C, Lenkowicz J, Carnero PR, Masciocchi C, Barbaro B, Gambacorta M, Cusumano D, Dinapoli N, Damiani A, Manfredi R, Valentini V. OC-083: Predicting 2 years distant metastasis rate in rectal cancer: a MRI delta radiomics model. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(20)30452-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Mariani S, Chiloiro G, Villa P, Meldolesi E, Barbaro B, Di Giorgio A, Corrado G, Corvari B, Giraffa M, Scambia G, Valentini V, Gambacorta MA. Fertility preservation in chemo-radiotherapy for rectal cancer: A combined approach. Clin Transl Radiat Oncol 2019; 19:77-79. [PMID: 31650042 PMCID: PMC6804737 DOI: 10.1016/j.ctro.2019.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/06/2019] [Accepted: 09/06/2019] [Indexed: 11/28/2022] Open
Abstract
Young females affected by rectal cancer need counselling on fertility preservation. Ovarian transposition and cryopreservation are feasible. Advances in radiation therapy techniques can help reducing fertility impairment. A multidisciplinar approach is recommended.
Introduction Colorectal cancer is a very common form of cancer worldwide, affecting an increasing number of young women. Standard treatment for locally advanced rectal cancer (LARC) can pose a threat to fertility in these patients. Case presentation We present the case of a young woman affected by LARC who expressed a desire for child-bearing. The treatment she was proposed, according to guidelines, was neoadjuvant chemo-radiotherapy (CRT) followed by delayed surgery, carrying with it a high risk for amenorrhea. Counselling was performed before the initiation of treatment, with the aim of preserving fertility by the proposal of GnRH agonist administration, ovarian transposition and ovarian tissue cryopreservation, which the patient accepted. Treatment was then successfully completed. The patient presented regular menstrual period from before the surgery. Discussion Ovarian tissue is very sensitive to radiations. Transposition of the organ can prevent ovarian insufficiency by placing it outside the radiation field, while ovarian tissue cryopreservation and orthotopic transplantation offers the possibility to restore fertility in the case of organ failure. We performed both of the techniques. GnRH analogs administration allowed to diminish the risk of ovarian cytotoxicity. Radiation treatment plan was optimized in order to minimize the dose to organs at risk (ovary and vagina in particular); position of the uterus, which is quite radiosensitive too, was monitored with daily cone-beam CT (CBCT). Conclusion The strategy proposed seemed safe and effective, resulting in radical treatment and persistence of regular menstrual period. Further studies are needed.
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Affiliation(s)
- S Mariani
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - G Chiloiro
- Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - P Villa
- Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - E Meldolesi
- Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - B Barbaro
- Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Bioimaging and Radiological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - A Di Giorgio
- Università Cattolica del Sacro Cuore, Roma, Italy.,Division of General Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - G Corrado
- Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - B Corvari
- Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - M Giraffa
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - G Scambia
- Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - V Valentini
- Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - M A Gambacorta
- Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
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27
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Casà C, Chiloiro G, Lenkowicz J, Rodriguez Carnero P, Masciocchi C, Boldrini L, Barbaro B, Gambacorta M, Cusumano D, Dinapoli N, Damiani A, Manfredi R, Valentini V. Delta Radiomics to Assess Tumor Behavior and Predict Distant Metastasis in Rectal Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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28
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Abstract
Anatomical variations of the hepatic artery have been described as responsible for the onset of jaundice or stone formation. We present three cases of intrahepatic stones secondary to a compression of the proximal common bile duct (CBD) by the right hepatic artery (RHA). Three consecutive patients (males, mean age 65 years) with symptoms of cholangitis and intra-hepatic stones admitted between October 2017 and June 2018 with a final diagnosis of CBD compression from the RHA. The three patients underwent ERCP and biliary sphincterotomy with extraction of intra-hepatic stones; after stone removal cholangiograhy showed CBD compression just below the main hepatic confluence which was confirmed to be secondary to RHA compression on subsequent MRI. The patients remained asymptomatic after 12 months mean follow-up. Compression of the CBD by the RHA might be responsible for intra-hepatic stone formation. Endoscopic treatment is feasible and effective on short-term follow-up.
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Affiliation(s)
- Vincenzo Bove
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma , Italia.,Centre for Endoscopic Research Therapeutics and Training - CERTT, Università Cattolica del Sacro Cuore , Roma , Italia
| | - Andrea Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma , Italia.,Centre for Endoscopic Research Therapeutics and Training - CERTT, Università Cattolica del Sacro Cuore , Roma , Italia
| | - Laura Flor Prades
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma , Italia
| | - Vincenzo Perri
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma , Italia.,Centre for Endoscopic Research Therapeutics and Training - CERTT, Università Cattolica del Sacro Cuore , Roma , Italia
| | - Brunella Barbaro
- Department of Bioimaging and Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma , Italia
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma , Italia.,Centre for Endoscopic Research Therapeutics and Training - CERTT, Università Cattolica del Sacro Cuore , Roma , Italia
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29
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Biolato M, Tarli C, Marrone G, Barbaro B, Liguori A, Gasbarrini A, Grieco A. Gallbladder perforation without cholecystitis in a patient awaiting liver transplantation: a peculiar case report of anaemia in cirrhosis. BMC Gastroenterol 2019; 19:112. [PMID: 31248359 PMCID: PMC6598236 DOI: 10.1186/s12876-019-1018-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 06/07/2019] [Indexed: 11/25/2022] Open
Abstract
Background Acute anaemia in decompensated liver cirrhosis is commonly caused due to gastrointestinal bleeding; however, sometimes, detecting the site of blood loss is challenging. Case summary A patient on waitlist for orthotopic liver transplantation because of decompensated liver cirrhosis was admitted with acute anaemia and recurrence of ascites. Their abdomen CT showed migration of gallbladder stones in the pelvis while paracentesis documented hemoperitoneum. A diagnosis of gallbladder perforation was performed. Conclusion Challenging choice of a “wait and see” strategy with conservative therapy, avoiding high-risk cholecystectomy, resulted in a successful liver transplant.
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Affiliation(s)
- Marco Biolato
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Claudia Tarli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giuseppe Marrone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Brunella Barbaro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonio Liguori
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonio Gasbarrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonio Grieco
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy. .,Università Cattolica del Sacro Cuore, Roma, Italy.
