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Cilla S, Campitelli M, Antonietta Gambacorta M, Michela Rinaldi R, Deodato F, Pezzulla D, Romano C, Fodor A, Laliscia C, Trippa F, De Sanctis V, Ippolito E, Ferioli M, Titone F, Russo D, Balcet V, Vicenzi L, Di Cataldo V, Raguso A, Giuseppe Morganti A, Ferrandina G, Macchia G. Machine-learning prediction of treatment response to stereotactic body radiation therapy in oligometastatic gynecological cancer: A multi-institutional study. Radiother Oncol 2024; 191:110072. [PMID: 38142932 DOI: 10.1016/j.radonc.2023.110072] [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: 06/27/2023] [Revised: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND AND PURPOSE We aimed to develop and validate different machine-learning (ML) prediction models for the complete response of oligometastatic gynecological cancer after SBRT. MATERIAL AND METHODS One hundred fifty-seven patients with 272 lesions from 14 different institutions and treated with SBRT with radical intent were included. Thirteen datasets including 222 lesions were combined for model training and internal validation purposes, with an 80:20 ratio. The external testing dataset was selected as the fourteenth Institution with 50 lesions. Lesions that achieved complete response (CR) were defined as responders. Prognostic clinical and dosimetric variables were selected using the LASSO algorithm. Six supervised ML models, including logistic regression (LR), classification and regression tree analysis (CART) and support vector machine (SVM) using four different kernels, were trained and tested to predict the complete response of uterine lesions after SBRT. The performance of models was assessed by receiver operating characteristic curves (ROC), area under the curve (AUC) and calibration curves. An explainable approach based on SHapley Additive exPlanations (SHAP) method was deployed to generate individual explanations of the model's decisions. RESULTS 63.6% of lesions had a complete response and were used as ground truth for the supervised models. LASSO strongly associated complete response with three variables, namely the lesion volume (PTV), the type of lesions (lymph-nodal versus parenchymal), and the biological effective dose (BED10), that were used as input for ML modeling. In the training set, the AUCs for complete response were 0.751 (95% CI: 0.716-0.786), 0.766 (95% CI: 0.729-0.802) and 0.800 (95% CI: 0.742-0.857) for the LR, CART and SVM with a radial basis function kernel, respectively. These models achieve AUC values of 0.727 (95% CI: 0.669-0.795), 0.734 (95% CI: 0.649-0.815) and 0.771 (95% CI: 0.717-0.824) in the external testing set, demonstrating excellent generalizability. CONCLUSION ML models enable a reliable prediction of the treatment response of oligometastatic lesions receiving SBRT. This approach may assist radiation oncologists to tailor more individualized treatment plans for oligometastatic patients.
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Affiliation(s)
- Savino Cilla
- Medical Physics Unit, Responsible Research Hospital, Campobasso, Italy.
| | - Maura Campitelli
- Radiation Oncology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | | | | | - Francesco Deodato
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
| | - Donato Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
| | - Carmela Romano
- Medical Physics Unit, Responsible Research Hospital, Campobasso, Italy
| | - Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Concetta Laliscia
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Fabio Trippa
- Radiation Oncology Center, S Maria Hospital, Terni, Italy
| | | | - Edy Ippolito
- Department of Radiation Oncology, Campus Bio-Medico University, Roma, Italy
| | - Martina Ferioli
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesca Titone
- Department of Radiation Oncology, University Hospital Udine, Udine, Italy
| | | | - Vittoria Balcet
- Radiation Oncology Department, Ospedale degli Infermi, Biella, Italy
| | - Lisa Vicenzi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Oncology Department, University of Florence, Firenze, Italy
| | - Arcangela Raguso
- Radiation Oncology Unit, Fondazione "Casa Sollievo della Sofferenza", IRCCS, S. Giovanni Rotondo, Italy
| | - Alessio Giuseppe Morganti
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Gabriella Ferrandina
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
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Macchia G, Cilla S, Pezzulla D, Campitelli M, Laliscia C, Lazzari R, Draghini L, Fodor A, D'Agostino GR, Russo D, Balcet V, Ferioli M, Vicenzi L, Raguso A, Di Cataldo V, Perrucci E, Borghesi S, Ippolito E, Gentile P, De Sanctis V, Titone F, Delle Curti CT, Huscher A, Gambacorta MA, Ferrandina G, Morganti AG, Deodato F. Efficacy of stereotactic body radiotherapy and response prediction using artificial intelligence in oligometastatic gynaecologic cancer. Gynecol Oncol 2024; 184:16-23. [PMID: 38271773 DOI: 10.1016/j.ygyno.2024.01.023] [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] [Received: 11/17/2023] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 01/27/2024]
Abstract
PURPOSE We present a large real-world multicentric dataset of ovarian, uterine and cervical oligometastatic lesions treated with SBRT exploring efficacy and clinical outcomes. In addition, an exploratory machine learning analysis was performed. METHODS A pooled analysis of gynecological oligometastases in terms of efficacy and clinical outcomes as well an exploratory machine learning model to predict the CR to SBRT were carried out. The CR rate following radiotherapy (RT) was the study main endpoint. The secondary endpoints included the 2-year actuarial LC, DMFS, PFS, and OS. RESULTS 501 patients from 21 radiation oncology institutions with 846 gynecological metastases were analyzed, mainly ovarian (53.1%) and uterine metastases(32.1%).Multiple fraction radiotherapy was used in 762 metastases(90.1%).The most frequent schedule was 24 Gy in 3 fractions(13.4%). CR was observed in 538(63.7%) lesions. The Machine learning analysis showed a poor ability to find covariates strong enough to predict CR in the whole series. Analyzing them separately, in uterine cancer, if RT dose≥78.3Gy, the CR probability was 75.4%; if volume was <13.7 cc, the CR probability became 85.1%. In ovarian cancer, if the lesion was a lymph node, the CR probability was 71.4%; if volume was <17 cc, the CR probability rose to 78.4%. No covariate predicted the CR for cervical lesions. The overall 2-year actuarial LC was 79.2%, however it was 91.5% for CR and 52.5% for not CR lesions(p < 0.001). The overall 2-year DMFS, PFS and OS rate were 27.3%, 24.8% and 71.0%, with significant differences between CR and not CR. CONCLUSIONS CR was substantially associated to patient outcomes in our series of gynecological cancer oligometastatic lesions. The ability to predict a CR through artificial intelligence could also drive treatment choices in the context of personalized oncology.
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Affiliation(s)
- Gabriella Macchia
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Molise, Italy.
| | - Savino Cilla
- Medical Physics Unit, Responsible Research Hospital, Campobasso, Molise, Italy
| | - Donato Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Molise, Italy
| | - Maura Campitelli
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Concetta Laliscia
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Italy
| | - Roberta Lazzari
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | | | - Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe R D'Agostino
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | | | - Vittoria Balcet
- UOC Radioterapia, Nuovo Ospedale degli Infermi, Biella, Italy
| | - Martina Ferioli
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, 40138, Italy
| | - Lisa Vicenzi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
| | - Arcangela Raguso
- UOC Radioterapia, Fondazione "Casa Sollievo della Sofferenza", IRCCS, S. Giovanni Rotondo, Foggia, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Oncology Department, University of Florence, Firenze, Italy
| | | | - Simona Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana sud est, Arezzo, Toscana, Italy
| | - Edy Ippolito
- Department of Radiation Oncology, Campus Bio-Medico University, Roma, Italy
| | - Piercarlo Gentile
- Radiation Oncology Unit, UPMC Hillman Cancer Center San Pietro FBF, Roma, Italy
| | - Vitaliana De Sanctis
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Roma, Italy
| | - Francesca Titone
- Department of Radiation Oncology, University Hospital Udine, Italy
| | - Clelia Teresa Delle Curti
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy
| | - Alessandra Huscher
- Fondazione Poliambulanza, U.O. di Radioterapia Oncologica "Guido Berlucchi", Brescia, Italy
| | - Maria Antonietta Gambacorta
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Istituto di Radiologia, Università Cattolica del Sacro Cuore Roma, Italy
| | - Gabriella Ferrandina
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Alessio G Morganti
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, 40138, Italy; Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Molise, Italy; Istituto di Radiologia, Università Cattolica del Sacro Cuore Roma, Italy
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Macchia G, Lancellotta V, Ferioli M, Casà C, Pezzulla D, Pappalardi B, Laliscia C, Ippolito E, Di Muzio J, Huscher A, Tortoreto F, Boccardi M, Lazzari R, Perrone AM, Raspagliesi F, Gadducci A, Garganese G, Fragomeni SM, Ferrandina G, Morganti AG, Gambacorta MA, Tagliaferri L. Definitive chemoradiation in vulvar squamous cell carcinoma: outcome and toxicity from an observational multicenter Italian study on vulvar cancer (OLDLADY 1.1). Radiol Med 2024; 129:152-159. [PMID: 37700153 PMCID: PMC10808465 DOI: 10.1007/s11547-023-01712-8] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/22/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Vulvar carcinoma is a rather uncommon gynecological malignancy affecting elderly women and the treatment of loco-regional advanced carcinoma of the vulva (LAVC) is a challenge for both gynecologic and radiation oncologists. Definitive chemoradiation (CRT) is the treatment of choice, but with disappointing results. In this multicenter study (OLDLADY-1.1), several institutions have combined their retrospective data on LAVC patients to produce a real-world dataset aimed at collecting data on efficacy and safety of CRT. METHODS The primary study end-point was 2-year-local control (LC), secondary end-points were 2-year-metastasis free-survival (MFS), 2-year-overall survival (OS) and the rate and severity of acute and late toxicities. Participating centers were required to fill data sets including age, stage, histology, grading as well as technical/dosimetric details of CRT. Data about response, local and regional recurrence, acute and late toxicities, follow-up and outcome measures were also collected. The toxicity was a posteriori documented through the Common Terminology Criteria for Adverse Events version 5 scale. RESULTS Retrospective analysis was performed on 65 patients with primary or recurrent LAVC treated at five different radiation oncology institutions covering 11-year time interval (February 2010-November 2021). Median age at diagnosis was 72 years (range 32-89). With a median follow-up of 19 months (range 1-114 months), 2-year actuarial LC, MFS and OS rate were 43.2%, 84.9% and 59.7%, respectively. In 29 patients (44%), CRT was temporarily stopped (median 5 days, range 1-53 days) due to toxicity. The treatment interruption was statistically significant at univariate analysis of factors predicting LC (p: 0.05) and OS rate (p: 0.011), and it was confirmed at the multivariate analysis for LC rate (p: 0.032). In terms of toxicity profile, no G4 event was recorded. Most adverse events were reported as grade 1 or 2. Only 14 acute G3 toxicities, all cutaneous, and 7 late G3 events (3 genitourinary, 3 cutaneous, and 1 vaginal stenosis) were recorded. CONCLUSION In the context of CRT for LAVC, the present study reports encouraging results even if there is clearly room for further improvements, in terms of both treatment outcomes, toxicity and treatment interruption management.
