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Francolini G, Allegra A, Caini S, Detti B, Di Cataldo V, Alitto A, Parisi S, D’Angelillo R, Bruni A, Ingrosso G, Timon G, Burchini L, Frosini G, Valzano M, Ganovelli M, Desideri I, Visani L, Olmetto E, Becherini C, Salvestrini V, Lapini A, Meattini I, Livi L. Early outcomes from a phase II randomized trial testing stereotactic body radiation therapy in patients undergoing I line treatment with abiraterone acetate for oligometastatic castration resistant prostate cancer (ARTO trial-NCT03449719). Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01226-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Francolini G, Detti B, Di Cataldo V, Caini S, Alitto A, S. Parisi, Demofonti C, Bruni A, Ingrosso G, Timon G, Allegra A, Burchini L, Salvestrini V, Frosini G, Cerbai C, Visani L, Becherini C, Desideri I, Meattini I, Livi L. 1369P Biochemical outcomes from ARTO trial (NCT03449719) a phase II randomized trial testing association between abiraterone acetate and stereotactic body radiation therapy in castrate-resistant prostate cancer patients. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1501] [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] Open
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Cozzi S, Timon G, Tagliavini E, Piro R, Borghi E, Tiseo M, Iotti C, ciammella P. PO-1271 Redetermination Of Pd-L1 Expression After Chemo-Radiation In Locally Advanced Pd-L1 Negative NSCLC (RECAL TRIAL. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03235-2] [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: 10/18/2022]
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Francolini G, Detti B, Di Cataldo V, Caini S, Alitto A, Parisi S, Demofonti C, Bruni A, Ingrosso G, Timon G, Tagliagambe A, Aquilano M, Ciccone L, Salvestrini V, Frosini G, Cerbai C, Allegra A, Burchini L, Desideri I, Mangoni M, Meattini I, Livi L. OC-0605 Early outcomes of a randomized trial of SBRT and Abiraterore in mCPRC: ARTO trial NCT03449719. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02627-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Francolini G, Detti B, Di Cataldo V, Caini S, Alitto AR, Parisi S, Demofonti C, Bruni A, Ingrosso G, Timon G, Allegra A, Aquilano M, Ciccone LP, Salvestrini V, Frosini G, Cerbai C, Desideri I, Meattini I, Mangoni M, Livi L. ARTO trial-(NCT03449719): Early results from a phase II randomized trial testing stereotactic body radiation therapy in patients with oligometastatic castration-resistant prostate cancer undergoing I line treatment with abiraterone acetate. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.100] [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
100 Background: ARTO (NCT03449719) is a multicentre, randomized trial started in January 2019 and currently running in 16 Italian centres, testing the benefit of adding stereotactic body radiation therapy (SBRT) to Abiraterone Acetate (AA) in oligometastatic Castrate Resistant Prostate Cancer (CRPC) patients. Seventy-nine per cent of the target accrual population has been currently enrolled. Here we present a report about early efficacy results of SBRT+AA combination. Methods: Data from patients with ≥ 6 months of follow up were reported. All patients were affected by oligometastatic CRPC, defined as ≤ 3 non-visceral metastatic lesions. Patients were randomized 1:1 to receive either AA alone (control arm) or associated with concomitant SBRT on all sites of disease (treatment arm). Primary endpoint of the trial is rate of biochemical response (BR, defined as a PSA decrease ≥ 50% from baseline measured within 6 months from treatment start). Complete biochemical response (CBR, defined as PSA at 6 months ≤ 0.2 ng/ml) is a secondary endpoint of the trial. Results: Overall, 123 patients have been currently enrolled in ARTO trial. To date, 98 patients had ≥ 6 months of follow-up and were evaluable for the present analysis. BR was detected in 75 (76.5%) patients (82.2% vs. 71.7% in treatment vs. control arm, respectively), with an unadjusted odds ratio (OR) equal to 1.83 (95% CI 0.69-4.82, p-value 0.22). After adjustment for baseline PSA and the number of metastatic sites ( > 1 vs. 1), the OR for BR was 2.23 (95% CI 0.74-6.73, p-value 0.15). CBR was detected in 36 (36.7%) patients (46.7% vs. 28.3% in treatment vs. control arm, respectively), with an unadjusted OR of 2.22 (95% CI 0.96-5.12, p-value 0.06), and an adjusted OR of 2.31 (95% CI 0.90-5.92, p-value 0.08). In multivariable models, baseline PSA and the number of metastatic sites > 1 were non-statistically associated with CBR, with OR equal to 0.92 (95% CI 0.85-1.01, p-value 0.06) and 1.20 (95% CI 0.46-3.09, p-value 0.71), respectively. Conclusions: Results showed promising efficacy of SBRT+AA combination if compared to systemic treatment alone for oligometastatic CRPC, OR for BR and CBR were doubled in treatment vs. control arm, even if statistical significance is not yet reached. Interestingly, baseline burden of disease seems to predict increased outcome after SBRT, suggesting that selection criteria for local treatment may be further refined. Complete results for primary endpoint are awaited in 2022, after enrollment and follow-up completion of whole cohort, and may confirm these early outcomes in a larger population. Clinical trial information: NCT03449719.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Vanessa Di Cataldo
- Cyberknife Center, Istituto Fiorentino di Cura e Assistenza (IFCA), Firenze, Italy
| | - Saverio Caini
- Institute for Cancer Research, Prevention and Clinical Network, Cancer Risk Factors and Life-Style Epidemiology Unit, Florence, Italy
| | - Anna Rita Alitto
- Fondazione Policlinico Universitario "A. Gemelli", Catholic University of Sacred Heart, Rome, Italy
| | - Silvana Parisi
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Chiara Demofonti
- Radiotherapy Unit, Department of Oncology and Hematology, Tor Vergata General Hospital, Rome, Italy
| | - Alessio Bruni
- Radiotherapy Unit, Azienda Policlinico Universitaria di Modena, Modena, Italy
| | | | - Giorgia Timon
- Radiation Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Allegra
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Firenze, Italy
| | - Michele Aquilano
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy
| | - Lucia Pia Ciccone
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy
| | - Viola Salvestrini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy
| | - Giulio Frosini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy
| | - Cecilia Cerbai
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy
| | - Icro Meattini
- Radiation Oncology Unit-Oncology Department, University of Florence, Florence, Italy
| | - Monica Mangoni
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit-Oncology Department, University of Florence, Florence, Italy
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Cozzi S, Botti A, Timon G, Blandino G, Najafi M, Manicone M, Bardoscia L, Ruggieri MP, Ciammella P, Iotti C. Prognostic factors, efficacy, and toxicity of involved-node stereotactic body radiation therapy for lymph node oligorecurrent prostate cancer : An investigation of 117 pelvic lymph nodes. Strahlenther Onkol 2021; 198:700-709. [PMID: 34757443 DOI: 10.1007/s00066-021-01871-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/21/2021] [Accepted: 10/17/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND The optimal radiotherapy regimen is not yet defined in the setting of oligorecurrent prostate cancer (oligorPC). There is evidence of high variability in treatment protocols among different centers worldwide, and no international consensus guidelines on treatment volumes, radiation schedules, and techniques. The purpose of the present retrospective study is to evaluate the efficacy and safety of involved-pelvic-node stereotactic body radiotherapy (SBRT) for oligorPC. MATERIALS AND METHODS Patients with pelvic node oligorPC following primary surgery, radical radiotherapy, or salvage radiotherapy for biochemical or local relapse of prostate cancer who underwent involved-node SBRT with biological effective dose (BED) > 100 Gy, with or without concurrent and adjuvant androgen deprivation therapy (ADT), were retrospectively evaluated. Biochemical progression-free survival (bPFS), distant progression-free survival (DPFS), overall survival (OS), possible prognostic factors, and toxicity outcomes were investigated. RESULTS From November 2012 to December 2019, 74 patients fitted the selection criteria. A total of 117 lesions were treated. Median follow-up was 31 months (range 6-89). Concurrent ADT was administered in 58.1% of patients. The 1‑year, 2‑year, and 3‑year DPFS was 77%, 37%, and 19%, respectively; the 1‑year, 2‑year, and 3‑year OS was 98%, 98%, and 95%, respectively. The presence of a single target lesion was associated with a statistically significant impact on OS. No in-field recurrence occurred. Patients who reached early prostate-specific antigen (PSA) nadir (< 3 months after SBRT) had a lower 3‑year survival (p = 0.004). The value of PSA nadir after SBRT and the time between primary treatment and SBRT had an impact on bPFS. Concomitant ADT was associated with improved DPFS. No acute or early late (> 6 months) genitourinary and gastrointestinal adverse events of any grade were reported, albeit with relatively short median follow-up. CONCLUSION SBRT is a safe and effective treatment for oligorPC, with a 100% local control rate in our series. It is not possible to clearly assess the opportunity to postpone ADT prescription in patients with two or more nodal metastases. The number of secondary lesions, time-to-nadir PSA, PSA nadir value, and the time interval between primary treatment and SBRT were identified as prognostic factors. Future prospective randomized studies are desirable to better understand the still open questions regarding the oligorecurrent prostate cancer state.
