1
|
Macchia G, Lancellotta V, Ferioli M, Casà C, Pezzulla D, Pappalardi B, Laliscia C, Ippolito E, Di Muzio J, Huscher A, Tortoreto F, Boccardi M, Lazzari R, Perrone AM, Raspagliesi F, Gadducci A, Garganese G, Fragomeni SM, Ferrandina G, Morganti AG, Gambacorta MA, Tagliaferri L. Definitive chemoradiation in vulvar squamous cell carcinoma: outcome and toxicity from an observational multicenter Italian study on vulvar cancer (OLDLADY 1.1). Radiol Med 2024; 129:152-159. [PMID: 37700153 PMCID: PMC10808465 DOI: 10.1007/s11547-023-01712-8] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/22/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Vulvar carcinoma is a rather uncommon gynecological malignancy affecting elderly women and the treatment of loco-regional advanced carcinoma of the vulva (LAVC) is a challenge for both gynecologic and radiation oncologists. Definitive chemoradiation (CRT) is the treatment of choice, but with disappointing results. In this multicenter study (OLDLADY-1.1), several institutions have combined their retrospective data on LAVC patients to produce a real-world dataset aimed at collecting data on efficacy and safety of CRT. METHODS The primary study end-point was 2-year-local control (LC), secondary end-points were 2-year-metastasis free-survival (MFS), 2-year-overall survival (OS) and the rate and severity of acute and late toxicities. Participating centers were required to fill data sets including age, stage, histology, grading as well as technical/dosimetric details of CRT. Data about response, local and regional recurrence, acute and late toxicities, follow-up and outcome measures were also collected. The toxicity was a posteriori documented through the Common Terminology Criteria for Adverse Events version 5 scale. RESULTS Retrospective analysis was performed on 65 patients with primary or recurrent LAVC treated at five different radiation oncology institutions covering 11-year time interval (February 2010-November 2021). Median age at diagnosis was 72 years (range 32-89). With a median follow-up of 19 months (range 1-114 months), 2-year actuarial LC, MFS and OS rate were 43.2%, 84.9% and 59.7%, respectively. In 29 patients (44%), CRT was temporarily stopped (median 5 days, range 1-53 days) due to toxicity. The treatment interruption was statistically significant at univariate analysis of factors predicting LC (p: 0.05) and OS rate (p: 0.011), and it was confirmed at the multivariate analysis for LC rate (p: 0.032). In terms of toxicity profile, no G4 event was recorded. Most adverse events were reported as grade 1 or 2. Only 14 acute G3 toxicities, all cutaneous, and 7 late G3 events (3 genitourinary, 3 cutaneous, and 1 vaginal stenosis) were recorded. CONCLUSION In the context of CRT for LAVC, the present study reports encouraging results even if there is clearly room for further improvements, in terms of both treatment outcomes, toxicity and treatment interruption management.
Collapse
Affiliation(s)
- Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100, Campobasso, Italy
| | - Valentina Lancellotta
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168, Rome, Italy.
| | - Martina Ferioli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Calogero Casà
- UOC Di Radioterapia Fatebenefratelli Isola Tiberina. Gemelli Isola, Rome, Italy
| | - Donato Pezzulla
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100, Campobasso, Italy
| | - Brigida Pappalardi
- Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Concetta Laliscia
- Division of Radiation Oncology, Department of New Technologies and Translational Research, University of Pisa, Pisa, Italy
| | - Edy Ippolito
- Radiation Oncology, Università Campus Bio-Medico, Rome, Italy
| | - Jacopo Di Muzio
- Dipartimento Di Oncologia P.O. S. Anna - SS Radioterapia, A.O.U "Città Della Salute E Della Scienza", Turin, Italy
| | - Alessandra Huscher
- Fondazione Poliambulanza, U.O. Di Radioterapia Oncologica "Guido Berlucchi", Brescia, Italy
| | - Francesca Tortoreto
- UOC Di Radioterapia Fatebenefratelli Isola Tiberina. Gemelli Isola, Rome, Italy
| | - Mariangela Boccardi
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100, Campobasso, Italy
| | - Roberta Lazzari
- Division of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Anna Myriam Perrone
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | | | - Angiolo Gadducci
- Division of Gynecology and Obstetrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giorgia Garganese
- Dipartimento Scienze Della Salute Della Donna, del bambino e Di Sanità Pubblica, UOC Ginecologia Oncologica,, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168, Rome, Italy
- Dipartimento Scienze Della Vita E Sanità Pubblica, Sezione Di Ginecologia Ed Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Maria Fragomeni
- Dipartimento Scienze Della Salute Della Donna, del bambino e Di Sanità Pubblica, UOC Ginecologia Oncologica,, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168, Rome, Italy
| | - Gabriella Ferrandina
- Dipartimento Scienze Della Salute Della Donna, del bambino e Di Sanità Pubblica, UOC Ginecologia Oncologica,, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168, Rome, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Maria Antonietta Gambacorta
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore Sede Di Roma, 00168, Rome, Italy
| | - Luca Tagliaferri
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168, Rome, Italy
| |
Collapse
|
2
|