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30
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Valentini V, Gambacorta MA, Cellini F, Aristei C, Coco C, Barbaro B, Alfieri S, D'Ugo D, Persiani R, Deodato F, Crucitti A, Lupattelli M, Mantello G, Navarria F, Belluco C, Buonadonna A, Boso C, Lonardi S, Caravatta L, Barba MC, Vecchio FM, Maranzano E, Genovesi D, Doglietto GB, Morganti AG, La Torre G, Pucciarelli S, De Paoli A. The INTERACT Trial: Long-term results of a randomised trial on preoperative capecitabine-based radiochemotherapy intensified by concomitant boost or oxaliplatin, for cT2 (distal)-cT3 rectal cancer. Radiother Oncol 2019; 134:110-118. [PMID: 31005204 DOI: 10.1016/j.radonc.2018.11.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/26/2018] [Accepted: 11/30/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Capecitabine-based radiochemotherapy (cbRCT) is standard for preoperative long-course radiochemotherapy of locally advanced rectal cancer. This prospective, parallel-group, randomised controlled trial investigated two intensification regimens. cT4 lesions were excluded. PRIMARY OBJECTIVE pathological outcome (TRG 1-2) among arms. MATERIALS AND METHODS Low-located cT2N0-2M0, cT3N0-2M0 (up to 12 cm from anal verge) presentations were treated with cbRCT randomly intensified by either radiotherapy boost (Xelac arm) or multidrug concomitant chemotherapy (Xelox arm). Xelac: concomitant boost to bulky site (45 Gy/1.8 Gy/die, 5 sessions/week to the pelvis, +10 Gy at 1 Gy twice/week to the bulky) plus concurrent capecitabine (1650 mg/mq/die). Xelox: 45 Gy to the pelvis + 5.4 Gy/1.8 Gy/die, 5 sessions/week to the bulky site + concurrent capecitabine (1300 mg/mq/die) and oxaliplatin (130 mg/mq on days 1,19,38). Surgery was planned 7-9 weeks after radiochemotherapy. RESULTS From June 2005 to September 2013, 534 patients were analysed: 280 in Xelac, 254 in Xelox arm. Xelox arm presented higher G ≥ 3 haematologic (p = 0.01) and neurologic toxicity (p < 0.001). Overall, 98.5% patients received curative surgery. The tumour regression grade distribution did not differ between arms (p = 0.102). TRG 1+2 rate significantly differed: Xelac arm 61.7% vs. Xelox 52.3% (p = 0.039). Pathological complete response (ypT0N0) rates were 24.4 and 23.8%, respectively (p non-significant). Median follow-up:5.62 years. Five-year disease-free survival rate were 74.7% (Xelac) and 73.8% (Xelox), respectively (p = 0.444). Five-year overall survival rate were 80.4% (Xelac) and 85.5% (Xelox), respectively (p = 0.155). CONCLUSION Xelac arm significantly obtained higher TRG1-2 rates. No differences were found about clinical outcome. Because of efficacy on TRG, inferior toxicity and good compliance, Xelac schedules or similar radiotherapy dose intensification schemes could be considered as reference treatments for cT3 lesions.
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Affiliation(s)
- Vincenzo Valentini
- Department Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Maria Antonietta Gambacorta
- Department Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Cellini
- Department Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgery and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Claudio Coco
- Chirurgia Generale Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Brunella Barbaro
- Department of Bioimaging and Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Sergio Alfieri
- Istituto di Clinica Chirurgica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Domenico D'Ugo
- Abdominal Surgery Area, General Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Roberto Persiani
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Deodato
- Radiotherapy Department, Fondazione Ricerca e Cura Giovanni Paolo II, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Antonio Crucitti
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Lupattelli
- Radiation Oncology Centre - S. Maria Misericordia Hospital, Perugia, Italy
| | - Giovanna Mantello
- Radiotherapy Unit, Azienda Ospedaliero Universitaria, Ospedali Riuniti Ancona, Italy
| | - Federico Navarria
- Radiation Oncology Department, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - Claudio Belluco
- Surgical Oncology Department, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - Angela Buonadonna
- Medical Oncology Department, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - Caterina Boso
- Radiotherapy and Nuclear Medicine Unit, IOV-IRCCS, Padova , Italy
| | - Sara Lonardi
- Medical Oncology Unit 1, IOV-IRCCS, Padova, Italy
| | - Luciana Caravatta
- Radiotherapy Unit, SS Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | | | - Fabio Maria Vecchio
- Department of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Domenico Genovesi
- Radiotherapy Unit, SS Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Giovanni Battista Doglietto
- Istituto di Clinica Chirurgica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology Center, Department of Experimental, Diagnostic and Speciality Medicine, DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Salvatore Pucciarelli
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Italy
| | - Antonino De Paoli
- Radiation Oncology Department, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
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Corallo S, Calegari MA, Zurlo IV, Marchesani S, Orlandi A, Dadduzio V, Di Stefano B, Camarda F, Di Dio C, Garufi G, Barbaro B, Vellone M, Ardito F, Giuliante F, Pozzo C, Cassano A, Barone CA, Bria E, Basso M. The impact of multidisciplinary team (MDT) management on outcome of hepatic resection in liver-limited colorectal metastases. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
671 Background: Hepatic resection is the gold standard treatment for pts with liver-limited mCRC with 5- and 10-yrs survival rates reaching up to 60% and 20%. Although multidisciplinary team (MDT) management might ensure a more accurate assessment of pts and a faster referral to surgeons, reports discussing the impact of MDTs on survival are controversial and to date there are no strong evidences supporting routinely MDT discussion. The aim of this study was to evaluate the benefit of MDT management in pts with liver-limited mCRC in our single institution experience. Methods: Clinical records of pts with liver-limited mCRC who underwent radical surgery at Fondazione Policlinico “A. Gemelli” - IRCCS from Jan-2006 to Dec-2016 were retrospectively analyzed. The objective of the analysis was to compare survivals of pts managed within our MDT (MDT cohort) to those of pts referred to surgery from other hospitals without MDT discussion (non-MDT cohort). Primary endpoints were DFS and OS. Differences in baseline characteristics and in post-operative morbidity were evaluated. Results: Of the 619 pts analyzed, 230 were included in the MDT cohort and 389 in the non-MDT cohort. No significant difference between the two groups was found in terms of DFS (12vs11 m; p 0.09) and OS (55vs51 m; p 0.68). Concerning baseline characteristics, in the MDT cohort compared to non-MDT cohort there was a statistically higher number of median metastases (4.5vs2.6; p < 0.0001) and a higher rate of synchronous metastases (61.7vs39.3%; p < 0.001). Despite pre-operative CT rate was higher in the MDT group (75.8vs70.7%), the median duration of CT before surgery was significantly lower in MDT pts (7 vs 8 cycle; p < 0.001). Moreover, post-operative morbidity was significantly lower in the MDT cohort (6.2vs19.2%; p < 0.00001). Conclusions: Our study does not demonstrate a survival benefit from MDT management of pts with liver limited mCRC. However, the analysis shows that MDT assessment allows to consider eligible for surgery pts with a more advanced disease. Moreover, MDT discussion seems to reduce the median duration of pre-operative CT with a consequent lower rate of post-operative morbidities. Our data warrant prospective validation.
