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Alves J, Prendki V, Chedid M, Yahav D, Bosetti D, Rello J. Challenges of antimicrobial stewardship among older adults. Eur J Intern Med 2024:S0953-6205(24)00017-7. [PMID: 38360513 DOI: 10.1016/j.ejim.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/06/2024] [Accepted: 01/15/2024] [Indexed: 02/17/2024]
Abstract
Older adults hospitalized in internal medicine wards or long-term care facilities (LTCF) are progressively increasing. Older adults with multimorbidity are more susceptible to infections, as well as to more vulnerable to adverse effects (and interactions) of antibiotics, resulting in a need for effective and safer strategies for antimicrobial stewardship (ASM), both in hospitalization wards and long-term care facilities. Studies on antimicrobial stewardship in older patients are scarce and guidelines are required. Given the peculiarities of the optimization of antimicrobial prescription in individual older adults for common infections, tactics to overcome barriers need an update. The use of rapid diagnosis tests, biomarkers, de-escalation and switching from intravenous to oral/subcutaneous therapy strategies are examples of successful AMS interventions. AMS interventions are associated with reduced side effects, lower mortality, shorter hospital stays, and reduced costs. The proposed AMS framework in LTCF should focus on five domains: strategic vision, team, interventions, patient-centred care and awareness. Internists can partner with geriatrists, pharmacists and infectious disease specialists to address barriers and to improve patient care.
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Affiliation(s)
- Joana Alves
- Infectious Diseases Specialist, Head of Local Unit of the Program for Prevention and Control of Infection and Antimicrobial Resistance, Hospital de Braga, Portugal.
| | - Virginie Prendki
- Department of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland; Department of Infectious Disease, Geneva University Hospital, Switzerland
| | - Marie Chedid
- Department of Infectious Disease, Geneva University Hospital, Switzerland
| | - Dafna Yahav
- Infectious Diseases Unit, Sheba Medical Centre, Ramat Gan, Israel
| | - Davide Bosetti
- Department of Infectious Disease, Geneva University Hospital, Switzerland; Infection Control Programme and WHO Collaborating Centre for Infection Prevention and Control and Antimicrobial Resistance, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jordi Rello
- Medicine Department, Universitat Internacional de Catalunya, Spain; Clinical Research Pneumonia and Sepsis (CRIPS) Research Group-Vall d'Hebrón Institute Research (VHIR), Barcelona, Spain; Formation, Recherche, Evaluation (FOREVA), CHU Nîmes, Nîmes, France
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Bosetti D. Firstline : l’univers de la bonne utilisation des antibiotiques à portée de main. Rev Med Suisse 2024; 20:159-160. [PMID: 38268367 DOI: 10.53738/revmed.2024.20.858.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Davide Bosetti
- Service des maladies infectieuses, Hôpitaux universitaires de Genève, 1211 Genève 14
- Service de prévention et contrôle de l'infection, Hôpitaux universitaires de Genève, 1211 Genève 14
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Bosetti D, Bernardi C, Maulini M, Giannotti F, Mamez AC, Masouridi-Levrat S, Chalandon Y, Neofytos D. Salvage Treatment of Refractory HSV Oral Lesions with Pritelivir in Allogeneic Hematopoietic Cell Transplant Recipients. Antimicrob Agents Chemother 2023; 67:e0173222. [PMID: 36971558 PMCID: PMC10112206 DOI: 10.1128/aac.01732-22] [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: 12/29/2022] [Accepted: 02/03/2023] [Indexed: 03/29/2023] Open
Abstract
We present two allogeneic hematopoietic cell transplantation recipients (HCTr) treated with pritelivir for acyclovir-resistant/refractory (r/r) HSV infection based on the expanded access program of the pritelivir manufacturer. Outpatient treatment with pritelivir was administered, with partial response by week 1 of treatment and complete response by week 4 of treatment in both patients. No adverse events were noted. Pritelivir appears to be an effective and safe option for the management of acyclovir-r/r HSV infections in highly immunocompromised patients in an outpatient setting.