Macchia G, Pezzulla D, Cilla S, Buwenge M, Romano C, Ferro M, Boccardi M, Ferioli M, Bonome P, Lancellotta V, Tagliaferri L, Ferrandina G, Gambacorta MA, Morganti AG, Deodato F. Stereotactic Body Reirradiation in Gynaecological Cancer: Outcomes and Toxicities from a Single Institution Experience. Clin Oncol (R Coll Radiol) 2023; 35:682-693. [PMID: 37558548 DOI: 10.1016/j.clon.2023.07.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/03/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023]
Abstract
AIMS To report toxicity profile, outcomes and quality of life (QoL) data in patients with recurrent gynaecological cancer who underwent stereotactic body radiotherapy (SBRT) retreatment. MATERIALS AND METHODS Data from patients' folders were retrospectively extracted, focusing on the primary neoplasm, previous systemic therapies and previous radiotherapy. Concerning SBRT, the total dose (five daily fractions) was delivered with a linear accelerator using intensity-modulated radiotherapy techniques. Acute and late toxicities were assessed by the CTCAE 4.03 scale. QoL was evaluated according to the Cancer Linear Analogue Scale [CLAS1 (fatigue), CLAS2 (energy level), CLAS3 (daily activities)]. RESULTS Between December 2005 and August 2021, 23 patients (median age 71 years, range 48-80) with 27 lesions were treated. Most patients had endometrial (34.8%), ovarian (26.1%) and cervical cancer (26.1%) as the primary tumour. The most common SBRT schedules in five fractions were 30 Gy (33.3%), 35 Gy (29.6%) and 40 Gy (29.6%). The median follow-up was 32 months (range 3-128). There were no patients reporting acute or late toxicities higher than grade 2, except for a bone fracture. One- and 2-year local control was 77.9% and 70.8%, respectively. One- and 2-year overall survival was 82.6% and 75.1%, respectively. The overall response rate was 96.0%. Regarding QoL, no statistically significant difference was identified between the baseline and follow-up values: the median CLAS1, CLAS2 and CLAS3 scores for each category were 6 (range 4-10) at baseline and 6 (range 3-10) 1 month after SBRT. CONCLUSIONS This preliminary experience suggests that SBRT retreatment for recurrent gynaecological cancer is a highly feasible and safe treatment with limited side-effects and no short-term QoL impairment.
Collapse
Affiliation(s)
- G Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy.
| | - D Pezzulla
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - S Cilla
- Medical Physics Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - M Buwenge
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy
| | - C Romano
- Medical Physics Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - M Ferro
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - M Boccardi
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - M Ferioli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - P Bonome
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - V Lancellotta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, UOC di Radioterapia Oncologica, Roma, Italy
| | - L Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, UOC di Radioterapia Oncologica, Roma, Italy
| | - G Ferrandina
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - M A Gambacorta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, UOC di Radioterapia Oncologica, Roma, Italy; Radiology Institute, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A G Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy
| | - F Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy; Radiology Institute, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
3
|
Cilla S, Deodato F, Romano C, Macchia G, Buwenge M, Boccardi M, Pezzulla D, Pierro A, Zamagni A, Morganti AG. Risk evaluation of secondary malignancies after radiotherapy of breast cancer in light of the continuous development of planning techniques. Med Dosim 2023; 48:279-285. [PMID: 37659968 DOI: 10.1016/j.meddos.2023.07.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/12/2023] [Accepted: 07/26/2023] [Indexed: 09/04/2023]
Abstract
Secondary cancer risk is a significant concern for women treated with breast radiation therapy due to improved long-term survival rates. We evaluated the potential of new advanced automated planning algorithms together with hybrid techniques to minimize the excess absolute risk (EAR) for secondary cancer in various organs after radiation treatment for early staged breast cancer. Using CT data set of 25 patients, we generated 4 different radiation treatment plans of different complexity, including 3-dimensional conformal radiotherapy (3D-CRT), field-in-field (FinF), hybrid-IMRT (HMRT) and automated hybrid-VMAT (HVMAT) techniques. The organ-equivalent dose (OED) was calculated from differential dose-volume histograms on the basis of the "linear-exponential," "plateau," and "full mechanistic" dose-response models and was used to evaluate the EAR for secondary cancer in the contralateral breast (CB), contralateral lung (CL), and ipsilateral lung (IL). Statistical comparisons of data were performed by a Kruskal-Wallis analysis of variance. The planning objectives were fulfilled with all the planning techniques for both target coverage and organs-at-risk sparing. The differences in EAR for CB, CL and IL secondary tumor induction were not significant among the 4 techniques. For the CB and CL, the mean absolute difference did not reach 1 case of 10000 patient-years. For the IL, the mean absolute difference was up to 5 cases of 10,000 patient-years. In conclusion, the automated HVMAT technique allows an EAR reduction at the level of well-consolidated tangential 3D-CRT or FinF techniques, keeping all the HVMAT dosimetric improvements unchanged. On the basis of this analysis, the adoption of the HVMAT technique poses no increase in EAR and could be considered safe also for younger patients.
