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Franceschini D, Cozzi L, Lo Faro L, Marzo A, Di Cristina L, Marini B, Franzese C, Galdieri C, Scorsetti M. MO-0712 Clinical outcomes of a large cohort of oligometastatic patients treated with SRT. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02410-0] [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: 10/18/2022]
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Esposito E, Fogliata A, Paganini L, Reggiori G, Tomatis S, Scorsetti M, Cozzi L. The impact of commissioning measurements accuracy on the configurations of both Acuros-XB and AAA dose calculation algorithms for photon beams. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00114-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Franceschini D, Fogliata A, Spoto R, Dominici L, Lo Faro L, Franzese C, Comito T, Lobefalo F, Reggiori G, Cozzi L, Sagona A, Gentile D, Scorsetti M. Long term results of a phase II trial of hypofractionated adjuvant radiotherapy for early-stage breast cancer with volumetric modulated arc therapy and simultaneous integrated boost. Radiother Oncol 2021; 164:50-56. [PMID: 34537289 DOI: 10.1016/j.radonc.2021.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/01/2021] [Accepted: 09/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE to report toxicity and cosmetic outcome with a median follow-up of 6 years of a phase II trial of hypofractionated radiotherapy with volumetric modulated arc therapy (VMAT) and simultaneous integrated boost (SIB) for early-stage breast cancer after conservative surgery. MATERIALS AND METHODS From August 2010 to September 2014, patients requiring adjuvant radiotherapy for early-stage breast cancer were treated according to a phase I-II protocol with SIB to 40.5 and 48 Gy to the breast and the boost region, respectively, with VMAT technique. The primary endpoint evaluated the treatment feasibility regarding adherence to required dose constraints for target, heart and lungs. Acute and late toxicity, local and distant control were secondary endpoints. RESULTS 450 patients were included in the trial and analysed after a median follow-up of 6 years. Acute toxicity was already presented in a previous paper. Regarding late toxicity, 93% of patients had no skin alteration at five years, while 5.3% and 1.3% did record G1 and G2 residual toxicity, respectively. Cosmetic outcome was scored good or excellent in almost all cases (97.2%), fair only in 2.3% of patients. Residual tenderness in the irradiated breast was reported by 10% of patients. Cosmesis and breast pain improved during follow-up. Two cases of G2 pneumonitis and two cases of ischemic cardiopathy were registered during follow-up. Five cases presented local recurrence in the homolateral breast, four patients had a new primary cancer in the contralateral breast, while distant metastasis developed in 7 patients. CONCLUSION After more than six years, hypofractionated VMAT with SIB for adjuvant radiotherapy in early-stage breast cancer patients remains a safe and effective approach. Mature data on skin toxicity and cosmetic outcome are encouraging. However, longer follow-up is required to evaluate local control, cardiac toxicity and secondary carcinogenesis.
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Affiliation(s)
- D Franceschini
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan-Rozzano, Italy
| | - A Fogliata
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan-Rozzano, Italy.
| | - R Spoto
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan-Rozzano, Italy
| | - L Dominici
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan-Rozzano, Italy
| | - L Lo Faro
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan-Rozzano, Italy
| | - C Franzese
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan-Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Milan-Pieve Emanuele, Italy
| | - T Comito
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan-Rozzano, Italy
| | - F Lobefalo
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan-Rozzano, Italy
| | - G Reggiori
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan-Rozzano, Italy
| | - L Cozzi
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan-Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Milan-Pieve Emanuele, Italy
| | - A Sagona
- IRCCS Humanitas Research Hospital, Breast Unit, Milan-Rozzano, Italy
| | - D Gentile
- Department of Biomedical Sciences, Humanitas University, Milan-Pieve Emanuele, Italy; IRCCS Humanitas Research Hospital, Breast Unit, Milan-Rozzano, Italy
| | - M Scorsetti
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan-Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Milan-Pieve Emanuele, Italy
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Piscitelli A, Agodi A, Agozzino E, Arrigoni C, Barchitta M, Brusaferro S, Castaldi S, Castiglia P, Cozzi L, D'Errico MM, De Caro F, De Giglio O, Iannazzo S, Laganà P, Laurenti P, Mascipinto S, Montagna MT, Mura I, Pasquarella C, Veronesi L, Rossi F, Ripabelli G, Rossini A, Scippa F, Sodano L, Squeri R, Staniscia T, Torregrossa V, Auxilia F. The Clean Care Contest: promoting hand hygiene among healthcare and medical students. Ann Ig 2021; 32:462-471. [PMID: 32744581 DOI: 10.7416/ai.2020.2370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Despite continuing efforts, compliance rates and knowledge of best practices in hand hygiene remain disappointing. Recognizing that conventional educational tools seem out of touch with young people and that the med and messages contents need refreshing, the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health devised a novel approach to promote the creation of innovative educational tools for improving knowledge of, and compliance with, hand hygiene rules among healthcare and medical students. METHODS A contest in creating educational material on hand hygiene practices involved university students of nursing and medicine, and of other healthcare degrees. Students from the universities of the GISIO network were invited to create educational material (e.g., videos, posters, presentations, leaflets, and screensavers) to be presented by May 5th 2019 during the World Hand Hygiene Day / Save Lives: Clean Your Hands Global Annual Initiative of the World Health Organization). A local and a national winners were awarded. RESULTS Three different local and national contests were performed during 2016, 2017 and 2018. During the three-year period, more than 270 educational tools have been developed: 130 (48%) were judged useful for hand hygiene promotion campaigns. The most frequent projects participating in the contests were videos (39%), posters (29%), leaflets (14%), and others (18%) submitted by more than 1,500 students of nursing (40%), medicine (31%), dentistry (7%), and of other healthcare courses in 14 universities. Products were evaluated by a local committee and, subsequently, local winners represented their University in a national contest. CONCLUSIONS The contest provided a framework for the creation of innovative and potentially effective educational tools via an engaging approach that leveraged student creativity. Given the need to improve compliance rates, this study suggests that new ways can be advantageously explored to teach hand hygiene procedures and increase awareness of the importance of their consistent use among healthcare and medical students.