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Affiliation(s)
- Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100, Campobasso, Italy
| | - Valentina Lancellotta
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168, Rome, Italy.
| | - Martina Ferioli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Calogero Casà
- UOC Di Radioterapia Fatebenefratelli Isola Tiberina. Gemelli Isola, Rome, Italy
| | - Donato Pezzulla
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100, Campobasso, Italy
| | - Brigida Pappalardi
- Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Concetta Laliscia
- Division of Radiation Oncology, Department of New Technologies and Translational Research, University of Pisa, Pisa, Italy
| | - Edy Ippolito
- Radiation Oncology, Università Campus Bio-Medico, Rome, Italy
| | - Jacopo Di Muzio
- Dipartimento Di Oncologia P.O. S. Anna - SS Radioterapia, A.O.U "Città Della Salute E Della Scienza", Turin, Italy
| | - Alessandra Huscher
- Fondazione Poliambulanza, U.O. Di Radioterapia Oncologica "Guido Berlucchi", Brescia, Italy
| | - Francesca Tortoreto
- UOC Di Radioterapia Fatebenefratelli Isola Tiberina. Gemelli Isola, Rome, Italy
| | - Mariangela Boccardi
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100, Campobasso, Italy
| | - Roberta Lazzari
- Division of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Anna Myriam Perrone
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | | | - Angiolo Gadducci
- Division of Gynecology and Obstetrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giorgia Garganese
- Dipartimento Scienze Della Salute Della Donna, del bambino e Di Sanità Pubblica, UOC Ginecologia Oncologica,, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168, Rome, Italy
- Dipartimento Scienze Della Vita E Sanità Pubblica, Sezione Di Ginecologia Ed Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Maria Fragomeni
- Dipartimento Scienze Della Salute Della Donna, del bambino e Di Sanità Pubblica, UOC Ginecologia Oncologica,, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168, Rome, Italy
| | - Gabriella Ferrandina
- Dipartimento Scienze Della Salute Della Donna, del bambino e Di Sanità Pubblica, UOC Ginecologia Oncologica,, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168, Rome, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Maria Antonietta Gambacorta
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore Sede Di Roma, 00168, Rome, Italy
| | - Luca Tagliaferri
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168, Rome, Italy
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Macchia G, Pezzulla D, Campitelli M, Laliscia C, Fodor A, Bonome P, Draghini L, Ippolito E, De Sanctis V, Ferioli M, Titone F, Balcet V, Di Cataldo V, Russo D, Vicenzi L, Cossa S, Lucci S, Cilla S, Deodato F, Gambacorta MA, Scambia G, Morganti AG, Ferrandina G. Efficacy and Safety of Stereotactic Body Radiation Therapy in Oligometastatic Uterine Cancer (MITO-RT2/RAD): A Large, Real-World Study in Collaboration With Italian Association of Radiation Oncology, Multicenter Italian Trials in Ovarian Cancer, and Mario Negri Gynecologic Oncology Group Groups. Int J Radiat Oncol Biol Phys 2023; 117:321-332. [PMID: 37150261 DOI: 10.1016/j.ijrobp.2023.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/22/2023] [Revised: 04/04/2023] [Accepted: 04/25/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE This retrospective, multicenter study analyzes the efficacy and safety of stereotactic body radiation therapy in a large cohort of patients with oligometastatic/persistent/recurrent uterine cancer. METHODS AND MATERIALS Clinical and radiation therapy data from several radiation therapy centers treating patients by stereotactic body radiation therapy between March 2006 and October 2021 were collected. Objective response rate was defined as complete and partial response, and clinical benefit included objective response rate plus stable disease. Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer and Common Terminology Criteria for Adverse Events scales were used to grade toxicities. Primary endpoints were the rate of complete response to stereotactic body radiation therapy, and the 2-year actuarial local control rate "per-lesion" basis. Secondary endpoints were progression-free survival and overall survival, as well as toxicity. RESULTS In the study, 157 patients with oligometastatic/persistent/recurrent uterine cancer bearing 272 lesions treated by stereotactic body radiation therapy at 14 centers were analyzed. Lymph node metastases (137, 50.4%) were prevalent, followed by parenchyma lesions (135, 49.6%). Median total dose was 35 Gy (10-75.2), in 5 fractions (range, 1-10). Complete and partial responses were 174 (64.0%), and 54 (19.9%), respectively. Stable disease was registered in 29 (10.6%), and 15 (5.5%) lesions progressed. Type of lesion (lymph node), volume (≤13.7 cc) and total dose (BED10 >59.5 Gy) were significantly associated with a higher probability of achieving complete response. Patients achieving complete response (CR) "per-lesion" basis experienced a 2-year actuarial local control rate of 92.4% versus 33.5% in lesions not achieving complete response (NCR; P < .001). Moreover, the 2-year actuarial progression-free survival rate in patients with CR was 45.4%, and patients with NCR had a 2-year rate of 17.6% (P < .001). Finally, patients who had a CR had a 2-year overall survival rate of 82.7%, compared with 56.5% for NCR patients (P <.001). Severe acute toxicity was around 2%, including one toxic death due to gastric perforation, and severe late toxicity around 4%. CONCLUSIONS The efficacy of stereotactic body radiation therapy in this setting was confirmed. The low toxicity profile and the high local control rate in complete responder patients encourage the wider use of this approach.
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Affiliation(s)
- Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy.
| | - Donato Pezzulla
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy
| | - Maura Campitelli
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Concetta Laliscia
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Bonome
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy
| | | | - Edy Ippolito
- Department of Radiation Oncology, Campus Bio-Medico University, Roma, Italy
| | - Vitaliana De Sanctis
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Roma, Italy
| | - Martina Ferioli
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum. Bologna University, Bologna, Italy
| | - Francesca Titone
- Department of Radiation Oncology, University Hospital Udine, Udine, Italy
| | - Vittoria Balcet
- Radiation Oncology Department, Ospedale degli Infermi, Biella
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Oncology Department, University of Florence, Firenze, Italy
| | | | - Lisa Vicenzi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
| | - Sabrina Cossa
- UOC Radioterapia, Fondazione "Casa Sollievo della Sofferenza," IRCCS, S. Giovanni Rotondo, Foggia, Italy
| | - Simona Lucci
- Department of Radiation Oncology, University Hospital Udine, Udine, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise, Campobasso, Molise, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy; Istituto di Radiologia, Università Cattolica del Sacro Cuore Roma, Italy
| | - Maria Antonietta Gambacorta
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Istituto di Radiologia, Università Cattolica del Sacro Cuore Roma, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Alessio Giuseppe Morganti
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum. Bologna University, Bologna, Italy
| | - Gabriella Ferrandina
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
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Laliscia C, Genovesi-Ebert F, Perrone F, Fuentes T, Cresti F, Guido F, Tripodi M, Paiar F. Photon-based high-dose single-fraction radiosurgery, an effective treatment modality for recurrent uveal melanoma. Contemp Oncol (Pozn) 2023; 27:109-112. [PMID: 37794987 PMCID: PMC10546965 DOI: 10.5114/wo.2023.129410] [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] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/30/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction To evaluate and report the outcome of a patient with locally recurrent uveal melanoma (UM) previously treated with brachytherapy (BT), using a second personalized globe-sparing radiotherapy approach. Material and methods In June 2020, a 78-year-old man arrived at our institution with diplopia and suspected uveal melanoma. At the ophthalmological evaluation (B-scan and A-scan ultrasonography) a lesion in the right eye at 6-7 hours of about 5 mm thickness, with internal lacunar areas, approximately 7 mm away from the limbus, was observed. The patient underwent ruthenium plaque BT at a total dose of 110 Gy prescribed to the apex of the tumour. At the follow-up, the lesion was under control until September 2021, but it recurred with a satellite exudative detachment in the lower and temporal sectors 7-10 hours. At the B-scan the lesion had a maximum thickness of 4.6 mm. Subsequently, in a multidisciplinary discussion, one single fraction stereotactic radiosurgery was scheduled. The prescribed dose was 27 Gy in the de-novo lesion and 24 Gy in the previously irradiated site. Stereotactic radiosurgery was performed in October 2021. Results The time interval between the 2 treatments was 15 months. Twenty months after recurrence, local tumour control was observed, and no metastases were detected on follow-up examinations. No severe acute or late toxicity was observed due to the retreatment. Conclusions Photon stereotactic radiotherapy is a feasible, acceptably tolerated modality, and it represents an eye-preserving treatment also for patients with recurrent UM unfit for BT.
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Affiliation(s)
- Concetta Laliscia
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University Hospital of Pisa, Pisa, Italy
| | - Federica Genovesi-Ebert
- Department of Ophthalmic Surgery, Division of Ophthalmic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Franco Perrone
- Department of Medical Physics, Division of Medical Physics, University Hospital of Pisa, Pisa, Italy
| | - Taiusha Fuentes
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University Hospital of Pisa, Pisa, Italy
| | - Federica Cresti
- Department of Ophthalmic Surgery, Division of Ophthalmic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Francesca Guido
- Department of Ophthalmic Surgery, Division of Ophthalmic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Maria Tripodi
- Department of Medical Physics, Division of Medical Physics, University Hospital of Pisa, Pisa, Italy
| | - Fabiola Paiar
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University Hospital of Pisa, Pisa, Italy
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Perrone F, Laliscia C, Traino AC, Tripodi M, Cresti F, Guido F, Genovesi Ebert F. An empirical approach to the definition of the target margins in eye radiosurgery. J Appl Clin Med Phys 2023:e13982. [PMID: 37401002 PMCID: PMC10402678 DOI: 10.1002/acm2.13982] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/10/2023] [Accepted: 03/20/2023] [Indexed: 07/05/2023] Open
Abstract
INTRODUCTION A system for stabilizing and monitoring eye movements during LINAC-based photon beam one single fraction stereotactic radiotherapy was developed at our Institution. This study aimed to describe the feasibility and the efficacy of our noninvasive optical localization system that was developed, tested, and applied in 20 patients treated for uveal melanoma. METHODS Our system consisted of a customized thermoplastic mask to immobilize the head, a gaze fixation LED, and a digital micro-camera. The localization procedure, which required the active collaboration of the patient, served to monitor the eye movements during all phases of the treatment, starting from the planning computed tomography up to the administration of radiotherapy, and allowed the operators to suspend the procedure and to interact with the patient in case of large movements of the pupil. RESULTS Twenty patients were treated with stereotactic radiosurgery (27 Gy in one fraction) for primary uveal melanoma. All patients showed a good tolerance to the treatment; until now, all patients were in local control during the follow up and one died for distant progression 6 months after radiosurgery. CONCLUSIONS This study showed that this noninvasive technique, based on eye position control, is appropriate and can contribute to the success of LINAC-based stereotactic radiotherapy. A millimetric safety margin to the clinical target volume was adequate to take account for the organ movement. All patients treated till now showed a good local control; failures in the disease control were due to metastatic spread.
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Affiliation(s)
- Franco Perrone
- Health Physics Division, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Concetta Laliscia
- Radiation Oncology Division, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Antonio C Traino
- Health Physics Division, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Maria Tripodi
- Health Physics Division, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
- Casa di Cura "S. Rossore,", Radiation Oncology Unit, viale delle Cascine, Pisa, Italy
| | - Federica Cresti
- Ophthalmic Surgery Division, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Francesca Guido
- Ophthalmic Surgery Division, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Gadducci A, Simonetti E, Cosio S, Fanucchi A, Dolci V, Laliscia C, Naccarato AG, Pistolesi S. Positive p16 Immunostaining Is an Independent Prognostic Variable for Disease-free Survival and Overall Survival in Patients With Squamous Cell Carcinoma of the Vulva Treated With Radical Surgery and Inguinofemoral Lymphadenectomy: An Italian Single Center Retrospective Study. Anticancer Res 2023; 43:1643-1648. [PMID: 36974801 DOI: 10.21873/anticanres.16315] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND/AIM The expression of the cyclin-dependent kinase inhibitor p16 correlates with the presence of human papillomavirus. The purpose of this investigation was to assess the prognostic relevance of p16 expression in patients with vulvar squamous cell carcinoma (VSCC) treated with radical surgery followed by adjuvant (chemo) radiation in selected cases. PATIENTS AND METHODS Seventy-eight patients were analyzed retrospectively. RESULTS Positive p16 immunostaining was detected in 19 (24.4%) patients. Five-year disease-free survival (DFS) and 5-year overall survival (OS) were better in p16-positive compared to p16-negative patients (83.9% versus 37.3% p=0.002 and 91.7% versus 57.6%, p=0.003, respectively). p16 expression retained prognostic relevance at multivariate analysis for both DFS and OS. CONCLUSION p16 expression was detected in 24.4% of patients with VSCC and was found to be an independent prognostic variable for both DFS and OS.
