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Barcellini A, Vitolo V, Cobianchi L, Vanoli A, Butturini G, Brugnatelli S, Pagani A, Fossati P, Preda L, Peloso A, Klersy C, Facoetti A, Molinelli S, Ciocca M, Imparato S, Pecorilla M, Orlandi E, Valvo F. Preoperative Carbon Ion Radiotherapy (CIRT) with Chemotherapy in Resectable and Borderline Resectable Pancreatic Adenocarcinoma (PCa): A Multicenter Prospective Phase II Clinical Study (Pioppo Study NCT 03822936). Int J Radiat Oncol Biol Phys 2023; 117:e347-e348. [PMID: 37785206 DOI: 10.1016/j.ijrobp.2023.06.2417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Preoperative chemoradiation and surgery may improve survival for resectable (Re) or borderline resectable (BRe) PCa. However, there is a lack of evidence regarding the feasibility of combined chemotherapy (CT) and CIRT in the neoadjuvant setting for Re/BRe PCa, especially in the Caucasian population. To assess the safety and efficacy of this challenging combination, we designed a prospective multicentric single-arm phase II trial MATERIALS/METHODS: PIOPPO trial was opened in September 2014. We prospectively treated patients with Re/BRe Pca with a neoadjuvant CT (3 cycles of FOLFIRINOX) and a short-course of CIRT (38.4 GyRBE, 8 fractions, 4 fractions per week) planned with 4D-imaging and delivered with breath-gating and rescanning. Four-6 weeks after CIRT patients (pts) received surgery followed by adjuvant-CT (FOLFIRINOX for 9 or gemcitabine for 6 cycles). After each step patients underwent a re-staging. The primary endpoint was Local Progression Free Survival (LPFS). RESULTS Fourteen (47%) of the foreseen 30 pts were evaluated for enrollment. There were 4 screening failures for duodenum infiltration. Ten Caucasian pts (M = 7; 70%; F = 3;30%) with a median age of 65.5 (range:46-76) started the treatment. There were four (40%) Re and 6 (60%) BRe Pca. 100% of the Re and 50% of BRe PCa completed the planned combined treatment for a total of 7 (70%) pts. Three (30%) pts developed systemic progression after CT and underwent palliative care (2 cases) or a second line of CT (1 case). With regards to toxicities, we recorded 2 (28.6%) cases of neutropenia during CT, none acute CIRT toxicity and one (14%) case of intra-operative ulceration of the gastro-enteric anastomosis. Moreover, we reported one (14%) case of fatal liver failure due to portal vein stenosis due to the combo approach (CT+CIRT+surgery). Six (86%) pts experienced Tumor Regression Grade (TRG) = 2 according to the College of American Pathologists (CAP) and 1 (14%) a TRG = 3. At the last follow-up, among pts who completed the scheme, 2 (28%) are currently alive and disease-free at 57 and 49 months, respectively. With a median follow-up of 13 months, the median LPFS was 9.4 months (range:4.9-57), with 1 case (14%) of systemic progression and 3 cases (43%) of local recurrence + systemic progression. The study was early closed due to low accrual in August 2022. CONCLUSION Although the small sample size limits the interpretation of the endpoints, a neoadjuvant approach combining CT and a short course of CIRT for resectable/borderline Pca seems feasible. Liver toxicity was similar to the Japanese series and needs to deepen investigation on the vascular dose constraints and surgical techniques. Considering the worse outcomes, a better selection of patients to treat also with a centralized imaging interpretation is mandatory.
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Affiliation(s)
- A Barcellini
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy; Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - V Vitolo
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - L Cobianchi
- General Surgery Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - A Vanoli
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - G Butturini
- Hepato Bilio Pancreatic Surgery Department "P. Pederzoli" Hospital, Peschiera del Garda, VR, Italy
| | - S Brugnatelli
- Medical Oncology Department, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Pagani
- Medical Oncology Department, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - P Fossati
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - L Preda
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Radiology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Peloso
- Department of Visceral and Transplantation Surgery, University of Geneva Hospitals, Geneva, GE, Switzerland
| | - C Klersy
- Clinical Epidemiology & Biometry Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - A Facoetti
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - S Molinelli
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - M Ciocca
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - S Imparato
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - M Pecorilla
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - E Orlandi
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - F Valvo
- National Centre of Oncological Hadrontherapy, Pavia, Italy
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De Simoni M, Baroni G, Battistoni G, Bisogni M, Cerello P, Ciocca M, Donetti M, Dong Y, Embriaco A, Ferrero V, Fiorina E, Fischetti M, Franciosini G, Giacchi G, Kraan A, Luongo C, Maggi M, Mancini Terracciano C, Marafini M, Malekzadeh E, Mattei I, Mazzoni E, Mirandola A, Morrocchi M, Muraro S, Patera V, Pennazio F, Schiavi A, Solfaroli-Camillucci E, Sportelli G, Tampellini S, Toppi M, Traini G, Trigilio A, Vischioni B, Vitolo V, Carlotti D, De Gregorio A, Sarti A. PD-0897 In vivo verification by detection of charged fragments in carbon ion therapy treatments at CNAO. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02976-0] [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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Ronchi S, Vischioni B, Cicchetti A, Bonora M, Ingargiola R, Rossi E, Russo S, Ciocca M, Orlandi E. MO-0482 Carbon ion radiotherapy for head and neck mucosal melanoma: single-center experience in 40 patients. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02376-3] [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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Fiore M, Ghirelli A, Molinelli S, Magro G, Chalaszczyk A, Mairani A, Donatelli A, Imparato S, Ciocca M, Orlandi E. MO-0150 Sacral insufficiency fractures after CIRT for sacral chordoma: dosimetric and LET analysis. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02310-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Riva G, Fiorina E, Cavallo I, Molinelli S, Vai A, Ciocca M, Iannalfi A, Orlandi E. OC-0090 Temporal lobe necrosis after proton therapy for skull base tumors and NTCP models evaluation. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02466-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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molinelli S, Vai A, Russo S, Loap P, Meschini G, Magro G, Paganelli C, Barcellini A, Vitolo V, Ciocca M, Orlandi E. MO-0635 The need for treatment adaptation in carbon ion radiotherapy of pancreatic cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02393-3] [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: 11/24/2022]
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Vai A, Molinelli S, Rossi E, Iacovelli N, Magro G, Cavallo A, Pignoli E, Rancati T, Mirandola A, Ingargiola R, Vischioni B, Bonora M, Ronchi S, Ciocca M, Orlandi E. PO-1509 Proton therapy for nasopharyngeal cancer: dosimetric and NTCP analysis supporting clinical decision. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03473-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mirandola A, Maestri D, Magro G, Mastella E, Molinelli S, Rossi E, Russo S, Vai A, Ciocca M. Determination of ion recombination and polarity effects for the PTW Advanced Markus ionization chamber in synchrotron based scanned proton and carbon ion beams. Phys Med 2022; 96:149-156. [DOI: 10.1016/j.ejmp.2022.03.007] [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] [Received: 02/23/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022] Open