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Affiliation(s)
- A Piscitelli
- Hospital Health Management, Azienda Ospedaliero-Universitaria Parma, Parma, Italy
| | - A Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Italy
| | - E Agozzino
- Department of Experimental Medicine, University of Campania Vanvitelli, Napoli, Italy
| | - C Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Unit of Hygiene, University of Pavia, Italy
| | - M Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Italy
| | - S Brusaferro
- Department of Medicine, University of Udine, Italy
| | - S Castaldi
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Ca' Granda, Milan, Italy
| | - P Castiglia
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - L Cozzi
- School of Specialization in Pediatrics, University of Milan, Italy
| | - M M D'Errico
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Torrette di Ancona, Italy
| | - F De Caro
- Department of Medicine, Surgery, Odontoiatrics University of Salerno, Fisciano (SA), Italy
| | - O De Giglio
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - S Iannazzo
- Department of Prevention, ASL Roma 3, Rome, Italy
| | - P Laganà
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - P Laurenti
- Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - S Mascipinto
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - M T Montagna
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - I Mura
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - C Pasquarella
- Department of Medicine and Surgery University of Parma, Italy
| | - L Veronesi
- Department of Medicine and Surgery University of Parma, Italy
| | - F Rossi
- European Institute of Design, Milan, Italy
| | - G Ripabelli
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Italy
| | - A Rossini
- IRCCS Santa Lucia Foundation Rome, Italy
| | | | - L Sodano
- Our Lady of Good Counsel, Catholic University, Elbasan, Albania
| | - R Squeri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - T Staniscia
- Department of Medicine and Aging Sciences, University of Chieti-Pescara "G. D'Annunzio", Chieti, Italy
| | - V Torregrossa
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties University of Palermo, Italy
| | - F Auxilia
- Department of Biomedical Sciences for Health, University of Milan, ASST Fatebenefratelli - Sacco, Milan, Italy
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Fogliata A, Girardi A, Cozzi L, Stravato A, Reggiori G, Scorsetti M. PD-0186: Impact of effective spot size parameter on MU calculation of Acuros algorithm in small MLC fields. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00210-3] [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: 10/22/2022]
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Cozzi L, Davide F, Fiorenza D, Pierina N, Antonella F, Ciro F, Donato P, Stefano T, Giacomo R, Marta S. PO-1567: A radiomic approach to predict outcome in patients treated with SBRT for early stage NSCLC. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01585-1] [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: 11/27/2022]
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Fogliata A, Esposito E, Paganini L, Reggiori G, Tomatis S, Scorsetti M, Cozzi L. The impact of scanning data measurements on the Acuros dose calculation algorithm configuration. Radiat Oncol 2020; 15:169. [PMID: 32650815 PMCID: PMC7350585 DOI: 10.1186/s13014-020-01610-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/02/2020] [Indexed: 11/24/2022] Open
Abstract
Background Many dose calculation algorithms for radiotherapy planning need to be configured for each clinical beam using pre-defined measurements. An optimization process adjusts the physical parameters able to estimate the energy released in the medium in any geometrical condition. This work investigates the impact of measured input data quality on the configuration of the type “c” Acuros-XB dose calculation algorithm in the Eclipse (Varian Medical Systems) treatment planning system. Methods Different datasets were acquired with the BeamScan water phantom (PTW) to configure 6 MV beams, for both flattened (6X) and flattening filter free mode (6FFF) for a Varian TrueBeam: (i) a correct dataset measured using a Semiflex-3D ion chamber, (ii) a set in missing lateral scatter conditions (MLS), (iii) a set with incorrect effective point of measurement (EPoM), (iv) sets acquired with PinPoint-3D chamber, DiodeP, microDiamond detectors. The Acuros-XB dose calculation algorithm (version 15.6) was configured using the reference dataset, the sets measured with the different detectors, with intentional errors, and using the representative beam data (RBD) made available by the vendor. The physical parameters obtained from each optimization process (spectrum, mean radial energy, electron contamination), were analyzed and compared. Calculated data were finally compared against the input and reference measurements. Results Concerning the physical parameters, the configurations presenting the largest differences were the MLS conditions (mean radial energy) and the incorrect EPoM (electron contamination). The calculation doses relative to the input data present low accuracy, with mean differences > 2% in some conditions. The PinPoint-3D ion chamber presented lower accuracy for the 6FFF beam. Regarding the RBD, calculations compared well with the input data used for the configuration, but not with the reference data. Conclusion The MLS conditions and the incorrect setting of the EPoM lead to erroneous configurations and should be avoided. The choice of an appropriate detector is important. Whenever the representative beam data is used, a careful check under more clinical geometrical conditions is advised.
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Affiliation(s)
- A Fogliata
- Radiotherapy and Radiosurgery Dept, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, Milan-Rozzano, Italy.
| | - E Esposito
- Radiotherapy and Radiosurgery Dept, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, Milan-Rozzano, Italy
| | - L Paganini
- Radiotherapy and Radiosurgery Dept, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, Milan-Rozzano, Italy
| | - G Reggiori
- Radiotherapy and Radiosurgery Dept, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, Milan-Rozzano, Italy
| | - S Tomatis
- Radiotherapy and Radiosurgery Dept, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, Milan-Rozzano, Italy
| | - M Scorsetti
- Radiotherapy and Radiosurgery Dept, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, Milan-Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Milan-Pieve Emanuele, Italy
| | - L Cozzi
- Radiotherapy and Radiosurgery Dept, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, Milan-Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Milan-Pieve Emanuele, Italy
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Fogliata A, Cayez R, Garcia R, Khamphan C, Reggiori G, Scorsetti M, Cozzi L. Technical Note: Flattening filter free beam from Halcyon linac: Evaluation of the profile parameters for quality assurance. Med Phys 2020; 47:3669-3674. [PMID: 32367534 DOI: 10.1002/mp.14217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/12/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION The use of flattening filter free (FFF) beams generated by standard linear accelerators is increasing in the clinical practice. The radiation intensity peaked toward the beam central axis is properly managed in the optimization process of treatment planning through intensity modulation. Specific FFF parameters for profile analysis, as unflatness and slope for FFF beams, based on the renormalization factor concept has been introduced for quality assurance purposes. Recently, Halcyon, an O-ring based linear accelerator equipped with a 6 MV FFF beam only has been introduced by Varian. METHODS Renormalization factors and related fit parameters according to Fogliata et al. ["Definition of parameters for quality assurance of FFF photon beams in radiation therapy," Med. Phys. 39, 6455-6464 (2012)] have been evaluated for the 6 MV FFF beam generated by Halcyon units. The Halcyon representative beam data provided by Varian were used. Dose fall-off at the field edges was matched with an unflattened beam generated by a 6 MV from a TrueBeam linac. Consistency of the results was evaluated against measurements on a clinical Halcyon unit, as well as a TrueBeam 6 MV FFF for comparison. RESULTS The five parameters in the analytical equation for estimating the renormalization factor were determined with an R2 of 0.997. The comparison of the unflatness parameters between the Halcyon representative and hospital beam data was consistent within a range of 0.6%. Consistently with the computed parameters, the Halcyon profiles resulted in a less pronounced peak than TrueBeam. CONCLUSION Renormalization factors and related fit parameters from the 6 MV FFF beam generated by the Varian Halcyon unit are provided.