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Affiliation(s)
- Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy;
| | - Enrico Simonetti
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Stefania Cosio
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Antonio Fanucchi
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Valentina Dolci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Concetta Laliscia
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Antonio Giuseppe Naccarato
- Department of New Technologies and Translational Research, Division of Pathology, University of Pisa, Pisa, Italy
| | - Sabina Pistolesi
- Department of New Technologies and Translational Research, Division of Pathology, University of Pisa, Pisa, Italy
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Laliscia C, Gadducci A, Coccia N, Mattioni R, Fuentes T, Caretto M, Pistolesi S, Puccini P, Perrone F, Morganti R, Paiar F. Lymph-vascular Space Involvement and/or p53 Overexpression Correlated With the Clinical Outcome of Early-stage Endometrial Cancer Patients Treated With Adjuvant Vaginal Brachytherapy. Anticancer Res 2023; 43:149-156. [PMID: 36585177 DOI: 10.21873/anticanres.16144] [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: 09/18/2022] [Revised: 10/20/2022] [Accepted: 11/29/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIM The majority of patients with endometrial cancer (EC) are diagnosed at an early stage and undergo primary surgery, followed by observation or adjuvant therapy according to risk factors on surgical samples. The objective of this study was to assess the correlation between a risk profile represented by the presence of substantial lymph-vascular space involvement (LVSI) and/or p53 overexpression and the clinical outcome of patients with early-stage endometrial cancer (EC) who received adjuvant vaginal brachytherapy (BT). PATIENTS AND METHODS This investigation assessed 79 patients who underwent hysterectomy, bilateral salpingo-oophorectomy, and pelvic and/o aortic lymphadenectomy or sentinel lymph node biopsy followed by hypofractionated (HDR)-vaginal BT, using 192Ir source, for stage I-II endometrioid (n=70) or non-endometrioid (n=9) EC. Thirty-four patients (43.0%) were considered to have an unfavorable risk profile defined by the presence of substantial LVSI and /or p53 overexpression. RESULTS Five-year disease-free survival (DFS) and five-year overall survival (OS) were 93.7% and 95%, respectively. There was a significant correlation between unfavorable risk-profile and pelvic recurrence rate (p=0.002) and distant recurrence rate (p=0.017). Patients with abnormal p53 had a higher risk of local relapse (p=0.041). Substantial LVSI was strongly associated with pelvic recurrence (p=0.001) and distant metastasis (p<0.001). CONCLUSION The presence of substantial LVSI and/or p53 overexpression strictly correlated with poor outcome of patients with early-stage EC and should be taken into consideration for better planning adjuvant treatment in this clinical setting.
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Affiliation(s)
- Concetta Laliscia
- Division of Radiation Oncology, Department of New Technologies and Translational Research, University of Pisa, Pisa, Italy;
| | - Angiolo Gadducci
- Division of Gynecology and Obstetrics, Department of Experimental and Clinical Medicine, University of Pisa, Pisa, Italy
| | - Natalina Coccia
- Division of Radiation Oncology, Department of New Technologies and Translational Research, University of Pisa, Pisa, Italy
| | - Roberto Mattioni
- Division of Radiation Oncology, Department of New Technologies and Translational Research, University of Pisa, Pisa, Italy
| | - Taiusha Fuentes
- Division of Radiation Oncology, Department of New Technologies and Translational Research, University of Pisa, Pisa, Italy
| | - Marta Caretto
- Division of Gynecology and Obstetrics, Department of Experimental and Clinical Medicine, University of Pisa, Pisa, Italy
| | - Sabina Pistolesi
- Division of Pathology, Department of New Technologies and Translational Research, University of Pisa, Pisa, Italy
| | - Paola Puccini
- Division of Radiation Oncology, Department of New Technologies and Translational Research, University of Pisa, Pisa, Italy
| | - Franco Perrone
- Medical Physics Department, University of Pisa, Pisa, Italy
| | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy
| | - Fabiola Paiar
- Division of Radiation Oncology, Department of New Technologies and Translational Research, University of Pisa, Pisa, Italy
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Macchia G, Casà C, Ferioli M, Lancellotta V, Pezzulla D, Pappalardi B, Laliscia C, Ippolito E, Di Muzio J, Huscher A, Tortoreto F, Boccardi M, Lazzari R, De Iaco P, Raspagliesi F, Gadducci A, Garganese G, Ferrandina G, Morganti AG, Tagliaferri L. Observational multicenter Italian study on vulvar cancer adjuvant radiotherapy (OLDLADY 1.2): a cooperation among AIRO Gyn, MITO and MaNGO groups. Radiol Med 2022; 127:1292-1302. [DOI: 10.1007/s11547-022-01538-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/28/2022] [Indexed: 12/01/2022]
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Laliscia C, Genovesi-Ebert F, Perrone F, Guido F, Cresti F, Fuentes T, Coccia N, Mattioni R, Morganti R, Paiar F. Photon-based High-dose Single-fraction Radiosurgery, an Effective Treatment Modality for Large and Posterior Uveal Melanoma. Anticancer Res 2022; 42:1965-1972. [PMID: 35347016 DOI: 10.21873/anticanres.15674] [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: 01/27/2022] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Uveal melanoma (UM) is the most common primary intraocular malignant tumor. This malignancy is frequently treated using brachytherapy, stereotactic radiotherapy, or proton therapy. The objective of this study was to assess the role of stereotactic radiosurgery in the treatment of large and posterior UM. PATIENTS AND METHODS From January 2014 to July 2021, we treated 65 patients (median age=71 years; range=31-89 years) affected by UM. Inclusion criteria were Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≤2, life expectancy >6 months, tumor thickness >10 mm, diameter >16 mm or posterior UM. The treatment was delivered with a True Beam™ LINAC with arc modulation technique. All patients received 27 Gy in one fraction (biological effective dose ≈100 Gy, assuming an α/β of 10). RESULTS The median follow-up was 36 (range=3-90) months. Acute toxicities were reported in 14 patients, whereas late toxicity occurred in 45 (69.2%). Fifteen patients (23.0%) underwent enucleation: eight (12.3%) for failure of local control and seven (10.7%) for late treatment co-morbidities. The 5-year local control, and progression-free, metastasis-free, enucleation-free, and overall survival rates were 80%, 43%, 62%, 65% and 56%, respectively. In multivariate analysis, tumor dimensions significantly influenced survival [larger basal diameter: progression-free [hazard ratio (HR)=2.42] and overall (HR=2.61) survival; greater thickness: overall survival (HR=2.36)]. In multivariate analysis, patients without local control had a higher risk of distant metastasis (HR=3.25). CONCLUSION Stereotactic radiosurgery offers an effective and safe approach for selected cases of UM due to the satisfactory results in terms of local control, eye conservation and survival.
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Affiliation(s)
- Concetta Laliscia
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University Hospital of Pisa, Pisa, Italy;
| | - Federica Genovesi-Ebert
- Department of Ophthalmic Surgery, Division of Ophthalmic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Franco Perrone
- Department of Medical Physics, Division of Medical Physics, University Hospital of Pisa, Pisa, Italy
| | - Francesca Guido
- Department of Ophthalmic Surgery, Division of Ophthalmic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Federica Cresti
- Department of Ophthalmic Surgery, Division of Ophthalmic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Taiusha Fuentes
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University Hospital of Pisa, Pisa, Italy
| | - Natalina Coccia
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University Hospital of Pisa, Pisa, Italy
| | - Roberto Mattioni
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University Hospital of Pisa, Pisa, Italy
| | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy
| | - Fabiola Paiar
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University Hospital of Pisa, Pisa, Italy
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Macchia G, Nardangeli A, Laliscia C, Fodor A, Draghini L, Gentile PC, D’Agostino GR, Balcet V, Bonome P, Ferioli M, Autorino R, Vicenzi L, Raguso A, Borghesi S, Ippolito E, Di Cataldo V, Cilla S, Perrucci E, Campitelli M, Gambacorta MA, Deodato F, Scambia G, Ferrandina G. Stereotactic body radiotherapy in oligometastatic cervical cancer (MITO-RT2/RAD study): a collaboration of MITO, AIRO GYN, and MaNGO groups. Int J Gynecol Cancer 2022; 32:732-739. [DOI: 10.1136/ijgc-2021-003237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ObjectiveThis retrospective, multicenter study analyzes the efficacy and safety of stereotactic body radiotherapy in a large cohort of patients with oligometastatic/persistent/recurrent cervical cancer.MethodsA standardized data collection from several radiotherapy centers that treated patients by stereotactic body radiotherapy between March 2006 and February 2021 was set up. Clinical and stereotactic body radiotherapy parameters were collected. Objective response rate was defined as a composite of complete and partial response, while clinical benefit included objective response rate plus stable disease. Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer and Common Terminology Criteria for Adverse Events scales were used to grade toxicities. The primary endpoints were the rate of complete response to stereotactic body radiotherapy, and the 2 year actuarial local control rate on a ‘per lesion’ basis. The secondary end points were progression-free survival and overall survival, as well as toxicity.ResultsA total of 83 patients with oligometastatic/persistent/recurrent cervical cancer bearing 125 lesions treated by stereotactic body radiotherapy at 15 different centers were selected for analysis. Of the sites of metastatic disease, lymph node metastases were most common (55.2%), followed by parenchyma lesions (44.8%). Median total dose was 35 Gy (range 10–60), in five fractions (range 1–10), with a median dose/fraction of 7 Gy (range 4–26). Complete, partial, and stable response were found in 73 (58.4%), 29 (23.2%), and 16 (12.8%) lesions, respectively, reaching 94.4% of the clinical benefit rate. Forty-six (55.4%) patients had a complete response. Patients achieving complete response on a ‘per lesion’ basis experienced a 2 year actuarial local control rate of 89.0% versus 22.1% in lesions not achieving complete response (p<0.001). The 2 year actuarial progression-free survival rate was 42.5% in patients with complete response versus 7.8% in patients with partial response or stable or progressive disease (p=0.001). The 2 year actuarial overall survival rate was 68.9% in patients with complete response versus 44.3% in patients with partial response or stable or progressive disease (p=0.015). Fifteen patients (18.1%) had mild acute toxicity, totaling 29 side events. Late toxicity was documented in four patients (4.8%) totaling seven adverse events.ConclusionOur analysis confirmed the efficacy of stereotactic body radiotherapy in oligometastatic/persistent/recurrent cervical cancer patients. The low toxicity profile encourages the wider use of stereotactic body radiotherapy in this setting.