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Affiliation(s)
- Salvatore Cozzi
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Andrea Botti
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giorgia Timon
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gladys Blandino
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Masoumeh Najafi
- Department of Radiation Oncology Shohadaye Haft-e-Tir Hospital, Iran University of Medical Science, Teheran, Iran
| | - Moana Manicone
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lilia Bardoscia
- Radiation Oncology Unit, S. Luca Hospital, Healtcare Company Tuscany Nord Ovest, Lucca, Italy
| | - Maria Paola Ruggieri
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Patrizia Ciammella
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cinzia Iotti
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Cagni E, Botti A, Rossi L, Iotti C, Iori M, Cozzi S, Galaverni M, Rosca A, Sghedoni R, Timon G, Spezi E, Heijmen B. Variations in Head and Neck Treatment Plan Quality Assessment Among Radiation Oncologists and Medical Physicists in a Single Radiotherapy Department. Front Oncol 2021; 11:706034. [PMID: 34712606 PMCID: PMC8545894 DOI: 10.3389/fonc.2021.706034] [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: 05/06/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background Agreement between planners and treating radiation oncologists (ROs) on plan quality criteria is essential for consistent planning. Differences between ROs and planning medical physicists (MPs) in perceived quality of head and neck cancer plans were assessed. Materials and Methods Five ROs and four MPs scored 65 plans for in total 15 patients. For each patient, the clinical (CLIN) plan and two or four alternative plans, generated with automated multi-criteria optimization (MCO), were included. There was always one MCO plan aiming at maximally adhering to clinical plan requirements, while the other MCO plans had a lower aimed quality. Scores were given as follows: 1-7 and 1-2, not acceptable; 3-5, acceptable if further planning would not resolve perceived weaknesses; and 6-7, straightway acceptable. One MP and one RO repeated plan scoring for intra-observer variation assessment. Results For the 36 unique observer pairs, the median percentage of plans for which the two observers agreed on a plan score (100% = 65 plans) was 27.7% [6.2, 40.0]. In the repeat scoring, agreements between first and second scoring were 52.3% and 40.0%, respectively. With a binary division between unacceptable (scores 1 and 2) and acceptable (3-7) plans, the median inter-observer agreement percentage was 78.5% [63.1, 86.2], while intra-observer agreements were 96.9% and 86.2%. There were no differences in observed agreements between RO-RO, MP-MP, and RO-MP pairs. Agreements for the highest-quality, automatically generated MCO plans were higher than for the CLIN plans. Conclusions Inter-observer differences in plan quality scores were substantial and could result in inconsistencies in generated treatment plans. Agreements among ROs were not better than between ROs and MPs, despite large differences in training and clinical role. High-quality automatically generated plans showed the best score agreements.
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Affiliation(s)
- Elisabetta Cagni
- Medical Physics Unit, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico (USL-IRCCS) di Reggio Emilia, Reggio Emilia, Italy.,School of Engineering, Cardiff University, Cardiff, United Kingdom
| | - Andrea Botti
- Medical Physics Unit, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico (USL-IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Linda Rossi
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Cinzia Iotti
- Radiotherapy Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mauro Iori
- Medical Physics Unit, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico (USL-IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Salvatore Cozzi
- Radiotherapy Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Galaverni
- Radiotherapy Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ala Rosca
- Radiotherapy Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Roberto Sghedoni
- Medical Physics Unit, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico (USL-IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Giorgia Timon
- Radiotherapy Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Emiliano Spezi
- School of Engineering, Cardiff University, Cardiff, United Kingdom
| | - Ben Heijmen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
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Masini C, Iotti C, De Giorgi U, Bellia RS, Buti S, Salaroli F, Zampiva I, Mazzarotto R, Mucciarini C, Vitale MG, Bruni A, Lohr F, Procopio G, Caffo O, Nole F, Morelli F, Baier S, Buttigliero C, Ciammella P, Timon G, Fantinel E, Carlinfante G, Berselli A, Pinto C. Nivolumab in Combination with Stereotactic Body Radiotherapy in Pretreated Patients with Metastatic Renal Cell Carcinoma. Results of the Phase II NIVES Study. Eur Urol 2021; 81:274-282. [PMID: 34602312 DOI: 10.1016/j.eururo.2021.09.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [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: 06/01/2021] [Accepted: 09/15/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Nivolumab showed an overall survival (OS) benefit in pretreated metastatic renal cell carcinoma (mRCC). The role of stereotactic body radiotherapy (SBRT) in mRCC remains to be defined. OBJECTIVE Our aim was to evaluate the efficacy and safety of SBRT in combination with nivolumab in second- and third-line mRCC patients. DESIGN, SETTING, AND PARTICIPANTS The NIVES study was a phase II, single-arm, multicenter trial in patients with mRCC with measurable metastatic sites who progressed after antiangiogenic therapy, of whom at least one was suitable for SBRT. INTERVENTION The patients received SBRT to a lesion at a dose of 10 Gy in three fractions for 7 d from the first infusion of nivolumab. Nivolumab was given at an initial dose of 240 mg every 14 d for 6 mo and then 480 mg q4-weekly in responding patients. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We hypothesized that nivolumab plus SBRT improves the objective response rate (ORR) compared with nivolumab alone from 25% (derived from historical controls) to 40%. Secondary endpoints were progression-free survival (PFS), OS, disease control rate (DCR) of irradiated and nonirradiated metastases, and safety. RESULTS AND LIMITATIONS Sixty-nine patients were enrolled from July 2017 to March 2019. The ORR was 17% and the DCR was 55%. The median PFS was 5.6 mo (95% confidence interval [CI], 2.9-7.1) and median OS 20 mo (95% CI, 17-not reached). After 1.5 yr of follow-up, 23 patients died. The median time to treatment response was 2.8 mo and median duration of response was 14 mo. No new safety concerns arose. CONCLUSIONS We did not find sufficient evidence to suggest that nivolumab in combination with SBRT provides an added benefit in pretreated mRCC patients; it should however be evaluated in patients with oligometastatic or oligoprogressive disease. PATIENT SUMMARY Nivolumab in combination with stereotactic body radiotherapy does not provide evidence of increased outcomes in metastatic renal cell carcinoma patients. However this approach was safe and showed a good response of the irradiated lesions.