Collapse
Affiliation(s)
- Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital, Campobasso, Italy.
| | - Francesco Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy; Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carmela Romano
- Medical Physics Unit, Gemelli Molise Hospital, Campobasso, Italy
| | | | - Milly Buwenge
- Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Donato Pezzulla
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy
| | - Antonio Pierro
- Radiology Unit, Gemelli Molise Hospital, Campobasso, Italy
| | - Alice Zamagni
- Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine-DIMES, Alma Mater Studiorum, Università di Bologna, Italy
| |
Collapse
|
4
|
Cilla S, Romano C, Craus M, Viola P, Macchia G, Boccardi M, De Vivo LP, Buwenge M, Morganti AG, Deodato F. Reproducibility and stability of spirometer-guided deep inspiration breath-hold in left-breast treatments using an optical surface monitoring system. J Appl Clin Med Phys 2023:e13922. [PMID: 36852489 DOI: 10.1002/acm2.13922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 03/01/2023] Open
Abstract
The aim of this study was to evaluate the reproducibility and stability of left breast positioning during spirometer-guided deep-inspiration breath-hold (DIBH) radiotherapy using an optical surface imaging system (AlignRT). The AlignRT optical tracking system was used to monitor five left-sided breast cancer patients treated using the Active Breathing Coordinator spirometer with DIBH technique. Treatment plans were created using an automated hybrid-VMAT technique on DIBH CTs. A prescribed dose of 60 Gy to the tumor bed and 50 Gy to the breast in 25 fractions was planned. During each treatment session, the antero-posterior (VRT), superior-inferior (LNG), and lateral (LAT) motion of patients was continuously recorded by AlignRT. The intra-breath-hold stability and the intra- and inter-fraction reproducibility were analyzed for all breath-holds and treatment fractions. The dosimetric impact of the residual motion during DIBH was evaluated from the isocenter shifts amplitudes obtained from the 50%, 90%, and 100% cumulative distribution functions of intra-fractional reproducibility. The positional variations of 590 breath-holds as measured by AlignRT were evaluated. The mean intra-breath-hold stability during DIBH was 1.0 ± 0.4 mm, 2.1 ± 1.9 mm, and 0.7 ± 0.5 mm in the VRT, LNG, and LAT directions, with a maximal value of 8.8 mm in LNG direction. Similarly, the mean intra-breath-hold reproducibility was 1.4 ± 0.8 mm, 1.7 ± 1.0 mm, and 0.8 ± 0.5 mm in the VRT, LNG, and LAT directions, with a maximal value of 4.1 mm in LNG direction. Inter-fractional reproducibility showed better reliability, with difference in breathing levels in all fractions of 0.3 mm on average. Based on tolerance limits corresponding to the 90% cumulative distribution level, gating window widths of 1 mm, 2 mm, and 5 mm in the LAT, VRT, and LNG directions were considered an appropriate choice. In conclusion, despite the use of a dedicated spirometer at constant tidal volume, a non-negligible variability of the breast surface position has been reported during breath-holds. The real-time monitoring of breast surface using surface-guided optical technology is strongly recommended.
Collapse
Affiliation(s)
- Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Carmela Romano
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Maurizio Craus
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Pietro Viola
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Mariangela Boccardi
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Livia P De Vivo
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Milly Buwenge
- Radiation Oncology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,DIMES, Alma Mater Studiorum, Bologna University, Bologna, Italy
| | - Alessio G Morganti
- Radiation Oncology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,DIMES, Alma Mater Studiorum, Bologna University, Bologna, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| |
Collapse
|
5
|
Cilla S, Romano C, Macchia G, Boccardi M, Pezzulla D, Buwenge M, Castelnuovo AD, Bracone F, Curtis AD, Cerletti C, Iacoviello L, Donati MB, Deodato F, Morganti AG. Machine-learning prediction model for acute skin toxicity after breast radiation therapy using spectrophotometry. Front Oncol 2023; 12:1044358. [PMID: 36686808 PMCID: PMC9853396 DOI: 10.3389/fonc.2022.1044358] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/08/2022] [Indexed: 01/09/2023] Open
Abstract
Purpose Radiation-induced skin toxicity is a common and distressing side effect of breast radiation therapy (RT). We investigated the use of quantitative spectrophotometric markers as input parameters in supervised machine learning models to develop a predictive model for acute radiation toxicity. Methods and materials One hundred twenty-nine patients treated for adjuvant whole-breast radiotherapy were evaluated. Two spectrophotometer variables, i.e. the melanin (IM) and erythema (IE) indices, were used to quantitatively assess the skin physical changes. Measurements were performed at 4-time intervals: before RT, at the end of RT and 1 and 6 months after the end of RT. Together with clinical covariates, melanin and erythema indices were correlated with skin toxicity, evaluated using the Radiation Therapy Oncology Group (RTOG) guidelines. Binary group classes were labeled according to a RTOG cut-off score of ≥ 2. The patient's dataset was randomly split into a training and testing set used for model development/validation and testing (75%/25% split). A 5-times repeated holdout cross-validation was performed. Three supervised machine learning models, including support vector machine (SVM), classification and regression tree analysis (CART) and logistic regression (LR), were employed for modeling and skin toxicity prediction purposes. Results Thirty-four (26.4%) patients presented with adverse skin effects (RTOG ≥2) at the end of treatment. The two spectrophotometric variables at the beginning of RT (IM,T0 and IE,T0), together with the volumes of breast (PTV2) and boost surgical cavity (PTV1), the body mass index (BMI) and the dose fractionation scheme (FRAC) were found significantly associated with the RTOG score groups (p<0.05) in univariate analysis. The diagnostic performances measured by the area-under-curve (AUC) were 0.816, 0.734, 0.714, 0.691 and 0.664 for IM, IE, PTV2, PTV1 and BMI, respectively. Classification performances reported precision, recall and F1-values greater than 0.8 for all models. The SVM classifier using the RBF kernel had the best performance, with accuracy, precision, recall and F-score equal to 89.8%, 88.7%, 98.6% and 93.3%, respectively. CART analysis classified patients with IM,T0 ≥ 99 to be associated with RTOG ≥ 2 toxicity; subsequently, PTV1 and PTV2 played a significant role in increasing the classification rate. The CART model provided a very high diagnostic performance of AUC=0.959. Conclusions Spectrophotometry is an objective and reliable tool able to assess radiation induced skin tissue injury. Using a machine learning approach, we were able to predict grade RTOG ≥2 skin toxicity in patients undergoing breast RT. This approach may prove useful for treatment management aiming to improve patient quality of life.