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Affiliation(s)
- Davide Bosetti
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Chiara Bernardi
- Division of Hematology, Bone Marrow Transplant Unit, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Marie Maulini
- Division of Hematology, Bone Marrow Transplant Unit, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Federica Giannotti
- Division of Hematology, Bone Marrow Transplant Unit, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Anne-Claire Mamez
- Division of Hematology, Bone Marrow Transplant Unit, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stavroula Masouridi-Levrat
- Division of Hematology, Bone Marrow Transplant Unit, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Yves Chalandon
- Division of Hematology, Bone Marrow Transplant Unit, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Dionysios Neofytos
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
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Bosetti D, Neofytos D. Invasive Aspergillosis and the Impact of Azole-resistance. Curr Fungal Infect Rep 2023; 17:1-10. [PMID: 37360857 PMCID: PMC10024029 DOI: 10.1007/s12281-023-00459-z] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2023] [Indexed: 06/28/2023]
Abstract
Purpose of Review IA (invasive aspergillosis) caused by azole-resistant strains has been associated with higher clinical burden and mortality rates. We review the current epidemiology, diagnostic, and therapeutic strategies of this clinical entity, with a special focus on patients with hematologic malignancies. Recent Findings There is an increase of azole resistance in Aspergillus spp. worldwide, probably due to environmental pressure and the increase of long-term azole prophylaxis and treatment in immunocompromised patients (e.g., in hematopoietic stem cell transplant recipients). The therapeutic approaches are challenging, due to multidrug-resistant strains, drug interactions, side effects, and patient-related conditions. Summary Rapid recognition of resistant Aspergillus spp. strains is fundamental to initiate an appropriate antifungal regimen, above all for allogeneic hematopoietic cell transplantation recipients. Clearly, more studies are needed in order to better understand the resistance mechanisms and optimize the diagnostic methods to identify Aspergillus spp. resistance to the existing antifungal agents/classes. More data on the susceptibility profile of Aspergillus spp. against the new classes of antifungal agents may allow for better treatment options and improved clinical outcomes in the coming years. In the meantime, continuous surveillance studies to monitor the prevalence of environmental and patient prevalence of azole resistance among Aspergillus spp. is absolutely crucial.
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Affiliation(s)
- Davide Bosetti
- Division of Infectious Diseases, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
| | - Dionysios Neofytos
- Division of Infectious Diseases, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
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Bosetti D, Spoerl D, Riat A, De Vito C, Masouridi-Levrat S, Chalandon Y, Neofytos D. Atypical pulmonary phaeohyphomycosis due to Aureobasidium spp. - case report and brief literature review. Swiss Med Wkly 2022; 152:40011. [PMID: 36509420 DOI: 10.57187/smw.2022.40011] [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: 12/15/2022] Open
Abstract
We report on a case of probable invasive Auerobasidium spp. pulmonary infection in a patient with myelodysplastic syndrome. The patient was successfully treated with liposomal amphotericin B monotherapy, with transition to orally administered isavuconazole. This case shows an atypical initial radiological presentation with diffuse ground-glass opacities, as previously demonstrated in cases of Aureobasidium spp. hypersensitivity pneumonitis. Moreover this case further highlights the difficulties associated with the diagnosis and complexity in the management of Aureobasidium spp. infections.
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Affiliation(s)
- Davide Bosetti
- Division of Infectious Diseases, University Hospital of Geneva, Switzerland
| | - David Spoerl
- Division of Immunology and Allergy, Department of Medicine, University Hospital and Faculty of Medicine, Geneva, Switzerland. Division of Laboratory Medicine, Department of Diagnostic, Geneva University Hospitals, Geneva, Switzerland
| | - Arnaud Riat
- Diagnostic Department, Laboratory of Bacteriology, University Hospital of Geneva, Switzerland
| | - Claudio De Vito
- Division of Clinical Pathology, University Hospital of Geneva, Switzerland
| | - Stavroula Masouridi-Levrat
- Division of Haematology, Bone Marrow Transplant Unit, University Hospital of Geneva and faculty of Medicine, University of Geneva, Switzerland
| | - Yves Chalandon
- Division of Haematology, Bone Marrow Transplant Unit, University Hospital of Geneva and faculty of Medicine, University of Geneva, Switzerland
| | - Dionysios Neofytos
- Division of Infectious Diseases, University Hospital of Geneva, Switzerland
