High dose craniospinal irradiation as independent risk factor of permanent alopecia in childhood medulloblastoma survivors: cohort study and literature review

PURPOSE

Our aim was to determine the main risk factors related to the occurrence of permanent alopecia in childhood medulloblastoma (MB) survivors.

METHODS

We retrospectively analyzed the clinical features of all consecutive MB survivors treated at our institute. We divided the patients into 3 groups depending on the craniospinal irradiation (CSI) dose received and defined permanent alopecia first in terms of the skin region affected (whole scalp and nape region), then on the basis of the toxicity degree (G). Any relationship between permanent alopecia and other characteristics was investigated by a univariate and multivariate analysis and Odds ratio (OR) with confidence interval (CI) was reported.

RESULTS

We included 41 patients with a mean10-year follow-up. High dose CSI resulted as an independent factor leading to permanent hair loss in both groups: alopecia of the whole scalp (G1 p-value 0.030, G2 p-value 0.003) and of the nape region (G1 p-value 0.038, G2 p-value 0.006). The posterior cranial fossa (PCF) boost volume and dose were not significant factors at multivariate analysis neither in permanent hair loss of the whole scalp nor only in the nuchal region.

CONCLUSION

In pediatric patients with MB, the development of permanent alopecia seems to depend only on the CSI dose ≥ 36 Gy. Acute damage to the hair follicle is dose dependent, but in terms of late side effects, constant and homogeneous daily irradiation of a large volume may have a stronger effect than a higher but focal dose of radiotherapy.

P03.11.A Potential role of pre-radiotherapy MRI for target delineation in high-grade gliomas: a multicenter retro-prospective cohort study

Background

The optimal timing for target identification in high-grade glioma (HGG) remains unclear due to variability in the hyper-signal T2/FLAIR between MRI performed at diagnosis, post-surgery and at radiotherapy (RT) start. The aim of this study was to retrospectively confirm that RT planned on delayed MRI might allow to spare more normal tissue without decreasing local tumour control, in order to prospectively evaluate the best standard and advanced MRI and metabolic imaging sequences for clinical tumor volume (CTV) adaptation.

Material and Methods

We analyzed a retrospective cohort of consecutive patients with HGG treated from 2017 to 2020. All patients had a diagnostic MRI and another performed immediately post-surgery or pre-RT. Target volumes were contoured, based on T2/FLAIR, on diagnostic and post-surgery MRI in group A, while in group B on pre-RT MRI. We analyzed GTV and CTV volume, and the percentage increase between them. Moreover, we compared the two groups in terms of clinical-pathological characteristics and progression-free survival (PFS) and overall survival (OS). A prospective study, started on January 2022, has enrolled patients with HGG evaluated by advanced sequences MRI at diagnosis, post-surgery and pre-RT. In addition, some selected patients have undergone diagnostic DOPA-PET and pre-RT DOPA-PET. 2 MRI-guided contours have been performed for each patient: adapted on T2/FLAIR post-surgery and CTV-adapt on pre-RT, to assess study objectives.

Results

In retrospective cohort we analyzed 54 patients (25 group A, 29 group B). The median age of patients was 61 years (IQR 17,75), 93% had an ECOG PS of 0 or 1, 51 were symptomatic at diagnosis. Patients in group B had more frequently MGMT methylation (59 % vs. 28%, p=0.01) while less frequently frontal lobe involvement (60% vs. 24%, p=0.01). The median percentage increase between GTV and CTV was higher in group A than B: 431% (range 62%-7335%) vs 385% (range 53%-3174%), respectively. No significant difference in the pattern of relapse was observed, since >90% of disease recurrences were in-field in both groups. Median PFS and OS of the overall population were 9.5 months (95% CI 7 - 12) and 18.5 months (95% CI 16 - 24), respectively. Patients in group B had a significant better PFS as compared to those in group A (p=0.03), but similar OS. Nevertheless, imbalance in MTMT methylation status between the two groups was a major driver for PFS. Overall, 37 out of 51 patients had improvement in neurological symptoms (p<0.001), with no difference between the two groups (p=0.54).

Conclusion

Our data suggest that CTV adaptation to pre-RT T2/FLAIR may allow reducing RT volume, without affecting symptoms relieving and disease control. Results from the prospective study will help identifying the best adaptation of CTV guided by T2/FLAIR, advanced MRI sequences and metabolic imaging, in order to optimize efficacy and safety of treatment planning.