Collapse
Affiliation(s)
- Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital, Campobasso, Italy,*Correspondence: Savino Cilla, ;
| | - Carmela Romano
- Medical Physics Unit, Gemelli Molise Hospital, Campobasso, Italy
| | | | | | - Donato Pezzulla
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy
| | - Milly Buwenge
- Radiation Oncology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Francesca Bracone
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Amalia De Curtis
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Chiara Cerletti
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy,Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy
| | | | - Francesco Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy,Istituto di Radiologia, Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy
| |
Collapse
|
6
|
Deodato F, Pezzulla D, Cilla S, Ferro M, Giannini R, Romano C, Boccardi M, Buwenge M, Valentini V, Morganti AG, Macchia G. Volumetric Intensity-Modulated Arc Stereotactic Radiosurgery Boost in Oligometastatic Patients with Spine Metastases: a Dose-escalation Study. Clin Oncol (R Coll Radiol) 2023; 35:e30-e39. [PMID: 36207236 DOI: 10.1016/j.clon.2022.09.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/12/2022] [Accepted: 09/13/2022] [Indexed: 01/06/2023]
Abstract
AIMS To report the final results of a dose-escalation study of volumetric intensity-modulated arc stereotactic radiosurgery (VMAT-SRS) boost after three-dimensional conformal radiation therapy in patients with spine metastases. MATERIALS AND METHODS Oligometastatic cancer patients bearing up to five synchronous metastases (visceral or bone, including vertebral ones) and candidates for surgery or radiosurgery were considered for inclusion. 25 Gy was delivered in 10 daily fractions (2 weeks) to the metastatic lesion, affected vertebrae and adjacent ones (one cranial and one caudal vertebra). Sequentially, the dose to spinal metastases was progressively increased (8 Gy, 10 Gy, 12 Gy) in the patient cohorts. Dose-limiting toxicities were defined as any treatment-related non-hematologic acute adverse effects rated as grade ≥3 or any acute haematological toxicity rated as ≥ 4 by the Radiation Therapy Oncology Group scale. RESULTS Fifty-two lesions accounting for 40 consecutive patients (male/female: 29/11; median age: 71 years; range 40-85) were treated from April 2011 to September 2020. Most patients had a primary prostate (65.0%) or breast cancer (22.5%). Thirty-two patients received 8 Gy VMAT-SRS boost (total BED α/β10: 45.6 Gy), 14 patients received 10 Gy (total BED α/β10: 51.2 Gy) and six patients received 12 Gy (total BED α/β10: 57.6 Gy). The median follow-up time was over 70 months (range 2-240 months). No acute toxicities > grade 2 and no late toxicities > grade 1 were recorded. The overall response rate based on computed tomography/positron emission tomography-computed tomography/magnetic resonance was 78.8%. The 24-month actuarial local control, distant metastases-free survival and overall survival rates were 88.5%, 27.1% and 90.3%, respectively. CONCLUSION A 12 Gy spine metastasis SRS boost following 25 Gy to the affected and adjacent vertebrae was feasible with an excellent local control rate and toxicity profile.
Collapse
Affiliation(s)
- F Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy; Radiology Institute, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - D Pezzulla
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy.
| | - S Cilla
- Medical Physics Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy.
| | - M Ferro
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy.
| | - R Giannini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, UOC di Radioterapia Oncologica, Rome, Italy.
| | - C Romano
- Medical Physics Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy.
| | - M Boccardi
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy.
| | - M Buwenge
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, Alma Mater Studiorum Bologna, Bologna, Italy.
| | - V Valentini
- Radiology Institute, Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, UOC di Radioterapia Oncologica, Rome, Italy.
| | - A G Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, Alma Mater Studiorum Bologna, Bologna, Italy.
| | - G Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy.