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Affiliation(s)
- A Fogliata
- Humanitas Clinical and Research Center - IRCCS, Radiotherapy Dept, via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - R Cayez
- Oscar Lambret Center, rue Frédéric Combemale, Radiotherapy, 59000, Lille, France
| | - R Garcia
- Medical Physics Department, Institut Sainte-Catherine, 250 Chemin de Baigne Pieds, 84000, Avignon, France
| | - C Khamphan
- Medical Physics Department, Institut Sainte-Catherine, 250 Chemin de Baigne Pieds, 84000, Avignon, France
| | - G Reggiori
- Humanitas Clinical and Research Center - IRCCS, Radiotherapy Dept, via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - M Scorsetti
- Humanitas Clinical and Research Center - IRCCS, Radiotherapy Dept, via Manzoni 56, 20089, Milan, Rozzano, Italy.,Department of Biomedical Science, Humanitas University, via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
| | - L Cozzi
- Humanitas Clinical and Research Center - IRCCS, Radiotherapy Dept, via Manzoni 56, 20089, Milan, Rozzano, Italy.,Department of Biomedical Science, Humanitas University, via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy
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Panda S, Swamidas J, Chopra S, Mangaj A, Fogliata A, Kupelian P, Agarwal JP, Cozzi L. Treatment planning comparison of volumetric modulated arc therapy employing a dual-layer stacked multi-leaf collimator and helical tomotherapy for cervix uteri. Radiat Oncol 2020; 15:22. [PMID: 32000832 PMCID: PMC6990476 DOI: 10.1186/s13014-020-1473-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/19/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose To ascertain the dosimetric performance of a new delivery system (the Halcyon system, H) equipped with dual-layer stacked multi-leaf collimator (MLC) for risk-adapted targets in cervix uteri cancer patients compared to another ring-based system in clinical operation (Helical Tomotherapy, HT). Methods Twenty patients were retrospectively included in a treatment planning study (10 with positive lymph nodes and 10 without). The dose prescription (45Gy to the primary tumour volume and a simultaneously integrated boost up to 55Gy for the positive patients) and the clinical planning objectives were defined consistently as recommended by an ongoing multicentric clinical trial. Halcyon plans were optimised for the volumetric modulated arc therapy. The plan comparison was performed employing the quantitative analysis of the dose-volume histograms. Results The coverage of the primary and nodal target volumes was comparable for both techniques and both subsets of patients. The primary planning target volume (PTV) receiving at least 95% of the prescription isodose ranged from 97.2 ± 1.1% (node-negative) to 99.1 ± 1.2% (node-positive) for H and from 96.5 ± 1.9% (node-negative) to 98.3 ± 0.9% (node-positive) for HT. The uncertainty is expressed at one standard deviation from the cohort of patient per each group. For the nodal clinical target volumes, the dose received by 98% of the planning target volume ranged 55.5 ± 0.1 to 56.0 ± 0.8Gy for H and HT, respectively. The only significant and potentially relevant differences were observed for the bowels. In this case, V40Gy resulted 226.3 ± 35.9 and 186.9 ± 115.9 cm3 for the node-positive and node-negative patients respectively for Halcyon. The corresponding findings for HT were: 258.9 ± 60.5 and 224.9 ± 102.2 cm3. On the contrary, V15Gy resulted 1279.7 ± 296.5 and 1557.2 ± 359.9 cm3 for HT and H respectively for node-positive and 1010.8 ± 320.9 versus 1203.8 ± 332.8 cm3 for node-negative. Conclusion This retrospective treatment planning study, based on the dose constraints derived from the Embrace II study protocol, suggested the essential equivalence between Halcyon based and Helical Tomotherapy based plans for the intensity-modulated rotational treatment of cervix uteri cancer. Different levels of sparing were observed for the bowels with H better protecting in the high-dose region and HT in the mid-low dose regions. The clinical impact of these differences should be further addressed.
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Affiliation(s)
- S Panda
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - J Swamidas
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - S Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - A Mangaj
- Department of Radiation Oncology and Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - A Fogliata
- Humanitas Research Hospital, Radiotherapy and Cancer Center Radiosurgery Dept, Via Manzoni 56, 20089, Milan-Rozzano, Italy
| | - P Kupelian
- Varian Medical Systems, Palo Alto, CA, USA.,Radiation Oncology Dept., University of California, Los Angeles, USA
| | - J P Agarwal
- Department of Radiation Oncology and Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - L Cozzi
- Humanitas Research Hospital, Radiotherapy and Cancer Center Radiosurgery Dept, Via Manzoni 56, 20089, Milan-Rozzano, Italy. .,Dept. of Biomedical Sciences, Humanitas University, Milan-Rozzano, Italy.
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Fogliata A, Cozzi L, Reggiori G, Stravato A, Lobefalo F, Franzese C, Franceschini D, Tomatis S, Scorsetti M. RapidPlan knowledge based planning: iterative learning process and model ability to steer planning strategies. Radiat Oncol 2019; 14:187. [PMID: 31666094 PMCID: PMC6822368 DOI: 10.1186/s13014-019-1403-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/21/2019] [Indexed: 01/23/2023] Open
Abstract
Purpose To determine if the performance of a knowledge based RapidPlan (RP) planning model could be improved with an iterative learning process, i.e. if plans generated by an RP model could be used as new input to re-train the model and achieve better performance. Methods Clinical VMAT plans from 83 patients presenting with head and neck cancer were selected to train an RP model, CL-1. With this model, new plans on the same patients were generated, and subsequently used as input to train a novel model, CL-2. Both models were validated on a cohort of 20 patients and dosimetric results compared. Another set of 83 plans was realised on the same patients with different planning criteria, by using a simple template with no attempt to manually improve the plan quality. Those plans were employed to train another model, TP-1. The differences between the plans generated by CL-1 and TP-1 for the validation cohort of patients were compared with respect to the differences between the original plans used to build the two models. Results The CL-2 model presented an improvement relative to CL-1, with higher R2 values and better regression plots. The mean doses to parallel organs decreased with CL-2, while D1% to serial organs increased (but not significantly). The different models CL-1 and TP-1 were able to yield plans according to each original strategy. Conclusion A refined RP model allowed the generation of plans with improved quality, mostly for parallel organs at risk and, possibly, also the intrinsic model quality.
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Affiliation(s)
- A Fogliata
- Radiotherapy Department, Humanitas Research Hospital and Cancer Center, Via Manzoni 56, 20089 Rozzano, Milan, Italy.
| | - L Cozzi
- Radiotherapy Department, Humanitas Research Hospital and Cancer Center, Via Manzoni 56, 20089 Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Rozzano, Italy
| | - G Reggiori
- Radiotherapy Department, Humanitas Research Hospital and Cancer Center, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - A Stravato
- Radiotherapy Department, Humanitas Research Hospital and Cancer Center, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - F Lobefalo
- Radiotherapy Department, Humanitas Research Hospital and Cancer Center, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - C Franzese
- Radiotherapy Department, Humanitas Research Hospital and Cancer Center, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - D Franceschini
- Radiotherapy Department, Humanitas Research Hospital and Cancer Center, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - S Tomatis
- Radiotherapy Department, Humanitas Research Hospital and Cancer Center, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - M Scorsetti
- Radiotherapy Department, Humanitas Research Hospital and Cancer Center, Via Manzoni 56, 20089 Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Rozzano, Italy
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De Rose F, Cozzi L, Meattini I, Fogliata A, Franceschini D, Franzese C, Tomatis S, Becherini C, Livi L, Scorsetti M. The Potential Role of Intensity-modulated Proton Therapy in the Regional Nodal Irradiation of Breast Cancer: A Treatment Planning Study. Clin Oncol (R Coll Radiol) 2019; 32:26-34. [PMID: 31377082 DOI: 10.1016/j.clon.2019.07.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 03/11/2019] [Revised: 06/13/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Abstract
AIMS To investigate the role of intensity-modulated proton therapy (IMPT) for regional nodal irradiation in patients with breast carcinoma in comparison with volumetric-modulated arc therapy (VMAT). MATERIALS AND METHODS A cohort of 20 patients (10 in the breast-conserving surgery group and 10 post-mastectomy patients with tissue expander implants) was investigated. Proton plans were also computed using robust optimisation methods. Plan quality was assessed by means of dose-volume histograms and scored with conventional metrics. Estimates of the risk of secondary cancer induction (excess absolute risk, EAR) were carried out, taking into account fractionation, repopulation and repair. RESULTS Concerning target coverage, the data proved a substantial equivalence of VMAT and IMPT: for example, coverage for the 50 Gy target, expressed in terms of V98%, was 47.8 ± 0.4, 47.6 ± 0.4, 47.3 ± 0.8, consistent with the objective of 47.5 Gy, for post-mastectomy patients for the three groups of patients. Also, the conformality of the dose distributions was similar for the two techniques, about 1.1, without statistically significant differences. Organ at risk planning aims were achieved for all structures for both techniques. The mean dose to the ipsilateral lung was 10.8 ± 1.1, 6.2 ± 0.8, 7.2 ± 1.0; for the contralateral lung was 3.2 ± 0.7, 0.3 ± 0.2, 0.4 ± 0.2; for the contralateral breast was: 3.1 ± 0.7, 0.3 ± 0.3 and 0.3 ± 0.3, whereas it was 3.9 ± 0.9, 0.4 ± 0.3 and 0.5 ± 0.5, respectively, for the heart for VMAT, IMPT and robust IMPT plans over the whole group of patients. Robust optimisation affected the near-to-maximum dose values for contralateral lung and breast, the mean dose for the heart and ipsilateral lung, with a deterioration ranging from 20 to 40% of the nominal value of IMPT plans (e.g. from 8.1 ± 6.4 to 11.4 ± 8.8 for the heart compared with 16.2 ± 5.2 for the VMAT plans). The numerical values of EAR per 10 000 patient-years were about one order of magnitude higher for VMAT than for IMPT for contralateral structures: 11.66 ± 2.01, 0.89 ± 0.80, 0.98 ± 0.77 for the contralateral breast and the three groups of plans, respectively; 14.31 ± 2.75, 1.42 ± 0.80, 1.78 ± 0.87 for the contralateral lung; and 34.86 ± 2.64, 18.85 ± 2.15, 20.98 ± 2.35 for the ipsilateral lung. CONCLUSION IMPT with or without robust optimisation seems to be a potentially promising approach for the radiation treatment of breast cancer when nodal volumes should be irradiated. This was measured in terms of dosimetric advantage and predicted clinical benefit. In fact, the significant reduction in estimated EAR could add further clinical value to the dosimetric sparing of the organs at risk achievable with IMPT.