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Affiliation(s)
- Cristina Masini
- Medical Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Cinzia Iotti
- Radiation Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Roberto Salvatore Bellia
- Radiotherapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Ilaria Zampiva
- Medical Oncology Unit, University Hospital, AOUI Verona, Italy
| | | | | | | | - Alessio Bruni
- Radiation Therapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Frank Lohr
- Radiation Therapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Giuseppe Procopio
- Department of Medical Oncology, Istituto Nazionale dei Tumori IRCCS, Milan, Italy
| | - Orazio Caffo
- Oncology Unit, S. Chiara Hospital, Trento, Italy
| | - Franco Nole
- Medical Oncology Division of Urogenital and Head & Neck Tumors IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Franco Morelli
- Department of Oncology, IRCCS Ospedale Casa Sollievo della Sofferenza, Opera di Padre Pio, San Giovanni Rotondo, Italy
| | - Susanne Baier
- Oncologia Medica Ospedale Regionale, Bolzano Azienda Sanitaria Alto Adige, Bolzano, Italy
| | - Consuelo Buttigliero
- Department of Oncology, AOU San Luigi Gonzaga, University of Turin, Orbassano (Turin), Italy
| | - Patrizia Ciammella
- Radiation Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giorgia Timon
- Radiation Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Emanuela Fantinel
- Medical Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gabriele Carlinfante
- Pathology Unit, Clinical Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Annalisa Berselli
- Medical Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carmine Pinto
- Medical Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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BARDOSCIA L, Ciammella P, Besutti G, Bonelli E, Botti A, Pellegrini M, Vigo F, Rosca A, Timon G, Cozzi S, Ruggieri M, Iotti C. PO-0991 Impact of low muscle quality in patients with head and neck cancer undergoing chemoradiation. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07442-9] [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: 11/25/2022]
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Francolini G, Timon G, Matrone F, Marvaso G, Nicosia L, Ognibene L, Vinciguerra A, Trodella LE, Franzese C, Borghetti P, Jereczek-Fossa BA, Arcangeli S. Postoperative radiotherapy after upfront radical prostatectomy: debated issues at a turning point-a survey exploring management trends on behalf of AIRO (Italian Association of Radiotherapy and Clinical Oncology). Clin Transl Oncol 2021; 23:2568-2578. [PMID: 34286475 DOI: 10.1007/s12094-021-02665-y] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/07/2021] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Postoperative prostate cancer patients are a heterogeneous population, and many prognostic factors (e.g., local staging, PSA kinetics, margin status, histopathological features) may influence their clinical management. In this complex scenario, univocal recommendations are often lacking. For these reasons, the present survey was developed by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) to collect the opinion of Italian radiation oncologists and delineate a representation of current clinical practice in our country. METHODS A questionnaire was administered online to AIRO (Italian Association of Radiotherapy and Clinical Oncology) members registered in 2020 with a clinical interest in uro-oncological disease. RESULTS Sixty-one per cent of AIRO members answered the proposed survey. Explored topics included career and expertise, indications to adjuvant RT, additional imaging in biochemical recurrence setting, use of salvage radiotherapy (SRT), management of clinically evident locoregional recurrence and future considerations. CONCLUSIONS Overall, good level of agreement was found between participants for most of the topics. Most debated issues regarded, as expected, implementation of new imaging methods in this setting. Notably, trend in favour of early SRT vs. immediate adjuvant RT was underlined, and preference for global evaluation rather than isolated risk factors for RT indications was noticed.
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Affiliation(s)
- G Francolini
- Radiotherapy Department, University of Florence, Florence, Italy.
| | - G Timon
- Radioterapia Oncologica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - F Matrone
- Department of Radiation Oncology, Centro di Riferimento, Oncologico di Aviano CRO-IRCCS, Aviano, PN, Italy
| | - G Marvaso
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - L Nicosia
- Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | - L Ognibene
- Radiotheray Unit, San Gaetano Radiotherapy and Nuclear Medicine Center, Palermo, Italy
| | - A Vinciguerra
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via dei Vestini, 66100, Chieti, Italy
| | - L E Trodella
- Radiation Oncology, Campus Bio-Medico University, Via A. del Portillo, 21, 00128, Rome, Italy
| | - C Franzese
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital-IRCCS, Via Manzoni 56, Rozzano, Milan, Italy
| | - P Borghetti
- Radiation Oncology Department, University and Spedali Civili of Brescia, Brescia, Italy
| | - B A Jereczek-Fossa
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - S Arcangeli
- Department of Radiation Oncology, School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
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Francolini G, Trodella LE, Marvaso G, Matrone F, Nicosia L, Timon G, Ognibene L, Vinciguerra A, Franzese C, Borghetti P, Arcangeli S. Radiotherapy role in non-seminomatous germ cell tumors, radiobiological and technical issues of an unexplored scenario. Int J Clin Oncol 2021; 26:1777-1783. [PMID: 34273014 DOI: 10.1007/s10147-021-01989-7] [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: 03/02/2021] [Accepted: 07/07/2021] [Indexed: 12/01/2022]
Abstract
Historically, non-seminomatous germ cell tumor (NSGCT) has been considered a radio-resistant disease, excluding radiotherapy (RT) from curative strategies. However, case series exploring the use of radiation treatment in this setting are often outdated, and prospective ongoing studies testing new radiotherapeutic approaches in NSGCT are lacking. Considering that tremendous advances in radiotherapy technology have enabled improved precision in RT delivery as well as dose escalation while decreasing treatment-related morbidity, we overviewed the currently available literature to explore the radiobiological basis, the technical issues, and potential strategies for implementation of RT in the management of this clinical entity. The purpose of the present overview is to provide insight for future research in this unexplored scenario. In summary, the biological rationale for RT use and potential implementation with systemic therapies exist, especially considering the advantage of new technologies, which were unavailable in the era of early literature reports. The NSGCT radioresistance paradigm could be based only on the fact that effective treatment schedules were simply undeliverable with older RT techniques due to toxicity issues, but the availability of actual techniques may prompt further exploration to offer treatment alternatives to these patients. Ongoing trials on this issue are lacking, but potential areas of research are platinum-refractory disease and consolidation therapy for residual masses after PST.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.