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Mastella E, Molinelli S, Pella A, Vai A, Maestri D, Vitolo V, Baroni G, Valvo F, Ciocca M. 4D restricted robust optimization in intensity modulated proton therapy for hypofractionated treatments of lung tumors. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00092-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Maestri D, Mirandola A, Magro G, Mastella E, Molinelli S, Rossi E, Russo S, Vai A, Ciocca M. Determination of ion recombination and polarity effects for the PTW Advanced Markus ionization chamber in synchrotron based scanning and collimated proton beams for ocular treatment. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00155-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Ricotti R, Pella A, Mirandola A, Fiore MR, Chalaszczyk A, Paganelli C, Antonioli L, Vai A, Tagaste B, Belotti G, Rossi M, Ciocca M, Orlandi E, Baroni G. Dosimetric effect of variable rectum and sigmoid colon filling during carbon ion radiotherapy to sacral chordoma. Phys Med 2021; 90:123-133. [PMID: 34628271 DOI: 10.1016/j.ejmp.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/13/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Carbon ion radiotherapy (CIRT) is sensitive to anatomical density variations. We examined the dosimetric effect of variable intestinal filling condition during CIRT to ten sacral chordoma patients. METHODS For each patient, eight virtual computed tomography scans (vCTs) were generated by varying the density distribution within the rectum and the sigmoid in the planning computed tomography (pCT) with a density override approach mimicking a heterogeneous combination of gas and feces. Totally full and empty intestinal preparations were modelled. In addition, five different intestinal filling conditions were modelled by a mixed density pattern derived from two combined and weighted Gaussian distributions simulating gas and feces respectively. Finally, a patient-specific mixing proportion was estimated by evaluating the daily amount of gas detected in the cone beam computed tomography (CBCT). Dose distribution was recalculated on each vCT and dose volume histograms (DVHs) were examined. RESULTS No target coverage degradation was observed at different vCTs. Rectum and sigma dose degradation ranged respectively between: [-6.7; 21.6]GyE and [-0.7; 15.4]GyE for D50%; [-377.4; 1197.9] and [-95.2; 1027.5] for AUC; [-1.2; 10.7]GyE and [-2.6; 21.5]GyE for D1%. CONCLUSIONS Variation of intestinal density can greatly influence the penetration depth of charged particle and might compromise dose distribution. In particular cases, with large clinical target volume in very close proximity to rectum and sigmoid colon, it is appropriate to evaluate the amount of gas present in the daily CBCT images even if it is totally included in the reference planning structures.
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Affiliation(s)
- R Ricotti
- Bioengineering Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.
| | - A Pella
- Bioengineering Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - A Mirandola
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - M R Fiore
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - A Chalaszczyk
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - C Paganelli
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - L Antonioli
- Bioengineering Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - A Vai
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - B Tagaste
- Bioengineering Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - G Belotti
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - M Rossi
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - M Ciocca
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - E Orlandi
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - G Baroni
- Bioengineering Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy; Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy
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12
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Elisei G, Pella A, Ricotti R, Via R, Fiore MR, Calvi G, Mastella E, Paganelli C, Tagaste B, Bello F, Fontana G, Meschini G, Buizza G, Valvo F, Orlandi E, Ciocca M, Baroni G. Development and validation of a new set-up simulator dedicated to ocular proton therapy at CNAO. Phys Med 2021; 82:228-239. [PMID: 33657472 DOI: 10.1016/j.ejmp.2021.01.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 11/27/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022] Open
Abstract
An Eye Tracking System (ETS) is used at CNAO for providing a stable and reproducible ocular proton therapy (OPT) set-up, featuring a fixation light (FL) and monitoring stereo-cameras embedded in a rigid case. The aim of this work is to propose an ETS set-up simulation algorithm, that automatically provides the FL positioning in space, according to patient-specific gaze direction and avoiding interferences with patient, beam and collimator. Two configurations are provided: one in the CT room for acquiring images required for treatment planning with the patient lying on a couch, and one related to the treatment room with the patient sitting in front of the beam. Algorithm validation was performed reproducing ETS simulation (CT) and treatment (room) set-up for 30 patients previously treated at CNAO. The positioning accuracy of the device was quantified through a set of 14 control points applied to the ETS case and localizable both in the CT volume and in room X-ray images. Differences between the position of ETS reference points estimated by the algorithm and those measured by imaging systems are reported. The corresponding gaze direction deviation is on average 0.2° polar and 0.3° azimuth for positioning in CT room and 0.1° polar and 0.4° azimuth in the treatment room. The simulation algorithm was embedded in a clinically usable software application, which we assessed as capable of ensuring ETS positioning with an average accuracy of 2 mm in CT room and 1.5 mm in treatment room, corresponding to gaze direction deviations consistently lower than 1°.
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Affiliation(s)
- G Elisei
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department-Bioengineering Unit, Pavia, Italy
| | - A Pella
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department-Bioengineering Unit, Pavia, Italy.
| | - R Ricotti
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department-Bioengineering Unit, Pavia, Italy
| | - R Via
- Center of Proton Therapy, Paul Scherrer Institut, 5232 Villigen, PSI, Switzerland
| | - M R Fiore
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department, Pavia, Italy
| | - G Calvi
- Centro Nazionale di Adroterapia Oncologica CNAO, Particle Accelerator Department, Pavia, Italy
| | - E Mastella
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department - Medical Physics Unit, Pavia, Italy
| | - C Paganelli
- Politecnico di Milano, Department of Electronics Information and Bioengineering, Milano, Italy
| | - B Tagaste
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department-Bioengineering Unit, Pavia, Italy
| | - F Bello
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department-Bioengineering Unit, Pavia, Italy
| | - G Fontana
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department-Bioengineering Unit, Pavia, Italy
| | - G Meschini
- Politecnico di Milano, Department of Electronics Information and Bioengineering, Milano, Italy
| | - G Buizza
- Politecnico di Milano, Department of Electronics Information and Bioengineering, Milano, Italy
| | - F Valvo
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department, Pavia, Italy
| | - E Orlandi
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department, Pavia, Italy
| | - M Ciocca
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department - Medical Physics Unit, Pavia, Italy
| | - G Baroni
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department-Bioengineering Unit, Pavia, Italy; Politecnico di Milano, Department of Electronics Information and Bioengineering, Milano, Italy
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13
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Fischetti M, Baroni G, Battistoni G, Bisogni G, Cerello P, Ciocca M, De Maria P, De Simoni M, Di Lullo B, Donetti M, Dong Y, Embriaco A, Ferrero V, Fiorina E, Franciosini G, Galante F, Kraan A, Luongo C, Magi M, Mancini-Terracciano C, Marafini M, Malekzadeh E, Mattei I, Mazzoni E, Mirabelli R, Mirandola A, Morrocchi M, Muraro S, Patera V, Pennazio F, Schiavi A, Sciubba A, Solfaroli Camillocci E, Sportelli G, Tampellini S, Toppi M, Traini G, Valle SM, Vischioni B, Vitolo V, Sarti A. Inter-fractional monitoring of [Formula: see text]C ions treatments: results from a clinical trial at the CNAO facility. Sci Rep 2020; 10:20735. [PMID: 33244102 PMCID: PMC7693236 DOI: 10.1038/s41598-020-77843-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/13/2020] [Indexed: 12/26/2022] Open
Abstract
The high dose conformity and healthy tissue sparing achievable in Particle Therapy when using C ions calls for safety factors in treatment planning, to prevent the tumor under-dosage related to the possible occurrence of inter-fractional morphological changes during a treatment. This limitation could be overcome by a range monitor, still missing in clinical routine, capable of providing on-line feedback. The Dose Profiler (DP) is a detector developed within the INnovative Solution for In-beam Dosimetry in hadronthErapy (INSIDE) collaboration for the monitoring of carbon ion treatments at the CNAO facility (Centro Nazionale di Adroterapia Oncologica) exploiting the detection of charged secondary fragments that escape from the patient. The DP capability to detect inter-fractional changes is demonstrated by comparing the obtained fragment emission maps in different fractions of the treatments enrolled in the first ever clinical trial of such a monitoring system, performed at CNAO. The case of a CNAO patient that underwent a significant morphological change is presented in detail, focusing on the implications that can be drawn for the achievable inter-fractional monitoring DP sensitivity in real clinical conditions. The results have been cross-checked against a simulation study.