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Affiliation(s)
- F De Rose
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - L Cozzi
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Milan-Rozzano, Italy.
| | - I Meattini
- Department of Biomedical Experimental and Clinical Sciences, University of Florence, Florence, Italy; Radiation Oncology Unit, Az. Osp. Careggi, Florence, Italy
| | - A Fogliata
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - D Franceschini
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - C Franzese
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - S Tomatis
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - C Becherini
- Department of Biomedical Experimental and Clinical Sciences, University of Florence, Florence, Italy; Radiation Oncology Unit, Az. Osp. Careggi, Florence, Italy
| | - L Livi
- Department of Biomedical Experimental and Clinical Sciences, University of Florence, Florence, Italy; Radiation Oncology Unit, Az. Osp. Careggi, Florence, Italy
| | - M Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Milan-Rozzano, Italy
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Franzese C, Fogliata A, Franceschini D, De Rose F, Comito T, Navarria P, Cozzi L, Tomatis S, Scorsetti M. EP-1171 Toxicity profile of locally advanced head and neck cancer patients treated in 30 or 33 fractions RT. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31591-9] [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: 10/26/2022]
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13
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Cozzi L, Comito T, Fogliata A, Franzese C, Franceschini D, Bonifacio C, Tozzi A, Di Brina L, Clerici E, Tomatis S, Reggiori G, Lobefalo F, Stravato A, Mancosu P, Zerbi A, Sollini M, Margarita K, Chiti A, Scorsetti M. PO-0955 Radiomics signature as predictors of survival and local control after pancreatic carcinoma SBRT. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31375-1] [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: 10/26/2022]
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14
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Fogliata A, Reggiori G, Franzese C, Franceschini D, Tomatis S, Scorsetti M, Cozzi L. PO-0925 On the ability of a knowledge based planning process to improve itself. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31345-3] [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: 10/26/2022]
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15
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Cozzi L, Comito T, Fogliata A, Franzese C, Tomatis S, Scorsetti M. EP-1850 Intensity modulated protons: feasibility for hypofractionated hepatocellular carcinoma treatment. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32270-4] [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: 11/17/2022]
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16
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Di Pasquale S, Cozzi L, Lena R, Di Sandro A, De Magistris I, De Medici D, Johne R, Suffredini E. Development of a viability PCR assay for the analysis of Hepatitis E virus in food matrices. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky213.132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Di Pasquale
- Istituto Superiore di Sanità - Department of Food Safety, Nutrition and Veterinary Public Health, Rome, Italy
| | - L Cozzi
- Istituto Superiore di Sanità - Department of Food Safety, Nutrition and Veterinary Public Health, Rome, Italy
| | - R Lena
- Ministero della Salute, Directorate General for Food Hygiene and Safety and Nutrition, Rome, Italy
| | - A Di Sandro
- Ministero della Salute, Directorate General for Food Hygiene and Safety and Nutrition, Rome, Italy
| | - I De Magistris
- Istituto Superiore di Sanità - Department of Food Safety, Nutrition and Veterinary Public Health, Rome, Italy
| | - D De Medici
- Istituto Superiore di Sanità - Department of Food Safety, Nutrition and Veterinary Public Health, Rome, Italy
| | - R Johne
- German Federal Institute for Risk Assessment - Department Biological Safety, Berlin, Germany
| | - E Suffredini
- Istituto Superiore di Sanità - Department of Food Safety, Nutrition and Veterinary Public Health, Rome, Italy
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17
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Fogliata A, Stravato A, Reggiori G, Tomatis S, Würfel J, Scorsetti M, Cozzi L. Collimator scatter factor: Monte Carlo and in-air measurements approaches. Radiat Oncol 2018; 13:126. [PMID: 29996873 PMCID: PMC6042423 DOI: 10.1186/s13014-018-1070-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Linac output as a function of field sizes has a phantom and a head scatter component. This last term can be measured in-air with appropriate build-up ensuring a complete electron equilibrium and the absence of the contaminant electrons. Equilibrium conditions could be achieved using a build-up cap or a mini-phantom. Monte Carlo simulations in a virtual phantom mimicking a mini-phantom were analysed with the aim of better understanding the setup conditions for measuring the collimator scatter factor that is the head scatter component of the linac output factors. METHODS Beams of 6 and 15 MV from a TrueBeam, with size from 4 × 4 to 40 × 40 cm2 were simulated in cylindrical acrylic phantoms 20 cm long, of different diameters, from 0.5 to 4 cm, with the cylinder axis coincident with the beam central axis. The PRIMO package, based on PENELOPE Monte Carlo code, was used. The phase-space files for a Varian TrueBeam linac, provided by the linac vendor, were used for the linac head simulation. Depth dose curves were analysed, and collimator scatter factors estimated at different depth in the different phantom conditions. Additionally, in-air measurements using acyrilic and brass build-up caps, as well as acrylic mini-phantom were acquired for 6 and 18 MV beams from a Varian Clinac DHX. RESULTS The depth dose curves along the cylinders were compared, showing, in each phantom, very similar curves for all analysed field sizes, proving the correctness in estimating the collimator scatter factor in the mini-phantom, provided to position the detector to a sufficient depth to exclude electron contamination. The results were confirmed by the measurements, where the acrylic build-up cap showed to be inadequate to properly estimate the collimator scatter factors, while the mini-phantom and the brass caps gave reasonable measurements. CONCLUSION A better understanding of the beam characteristics inside a virtual mini-phantom through the analysis of depth dose curves, showed the critical points of using the acrylic build-up cap, and suggested the use of the mini-phantom for the collimator scatter factor measurements in the medium-large field size range.
