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Bonù ML, La Mattina S, Singh N, Toraci C, Spiazzi L, Terraneo F, Barbera F, Vitali P, Frassine F, Guerini A, Triggiani L, Tomasini D, Morelli V, Imbrescia J, Andreuccetti J, Frittoli B, Pittiani F, Grazioli L, Portolani N, Nicosia L, Albano D, Bertagna F, Magrini SM, Buglione M. Anal squamous cell carcinoma: Impact of radiochemotherapy evolution over years and an explorative analysis of MRI prediction of tumor response in a mono-institutional series of 131 patients. Front Oncol 2022; 12:973223. [PMID: 36353538 PMCID: PMC9639749 DOI: 10.3389/fonc.2022.973223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/27/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Radiochemotherapy (RCHT) for the treatment of anal squamous cell carcinoma (ASCC) has evolved dramatically, also thanks to intensity-modulated RT (IMRT) and 3D image guidance (3D IGRT). Despite most patients presenting fair outcomes, unmet needs still exist. Predictors of poor tumor response are lacking; acute toxicity remains challenging; and local relapse remains the main pattern of failure. Patients and methods Between 2010 and 2020, ASCC stages I–III treated with 3D conformal radiotherapy or IMRT and CDDP-5FU or Mytomicine-5FU CHT were identified. Image guidance accepted included 2D IGRT or 3D IGRT. The study endpoints included freedom from locoregional recurrence (FFLR), colostomy free survival (CFS), freedom from distant metastasis (FFDM), overall survival (OS), and acute and late toxicity as measured by common terminology criteria for adverse events (CTCAE) version 5.0. An exploratory analysis was performed to identify possible radiomic predictors of tumor response. Feature extraction and data analysis were performed in Python™, while other statistics were performed using SPSS® v.26.0 software (IBM®). Results A total of 131 patients were identified. After a median FU of 52 months, 83 patients (63.4%) were alive. A total of 35 patients (26.7%) experienced locoregional failure, while 31 patients (23.7%) relapsed with distant metastasis. Five year FFLR, CFS, DMFS and PS resulted 72.3%, 80.1%, 74.5% and 64.6%. In multivariate analysis, 2D IGRT was associated with poorer FFLR, OS, and CFS (HR 4.5, 4.1, and 5.6, respectively); 3DcRT was associated with poorer OS and CFS (HR 3.1 and 6.6, respectively). IMRT reduced severe acute gastro-intestinal (GI) and severe skin acute toxicity in comparison with 3DcRT. In the exploratory analysis, the risk of relapse depended on a combination of three parameters: Total Energy, Gray Level Size Zone Matrix’s Large Area High Gray Level Emphasis (GLSZM’s LAHGLE), and GTV volume. Conclusions Advances in radiotherapy have independently improved the prognosis of ASCC patients over years while decreasing acute GI and skin toxicity. IMRT and daily 3D image guidance may be considered standard of care in the management of ASCC. A combination of three pre-treatment MRI parameters such as low signal intensity (SI), high GLSZM’s LAHGLE, and GTV volume could be integrated in risk stratification to identify candidates for RT dose-escalation to be enrolled in clinical trials.
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Affiliation(s)
- Marco Lorenzo Bonù
- Department of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Salvatore La Mattina
- Department of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Navdeep Singh
- Department of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Cristian Toraci
- Department of Medical Physics, Spedali Civili Hospital, Brescia, Italy
| | - Luigi Spiazzi
- Department of Medical Physics, Spedali Civili Hospital, Brescia, Italy
| | - Fabrizia Terraneo
- Department of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Fernando Barbera
- Department of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Paola Vitali
- Department of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Francesco Frassine
- Department of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Andrea Guerini
- Department of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Luca Triggiani
- Department of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Davide Tomasini
- Department of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Vittorio Morelli
- Department of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Jessica Imbrescia
- Department of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | | | - Barbara Frittoli
- Department of Radiology, Spedali Civili Hospital, Brescia, Italy
| | - Frida Pittiani
- Department of Radiology, Spedali Civili Hospital, Brescia, Italy
| | - Luigi Grazioli
- Department of Radiology, Spedali Civili Hospital, Brescia, Italy
| | - Nazario Portolani
- Department of General Surgery, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Luca Nicosia