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Affiliation(s)
- M. Fischetti
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Università di Roma, Rome, Italy
- INFN Sezione di Roma I, Rome, Italy
| | - G. Baroni
- Dipartimento di Elettronica Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | | | - G. Bisogni
- INFN Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica “E. Fermi”, Università di Pisa, Pisa, Italy
| | | | - M. Ciocca
- CNAO Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - P. De Maria
- Scuola di Specializzazione di Fisica Medica, Sapienza Università di Roma, Rome, Italy
| | - M. De Simoni
- Dipartimento di Fisica, Sapienza Università di Roma, Rome, Italy
- INFN Sezione di Roma I, Rome, Italy
| | - B. Di Lullo
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Università di Roma, Rome, Italy
| | - M. Donetti
- CNAO Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Y. Dong
- INFN Sezione di Milano, Milan, Italy
- Dipartimento di Fisica, Università degli Studi di Milano, Milan, Italy
| | | | | | - E. Fiorina
- INFN Sezione di Torino, Turin, Italy
- CNAO Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - G. Franciosini
- Dipartimento di Fisica, Sapienza Università di Roma, Rome, Italy
- INFN Sezione di Roma I, Rome, Italy
| | - F. Galante
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Università di Roma, Rome, Italy
| | - A. Kraan
- INFN Sezione di Pisa, Pisa, Italy
| | - C. Luongo
- INFN Sezione di Pisa, Pisa, Italy
- Dipartimento di Chimica e Chimica Industriale, Università di Pisa, Pisa, Italy
| | - M. Magi
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Università di Roma, Rome, Italy
| | - C. Mancini-Terracciano
- Dipartimento di Fisica, Sapienza Università di Roma, Rome, Italy
- INFN Sezione di Roma I, Rome, Italy
| | - M. Marafini
- INFN Sezione di Roma I, Rome, Italy
- Museo Storico della Fisica e Centro Studi e Ricerche “E. Fermi”, Rome, Italy
| | - E. Malekzadeh
- CNAO Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - I. Mattei
- INFN Sezione di Milano, Milan, Italy
| | | | - R. Mirabelli
- Dipartimento di Fisica, Sapienza Università di Roma, Rome, Italy
- INFN Sezione di Roma I, Rome, Italy
- Museo Storico della Fisica e Centro Studi e Ricerche “E. Fermi”, Rome, Italy
| | - A. Mirandola
- CNAO Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - M. Morrocchi
- INFN Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica “E. Fermi”, Università di Pisa, Pisa, Italy
| | - S. Muraro
- INFN Sezione di Milano, Milan, Italy
| | - V. Patera
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Università di Roma, Rome, Italy
- INFN Sezione di Roma I, Rome, Italy
- Museo Storico della Fisica e Centro Studi e Ricerche “E. Fermi”, Rome, Italy
| | | | - A. Schiavi
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Università di Roma, Rome, Italy
- INFN Sezione di Roma I, Rome, Italy
| | - A. Sciubba
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Università di Roma, Rome, Italy
- INFN Sezione dei Laboratori di Frascati, Rome, Italy
- Museo Storico della Fisica e Centro Studi e Ricerche “E. Fermi”, Rome, Italy
| | - E. Solfaroli Camillocci
- Dipartimento di Fisica, Sapienza Università di Roma, Rome, Italy
- INFN Sezione di Roma I, Rome, Italy
- Scuola di Specializzazione in Fisica Medica, Sapienza Università di Roma, Rome, Italy
| | - G. Sportelli
- INFN Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica “E. Fermi”, Università di Pisa, Pisa, Italy
| | - S. Tampellini
- CNAO Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - M. Toppi
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Università di Roma, Rome, Italy
- INFN Sezione dei Laboratori di Frascati, Rome, Italy
| | - G. Traini
- INFN Sezione di Roma I, Rome, Italy
- Museo Storico della Fisica e Centro Studi e Ricerche “E. Fermi”, Rome, Italy
| | | | - B. Vischioni
- CNAO Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - V. Vitolo
- CNAO Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - A. Sarti
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Università di Roma, Rome, Italy
- INFN Sezione di Roma I, Rome, Italy
- Museo Storico della Fisica e Centro Studi e Ricerche “E. Fermi”, Rome, Italy
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Ronchi S, Vischioni B, Bonora M, Vitolo V, Fiore M, Iannalfi A, Barcellini A, Molinelli S, Russo S, Maestri D, Ciocca M, Preda L, Valvo F. PO-0850: Proton Beam Reirradiation In Head And Neck Patients at CNAO: preliminary results. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00867-7] [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: 10/22/2022]
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15
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Vischioni B, Mirandola A, Bonora M, Ronchi S, Mastella E, Orlandi E, Iacovelli N, Cavallo A, Licitra L, Fallai C, Ciocca M, Pignoli E, Magrini S, Antognoni P, Valvo F. PO-1798: Quality of radiotherapy treatment plans for locally advanced sinonasal tumors in a phase II trial. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01816-8] [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: 10/22/2022]
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16
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Guida F, Barbato A, Ciocca M, Schwarz M, Lorentini S, Mastella E, Cirrone GAP, Petringa G, Liotta M, Tarabelli De Fatis P, Masi M, Mettivier G, Russo P. Dose intercomparison at Italian hadrontherapy centers. Phys Med 2019; 68:83-87. [PMID: 31765885 DOI: 10.1016/j.ejmp.2019.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To perform the first dosimetric intercomparison for proton beams in Italy using ionization chambers, according to the IAEA TRS-398 code of practice. METHODS Measurement sites included: National Center for Oncological Hadron Therapy (CNAO, Pavia), Center for Proton Therapy (CTP, Trento) and Center for Hadron Therapy and for advanced Nuclear Applications (CATANA, Catania). For comparison we also included a 6 MV photon beam produced at Istituti Clinici Scientifici Maugeri (ICSM, Pavia). For proton beams, both single pseudo-monoenergetic layers (in order to obtain a planned dose of 2 Gy at the reference depth of 2 cm in a water phantom) and Spread-out Bragg peaks (SOBP) have been delivered. Measurements were performed with a PTW Farmer 30010-1 and a PTW Advanced Markus type 34,045 ionization chamber. RESULTS Data obtained at CATANA, CNAO and CPT in terms of absorbed dose to water depth show good consistency within the experimental uncertainties, with a weighted mean of 1.99 ± 0.01 Gy and a standard error of 0.003 Gy, with reference to a nominal dose of 2 Gy as designed by the treatment planning system. CONCLUSIONS The results showed a standard deviation of less than 1% for single layer and SOBP beams, for all chambers and a percent deviation less than 1.5% for single layer measurements. The weighted means of the absorbed doses for clinical proton beams (118.19 MeV and 173.61 MeV) are consistent within less than 1%. These results agree within the 1.5% difference considered acceptable for national dose intercomparison.