| |
Collapse
|
7
|
Macchia G, Casà C, Ferioli M, Lancellotta V, Pezzulla D, Pappalardi B, Laliscia C, Ippolito E, Di Muzio J, Huscher A, Tortoreto F, Boccardi M, Lazzari R, De Iaco P, Raspagliesi F, Gadducci A, Garganese G, Ferrandina G, Morganti AG, Tagliaferri L. Observational multicenter Italian study on vulvar cancer adjuvant radiotherapy (OLDLADY 1.2): a cooperation among AIRO Gyn, MITO and MaNGO groups. Radiol Med 2022; 127:1292-1302. [DOI: 10.1007/s11547-022-01538-w] [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] [Received: 05/09/2022] [Accepted: 07/28/2022] [Indexed: 12/01/2022]
|
8
|
Ciabattoni A, Gregucci F, De Rose F, Falivene S, Fozza A, Daidone A, Morra A, Smaniotto D, Barbara R, Lozza L, Vidali C, Borghesi S, Palumbo I, Huscher A, Perrucci E, Baldissera A, Tolento G, Rovea P, Franco P, De Santis MC, Grazia AD, Marino L, Meduri B, Cucciarelli F, Aristei C, Bertoni F, Guenzi M, Leonardi MC, Livi L, Nardone L, De Felice F, Rosetto ME, Mazzuoli L, Anselmo P, Arcidiacono F, Barbarino R, Martinetti M, Pasinetti N, Desideri I, Marazzi F, Ivaldi G, Bonzano E, Cavallari M, Cerreta V, Fusco V, Sarno L, Bonanni A, Mangiacotti MG, Prisco A, Buonfrate G, Andrulli D, Fontana A, Bagnoli R, Marinelli L, Reverberi C, Scalabrino G, Corazzi F, Doino D, Di Genesio-Pagliuca M, Lazzari M, Mascioni F, Pace MP, Mazza M, Vitucci P, Spera A, Macchia G, Boccardi M, Evangelista G, Sola B, La Porta MR, Fiorentino A, Levra NG, Ippolito E, Silipigni S, Osti MF, Mignogna M, Alessandro M, Ursini LA, Nuzzo M, Meattini I, D’Ermo G. AIRO Breast Cancer Group Best Clinical Practice 2022 Update. Tumori 2022; 108:1-144. [DOI: 10.1177/03008916221088885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Breast cancer is the most common tumor in women and represents the leading cause of cancer death. Radiation therapy plays a key-role in the treatment of all breast cancer stages. Therefore, the adoption of evidence-based treatments is warranted, to ensure equity of access and standardization of care in clinical practice. Method: This national document on the highest evidence-based available data was developed and endorsed by the Italian Association of Radiation and Clinical Oncology (AIRO) Breast Cancer Group. We analyzed literature data regarding breast radiation therapy, using the SIGN (Scottish Intercollegiate Guidelines Network) methodology ( www.sign.ac.uk ). Updated findings from the literature were examined, including the highest levels of evidence (meta-analyses, randomized trials, and international guidelines) with a significant impact on clinical practice. The document deals with the role of radiation therapy in the treatment of primary breast cancer, local relapse, and metastatic disease, with focus on diagnosis, staging, local and systemic therapies, and follow up. Information is given on indications, techniques, total doses, and fractionations. Results: An extensive literature review from 2013 to 2021 was performed. The work was organized according to a general index of different topics and most chapters included individual questions and, when possible, synoptic and summary tables. Indications for radiation therapy in breast cancer were examined and integrated with other oncological treatments. A total of 50 questions were analyzed and answered. Four large areas of interest were investigated: (1) general strategy (multidisciplinary approach, contraindications, preliminary assessments, staging and management of patients with electronic devices); (2) systemic therapy (primary, adjuvant, in metastatic setting); (3) clinical aspects (invasive, non-invasive and micro-invasive carcinoma; particular situations such as young and elderly patients, breast cancer in males and cancer during pregnancy; follow up with possible acute and late toxicities; loco-regional relapse and metastatic disease); (4) technical aspects (radiation after conservative surgery or mastectomy, indications for boost, lymph node radiotherapy and partial breast irradiation). Appendixes about tumor bed boost and breast and lymph nodes contouring were implemented, including a dedicated web application. The scientific work was reviewed and validated by an expert group of breast cancer key-opinion leaders. Conclusions: Optimal breast cancer management requires a multidisciplinary approach sharing therapeutic strategies with the other involved specialists and the patient, within a coordinated and dedicated clinical path. In recent years, the high-level quality radiation therapy has shown a significant impact on local control and survival of breast cancer patients. Therefore, it is necessary to offer and guarantee accurate treatments according to the best standards of evidence-based medicine.
Collapse
Affiliation(s)
| | - Fabiana Gregucci
- UOC Radioterapia Oncologica, Ospedale Generale Regionale F. Miulli, Acquaviva delle Fonti (BA), Acquaviva delle Fonti, Italy
| | - Fiorenza De Rose
- UO Radioterapia Oncologica, Ospedale Santa Chiara, Trento, Italy
| | - Sara Falivene
- SC Radioterapia, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italy
| | - Alessandra Fozza
- UO Radioterapia Oncologica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Antonio Daidone
- UO Radioterapia Oncologica, Villa S.Teresa, Bagheria (PA), Palermo, Italy
| | - Anna Morra
- Divisione di Radioterapia Oncologica, Istituto Europeo di Oncologia, Milano, Italy
| | - Daniela Smaniotto
- UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
| | - Raffaele Barbara
- UOC Radioterapia Oncologica - Dipartimento Oncologico Internistico - ARNAS G.Brotzu - P. O. A Businco, Cagliari, Italy
| | - Laura Lozza
- SC Radioterapia 1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - Cristiana Vidali