- Advanced Radiation Oncology Department, Cancer Care Centre, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Domenico Albano
- Department of Nuclear Medicine, ASST Spedali Civili di Brescia and Brescia University, Brescia, Italy
| | - Francesco Bertagna
- Department of Nuclear Medicine, ASST Spedali Civili di Brescia and Brescia University, Brescia, Italy
| | - Stefano Maria Magrini
- Department of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Michela Buglione
- Department of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, Italy
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2
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Mazzei MA, Bagnacci G, Gentili F, Capitoni I, Mura G, Marrelli D, Petrioli R, Brunese L, Cappabianca S, Catarci M, Degiuli M, De Manzoni G, De Prizio M, Donini A, Romario UF, Funicelli L, Laghi A, Minetti G, Morgagni P, Petrella E, Pittiani F, Rausei S, Romanini L, Rosati R, Ianora AAS, Tiberio GAM, Volterrani L, Roviello F, Grassi R. Structured and shared CT radiological report of gastric cancer: a consensus proposal by the Italian Research Group for Gastric Cancer (GIRCG) and the Italian Society of Medical and Interventional Radiology (SIRM). Eur Radiol 2022; 32:938-949. [PMID: 34383148 PMCID: PMC8359760 DOI: 10.1007/s00330-021-08205-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/15/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Written radiological report remains the most important means of communication between radiologist and referring medical/surgical doctor, even though CT reports are frequently just descriptive, unclear, and unstructured. The Italian Society of Medical and Interventional Radiology (SIRM) and the Italian Research Group for Gastric Cancer (GIRCG) promoted a critical shared discussion between 10 skilled radiologists and 10 surgical oncologists, by means of multi-round consensus-building Delphi survey, to develop a structured reporting template for CT of GC patients. METHODS Twenty-four items were organized according to the broad categories of a structured report as suggested by the European Society of Radiology (clinical referral, technique, findings, conclusion, and advice) and grouped into three "CT report sections" depending on the diagnostic phase of the radiological assessment for the oncologic patient (staging, restaging, and follow-up). RESULTS In the final round, 23 out of 24 items obtained agreement ( ≥ 8) and consensus ( ≤ 2) and 19 out 24 items obtained a good stability (p > 0.05). CONCLUSIONS The structured report obtained, shared by surgical and medical oncologists and radiologists, allows an appropriate, clearer, and focused CT report essential to high-quality patient care in GC, avoiding the exclusion of key radiological information useful for multidisciplinary decision-making. KEY POINTS • Imaging represents the cornerstone for tailored treatment in GC patients. • CT-structured radiology report in GC patients is useful for multidisciplinary decision making.
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Affiliation(s)
- Maria Antonietta Mazzei
- Department of Medical, Surgical and Neuro Sciences, University of Siena and Department of Radiological Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy ,SIRM, Italian College of Computed Tomography, Italian Society of Medical and Interventional Radiology, Milan, Italy
| | - Giulio Bagnacci
- Department of Medical, Surgical and Neuro Sciences, University of Siena and Department of Radiological Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy ,SIRM, Italian College of Computed Tomography, Italian Society of Medical and Interventional Radiology, Milan, Italy
| | - Francesco Gentili
- SIRM, Italian College of Computed Tomography, Italian Society of Medical and Interventional Radiology, Milan, Italy ,Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Iacopo Capitoni
- Department of Medical, Surgical and Neuro Sciences, University of Siena and Department of Radiological Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Gianni Mura
- Department of Surgery, Division of General Surgery, Arezzo Hospital, Arezzo, Italy
| | - Daniele Marrelli
- Department of Medicine, Surgery and Neuroscience, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Roberto Petrioli
- Department of Oncology, Unit of Medical Oncology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Luca Brunese
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy ,SIRM, Italian College of Oncology, Italian Society of Medical and Interventional Radiology, Milan, Italy
| | - Salvatore Cappabianca
- SIRM, Italian College of Oncology, Italian Society of Medical and Interventional Radiology, Milan, Italy ,Division of Radiology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marco Catarci
- FACS; UOC Chirurgia Generale; Ospedale Sandro Pertini – ASL Roma 2, Roma, Italy
| | - Maurizio Degiuli