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Affiliation(s)
- F Guida
- Università di Napoli Federico II, Dipartimento di Fisica "Ettore Pancini", Napoli, Italy; INFN Sezione di Napoli, Napoli, Italy
| | - A Barbato
- Università di Napoli Federico II, Dipartimento di Fisica "Ettore Pancini", Napoli, Italy; INFN Sezione di Napoli, Napoli, Italy
| | | | - M Schwarz
- Centro di Protonterapia, APSS, Trento, Italy
| | - S Lorentini
- Centro di Protonterapia, APSS, Trento, Italy
| | | | | | - G Petringa
- INFN-LNS, Catania, Italy; Università di Catania, Dipartimento di Fisica ed Astronomia, Catania, Italy
| | - M Liotta
- Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | | | - M Masi
- Università di Napoli Federico II, Dipartimento di Fisica "Ettore Pancini", Napoli, Italy; INFN Sezione di Napoli, Napoli, Italy
| | - G Mettivier
- Università di Napoli Federico II, Dipartimento di Fisica "Ettore Pancini", Napoli, Italy; INFN Sezione di Napoli, Napoli, Italy.
| | - P Russo
- Università di Napoli Federico II, Dipartimento di Fisica "Ettore Pancini", Napoli, Italy; INFN Sezione di Napoli, Napoli, Italy
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Morini J, Babini G, Barbieri S, Baiocco G, Ciocca M, Ivaldi GB, Liotta M, Molinelli S, Tabarelli de Fatis P, Ottolenghi A. A COMPARISON BETWEEN X-RAY AND CARBON ION IRRADIATION IN HUMAN NEURAL STEM CELLS. Radiat Prot Dosimetry 2019; 183:102-106. [PMID: 30535035 DOI: 10.1093/rpd/ncy231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Indexed: 06/09/2023]
Abstract
Glioblastoma multiforme (GBM) is characterized by a poor prognosis and a median survival of ~12-18 months. GBM is usually managed by neurosurgery followed by both chemotherapy and radiotherapy. Since GBM develops resistance to conventional therapies, treatment with C-ions is promising to completely eradicate the tumoural mass. During cranial irradiation, exposure of healthy tissues is inevitable. Because of the presence of neural stem cells, a deep investigation on the effects of C-ion irradiation with respect to X-ray induced damage is mandatory to allow a better definition of treatments. In this work, the comparison of X-rays and C-ion irradiation-induced effects on human neural stem cell, focusing on multiple endpoints, such as cell viability, cytokine secretion and spheroid formation is presented. Results show different temporal and dose responses of human neural stem cells to the different radiation qualities, suggesting different underpinning mechanisms of radiation-induced damages.
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Affiliation(s)
- J Morini
- Department of Physics, University of Pavia, via Bassi 6, Pavia, Italy
| | - G Babini
- Department of Physics, University of Pavia, via Bassi 6, Pavia, Italy
| | - S Barbieri
- Department of Physics, University of Pavia, via Bassi 6, Pavia, Italy
| | - G Baiocco
- Department of Physics, University of Pavia, via Bassi 6, Pavia, Italy
| | - M Ciocca
- Department of Medical Physics, National Center of Oncological Handrontherapy (CNAO), Strada Campeggi 53, Pavia, Italy
| | - G B Ivaldi
- Department of Radiation Oncology, ICS Maugeri, via Maugeri 10, Pavia, Italy
| | - M Liotta
- Department of Medical Physics, ICS Maugeri, via Maugeri 10, Pavia, Italy
| | - S Molinelli
- Department of Medical Physics, National Center of Oncological Handrontherapy (CNAO), Strada Campeggi 53, Pavia, Italy
| | | | - A Ottolenghi
- Department of Physics, University of Pavia, via Bassi 6, Pavia, Italy
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Mirandola A, Magro G, Maestri D, Mairani A, Mastella E, Molinelli S, Russo S, Vai A, Ciocca M. Determination of ion recombination and polarity effect correction factors for a plane-parallel ionization Bragg peak chamber under proton and carbon ion pencil beams. Phys Med Biol 2019; 64:095010. [PMID: 30844771 DOI: 10.1088/1361-6560/ab0db4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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
Within the dosimetric characterization of particle beams, laterally-integrated depth-dose-distributions (IDDs) are measured and provided to the treatment planning system (TPS) for beam modeling or used as a benchmark for Monte Carlo (MC) simulations. The purpose of this work is the evaluation, in terms of ion recombination and polarity effect, of the dosimetric correction to be applied to proton and carbon ion curves as a function of linear energy transfer (LET). LET was calculated with a MC code for selected IDDs. Several regions of Bragg peak (BP) curve were investigated. The charge was measured with the plane-parallel BP-ionization chamber mounted in the Peakfinder as a field detector, by delivering a fixed number of particles at the maximum flux. The dose rate dependence was evaluated for different flux levels. The chamber was connected to an electrometer and exposed to un-scanned pencil beams. For each measurement the chamber was supplied with {±400, +200, +100} V. Recombination and polarity correction factors were then calculated as a function of depth and LET in water. Three energies representative of the clinical range were investigated for both particle types. The corrected IDDs (IDD k s) were then compared against MC. Recombination correction factors were LET and energy dependent, ranging from 1.000 to 1.040 (±0.5%) for carbon ions, while nearly negligible for protons. Moreover, no corrections need to be applied due to polarity effect being <0.5% along the whole IDDs for both particle types. IDD k s showed a better agreement than uncorrected curves when compared to MC, with a reduction of the mean absolute variation from 1.2% to 0.9%. The aforementioned correction factors were estimated and applied along the IDDs, showing an improved agreement against MC. Results confirmed that corrections are not negligible for carbon ions, particularly around the BP region.