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Bosetti D, Mugglin C, Calmy A, Cavassini M, Stöckle M, Braun D, Notter J, Haerry D, Hampel B, Kovari H, Bernasconi E, Wandeler G, Rauch A, Aebi-Popp K, Anagnostopoulos A, Battegay M, Bernasconi E, Braun DL, Bucher HC, Calmy A, Cavassini M, Ciuffi A, Dollenmaier G, Egger M, Elzi L, Fehr J, Fellay J, Furrer H, Fux CA, Günthard HF, Hachfeld A, Haerry D, Hasse B, Hirsch HH, Hoffmann M, Hösli I, Huber M, Kahlert CR, Kaiser L, Keiser O, Klimkait T, Kouyos RD, Kovari H, Kusejko K, Martinetti G, Martinez de Tejada B, Marzolini C, Metzner KJ, Müller N, Nemeth J, Nicca D, Paioni P, Pantaleo G, Perreau M, Rauch A, Schmid P, Speck R, Stöckle M, Tarr P, Trkola A, Wandeler G, Yerly S. Risk Factors and Incidence of Sexually Transmitted Infections in the Swiss HIV Cohort Study. Open Forum Infect Dis 2022; 9:ofac592. [PMID: 36504700 PMCID: PMC9728517 DOI: 10.1093/ofid/ofac592] [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: 07/01/2022] [Accepted: 11/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background Sexually transmitted infections (STIs) are common among people with human immunodeficiency virus (PWH), but there are limited data about risk factors and incidence of STIs in large, representative cohort studies. Methods We assessed incidence and risk factors of STIs reported by treating physicians within the Swiss HIV Cohort Study (SHCS). Sexually transmitted infections and demographic, clinical, and behavioral characteristics were prospectively collected at 6-month follow-up visits between October 2017 and November 2019. We used multilevel Poisson regression to assess incidence rate ratios of different STIs. Results Among 10 140 study participants, a total of 1634 STIs in 1029 SHCS participants were reported over 17 766 person-years of follow up (PYFUP). The overall incidence of any reported STI was 91.9 per 1000 PYFU (95% confidence interval [CI], 85.8 -98.5). Among the 1634 STI episodes, there were 573 (35.1%) incident cases of syphilis, 497 gonorrhea (30.4%), and 418 chlamydia (25.6%). Men who have sex with men (MSM) younger than 50 years represented 21% of the study population, but accounted for 61% of reported STIs. Male sex (adjusted incidence rate ratio [aIRR], 2.03; 95% CI, 1.36-3.02), MSM (aIRR, 3.62; 95% CI, 2.88-4.55), age group 18-34 years (aIRR, 1.78; 95% CI, 1.51-2.10), history of sexual relationships with occasional partners (aIRR, 6.87; 95% CI, 5.40-8.73), and reporting injecting drug use (aIRR, 2.48; 95% CI, 1.91-3.23) were associated with a higher risk of incident STIs. Conclusions Sexually transmitted infections were frequent among PWH and varied considerably between age and risk groups. Screening programs and recommendations for STI testing need to be adapted according to risk factors and demographic characteristics.
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Affiliation(s)
| | - Catrina Mugglin
- Correspondence: Catrina Mugglin, MSc, MD, PhD, Inselspital, Bern University Hospital, Freiburgstrasse, CH-3010 Bern, Switzerland ()
| | - Alexandra Calmy
- HIV/AIDS Unit, Department of Infectious Diseases, Geneva, Switzerland
| | - Matthias Cavassini
- University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Marcel Stöckle
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Dominique Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Julia Notter
- Division of Infectious Diseases and Hospital Epidemiology, St. Gallen, Switzerland
| | | | - Benjamin Hampel
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland,Checkpoint Zurich, Zurich, Switzerland
| | - Helen Kovari
- Zentrum für Infektionskrankheiten, Klinik im Park, Zurich, Switzerland
| | - Enos Bernasconi
- Ente Ospedaliero Cantonale, Lugano, University of Geneva, and University of Southern Switzerland, Lugano, Switzerland
| | - Gilles Wandeler
- Department of Infectious Diseases, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
| | - Andri Rauch
- Department of Infectious Diseases, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
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Deantonio L, Bosetti D, Cima S, Martucci F, Borgonovo G, Di Bella G, Pesce GA, Valli M, Richetti A. #Stayathome: Smart working for radiation oncologists during the corona pandemic. Strahlenther Onkol 2020; 196:1094-1095. [PMID: 32945893 PMCID: PMC7499407 DOI: 10.1007/s00066-020-01683-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/24/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Letizia Deantonio
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Via Gallino, 6500, Bellinzona, Switzerland.
| | - Davide Bosetti
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Via Gallino, 6500, Bellinzona, Switzerland
| | - Simona Cima
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Via Gallino, 6500, Bellinzona, Switzerland
| | - Francesco Martucci
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Via Gallino, 6500, Bellinzona, Switzerland
| | - Giulia Borgonovo
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Via Gallino, 6500, Bellinzona, Switzerland
| | - Gianluca Di Bella
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Via Gallino, 6500, Bellinzona, Switzerland
| | - Gianfranco Angelo Pesce
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Via Gallino, 6500, Bellinzona, Switzerland
| | - Mariacarla Valli
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Via Gallino, 6500, Bellinzona, Switzerland
| | - Antonella Richetti
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Via Gallino, 6500, Bellinzona, Switzerland
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Valli M, Cima S, Gaudino D, Cartolari R, Deantonio L, Frapolli M, Daniele D, Pesce GA, Martucci F, Azinwi NC, Bosetti D, Presilla S, Richetti A. Skin and lung toxicity in synchronous bilateral breast cancer treated with volumetric-modulated arc radiotherapy: a mono-institutional experience. Clin Transl Oncol 2019; 21:1492-1498. [DOI: 10.1007/s12094-019-02077-z] [Citation(s) in RCA: 7] [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: 12/04/2018] [Accepted: 02/27/2019] [Indexed: 12/25/2022]