| | - Luca Eolo Trodella
- Radiation Oncology, Campus Bio-Medico University, Via A. del Portillo, 21, 00128, Rome, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Fabio Matrone
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano CRO-IRCCS, Aviano, Pordenone, Italy
| | - Luca Nicosia
- Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | - Giorgia Timon
- Radioterapia Oncologica, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lucia Ognibene
- Radiotherapy Unit, San Gaetano Radiotherapy and Nuclear Medicine Center, Palermo, Italy
| | - Annamaria Vinciguerra
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via dei Vestini, 66100, Chieti, Italy
| | - Ciro Franzese
- Department of Biomedical Sciences, Humanitas University, Radiotherapy and Radiosurgery Department -Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Paolo Borghetti
- Radiation Oncology Department, University and Spedali Civili of Brescia, Brescia, Italy
| | - Stefano Arcangeli
- Department of Radiation Oncology, School of Medicine and Surgery-University of Milan Bicocca, Milan, Italy
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Cambria R, Ciardo D, Bazani A, Pansini F, Rondi E, Maestri D, Zerini D, Marvaso G, Romanelli P, Timon G, Fodor C, Petralia G, Alessi S, Pricolo P, Vischioni B, Fossati P, Molinelli S, Russo S, Ciocca M, De Cobelli O, Renne G, Orecchia R, Cattani F, Jereczek-Fossa BA. Ultrahypofractionated radiotherapy for localized prostate cancer with simultaneous boost to the dominant intraprostatic lesion: a plan comparison. Tumori 2021; 108:263-269. [PMID: 33896239 DOI: 10.1177/03008916211011667] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare different stereotactic body techniques-intensity-modulated radiotherapy with photons and protons, applied to radiotherapy of prostatic cancer-with simultaneous integrated boost (SIB) on the dominant intraprostatic lesion (DIL). METHODS Ten patients were selected for this planning study. Dosimetric results were compared between volumetric modulated arc therapy, intensity-modulated radiation therapy (IMRT), and intensity-modulated proton therapy both with two (IMPT 2F) and five fields (IMPT 5F) planning while applying the prescription schemes of 7.25 Gy/fraction to the prostate gland and 7.5 Gy/fraction to the DIL in 5 fractions. RESULTS Comparison of the coverages of the planning target volumes showed that small differences exist. The IMPT-2F-5F techniques allowed higher doses in the targets; conformal indexes resulted similar; homogeneity was better in the photon techniques (2%-5%). Regarding the organs at risk, all the techniques were able to maintain the dose well below the prescribed constraints: in the rectum, the IMPT-2F-5F and IMRT were more efficient in lowering the intermediate doses; in the bladder, the median dose was significantly better in the case of IMPT (2F-5F). In the urethra, the best sparing was achieved only by IMPT-5F. CONCLUSIONS Stereotactic radiotherapy with SIB for localized prostate cancer is feasible with all the investigated techniques. Concerning IMPT, the two-beam technique does not seem to have a greater advantage compared to the standard techniques; the 5-beam technique seems more promising also accounting for the range uncertainty.
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Affiliation(s)
- Raffaella Cambria
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Delia Ciardo
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Alessia Bazani
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Floriana Pansini
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Elena Rondi
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Davide Maestri
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Dario Zerini
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Giulia Marvaso
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, via Festa del Perdono, Milan, Italy
| | - Pola Romanelli
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Giorgia Timon
- Radiotherapy Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cristiana Fodor
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Giuseppe Petralia
- Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, Istituto Europeo di Oncologia IRCCS, via Ripamonti 435, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, via Festa del Perdono, Milan, Italy
| | - Sarah Alessi
- Department of Radiology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Paola Pricolo
- Department of Radiology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | | | - Piero Fossati
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, via Festa del Perdono, Milan, Italy
| | | | - Stefania Russo
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Mario Ciocca
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Ottavio De Cobelli
- Department of Urology, Istituto Europeo di Oncologia IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, via Festa del Perdono, Milan, Italy
| | - Giuseppe Renne
- Uropathology and Intraoperative Diagnostic Division, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Federica Cattani
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Barbara A Jereczek-Fossa
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, via Festa del Perdono, Milan, Italy
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Galaverni M, Chendi A, Trojani V, Bertolini M, Botti A, Ciammella P, Ruggieri M, Giaccherini L, Blandino G, Manicone M, Rossi R, Timon G, Cozzi S, Bardoscia L, Solla S, Orlandi M, Fioroni F, Spaggiari L, Iori M, Iotti C. Radiomics Analysis of Stereotactic Body Radiation Therapy Patients with Lung Cancer as a Toxicity Biomarker. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1338] [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: 11/15/2022]
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14
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Ciammella P, Timon G, Masini C, Belli R, Salaroli F, Mazzarotto R, Bruni A, Pinto C, Iotti C. PO-1217: Safety of Nivolumab and stereotactic RT in metastatic renal carcinoma: early results of NIVES study. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01235-4] [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: 10/22/2022]
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15
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Cagni E, Rossi L, Botti A, Iori M, Sghedoni R, Iotti C, Rosca A, Timon G, Cozzi S, Galaverni M, Orlandi M, Spezi E, Heijmen B. OC-0105: Inter-observer variability in quality scores of Pareto optimal plans. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00131-6] [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: 11/17/2022]
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16
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Masini C, Ciammella P, Timon G, Gnoni R, De Giorgi U, Bellia S, Buti S, Salaroli F, Milella M, Mazzarotto R, Mucciarini C, Vitale M, Bruni A, Procopio G, Kinspergher S, Nole F, Morelli F, Pappagallo G, buttigliero C, Pinto C. First results of safety profile of nivolumab (NIVO) in combination with stereotactic body radiotherapy (SBRT) in II and III line of patients (pts) with metastatic renal cell carcinoma (mRCC) in NIVES study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz249.057] [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: 11/12/2022] Open
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17
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Giaccherini L, Galaverni M, Renna I, Timon G, Galeandro M, Pisanello A, Russo M, Botti A, Iotti C, Ciammella P. Role of multidimensional assessment of frailty in predicting outcomes in older patients with glioblastoma treated with adjuvant concurrent chemo-radiation. J Geriatr Oncol 2019; 10:770-778. [DOI: 10.1016/j.jgo.2019.03.009] [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: 08/27/2018] [Revised: 01/30/2019] [Accepted: 03/13/2019] [Indexed: 12/13/2022]