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Affiliation(s)
- A Fogliata
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy.
| | - A Stravato
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - G Reggiori
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - S Tomatis
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - J Würfel
- PTW-Freiburg GmbH, Freiburg, Germany
| | - M Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy.,Biomedical Science Faculty, Humanitas University, Milan-Rozzano, Italy
| | - L Cozzi
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy.,Biomedical Science Faculty, Humanitas University, Milan-Rozzano, Italy
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Fogliata A, De Rose F, Stravato A, Reggiori G, Tomatis S, Scorsetti M, Cozzi L. Evaluation of target dose inhomogeneity in breast cancer treatment due to tissue elemental differences. Radiat Oncol 2018; 13:92. [PMID: 29764450 PMCID: PMC5952506 DOI: 10.1186/s13014-018-1022-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Monte Carlo simulations were run to estimate the dose variations generated by thedifference arising from the chemical composition of the tissues. METHODS CT datasets of five breast cancer patients were selected. Mammary gland was delineated as clinical target volume CTV, as well as CTV_lob and CTV_fat, being the lobular and fat fractions of the entire mammary gland. Patients were planned for volumetric modulated arc therapy technique, optimized in the Varian Eclipse treatment planning system. CT, structures and plans were imported in PRIMO, based on Monte Carlo code Penelope, to run three simulations: AdiMus, where the adipose and muscle tissues were automatically assigned to fat and lobular fractions of the breast; Adi and Mus, where adipose and muscle, respectively were assigned to the whole mammary gland. The specific tissue density was kept identical from the CT dataset. Differences in mean doses in the CTV_lob and CTV_fat structures were evaluated for the different tissue assignments. Differences generated by the tissue composition and estimated by Acuros dose calculations in Eclipse were also analysed. RESULTS From Monte Carlo simulations, the dose in the lobular fraction of the breast, when adipose tissue is assigned in place of muscle, is overestimated by 1.25 ± 0.45%; the dose in the fat fraction of the breast with muscle tissue assignment is underestimated by 1.14 ± 0.51%. Acuros showed an overestimation of 0.98 ± 0.06% and an underestimation of 0.21 ± 0.14% in the lobular and fat portions, respectively. Reason of this dissimilarity resides in the fact that the two calculations, Monte Carlo and Acuros, differently manage the range of CT numbers and the material assignments, having Acuros an overlapping range, where two tissues are both present in defined proportions. CONCLUSION Although not clinically significant, the dose deposition difference in the lobular and connective fat fraction of the breast tissue lead to an improved knowledge of the possible dose distribution and homogeneity in the breast radiation treatment.
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Affiliation(s)
- A Fogliata
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Dept, Via Manzoni 56, 20089, Milan, Rozzano, Italy.
| | - F De Rose
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Dept, Via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - A Stravato
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Dept, Via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - G Reggiori
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Dept, Via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - S Tomatis
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Dept, Via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - M Scorsetti
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Dept, Via Manzoni 56, 20089, Milan, Rozzano, Italy.,Humanitas University, Biomedical Science Faculty, Milan, Rozzano, Italy
| | - L Cozzi
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Dept, Via Manzoni 56, 20089, Milan, Rozzano, Italy.,Humanitas University, Biomedical Science Faculty, Milan, Rozzano, Italy
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19
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Fogliata A, De Rose F, Franceschini D, Stravato A, Seppälä J, Scorsetti M, Cozzi L. PO-0898: Second cancer induction risk from breast radiotherapy with VMAT and 3D conformal therapy. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31208-8] [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: 11/26/2022]
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20
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Kirienko M, Lozza L, Cozzi L, Gennaro N, Rossi A, Voulaz E, Chiti A, Sollini M. EP-1362: Random forest analysis to predict Disease-Free Survival using FDG-PET and CT in Lung Cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31671-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Sollini M, Cozzi L, Pepe G, Antunovic L, Lania A, Di Tommaso L, Magnoni P, Erba PA, Kirienko M. [ 18F]FDG-PET/CT texture analysis in thyroid incidentalomas: preliminary results. Eur J Hybrid Imaging 2017; 1:3. [PMID: 29782578 PMCID: PMC5954705 DOI: 10.1186/s41824-017-0009-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 09/01/2017] [Indexed: 02/08/2023] Open
Abstract
Background significance of incidental thyroid 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) uptake on positron emission tomography/computed tomography (PET/CT) scans remains controversial. We aimed to evaluate the ability of [18F]FDG-PET/CT texture analysis to predict final diagnosis in thyroid incidentaloma. Methods We retrospectively evaluated medical records of all patients who performed a [18F]FDG-PET/CT from January 2012 to October 2016. Those patients who presented a thyroid incidentaloma described in the medical records and performed a fine needle aspiration in our institution were considered for the analysis. Cytological and/or histological results were used as reference standard to define the final diagnosis. In case of negative cytology, the nodule was considered benign. In case of non-diagnostic or inconclusive results ultrasound, follow-up and further cytology/histology were used as final diagnosis. For suspected or positive cytological result, histology was used as reference standard. PET images were segmented using a General Electric AW workstation running PET VCAR software (GE Healthcare, Waukesha, WI, USA) settled with a threshold of 40% SUVmax. LifeX software (http://www.lifexsoft.org) was used to perform texture analysis. Statistical analysis was performed with R package (https://www.r-project.org). Results We identified 55 patients with incidental thyroid [18F]FDG uptake. Five patients were excluded from the analysis because a final diagnosis was not available. Thirty-two out of 50 patients had benign nodules while in 18/50 cases a malignancy (primary thyroid cancer = 15, metastases = 3) was diagnosed. Conventional PET parameters and histogram-based features were calculated for all 50 patients, while other matrices-based features were available for 28/50 patients. SUVmax and skewness resulted significantly different in benign and malignant nodules (p = 0.01 and = 0.02, respectively). Using ROC analysis, seven features were identified as potential predictors. Among all the textural features tested, skewness showed the best area under the curve (= 0.66). SUV-based parameters resulted in the highest specificity while MTV, TLG, skewness and kurtosis, as well as correlationGLCM resulted better in sensitivity. Conclusions [18F]FDG-PET/CT texture analysis seems to be a promising approach to stratify the patients with thyroid incidentaloma identified on PET scans, with respect to the risk of the diagnosis of a malignant thyroid nodule and thus, could refine the selection of the patients to be referred for cytology.