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Laliscia C, Coccia N, Fuentes T, Perrone F, Paiar F. Two different sizes of Valencia applicators in non-melanoma skin cancer treatment with iridium-192 high-dose-rate brachytherapy. J Contemp Brachytherapy 2021; 13:615-619. [PMID: 35079246 PMCID: PMC8782077 DOI: 10.5114/jcb.2021.112111] [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] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of this retrospective study was to analyze tumor control, toxicity, and aesthetic outcome of patients affected by non-melanoma skin cancer (NMSC) and treated with iridium-192 (192Ir) high-dose-rate (HDR) brachytherapy (BT) using Valencia applicators at the Division of Radiotherapy, University of Pisa. MATERIAL AND METHODS From June 2015 to December 2020, 95 NMSC patients, including 61.5% basal cell carcinoma and 38.5% squamous cell carcinoma patients, with median age of 83 years (range, 32-96 years) were treated. In total, 182 lesions with a diameter ≤ 25 mm (median, 12 mm) and a depth ≤ 4 mm, located in scalp (19.2%), face (20.9%), chest (8.8%), nose (16.5%), ear (15.4%), and extremities (19.2%) were analyzed. All lesions were treated with 192Ir-based HDR afterloader using Valencia applicators. 105 lesions (57.7%) were treated with applicator of 20 mm and 77 lesions (42.3%) with applicator of 30 mm in diameter, depending on the size of lesions. Prescribed dose was 40 Gy in 8 fractions (5 Gy/fraction) delivered 2-3 times a week. Biological effective dose (BED) was ≈ 60 Gy. RESULTS The median follow-up was 14 months (range, 3-59 months). The 2-year local control rate was 96%. According to common terminology criteria for adverse events (CTCAE v. 5.0), G1-G2 acute toxicities included dermatitis (22.0%) and pain (8.2%). The most common G1 late toxicities were hypopigmentation (27.5%) and fibrosis (8.2%), and G2 late toxicity included ulceration (0.5%). No G3 or higher acute or late toxicities were reported. Excellent cosmetic results were observed in 77.5% of the lesions, with one only (0.5%) reported as a poor cosmetic result (ulceration refractory to therapy). CONCLUSIONS HDR-BT using Valencia applicators is a safe, effective, and well-tolerated treatment modality for NMSC, and can be considered a good alternative for treatment, especially in elderly patients who are often unfit for surgery.
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Affiliation(s)
- Concetta Laliscia
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Natalina Coccia
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Taiusha Fuentes
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Franco Perrone
- Medical Physics Department, University of Pisa, Pisa, Italy
| | - Fabiola Paiar
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University of Pisa, Pisa, Italy
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Pasqualetti F, Sainato A, Morganti R, Laliscia C, Vasile E, Gonnelli A, Montrone S, Gadducci G, Giannini N, Coccia N, Fuentes T, Zanotti S, Falconi M, Paiar F. Adjuvant Radiotherapy in Patients With Pancreatic Adenocarcinoma. Is It Still Appealing in Clinical Trials? A Meta-analysis and Review of the Literature. Anticancer Res 2021; 41:4697-4704. [PMID: 34593417 DOI: 10.21873/anticanres.15283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/08/2021] [Revised: 08/06/2021] [Accepted: 09/02/2021] [Indexed: 11/10/2022]
Abstract
AIM Pancreatic adenocarcinoma is a life-threatening disease with a rising frequency and the fourth leading cause of cancer death. This review aimed to assess the impact of postoperative radiotherapy through a meta-analysis of prospective randomized studies. MATERIALS AND METHODS Six studies met the inclusion criteria and were analyzed to calculate the cumulative risk of death (hazard ratio) in patients affected by pancreatic cancer treated with or without radiotherapy. Higgins' index was used to determine heterogeneity in between-study variability and, subsequently, the random-effects model was applied according to DerSimonian and Laird. RESULTS Eight hundred and thirty-seven patients were analyzed (418 in the control arm and 419 in the treatment one), the hazard ratio for death after randomization was 0.92 (p=0.560, 95% confidence interval=0.70-1.22). When scrutinizing these studies, only one out of six showed a statistically significant benefit due to the addition of radiotherapy in the postoperative setting. CONCLUSION We conclude that the use of adjuvant radiotherapy is not beneficial in treating all patients affected by pancreatic cancer but only for a subset of cases with potential residual local disease.
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Affiliation(s)
- Francesco Pasqualetti
- Department of Oncology, University of Oxford, Oxford, U.K.;
- Unit of Radiation Oncology, Pisa University Hospital, Pisa, Italy
| | - Aldo Sainato
- Unit of Radiation Oncology, Pisa University Hospital, Pisa, Italy
| | - Riccardo Morganti
- Unit of Section of Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Enrico Vasile
- Unit of Medical Oncology, Pisa University Hospital, Pisa, Italy
| | | | - Sabrina Montrone
- Unit of Radiation Oncology, Pisa University Hospital, Pisa, Italy
| | | | - Noemi Giannini
- Unit of Radiation Oncology, Pisa University Hospital, Pisa, Italy
| | - Natalina Coccia
- Unit of Radiation Oncology, Pisa University Hospital, Pisa, Italy
| | - Taiusha Fuentes
- Unit of Radiation Oncology, Pisa University Hospital, Pisa, Italy
| | - Sofia Zanotti
- Anatomic Pathology Unit, IRCCS Humanitas University Research Hospital, Milan, Italy
| | - Massimo Falconi
- Division of Pancreatic Surgery, Department of Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabiola Paiar
- Unit of Radiation Oncology, Pisa University Hospital, Pisa, Italy
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Casà C, Macchia G, Ferioli M, Lancellotta V, Boccardi M, Cerrotta A, Tortoreto F, Ippolito E, Laliscia C, Huscher A, Di Muzio J, Morganti A, Lazzari R, Ferrandina G, Tagliaferri L. PH-0445 Preliminary results of the Italian Retrospective Study on adjuvant radiotherapy for vulvar cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07336-9] [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: 10/20/2022]
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Giannini N, Gonnelli A, Gadducci G, Montrone S, Sainato A, Manfredi B, Pasqualetti F, Laliscia C, Malfatti G, Calistri E, Morganti R, Paiar F. PO-1247 Radiochemotherapy in anal cancer, what is the optimal dose? A single istitutional experience. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07698-2] [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: 10/20/2022]
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Casà C, Tagliaferri L, Ferioli M, Lancellotta V, Boccardi M, Cerrotta A, Tortoreto F, Ippolito E, Laliscia C, Huscher A, Gribaudo S, Morganti A, Lazzari R, Garganese G, Macchia G. OC-0297 Preliminary results of the Italian Retrospective Study on exclusive radiotherapy for vulvar cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06844-4] [Citation(s) in RCA: 1] [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: 11/24/2022]
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Laliscia C, Gadducci A, Mattioni R, Orlandi F, Giusti S, Barcellini A, Gabelloni M, Morganti R, Neri E, Paiar F. MRI-based radiomics: promise for locally advanced cervical cancer treated with a tailored integrated therapeutic approach. Tumori 2021; 108:376-385. [PMID: 34235995 DOI: 10.1177/03008916211014274] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess prognostic factors by analyzing clinical and radiomic data of patients with locally advanced cervical cancer (LACC) treated with definitive concurrent cisplatin-based chemoradiotherapy (CCRT) using magnetic resonance imaging (MRI). METHODS We analyzed radiomic features from MRI in 60 women with FIGO (International Federation of Gynecology and Obstetrics) stage IB2-IVA cervical cancer who underwent definitive CCRT 45-50.4 Gy (in 25-28 fractions). Thirty-nine (65.0%) received EBRT sequential boost (4-20 Gy) on primary tumor site and 56 (93.3%) received high-dose-rate brachytherapy boost (6-28 Gy) (daily fractions of 5-7 Gy). Moreover, 71.7% of patients received dose-dense neoadjuvant chemotherapy for 6 cycles. The gross tumor volume was defined on T2-weighted sequences and 29 features were extracted from each MRI performed before and after CCRT, using dedicated software, and their prognostic value was correlated with clinical information. RESULTS In univariate analysis, age ⩾60 years and FIGO stage IB2-IIB had significantly better progression-free survival (PFS) (p = 0.022 and p = 0.009, respectively). There was a trend for significance for worse overall survival (OS) in patients with positive nodes (p = 0.062). In multivariate analysis, only age ⩾60 years and FIGO stage IB2-IIB reached significantly better PFS (p = 0.020 and p = 0.053, respectively). In radiomic dataset, in multivariate analysis, pregray level p75 was significantly associated with PFS (p = 0.047), pre-D3D value with OS (p = 0.049), and preinformation measure of correlation value with local control (p = 0.031). CONCLUSION The combination of clinical and radiomics features can provide information to predict behavior and prognosis of LACC and to make more accurate treatment decisions.
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Affiliation(s)
- Concetta Laliscia
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Angiolo Gadducci
- Department of Experimental and Clinical Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Roberto Mattioni
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Francesca Orlandi
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Sabina Giusti
- Department of New Technologies and Translational Research, Division of Radiology, University of Pisa, Pisa, Italy
| | - Amelia Barcellini
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Michela Gabelloni
- Department of New Technologies and Translational Research, Division of Radiology, University of Pisa, Pisa, Italy
| | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy
| | - Emanuele Neri
- Department of New Technologies and Translational Research, Division of Radiology, University of Pisa, Pisa, Italy
| | - Fabiola Paiar
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University of Pisa, Pisa, Italy
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Laliscia C, Fuentes T, Coccia N, Mattioni R, Perrone F, Paiar F. High-dose-rate brachytherapy for non-melanoma skin cancer using tailored custom moulds - a single-centre experience. Contemp Oncol (Pozn) 2021; 25:12-16. [PMID: 33911976 PMCID: PMC8063903 DOI: 10.5114/wo.2021.104688] [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: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY The aim of this retrospective study was to analyse tumour control, toxicity, and aesthetic outcome of patients affected by non-melanoma skin cancer (NMSC) treated with 192 Ir high-dose-rate (HDR)-brachytherapy (BT) at the Division of Radiotherapy, University of Pisa. MATERIAL AND METHODS From January 2014 to December 2019 we treated 37 patients (median age 79 years; range 31-91 years) affected by NMSC, with the following histological subtypes: 62.2% basal cell carcinoma and 37.8% squamous cell carcinoma. We analysed 40 lesions with a depth ≤ 5 mm, located in 40.0% scalp, 17.5% nose, 25.0% face, and 17.5% ear, all treated with 192 Ir-based HDR-BT, using tailored custom moulds, with a median of 5 catheters (range, 1-9) spaced 1 cm apart. The most common fractionation scheme was 40 Gy in 8 daily fractions; the biological effective dose was 60 Gy. RESULTS The median follow-up was 25 months (range, 3-70 months). The 2-year local control rate was 90%. Common terminology criteria for adverse event (CTCAE vs. 5.0) G1 toxicities were dermatitis (52%), pain (25%), and ulceration (22%). The only G2 acute toxicities were dermatitis and ulceration. The most common G1 late toxicities were fibrosis (17%), atrophy (15%), and hypopigmentation (12%). No G3 or higher acute or late toxicity was reported. Excellent cosmetic results were observed in 65.0% of the lesions; only 1 case (2.5%) reported a poor cosmetic result. CONCLUSIONS Surface mould HDR-BT is a safe, effective, and well tolerated treatment modality for NMSC and can be considered a good alternative, especially for elderly patients who are often unfit for surgery.
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Affiliation(s)
| | - Taiusha Fuentes
- Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Natalina Coccia
- Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | | | | | - Fabiola Paiar
- Division of Radiation Oncology, University of Pisa, Pisa, Italy
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Barcellini A, Roccio M, Laliscia C, Zanellini F, Pettinato D, Valvo F, Mirandola A, Orlandi E, Gadducci A. Endometrial Cancer: When Upfront Surgery Is Not an Option. Oncology 2020; 99:65-71. [PMID: 33032278 DOI: 10.1159/000510690] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 07/03/2020] [Accepted: 08/04/2020] [Indexed: 11/19/2022]
Abstract
Background and Summary: The management of endometrial cancer, in an ever-older population with considerable comorbidity, remains a challenge for gynecological and radiation oncologists. Key Message: The present paper reviews literature data on treatment options for endometrial cancer patients unfit for surgery.