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18
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Giaccherini L, Ciammella P, Galaverni M, Manicone M, Renna I, Galeandro M, Timon G, Bellafiore F, Ramundo D, Vigo F, Rosca A, Palmieri T, Ruggieri M, Botti A, Sghedoni R, Cagni E, Orlandi M, Iori M, Russo M, Iotti C. EP-1650 Elderly glioblastoma patients:role of multidimensional assessment of frailty in predicting outcomes. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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Caravatta L, Fiorica F, Alitto A, Rosa C, Nardangeli A, Munoz F, Bianco L, Giaccherini L, Timon G, Dionisi F, Massaccesi M. EP-1464 A systematic literature review of rectal re-irradiation: tolerance and outcomes. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31884-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Manicone M, Galaverni M, Renna I, Ciammella P, Giaccherini L, Bellafiore F, Timon G, Vigo F, Rosca A, Ramundo D, Galeandro M, Ruggieri M, Palmieri T, Botti A, Sghedoni R, Cagni E, Orlandi M, Russo M, Bonelli C, Pagano M, Iotti C. EP-1248 Stereotactic radiotherapy for brain metastasis and systemic therapies: a safe combination? Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31668-8] [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: 10/26/2022]
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21
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Parisi G, Mazzola R, Ciammella P, Timon G, Fozza A, Franceschini D, Navarria F, Bruni A, Perna M, Giaj-Levra N, Alongi F, Scotti V, Trovo M. Hypofractionated radiation therapy in the management of locally advanced NSCLC: a narrative review of the literature on behalf of the Italian Association of Radiation Oncology (AIRO)-Lung Working Group. Radiol Med 2018; 124:136-144. [PMID: 30368721 DOI: 10.1007/s11547-018-0950-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/15/2018] [Indexed: 12/19/2022]
Abstract
A systematic literature was performed to assess the benefit in terms of effectiveness and feasibility of hypofractionated radiotherapy (HypoRT), with or without chemotherapy (CT), in the treatment of locally advanced non-small cell lung cancer (NSCLC). We have identified all studies, published from 2007 onwards, on patients with locally advanced NSCLC treated with HypoRT with radical intent, with a minimal dose per fraction of 2.4 Gy, with or without concurrent chemotherapy. Twenty-nine studies were identified, for a total of 2614 patients. Patients were divided in the concurrent chemo-radiation therapy group (CT-RT) and radiotherapy alone (RT). In RT group, the delivered dose ranged from 45 to 85.5 Gy, with a dose/fraction from 2.4 to 4 Gy. Actuarial 2-year PFS ranged from 13 to 57.8%, and 1, 2- and 3-year overall survival (OS) ranged from 51.3 to 95%, from 22 to 68.7%, and from 7 to 32%, respectively. Acute Grade ≥ 3 esophagitis occurred in 0-15%, while late esophageal toxicity was 0-16%. Acute pneumonitis occured in 0-44%, whereas late pneumonitis occured in 0-47%, most commonly grade ≤ G3. In CT-RT group, the delivered dose ranged from 52.5 to 75 Gy, with a dose/fraction ranging from 2.4 to 3.5 Gy. Actuarial 2-year PFS ranged from 19 to 57.8%, and OS at 1, 2 and 3 years ranged from 28 to 95%, 38.6 to 68.7%, and 31 to 44%, respectively. Acute Grade 2 and 3 esophagitis occurred in 3-41.7%, while late esophageal toxicity occurred in 0-8.3%. Acute pneumonitis ranged from 0 to 23%, whereas late pneumonitis occured 0-47%. HypoRT seems to be safe in patients with locally advanced NSCLC. The encouraging survival results of several studies analyzed suggest that hypofractionated radiation schemes should be further investigated in the future.
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Affiliation(s)
- Giuseppe Parisi
- Department of Radiation Oncology, Azienda Sanitaria Universitaria Integrata UD, P.le Santa Maria della Misericordia 15, 33100, Udine, Italy.
| | - Rosario Mazzola
- Department of Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy
| | - Patrizia Ciammella
- Department of Oncology and Advanced Technology, Arcispedale S Maria Nuova-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Giorgia Timon
- Department of Oncology and Advanced Technology, Arcispedale S Maria Nuova-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Fozza
- Department of Radiation Oncology, SS.Antonio e Biagio e C.Arrigo Hospital Alessandria, Alessandria, Italy
| | - Davide Franceschini
- Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | | | - Alessio Bruni
- Radiotherapy Unit - Department of Oncology and Hematology, University Hospital of Modena Italy, Modena, Italy
| | - Marco Perna
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Niccolò Giaj-Levra
- Department of Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy
| | - Filippo Alongi
- Department of Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy
| | - Vieri Scotti
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Marco Trovo
- Department of Radiation Oncology, Azienda Sanitaria Universitaria Integrata UD, P.le Santa Maria della Misericordia 15, 33100, Udine, Italy
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22
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Timon G, Jereczek-Fossa BA, Fersino S, Iotti C, Corvò R, Magrini SM, Alongi F. Non-palliative radiotherapy in ab initio oligometastatic prostate cancer: an Italian national survey. Radiol Med 2018; 124:211-217. [DOI: 10.1007/s11547-018-0952-x] [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] [Received: 10/05/2018] [Accepted: 10/15/2018] [Indexed: 12/24/2022]
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23
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Timon G, Ciardo D, Bazani A, Marvaso G, Riva G, Volpe S, Rojas DP, Renne G, Petralia G, Zerini D, Fodor C, Dicuonzo S, Maestri D, Pansini F, Cambria R, Cattani F, Golino F, Scroffi V, De Lorenzo D, De Cobelli O, Orecchia R, Jereczek-Fossa BA. Short-term high precision radiotherapy for early prostate cancer with concomitant boost to the dominant lesion: ad interim analysis and preliminary results of Phase II trial AIRC-IG-13218. Br J Radiol 2018; 91:20160725. [PMID: 29750539 DOI: 10.1259/bjr.20160725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To report preliminary results of a cutting edge extreme hypofractionated treatment with concomitant boost to the dominant lesion for patients with early stage prostate cancer (PCa). METHODS AIRC-IG-13218 is a prospective Phase II trial started in June 2015. Patients with low and intermediate risk PCa who met the inclusion criteria underwent extreme hypofractionated radiotherapy to the prostate (36.25 Gy in 5 fractions) and a simultaneous integrated boost to the dominant intraprostatic lesion (DIL) to 37.5 Gy. The DIL was identified by a multiparamentric MRI (mpMRI) co-registered with planning CT. Toxicity was assessed according to CTCAE v4.0 and RTOG/EORTC criteria. The preliminary evaluation of the first 13 patients was required to confirm the feasibility of the treatment before completing the enrollment of 65 patients. RESULTS The first 13 patients completed the treatment between June 2015 and February 2016. With a median clinical follow-up of 17 months (range 11-26), no Grade 3 or 4 early toxicity was reported. CONCLUSIONS Our preliminary data about early toxicity of an extreme hypofractionated schedule with concomitant boost on the DIL are encouraging. The higher number of patients expected for the trial and a longer follow-up are needed to confirm these results. Advances in knowledge: The use of mpMRI to identify and boost the DIL is an innovative and interesting approach to PCa. Our preliminary findings suggest that dose escalation using DIL boost and extremely hypofractionated radiotherapy regimens might be a safe approach, allowing for short and effective treatment of organ-confined PCa.