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Affiliation(s)
| | | | - Ina Valeria Zurlo
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Roma, Italy
| | - Silvio Marchesani
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Roma, Italy
| | - Armando Orlandi
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Roma, Italy
| | | | - Brunella Di Stefano
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Roma, Italy
| | - Floriana Camarda
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Rome, Italy
| | - Carmela Di Dio
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Roma, Italy
| | - Giovanna Garufi
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Roma, Italy
| | - Brunella Barbaro
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - Istituto di Radiologia, Rome, Italy
| | - Maria Vellone
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Chirugia Epato-biliare, Rome, Italy
| | - Francesco Ardito
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Chirurgia Epato-biliare, Roma, Italy
| | - Felice Giuliante
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Chirurgia Epato-biliare, Roma, Italy
| | - Carmelo Pozzo
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Rome, Italy
| | - Alessandra Cassano
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Rome, Italy
| | - Carlo Antonio Barone
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Rome, Italy
| | - Emilio Bria
- Medical Oncology Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Michele Basso
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - UOC Oncologia Medica, Roma, Italy
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Dinapoli N, Barbaro B, Gatta R, Chiloiro G, Casà C, Masciocchi C, Damiani A, Boldrini L, Gambacorta MA, Dezio M, Mattiucci GC, Balducci M, van Soest J, Dekker A, Lambin P, Fiorino C, Sini C, De Cobelli F, Di Muzio N, Gumina C, Passoni P, Manfredi R, Valentini V. Magnetic Resonance, Vendor-independent, Intensity Histogram Analysis Predicting Pathologic Complete Response After Radiochemotherapy of Rectal Cancer. Int J Radiat Oncol Biol Phys 2018; 102:765-774. [PMID: 29891200 DOI: 10.1016/j.ijrobp.2018.04.065] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/13/2018] [Accepted: 04/23/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The objective of this study is finding an intensity based histogram (IBH) signature to predict pathologic complete response (pCR) probability using only pre-treatment magnetic resonance (MR) and validate it externally in order to create a workflow for the external validation of an MR IBH signature and to apply the model out of the environment where it has been tuned. The impact of pCR and the final predictors on the survival outcome were also evaluated. METHODS AND MATERIALS Three centers using different MR scanners were involved in this retrospective study. The first center recruited 162 patients for model training, and the second and third centers provided 34 plus 25 patients for external validation. Patients provided written consent. Accrual period was from May 2008 to December 2014. After surgery pathologic response was defined. T2-weighted MR scans acquired before chemoradiation therapy (CRT) were used for analysis addressed on primary lesions. Images were pre-processed using Laplacian of Gaussian (LoG) filter with multiple σ, and first order intensity histogram-based features (kurtosis, skewness, and entropy) were extracted. Features selection was performed using Mann-Whitney test. Tumor staging (cT, cN) was added to build a logistic regression model and predict pCR. Model performance was evaluated with internal and external validation using area under the curve (AUC) of the receiver operator characteristic (ROC) and calibration with Hosmer-Lemeshow test. The linear cross-correlation matrix (Pearson's coefficient) and the variance inflation factor (VIF) were used to check the correlation and the co-linearity among the final predictors. The amount of the information added through the radiomics features was estimated by using the DeLong's test, and the impact of pCR and the final predictors on survival outcomes were evaluated through the Kaplan-Meier curves by using the log-rank test and the multivariate Cox model. RESULTS Candidate-to-analysis features were skewness (σ = 0.485, P value = .01) and entropy (σ = 0.344, P value < .05). Logistic regression analysis showed as significant covariates cT (P value < .01), skewness-σ = 0.485 (P value = .01), and entropy-σ = 0.344 (P value < .05). Model AUCs were 0.73 (internal) and 0.75 (external). CONCLUSIONS This MR-based, vendor-independent model can be helpful for predicting pCR probability in locally advanced rectal cancer (LARC) patients only using pre-treatment imaging.
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Affiliation(s)
- Nicola Dinapoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italia
| | - Brunella Barbaro
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Istituto di Radiologia, Roma, Italia
| | - Roberto Gatta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italia
| | - Giuditta Chiloiro
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Istituto di Radiologia, Roma, Italia
| | - Calogero Casà
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Istituto di Radiologia, Roma, Italia
| | - Carlotta Masciocchi
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Istituto di Radiologia, Roma, Italia.
| | - Andrea Damiani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italia
| | - Luca Boldrini
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Istituto di Radiologia, Roma, Italia
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Istituto di Radiologia, Roma, Italia
| | - Michele Dezio
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Istituto di Radiologia, Roma, Italia
| | - Gian Carlo Mattiucci
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Istituto di Radiologia, Roma, Italia
| | - Mario Balducci
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Istituto di Radiologia, Roma, Italia
| | - Johan van Soest
- Department of Radiation Oncology MAASTRO Clinic GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, The Netherlands
| | - Andre Dekker
- Department of Radiation Oncology MAASTRO Clinic GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, The Netherlands
| | - Philippe Lambin
- Department of Radiation Oncology MAASTRO Clinic GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, The Netherlands
| | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - Carla Sini
- Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | | | - Nadia Di Muzio
- Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
| | - Calogero Gumina
- Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Passoni
- Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Manfredi
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Istituto di Radiologia, Roma, Italia
| | - Vincenzo Valentini
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Istituto di Radiologia, Roma, Italia
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Masciocchi C, Cordelli E, Sicilia R, Dinapoli N, Damiani A, Barbaro B, Boldrini L, Casà C, Cusumano D, Chiloiro G, Gambacorta M, Gatta R, Lenkowicz J, Van Soest J, Dekker A, Lambin P, Soda P, Iannello G, Valentini V. PO-0799: An externally validated MRI radiomics model for predicting clinical response in rectal cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31109-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gambacorta MA, De Paoli A, Lupattelli M, Chiloiro G, Solazzo AP, Barbaro B, Alfieri S, Vecchio FM, Lenkowicz J, Navarria F, Palazzari E, Bertola G, Frattegiani A, Minsky B, Valentini V. Phase I and II trial on infusional 5-fluorouracil and gefitinib in combination with preoperative radiotherapy in rectal cancer: 10-years median follow-up. Clin Transl Radiat Oncol 2018; 10:23-28. [PMID: 29928702 PMCID: PMC6008630 DOI: 10.1016/j.ctro.2018.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/12/2018] [Accepted: 02/12/2018] [Indexed: 01/04/2023] Open
Abstract
We report the long-term results of addiction of gefitinib to preoperative chemoradiotherapy in locally advanced rectal cancer. We wanted to see if the hight rate of pCR, already shown in previous studies, influenced survival outcomes. The first promising results have not been confirmed by a significant improvement in outcomes.