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Gaudino D, Cima S, Frapolli M, Daniele D, Muoio B, Pesce GA, Martucci F, Azinwi NC, Bosetti D, Bellesi L, Casiraghi M, Piliero MA, Pupillo F, Presilla S, Richetti A, Valli M. Volumetric modulated arc therapy applied to synchronous bilateral breast cancer radiotherapy: dosimetric study on deep inspiration breath hold versus free breathing set up. Biomed Phys Eng Express 2018. [DOI: 10.1088/2057-1976/aac19b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Valli M, Donegani I, Cekani E, Gaudino D, Daniele D, Bignasca D, Richetti A, Cima S, Martucci F, Azinwi C, Pesce G, Bosetti D, Yordanov K, Maddalena I, Presilla S. EP-1330: Dosimetric comparison of two techniques in left breast cancer with respiratory gating. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31640-2] [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: 11/26/2022]
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Fozza A, Giannelli F, Blandino G, Bosetti D, Milanese M, Agostinelli S, Garelli S, Corvò R, Guenzi M. Mono-institutional Italian Experience with a Double-lumen Balloon-brachytherapy Device for Early Breast Cancer: Results at a 5-year Minimum follow-up. Tumori 2018; 100:163-8. [DOI: 10.1177/030089161410000208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and Background To report the 5-year minimum follow-up in low-risk breast cancer patients treated with a double-lumen balloon-brachytherapy device in one mono-institutional Italian experience. Local control data and cosmetic outcomes were collected and analyzed. Methods Between October 2004 and December 2007, we treated 30 early stage breast cancer patients who underwent conservative surgery followed by adjuvant accelerated partial breast irradiation with a double-lumen balloon-brachytherapy system. Eligibility criteria for the protocol were based on the indications of the American Brachytherapy Society and the American Society of Breast Surgeons. The device was placed inside the lumpectomy cavity during surgery by open technique in all the patients. Computed tomography images and standard X-ray were used for treatment planning. The total irradiation dose was 34 Gy in 10 fractions of 3.4 Gy (twice daily) over 5 days to the lumpectomy cavity. Results Median follow-up was 80.5 months (range, 60–98). No patient developed local recurrence or distant metastasis. At the end of treatment, there was evidence of a symptomatic seroma in 83% of the total patients, with a yearly decreasing trend. However, the incidence of mild and moderate fibrosis progressively increased. Seventy seven percent of the patients were satisfied with their cosmetic results. Conclusions Our findings reinforce the hypothesis that an accelerated double-lumen balloon-breast brachytherapy catheter in selected low-risk patients is safe, and a favorable cosmetic outcome can be achieved.
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Affiliation(s)
- Alessandra Fozza
- Department of Radiotherapy, and IRCCS AOU San Martino, IST, Genoa, Italy
| | - Flavio Giannelli
- Department of Radiotherapy, and IRCCS AOU San Martino, IST, Genoa, Italy
| | - Gladys Blandino
- Department of Radiotherapy, and IRCCS AOU San Martino, IST, Genoa, Italy
| | - Davide Bosetti
- Department of Radiotherapy, and IRCCS AOU San Martino, IST, Genoa, Italy
| | | | | | - Stefania Garelli
- Department of Medical Physics, IRCCS AOU San Martino, IST, Genoa, Italy
| | - Renzo Corvò
- Department of Radiotherapy, and IRCCS AOU San Martino, IST, Genoa, Italy
| | - Marina Guenzi
- Department of Radiotherapy, and IRCCS AOU San Martino, IST, Genoa, Italy
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Menichetti J, Villa S, Magnani T, Avuzzi B, Bosetti D, Marenghi C, Morlino S, Rancati T, Van Poppel H, Salvioni R, Valdagni R, Bellardita L. Lifestyle interventions to improve the quality of life of men with prostate cancer: A systematic review of randomized controlled trials. Crit Rev Oncol Hematol 2016; 108:13-22. [PMID: 27931831 DOI: 10.1016/j.critrevonc.2016.10.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 01/22/2016] [Revised: 09/05/2016] [Accepted: 10/18/2016] [Indexed: 11/24/2022] Open
Abstract
Improving quality of life is a key issue for patients with prostate cancer (PCa). Lifestyle interventions could positively impact the quality of life of patients. However, there is no clear-cut understanding of the role of diet, exercise and risky behaviour reduction in improving the quality of life of men with PCa. The aim of this review was to systematically summarize randomized controlled trials on lifestyle in PCa patients with quality of life as main outcome. 17 trials were included. Most of them referred to exercise interventions (71%) and involved men undergoing androgen deprivation therapy (47%). Exercise studies yielded the greater amount of positive results on quality of life outcomes (67%), followed by dietary interventions (50%) and combined lifestyle interventions (33%). In particular, supervised exercise programs with resistance training sessions were the ones producing greater convincing evidence for benefits on quality of life. Further studies with high methodological quality providing adequate information to develop evidence-based, personalized lifestyle interventions that can effectively ameliorate PCa-related quality of life are needed.