AB1160 IMPACT OF COVID-19 TREATMENTS ON PERIPHERAL CAPILLARY DENSITY EVALUATED BY NAILFOLD VIDEOCAPILLAROSCOPY

Background

Human SARS-CoV-2 infection can induce a wide spectrum of organ dysfunctions, including microvascular impairment [1]. S1 subunit of viral receptor-binding domain binds to the angiotensin-converting enzyme 2 receptor on endothelium and S2 subunit allows the virus to enter endothelial cells. The resulting breakdown of barrier integrity drives a cascade of inflammatory and thrombotic events, that aggravate the course of COVID-19 together with other risk factors [2-4]. Up to date, a lower capillary density has been reported in several distinct body districts, using sublingual video microscopy, ocular optical coherence tomography angiography, skin functional laser Doppler perfusion imaging and nailfold videocapillaroscopy (NVC) [5-8]. NVC examination has been performed in adult COVID-19 patients, however, without a control group [8].

Objectives

To confirm the statistical significance of the reduction in capillary density per linear millimeter evaluated by NVC in comparison with primary Raynaud’s phenomenon (PRP) patients and control subjects (CNT) and to evaluate the impact of an aggressive therapy against COVID-19 on the sparing in the number of capillaries.

Methods

Sixty-one COVID-19 survivors, thirty-one PRP patients and thirty CNT age and sex-matched underwent NVC analysis. Demographic and clinical data of COVID-19 survivors were collected with special regard to concomitant therapies, that included antivirals, antibiotics, anticoagulants and anti-inflammatory/immunomodulant drugs (glucocorticoids, hydroxychloroquine, IL-6 receptor antagonist). COVID-19 survivors were divided in two subgroups according to the severity of the active infection: thirty-four survivors with past mild-moderate disease (either unneedy for oxygen supplementation or need for Venturi mask) and twenty-seven survivors with past severe disease (need for Continuous Positive Airways Pressure and/or mechanical ventilation). The same Rheumatologist performed NVC evaluations in all patients and controls, using an optical probe, equipped with a 200x magnification lens and connected to a picture analysis software (Videocap, DS Medica, Milan, Italy). Absolute capillary number per linear millimeter was counted.

Results

COVID-19 survivors underwent NVC examination after a mean period of 126±53 days from the disease onset. Multivariate analysis showed differences in absolute capillary number per linear millimeter (p<0.001) after adjusting for age, sex, body mass index, comorbidities and concomitant drugs. The mean (± standard deviation) absolute nailfold capillary number per linear millimeter was significantly lower in severe (8.2±1.15) and mild-moderate (8.4±0.75) COVID-19 survivors than in both PRP (8.7±0.68) and CNT subjects (9.3±0.53) (p<0.001). The analysis of the impact of treatments on capillary density in the severe COVID-19 patients showed a positive trend (preservation of the capillary number) with antivirals (no: 7.8±1.53; yes: 8.5±0.64; p=0.35) and anti-IL-6 receptor antagonist administration (no: 7.8±1.36; yes: 8.6±0.74; p=0.16), while none of the other drugs was shown to be effective (glucocorticoids p = 0.46; antibiotics = 0.52; anticoagulants not evaluable as they were used in all COVID-19 patients).

Conclusion

SARS-CoV-2 infection seems associated to a significant capillary loss as distinctive NVC feature and data concerning the comparison of capillary density pre COVID-19 and post COVID-19 are desirable to reinforce this observation. The positive trend in saving the number of capillaries induced by aggressive anti-inflammatory therapies in COVID-19 survivors needs larger cohorts of patients.

References

[1]Rovas A et al. Angiogenesis. 2021;24:145-157.

[2]Raghavan S et al. Front Cardiovasc Med. 2021;8:687783.

[3]Cutolo M et al. RMD Open. 2020;6:e001454.

[4]Sulli A et al. Nutrients. 2021;13(3):717.

[5]Kanoore Edul VS et al. J Crit Care. 2021;61:73-75.

[6]Teo KY et al. Am J Ophtalmol. 2021;235:98-110.

[7]Sabioni L et al. Microvasc Res. 2021;134:104119.

[8]Natalello G et al. Microvasc Res. 2021;133:104071.