Purpose The aim of this study is to evaluate the long term survival of the addition of gefitinib to chemoradiotherapy (CRT) in locally advanced rectal cancer (LARC). Methods and materials This previously published multicentre, open-label, phase I-II study, enrolled patients (pts) with LARC to receive CRT with concurrent 5-fluorouracil continuous intravenous infusion and a dose escalation of orally administered gefitinib, followed 6–8 weeks later by surgery. An intra-operative radiotherapy boost of 10 Gy was planned. Adjuvant chemotherapy was administrated in ypN1-2 pts. After a median f/u of >10 years, we analyzed Local Control (LC), Metastasis Free Survival (MFS), Disease Free Survival (DFS), Disease Specific Survival (DSS) and Overall Survival (OS). Predictive endpoints of clinical outcomes were tested by univariate and multivariate analysis. Variables analyzed included: age, gefitinib dose and interruptions, adjuvant CT, surgery type, ypT, ypN, and TRG grade. We have also analyzed late toxicity according to CTCAEv4. Results Of the 41 initially enrolled pts, 39 were evaluable (27M, 12F). With a median f/u of 133 months, LC, MFS, DFS, OS and DSS at 5 years were 84%; 71%; 64%; 87% and 92%, respectively. The OS and DSS at 10 years were 61,5% and 76%, respectively. Grade 3-4 late toxicity occurred in 38% of pts: sexual (28,2%) and gastrointestinal toxicities (10,2%). Conclusion Long term outcomes and late toxicity were similar to previously reported series. The addition of gefitinib did not improve outcomes in LARC. Gefitinib is not recommended for rectal cancer patients who received 5-FU based preoperative CRT. Further studies may identify if gefitinib is beneficial in selected group of patients.
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Affiliation(s)
| | - Antonino De Paoli
- Department of Radiotherapy, Centro di Riferimento Oncologico, Aviano, Italy
| | - Marco Lupattelli
- Department of Radiotherapy, Ospedale Santa Maria della Misericordia, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Giuditta Chiloiro
- Polo scienze oncologiche ed ematologiche, Fondazione Policlinico Universitario Agostino Gemelli Roma, Italy
- Corresponding author at: Gemelli ART, Fondazione Policlinico Universitario “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Roma, Italy.
| | | | - Brunella Barbaro
- Department of Bioimaging and Radiological Sciences, Fondazione Policlinico Universitario “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Sergio Alfieri
- Department of Digestive Surgery, Fondazione Policlinico Universitario “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Fabio Maria Vecchio
- Department of Pathology, Fondazione Policlinico Universitario “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Jacopo Lenkowicz
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Navarria
- Department of Radiotherapy, Centro di Riferimento Oncologico, Aviano, Italy
| | - Elisa Palazzari
- Department of Radiotherapy, Centro di Riferimento Oncologico, Aviano, Italy
| | - Giulio Bertola
- Department of Surgical Oncology, Centro di Riferimento Oncologico, Aviano, Italy
| | - Alessandro Frattegiani
- Department of Radiotherapy, Ospedale Santa Maria della Misericordia, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Bruce Minsky
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Vincenzo Valentini
- Polo scienze oncologiche ed ematologiche, Fondazione Policlinico Universitario Agostino Gemelli Roma, Italy
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Gambacorta MA, Valentini V, Coco C, Manno A, Doglietto GB, Ratto C, Cosimelli M, Miccichè F, Maurizi F, Tagliaferri L, Mantini G, Balducci M, La Torre G, Barbaro B, Picciocchi A. Sphincter Preservation in Four Consecutive Phase II Studies of Preoperative Chemoradiation: Analysis of 247 T3 Rectal Cancer Patients. Tumori 2018; 93:160-9. [PMID: 17557563 DOI: 10.1177/030089160709300209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background To evaluate the impact of preoperative chemoradiation on sphincter preservation in patients with low- medium locally advanced resectable rectal cancer treated by four chemoradiation schedules. Materials and Methods Between 1990 and 2002, 247 patients were treated according to four schedules of chemoradiotherapy: FUMIR (5-fluorouracil, mitomycin, external beam radiotherapy 37.8 Gy), PLAFUR (cisplatinum, 5-fluorouracil, external beam radiotherapy 50.4 Gy), TOMRT (raltitrexed, external beam radiotherapy 50.4 Gy), and TOMOXRT (raltitrexed, oxaliplatin, external beam radiotherapy 50.4 Gy). Four to five weeks after chemoradiation, patients were restaged and surgery was performed 2-3 weeks later. Results Overall, the sphincter-saving surgery was performed in 82.5% of patients. In patients candidate to an abdominoperineal resection before chemoradiaton (distance tumor-anorectal ring, <30 mm) a sphincter-saving surgery was possible in 58% of cases: 44% (FUMIR), 52% (PLAFUR), 63% (TOMRT), 76% (TOMOXRT) (P <0.017). The involved surgeons kept the same surgical criteria in performing sphincter-saving surgery. After chemoradiation, patients with tumor location still between 0 and 30 mm received sphincter-saving surgery according to the protocols: 33% (FUMIR), 42% (PLAFUR), 50% (TOMRT), 64% (TOMOXRT) (P = 0.066) Conclusions Even though the surgeons’ skill in performing sphincter-saving surgery could be improved with time, the high rate of this procedure in the latest schedules suggests an impact of the new drugs in promoting tumor downsizing and therefore sphincter-saving surgery.
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Beets-Tan RGH, Lambregts DMJ, Maas M, Bipat S, Barbaro B, Curvo-Semedo L, Fenlon HM, Gollub MJ, Gourtsoyianni S, Halligan S, Hoeffel C, Kim SH, Laghi A, Maier A, Rafaelsen SR, Stoker J, Taylor SA, Torkzad MR, Blomqvist L. Correction to: Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol 2018; 28:2711. [PMID: 29322331 DOI: 10.1007/s00330-017-5204-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The article Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting, written by [§§§ AuthorNames §§§].
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Affiliation(s)
- Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands.