- Surgical Oncology and Digestive Surgery Unit, Department of Oncology, University of Turin; San Luigi University Hospital, Orbassano, Italy
| | | | - Marco De Prizio
- Department of Surgery, Division of General Surgery, Arezzo Hospital, Arezzo, Italy
| | - Annibale Donini
- Department of Surgery and Biomedical Sciences, University of Perugia, Perugia, Italy
| | | | - Luigi Funicelli
- SIRM, Italian College of Computed Tomography, Italian Society of Medical and Interventional Radiology, Milan, Italy ,SIRM, Italian College of Oncology, Italian Society of Medical and Interventional Radiology, Milan, Italy ,Digestive Surgery, IEO European Institute of Oncology – IRCCS, Milan, Italy
| | - Andrea Laghi
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome – Sant’Andrea University Hospital, Rome, Italy ,SIRM, Italian College of Gastroenterology, Italian Society of Medical and Interventional Radiology, Milan, Italy
| | - Giuseppe Minetti
- SIRM, Italian College of Computed Tomography, Italian Society of Medical and Interventional Radiology, Milan, Italy ,Radiology Department, Ospedale Policlinico San Martino, IRCCS per L’Oncologia e le Neuroscienze, Genoa, Italy
| | - Paolo Morgagni
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Enrico Petrella
- Radiology Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Frida Pittiani
- SIRM, Italian College of Computed Tomography, Italian Society of Medical and Interventional Radiology, Milan, Italy ,Department of Radiology, ASST Spedali Civili Brescia, Brescia, Italy
| | - Stefano Rausei
- Department of Surgery, ASST Valle Olona, Gallarate, Varese, Italy
| | | | - Riccardo Rosati
- Endocrine Unit, Department of Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Amato Antonio Stabile Ianora
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari, Bari, Italy
| | - Guido A. M. Tiberio
- Surgical Unit, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Luca Volterrani
- Department of Medical, Surgical and Neuro Sciences, University of Siena and Department of Radiological Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy ,SIRM, Italian College of Oncology, Italian Society of Medical and Interventional Radiology, Milan, Italy
| | - Franco Roviello
- Department of Medicine, Surgery and Neuroscience, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Roberto Grassi
- Division of Radiology, University of Campania Luigi Vanvitelli, Naples, Italy ,SIRM Foundation, Italian Society of Medical and Interventional Radiology, Milan, Italy
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Lombardi D, Tomasoni M, Nicolai A, Paderno A, Grammatica A, Arcuri M, Lancini D, Battocchio S, Ardighieri L, Bozzola A, Pittiani F, Farina D, Redaelli de Zinis LO, Nicolai P, Piazza C. Parotid pleomorphic and non-pleomorphic adenomas: a mono-institutional series of 512 patients. Eur Arch Otorhinolaryngol 2021; 279:2543-2551. [PMID: 34355271 DOI: 10.1007/s00405-021-07018-7] [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] [Received: 05/03/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Pleomorphic adenoma (PA) is the most common benign parotid tumor, with a well-known propensity to recur. Many factors have been advocated as prognostic, but there is no consensus on how they affect local control. We studied how PA recurrence-free survival (RFS) may be affected by the most relevant risk factors in a time-to-event analysis, comparing them with those observed in a population of non-PA (NPA). METHODS Patients undergoing parotidectomy for benign lesions between 2002 and 2018 in a single academic tertiary referral center were included. A description of patients, tumors, and treatment characteristics was performed, highlighting differences between PA and NPA. Analysis of PA RFS and relative risk factors was also conducted. RESULTS Eight hundred fifty patients underwent parotidectomy for benign lesions, 455 (53.5%) for PA and 57 (6.7%) for NPA. Significant differences between PA and NPA were age at surgery, surgical procedure, and resection margins. Recurrence occurred in 3.1% of PA, with a median disease-free interval of 54 months. 2-, 5-, and 10-year RFS were 99.2, 98.5, and 93.9%, respectively. Age < 18 years (HR = 31.31, p < 0.001), intraoperative tumor spillage (HR = 6.57, p = 0.041), extensive pseudo-capsule interruption (HR = 5.85, p = 0.023), and resection margins < 1 mm (HR = 3.16, p = 0.085) were associated with RFS. CONCLUSION Patients affected by NPA were significantly older and treated with more conservative surgical procedures compared to those with PA. In PA, younger age, major pseudo-capsule defects, and surgical margins were the most relevant factors affecting local control. These results confirm the importance of an appropriate surgical management and long-term follow-up in PA.
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Affiliation(s)
- Davide Lombardi
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.