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Affiliation(s)
- M Sollini
- 1Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 20090 Pieve Emanuele (Milan), Italy
| | - L Cozzi
- 2Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy.,1Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 20090 Pieve Emanuele (Milan), Italy
| | - G Pepe
- 3Nuclear Medicine, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - L Antunovic
- 3Nuclear Medicine, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - A Lania
- 1Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 20090 Pieve Emanuele (Milan), Italy.,4Endocrinology, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - L Di Tommaso
- 1Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 20090 Pieve Emanuele (Milan), Italy.,5Pathology, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - P Magnoni
- 6Ultrasound Service, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - P A Erba
- 7Regional Center of Nuclear Medicine, University of Pisa, via Roma 55, 56025 Pisa, Italy
| | - M Kirienko
- 1Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 20090 Pieve Emanuele (Milan), Italy
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Comito T, Cozzi L, Clerici E, Franzese C, Tozzi A, Iftode C, Navarria P, D’Agostino G, Rimassa L, Carnaghi C, Personeni N, Tronconi MC, De Rose F, Franceschini D, Ascolese AM, Fogliata A, Tomatis S, Santoro A, Zerbi A, Scorsetti M. Can Stereotactic Body Radiation Therapy Be a Viable and Efficient Therapeutic Option for Unresectable Locally Advanced Pancreatic Adenocarcinoma? Results of a Phase 2 Study. Technol Cancer Res Treat 2017; 16:295-301. [PMID: 27311310 PMCID: PMC5616043 DOI: 10.1177/1533034616650778] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [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: 01/07/2016] [Revised: 03/14/2016] [Accepted: 04/22/2016] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To assess the efficacy of stereotactic body radiotherapy in patients with unresectable locally advanced pancreatic cancer. MATERIALS AND METHODS All patients received a prescription dose of 45 Gy in 6 fractions. Primary end point was freedom from local progression. Secondary end points were overall survival, progression-free survival, and toxicity. Actuarial survival analysis and univariate or multivariate analysis were investigated. RESULTS Forty-five patients were enrolled in a phase 2 trial. Median follow-up was 13.5 months. Freedom from local progression was 90% at 2 years. On univariate ( P < .03) and multivariate analyses ( P < .001), lesion size was statistically significant for freedom from local progression. Median progression-free survival and overall survival were 8 and 13 months, respectively. On multivariate analysis, tumor size ( P < .001) and freedom from local progression ( P < .002) were significantly correlated with overall survival. Thirty-two (71%) patients with locally advanced pancreatic cancer received chemotherapy before stereotactic body radiotherapy. Median overall survival from diagnosis was 19 months. Multivariate analysis showed that freedom from local progression ( P < .035), tumor diameter ( P < .002), and computed tomography before stereotactic body radiotherapy ( P < .001) were significantly correlated with overall survival from diagnosis. CONCLUSION Stereotactic body radiotherapy is a safe and effective treatment for patients with locally advanced pancreatic cancer with no G3 toxicity or greater and could be a promising therapeutic option in multimodality treatment regimen.
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Affiliation(s)
| | - L. Cozzi
- Radiotherapy, Istituto Clinico Humanitas, Milano, Italy
| | - E. Clerici
- Radiotherapy, Istituto Clinico Humanitas, Milano, Italy
| | - C. Franzese
- Radiotherapy, Istituto Clinico Humanitas, Milano, Italy
| | - A. Tozzi
- Radiotherapy, Istituto Clinico Humanitas, Milano, Italy
| | - C. Iftode
- Radiotherapy, Istituto Clinico Humanitas, Milano, Italy
| | - P. Navarria
- Radiotherapy, Istituto Clinico Humanitas, Milano, Italy
| | - G. D’Agostino
- Radiotherapy, Istituto Clinico Humanitas, Milano, Italy
| | - L. Rimassa
- Oncology and Hematology, Istituto Clinico Humanitas, Milano, Italy
| | - C. Carnaghi
- Oncology and Hematology, Istituto Clinico Humanitas, Milano, Italy
| | - N. Personeni
- Oncology and Hematology, Istituto Clinico Humanitas, Milano, Italy
| | - M. C. Tronconi
- Oncology and Hematology, Istituto Clinico Humanitas, Milano, Italy
| | - F. De Rose
- Radiotherapy, Istituto Clinico Humanitas, Milano, Italy
| | | | | | - A. Fogliata
- Radiotherapy, Istituto Clinico Humanitas, Milano, Italy
| | - S. Tomatis
- Radiotherapy, Istituto Clinico Humanitas, Milano, Italy
| | - A. Santoro
- Oncology and Hematology, Istituto Clinico Humanitas, Milano, Italy
| | - A. Zerbi
- Pancreatic Surgery, Istituto Clinico Humanitas, Milano, Italy
| | - M. Scorsetti
- Radiotherapy, Istituto Clinico Humanitas, Milano, Italy
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Nicolini G, Fogliata A, Vanetti E, Reggiori G, Stravato A, Mancosu P, Scorsetti M, Cozzi L. EP-1469: Flattening filter free beam profile analysis using two different normalization methods. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31904-7] [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: 11/16/2022]
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Subramanian S, Chilukuri S, Subramani V, Kathirvel M, Arun G, Swamy S, Subramanian K, Fogliata A, Cozzi L. PO-0831: Multi isocentric 4-pi volumetric modulated arc therapy approach for head and neck cancer. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31268-9] [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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Clerici E, Navarria P, Ascolese A, Pessina F, Tomatis S, Cozzi L, Simonelli M, Santoro A, Franzese C, Bello L, Scorsetti M. EP-1409: Prospective study of hypofractionated radiotherapy for elderly patients with High Grade Glioma. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31844-3] [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: 10/19/2022]
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26
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Cozzi L, Reggiori G, Franzese C, Lobefalo F, Scorsetti M, Fogliata A. EP-1528: RapidPlan Head and Neck model: the objectives and possible clinical benefits. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31963-1] [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: 12/01/2022]
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Fogliata A, Seppala J, Reggiori G, Lobefalo F, Palumbo V, De Rose F, Franceschini D, Scorsetti M, Cozzi L. EP-1560: Left breast cancer planning with VMAT technique: the dosimetric trade-offs. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31995-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fogliata A, Reggiori G, Stravato A, Lobefalo F, Franzese C, Franceschini D, Tomatis S, Mancosu P, Scorsetti M, Cozzi L. RapidPlan head and neck model: the objectives and possible clinical benefit. Radiat Oncol 2017; 12:73. [PMID: 28449704 PMCID: PMC5408433 DOI: 10.1186/s13014-017-0808-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 04/14/2017] [Indexed: 11/27/2022] Open
Abstract
Background To evaluate a knowledge based planning model for RapidPlan (RP) generated for advanced head and neck cancer (HNC) patient treatments, as well its ability to possibly improve the clinical plan quality. The stability of the model was assessed also for a different beam geometry, different dose fractionation and different management of bilateral structures (parotids). Methods Dosimetric and geometric data from plans of 83 patients presenting HNC were selected for the model training. All the plans used volumetric modulated arc therapy (VMAT, RapidArc) to treat two targets at dose levels of 69.96 and 54.45 Gy in 33 fractions with simultaneous integrated boost. Two models were generated, the first separating the ipsi- and contra-lateral parotids, while the second associating the two parotids to a single structure for training. The optimization objectives were adjusted to the final model to better translate the institutional planning and dosimetric strategies and trade-offs. The models were validated on 20 HNC patients, comparing the RP generated plans and the clinical plans. RP generated plans were also compared between the clinical beam arrangement and a simpler geometry, as well as for a different fractionation scheme. Results RP improved significantly the clinical plan quality, with a reduction of 2 Gy, 5 Gy, and 10 Gy of the mean parotid, oral cavity and laryngeal doses, respectively. A simpler beam geometry was deteriorating the plan quality, but in a small amount, keeping a significant improvement relative to the clinical plan. The two models, with one or two parotid structures, showed very similar results. NTCP evaluations indicated the possibility of improving (NTCP decreasing of about 7%) the toxicity profile when using the RP solution. Conclusions The HNC RP model showed improved plan quality and planning stability for beam geometry and fractionation. An adequate choice of the objectives in the model is necessary for the trade-offs strategies.