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Affiliation(s)
- A Mirandola
- Centro Nazionale di Adroterapia Oncologica (CNAO Foundation), I-27100 Pavia, Italy. Author to whom any correspondence should be addressed
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Giordanengo S, Vignati A, Attili A, Ciocca M, Donetti M, Fausti F, Manganaro L, Milian FM, Molinelli S, Monaco V, Russo G, Sacchi R, Varasteh Anvar M, Cirio R. RIDOS: A new system for online computation of the delivered dose distributions in scanning ion beam therapy. Phys Med 2019; 60:139-149. [PMID: 31000074 DOI: 10.1016/j.ejmp.2019.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 02/21/2019] [Accepted: 03/27/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To describe a new system for scanned ion beam therapy, named RIDOS (Real-time Ion DOse planning and delivery System), which performs real time delivered dose verification integrating the information from a clinical beam monitoring system with a Graphic Processing Unit (GPU) based dose calculation in patient Computed Tomography. METHODS A benchmarked dose computation algorithm for scanned ion beams has been parallelized and adapted to run on a GPU architecture. A workstation equipped with a NVIDIA GPU has been interfaced through a National Instruments PXI-crate with the dose delivery system of the Italian National Center of Oncological Hadrontherapy (CNAO) to receive in real-time the measured beam parameters. Data from a patient monitoring system are also collected to associate the respiratory phases with each spot during the delivery of the dose. Using both measured and planned spot properties, RIDOS evaluates during the few seconds of inter-spill time the cumulative delivered and prescribed dose distributions and compares them through a fast γ-index algorithm. RESULTS The accuracy of the GPU-based algorithms was assessed against the CPU-based ones and the differences were found below 1‰. The cumulative planned and delivered doses are computed at the end of each spill in about 300 ms, while the dose comparison takes approximatively 400 ms. The whole operation provides the results before the next spill starts. CONCLUSIONS RIDOS system is able to provide a fast computation of the delivered dose in the inter-spill time of the CNAO facility and allows to monitor online the dose deposition accuracy all along the treatment.
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Affiliation(s)
- S Giordanengo
- Istituto Nazionale di Fisica Nucleare, Via Giuria 1, 10125 Torino, Italy.
| | - A Vignati
- Istituto Nazionale di Fisica Nucleare, Via Giuria 1, 10125 Torino, Italy
| | - A Attili
- Istituto Nazionale di Fisica Nucleare, Via Giuria 1, 10125 Torino, Italy
| | - M Ciocca
- Centro Nazionale di Adroterapia Oncologica, Strada Campeggi 53, 27100 Pavia, Italy
| | - M Donetti
- Centro Nazionale di Adroterapia Oncologica, Strada Campeggi 53, 27100 Pavia, Italy
| | - F Fausti
- Istituto Nazionale di Fisica Nucleare, Via Giuria 1, 10125 Torino, Italy; Politecnico di Torino, C.so Duca degli Abruzzi 24, 10129 Torino, Italy
| | - L Manganaro
- Istituto Nazionale di Fisica Nucleare, Via Giuria 1, 10125 Torino, Italy; Università di Torino, Via Giuria 1, 10125 Torino, Italy
| | - F M Milian
- Universidade Estadual de Santa Cruz, Rod Jorge Amado, km 16, 45652900 Ilheus, Brazil; Università di Torino, Via Giuria 1, 10125 Torino, Italy
| | - S Molinelli
- Centro Nazionale di Adroterapia Oncologica, Strada Campeggi 53, 27100 Pavia, Italy
| | - V Monaco
- Istituto Nazionale di Fisica Nucleare, Via Giuria 1, 10125 Torino, Italy; Università di Torino, Via Giuria 1, 10125 Torino, Italy
| | - G Russo
- Istituto Nazionale di Fisica Nucleare, Via Giuria 1, 10125 Torino, Italy
| | - R Sacchi
- Istituto Nazionale di Fisica Nucleare, Via Giuria 1, 10125 Torino, Italy; Università di Torino, Via Giuria 1, 10125 Torino, Italy
| | - M Varasteh Anvar
- Istituto Nazionale di Fisica Nucleare, Via Giuria 1, 10125 Torino, Italy; Università di Torino, Via Giuria 1, 10125 Torino, Italy
| | - R Cirio
- Istituto Nazionale di Fisica Nucleare, Via Giuria 1, 10125 Torino, Italy; Università di Torino, Via Giuria 1, 10125 Torino, Italy
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Facoetti A, Aprile C, Cavagnini M, Ciocca M, Iannalfi A, Lodola L, Marenco M, Nano R, Pasi F, Persico M, Valvo F, Orecchia R. EP-2159 Influence of L-Dopa pretreatment on cellular features in T98G cells. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32579-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Vai A, Meschini G, Molinelli S, Paganelli C, Maestri D, Magro G, Mastella E, Mairani A, Mirandola A, Russo S, Preda L, Viselener G, Barcellini A, Vitolo V, Mancin A, Fontana G, Baroni G, Ciocca M. EP-1968 Respiratory-gated carbon-ion beam treatments of abdominal targets: clinical introduction of 4DMRI. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32388-6] [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: 10/26/2022]
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Vai A, Maestri D, Magro G, Mairani A, Mastella E, Mirandola A, Molinelli S, Russo S, Togno M, La Civita S, Ciocca M. PO-0894 Characterization of a multilayer ionization chamber for relative depth-dose curves in particle beams. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31314-3] [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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D’Ippolito E, Iannalfi A, Bonora M, Vischioni B, Fiore M, Ronchi S, Vitolo V, Barcellini A, Petrucci R, Mirandola A, Maestri D, Magro G, Facoetti A, Viselner G, Ciocca M, Preda L, Valvo F, Orecchia R. PO-0741 Active spot-scanning proton therapy for intracranial meningiomas: CNAO experience. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31161-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ricotti R, Tagaste B, Pella A, Fontana G, Elisei G, Tampellini S, Ciocca M, Valvo F, Baroni G. EP-2015 Interfraction setup error using multiple immobilization devices for limb-extremity particle therapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32435-1] [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: 11/29/2022]
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Maestri D, Mirandola A, Magro G, Mairani A, Mastella E, Molinelli S, Russo S, Vai A, Ciocca M. EP-1756 Ion recombination and polarity correction for a plane-parallel ionization chamber in hadrontherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32176-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Barcellini A, Vitolo V, Fiore M, Iannalfi A, Vischioni B, Fossati P, Ronchi S, Bonora M, D'Ippolito E, Petrucci R, Facoetti A, Mirandola A, Vai A, Molinelli S, Mastella E, Russo S, Viselner G, Preda L, Ciocca M, Valvo F, Orecchia R. EP-1496 Feasibility of carbon ion radiotherapy for the melanoma of the lower genital tract. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31916-4] [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: 11/26/2022]
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Elisei G, Via R, Pella A, Calvi G, Ricotti R, Tagaste B, Fontana G, Fiore M, Ciocca M, Valvo F, Baroni G. OC-0188 Development and commissioning of a set-up optimization routine for ocular proton therapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30608-5] [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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D’Ippolito E, Iannalfi A, Vischioni B, Vitolo V, Fiore M, Ronchi S, Bonora M, Barcellini A, Petrucci R, Mirandola A, Vai A, Mastella E, Viselner G, Ciocca M, Preda L, Valvo F, Orecchia R. EP-1147 Local control rate in patients with skull-base chondrosarcoma treated with particle therapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31567-1] [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: 11/28/2022]