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Affiliation(s)
- Julia Menichetti
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; Dept. of Psychology, Università Cattolica, Largo Gemelli 1, 20123 Milan, Italy.
| | - Silvia Villa
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
| | - Tiziana Magnani
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
| | - Barbara Avuzzi
- Dept. of Radiation Oncology 1, Fondazione IRCCS Istituto nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
| | - Davide Bosetti
- Dept. of Radiation Oncology 1, Fondazione IRCCS Istituto nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
| | - Cristina Marenghi
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
| | - Sara Morlino
- Dept. of Radiation Oncology 1, Fondazione IRCCS Istituto nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
| | - Hein Van Poppel
- University Hospitals Leuven, Department of Urology, Leuven, Belgium
| | - Roberto Salvioni
- Dept. of Radiation Oncology 1, Fondazione IRCCS Istituto nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
| | - Riccardo Valdagni
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; Dept. of Radiation Oncology 1, Fondazione IRCCS Istituto nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; Department of Oncology and Hemato-Oncology, Università di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Lara Bellardita
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
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Giandini T, Carrara M, Pignoli E, Bedini N, Morlino S, Bosetti D, Avuzzi B, Villa S, Hasegawa A, Russo S, Vischioni B, Ciocca M, Valvo F, Jereczek-Fossa B, Ciardo D, Zerini D, Colangione S, Fodor C, Cattani F, Valdagni R, Orecchia R. EP-1374: Contouring guideline optimisation for prostate pts undergoing carbon ions/photons combined treatment. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32624-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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Barra S, Agostinelli S, Vagge S, Giannelli F, Siccardi D, Garelli S, Aloi D, Belgioia L, Bosetti D, Zeverino M, Corvò R. Radiosurgery with Helical Tomotherapy: Outcomes for Patients with One or Multifocal Brain Metastasis. Technol Cancer Res Treat 2015; 14:693-699. [PMID: 24750003 DOI: 10.7785/tcrt.2012.500427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 09/03/2013] [Accepted: 02/05/2014] [Indexed: 09/01/2023] Open
Abstract
To evaluate the feasibility and report the preliminary results for stereotactic radiosurgery (SRS) treatments of single or multiple brain metastases delivered with helical tomotherapy (HT) by means of the InterFix™ Radiosurgery kit. Between September 2010 and August 2012, thirty patients underwent SRS for treatment of 46 brain metastases with a median prescription dose of 20 Gy (range 15-21 Gy). Clinical response was assessed with 2-3 month intervals by magnetic resonance imaging (MRI). Dose distribution indexes were computed and compared with published data for SRS performed with dedicated machines. After a median follow-up of 14 months (range 4-31) the estimated overall survival (OS) rate was 70% at 6 months, 60% at 12 months and 44% at 18 months. Local control (LC) was 72% at 6 months, 65% at 12 months and 50% at 18 months. Acute toxicity as headache and epileptic crisis occurred in only two patients. The mean values of conformity, homogeneity and gradient score indexes were 1.36, 1.04 and 50 respectively. HT-SRS for single or multiple brain metastases appears a reliable technique with encouraging clinical outcomes and competitive dosimetrical results.
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Affiliation(s)
- Salvina Barra
- Department of Radiation Oncology, IRCCS San Martino IST, National Cancer Research Institute, L.go R. Benzi 10, 16132 Genoa, Italy
| | - Stefano Agostinelli
- Department of Medical Physics, IRCCS San Martino IST, National Cancer Research Institute, L.go R. Benzi 10, 16132 Genoa, Italy
| | - Stefano Vagge
- Department of Radiation Oncology, IRCCS San Martino IST, National Cancer Research Institute, L.go R. Benzi 10, 16132 Genoa, Italy
| | - Flavio Giannelli
- Department of Radiation Oncology, IRCCS San Martino IST, National Cancer Research Institute, L.go R. Benzi 10, 16132 Genoa, Italy
| | - Desiderio Siccardi
- Department of Neurosurgery, IRCCS San Martino IST, National Cancer Research Institute, L.go R. Benzi 10, 16132 Genoa, Italy
| | - Stefania Garelli
- Department of Medical Physics, IRCCS San Martino IST, National Cancer Research Institute, L.go R. Benzi 10, 16132 Genoa, Italy
| | - Deborah Aloi
- Department of Radiation Oncology, IRCCS San Martino IST, National Cancer Research Institute, L.go R. Benzi 10, 16132 Genoa, Italy
| | - Liliana Belgioia
- Department of Radiation Oncology, IRCCS San Martino IST, National Cancer Research Institute, L.go R. Benzi 10, 16132 Genoa, Italy
| | - Davide Bosetti
- Department of Radiation Oncology, IRCCS San Martino IST, National Cancer Research Institute, L.go R. Benzi 10, 16132 Genoa, Italy
| | - Michele Zeverino
- Department of Medical Physics, IRCCS San Martino IST, National Cancer Research Institute, L.go R. Benzi 10, 16132 Genoa, Italy
| | - Renzo Corvò