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Affiliation(s)
- Amelia Barcellini
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy,
| | - Marianna Roccio
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Concetta Laliscia
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Francesca Zanellini
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Diana Pettinato
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Alfredo Mirandola
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Ester Orlandi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
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20
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Miniati M, Conversano C, Palagini L, Buccianelli B, Fabrini M, Mancino M, Laliscia C, Marazziti D, Paiar F, Gemignani A. Bipolar Disorder Treatments and Ovarian Cancer: A Systematic Review. Clin Neuropsychiatry 2020; 17:300-313. [PMID: 34909008 PMCID: PMC8629050 DOI: 10.36131/cnfioritieditore20200508] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE We reviewed literature on drugs for bipolar disorders (BD), utilized in ovarian cancer (OC). METHOD We adhered to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines in completion of this systematic review. RESULTS We identified 73 papers. Thirty-two studies were finally included. BD is rarely diagnosed in OC patients. Limited finding from case reports is available. Drugs used to treat BD (mainly lithium and valproic acid) have been extensively studied in add-on to chemotherapy for treatment-resistant OC cells or in animal models, with promising results in vitro but not in vivo. CONCLUSIONS The clinical underestimation of BD in OC has leaded to the almost complete absence of evidences for a soundly based clinical guidance in this field. There is a urgent need for a systematic multi-disciplinary approach to OC.
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Affiliation(s)
- Mario Miniati
- Department of Clinical and Experimental Medicine, University of Pisa, 57 Via Roma, Italy,(E-MAIL:)
| | - Ciro Conversano
- Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa, 57 Via Roma, Pisa, Italy,(E-MAIL:)
| | - Laura Palagini
- Corresponding author Laura Palagini, M.D., Ph.D. Department of Clinical and Experimental Medicine, University of Pisa 57 Via Roma, Pisa, Italy E-mail:
| | | | - Mariagrazia Fabrini
- Department of Radiotherapy, University of Pisa, 57 Via Roma, Pisa, Italy,(E-MAIL:)
| | - Maricia Mancino
- Department of Radiotherapy, University of Pisa, 57 Via Roma, Pisa, Italy,(E-MAIL:)
| | - Concetta Laliscia
- Department of Radiotherapy, University of Pisa, 57 Via Roma, Pisa, Italy,(E-MAIL:)
| | | | - Fabiola Paiar
- Department of Radiotherapy, University of Pisa, 57 Via Roma, Pisa, Italy,(E-MAIL:)
| | - Angelo Gemignani
- Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa, 57 Via Roma, Pisa, Italy,(E-MAIL:)
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Barcellini A, Gadducci A, Laliscia C, Imparato S, Vitolo V, Preda L, Valvo F. Adenoid Cystic Carcinoma of Bartholin's Gland: What Is the Best Approach? Oncology 2020; 98:513-519. [PMID: 32408297 DOI: 10.1159/000506485] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 01/30/2020] [Accepted: 02/13/2020] [Indexed: 11/19/2022]
Abstract
Background and summary: Among all vulvar cancers, primary adenoid cystic carcinoma (ACC) of Bartholin's gland is a very rare tumor characterized by a slow growth, a high local aggressiveness, and a remarkable recurrence rate. Due to its rarity, treatment remains a challenge for oncologists and gynecological surgeons. Key message: The present paper reports clinical, radiological, and histological features of ACC of Bartholin's gland and reviews the literature data on the treatment options with a particular focus on the potential role of particle radiation therapy.
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Affiliation(s)
- Amelia Barcellini
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy,
| | - Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Concetta Laliscia
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Sara Imparato
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Viviana Vitolo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Lorenzo Preda
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
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Macchia G, Lazzari R, Colombo N, Laliscia C, Capelli G, D'Agostino GR, Deodato F, Maranzano E, Ippolito E, Ronchi S, Paiar F, Scorsetti M, Cilla S, Ingargiola R, Huscher A, Cerrotta AM, Fodor A, Vicenzi L, Russo D, Borghesi S, Perrucci E, Pignata S, Aristei C, Morganti AG, Scambia G, Valentini V, Jereczek-Fossa BA, Ferrandina G. A Large, Multicenter, Retrospective Study on Efficacy and Safety of Stereotactic Body Radiotherapy (SBRT) in Oligometastatic Ovarian Cancer (MITO RT1 Study): A Collaboration of MITO, AIRO GYN, and MaNGO Groups. Oncologist 2019; 25:e311-e320. [PMID: 32043791 DOI: 10.1634/theoncologist.2019-0309] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 08/23/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Recent studies have reported improvement of outcomes (progression-free survival, overall survival, and prolongation of androgen deprivation treatment-free survival) with stereotactic body radiotherapy (SBRT) in non-small cell lung cancer and prostate cancer. The aim of this retrospective, multicenter study (MITO RT-01) was to define activity and safety of SBRT in a very large, real-world data set of patients with metastatic, persistent, and recurrent ovarian cancer (MPR-OC). MATERIALS AND METHODS The endpoints of the study were the rate of complete response (CR) to SBRT and the 24-month actuarial local control (LC) rate on "per-lesion" basis. The secondary endpoints were acute and late toxicities and the 24-month actuarial late toxicity-free survival. Objective response rate (ORR) included CR and partial response (PR). Clinical benefit (CB) included ORR and stable disease (SD). Toxicity was evaluated by the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) and Common Terminology Criteria for Adverse Events (CTCAE) scales, according to center policy. Logistic and Cox regression were used for the uni- and multivariate analysis of factors predicting clinical CR and actuarial outcomes. RESULTS CR, PR, and SD were observed in 291 (65.2%), 106 (23.8%), and 33 (7.4%) lesions, giving a rate of CB of 96.4%. Patient aged ≤60 years, planning target volume (PTV) ≤18 cm3 , lymph node disease, and biologically effective dose α/β10 > 70 Gy were associated with higher chance of CR in the multivariate analysis. With a median follow-up of 22 months (range, 3-120), the 24-month actuarial LC rate was 81.9%. Achievement of CR and total dose >25 Gy were associated with better LC rate in the multivariate analysis. Mild toxicity was experienced in 54 (20.7%) patients; of 63 side effects, 48 were grade 1, and 15 were grade 2. The 24-month late toxicity-free survival rate was 95.1%. CONCLUSIONS This study confirms the activity and safety of SBRT in patients with MPR-OC and identifies clinical and treatment parameters able to predict CR and LC rate. IMPLICATIONS FOR PRACTICE This study aimed to define activity and safety of stereotactic body radiotherapy (SBRT) in a very large, real life data set of patients with metastatic, persistent, recurrent ovarian cancer (MPR-OC). Patient age <60 years, PTV <18 cm3 , lymph node disease, and biologically effective dose α/β10 >70 Gy were associated with higher chance of complete response (CR). Achievement of CR and total dose >25 Gy were associated with better local control (LC) rate. Mild toxicity was experienced in 20.7% of patients. In conclusion, this study confirms the activity and safety of SBRT in MPR-OC patients and identifies clinical and treatment parameters able to predict CR and LC rate.
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Affiliation(s)
- Gabriella Macchia
- Fondazione "Giovanni Paolo II," Unità Operativa di Radioterapia, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Roberta Lazzari
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Nicoletta Colombo
- Division of Medical Gynecologic Oncology, IEO European Institute of Oncology, IRCCS and University of Milan-Bicocca, Milan, Italy
| | - Concetta Laliscia
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Giovanni Capelli
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Italy
| | - Giuseppe Roberto D'Agostino
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Hospital, IRCSS, Rozzano, Milan, Italy
| | - Francesco Deodato
- Fondazione "Giovanni Paolo II," Unità Operativa di Radioterapia, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | | | - Edy Ippolito
- Department of Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Sara Ronchi
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Fabiola Paiar
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Marta Scorsetti
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Hospital, IRCSS, Rozzano, Milan, Italy
- Humanitas University, Department of Biomedical Sciences, Rozzano, Milano, Italy
| | - Savino Cilla
- Fondazione "Giovanni Paolo II," Unità Operativa di Fisica Medica, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Rossana Ingargiola
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Alessandra Huscher
- U.O. di Radioterapia Oncologica "Guido Berlucchi," Fondazione Poliambulanza, Brescia, Italy
| | - Anna Maria Cerrotta
- Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrei Fodor
- Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Lisa Vicenzi
- Department of Oncology and Radiotherapy, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
| | | | - Simona Borghesi
- Radiotherapy Department, Azienda USL Toscana sud est, San Donato Hospital-Arezzo, Italy
| | - Elisabetta Perrucci
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Sandro Pignata
- Istituto Nazionale Tumori di Napoli, Fondazione Pascale IRCCS, Naples, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Alessio Giuseppe Morganti
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unità Operativa Complessa Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy
- Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italy
| | - Vincenzo Valentini
- Fondazione "Giovanni Paolo II," Unità Operativa di Radioterapia, Università Cattolica del Sacro Cuore, Campobasso, Italy
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unità Operativa Complessa di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italy
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Gabriella Ferrandina
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unità Operativa Complessa Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy
- Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italy
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Laliscia C, Cosio S, Morganti R, Mazzotti V, Fabrini MG, Paiar F, Gadducci A. Patterns of Failures and Clinical Outcome of Patients with Early-Stage, High-Risk, Node-Negative Endometrial Cancer Treated with Surgery Followed by Adjuvant Platinum-Based Chemotherapy and Vaginal Brachytherapy. Oncology 2019; 96:235-241. [PMID: 30904907 DOI: 10.1159/000492430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 06/21/2018] [Accepted: 07/24/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the clinical outcome of patients with high-risk early-stage endometrial cancer and negative pelvic nodes who received adjuvant platinum-based chemotherapy plus vaginal brachytherapy (VBT). METHODS This investigation assessed 80 patients who underwent hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy for stage Ib-II, grade 2-3 endometrioid (n = 43) or stage Ia-II nonendometrioid (n = 37) endometrial cancer. RESULTS Five-year local control rate, 5-year disease-free survival, and 5-year overall survival were 97, 87, and 97%, respectively, for endometrioid carcinoma, and 66, 50, and 72%, respectively, for nonendometrioid carcinoma. CONCLUSIONS This retrospective study appears to show that adjuvant platinum-based chemotherapy plus VBT achieve very good results in endometrioid carcinoma. This combined treatment seems to be less effective in nonendometrioid carcinoma.