| | - Michele Tomasoni
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alessio Nicolai
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Grammatica
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy
| | - Mara Arcuri
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy
| | | | - Laura Ardighieri
- Unit of Pathology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Anna Bozzola
- Unit of Pathology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Frida Pittiani
- Unit of Radiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Davide Farina
- Unit of Radiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | | | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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4
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Mazzei MA, Di Giacomo L, Bagnacci G, Nardone V, Gentili F, Lucii G, Tini P, Marrelli D, Morgagni P, Mura G, Baiocchi GL, Pittiani F, Volterrani L, Roviello F. Delta-radiomics and response to neoadjuvant treatment in locally advanced gastric cancer-a multicenter study of GIRCG (Italian Research Group for Gastric Cancer). Quant Imaging Med Surg 2021; 11:2376-2387. [PMID: 34079708 DOI: 10.21037/qims-20-683] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background To predict response to neoadjuvant chemotherapy (NAC) of gastric cancer (GC), prior to surgery, would be pivotal to customize patient treatment. The aim of this study is to investigate the reliability of computed tomography (CT) texture analysis (TA) in predicting the histo-pathological response to NAC in patients with resectable locally advanced gastric cancer (AGC). Methods Seventy (40 male, mean age 63.3 years) patients with resectable locally AGC, treated with NAC and radical surgery, were included in this retrospective study from 5 centers of the Italian Research Group for Gastric Cancer (GIRCG). Population was divided into two groups: 29 patients from one center (internal cohort for model development and internal validation) and 41 from other four centers (external cohort for independent external validation). Gross tumor volume (GTV) was segmented on each pre- and post-NAC multidetector CT (MDCT) image by using a dedicated software (RayStation), and 14 TA parameters were then extrapolated. Correlation between TA parameters and complete pathological response (tumor regression grade, TRG1), was initially investigated for the internal cohort. The univariate significant variables were tested on the external cohort and multivariate logistic analysis was performed. Results In multivariate logistic regression the only significant TA variable was delta gray-level co-occurrence matrix (GLCM) contrast (P=0.001, Nagelkerke R2: 0.546 for the internal cohort and P=0.014, Nagelkerke R2: 0.435 for the external cohort). Receiver operating characteristic (ROC) curves, generated from the logistic regression of all the patients, showed an area under the curve (AUC) of 0.763. Conclusions Post-NAC GLCM contrast and dissimilarity and delta GLCM contrast TA parameters seem to be reliable for identifying patients with locally AGC responder to NAC.
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Affiliation(s)
- Maria Antonietta Mazzei
- Department of Medical, Surgical and Neuro Sciences, University of Siena and Department of Radiological Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Letizia Di Giacomo
- Department of Medical, Surgical and Neuro Sciences, University of Siena and Department of Radiological Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giulio Bagnacci
- Department of Medical, Surgical and Neuro Sciences, University of Siena and Department of Radiological Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Francesco Gentili
- Section of Radiology, Unit of Surgical Sciences, University of Parma, Parma, Italy
| | - Gabriele Lucii
- Department of Medical, Surgical and Neuro Sciences, University of Siena and Department of Radiological Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Paolo Tini
- Unit of Radiation Oncology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Daniele Marrelli
- Department of Medical, Surgical and Neuro Sciences, Unit of Surgical Oncology, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Paolo Morgagni
- Department of General Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Gianni Mura
- Department of Surgery, San Donato Hospital, Arezzo, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Studies, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Frida Pittiani
- Department of Radiology, ASST Spedali Civili Brescia, Brescia, Italy
| | - Luca Volterrani
- Department of Medical, Surgical and Neuro Sciences, University of Siena and Department of Radiological Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Franco Roviello
- Department of Medical, Surgical and Neuro Sciences, Unit of Surgical Oncology, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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5
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Bagnacci G, Gentili F, Vindigni C, Petrella E, Pittiani F, Verdelli B, Morgagni P, Baiocchi G, Marrelli D, Mazzei M. Tumor size (D-Max) reduction rate at CT examination as radiological index for predicting histopathological regression after neoadjuvant treatment in advanced gastric cancer. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.07.010] [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] Open
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6
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Ministrini S, Baiocchi G, Pittiani F, Lomiento D, Gheza F, Portolani N. Gunshot wound without entrance hole: where is the trick? - a case report and review of the literaturer. World J Emerg Surg 2015; 10:52. [PMID: 26561497 PMCID: PMC4641384 DOI: 10.1186/s13017-015-0048-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 08/23/2015] [Accepted: 10/23/2015] [Indexed: 11/10/2022] Open
Abstract
The presence at CT scan of more retained bullets than expected could be a very difficult interpretation challenge in the early management of gunshot wounds. The modern non operative management of haemodinamically stable patients without peritonitis requires that the trajectory of the bullet is clearly recognized. This clinical case reporting of a gunshot wound without evident entry hole, allows to discuss the diagnostic and therapeutic implications in the management of gunshot wounds cases with atypical entry and/or exit holes.