Disclosure of Interests

Emanuele Gotelli: None declared, Alberto Sulli Grant/research support from: Laboratori Baldacci S.p.a., Pietro Francesco Bica: None declared, Irene Schiavetti: None declared, Teresita Aloe’: None declared, Marco Grosso: None declared, Emanuela Barisione: None declared, Carmen Pizzorni: None declared, Sabrina Paolino: None declared, Vanessa Smith Grant/research support from: Boehringer Ingelheim, Janssen-Cilag, Maurizio Cutolo Grant/research support from: Bristol-Myers Squibb, Celgene, Pfizer, Boehringer Ingelheim

The role of hepatitis B vaccine challenge dose in patients with underlying health conditions

We have evaluated the immunological response to Hepatitis B virus (HBV) booster vaccine dose in 129 adults with underlying diseases in comparison with 694 subjects at occupational risk of infection, who have previously completed the primary series and resulted with anti-HBs <10 mIU/mL. After booster dose, 60.5% of the patients with underlying diseases and 14.8% of the subjects at occupational risk resulted seronegative. By comparing two groups, rate of subjects with anamnestic response was higher in at occupational risk group respect to that at risk for medical conditions (OR: 5.99 [95%IC, 3.81-9.41], p < .001). This difference was associated to gender (males/females: OR: 0.619 [95%IC, 0.421-0.910], p = .015) and age (better response for younger people, p = .011).

Exhaled nitric oxide in relation to asthma control: A real-life survey

BACKGROUND

Asthma is characterised by chronic airway inflammation, a complex cascade of events, mostly sustained by eosinophil recruitment and activation. Fractional exhaled nitric oxide (FeNO) is a surrogate marker of airway inflammation closely associated with bronchial eosinophilia. FeNO is used to define asthma phenotype, to assess eosinophilic inflammatory severity and to predict corticosteroid responsiveness.

OBJECTIVE

The aim of this study was to investigate whether FeNO may be associated with some clinical and functional factors in asthmatics evaluated in a real life setting.

METHODS

Globally 363 patients (150 males, mean age 46.3 years) with asthma were consecutively evaluated. The following parameters were assessed: history, including comorbidities, physical examination, body mass index (BMI), lung function, asthma control grade, asthma control test (ACT), and FeNO.

RESULTS

FeNO values were significantly higher in patients with poorly controlled asthma (p<0.01), asthma symptoms (p=0.015), wheezing (p<0.001), rhinitis diagnosis, (p=0.049) and rhinitis symptoms (p=0.019), but lower in patients with GERD (p=0.024) and pneumonia history (p=0.048). FeNO values increased in patients with the lowest corticosteroid dose (p=0.031). FeNO values>25ppb were associated with poorly controlled asthma (OR 3.71), asthma signs (OR 3.5) and symptoms (OR 1.79). A FeNO value cut-off of 29.9ppb was fairly predictive of (AUC 0.7) poorly controlled asthma.

CONCLUSIONS

FeNO assessment in clinical practice may be a useful tool for monitoring asthmatics as it is associated with several clinical factors, including asthma control.

Anaphylaxis: a one-year survey on Medical Emergency Service in Liguria (Italy)

Anaphylaxis is a severe, life-threatening, generalized or systemic hypersensitivity reaction. The diagnosis is mainly based on clinical ground. This study aimed at evaluating the records of phone calls and medical visits for anaphylaxis occurred in Region Liguria during 2013. The phone call is managed in each headquarter, and classified according to a level of care intensity and a presumed level of criticality, according to established criteria. Criticality is then re-evaluated (detected criticality) at the end of medical visit, following the same score adding the black code defining died patients. Most of the phone calls (553) to the MES were recorded in summer (37.4%). Anaphylaxis was confirmed in about half of patients. There was a fair agreement between presumed and detected criticality (k=0.322, p<0.001). In addition, 530 patients (95.8%) were transported to Emergency Room. In conclusion, the present study shows that anaphylaxis represents a serious and relevant medical problem in the general population at any age, and should always be carefully managed.

Evaluation of the cephalometrics modification of growing Class II Division I patients after treatment with the PUL appliance: a pilot study

AIM

The aim of this preliminary study was to evaluate short-term dentoskeletal changes obtained with a functional appliance for Class II Division I malocclusions called propulsor universal light (PUL).

METHODS

Fifteen Class II Division 1 patients (10.6±1.2 years) were consecutively treated by one expert operator with PUL appliance and they were compared with a longitudinal group of Class II Division I untreated patients (9.9±1.9 years) matched for pubertal growth spurt stage and sex. Lateral cephalograms were taken before PUL therapy and at the end of treatment. The mean duration of treatment was 11.2±0.3 months; t-test or Mann-Whitney U-test was used (P <0.05).

RESULTS

Statistically significant reduction of the overjet, WITS and ANB was noticed in treated group as well as a significant improvement of CoGo and Ramus.

CONCLUSION

Class II Division I malocclusion in the short term was efficiently treated by PUL appliance with both skeletal and dentoalveolar changes.