- Radioterapia Oncologica, Radioterapia Oncologica, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Simona Borghesi
- UO Radioterapia Oncologica di Arezzo Valdarno, Azienda USL Toscana Sud Est, Arezzo, Italy
| | - Isabella Palumbo
- Sezione di Radioterapia Oncologica, Università degli Studi di Perugia e Azienda Ospedaliera di Perugia, Perugia, Italy
| | | | | | | | - Giorgio Tolento
- Radioterapia Oncologica, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paolo Rovea
- Radioterapia Oncologica, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Pierfrancesco Franco
- Dipartimento Medicina Traslazionale (DIMET), Università del Piemonte Orientale, Novara, Italy
| | | | - Alfio Di Grazia
- Radioterapia Humanitas, Istituto Clinico Catanese, Catania, Italy
| | - Lorenza Marino
- Radioterapia Humanitas, Istituto Clinico Catanese, Catania, Italy
| | - Bruno Meduri
- Dipartimento Radioterapia Oncologica, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Francesca Cucciarelli
- UO Radioterapia, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Cynthia Aristei
- Sezione di Radioterapia Oncologica, Università degli Studi di Perugia e Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Filippo Bertoni
- Radioterapia Oncologica, Associazione Italiana di Radioterapia ed Oncologia Clinica, Roma, Italy
| | - Marina Guenzi
- Radioterapia Oncologica, IRCCS Policlinico San Martino e Università, Genova, Italy
| | | | - Lorenzo Livi
- Dipartimento di Scienze Biomediche Sperimentali e Cliniche "M. Serio" - Università di Firenze, Firenze, e Radioterapia Oncologica, Dipartimento di Oncologia - Azienda Ospedaliero-Universitaria Careggi (AOUC), Italy
| | - Luigia Nardone
- UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
| | - Francesca De Felice
- Dipartimento Radioterapia, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza, Università di Roma, Roma, Italy
| | | | | | - Paola Anselmo
- SC Radioterapia Oncologica, Azienda Ospedaliera S. Maria, Terni, Italy
| | - Fabio Arcidiacono
- SC Radioterapia Oncologica, Azienda Ospedaliera S. Maria, Terni, Italy
| | | | | | - Nadia Pasinetti
- Servizio Radioterapia, ASST Valcamonica Esine e Università degli Studi di Brescia, Esine (BS), Italy
| | - Isacco Desideri
- Dipartimento di Scienze Biomediche Sperimentali e Cliniche "M. Serio" - Università di Firenze, Firenze, e Radioterapia Oncologica, Dipartimento di Oncologia - Azienda Ospedaliero-Universitaria Careggi (AOUC), Italy
| | - Fabio Marazzi
- UOC Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | - Elisabetta Bonzano
- PhD Medicina Sperimentale, Università degli Studi di Pavia, Pavia e Dipartimento di Radioterapia Oncologica, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | | | | | - Vincenzo Fusco
- UOC Radioterapia Oncologica, IRCCS-CROB Rionero in Vulture, Potenza, Italy
| | - Laura Sarno
- SC Radioterapia, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Alessio Bonanni
- UOC Radioterapia Oncologica, Ospedale S. Giovanni Calibita Fatebenefratelli - Isola Tiberina, Roma, Italy
| | | | - Agnese Prisco
- Dipartimento Radioterapia Oncologica, Azienda Ospedaliero Universitaria S. Maria della Misericordia, Udine, Italy
| | - Giovanna Buonfrate
- UOC Radioterapia, Ospedale della Misericordia, Azienda USL Toscana Sud Est, Grosseto, Italy
| | - Damiana Andrulli
- UOC Radioterapia, Oncologica Azienda Ospedaliera San Giovanni – Addolorata, Roma, Italy
| | - Antonella Fontana
- SC Radioterapia Oncologica, Ospedale S. Maria Goretti, Latina, Italy
| | - Rita Bagnoli
- SC Radioterapia, Area Omogenea Radioterapia, Ospedale San Luca, Azienda USL Toscana Nord Ovest, Lucca, Italy
| | - Luca Marinelli
- Radioterapia Oncologica, Fondazione Policlinico Universitario Campus Biomedico, Roma, Italy
| | - Chiara Reverberi
- Dipartimento Radioterapia Oncologica, Azienda Ospedaliero Universitaria S. Maria della Misericordia, Udine, Italy
| | - Giovanna Scalabrino
- UOC Radioterapia, Azienda Ospedaliero-Universitaria Policlinico Sant’Andrea, Sapienza, Università di Roma, Roma, Italy
| | - Francesca Corazzi
- SC Radioterapia Oncologica, Ospedale di Città di Castello, Città di Castello (PG), Italy
| | - Daniela Doino
- UO Radioterapia, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | | | - Francesca Mascioni
- UOC Radioterapia Oncologica, Ospedale Generale Provinciale di Macerata, Area Vasta 3, Macerata, Italy
| | - Maria Paola Pace
- UOC Radioterapia Oncologica, Ospedale Generale Provinciale di Macerata, Area Vasta 3, Macerata, Italy
| | - Mirko Mazza
- Azienda Ospedaliera San Salvatore Muraglia, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Pasquale Vitucci
- Département de Radiothérapie et Physique Médicale, CLCC “Henry Becquerel”, Rouen, France
| | | | - Gabriella Macchia
- UOC Radioterapia Oncologica-Gemelli Molise Hospital- Università Cattolica S. Cuore, Campobasso, Italy
| | - Mariangela Boccardi
- UOC Radioterapia Oncologica-Gemelli Molise Hospital- Università Cattolica S. Cuore, Campobasso, Italy
| | | | - Barbara Sola
- SS Radioterapia, Ospedale San Giovanni Antica Sede (SC Radioterapia U-AOU Città della Salute e della Scienza), Torino, Italy
| | | | - Alba Fiorentino
- UOC Radioterapia Oncologica, Ospedale Generale Regionale F. Miulli, Acquaviva delle Fonti (BA), Acquaviva delle Fonti, Italy
| | - Niccolò Giaj Levra
- Dipartimento di Radioterapia Oncologica Avanzata, IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar (VR), Italy
| | - Edy Ippolito
- Radioterapia Oncologica, Fondazione Policlinico Universitario Campus Biomedico, Roma, Italy
| | - Sonia Silipigni
- Radioterapia Oncologica, Fondazione Policlinico Universitario Campus Biomedico, Roma, Italy