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | | | | | | | - Helen M Fenlon
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Marc J Gollub
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | | | - Seung Ho Kim
- Inje University Haeundae Paik Hospital, Busan, South Korea
| | | | | | | | - Jaap Stoker
- Academic Medical Centre, Amsterdam, The Netherlands
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | | | - Lennart Blomqvist
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
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Sodin-Semrl S, Spagnolo A, Mikus R, Barbaro B, Varga J, Fiore S. Opposing Regulation of Interleukin-8 and NF-kB Responses by Lipoxin A4 and Serum Amyloid a via the Common Lipoxin a Receptor. Int J Immunopathol Pharmacol 2017; 17:145-56. [PMID: 15171815 DOI: 10.1177/039463200401700206] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lipoxin A4 (LXA4) is a potent eicosanoid that inhibits IL-1β-induced activation of human fibroblast-like synoviocytes (FLS) via the LXA4 receptor (ALXR). Serum amyloid A (SAA) is an acute phase reactant with cytokine-like properties. SAA has been shown to bind the same seven transmembrane G protein-coupled receptor ligated by LXA4. Here we compared the inflammatory responses of lipid (LXA4) and peptide (SAA) ligands in human FLS via the shared ALX and characterized their downstream signaling. LXA4 induced stimulation of tissue inhibitors of metalloproteinase-2, whereas SAA induced interleukin-8 and matrix metalloproteinase-3 production. SAA up-regulated NF-kB and AP-1 DNA binding activity, while LXA4 markedly inhibited these responses after IL-1β stimulation. A human IL-8 promoter luciferase construct was transfected into CHO cells stably expressing ALXR in order to determine the role of NF-kB and/or AP-1 in the regulation of IL-8 gene expression. The NF-kB pathway proved to be the preeminent for the biological responses elicited by both ligands. These findings suggest that two endogenous molecules, targeting a common receptor, could participate in the pathogenesis of inflammatory arthritis by differentially regulating inflammatory responses in tissues expressing the ALXR.
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Affiliation(s)
- S Sodin-Semrl
- Section of Rheumatology, Dept Med, COM, University of Illinois, Chicago, IL 60607-7171, USA
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Ansite J, Balamurugan AN, Barbaro B, Battle J, Brandhorst D, Cano J, Chen X, Deng S, Feddersen D, Friberg A, Gilmore T, Goldstein JS, Holbrook E, Khan A, Kin T, Lei J, Linetsky E, Liu C, Luo X, McElvaney K, Min Z, Moreno J, O'Gorman D, Papas KK, Putz G, Ricordi C, Szot G, Templeton T, Wang L, Wilhelm JJ, Willits J, Wilson T, Zhang X, Avila J, Begley B, Cano J, Carpentier S, Holbrook E, Hutchinson J, Larsen CP, Moreno J, Sears M, Turgeon NA, Webster D, Deng S, Lei J, Markmann JF, Bridges ND, Czarniecki CW, Goldstein JS, Putz G, Templeton T, Wilson T, Eggerman TL, Al-Saden P, Battle J, Chen X, Hecyk A, Kissler H, Luo X, Molitch M, Monson N, Stuart E, Wallia A, Wang L, Wang S, Zhang X, Bigam D, Campbell P, Dinyari P, Kin T, Kneteman N, Lyon J, Malcolm A, O'Gorman D, Onderka C, Owen R, Pawlick R, Richer B, Rosichuk S, Sarman D, Schroeder A, Senior PA, Shapiro AMJ, Toth L, Toth V, Zhai W, Johnson K, McElroy J, Posselt AM, Ramos M, Rojas T, Stock PG, Szot G, Barbaro B, Martellotto J, Oberholzer J, Qi M, Wang Y, Bayman L, Chaloner K, Clarke W, Dillon JS, Diltz C, Doelle GC, Ecklund D, Feddersen D, Foster E, Hunsicker LG, Jasperson C, Lafontant DE, McElvaney K, Neill-Hudson T, Nollen D, Qidwai J, Riss H, Schwieger T, Willits J, Yankey J, Alejandro R, Corrales AC, Faradji R, Froud T, Garcia AA, Herrada E, Ichii H, Inverardi L, Kenyon N, Khan A, Linetsky E, Montelongo J, Peixoto E, Peterson K, Ricordi C, Szust J, Wang X, Abdulla MH, Ansite J, Balamurugan AN, Bellin MD, Brandenburg M, Gilmore T, Harmon JV, Hering BJ, Kandaswamy R, Loganathan G, Mueller K, Papas KK, Pedersen J, Wilhelm JJ, Witson J, Dalton-Bakes C, Fu H, Kamoun M, Kearns J, Li Y, Liu C, Luning-Prak E, Luo Y, Markmann E, Min Z, Naji A, Palanjian M, Rickels M, Shlansky-Goldberg R, Vivek K, Ziaie AS, Fernandez L, Kaufman DB, Zitur L, Brandhorst D, Friberg A, Korsgren O. Purified Human Pancreatic Islets, CIT Culture Media with Lisofylline or Exenatide. CellR4 Repair Replace Regen Reprogram 2017; 5:e2377. [PMID: 30613755 PMCID: PMC6319648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Calegari MA, Inno A, Monterisi S, Orlandi A, Santini D, Basso M, Cassano A, Martini M, Cenci T, de Pascalis I, Camarda F, Barbaro B, Larocca LM, Gori S, Tonini G, Barone C. A phase 2 study of temozolomide in pretreated metastatic colorectal cancer with MGMT promoter methylation. Br J Cancer 2017; 116:1279-1286. [PMID: 28427088 PMCID: PMC5482728 DOI: 10.1038/bjc.2017.109] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/19/2017] [Accepted: 03/28/2017] [Indexed: 01/04/2023] Open
Abstract
Background: Presently, few options are available for refractory colorectal cancer (CRC). O6-methyl-guanine-DNA-methyltransferase (MGMT) promoter methylation is a frequent and early event in CRC tumourigenesis. This epigenetic silencing is a predictor of response to the alkylating drug temozolomide in glioblastoma. Preclinical evidences and some case reports showed temozolomide activity in CRC with MGMT silencing, but the available data from clinical trials are inconsistent. Methods: This was a multicentre, phase 2 trial, planned according to a two-stage Simon’s optimal design to investigate activity and safety of temozolomide in refractory CRC harbouring MGMT promoter methylation. The primary end point was overall response rate (ORR). Patients who failed two or more prior treatments received temozolomide at a dose of 150–200 mg m−2 per day on days 1–5 every 28 days. Results: From July 2012 to June 2016, 225 patients were screened, 80 showed MGMT promoter methylation and 41 were enrolled. Overall response rate was 10% and disease control rate was 32%. Median progression-free survival and overall survival were 1.9 and 5.1 months, respectively. Conclusions: Temozolomide showed a modest activity in this heavily pretreated population and the study did not meet its primary end point. The role of temozolomide in CRC remains still controversial and further research is warranted.