- Department of Radiation Oncology, IRCCS San Martino IST, National Cancer Research Institute, L.go R. Benzi 10, 16132 Genoa, Italy
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Agostinelli S, Garelli S, Bellini A, Pupillo F, Guenzi M, Bosetti D, Blandino G, Taccini G. Helical Tomotherapy of the breast: can thermoplastic immobilization improve the reproducibility of the treatment setup and the accuracy of the delivered dose? Phys Med 2014; 31:49-53. [PMID: 25281291 DOI: 10.1016/j.ejmp.2014.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 08/31/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate the impact of thermoplastic mask immobilization in the setup reproducibility and delivered dose for Helical Tomotherapy (HT) of the breast/chest wall. METHODS 16 patients treated with Accuray Hi-Art HT for breast-cancer were considered. Patients were positioned supine with arms extended above the head using Civco Wing Board (WB) system. In 50% of patients an Orfit thermoplastic mask was added in order to improve immobilization. Before each treatment fraction a megavoltage CT (MVCT) scan was taken and registered to the planning CT by experienced medical staff. The impact of thermoplastic mask was investigated analysing MVCT shift-roll data and MVCT dose distribution using Planned Adaptive software. RESULTS In the analysed cases, the addition of thermoplastic mask had minor impact on the lateral, longitudinal and roll data distribution. Variance of vertical shifts was significantly reduced in the WB + Orfit group. Van Herk's margins were not affected by addition of thermoplastic immobilization. In both groups, target coverage (V95) and maximum dose (D1) were almost identical to planned values. D1 of organs at risk were not significantly different in the two groups. CONCLUSIONS Analysis of shift-roll data shows no improvement in the group of patients immobilized with the addition of thermoplastic mask. Van Herk's margin is quite large (7-10 mm) in both groups evidencing the need to perform daily setup correction. The adapted dose distribution complies well with the planned one, showing that if MVCT is used before each treatment fraction, a 3 mm margin (setup component) for CTVs expansion could be adequate.
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Affiliation(s)
- S Agostinelli
- UOC Fisica Medica e Sanitaria, IRCCS AOU San Martino - IST, L.go R. Benzi 10, 16132 Genova, Italy.
| | - S Garelli
- UOC Fisica Medica e Sanitaria, IRCCS AOU San Martino - IST, L.go R. Benzi 10, 16132 Genova, Italy
| | - A Bellini
- UOC Fisica Medica e Sanitaria, IRCCS AOU San Martino - IST, L.go R. Benzi 10, 16132 Genova, Italy
| | - F Pupillo
- UOC Fisica Medica e Sanitaria, IRCCS AOU San Martino - IST, L.go R. Benzi 10, 16132 Genova, Italy
| | - M Guenzi
- UOC Oncologia Radioterapica, IRCCS AOU San Martino - IST, L.go R. Benzi 10, 16132 Genova, Italy
| | - D Bosetti
- UOC Oncologia Radioterapica, IRCCS AOU San Martino - IST, L.go R. Benzi 10, 16132 Genova, Italy
| | - G Blandino
- UOC Oncologia Radioterapica, IRCCS AOU San Martino - IST, L.go R. Benzi 10, 16132 Genova, Italy
| | - G Taccini
- UOC Fisica Medica e Sanitaria, IRCCS AOU San Martino - IST, L.go R. Benzi 10, 16132 Genova, Italy
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Fozza A, Giannelli F, Blandino G, Bosetti D, Milanese M, Agostinelli S, Garelli S, Corvò R, Guenzi M. Mono-institutional Italian experience with a double-lumen balloon-brachytherapy device for early breast cancer: results at a 5-year minimum follow-up. Tumori 2014. [PMID: 24852860 DOI: 10.1700/1491.16403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND BACKGROUND To report the 5-year minimum follow-up in low-risk breast cancer patients treated with a double-lumen balloon-brachytherapy device in one mono-institutional Italian experience. Local control data and cosmetic outcomes were collected and analyzed. METHODS Between October 2004 and December 2007, we treated 30 early stage breast cancer patients who underwent conservative surgery followed by adjuvant accelerated partial breast irradiation with a double-lumen balloon-brachytherapy system. Eligibility criteria for the protocol were based on the indications of the American Brachytherapy Society and the American Society of Breast Surgeons. The device was placed inside the lumpectomy cavity during surgery by open technique in all the patients. Computed tomography images and standard X-ray were used for treatment planning. The total irradiation dose was 34 Gy in 10 fractions of 3.4 Gy (twice daily) over 5 days to the lumpectomy cavity. RESULTS Median follow-up was 80.5 months (range, 60-98). No patient developed local recurrence or distant metastasis. At the end of treatment, there was evidence of a symptomatic seroma in 83% of the total patients, with a yearly decreasing trend. However, the incidence of mild and moderate fibrosis progressively increased. Seventy-seven percent of the patients were satisfied with their cosmetic results. CONCLUSIONS Our findings reinforce the hypothesis that an accelerated double-lumen balloon-breast brachytherapy catheter in selected low-risk patients is safe, and a favorable cosmetic outcome can be achieved.