| | - Mattia Falchetto Osti
- UOC Radioterapia, Azienda Ospedaliero-Universitaria Policlinico Sant’Andrea, Sapienza, Università di Roma, Roma, Italy
| | - Marcello Mignogna
- SC Radioterapia, Area Omogenea Radioterapia, Ospedale San Luca, Azienda USL Toscana Nord Ovest, Lucca, Italy
| | - Marina Alessandro
- SC Radioterapia Oncologica, Ospedale di Città di Castello, Città di Castello (PG), Italy
| | - Lucia Anna Ursini
- UOC Radioterapia Oncologica, Ospedale SS Annunziata, Università G d’Annunzio, Chieti, Italy
| | - Marianna Nuzzo
- UOC Radioterapia Oncologica, Ospedale SS Annunziata, Università G d’Annunzio, Chieti, Italy
| | - Icro Meattini
- Dipartimento di Scienze Biomediche Sperimentali e Cliniche "M. Serio" - Università di Firenze, Firenze, e Radioterapia Oncologica, Dipartimento di Oncologia - Azienda Ospedaliero-Universitaria Careggi (AOUC), Italy
| | - Giuseppe D’Ermo
- Dipartimento di Chirurgia P. Valdoni, Sapienza Università di Roma, Co-Coordinatore Task force per le Malattie del Seno LILT Sede Centrale, Italy
| |
Collapse
|
9
|
Ferro M, Deodato F, Ferro M, Panza G, Buwenge M, Pezzulla D, Cilla S, Boccardi M, Romano C, Arcelli A, Cammelli S, Zamagni A, Morganti AG, Macchia G. A SHort course Accelerated RadiatiON therapy (SHARON) dose-escalation trial in older adults head and neck non-melanoma skin cancer. Br J Radiol 2022; 95:20211347. [PMID: 35451856 PMCID: PMC10996410 DOI: 10.1259/bjr.20211347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/01/2022] [Accepted: 03/14/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To assess feasibility and safety of a SHort-course Accelerated RadiatiON therapy (SHARON) regimen, in the treatment of non-melanoma skin cancers (NMSC) in older patients. METHODS Old patients (age ≥ 80 years) with histological confirmed non-melanoma skin cancers were enrolled. The primary endpoint was to determine the maximum tolerated dose (MTD). Radiotherapy regimen was based on the delivery of four radiotherapy fractions (5 Gy per fraction) with a twice daily fractionation in two consecutive days. Three different level of dose were administered: 20 Gy (one cycle), 40 Gy (two cycles) and 60 Gy (three cycles). RESULTS Thirty patients (median age: 91 years; range: 80-96) were included in this analysis. Among fourteen patients who completed the one cycle, only one (7%) experimented acute G4 skin toxicity. Twelve patients reported an improvement or resolution of baseline symptoms (overall palliative response rate: 85.8%). Nine and seven patients underwent to two and three RT cycles, respectively: of these, no G3 toxicities were recorded. The overall response rate was 100% when three cycles were delivered. The overall six-month symptom-free survival was 78.7% and 77.8% in patients treated with one course and more courses, respectively. CONCLUSIONS Short-course accelerated radiotherapy in older patients with non-melanoma skin cancers is well tolerated. High doses seem to be more effective in terms of response rate. ADVANCES IN KNOWLEDGE This approach could represent an option for older adults with NMSC, being both palliative (one course) or potentially curative (more courses) in the aim, accordingly to the patient's condition.
Collapse
Affiliation(s)
- Milena Ferro
- Radiation Oncology Unit, Gemelli Molise Hospital,
Università Cattolica del Sacro Cuore,
Campobasso, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital,
Università Cattolica del Sacro Cuore,
Campobasso, Italy
- Istituto di Radiologia, Università Cattolica del Sacro
Cuore, Rome,
Italy
| | - Marica Ferro
- Radiation Oncology Unit, Gemelli Molise Hospital,
Università Cattolica del Sacro Cuore,
Campobasso, Italy
| | - Giulia Panza
- Università Cattolica del Sacro Cuore,
Rome, Italy
| | - Milly Buwenge
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di
Bologna, Bologna,
Italy
- Department of Experimental, Diagnostic, and Specialty Medicine
- DIMES, Alma Mater Studiorum Bologna University,
Bologna, Italy
| | - Donato Pezzulla
- Radiation Oncology Unit, Gemelli Molise Hospital,
Università Cattolica del Sacro Cuore,
Campobasso, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital,
Università Cattolica del Sacro Cuore,
Campobasso, Italy
| | - Mariangela Boccardi
- Radiation Oncology Unit, Gemelli Molise Hospital,
Università Cattolica del Sacro Cuore,
Campobasso, Italy
| | - Carmela Romano
- Medical Physics Unit, Gemelli Molise Hospital,
Università Cattolica del Sacro Cuore,
Campobasso, Italy
| | - Alessandra Arcelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di
Bologna, Bologna,
Italy
- Department of Experimental, Diagnostic, and Specialty Medicine
- DIMES, Alma Mater Studiorum Bologna University,
Bologna, Italy
| | - Silvia Cammelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di
Bologna, Bologna,
Italy
- Department of Experimental, Diagnostic, and Specialty Medicine
- DIMES, Alma Mater Studiorum Bologna University,
Bologna, Italy
| | - Alice Zamagni
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di
Bologna, Bologna,
Italy
- Department of Experimental, Diagnostic, and Specialty Medicine
- DIMES, Alma Mater Studiorum Bologna University,
Bologna, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di
Bologna, Bologna,
Italy
- Department of Experimental, Diagnostic, and Specialty Medicine
- DIMES, Alma Mater Studiorum Bologna University,
Bologna, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital,
Università Cattolica del Sacro Cuore,
Campobasso, Italy
| |
Collapse
|
10
|
Pezzulla D, Macchia G, Ferro M, Cilla S, Buwenge M, Boccardi M, Romano C, Cammelli S, Bonome P, Valentini V, Morganti A, Deodato F. PO-1354 Stereotactic body re-irradiation for gynaecological cancer: outcomes and toxicities. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03318-7] [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: 10/18/2022]