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Affiliation(s)
- Silvia Ministrini
- Surgical Clinic, University of Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy
| | - Gianluca Baiocchi
- Surgical Clinic, University of Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy
| | - Frida Pittiani
- Radiologic Department, University of Brescia, Brescia, Italy
| | - Daniele Lomiento
- Surgical Clinic, University of Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy
| | - Federico Gheza
- Surgical Clinic, University of Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy
| | - Nazario Portolani
- Surgical Clinic, University of Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy
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7
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Amoroso V, Pittiani F, Grisanti S, Valcamonico F, Simoncini E, Ferrari VD, Marini G. Osteoblastic flare in a patient with advanced gastric cancer after treatment with pemetrexed and oxaliplatin: implications for response assessment with RECIST criteria. BMC Cancer 2007; 7:94. [PMID: 17540044 PMCID: PMC1896169 DOI: 10.1186/1471-2407-7-94] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Accepted: 06/01/2007] [Indexed: 12/26/2022] Open
Abstract
Background The RECIST guidelines are commonly used in phase II and III clinical trials. The correct definition of response can be controversial in some situations, as in the case we describe. Case presentation A 43 year-old man with advanced gastric cancer was enrolled in a phase II trial where he was treated with pemetrexed 500 mg/m2 plus oxaliplatin 120 mg/m2 every 3 weeks. At baseline, the target lesions were lymph-nodes, and the non-target lesions were small pulmonary nodules. At first re-evaluation, the target lesions showed partial response and the non-target lesions showed complete response, but new diffuse osteoblastic lesions appeared. The investigator decided to continue treatment until the second re-evaluation. CT scan confirmed the response of the target and non-target lesions, while the osteoblastic lesions did not change. Conclusion The appearance of osteoblastic lesions after an active antitumor treatment, a phenomenon known as flare, can complicate the definition of the best overall response using RECIST criteria. This possibility should be considered by oncologists involved in clinical trials.
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Affiliation(s)
- Vito Amoroso
- Medical Oncology Unit, Beretta Foundation, Azienda Spedali Civili, Brescia, Italy
| | - Frida Pittiani
- Department of Radiology, University of Brescia, Brescia, Italy
| | - Salvatore Grisanti
- Medical Oncology Unit, Beretta Foundation, Azienda Spedali Civili, Brescia, Italy
| | | | - Edda Simoncini
- Medical Oncology Unit, Beretta Foundation, Azienda Spedali Civili, Brescia, Italy
| | - Vittorio D Ferrari
- Medical Oncology Unit, Beretta Foundation, Azienda Spedali Civili, Brescia, Italy
| | - Giovanni Marini
- Medical Oncology Unit, Beretta Foundation, Azienda Spedali Civili, Brescia, Italy
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8
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Crispino M, Gasparotti R, Pavia M, Bonetti M, Pittiani F, Prandini F, Chiesa A. [Magnetic resonance myelography. Preliminary experience]. Radiol Med 1995; 89:42-8. [PMID: 7716310] [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: 01/26/2023]
Abstract
Three-dimensional (3D) MR Myelography is a new technique using constructive interference steady-state (CISS) sequences, which are characterized by a symmetric flow compensation enhancing CSF signal intensity compared with neural and extradural structures. 3D myelographic projections with different rotation angles are obtained from the 3D dataset with a mathematical algorithm called maximum intensity projection (MIP). Myelographic projections yield a global view of subarachnoid spaces and of root sleeves with no intrathecal contrast agent injection. This study was aimed at assessing the feasibility, the clinical value and the diagnostic accuracy of 3D MR Myelography in comparison with conventional myelography. From September 1992 to January 1994, thirty-five myelograms were performed. The study population consisted of 10 volunteers, 8 patients with traumatic brachial plexus lesions, 7 with herniated disks (4 lumbar and 3 cervical disks), 4 with sacral radicular cysts, 2 with spinal vascular malformations, 3 with extramedullary intradural neoplasms (2 cervical neuromas and 1 cervical meningioma) and 1 with an intramedullary tumor (a conus medullaris ependymoma). All patients underwent SE MRI and conventional myelography (22 lumbar injections, 3 cervical injections of nonionic iodinated contrast agent) followed by CT (CT myelography). This trial demonstrates the feasibility of 3D MR myelography in the study of the cervical and lumbar spine: its results are comparable to those obtained with conventional myelography also in some specific indications like traumatic brachial plexus injuries, where invasive conventional myelography is usually thought to be essential.
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Affiliation(s)
- M Crispino
- Sezione di Neuroradiologia, Università di Brescia
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Bonetti M, Prandini F, Gasparotti R, Pavia M, Crispino M, Pittiani F. [Magnetic resonance diagnosis of Hallervorden-Spatz disease]. Radiol Med 1994; 88:869-70. [PMID: 7878250] [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] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- M Bonetti
- Sezione di Neuroradiologia, Università degli Studi, Brescia
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