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Affiliation(s)
- M A Calegari
- Division of Medical Oncology, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, Rome 00168, Italy
| | - A Inno
- Medical Oncology Unit, 'Sacro Cuore Don Calabria' Hospital Cancer Care Center, Verona 37024, Italy
| | - S Monterisi
- Division of Medical Oncology, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, Rome 00168, Italy
| | - A Orlandi
- Division of Medical Oncology, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, Rome 00168, Italy
| | - D Santini
- Division of Medical Oncology, Campus Bio-medico University, Rome 00128, Italy
| | - M Basso
- Division of Medical Oncology, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, Rome 00168, Italy
| | - A Cassano
- Division of Medical Oncology, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, Rome 00168, Italy
| | - M Martini
- Institute of Pathological Anatomy, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - T Cenci
- Institute of Pathological Anatomy, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - I de Pascalis
- Institute of Pathological Anatomy, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - F Camarda
- Division of Medical Oncology, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, Rome 00168, Italy
| | - B Barbaro
- Institute of Radiology, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - L M Larocca
- Institute of Pathological Anatomy, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - S Gori
- Medical Oncology Unit, 'Sacro Cuore Don Calabria' Hospital Cancer Care Center, Verona 37024, Italy
| | - G Tonini
- Division of Medical Oncology, Campus Bio-medico University, Rome 00128, Italy
| | - C Barone
- Division of Medical Oncology, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, Rome 00168, Italy
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Calegari MA, Monterisi S, Inno A, Orlandi A, Basso M, Cassano A, Santini D, Martini M, Cenci T, de Pascalis I, Barbaro B, Camarda F, Colosimo C, Larocca LM, Tonini G, Gori S, Barone CA. A phase 2 study of temozolomide in patients affected by pretreated metastatic colorectal cancer with MGMT promoter methylation. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
629 Background: Presently few options are available for pts with mCRC who failed standard treatments and prognosis remains grim. MGMT promoter methylation is a frequent and early event in CRC tumorigenesis. This epigenetic silencing is a predictor of response to the alkylating drug TMZ in glioblastoma. Preclinical evidences and a couple of clinical cases showed TMZ activity in pts affected by mCRC with MGMT silencing. We designed a study to evaluate the efficacy and safety of TMZ in pts with refractory mCRC harboring MGMT promoter methylation. While the trial was ongoing three analogous studies, reporting discordant results, were published. Methods: This was a 3-institutional, single arm, phase 2 trial, planned according to a 2-stage Simon’s optimal design. The primary endpoint was ORR. Secondary outcomes included DCR, OS, PFS and safety. A first cohort of 21 pts was accrued: if more than 1 response was observed a second cohort of 20 pts would be enrolled; if 4 or fewer responses were observed by the end of stage two, then no further investigation would be warranted. MGMT promoter methylation was assessed on archival tissue samples by MS-PCR. Patients affected by MGMT methylated mCRC, who failed 2 or more prior treatments, received TMZ, provided by TEVA Pharmaceutical Industries, at a dose of 150-200 mg/mq/day once a day on days 1-5 every 28 days. Results: From July 2012 to June 2016, 225 pts were screened and 80 showed MGMT promoter methylation, among those 42 met the inclusion and exclusion criteria and were enrolled. ORR was 10% with no CR and 4 (10%) PR. SD was achieved in 9 (22%) pts, accounting for a DCR of 32%. At a median FU of 9 months all pts experienced PD and 88% died. Median PFS and OS were 2.6 months (95% CI 2.1-3.2) and 7.1 months (95% CI 5.1-9.2) respectively. Overall, any-grades AEs were reported in 75.6% pts, most of them were G1-2 (84%). The most frequent AE were nausea (56%) and platelet count decreased (39%). 4 pts discontinued study treatment due to AE. No SAE neither toxic death was recorded. Conclusions: The study did not meet its primary endpoint, however an interesting DCR (32%) and 4 PR were achieved. The role of TMZ in mCRC treatment remains still controversial and might warrant further analysis. Clinical trial information: 2012-002766-13.
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Affiliation(s)
| | - Santa Monterisi
- Fondazione Policlinico Universitario Agostino Gemelli - UOC Oncologia Medica, Rome, Italy
| | - Alessandro Inno
- Oncologia Medica, Ospedale Sacro Cuore, Negrar, Italy, Rome, Italy
| | - Armando Orlandi
- Fondazione Policlinico Universitario Agostino Gemelli - UOC Oncologia Medica, Rome, Italy
| | - Michele Basso
- Fondazione Policlinico Universitario Agostino Gemelli - UOC Oncologia Medica, Roma, Italy
| | - Alessandra Cassano
- Fondazione Policlinico Universitario Agostino Gemelli - UOC Oncologia Medica, Rome, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Maurizio Martini
- Fondazione Policlinico Universitario Agostino Gemelli - Istituto di Anatomia Patologica, Rome, Italy
| | - Tonia Cenci
- Fondazione Policlinico Universitario Agostino Gemelli - Istituto di Anatomia Patologica, Rome, Italy
| | - Ivana de Pascalis
- Fondazione Policlinico Universitario Agostino Gemelli - Istituto di Anatomia Patologica, Rome, Italy
| | - Brunella Barbaro
- Fondazione Policlinico Universitario Agostino Gemelli - Istituto di Radiologia, Rome, Italy
| | - Floriana Camarda
- Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Cesare Colosimo
- Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi Maria Larocca
- Fondazione Policlinico Universitario Agostino Gemelli - Istituto di Anatomia Patologica, Rome, Italy
| | | | - Stefania Gori
- Oncology Unit, Ospedale Sacro Cuore-don Calabria, Negrar (VR), Italy
| | - Carlo Antonio Barone
- Fondazione Policlinico Universitario Agostino Gemelli - UOC Oncologia Medica, Rome, Italy
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Barbaro B, Leccisotti L, Vecchio FM, Di Matteo M, Serra T, Salsano M, Poscia A, Coco C, Persiani R, Alfieri S, Gambacorta MA, Valentini V, Giordano A, Bonomo L. The potential predictive value of MRI and PET-CT in mucinous and nonmucinous rectal cancer to identify patients at high risk of metastatic disease. Br J Radiol 2016; 90:20150836. [PMID: 27845566 DOI: 10.1259/bjr.20150836] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To correlate imaging parameters from baseline MRI diffusion-weighted imaging (DWI) and fludeoxyglucose (FDG) positron emission tomography (PET)-CT with synchronous and metachronous metastases in mucinous carcinoma (MC) and non-mucinous carcinoma (NMC) rectal cancer. METHODS 111 patients with extraperitoneal locally advanced rectal cancer, who underwent pelvic MRI, DWI and FDG PET-CT, were stratified into MC (n = 23) and NMC (n = 88). We correlated adverse morphologic features on MRI [mT4, mesorectal fascia involvement, extramural venous invasion (mEMVI), mN2] and quantitative imaging parameters [minimum apparent diffusion coefficient (ADCmin), maximum standardized uptake value, total lesion glycolysis, metabolic tumour volume, T2 weighted and DWI tumour volumes] with the presence of metastatic disease. All patients underwent pre-operative chemoradiation therapy (CRT); 100/111 patients underwent surgery after CRT and were classified as pathological complete response (PCR) and no PCR [tumour regression grade (TRG)1 vs TRG2-5] and as ypN0 and ypN1-2. Median follow-up time was 48 months. Metastases were confirmed on FDG PET-CT and contrast-enhanced multidetector CT. RESULTS The percentage of mucin measured by MRI correlates with that quantified by histology. On multivariate analysis, the synchronous metastases were correlated with mEMVI [odds ratio (OR) = 21.48, p < 0.01] and low ADCmin (OR = 0.04, p = 0.038) in NMC. The difference of metachronous recurrence between the MC group (10-90% mucin) and NMC group was significant (p < 0.01) (OR = 21.67, 95% confidence interval 3.8-120.5). Metachronous metastases were correlated with ypN2 (OR = 8.24, p = 0.01) in MC and in NMC. In NMC, mEMVI correlated with no PCR (p = 0.018) and ypN2 (p < 0.01). CONCLUSION mEMVI could identify patients with NMC, who are at high risk of synchronous metastases. The MC group is at a high risk of developing metachronous metastases. Advances in knowledge: Patients at high risk of metastases are more likely to benefit from more aggressive neoadjuvant therapy.