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Ronchi S, Vischioni B, Vitolo V, Bonora M, Hasegawa A, Fiore M, Iannalfi A, D’Ippolito E, Petrucci R, Barcellini A, Molinelli S, Maestri D, Viselner G, Facoetti A, Ciocca M, Preda L, Valvo F, Orecchia R. EP-1188 Carbon ion radiotherapy for recurrent pleomorphic adenoma at CNAO: preliminary results. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31608-1] [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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Iannalfi A, D’Ippolito E, Vitolo V, Vischioni B, Fiore M, Bonora M, Ronchi S, Barcellini A, Petrucci R, Molinelli S, Mirandola A, Russo S, Facoetti A, Vai A, Mastella E, Viselner G, Magro G, Ciocca M, Preda L, Valvo F, Orecchia R. PO-0716 Skull-base chordoma treated with proton and carbon ion radiotherapy : CNAO clinical experience. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31136-3] [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: 11/26/2022]
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Gambarini G, Bettega D, Camoni G, Barzon G, Bettinelli L, Giove D, Carrara M, Mirandola A, Ciocca M. Development of a procedure for quenching-effect correction in images of absorbed dose from protons or carbon ions acquired with Gafchromic EBT3 films. Radiat Phys Chem Oxf Engl 1993 2019. [DOI: 10.1016/j.radphyschem.2018.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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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Garibaldi C, Ferrari M, Colandrea M, Cascio A, Ciocca M, Iannalfi A, D’Ippolito E, Pesente S, Grana C, Jereczek-Fossa B, Cremonesi M. 244. Target volume definition with MRI and 68 Ga-DOTATOC-PET/CT for patients with meningiomas. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.255] [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: 11/24/2022] Open
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Iannalfi A, D’Ippolito E, Vitolo V, Vischioni B, Fiore M, Bonora M, Ronchi S, Caivano D, Barcellini A, Mirandola A, Molinelli S, Russo S, Facoetti A, Vai A, Mastella E, Viselner G, Raciti M, Fanizza M, Magro G, Maestri D, Ciocca M, Preda L, Valvo F, Orecchia R. P05.39 Skull-base chordoma treated with proton and carbon ion radiotherapy: C.N.A.O. clinical experience. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - M Raciti
- Università degli Studi di Pavia, Pavia, Italy
| | - M Fanizza
- Università degli Studi di Pavia, Pavia, Italy
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Latorre A, Rocchi L, Stamelou M, Batla A, Ciocca M, Balint B, Sidle K, Berardelli A, Rothwell JC, Bhatia KP. Tremor in motor neuron disease may be central rather than peripheral in origin. Eur J Neurol 2018; 26:394-e31. [PMID: 29953699 DOI: 10.1111/ene.13743] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 06/21/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Motor neuron disease (MND) refers to a spectrum of degenerative diseases affecting motor neurons. Recent clinical and post-mortem observations have revealed considerable variability in the phenotype. Rhythmic involuntary oscillations of the hands during action, resembling tremor, can occur in MND, but their pathophysiology has not yet been investigated. METHODS A total of 120 consecutive patients with MND were screened for tremor. Twelve patients with action tremor and no other movement disorders were found. Ten took part in the study. Tremor was recorded bilaterally using surface electromyography (EMG) and triaxial accelerometer, with and without a variable weight load. Power spectra of rectified EMG and accelerometric signal were calculated. To investigate a possible cerebellar involvement, eyeblink classic conditioning was performed in five patients. RESULTS Action tremor was present in about 10% of our population. All patients showed distal postural tremor of low amplitude and constant frequency, bilateral with a small degree of asymmetry. Two also showed simple kinetic tremor. A peak at the EMG and accelerometric recordings ranging from 4 to 12 Hz was found in all patients. Loading did not change peak frequency in either the electromyographic or accelerometric power spectra. Compared with healthy volunteers, patients had a smaller number of conditioned responses during eyeblink classic conditioning. CONCLUSIONS Our data suggest that patients with MND can present with action tremor of a central origin, possibly due to a cerebellar dysfunction. This evidence supports the novel idea of MND as a multisystem neurodegenerative disease and that action tremor can be part of this condition.
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Affiliation(s)
- A Latorre
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, UK.,Department of Neurology and Psychiatry, Sapienza, University of Rome, Rome, Italy
| | - L Rocchi
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, UK
| | - M Stamelou
- Department of Neurology, Philipps University, Marburg, Germany.,Parkinson's Disease and Movement Disorders Department, HYGEIA Hospital, Athens, Greece
| | - A Batla
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, UK
| | - M Ciocca
- Department of Neurology, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - B Balint
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, UK.,Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - K Sidle
- Department of Clinical Neuroscience, University College London Institute of Neurology, London, UK
| | - A Berardelli
- Department of Neurology and Psychiatry, Sapienza, University of Rome, Rome, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
| | - J C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, UK
| | - K P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, UK
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Colautti P, Conte V, Selva A, Chiriotti S, Pola A, Bortot D, Fazzi A, Agosteo S, Ciocca M. MICRODOSIMETRIC STUDY AT THE CNAO ACTIVE-SCANNING CARBON-ION BEAM. Radiat Prot Dosimetry 2018; 180:157-161. [PMID: 29087524 DOI: 10.1093/rpd/ncx217] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Indexed: 06/07/2023]
Abstract
The Italian National Centre for Oncological Hadrontherapy (CNAO) has been treating patients since 2011 with carbon-ion beams using the active-scanning modality. In such irradiation modality, the beam spot, which scans the treatment area, is characterised by very high particle-fluence rates (more than 105 s-1 mm-2). Moreover, the Bragg-peak is only ~1 mm-FWHM. Commercial tissue-equivalent proportional counters (TEPC), like the Far West Technologies LET-½, are large, hence they have limited capability to measure at high counting fluence rates. In this study we have used two home-made detectors, a mini-TEPC 0.81 mm2 in sensitive area and a silicon telescope 0.125 mm2 in sensitive area, to perform microdosimetric measurements in the therapeutic carbon-ion beam of CNAO. A monoenergetic carbon-ion beam of 189.5 ± 0.3 MeV/u scanning a 3 × 3 cm2 area has been used. Spectral differences are visible in the low y-value region, but the mean microdosimetric values, measured with the two detectors, result to be pretty consistent, as well as the microdosimetric spectra in the high y-value region.