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Affiliation(s)
- Giorgia Timon
- 1 Department of Radiotherapy, European Institute of Oncology , Milan , Italy.,2 Radiation Oncology Unit, Arcispedale Santa Maria Nuova - IRCCS , Reggio Emilia , Italy
| | - Delia Ciardo
- 1 Department of Radiotherapy, European Institute of Oncology , Milan , Italy
| | - Alessia Bazani
- 3 Medical Physics Unit, European Institute of Oncology , Milan , Italy
| | - Giulia Marvaso
- 1 Department of Radiotherapy, European Institute of Oncology , Milan , Italy
| | - Giulia Riva
- 1 Department of Radiotherapy, European Institute of Oncology , Milan , Italy.,4 Department of Oncology and Hemato-oncology, University of Milan , Milan , Italy
| | - Stefania Volpe
- 1 Department of Radiotherapy, European Institute of Oncology , Milan , Italy.,4 Department of Oncology and Hemato-oncology, University of Milan , Milan , Italy
| | - Damaris P Rojas
- 1 Department of Radiotherapy, European Institute of Oncology , Milan , Italy.,4 Department of Oncology and Hemato-oncology, University of Milan , Milan , Italy
| | - Giuseppe Renne
- 5 Department of Pathology, European Institute of Oncology , Milan , Italy
| | - Giuseppe Petralia
- 4 Department of Oncology and Hemato-oncology, University of Milan , Milan , Italy.,6 Department of Radiology, European Institute of Oncology , Milan , Italy
| | - Dario Zerini
- 1 Department of Radiotherapy, European Institute of Oncology , Milan , Italy
| | - Cristiana Fodor
- 1 Department of Radiotherapy, European Institute of Oncology , Milan , Italy
| | - Samantha Dicuonzo
- 1 Department of Radiotherapy, European Institute of Oncology , Milan , Italy
| | - Davide Maestri
- 3 Medical Physics Unit, European Institute of Oncology , Milan , Italy.,4 Department of Oncology and Hemato-oncology, University of Milan , Milan , Italy
| | - Floriana Pansini
- 3 Medical Physics Unit, European Institute of Oncology , Milan , Italy
| | - Raffaella Cambria
- 3 Medical Physics Unit, European Institute of Oncology , Milan , Italy
| | - Federica Cattani
- 3 Medical Physics Unit, European Institute of Oncology , Milan , Italy
| | - Federica Golino
- 1 Department of Radiotherapy, European Institute of Oncology , Milan , Italy
| | - Valerio Scroffi
- 1 Department of Radiotherapy, European Institute of Oncology , Milan , Italy
| | | | - Ottavio De Cobelli
- 4 Department of Oncology and Hemato-oncology, University of Milan , Milan , Italy.,8 Department of Urology, European Institute of Oncology , Milan , Italy
| | - Roberto Orecchia
- 7 Scientific Direction, European Institute of Oncology , Milan , Italy.,9 Department of Medical Imaging and Radiation Sciences, European Institute of Oncology , Milan , Italy
| | - Barbara Alicja Jereczek-Fossa
- 1 Department of Radiotherapy, European Institute of Oncology , Milan , Italy.,4 Department of Oncology and Hemato-oncology, University of Milan , Milan , Italy
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24
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Galaverni M, Ciammella P, Renna I, Lattanzi E, Rosca A, Vigo F, Giaccherini L, Bellafiore F, Timon G, Galeandro M, Ruggieri M, Iotti C. PO-0732: First line low doses RT and chemoimmunotherapy in stage II/IV follicular lymphoma patients. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31042-9] [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: 10/14/2022]
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25
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Ciammella P, Galaverni M, Lattanzi E, Timon G, Renna I, Botti A, Orlandi M, Giaccherini L, Bellafiore F, Iotti C. EP-1365: F-FDG-PET/CT metabolic features as prognostic and predictive factors in lung tumors undergoing SBRT. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31674-8] [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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26
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Ciardo D, Jereczek-Fossa BA, Petralia G, Timon G, Zerini D, Cambria R, Rondi E, Cattani F, Bazani A, Ricotti R, Garioni M, Maestri D, Marvaso G, Romanelli P, Riboldi M, Baroni G, Orecchia R. Multimodal image registration for the identification of dominant intraprostatic lesion in high-precision radiotherapy treatments. Br J Radiol 2017; 90:20170021. [PMID: 28830203 DOI: 10.1259/bjr.20170021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE The integration of CT and multiparametric MRI (mpMRI) is a challenging task in high-precision radiotherapy for prostate cancer. A simple methodology for multimodal deformable image registration (DIR) of prostate cancer patients is presented. METHODS CT and mpMRI of 10 patients were considered. Organs at risk and prostate were contoured on both scans. The dominant intraprostatic lesion was additionally delineated on MRI. After a preliminary rigid image registration, the voxel intensity of all the segmented structures in both scans except the prostate was increased by a specific amount (a constant additional value, A), in order to enhance the contrast of the main organs influencing its position and shape. 70 couples of scans were obtained by varying A from 0 to 800 and they were subsequently non-rigidly registered. Quantities derived from image analysis and contour statistics were considered for the tuning of the best performing A. RESULTS A = 200 resulted the minimum enhancement value required to obtain statistically significant superior registration results. Mean centre of mass distance between corresponding structures decreases from 7.4 mm in rigid registration to 5.3 mm in DIR without enhancement (DIR-0) and to 2.7 mm in DIR with A = 200 (DIR-200). Mean contour distance was 2.5, 1.9 and 0.67 mm in rigid registration, DIR-0 and DIR-200, respectively. In DIR-200 mean contours overlap increases of +13 and +24% with respect to DIR-0 and rigid registration, respectively. CONCLUSION Contour propagation according to the vector field resulting from DIR-200 allows the delineation of dominant intraprostatic lesion on CT scan and its use for high-precision radiotherapy treatment planning. Advances in knowledge: We investigated the application of a B-spline, mutual information-based multimodal DIR coupled with a simple, patient-unspecific but efficient contrast enhancement procedure in the pelvic body area, thus obtaining a robust and accurate methodology to transfer the functional information deriving from mpMRI onto a planning CT reference volume.