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Corvò R, Lamanna G, Vagge S, Belgioia L, Bosetti D, Aloi D, Timon G, Bacigalupo A. Once-weekly stereotactic radiotherapy for patients with oligometastases: compliance and preliminary efficacy. Tumori 2013. [PMID: 23748808 DOI: 10.1700/1283.14186] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND BACKGROUND This retrospective analysis reports the outcomes obtained with an original once-weekly stereotactic radiotherapy fractionation given to patients affected by evolving oligometastases from different solid malignancies. METHODS From 2009 to 2011, patients with symptomatic and/or evolving oligometastases were submitted to a median 5-fraction cycle of stereotactic radiotherapy of one fraction per week in order to exploit a radiobiological rationale designed to increase the therapeutic index. Individual fractionation was mainly planned according to patient performance status, oligometastasis size and site, and record of previous irradiation in the same site. RESULTS Thirty-six patients in stage IV UICC-TNM affected by oligometastases were treated with image-guided intensity-modulated stereotactic tomotherapy with a single weekly radiation. Median age was 70 years (range, 34-89). The median weekly single dose, number of fractions and overall total radiation dose were 7 Gy, 5 fractions and 35 Gy, respectively. Thirty-five (97%) patients completed the treatment schedule. No patient suffered mild or severe radiation-related side effects. Twenty-one (87%) of 24 patients with local pain had complete symptomatic response within 30 days following the end of radiotherapy. Local control assessed at imaging after stereotactic radiotherapy was evidenced in 30 (83%) patients. Median time to response after the end of radiotherapy was 40 days. CONCLUSIONS The original radiotherapy regimen delivering only a single stereotactic dose per week seems to be highly feasible with an interesting high efficacy rate in patients with oligometastases from different solid tumors. Overall, the once-weekly treatment was very compliant in an advanced cancer stage especially for elderly and frail patients.
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Affiliation(s)
- Renzo Corvò
- Department of Radio-Oncology, IRCCS AOU San Martino, IST, National Institute for Cancer Research, Genoa, Italy.
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Guenzi M, Giannelli F, Bosetti D, Blandino G, Milanese ML, Pupillo F, Corvò R, Fozza A. Two different hypofractionated breast radiotherapy schedules for 113 patients with ductal carcinoma in situ: preliminary results. Anticancer Res 2013; 33:3503-3507. [PMID: 23898126] [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: 06/02/2023]
Abstract
AIM To assess local control and cosmetic outcomes for two different hypofractionated radiotherapy schedules after breast-conserving surgery for ductal carcinoma in situ (DCIS). PATIENTS AND METHODS A total of 113 breast-conserving operated patients with DCIS were treated from August 2006 to August 2011: 41 women received 46 Gy in 20 fractions of 2.3 Gy four times a week, for five weeks; the other 72 patients received 39 Gy in 13 fractions of 3 Gy four times a week for 3.5 weeks. Both schedules involved a concomitant boost to the tumor bed, with dose adjustment according to the surgical margins. RESULTS The median follow-up is 30.5 months. Overall, the treatments were well-tolerated. The most common acute effect was erythema: grade 1 in 56.1% and 31.9% in the longer and in the shorter hypofractionated treatment, grade 2 in 9.8% and 0% of cases respectively. Late toxicity of fibrosis occurred at grade 1 in 19.6% and 15.3% respectively and at grade 2 in 0% and 2.8%. CONCLUSION These results suggest that patients with DCIS can be safely treated with a shorter radiotherapy regimen.
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Affiliation(s)
- Marina Guenzi
- Oncologia Radioterapica, IRCCS A.O.U. San Martino-IST-Istituto Nazionale per la Ricerca, sul Cancro, Largo R. Benzi, 10, 16132 Genoa, Italy.