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Affiliation(s)
- A Fogliata
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Department, Milan, Rozzano, Italy.
| | - G Reggiori
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Department, Milan, Rozzano, Italy
| | - A Stravato
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Department, Milan, Rozzano, Italy
| | - F Lobefalo
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Department, Milan, Rozzano, Italy
| | - C Franzese
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Department, Milan, Rozzano, Italy
| | - D Franceschini
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Department, Milan, Rozzano, Italy
| | - S Tomatis
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Department, Milan, Rozzano, Italy
| | - P Mancosu
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Department, Milan, Rozzano, Italy
| | - M Scorsetti
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Department, Milan, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Rozzano, Italy
| | - L Cozzi
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Department, Milan, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Rozzano, Italy
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Sollini M, Cozzi L, Antunovic L, Chiti A, Kirienko M. PET Radiomics in NSCLC: state of the art and a proposal for harmonization of methodology. Sci Rep 2017; 7:358. [PMID: 28336974 PMCID: PMC5428425 DOI: 10.1038/s41598-017-00426-y] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 02/23/2017] [Indexed: 12/21/2022] Open
Abstract
Imaging with positron emission tomography (PET)/computed tomography (CT) is crucial in the management of cancer because of its value in tumor staging, response assessment, restaging, prognosis and treatment responsiveness prediction. In the last years, interest has grown in texture analysis which provides an "in-vivo" lesion characterization, and predictive information in several malignances including NSCLC; however several drawbacks and limitations affect these studies, especially because of lack of standardization in features calculation, definitions and methodology reporting. The present paper provides a comprehensive review of literature describing the state-of-the-art of FDG-PET/CT texture analysis in NSCLC, suggesting a proposal for harmonization of methodology.
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Affiliation(s)
- M Sollini
- Department of Biomedical Sciences, Humanitas University, via Manzoni, 113-20089, Rozzano, (Milan), Italy.
| | - L Cozzi
- Department of Biomedical Sciences, Humanitas University, via Manzoni, 113-20089, Rozzano, (Milan), Italy.,Radiotherapy and Radiosurgery Unit, Humanitas Clinical and Research Center, via Manzoni, 56-20089, Rozzano, (Milan), Italy
| | - L Antunovic
- Nuclear Medicine Unit, Humanitas Clinical and Research Center, via Manzoni, 56-20089, Rozzano, (Milan), Italy
| | - A Chiti
- Department of Biomedical Sciences, Humanitas University, via Manzoni, 113-20089, Rozzano, (Milan), Italy.,Nuclear Medicine Unit, Humanitas Clinical and Research Center, via Manzoni, 56-20089, Rozzano, (Milan), Italy
| | - M Kirienko
- Department of Biomedical Sciences, Humanitas University, via Manzoni, 113-20089, Rozzano, (Milan), Italy
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De Rose F, Franceschini D, Cozzi L, Comito T, D'Agostino G, Navarria P, Ascolese A, Tozzi A, Iftode C, Franzese C, Clerici E, Tomatis S, Fogliata A, Scorsetti M. Is There a Role for Stereotactic Body Radiation Therapy (SBRT) in Oligometastatic Breast Cancer? Results From an Observational Study. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.624] [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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31
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Pessina F, Navarria P, Ascolese A, Cozzi L, Tomatis S, Riva M, Rossi M, Scorsetti M, Bello L. P08.27 The role of supramarginal resection for single large brain metastases: feasibility, morbidity and local control evaluation. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.160] [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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Navarria P, Ascolese A, Cozzi L, Tomatis S, Picozzi P, Pecchioli G, Attuati L, Clerici E, Maggi G, Scorsetti M. P19.03 Randomized double arm phase III study to evaluate feasibility and safety of Gamma Knife radiosurgery versus Linac Based (Edge) radiosurgery in brain metastatic patients. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.286] [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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Navarria P, Pessina F, Ascolese A, Cozzi L, Tomatis S, Riva M, Bello L, Clerici E, Lobefalo F, Scorsetti M. P13.11 Outcome evaluation of oligometastatic patients with single, large brain metastases treated with gross total resection (GTR) followed by hypofractionated stereotactic radiosurgery (HSRS) on the tumor bed. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.255] [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: 11/14/2022] Open
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Franzese C, Cozzi L, Clerici E, D'Agostino G, Navarria P, Comito T, De Rose F, Ascolese A, Franceschini D, Mancosu P, Tomatis S, Scorsetti M. Role of Stereotactic Body Radiation Therapy With Volumetric Modulated Arc Therapy Technique and FFF Beams for Abdomino-Pelvic Lymph Node Metastases in Oligometastatic Patients. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.949] [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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Pessina F, Navarria P, Ascolese A, Cozzi L, Tomatis S, Riva M, Simonelli M, Scorsetti M, Bello L. P08.28 Role of surgical resection in recurrent glioblastoma: prognostic factors and outcome evaluation. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.161] [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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Gilles M, Fayad H, Miglierini P, Clement JF, Scheib S, Cozzi L, Bert J, Boussion N, Schick U, Pradier O, Visvikis D. Patient positioning in radiotherapy based on surface imaging using time of flight cameras. Med Phys 2016; 43:4833. [DOI: 10.1118/1.4959536] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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D'Agostino G, Franzese C, De Rose F, Franceschini D, Comito T, Villa E, Alongi F, Liardo R, Tomatis S, Navarria P, Mancosu P, Reggiori G, Cozzi L, Scorsetti M. High-quality Linac-based Stereotactic Body Radiation Therapy with Flattening Filter Free Beams and Volumetric Modulated Arc Therapy for Low-Intermediate Risk Prostate Cancer. A Mono-institutional Experience with 90 Patients. Clin Oncol (R Coll Radiol) 2016; 28:e173-e178. [PMID: 27389021 DOI: 10.1016/j.clon.2016.06.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 05/30/2016] [Accepted: 06/01/2016] [Indexed: 12/29/2022]
Abstract
AIMS The aim of this phase II study was to evaluate the efficacy and toxicity of stereotactic body radiotherapy in patients with low or intermediate risk prostate cancer. MATERIALS AND METHODS Biopsy-confirmed prostate cancer patients were enrolled, provided that they had the following characteristics: initial prostate-specific antigen (PSA) ≤ 20 ng/ml, Gleason Score < 7, International Prostate Symptom Score < 7. The treatment schedule was 35 Gy in five fractions, delivered with volumetric modulated arcs with flattening filter free beams. Toxicity was recorded according to CTCAE criteria v4.0. Biochemical failure was calculated according to the Phoenix definition. The Expanded Prostate Cancer Index Composite questionnaire was used to record health-related quality of life. RESULTS Between December 2011 and March 2015, 90 patients were enrolled (53 low risk, 37 intermediate risk). The median age was 71 years (range 48-82). In total, 58 (64.5%) of the patients had Gleason Score=6, the remaining had Gleason Score=7.The median initial PSA was 6.9 ng/ml (range 2.7-17.0). Acute toxicity was mild, with 32.2 patients presenting grade 1 urinary toxicity and 32.2% of patients presenting grade 2 urinary toxicity, mainly represented by urgency, dysuria and stranguria. Rectal grade 1 toxicity was found in 15.5% of patients, whereas grade 2 toxicity was recorded in 6.6% of patients. Regarding late toxicity, grade 1 proctitis was recorded in 11.1% of patients and grade 1 urinary in 38.8%; only two events of grade 2 urinary toxicity were observed (transient urethral stenosis, resolved by a 24 h catheterisation). At a median follow-up of 27 months (6-62 months) only two intermediate risk patients experienced a biochemical failure. Health-related quality of life revealed a slight worsening in all the domains during treatment, with a return to baseline 3 months after treatment. CONCLUSIONS Stereotactic body radiotherapy delivered using linac-based flattening filter free volumetric modulated arc radiotherapy in low and intermediate risk prostate cancer patients is associated with mild toxicity profiles and good patient-reported quality of life.