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Affiliation(s)
- Brunella Barbaro
- 1 Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Lucia Leccisotti
- 1 Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Fabio M Vecchio
- 2 Department of Pathology, Catholic University of Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Marialuisa Di Matteo
- 1 Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Teresa Serra
- 1 Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Marco Salsano
- 1 Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Andrea Poscia
- 4 Department of Hygiene, Catholic University of Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Claudio Coco
- 3 Department of Surgery, Catholic University of Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Roberto Persiani
- 3 Department of Surgery, Catholic University of Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Sergio Alfieri
- 3 Department of Surgery, Catholic University of Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Maria Antonietta Gambacorta
- 1 Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Vincenzo Valentini
- 1 Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Alessandro Giordano
- 1 Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Lorenzo Bonomo
- 1 Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
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Valentini V, Gambacorta MA, Barbaro B, Chiloiro G, Coco C, Das P, Fanfani F, Joye I, Kachnic L, Maingon P, Marijnen C, Ngan S, Haustermans K. International consensus guidelines on Clinical Target Volume delineation in rectal cancer. Radiother Oncol 2016; 120:195-201. [PMID: 27528121 DOI: 10.1016/j.radonc.2016.07.017] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/07/2016] [Accepted: 07/23/2016] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The delineation of Clinical Target Volume (CTV) is a critical step in radiotherapy. Several guidelines suggest different subvolumes and anatomical boundaries in rectal cancer (RC), potentially leading to a misunderstanding in the CTV definition. International consensus guidelines (CG) are needed to improve uniformity in RC CTV delineation. MATERIAL AND METHODS The 7 radiation oncologist experts defined a roadmap to produce RC CG. Step 1: revision of the published guidelines. Step 2: selection of RC cases with different clinical stages. Step 3: delineation of cases using Falcon following previously published guidelines. Step 4: meeting in person to discuss the initial delineation outcome, followed by a CTV proposal based on revised and if needed, adapted anatomical boundaries. Step 5: peer review of the agreed consensus. Step 6: peer review meeting to validate the final outcome. Step 7: completion of RC delineation atlases. RESULTS A new ontology of structure sets was defined and the related table of anatomical boundaries was generated. The major modifications were about the lateral lymph nodes and the ischio-rectal fossa delineation. Seven RC cases were made available online as consultation atlases. CONCLUSION The definition of international CG for RC delineation endorsed by international experts might support a future homogeneous comparison between clinical trial outcomes.
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Affiliation(s)
- Vincenzo Valentini
- Università Cattolica del Sacro Cuore, Radiation Oncology Department, Rome, Italy.
| | | | - Brunella Barbaro
- Università Cattolica del Sacro Cuore, Department of Radiological Sciences, Rome, Italy.
| | - Giuditta Chiloiro
- Università Cattolica del Sacro Cuore, Radiation Oncology Department, Rome, Italy.
| | - Claudio Coco
- Università Cattolica del Sacro Cuore, Department of Surgical Science, Rome, Italy.
| | - Prajnan Das
- University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, USA.
| | - Francesco Fanfani
- University G. D'Annunzio, Gynecologic Oncology Department of Medicine and Aging Sciences, Chieti, Italy.
| | - Ines Joye
- KU Leuven - University of Leuven, Department of Oncology and University Hospitals Leuven, Radiation Oncology, Belgium.
| | - Lisa Kachnic
- Boston Medical Center, Department of Radiation Oncology, USA.
| | - Philippe Maingon
- Centre Georges-François Leclerc, Department of Radiation Oncology, Dijon, France.
| | - Corrie Marijnen
- Leiden University Medical Center, Department of Radiation Oncology, The Netherlands.
| | - Samuel Ngan
- Peter MacCallum Cancer Centre, Division of Radiation Oncology and Cancer Imaging, Melbourne, Australia.
| | - Karin Haustermans
- KU Leuven - University of Leuven, Department of Oncology and University Hospitals Leuven, Radiation Oncology, Belgium.