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Affiliation(s)
- Concetta Laliscia
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University of Pisa, Pisa, Italy,
| | - Stefania Cosio
- Department of Experimental and Clinical Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy
| | - Valentina Mazzotti
- Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy
| | - Maria Grazia Fabrini
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Fabiola Paiar
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Angiolo Gadducci
- Department of Experimental and Clinical Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
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Laliscia C, Gadducci A, Fabrini MG, Barcellini A, Parietti E, Pasqualetti F, Morganti R, Mazzotti V, Cafaro I, Paiar F. Definitive radiotherapy for recurrent vulvar carcinoma after primary surgery: a two-institutional Italian experience. Tumori 2019; 105:225-230. [DOI: 10.1177/0300891618811279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective: To assess the clinical outcome of patients treated with radiotherapy (RT) for recurrent squamous cell carcinoma of the vulva after primary surgery. Methods: Fifty-six patients developed recurrent disease after surgery, consisting of deep total vulvectomy with inguino-femoral lymphadenectomy in 44 (78.6%) and deep partial vulvectomy with inguino-femoral lymphadenectomy in 12 (21.4%). All patients underwent RT at the Divisions of Radiotherapy, University of Pisa and ASST Cremona, between 1992 and 2016. Forty-three patients (76.8%) underwent external beam RT and 13 (23.2%) were treated with exclusive high-dose rate brachytherapy. Results: Five-year progression-free survival (PFS) and overall survival (OS) were 19% and 43%, respectively. Primary tumor size ⩽4 cm, early FIGO stage, and negative lymph node status were significantly associated with better PFS ( p = .005, p = .020 and p = .036, respectively) and OS ( p < .0001, p = .023 and p = .008, respectively). Patients with more than 1 positive lymph node at primary surgery had significantly worse PFS ( p = .028) and OS ( p = .001). Patients with local recurrence had significantly better PFS and OS ( p = .022, p = .002, respectively). RT total dose >54 Gy was associated with a lower risk of recurrence. Conclusions: Primary tumor size, FIGO stage, nodal status, and site of recurrent disease were significant predictors of clinical outcome in patients treated with RT for recurrent squamous cell carcinoma of the vulva.
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Affiliation(s)
- Concetta Laliscia
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Italy
| | - Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy
| | - Maria Grazia Fabrini
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Italy
| | - Amelia Barcellini
- Department of Radiotherapy and Nuclear Medicine, Radiation Oncology ASST Cremona, Italy
| | - Emanuela Parietti
- Department of Radiotherapy and Nuclear Medicine, Radiation Oncology ASST Cremona, Italy
| | - Francesco Pasqualetti
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Italy
| | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Italy
| | - Valentina Mazzotti
- Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Italy
| | - Ines Cafaro
- Department of Radiotherapy and Nuclear Medicine, Radiation Oncology ASST Cremona, Italy
| | - Fabiola Paiar
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Italy
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Montrone S, Pasqualetti F, Morganti R, Manfredi B, Laliscia C, Gonnelli A, Orlandi F, Cristaudo A, Baldaccini D, Molinari A, Sainato A, Paiar F. EP-1496: The natural history of pulmonary micronodules evidenced at initial CT scan in pts affected by LARC. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31805-x] [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: 12/01/2022]
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26
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Gadducci A, Guerrieri ME, Cosio S, Fabrini MG, Laliscia C, Attianese D, Rossi A, Ferrero A. Rates, Sites and Times of Recurrence and Clinical Outcome of Endometrial Cancer Patients with Histologically-positive Nodes: An Italian Two-center Retrospective Study. Anticancer Res 2018; 38:1695-1703. [PMID: 29491104 DOI: 10.21873/anticanres.12403] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To assess the patterns of recurrence of node-positive endometrial cancer patients. PATIENTS AND METHODS This investigation assessed 82 patients who received different postoperative treatments. RESULTS Recurrence developed in 36 patients after a median time of 13.5 months, and involved the vagina, pelvic nodes, para-aortic nodes and distant sites in 5, 8, 16 and 17 patients, respectively. Five-year progression-free survival (PFS) and 5-year overall survival (OS) were 51.1% and 59.8%. PFS and OS were significantly better for endometrioid than for non-endometrioid tumors. There was a trend towards a better outcome for patients who underwent chemotherapy±radiotherapy compared to those who received radiotherapy alone. Among the former, there was a better 5-year PFS (65.8% versus 33.7%, p=0.038) in patients who received platinum/paclitaxel-based regimens compared to those who received platinum-based chemotherapy. CONCLUSION Disease recurred in 43.9% of patients, and platinum/paclitaxel-based chemotherapy plus radiotherapy appeared to be the best adjuvant treatment.
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Affiliation(s)
- Angiolo Gadducci
- Department of Experimental and Clinical Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Maria Elena Guerrieri
- Department of Experimental and Clinical Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Stefania Cosio
- Department of Experimental and Clinical Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Maria Grazia Fabrini
- Department of Oncology, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Concetta Laliscia
- Department of Oncology, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Daniela Attianese
- Academic Department of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, Turin, Italy
| | - Annalisa Rossi
- Division of Radiation Therapy, Mauriziano Hospital, Turin, Italy
| | - Annamaria Ferrero
- Academic Department of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, Turin, Italy
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Laliscia C, Fabrini MG, Cafaro I, Barcellini A, Baldaccini D, Miniati M, Parietti E, Morganti R, Paiar F, Gadducci A. Adjuvant Radiotherapy in High-Risk Squamous Cell Carcinoma of the Vulva: A Two-Institutional Italian Experience. Oncol Res Treat 2017; 40:778-783. [PMID: 29183034 DOI: 10.1159/000479876] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/31/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to assess the treatment benefit and patterns of recurrence for patients with high-risk vulvar squamous cell carcinoma treated with surgery followed by adjuvant radiotherapy (RT). PATIENTS AND METHODS From January 1999 to June 2016, 51 patients underwent total or partial deep vulvectomy with inguinofemoral lymphadenectomy followed by adjuvant RT with 45-50 Gy in 25 fractions +/- a 4-10 Gy boost. 17 (33.3%) women received concomitant chemotherapy. RESULTS Median overall survival was 81 months. The 5-year disease-free survival and overall survival rates were 52 and 63%, respectively. In univariate and multivariate analysis, patients aged ≤ 76 years and those receiving an RT total dose of > 54 Gy had a significantly lower risk of progression (p = 0.044 and 0.045; p = 0.012 and 0.018, respectively) and death (p = 0.015 and 0.011; p = 0.015 and 0.026, respectively). There was a trend towards a lower risk of progression for patients with tumor size ≤ 4 (p = 0.098) and negative lymphovascular space involvement (p = 0.080). Also, there was a trend towards a higher risk of death (p = 0.075) for grade 3 tumors. Concomitant chemotherapy provided no significant benefit. CONCLUSION Only age and RT total dose are significant prognostic variables for squamous cell carcinoma of the vulva treated with primary surgery and adjuvant RT to improve local and locoregional control.
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Affiliation(s)
- Concetta Laliscia
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Pisa, Italy
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Laliscia C, Gadducci A, Fabrini MG, Barcellini A, Guerrieri ME, Parietti E, Ursino S, Morganti R, Cafaro I, Paiar F. Definitive Radiotherapy for Primary Squamous Cell Carcinoma of the Vagina: Are High-Dose External Beam Radiotherapy and High-Dose-Rate Brachytherapy Boost the Best Treatment? Experience of Two Italian Institutes. Oncol Res Treat 2017; 40:697-701. [DOI: 10.1159/000480350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/15/2017] [Indexed: 11/19/2022]
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Delishaj D, Ursino S, Mazzotti V, Fatigante L, Spagnesi S, Manfredi B, Cristaudo- A, Pasqualetti F, Sainato A, Laliscia C, Pnichi M, Orlandi F, Matteucci F, Morganti R, Lombardo E, Cantarella M, Baldaccini D, Gonnelli A, Fabrini M, Molinari A, Roncella M, Falcone A, Caramella D, Paiar F. PO-0665: The role of post-mastectomy radiotherapy (PMRT) and prognostic factors of locoregional recurrence. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31102-7] [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: 10/19/2022]
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Ursino S, Fiorica F, Mazzotti V, Delishaj D, Cristaudo A, Spagnesi S, Laliscia C, Pasqualetti F, Fontana A, Ghilli M, Morganti R, Falcone A, Roncella M, Paiar F. The role of clinicopathologic and molecular prognostic factors in the post-mastectomy radiotherapy (PMRT): a retrospective analysis of 912 patients. Eur Rev Med Pharmacol Sci 2017; 21:2157-2166. [PMID: 28537668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess the association of clinicopathologic and molecular features with loco-regional recurrence (LRR) in post-mastectomy breast cancer patients with or without adjuvant radiotherapy (PMRT). PATIENTS AND METHODS We retrospectively reviewed data of patients undergone to mastectomy followed or not by PMRT between January 2004 and June 2013. The patients were divided according to clinicopathologic and molecular sub-classification features. LRR and Cancer Specific Survival (CSS) were calculated using the Kaplan-Meier method; the prognostic factors were compared using long-rank tests and Cox regression model. RESULTS A total of 912 patients underwent to mastectomy of whom 269 (29.5%) followed by PMRT and 643 (70.5%) not; among the PMRT group, 77 underwent to the chest wall (CW) and 202 to the chest wall and lymphatic drainage (CWLD) irradiation. The median follow-up was 54 months (range, 3-118). No significant difference in terms of LRR and CSS was found between non-PMRT and PMRT group (p=0.175; and p=0.628). The multivariate analysis of LRR for patients who did not undergo PMRT showed a significant correlation with the presence of extracapsular extension (ECE) (p=0.049), Ki-67>30% (p=0.048) and triple negative status (p=0.001). In the PMRT group, triple negative status resulted as the only variable significantly correlated to LRR (p=0.006) at the multivariate analysis and T-stage also showed a trend to significance (p=0.073). Finally, no difference in LRR control was shown between CW and CWLD-PMRT (p=0.078). CONCLUSIONS After mastectomy ECE, a cut off of Ki-67>30% and triple negative status were strictly correlated with LRR regardless of clinicopathologic stage. PMRT has a positive impact in decreasing LRR in patients with this molecular profile. Besides, CW might represent a valid option for patients with one to three positive nodes.
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Affiliation(s)
- S Ursino
- Department of Radiation Oncology, University Hospital S. Chiara, Pisa, Italy.
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Montrone S, Sainato A, Morganti R, Vivaldi C, Laliscia C, Manfredi B, Coraggio G, Cantarella M, Musettini G, Delishaj D, Lombardo E, Cristaudo A, Orlandi F, Masi G, Buccianti P, Falcone A, Pasqualetti F, Paiar F. EP-1282: Clinical and pathological prognostic factors in locally advanced rectal cancer (larc). Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31717-6] [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: 10/19/2022]
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Montrone S, Sainato A, Morganti R, Vivaldi C, Manfredi B, Laliscia C, Cantarella M, Coraggio G, Musettini G, Gonnelli A, Masi G, Buccianti P, Pasqualetti F, Paiar F. EP-1275: Patients with locally advanced rectal cancer (larc): predictive factors of pathological response. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31710-3] [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: 11/27/2022]
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Laliscia C, Delishaj D, Fabrini M, Manfredi B, Orlandi F, Morganti R, Perrone F, Gonnelli A, Molinari A, Gadducci A, Paiar F. The treatment of acute and late vaginal toxicity after adjuvant high dose rate [HDR] vaginal brachytherapy in patients with intermediate risk endometrial cancer: Is local therapy with hyaluronic acid of clinical benefit? Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30386-6] [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: 10/20/2022]
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Pasqualetti F, Montrone S, Vivaldi C, Zani M, Fedele D, Fornaro L, Pasqualetti G, Salvatore L, Manfredi B, Laliscia C, Coraggio G, Gonnelli A, Loupakis F, Masi G, Sainato A, Monzani F, Falcone A, Paiar F. Stereotactic Body Radiotherapy in Patients with Lung Oligometastases from Colorectal Cancer. Anticancer Res 2017; 37:315-319. [PMID: 28011508 DOI: 10.21873/anticanres.11323] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 09/05/2016] [Revised: 09/29/2016] [Accepted: 11/21/2016] [Indexed: 11/10/2022]
Abstract
AIM To assess the role of stereotactic body radiotherapy (SBRT) in pulmonary metastases from colorectal cancer (CRC). PATIENTS AND METHODS Thirty-three consecutive patients with pulmonary metastases from CRC who received SBRT were included in the analysis. The primary endpoints were local and systemic progression-free survival, a secondary endpoint was the safety profile of SBRT. RESULTS A total of 56 lesions were treated with SBRT. A single nodule was treated in 15 patients, two in 13 and three in five. The radiotherapy dose and the adopted fractionations were 24-27 Gy as a single fraction for 40 lesions and 27-42 Gy in three fractions (2-3 times a week) for the other 16 lesions. After a median follow-up of 22.8 months (range=1.3-45.7 months), the median progression-free survival of the irradiated sites was 13.4 months. CONCLUSION SBRT can be considered as local therapy in patients with lung metastases from CRC.