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Affiliation(s)
- Delia Ciardo
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.,2 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Giuseppe Petralia
- 3 Division of Radiology, European Institute of Oncology, Milan, Italy
| | - Giorgia Timon
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Dario Zerini
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Raffaella Cambria
- 4 Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Elena Rondi
- 4 Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Federica Cattani
- 4 Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Alessia Bazani
- 4 Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Rosalinda Ricotti
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Maria Garioni
- 4 Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Davide Maestri
- 4 Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Giulia Marvaso
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Paola Romanelli
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Marco Riboldi
- 5 Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Guido Baroni
- 5 Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.,6 Bioengineering Unit, Centro Nazionale di Adroterapia Oncologica (CNAO Foundation), Pave, Italy
| | - Roberto Orecchia
- 2 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,7 Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Milan, Italy
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Riva G, Timon G, Ciardo D, Bazani A, Maestri D, De Lorenzo D, Pansini F, Cambria R, Cattani F, Marvaso G, Zerini D, Rojas D, Volpe S, Golino F, Scroffi V, Fodor C, Petralia G, De Cobelli O, Orecchia R, Jereczek-Fossa B. EP-1338: High precision radiotherapy for early prostate cancer with concomitant boost to the dominant lesion. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31773-5] [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: 10/19/2022]
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Marvaso G, Riva G, Bassi C, Fodor C, Ciardo D, Zerini D, Timon G, Surgo A, Maucieri A, Pansini F, De Marco P, Cattani F, De Cobelli O, Orecchia R, Jereczek-Fossa B. EP-1339: Feasibility and efficacy of moderately hypofractionated radiotherapy in high risk prostate cancer. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31774-7] [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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Jereczek-Fossa BA, Fanetti G, Fodor C, Ciardo D, Santoro L, Francia CM, Muto M, Surgo A, Zerini D, Marvaso G, Timon G, Romanelli P, Rondi E, Comi S, Cattani F, Golino F, Mazza S, Matei DV, Ferro M, Musi G, Nolè F, de Cobelli O, Ost P, Orecchia R. Salvage Stereotactic Body Radiotherapy for Isolated Lymph Node Recurrent Prostate Cancer: Single Institution Series of 94 Consecutive Patients and 124 Lymph Nodes. Clin Genitourin Cancer 2017; 15:e623-e632. [PMID: 28185875 DOI: 10.1016/j.clgc.2017.01.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/23/2016] [Accepted: 01/03/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND The purpose of the study was to evaluate the prostate serum antigen (PSA) response, local control, progression-free survival (PFS), and toxicity of stereotactic body radiotherapy (SBRT) for lymph node (LN) oligorecurrent prostate cancer. PATIENTS AND METHODS Between May 2012 and October 2015, 124 lesions were treated in 94 patients with a median dose of 24 Gy in 3 fractions. Seventy patients were treated for a single lesion and 25 for > 1 lesion. In 34 patients androgen deprivation (AD) was combined with SBRT. We evaluated biochemical response according to PSA level every 3 months after SBRT: a 3-month PSA decrease from pre-SBRT PSA of more than 10% identified responder patients. In case of PSA level increase, imaging was performed to evaluate clinical progression. Toxicity was assessed every 6 to 9 months after SBRT. RESULTS Median follow-up was 18.5 months. In 13 patients (14%) Grade 1 to 2 toxicity was reported without any Grade 3 to 4 toxicity. Biochemical response, stabilization, and progression were observed in 64 (68%), 10 (11%), and 20 (21%) of 94 evaluable patients. Clinical progression was observed in 31 patients (33%) after a median time of 8.1 months. In-field progression occurred in 12 lesions (9.7%). Two-year local control and PFS rates were 84% and 30%, respectively. Age older than 75 years correlated with better biochemical response rate. Age older than 75 years, concomitant AD administered up to 12 months, and pelvic LN involvement correlated with longer PFS. CONCLUSION SBRT is safe and offers good in-field control. At 2 years after SBRT, 1 of 3 patients is progression-free. Further investigation is warranted to identify patients who benefit most from SBRT and to define the optimal combination with AD.
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Affiliation(s)
- Barbara Alicja Jereczek-Fossa
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Giuseppe Fanetti
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
| | - Cristiana Fodor
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Delia Ciardo
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Luigi Santoro
- Department of Epidemiology and Statistics, European Institute of Oncology, Milan, Italy
| | - Claudia Maria Francia
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Matteo Muto
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Alessia Surgo
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Dario Zerini
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Giulia Marvaso
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Giorgia Timon
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Paola Romanelli
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Elena Rondi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Stefania Comi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Federica Golino
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Stefano Mazza
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | | | - Matteo Ferro
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Franco Nolè
- Division of Urogenital and Head and Neck Tumours, Department of Medical Oncology, European Institute of Oncology, Milan, Italy
| | | | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Roberto Orecchia
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Scientific Directorate, European Institute of Oncology, Milan, Italy
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Vagge S, Marcenaro M, Timon G, Siffredi G, Corvò R. EP-1255: SABR and FDG-PET in lung cancer: a SUV cut-off value before treatment to predict local control. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32505-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Timon G, Zerini D, Fodor C, Bazzani F, Maucieri A, Ronchi S, Rojas D, Volpe S, Vavassori A, Cattani F, Garibaldi C, Comi S, Cambria R, De Cobelli O, Orecchia R, Jereczek-Fossa B. EP-1372: Salvage image-guided stereotactic re-irradiation of local recurrence in prostate cancer. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32622-6] [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: 11/30/2022]
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Jereczek-Fossa B, Ciardo D, Colangione S, Fodor C, Zerini D, Cecconi A, Surgo A, Gerardi M, Muto M, Timon G, Comi S, Pansini F, Bazani A, Maestri D, Garioni M, Scroffi V, Cattani F, Cambria R, De Cobelli O, Orecchia R. OC-0448: Give me five: extreme hypofractionated IG-IMRT for organ confined prostate cancer. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31697-8] [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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Barra S, Vagge S, Marcenaro M, Blandino G, Timon G, Vidano G, Agnese D, Gusinu M, Cavagnetto F, Corvò R. Image guided hypofractionated radiotherapy by helical tomotherapy for prostate carcinoma: toxicity and impact on Nadir PSA. Biomed Res Int 2014; 2014:541847. [PMID: 24745018 PMCID: PMC3976914 DOI: 10.1155/2014/541847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 02/13/2014] [Indexed: 11/17/2022]
Abstract
AIM To evaluate the toxicity of a hypofractionated schedule for primary radiotherapy (RT) of prostate cancer as well as the value of the nadir PSA (nPSA) and time to nadir PSA (tnPSA) as surrogate efficacy of treatment. MATERIAL AND METHODS Eighty patients underwent hypofractionated schedule by Helical Tomotherapy (HT). A dose of 70.2 Gy was administered in 27 daily fractions of 2.6 Gy. Acute and late toxicities were graded on the RTOG/EORTC scales. The nPSA and the tnPSA for patients treated with exclusive RT were compared to an equal cohort of 20 patients treated with conventional fractionation and standard conformal radiotherapy. RESULTS Most of patients (83%) did not develop acute gastrointestinal (GI) toxicity and 50% did not present genitourinary (GU) toxicity. After a median follow-up of 36 months only grade 1 of GU and GI was reported in 6 and 3 patients as late toxicity. Average tnPSA was 30 months. The median value of nPSA after exclusive RT with HT was 0.28 ng/mL and was significantly lower than the median nPSA (0.67 ng/mL) of the conventionally treated cohort (P = 0.02). CONCLUSIONS Hypofractionated RT schedule with HT for prostate cancer treatment reports very low toxicity and reaches a low level of nPSA that might correlate with good outcomes.