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Affiliation(s)
- P Colautti
- INFN Laboratori Nazionali di Legnaro, Viale dell'Università 2, Legnaro, Italy
| | - V Conte
- INFN Laboratori Nazionali di Legnaro, Viale dell'Università 2, Legnaro, Italy
| | - A Selva
- INFN Laboratori Nazionali di Legnaro, Viale dell'Università 2, Legnaro, Italy
| | - S Chiriotti
- Belgian Nuclear Research Centre, SCK•CEN, Boeretang 200, Mol, Belgium
| | - A Pola
- Politecnico di Milano, Dipartimento di Energia, via La Masa 34, Milano, Italy
- INFN, Sezione di Milano, via Celoria 16, Milano, Italy
| | - D Bortot
- Politecnico di Milano, Dipartimento di Energia, via La Masa 34, Milano, Italy
- INFN, Sezione di Milano, via Celoria 16, Milano, Italy
| | - A Fazzi
- Politecnico di Milano, Dipartimento di Energia, via La Masa 34, Milano, Italy
- INFN, Sezione di Milano, via Celoria 16, Milano, Italy
| | - S Agosteo
- Politecnico di Milano, Dipartimento di Energia, via La Masa 34, Milano, Italy
- INFN, Sezione di Milano, via Celoria 16, Milano, Italy
| | - M Ciocca
- Fondazione CNAO, Strada Campeggi 53, Pavia, Italy
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Fiorina E, Ferrero V, Pennazio F, Baroni G, Battistoni G, Belcari N, Cerello P, Camarlinghi N, Ciocca M, Del Guerra A, Donetti M, Ferrari A, Giordanengo S, Giraudo G, Mairani A, Morrocchi M, Peroni C, Rivetti A, Da Rocha Rolo M, Rossi S, Rosso V, Sala P, Sportelli G, Tampellini S, Valvo F, Wheadon R, Bisogni M. Monte Carlo simulation tool for online treatment monitoring in hadrontherapy with in-beam PET: A patient study. Phys Med 2018; 51:71-80. [DOI: 10.1016/j.ejmp.2018.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/29/2018] [Accepted: 05/02/2018] [Indexed: 10/17/2022] Open
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Italia C, Fiorino C, Ciocca M, Cattaneo GM, Montanaro P, Bolognesi A, Lanceni A, Reni M, Bonini A, Modugno A, Calandrino R, Valdagni R. Quality Control by Portal Film Analysis in Radiotherapy for Prostate Cancer: A Comparison between Two Different Institutions and Treatment Techniques. Tumori 2018; 84:640-8. [PMID: 10080668 DOI: 10.1177/030089169808400605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS AND BACKGROUND Accuracy and reproducibility of patient setup during radiotherapy for prostate cancer were investigated in two different Institutions (A and B), within their Quality Assurance programs. The purpose of the study was to evaluate and compare setup accuracy and reproducibility in Institutions A and B, which adopt different patient positioning and treatment techniques for prostate irradiation. MATERIALS AND METHODS A retrospective analysis of portal localization films taken during the treatment course was performed: 30 and 21 patients in Institutes A and B, respectively, entered the study. In Institute A, patients were treated in a prone position, utilizing an individualized immobilization cast (either an alpha cradle or a heat and vacuum-formed cellulose acetate cast) with an open table top and individual abdominal wall compressor to minimize small bowel irradiation; a 5-field conformal technique was used. In Institute B, patients were treated in a supine position without any immobilization device; a 6-field BEV-based technique (conformal only for patients treated with a radical aim) was adopted. A total of 598 portal films (420 from Institute A and 178 from Institute B) were analyzed. The mean number of films per patient was 12 (range, 4-29). Systematic and random setup errors were estimated utilizing the statistical method suggested by Bijhold et al. (1992). RESULTS When patients with a mean (systematic) error larger than 5, 8 and 10 mm in craniocaudal, lateral and posterior-anterior directions, respectively, were compared, no statistically significant difference between the two groups was observed. Similarly, when comparing portal films, a significant difference (P <0.01) appeared only in the craniocaudal direction (errors > 5 mm: Institute A = 24%; Institute B = 11%). In both Institutes, the SD of random and systematic error distribution ranged from 1.8 to 4.2 mm, with a small prevalence of systematic errors. Only for craniocaudal shifts in Institute A was the random error larger than the systematic error, and it was significantly worse than in Institute B (1 SD, 4.2 mm in Institute A vs 1.8 mm in Institute B). CONCLUSIONS Setup errors observed in Institutes A and B were similar and in accord with data reported in the literature. In Institute B, satisfactory geometrical treatment quality was achieved without patient immobilization. In Institute A, the goal of minimizing small bowel irradiation and prostate motion through the aforementioned technique, which makes patient position less comfortable, did not seem to considerably increase daily setup uncertainty.