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Affiliation(s)
- Francesco Pasqualetti
- Department of Clinical and Translational Sciences, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Sabrina Montrone
- Department of Clinical and Translational Sciences, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Caterina Vivaldi
- Department of Clinical and Translational Sciences, Division of Medical Oncology, University of Pisa, Pisa, Italy
| | - Margherita Zani
- Casa di Cura San Rossore, Division of Radiation Oncology, Pisa, Italy
| | - David Fedele
- Casa di Cura San Rossore, Division of Radiation Oncology, Pisa, Italy
| | - Lorenzo Fornaro
- Department of Clinical and Translational Sciences, Division of Medical Oncology, University of Pisa, Pisa, Italy
| | - Giuseppe Pasqualetti
- Department of Experimental and Clinical Medicine, Division of Geriatric Unit, University of Pisa, Pisa, Italy
| | - Lisa Salvatore
- Department of Clinical and Translational Sciences, Division of Medical Oncology, University of Pisa, Pisa, Italy
| | - Bruno Manfredi
- Department of Clinical and Translational Sciences, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Concetta Laliscia
- Department of Clinical and Translational Sciences, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Gabriele Coraggio
- Department of Clinical and Translational Sciences, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Alessandra Gonnelli
- Department of Clinical and Translational Sciences, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Fotios Loupakis
- Department of Clinical and Translational Sciences, Division of Medical Oncology, University of Pisa, Pisa, Italy
| | - Gianluca Masi
- Department of Clinical and Translational Sciences, Division of Medical Oncology, University of Pisa, Pisa, Italy
| | - Aldo Sainato
- Department of Clinical and Translational Sciences, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Fabio Monzani
- Department of Experimental and Clinical Medicine, Division of Geriatric Unit, University of Pisa, Pisa, Italy
| | - Alfredo Falcone
- Department of Clinical and Translational Sciences, Division of Medical Oncology, University of Pisa, Pisa, Italy
| | - Fabiola Paiar
- Department of Clinical and Translational Sciences, Division of Radiation Oncology, University of Pisa, Pisa, Italy
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Delishaj D, Rembielak A, Manfredi B, Ursino S, Pasqualetti F, Laliscia C, Orlandi F, Morganti R, Fabrini MG, Paiar F. Non-melanoma skin cancer treated with high-dose-rate brachytherapy: a review of literature. J Contemp Brachytherapy 2016; 8:533-540. [PMID: 28115960 PMCID: PMC5241375 DOI: 10.5114/jcb.2016.64112] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [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: 08/28/2016] [Accepted: 11/01/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The incidence of non-melanoma skin cancer (NMSC) has been increasing over the past 30 years. There are different treatment options and surgical excision is the most frequent treatment due to its low rates of recurrence. Radiotherapy is an effective alternative of surgery, and brachytherapy (BT) might be a better therapeutic option due to high radiation dose concentration to the tumor with rapid dose fall-off resulting in normal tissues sparing. The aim of this review was to evaluate the local control, toxicity, and cosmetic outcomes in NMSC treated with high-dose-rate BT (HDR-BT). MATERIAL AND METHODS In May 2016, a systematic search of bibliographic database of PubMed, Web of Science, Scopus, and Cochrane Library with a combination of key words of "skin cancer", "high dose rate brachytherapy", "squamous cell carcinoma", "basal cell carcinoma", and "non melanoma skin cancer" was performed. In this systematic review, we included randomized trials, non-randomized trials, prospective and retrospective studies in patients affected by NMSC treated with HDR-BT. RESULTS Our searches generated a total of 85 results, and through a process of screening, 10 publications were selected for the review. Brachytherapy was well tolerated with acceptable toxicity and high local control rates (median: 97%). Cosmetic outcome was reported in seven study and consisted in an excellent and good cosmetic results in 94.8% of cases. CONCLUSIONS Based on the review data, we can conclude that the treatment of NMSC with HDR-BT is effective with excellent and good cosmetics results, even in elderly patients. The hypofractionated course appears effective with very good local disease control. More data with large-scale randomized controlled trials are needed to assess the efficacy and safety of brachytherapy.
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Affiliation(s)
- Durim Delishaj
- Department of Translational Medicine, Division of Radiation Oncology – University of Pisa, Pisa, Italy
| | - Agata Rembielak
- Clinical Oncologist, The Christie NHS Foundation Trust, Manchester, M20 4BX, United Kingdom
| | - Bruno Manfredi
- Department of Translational Medicine, Division of Radiation Oncology – University of Pisa, Pisa, Italy
| | - Stefano Ursino
- Department of Translational Medicine, Division of Radiation Oncology – University of Pisa, Pisa, Italy
| | - Francesco Pasqualetti
- Department of Translational Medicine, Division of Radiation Oncology – University of Pisa, Pisa, Italy
| | - Concetta Laliscia
- Department of Translational Medicine, Division of Radiation Oncology – University of Pisa, Pisa, Italy
| | - Francesca Orlandi
- Department of Translational Medicine, Division of Radiation Oncology – University of Pisa, Pisa, Italy
| | - Riccardo Morganti
- Department of Experimental and Clinical Medicine, Section of Statistics – University of Pisa, Pisa, Italy
| | - Maria Grazia Fabrini
- Department of Translational Medicine, Division of Radiation Oncology – University of Pisa, Pisa, Italy
| | - Fabiola Paiar
- Department of Translational Medicine, Division of Radiation Oncology – University of Pisa, Pisa, Italy
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Laliscia C, Fabrini MG, Delishaj D, Coraggio G, Morganti R, Tana R, Paiar F, Gadducci A. Concomitant External-beam Irradiation and Chemotherapy Followed by High-dose Rate Brachytherapy Boost in the Treatment of Squamous Cell Carcinoma of the Vagina: A Single-Center Retrospective Study. Anticancer Res 2016; 36:1885-1889. [PMID: 27069175] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/23/2016] [Indexed: 06/05/2023]
Abstract
AIM To assess the outcome of 35 patients with vaginal carcinoma treated with different radiotherapy modalities. MATERIALS AND METHODS Thirty-one patients received external-beam irradiation (EBRT) to the entire vagina, para-vaginal area and pelvic nodes (total dose=45-50.4 Gy). Concomitant chemotherapy was used in 22 patients. Nineteen patients received additional 15-25 Gy high-dose-rate brachytherapy (BT) boost and eight received additional EBRT boost to the primary tumor site. Four women received exclusive 30-40 Gy high-dose-rate BT. RESULTS Median progression-free survival and median overall survival were 22 months and 89 months, respectively. Age <70 years, use of EBRT plus BT, and concomitant chemotherapy were associated with better progression-free (p=0.002, p=0.007, and p=0.02) and overall (p=0.01, p=0.009, p=0.009) survival. CONCLUSION Concomitant EBRT and chemotherapy followed by BT is the best treatment for vaginal carcinoma.
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Affiliation(s)
- Concetta Laliscia
- Division of Radiation Oncology, Department of Translation Medicine, University of Pisa, Pisa, Italy
| | - Maria Grazia Fabrini
- Division of Radiation Oncology, Department of Translation Medicine, University of Pisa, Pisa, Italy
| | - Durim Delishaj
- Division of Radiation Oncology, Department of Translation Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Coraggio
- Division of Radiation Oncology, Department of Translation Medicine, University of Pisa, Pisa, Italy
| | - Riccardo Morganti
- Section of Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Roberta Tana
- Division of Gynecology and Obstetrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabiola Paiar
- Division of Radiation Oncology, Department of Translation Medicine, University of Pisa, Pisa, Italy
| | - Angiolo Gadducci
- Division of Gynecology and Obstetrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Montrone S, Vivaldi C, Coraggio G, Cantarella M, Manfredi B, Laliscia C, Masi G, Loupakis F, Falcone A, Fabrini M, Sainato A, Pasqualetti F. EP-1298: Stereotactic radiotherapy in oligometastatic patients with lung metastasis from colon-rectal cancer. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32548-8] [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: 10/21/2022]
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Vivaldi C, Sainato A, Lonardi S, Buccianti P, Marcucci L, Di Clemente F, Musettini G, Montrone S, Bergamo F, Franceschi M, Ginocchi L, Martignetti A, Laliscia C, Battaglin F, Urbani L, Manfredi B, Rumano' L, Sidoti F, Falcone A, Masi G. Induction treatment with FOLFOXIRI + bevacizumab (BV) followed by chemo-radiotherapy (CRT) + BV and surgery in locally advanced rectal carcinoma (LARC): The phase II TRUST trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.673] [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
673 Background: Induction chemotherapy (CT) is a promising option in LARC. FOLFOXIRI + BV is an effective treatment in metastatic colorectal cancer. Methods: Patients (pts) with LARC at < 12 cm from the anal verge, N+ or cT4 or high risk cT3 (MRI criteria) underwent 6 cycles of FOLFOXIRI + BV followed by CRT (50.4 Gy + 5FU 225 mg/m2/day or capecitabine 800 mg/m2/bid 5 days/week + BV 5 mg/kg on days 1, 15, 28). Surgery was planned 8 weeks after CRT. Primary endpoint is 2-year disease-free survival (DFS). Results: From April 2012 to April 2015 48 pts were enrolled. At now, 46 pts completed induction CT, 43 completed CRT and 39 underwent surgery (5 pts ongoing). Pts characteristics were: median age, 53 years (range 30-74); cT2/cT3/cT4, 4%/60%/36%; cN0/N+, 4%/96%. Main grade (G) 3/4 toxicities during induction were neutropenia (42%), febrile neutropenia (4.2%), diarrhea (12.5. Two pts did not complete induction: one died due to bowel perforation and sepsis and one discontinued CT after acute kidney injury. Response rate (RR) after induction was 77%. Forty-five pts started CRT (1 pts underwent surgery after induction because of SAE). After the first 13 patients, protocol was amended and schedule of capecitabine modified due to an excessive rate of G3 toxicities during CRT: hand-foot syndrome (23%), proctalgia (23%), proctitis (23%) and diarrhea (15%). After amendment all pts completed CRT with acceptable toxicity: G3 proctitis 6.7% and proctalgia 3.3%. One pts died due to early progressive disease (PD) after CRT. RR after CRT was 88%. Surgery was low anterior resection 87%, abdomino-perineal resection 8%, other 5%. Radical resection was achieved in 95% of pts. Early post-surgical complication rate was 31%. Pathologic complete response was reached in 33% and pathological downstaging in 44% of pts. At a median follow up of 17 months, 8 pts had PD and estimated 2y-DFS is 72%. Conclusions: Induction CT with FOLFOXIRI + BV is feasible and highly active. A protocol amendment was needed due to toxicities during CRT. The rate of early post-surgical complications is not negligible. A longer follow up is needed for DFS. Clinical trial information: 2011-003340-45.