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Affiliation(s)
- Salvina Barra
- Department of Radiation Oncology, IRCCS San Martino-IST, National Cancer Research Institute, 16100 Genoa, Italy
| | - Stefano Vagge
- Department of Radiation Oncology, IRCCS San Martino-IST, National Cancer Research Institute, 16100 Genoa, Italy
| | - Michela Marcenaro
- Department of Radiation Oncology, IRCCS San Martino-IST, National Cancer Research Institute, 16100 Genoa, Italy
| | | | | | | | | | - Marco Gusinu
- Department of Medical Physics, IRCCS San Martino-IST, National Cancer Research Institute, Genova, Italy
| | - Francesca Cavagnetto
- Department of Medical Physics, IRCCS San Martino-IST, National Cancer Research Institute, Genova, Italy
| | - Renzo Corvò
- Department of Radiation Oncology, IRCCS San Martino-IST, National Cancer Research Institute, 16100 Genoa, Italy ; University of Genoa, DISSAL, 16100 Genoa, Italy
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Aloi D, Timon G, Vidano G, Blandino G, Giannelli F, Gusinu M, Garrè M, Milanaccio C, Barra S, Corvò R. PD-0235: Combined chemo-radiotherapy in paediatric astrocytary gliomas. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30340-6] [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: 11/26/2022]
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Blandino G, Timon G, Vidano G, Verzanini E, Vagge S, Marcenaro M, Barra S, Corvò R. EP-1279: Evauation of biochemical response in relation to RT schedule for prostate cancer: Preliminary experience. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31397-9] [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: 11/24/2022]
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36
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Vidano G, Giannelli F, Blandino G, Timon G, Garelli S, Agostinelli S, Barra S, Corvò R. EP-1362: Intensity modulated radiotherapy and endocavitary BRT in elderly patients with locally advanced cervical cancer. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31480-8] [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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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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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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Timon G, Bacigalupo A, Vagge S, Belgioia L, Garelli S, Corvò R. PO-0699: IMRT with SIB in the treatment of anal cancer: a mono-institutional experience. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33005-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: 10/23/2022]
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Belgioia L, Timon G, Bacigalupo A, Vagge S, Pupillo F, Marcenaro M, Vecchio S, Corvò R. PO-056: Early-Outcome and Toxicity of RT/CT in the Management of Unknown HN Primary Site with Helical Tomotherapy. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)34675-2] [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: 11/30/2022]
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Bacigalupo A, Timon G, Vagge S, Belgioia L, Bellini A, Marcenaro M, Vecchio S, Corvò R. PO-057: SIB-IMRT Delivered By Helical Tomotherapy for Patients with Nasopharyngeal Carcinoma. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)34676-4] [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: 10/23/2022]
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Guenzi M, Fozza A, Blandino G, Timon G, Belgioia L, Vidano G, Cavagnetto F, Gusinu M, Agostinelli S, Garelli S, Zeverino M, Taccini G, Corvò R. Focus on the actual clinical target volume irradiated with intraoperative radiotherapy for breast cancer. Anticancer Res 2012; 32:4945-4950. [PMID: 23155264] [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: 06/01/2023]
Abstract
AIM Intraoperative radiotherapy (IORT) has been investigated as an exclusive adjuvant treatment option for early-stage breast cancer (BC). We analysed our experience on the technical aspects of this innovative approach in terms of identification of breast volume actually to be treated during IORT. PATIENTS AND METHODS A total of 315 patients at low risk of breast cancer recurrence underwent IORT as exclusive treatment after breast-conservative surgery. To evaluate the breast volume actually irradiated with IORT, we considered a sample of eight patients, chosen retrospectively as having enough clips to identify the tumour bed and IORT site in computed-tomography (CT). The clinical target volume (CTV) was assessed for each patient with two different methods: the first, cc-IORT, was considered during surgery according to the chosen collimator diameter and glandular thickness, while the second, cc-CT, was evaluated through computed-tomography performed after surgery. The cc-CT CTV was obtained by contouring the cc-IORT on the CT section on the basis of the clips placed by the surgeon on the resection margins. RESULTS In our experience, the 5-cm (50%) and the 6-cm (36%) diameter collimators have been the ones, used the most. The diameter of the collimator used did not appear to adversely affect the satisfactory aesthetic result. The comparison between CTVs showed that glandular breast volume contoured with CT (cc-CT) appeared to be three fold larger than the target identified at surgery and included in the area of chosen collimator (cc-IORT). CONCLUSION The actual volume of breast gland irradiated with the IORT procedure appears to be larger than expected. This may be due to the area being prepared for IORT by placing tissue compactly.
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Affiliation(s)
- Marina Guenzi
- Department of Radiotherapy, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliera Universitaria, Istituto Nazionale per la Ricerca sul Cancro, San Martino, Genoa, Italy.
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Bacigalupo A, Marcenaro M, Vagge S, Timon G, Torielli P, Vecchio S, Cavagnetto F, Gusinu M, Corvò R. EP-1162 DOSE DISTRIBUTION AND COMPLIANCE IN NPC TREATED BY TOMOTHERAPY COMBINED WITH CT: A MONO-INSTITUTIONAL EXPERIENCE. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71495-0] [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: 11/17/2022]
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Fozza A, Timon G, Belgioia L, Agostinelli S, Garelli S, Friedman D, Vidano G, Vallerga F, Corvò R, Guenzi M. EP-1002 INTRA OPERATIVE RADIOTHERAPY (IORT) IN RELAPSED BREAST CANCER: A POSSIBILITY FOR A NEW CONSERVATIVE THERAPY? Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71335-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: 11/25/2022]
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Fozza A, Belgioia L, Timon G, Cavagnetto F, Gusinu M, Canavese G, Meszaros P, Vidano G, Corvò R, Guenzi M. PD-0285 EVALUATION OF TOLERANCE TO EXCLUSIVE IORT WITH DIFFERENT DOSES FOR CONSERVATIVE BREAST CANCER TREATMENT. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70624-2] [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: 10/28/2022]
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Guenzi M, Fozza A, Timon G, Belgioia L, Vidano G, Cavagnetto F, Agostinelli S, Gusinu M, Carli F, Cafiero F, Friedman D, Canavese G, Corvò R. A two-step selection of breast cancer patients candidates for exclusive IORT with electrons: a mono-institutional experience. Anticancer Res 2012; 32:1533-1536. [PMID: 22493397] [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: 05/31/2023]
Abstract
AIM To assess the impact of a two-step multiparameter selection on the actual enrollment of women with breast cancer into a prospective intraoperative radiotherapy (IORT) trial. PATIENTS AND METHODS From September 2009, a prospective clinical trial was started in order to deliver adjuvant exclusive single -fraction IORT to patients with early breast cancer. To select patients meeting suitable eligibility criteria for the clinical trial, a two-step decision process was developed: at pre-surgical examination (first step) and during surgery (second step). RESULTS A series of 464 patients with breast cancer was analysed: at the first step, out of 464 patients, 333 (71%) were considered eligible for the IORT protocol; at the second step, out of 333 patients, 199 (60%) met the eligibility criteria and received the IORT fraction according to the criteria of the controlled trial. CONCLUSION In our experience, the ultimate rate of patients who enrolled in the IORT clinical trial after the two-step decision process was 43%.
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Affiliation(s)
- M Guenzi
- Department of Radiotherapy, IRCCS AUO San Martino - IST - National Institute for Cancer Research, Genoa, Italy.
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Belgioia L, Guenzi M, D'Alonzo A, Timon G, Ricchetti F, Agostinelli S, Corvo R. 6 poster FEASIBILITY OF INTRAOPERATIVE RADIATION THERAPY (IORT) IN WOMEN WITH EARLY BREAST CANCER. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70129-3] [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: 10/18/2022]
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