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Castelli F, Bosetti D, Negrelli R, Di Paola V, Zantedeschi L, Ventriglia A, Manfredi R, Mucelli RP. Multifocal branch-duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas: magnetic resonance (MR) imaging pattern and evolution over time. Radiol Med 2013; 118:917-29. [PMID: 23801393 DOI: 10.1007/s11547-013-0945-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 08/14/2012] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of our study was to follow the evolution over time of multifocal intraductal papillary mucinous neoplasms (IPMN) of the pancreatic duct side branches by means of magnetic resonance imaging (MRI). MATERIALS AND METHODS A total of 155 patients with multifocal IPMN of the side branches were examined with MRI and MR cholangiopancreatography (MRI/MRCP). Inclusion criteria were patients with ≥2 dilated side branches involving any site of the parenchyma; presence of communication with the main pancreatic duct and previous investigations by MRI/MRCP within at least six months. Median follow-up was 25.8 months (range, 12-217). Patients with a follow-up period shorter than 12 months (n=33) and those with a diagnosis of multifocal IPMN of the side branches without any follow-up (n=14) were excluded from the study. The final study population thus comprised 108 patients. A double, quantitative and qualitative, analysis was carried out. The quantitative image analysis included: number of dilated side branches in the head-uncinate process and body-tail; maximum diameter of lesions in the head-uncinate process; maximum diameter in the body-tail; maximum diameter of the main pancreatic duct in the head and body-tail. The qualitative image analysis included: presence of malformations or anatomical variants of the pancreatic ductal system; site of the lesions (head-uncinate process, body-tail, ubiquitous, bridge morphology); presence of gravity-dependent intraluminal filling defects; presence of enhancing mural nodules. RESULTS At diagnosis, the mean number of cystic lesions of the side branches was 7.09. The mean diameter of the cystic lesions was 13.7 mm. The mean diameter of the main pancreatic duct was 3.6 mm. At follow-up, the mean number of cystic lesions was 7.76. The mean diameter of the cystic lesions was 13.9 mm. The mean diameter of the main pancreatic duct was 3.7 mm. Intraluminal filling defects in the side branches were seen in 18/108 patients (16.6%); enhancing mural nodules were seen in 3/108 patients (2.7%). CONCLUSIONS Multifocal IPMN of the branch ducts shows a very slow growth and evolution over time. In our study, only 3/108 patients showed mural nodules which, however, did not require any surgical procedure, indicating that careful nonoperative management may be safe and effective in asymptomatic patients.
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Affiliation(s)
- Federica Castelli
- Istituto di Radiologia, Azienda Ospedaliero Universitaria Integrata - Policlinico "G.B. Rossi", P.le L.A. Scuro 10, 37134, Verona, Italy
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Agostinelli S, Bellini A, Pupillo F, Bosetti D, Guenzi M, Corvò R, Taccini G. EP-1251: Helical Tomotherapy of breast/chest wall with N: can thermoplastic immobilization improve the treatment delivery? Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33557-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: 11/28/2022]
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21
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Corvò R, Lamanna G, Vagge S, Belgioia L, Bosetti D, Aloi D, Timon G, Bacigalupo A. Once-weekly stereotactic radiotherapy for patients with oligometastases: compliance and preliminary efficacy. Tumori 2013; 99:159-163. [PMID: 23748808 DOI: 10.1177/030089161309900207] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
AIMS AND BACKGROUND This retrospective analysis reports the outcomes obtained with an original once-weekly stereotactic radiotherapy fractionation given to patients affected by evolving oligometastases from different solid malignancies. METHODS From 2009 to 2011, patients with symptomatic and/or evolving oligometastases were submitted to a median 5-fraction cycle of stereotactic radiotherapy of one fraction per week in order to exploit a radiobiological rationale designed to increase the therapeutic index. Individual fractionation was mainly planned according to patient performance status, oligometastasis size and site, and record of previous irradiation in the same site. RESULTS Thirty-six patients in stage IV UICC-TNM affected by oligometastases were treated with image-guided intensity-modulated stereotactic tomotherapy with a single weekly radiation. Median age was 70 years (range, 34-89). The median weekly single dose, number of fractions and overall total radiation dose were 7 Gy, 5 fractions and 35 Gy, respectively. Thirty-five (97%) patients completed the treatment schedule. No patient suffered mild or severe radiation-related side effects. Twenty-one (87%) of 24 patients with local pain had complete symptomatic response within 30 days following the end of radiotherapy. Local control assessed at imaging after stereotactic radiotherapy was evidenced in 30 (83%) patients. Median time to response after the end of radiotherapy was 40 days. CONCLUSIONS The original radiotherapy regimen delivering only a single stereotactic dose per week seems to be highly feasible with an interesting high efficacy rate in patients with oligometastases from different solid tumors. Overall, the once-weekly treatment was very compliant in an advanced cancer stage especially for elderly and frail patients.
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Affiliation(s)
- Renzo Corvò
- Department of Radio-Oncology, IRCCS AOU San Martino, IST, National Institute for Cancer Research, Genoa, Italy.
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Lamanna G, Vagge S, Vidano G, Bosetti D, Blandino G, Siffredi G, Milanese M, Corvò R. PO-0743: Once weekly stereotactic radiotherapy for oligometastatic patients: compliance and preliminary efficacy. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33049-8] [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: 11/30/2022]
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Barra S, Giannelli F, Siccardi D, Zeverino M, Agostinelli S, Torielli P, Doino D, Bosetti D, Aloi D, Corvò R. EP-1294 INITIAL EXPERIENCE WITH HELICAL TOMO THERAPY FOR INTRACRANIAL STEREOTACTIC RADIOSURGERY (SRS). Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71627-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bacigalupo A, Vagge S, Bosetti D, Vidano G, Gusinu M, Agostinelli S, Marcenaro M, Vecchio S, Zeverino M, Corvò R. PRELIMINARY EXPERIENCE WITH HELICAL TOMOTHERAPY USING SIMULTANEOUS INTEGRATED BOOST (SIB) IN NASOPHARYNX CANCER. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70079-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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