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Affiliation(s)
| | - Aldo Sainato
- U.O. Radioterapia, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Sara Lonardi
- Dipartimento di Oncologia Clinica e Sperimentale, UOC Oncologia Medica I, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - Piero Buccianti
- U.O. Chirurgia Generale, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | | | - Gianna Musettini
- U.O. Oncologia Medica II, Universitaria Ospedale S. Chiara, Azienda Ospedaliero-Universitaria Pisana Istituto Toscano Tumori, Pisa, Italy
| | - Sabrina Montrone
- U.O. Radioterapia, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesca Bergamo
- U.O.C. Oncologia Medica I, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Matteo Franceschi
- U.O. Chirurgia Generale, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | | | - Concetta Laliscia
- U.O. Radioterapia, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesca Battaglin
- Dipartimento di Oncologia Clinica e Sperimentale, UOC Oncologia Medica I, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - Lucio Urbani
- U.O. Chirurgia Generale, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Bruno Manfredi
- U.O. Radioterapia, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Laura Rumano'
- Dipartimento di Oncologia Clinica e Sperimentale, UOC Oncologia Medica I, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - Francesco Sidoti
- U.O. Chirurgia Generale, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Gianluca Masi
- U.O. Oncologia Medica II, Azienda Ospedaliero-Universitaria Pisana Istituto Toscano Tumori, Pisa, Italy
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Laliscia C, Gadducci A, Montrone S, Tana R, Morganti R, Fabrini MG. Radiotherapy as Definitive Treatment of Patients with Primary Vulvar Carcinoma Unfit for Surgery and with Recurrent Vulvar Carcinoma After Primary Radical Surgery: Results of a Retrospective Single-center Study. Anticancer Res 2016; 36:387-391. [PMID: 26722070] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM To assess the outcome of patients with vulvar carcinoma unfit for surgery treated with radiotherapy for primary disease and for those with recurrent disease after primary surgery. PATIENTS AND METHODS The study was conducted on 16 patients with primary disease and 31 with recurrent disease. RESULTS An objective response and long-term control were obtained in 43.8% and 18.8% of patients with primary carcinoma. Median survival after primary radiotherapy was 15 months. An objective response and long-term control were achieved in 100% and 20% of the 15 patients with local recurrence. Only two out of the 13 patients with groin recurrence were recovered by salvage treatment, and all three patients with distant recurrence died of their disease. Median survival after relapse in the 31 patients was 33 months. CONCLUSION Radiotherapy achieves unsatisfactory results in patients with primary vulvar carcinoma who are unfit for surgery as well as in those with recurrent disease after surgery.
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Affiliation(s)
- Concetta Laliscia
- Department of Translational Medicine, Division of Radiation Oncology, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Angiolo Gadducci
- Department of Experimental and Clinical Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Sabrina Montrone
- Department of Translational Medicine, Division of Radiation Oncology, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Roberta Tana
- Department of Experimental and Clinical Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Riccardo Morganti
- Department of Translational Medicine, Division of Radiation Oncology, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Maria Grazia Fabrini
- Department of Translational Medicine, Division of Radiation Oncology, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
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Delishaj D, Ursino S, Pasqualetti F, Pesaresi I, Desideri I, Cosottini M, Laliscia C, Paiar F, Fabrini MG. The Effectiveness of Bevacizumab in Radionecrosis After Radiosurgery of a Single Brain Metastasis. Rare Tumors 2015; 7:6018. [PMID: 26788278 PMCID: PMC4703924 DOI: 10.4081/rt.2015.6018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 05/16/2015] [Revised: 07/26/2015] [Accepted: 07/29/2015] [Indexed: 11/22/2022] Open
Abstract
Radionecrosis (RN) of brain tissue is a serious late complication of brain irradiation and historically has been treated with corticos-teroid therapy and alternatively surgical decompression. Recently, bevacizumab has been suggested for treatment of cerebral radiation necrosis. We present a case of a 73-years-old women affected by a primary non-small cell lung cancer with a single brain metastasis treated with radiosurgery. Two years after radiosurgery the patient referred neurological symptoms and a brain magnetic resonance confirmed the presence of RN. The patient refused surgical decompression so underwent at the treatment with bevacizumab 7.5 mg/kg/2 weeks for a total of 4 cycles. After two months of treatment the patient reported strumental and clinical improvement. Ten months after bevacizumab discontinuation the patient experienced a recurrence of RN with evident clinical manifestation and confirmed by radiological imaging. A new treatment with bevacizumab was not performed due to the systemic progression disease and the worsening of clinical status. Despite limited to only one clinical case, our study suggests the efficacy of bevacizumab to treat RN. Future studies are needed to confirm its mechanism and to properly define the optimal scheduling, dosage and duration of therapy.
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Affiliation(s)
- Durim Delishaj
- Department of Radiotherapy, University Hospital of Pisa , Italy
| | - Stefano Ursino
- Department of Radiotherapy, University Hospital of Pisa , Italy
| | | | | | | | | | | | - Fabiola Paiar
- Department of Radiotherapy, University Hospital of Pisa , Italy
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Delishaj D, Laliscia C, Manfredi B, Ursino S, Pasqualetti F, Lombardo E, Perrone F, Morganti R, Paiar F, Fabrini MG. Non-melanoma skin cancer treated with high-dose-rate brachytherapy and Valencia applicator in elderly patients: a retrospective case series. J Contemp Brachytherapy 2015; 7:437-44. [PMID: 26816500 PMCID: PMC4716125 DOI: 10.5114/jcb.2015.55746] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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: 08/06/2015] [Accepted: 10/22/2015] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The incidence of non-melanoma skin cancer (NMSC) has been increasing over the past 30 years. Basal cell carcinoma and squamous cell carcinoma are the two most common subtypes of NMSC. The aim of this study was to estimate tumour control, toxicity, and aesthetic events in elderly patients treated with high-dose-rate (HDR) brachytherapy (BT) using Valencia applicator. MATERIAL AND METHODS From January 2012 to May 2015, 57 lesions in 39 elderly eligible patients were enrolled. All the lesions had a diameter ≤ 25 mm (median: 12.5 mm) and a depth ≤ 4 mm. The appropriate Valencia applicator, 2 or 3 cm in diameter was used. The prescribed dose was 40 Gy in 8 fractions (5 Gy/fraction) in 48 lesions (group A), and 50 Gy in 10 fractions (5 Gy/fraction) in 9 lesions (group B), delivered 2/3 times a week. The biological effective dose (BED) was 60 Gy and 75 Gy, respectively. RESULTS After median follow-up of 12 months, 96.25% lesions showed a complete response and only two cases presented partial remission. Radiation Therapy Oncology Group - European Organization for Research and Treatment of Cancer (RTOG/EORTC) G 1-2 acute toxicities were observed in 63.2% of the lesions: 56.3% in group A and 77.7% in group B. Late G1-G2 toxicities was observed in 19.3% of the lesions: 18.8% in group A and 22.2% in group B, respectively. No G3 or higher acute or late toxicities occurred. In 86% of the lesions, an excellent cosmetic result was observed (87.5% in group A and 77.8% in group B). Six lesions had a good cosmetic outcome and only 2.3% presented a fair cosmetic impact. CONCLUSIONS The treatment of NMSC with HDR-BT using Valencia surface applicator is effective with excellent and good cosmetics results in elderly patients. The hypofractionated course appears effective and no statistical differences were observed between the two groups analysed.
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Affiliation(s)
| | | | | | | | | | | | | | - Riccardo Morganti
- Section of Statistics, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
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Montrone S, Cantarella M, Coraggio G, Lombardo E, Delishaj D, Pasqualetti F, Laliscia C, Manfredi B, Balestri R, Buccianti P, Sainato A. 2042 Preoperative short course radiotherapy in elderly patients (^75 years) affected by locally advanced rectal cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30965-0] [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: 11/29/2022]
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Delishaj D, Manfredi B, Laliscia C, Lombardo E, Cantarella M, Montrone S, Perrone F, Coraggio G, Cocuzza P, Ursino S, Pasqualetti F, Fabrini M. 3316 Non-melanoma skin cancer treated with HDR Brachytherapy and Valencia applicator in elderly patients. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31834-2] [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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Gadducci A, Fabrini MG, Perrone F, Manfredi B, Fanucchi A, Laliscia C, Barsotti C, Scotti V, Genazzani AR, Greco C. Pattern of failures and clinical outcome of patients with locally advanced cervical cancer treated with a tailored integrated therapeutic approach. Anticancer Res 2010; 30:3731-3735. [PMID: 20944162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM To review a tailored treatment with concurrent chemoradiotherapy (CT/RT) or neoadjuvant chemotherapy (NACT) followed by radical hysterectomy in locally advanced cervical cancer. PATIENTS AND METHODS One hundred and four patients were treated with a tailored therapeutic approach. CT/RT was the standard treatment for patients with stage Ib2-IIb disease aged more than 70 years, or with high surgical risk, as well as for those with stage III-IV disease. NACT followed by radical hysterectomy was the treatment of choice for patients with stage Ib(2)-IIb disease, maximum age of 70 years and good performance status. RESULTS For the 61 women who underwent CT/RT, 5-year disease-free (DFS) survival and 5-year overall survival (OS) were 62% and 71%, respectively. Patient outcome was associated with the clinical response to CT/RT (complete responders versus others: 5-year DFS, 81% versus 19%, p<0.001; 5-year OS, 84% versus 37%, p=0.001). For the 43 women who underwent NACT, 5-year DFS and 5-year OS were 66% and 75%, respectively. Patient outcome was associated with the pathological response to chemotherapy (optimal responders versus others: 5-year DFS, 89% versus 62%, p=0.03; 5-year OS, 90% versus 72%, p=0.05). CONCLUSION Tailored treatments obtained satisfactory clinical outcomes in locally advanced cervical cancer. Optimal pathological response to NACT has been found to be a surrogate endpoint of OS. The identification of biological variables able to predict response to NACT is strongly warranted for an accurate selection of patients who may really benefit from chemosurgical treatment.
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Affiliation(s)
- Angiolo Gadducci
- Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy.
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Fabrini MG, Gadducci A, Perrone F, Cosio S, Laliscia C, Pasqualetti F, Grespi S, Cionini L. Clinical outcome of tailored adjuvant postoperative chemoradiotherapy in IB FIGO stage cervical cancer. Anticancer Res 2009; 29:4205-4210. [PMID: 19846974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM The aim of the present report is to review a mono-institutional experience of postoperative radiotherapy in selected patients with cervical cancer. PATIENTS AND METHODS Between 1999 and 2008, fifty-one patients with high-risk stage IB cervical cancer underwent tailored adjuvant postoperative radiotherapy; concurrent chemoradiotherapy was administered to patients presenting a high risk of recurrence. The median follow-up was 58 months. RESULTS All patients were in complete remission at first follow-up assessment. Ten patients were subject to recurrences between 7 and 54 months after treatment. The 2-year and 5-year disease-free survival rates were 88.1% and 74.9%, respectively; 2-year and 5-year overall survival rates of the whole group were 91.8% and 82.0%, respectively. Only one case of grade 4 and four cases of grade 3 side effects were reported. CONCLUSION Tailored adjuvant postoperative chemoradiotherapy is able to obtain a satisfactory clinical outcome in patients with high-risk early-stage IB cervical cancer.
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Cionini L, Cartei F, Manfredi B, Laliscia C, Sainato A, Valentini V, Lupattelli M, Pizzi G, Osti M, Santoni R. 61 Randomized study of preoperative chemoradiation (CTRT) in locally advanced rectal cancer. Preliminary results. Int J Radiat Oncol Biol Phys 1999. [DOI: 10.1016/s0360-3016(99)90079-2] [Citation(s) in RCA: 2] [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: 10/26/2022]
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