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Dinapoli N, Casà C, Barbaro B, Chiloiro GV, Damiani A, Di Matteo M, Farchione A, Gambacorta MA, Gatta R, Lanzotti V, Masciocchi C, Valentini V. Radiomics for rectal cancer. Transl Cancer Res 2016. [DOI: 10.21037/tcr.2016.06.08] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Sodin-Semrl S, Spagnolo A, Barbaro B, Varga J, Fiore S. Lipoxin A4 Counteracts Synergistic Activation of Human Fibroblast-like Synoviocytes. Int J Immunopathol Pharmacol 2016; 17:15-25. [PMID: 15000862 DOI: 10.1177/039463200401700103] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Excessive production of interleukin-6 (IL-6) and metalloproteinases (MMPs) has been implicated in the pathogenesis of rheumatoid arthritis. Lipoxin A4 (LXA4) and transforming growth factor (32 (TGF-|32) have potential anti-inflammatory activities; these two mediators were tested to determine how they affect IL-1β-dependent release of IL-6 and MMPs in human fibroblast-like synoviocytes. The results revealed dramatic differences between the mediators: TGF-β2 acted synergistically with IL-1β to stimulate IL-6 protein levels, whereas LXA4 inhibited IL-6 expression in a dose- and time-dependent manner. Inhibition, by LXA4 was abrogated when cells were pre-incubated with antibody against the ALXR (Lipoxin A4 Receptor) TGF-β2 by itself had no significant effect on IL-6 or MMP levels. LXA4, at nanomolar concentrations, altered the MMP-1 and MMP-3 expression levels of IL-1β and TGF-β2 stimulated fibroblast-like synoviocytes. Furthermore, IL-1β and TGF-β2 up-regulated ALXR mRNA. These results demonstrate, for the first time, that ALXR mediate the effects of LXA4 on inflammatory responses after stimulation of fibroblast-like synoviocytes with IL-1β plus TGF-β2. These activities might constitute an important mechanism by which LXA4 regulates synovial fibroblast activation.
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Affiliation(s)
- S Sodin-Semrl
- Department of Medicine/Rheumatology, COM, University of Illinois, Chicago, IL 60607, USA
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Dinapoli N, Barbaro B, Gatta R, Chiloiro G, Casà C, Masciocchi C, Damiani A, Boldrini L, Gambacorta M, Di Matteo M, Mattiucci G, Balducci M, Bonomo L, Valentini V. OC-0241: MR radiomics predicting complete response in radiochemotherapy (RTCT) of rectal cancer (LARC). Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31490-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fioravanzo E, Bassan A, Dorne JL, Richardson J, Kovarich S, Pavan M, Barbaro B. The EFSA's Chemical Hazards Database, structure and content. Toxicol Lett 2015. [DOI: 10.1016/j.toxlet.2015.08.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gori M, Barbaro B, Arciello M, Maggio R, Viscomi C, Longo A, Balsano C. Protective Effect of the Y220C Mutant p53 Against Steatosis: Good News? J Cell Physiol 2015; 230:1400. [PMID: 26179116 DOI: 10.1002/jcp.24874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Spada C, Hassan C, Barbaro B, Iafrate F, Cesaro P, Petruzziello L, Minelli Grazioli L, Senore C, Brizi G, Costamagna I, Alvaro G, Iannitti M, Salsano M, Ciolina M, Laghi A, Bonomo L, Costamagna G. Colon capsule versus CT colonography in patients with incomplete colonoscopy: a prospective, comparative trial. Gut 2015; 64:272-81. [PMID: 24964317 DOI: 10.1136/gutjnl-2013-306550] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE In case of incomplete colonoscopy, several radiologic methods have traditionally been used, but more recently, capsule endoscopy was also shown to be accurate. Aim of this study was to compare colon capsule endoscopy (CCE) and CT colonography (CTC) in a prospective cohort of patients with incomplete colonoscopy. DESIGN Consecutive patients with a previous incomplete colonoscopy underwent CCE and CTC followed by colonoscopy in case of positive findings on either test (polyps/mass lesions ≥6 mm). Clinical follow-up was performed in the other cases to rule out missed cancer. CTC was performed after colon capsule excretion or 10-12 h postingestion. Since the gold standard colonoscopy was performed only in positive cases, diagnostic yield and positive predictive values of CCE and CTC were used as study end-points. RESULTS 100 patients were enrolled. CCE and CTC were able to achieve complete colonic evaluation in 98% of cases. In a per-patient analysis for polyps ≥6 mm, CCE detected 24 patients (24.5%) and CTC 12 patients (12.2%). The relative sensitivity of CCE compared to CTC was 2.0 (95% CI 1.34 to 2.98), indicating a significant increase in sensitivity for lesions ≥6 mm. Of larger polyps (≥10 mm), these values were 5.1% for CCE and 3.1% for CTC (relative sensitivity: 1.67 (95% CI 0.69 to 4.00)). Positive predictive values for polyps ≥6 mm and ≥10 mm were 96% and 85.7%, and 83.3% and 100% for CCE and CTC, respectively. No missed cancer occurred at clinical follow-up of a mean of 20 months. CONCLUSIONS CCE and CTC were of comparable efficacy in completing colon evaluation after incomplete colonoscopy; the overall diagnostic yield of colon capsule was superior to CTC. TRIAL REGISTRATION NUMBER NCT01525940.
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Affiliation(s)
| | - Cesare Hassan
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Brunella Barbaro
- Department of Bioimaging and Radiological Sciences, Catholic University, Rome, Italy
| | - Franco Iafrate
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, Rome, Italy
| | - Paola Cesaro
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | | | | | - Carlo Senore
- Epidemiologia dei Tumori II, AOU S Giovanni Battista-CPO Piemonte Torino, Torino, Italy
| | - Gabriella Brizi
- Department of Bioimaging and Radiological Sciences, Catholic University, Rome, Italy
| | | | - Giuseppe Alvaro
- Department of Bioimaging and Radiological Sciences, Catholic University, Rome, Italy
| | - Marcella Iannitti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, Rome, Italy
| | - Marco Salsano
- Department of Bioimaging and Radiological Sciences, Catholic University, Rome, Italy
| | - Maria Ciolina
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, Rome, Italy
| | - Andrea Laghi
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, Rome, Italy
| | - Lorenzo Bonomo
- Department of Bioimaging and Radiological Sciences, Catholic University, Rome, Italy
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Biolato M, Barbaro B, Siciliani L, Grieco A. Vanishing-recurrent benign liver lesions. Liver Int 2014; 34:1126. [PMID: 24134727 DOI: 10.1111/liv.12358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 10/13/2013] [Indexed: 02/13/2023]
Affiliation(s)
- Marco Biolato
- Internal Medicine, Policlinico Gemelli Hospital, Catholic University of the Sacred Heart, Rome, Italy
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Ricordi C, Hering B, Bridges N, Eggerman T, Naji A, Posselt A, Stock P, Kaufman D, Larsen C, Turgeon N, Oberholzer J, Barbaro B, Korsgren O, Markmann J, Alejandro R, Rickels M, Senior P, Luo X, Zhang X, Bellin M, Lei J, Clarke W, Hunsicker L, Goldstein J, Czarniecki C, Priore A, Green N, Shapiro A. Completion of the first FDA phase 3 multicenter trial of Islet transplantation in type 1 diabetes by the NIH CIT consortium. Cytotherapy 2014. [DOI: 10.1016/j.jcyt.2014.01.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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