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Affiliation(s)
- C Italia
- Department of Radiation Oncology, Casa di Cura S. Pio X, Milan, Italy
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Garibaldi C, Ferrari M, Colandrea M, Cascio A, Ciocca M, Iannalfi A, D'Ippolito E, Pesente S, Grana C, Cremonesi M. EP-2110: Target volume definition with MRI and 68Ga-DOTATOC-PET/CT for patients with meningiomas. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32419-8] [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: 10/14/2022]
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Caivano D, Vitolo V, Fiore M, Iannalfi A, Vischioni B, Bonora M, D'ippolito E, Ronchi S, Molinelli S, Ciocca M, Valvo F, Orecchia R. EP-1421: Carbon Ions In The Treatment Of Pancreatic Disease. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31730-4] [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: 11/24/2022]
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Mastella E, Molinelli S, Magro G, Mirandola A, Russo S, Vai A, Mairani A, Choi K, Fiore M, Fossati P, Cuzzocrea F, Gasbarrini A, Benazzo F, Boriani S, Valvo F, Orecchia R, Ciocca M. Dosimetric characterization of carbon fiber stabilization devices for post-operative particle therapy. Phys Med 2017; 44:18-25. [DOI: 10.1016/j.ejmp.2017.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/05/2017] [Accepted: 11/09/2017] [Indexed: 11/15/2022] Open
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Gambarini G, Bettega D, Camoni G, Felisi M, Gebbia A, Massari E, Regazzoni V, Veronese I, Giove D, Mirandola A, Ciocca M. Correction method of measured images of absorbed dose for quenching effects due to relatively high LET. Radiat Phys Chem Oxf Engl 1993 2017. [DOI: 10.1016/j.radphyschem.2017.03.039] [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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Senzacqua M, Schiavi A, Patera V, Pioli S, Battistoni G, Ciocca M, Mairani A, Magro G, Molinelli S. A fast - Monte Carlo toolkit on GPU for treatment plan dose recalculation in proton therapy. ACTA ACUST UNITED AC 2017. [DOI: 10.1088/1742-6596/905/1/012027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Conte V, Colautti P, Chiriotti S, Moros D, Ciocca M, Mairani A. Mini-TEPC Microdosimetric Study of Carbon Ion Therapeutic Beams at CNAO. EPJ Web Conf 2017. [DOI: 10.1051/epjconf/201715301012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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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Schiavi A, Senzacqua M, Pioli S, Mairani A, Magro G, Molinelli S, Ciocca M, Battistoni G, Patera V. Fred: a GPU-accelerated fast-Monte Carlo code for rapid treatment plan recalculation in ion beam therapy. ACTA ACUST UNITED AC 2017; 62:7482-7504. [DOI: 10.1088/1361-6560/aa8134] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rossomme S, Horn J, Brons S, Jäkel O, Mairani A, Ciocca M, Floquet V, Romano F, Rodriguez Garcia D, Vynckier S, Palmans H. Ion recombination correction factor in scanned light-ion beams for absolute dose measurement using plane-parallel ionisation chambers. Phys Med Biol 2017; 62:5365-5382. [DOI: 10.1088/1361-6560/aa730f] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Magro G, Dahle TJ, Molinelli S, Ciocca M, Fossati P, Ferrari A, Inaniwa T, Matsufuji N, Ytre-Hauge KS, Mairani A. The FLUKA Monte Carlo code coupled with the NIRS approach for clinical dose calculations in carbon ion therapy. Phys Med Biol 2017; 62:3814-3827. [DOI: 10.1088/1361-6560/aa642b] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Russo S, Mirandola A, Molinelli S, Mastella E, Vai A, Magro G, Mairani A, Boi D, Donetti M, Ciocca M. Characterization of a commercial scintillation detector for 2-D dosimetry in scanned proton and carbon ion beams. Phys Med 2017; 34:48-54. [DOI: 10.1016/j.ejmp.2017.01.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/23/2016] [Accepted: 01/14/2017] [Indexed: 01/10/2023] Open
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Mairani A, Dokic I, Magro G, Tessonnier T, Bauer J, Böhlen TT, Ciocca M, Ferrari A, Sala PR, Jäkel O, Debus J, Haberer T, Abdollahi A, Parodi K. A phenomenological relative biological effectiveness approach for proton therapy based on an improved description of the mixed radiation field. Phys Med Biol 2017; 62:1378-1395. [DOI: 10.1088/1361-6560/aa51f7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Russo S, Boi D, Mirandola A, Molinelli S, Mairani A, Mastella E, Magro G, Giordanengo S, Ciocca M. Dosimetric characterization of a commercial 2-D scintillation detector for quality assurance tests in scanned proton and carbon ion beams. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.07.675] [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: 11/16/2022] Open
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Mirandola A, Molinelli S, Vilches Freixas G, Mairani A, Gallio E, Panizza D, Russo S, Ciocca M, Donetti M, Magro G, Giordanengo S, Orecchia R. Dosimetric commissioning and quality assurance of scanned ion beams at the Italian National Center for Oncological Hadrontherapy. Med Phys 2016; 42:5287-300. [PMID: 26328978 DOI: 10.1118/1.4928397] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To describe the dosimetric commissioning and quality assurance (QA) of the actively scanned proton and carbon ion beams at the Italian National Center for Oncological Hadrontherapy. METHODS The laterally integrated depth-dose-distributions (IDDs) were acquired with the PTW Peakfinder, a variable depth water column, equipped with two Bragg peak ionization chambers. fluka Monte Carlo code was used to generate the energy libraries, the IDDs in water, and the fragment spectra for carbon beams. EBT3 films were used for spot size measurements, beam position over the scan field, and homogeneity in 2D-fields. Beam monitor calibration was performed in terms of number of particles per monitor unit using both a Farmer-type and an Advanced Markus ionization chamber. The beam position at the isocenter, beam monitor calibration curve, dose constancy in the center of the spread-out-Bragg-peak, dose homogeneity in 2D-fields, beam energy, spot size, and spot position over the scan field are all checked on a daily basis for both protons and carbon ions and on all beam lines. RESULTS The simulated IDDs showed an excellent agreement with the measured experimental curves. The measured full width at half maximum (FWHM) of the pencil beam in air at the isocenter was energy-dependent for both particle species: in particular, for protons, the spot size ranged from 0.7 to 2.2 cm. For carbon ions, two sets of spot size are available: FWHM ranged from 0.4 to 0.8 cm (for the smaller spot size) and from 0.8 to 1.1 cm (for the larger one). The spot position was accurate to within ± 1 mm over the whole 20 × 20 cm(2) scan field; homogeneity in a uniform squared field was within ± 5% for both particle types at any energy. QA results exceeding tolerance levels were rarely found. In the reporting period, the machine downtime was around 6%, of which 4.5% was due to planned maintenance shutdowns. CONCLUSIONS After successful dosimetric beam commissioning, quality assurance measurements performed during a 24-month period show very stable beam characteristics, which are therefore suitable for performing safe and accurate patient treatments.
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Affiliation(s)
| | - S Molinelli
- Fondazione CNAO, strada Campeggi 53, Pavia 27100, Italy
| | | | - A Mairani
- Fondazione CNAO, strada Campeggi 53, Pavia 27100, Italy
| | - E Gallio
- Fondazione CNAO, strada Campeggi 53, Pavia 27100, Italy
| | - D Panizza
- Fondazione CNAO, strada Campeggi 53, Pavia 27100, Italy
| | - S Russo
- Fondazione CNAO, strada Campeggi 53, Pavia 27100, Italy
| | - M Ciocca
- Fondazione CNAO, strada Campeggi 53, Pavia 27100, Italy
| | - M Donetti
- INFN, Torino 10125, Italy and Fondazione CNAO, strada Campeggi 53, Pavia 27100, Italy
| | - G Magro
- INFN-Dipartimento di Fisica, Università degli Studi di Pavia, Via U. Bassi 6, Pavia 27100, Italy and Fondazione CNAO, strada Campeggi 53, Pavia 27100, Italy
| | | | - R Orecchia
- Fondazione CNAO, strada Campeggi 53, Pavia 27100, Italy and Radiotherapy Division, European Institute of Oncology, Via Ripamonti 435, Milano 20141, Italy
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