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Affiliation(s)
- G D'Agostino
- Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy.
| | - C Franzese
- Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - F De Rose
- Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - D Franceschini
- Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - T Comito
- Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - E Villa
- Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - F Alongi
- Radiotherapy Department, Ospedale Sacro Cuore don Calabria, Negrar, Milan, Italy
| | - R Liardo
- Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - S Tomatis
- Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - P Navarria
- Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - P Mancosu
- Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - G Reggiori
- Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - L Cozzi
- Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - M Scorsetti
- Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
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Botti A, Cagni E, Micera R, Nicola S, Orsingher L, Orlandi M, Iotti C, Cozzi L, Iori M. EP-1643: Rapidplan: 'knowledge-based' model with Tomotherapy plans. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32894-8] [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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Ascolese A, Franceschini D, De rose F, Cozzi L, Navarria P, Tozzi A, Iftode C, Villa E, Franzese C, Comito T, D'agostino G, Tomatis S, Liardo L, Scorsetti M. EP-1443: Radical hypofractionated VMAT-RA for stage III NSCLC in the elderly: feasibility and toxicity. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32693-7] [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: 10/21/2022]
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40
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Franceschini D, Clerici E, Cozzi L, Tozzi A, Iftode C, Franzese C, Comito T, De Rose F, Navarria P, D'Agostino G, Villa E, Rocco Luca L, Ascolese A, Zucconi F, Scorsetti M. EP-1442: Oligometastatic colorectal cancer in elderly patients: role of stereotactic body radiation therapy. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32692-5] [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: 11/28/2022]
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41
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Fogliata A, Fleckenstein J, Schneider F, Pachoud M, Ghandour S, Krauss H, Reggiori G, Stravato A, Lohr F, Scorsetti M, Cozzi L. PO-0809: FFF beams from TrueBeam and Versa HD units: evaluation of the parameters for quality assurance. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32059-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: 10/21/2022]
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Comito T, Franzese C, Clerici E, De Rose F, Tozzi A, D'Agostino G, Navarria P, Iftode C, Villa E, Ascolese A, Franceschini D, Liardo R, Cozzi L, Foglliata A, Stravato A, Zucconi F, Reggiori G, Tomatis S, Scorsetti M. PO-0705: Clinical outcomes for inoperable HCC treated with SBRT: results on 71 patients and 102 lesions. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31955-7] [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: 11/26/2022]
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Clerici E, Comito T, Cozzi L, Fogliata A, Tozzi A, Iftode C, Franzese C, Navarria P, D'Agostino G, Mancosu P, Lobefalo F, Tomatis S, Scorsetti M. EP-1279: SABR in inoperable liver oligometastatic patients and radioresistant primary tumors. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32529-4] [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: 11/16/2022]
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De Rose F, Cozzi L, Navarria P, Ascolese A, Clerici E, Infante M, Alloisio M, Testori A, Toschi L, Finocchiaro G, Santoro A, Scorsetti M. Clinical Outcome of Stereotactic Ablative Body Radiotherapy for Lung Metastatic Lesions in Non-small Cell Lung Cancer Oligometastatic Patients. Clin Oncol (R Coll Radiol) 2016; 28:13-20. [DOI: 10.1016/j.clon.2015.08.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/22/2015] [Accepted: 08/26/2015] [Indexed: 12/25/2022]
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Rubini S, Barbieri S, Pavoni E, Bertasi B, Cozzi L, Bergamini M, Suffredini E. Risk associated to Vibrio parahaemolyticus in shellfish in Ferrara (Emilia Romagna). Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv176.117] [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: 11/14/2022] Open
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Rodriguez M, Sempau J, Fogliata A, Cozzi L, Sauerwein W, Brualla L. A geometrical model for the Monte Carlo simulation of the TrueBeam linac. Phys Med Biol 2015; 60:N219-29. [PMID: 25984796 DOI: 10.1088/0031-9155/60/11/n219] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Monte Carlo simulation of linear accelerators (linacs) depends on the accurate geometrical description of the linac head. The geometry of the Varian TrueBeam linac is not available to researchers. Instead, the company distributes phase-space files of the flattening-filter-free (FFF) beams tallied at a plane located just upstream of the jaws. Yet, Monte Carlo simulations based on third-party tallied phase spaces are subject to limitations. In this work, an experimentally based geometry developed for the simulation of the FFF beams of the Varian TrueBeam linac is presented. The Monte Carlo geometrical model of the TrueBeam linac uses information provided by Varian that reveals large similarities between the TrueBeam machine and the Clinac 2100 downstream of the jaws. Thus, the upper part of the TrueBeam linac was modeled by introducing modifications to the Varian Clinac 2100 linac geometry. The most important of these modifications is the replacement of the standard flattening filters by ad hoc thin filters. These filters were modeled by comparing dose measurements and simulations. The experimental dose profiles for the 6 MV and 10 MV FFF beams were obtained from the Varian Golden Data Set and from in-house measurements performed with a diode detector for radiation fields ranging from 3 × 3 to 40 × 40 cm(2) at depths of maximum dose of 5 and 10 cm. Indicators of agreement between the experimental data and the simulation results obtained with the proposed geometrical model were the dose differences, the root-mean-square error and the gamma index. The same comparisons were performed for dose profiles obtained from Monte Carlo simulations using the phase-space files distributed by Varian for the TrueBeam linac as the sources of particles. Results of comparisons show a good agreement of the dose for the ansatz geometry similar to that obtained for the simulations with the TrueBeam phase-space files for all fields and depths considered, except for the 40 × 40 cm(2) field where the ansatz geometry was able to reproduce the measured dose more accurately. Our approach overcomes some of the limitations of using the Varian phase-space files. It makes it possible to: (i) adapt the initial beam parameters to match measured dose profiles; (ii) reduce the statistical uncertainty to arbitrarily low values; and (iii) assess systematic uncertainties (type B) by using different Monte Carlo codes. One limitation of using phase-space files that is retained in our model is the impossibility of performing accurate absolute dosimetry simulations because the geometrical description of the TrueBeam ionization chamber remains unknown.
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Affiliation(s)
- M Rodriguez
- Institut de Tècniques Energètiques, Universitat Politècnica de Catalunya, Diagonal 647, E-08028, Barcelona, Spain
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Nicolini G, Clivio A, Vanetti E, Tomatis S, Reggiori G, Cozzi L, Fogliata A. PO-0863: Dosimetric testing of the new aS1200 MV imager with FF and FFF beams. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40855-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Stravato A, Reggiori G, Pimpinella M, Lobefalo F, Cozzi L, Fogliata A, Gaudino A, Mancosu P, Palumbo V, Scorsetti M, Tomatis S. PO-0827: Dosimetric characterization of PTW MicroDiamond for FFF beams and small fields: experimental and Monte Carlo study. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40819-9] [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: 10/23/2022]
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De Rose F, Navarria P, Ascolese A, Comito T, Franzese C, Tozzi A, Clerici E, Iftode C, D'Agostino G, Villa E, Tomatis S, Cozzi L, Scorsetti M. EP-1177: SABR for lung lesions in NSCLC oligometastatic patients: toxicity and clinical outcomes. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41169-7] [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: 11/24/2022]
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50
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Clivio A, Fogliata A, Nicolini G, Vanetti E, Laksar S, Tozzi A, Scorsetti M, Cozzi L. PD-0449: A knowledge based model for VMAT in esophageal cancer: plan quality assessment among different centres. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40445-1] [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: 11/17/2022]
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