|
11
|
Cilla S, Romano C, Macchia G, Boccardi M, De Vivo LP, Morabito VE, Buwenge M, Strigari L, Indovina L, Valentini V, Deodato F, Morganti AG. Automated hybrid volumetric modulated arc therapy (HVMAT) for whole-breast irradiation with simultaneous integrated boost to lumpectomy area : A treatment planning study. Strahlenther Onkol 2021; 198:254-267. [PMID: 34767044 DOI: 10.1007/s00066-021-01873-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/17/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To develop an automated treatment planning approach for whole breast irradiation with simultaneous integrated boost using an automated hybrid VMAT class solution (HVMAT). MATERIALS AND METHODS Twenty-five consecutive patients with left breast cancer received 50 Gy (2 Gy/fraction) to the whole breast and an additional simultaneous 10 Gy (2.4 Gy/fraction) to the tumor cavity. Ipsilateral lung, heart, and contralateral breast were contoured as main organs-at-risk. HVMAT plans were inversely optimized by combining two open fields with a VMAT semi-arc beam. Open fields were setup to include the whole breast with a 2 cm flash region and to carry 80% of beams weight. HVMAT plans were compared with three tangential techniques: conventional wedged-field tangential plans (SWF), field-in-field forward planned tangential plans (FiF), and hybrid-IMRT plans (HMRT). Dosimetric differences among the plans were evaluated using Kruskal-Wallis one-way analysis of variance. Dose accuracy was validated using the PTW Octavius-4D phantom together with the 1500 2D-array. RESULTS No significant differences were found among the four techniques for both targets coverage. HVMAT plans showed consistently better PTVs dose contrast, conformity, and homogeneity (p < 0.001 for all metrics) and statistically significant reduction of high-dose breast irradiation. V55 and V60 decreased by 30.4, 26.1, and 20.8% (p < 0.05) and 12.3, 9.9, and 6.0% (p < 0.05) for SWF, FIF, and HMRT, respectively. Pretreatment dose verification reported a gamma pass-rate greater than the acceptance threshold of 95% for all HVMAT plans. In addition, HVMAT reduced the time for full planning optimization to about 20 min. CONCLUSIONS HVMAT plans resulted in superior target dose conformity and homogeneity compared to other tangential techniques. Due to fast planning time HVMAT can be applied for all patients, minimizing the impact on human or departmental resources.
Collapse
Affiliation(s)
- Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 86100, Campobasso, Italy.
| | - Carmela Romano
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 86100, Campobasso, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Mariangela Boccardi
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Livia P De Vivo
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Vittoria E Morabito
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 86100, Campobasso, Italy
| | - Milly Buwenge
- Radiation Oncology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lidia Strigari
- Medical Physics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luca Indovina
- Radiation Oncology Department, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Vincenzo Valentini
- Radiation Oncology Department, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alessio G Morganti
- Radiation Oncology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,DIMES, Alma Mater Studiorum, Bologna University, Bologna, Italy
| |
Collapse
|
12
|
Macchia G, Pezzulla D, Cilla S, Boccardi M, Deodato F. New Technologies and Multidisciplinarity as Strategic Factors to Cope With Challenges in Postmastectomy Breast Cancer Radiation Therapy. Adv Radiat Oncol 2021; 6:100777. [PMID: 34604608 PMCID: PMC8473665 DOI: 10.1016/j.adro.2021.100777] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/25/2021] [Accepted: 08/09/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Donato Pezzulla
- Radiation Oncology Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Mariangela Boccardi
- Radiation Oncology Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| |
Collapse
|
13
|
Pezzulla D, Macchia G, Cilla S, Boccardi M, Re A, Bonome P, Picardi V, Ferro M, Romano C, Buwenge M, Cammelli S, Valentini V, Valenti V, Morganti A, Deodato F. PD-0887 VMAT Radiotherapy boost in oligometastatic patients with Spinal Metastases: a dose escalation study. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07166-8] [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: 11/29/2022]
|
14
|
Casà C, Macchia G, Ferioli M, Lancellotta V, Boccardi M, Cerrotta A, Tortoreto F, Ippolito E, Laliscia C, Huscher A, Di Muzio J, Morganti A, Lazzari R, Ferrandina G, Tagliaferri L. PH-0445 Preliminary results of the Italian Retrospective Study on adjuvant radiotherapy for vulvar cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07336-9] [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: 10/20/2022]
|
15
|
Romano C, Craus M, Viola P, Morabito V, Deodato F, Macchia G, Boccardi M, Buwenge M, Cammelli S, Morganti A, Valentini V, Cilla S. PO-1774 Reproducibility of spirometer-guided DIBH in left-breast treatments with optical surface monitoring. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08225-6] [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: 10/20/2022]
|
16
|
Zamagni A, Bonetti M, Buwenge M, Ntreta M, Tolento G, Cammelli S, Donati C, Lodi Rizzini E, Boccardi M, Re A, Deodato F, Cilla S, Macchia G, Morganti A. PO-1394 Stereotactic body radiotherapy for prostate cancer lymph node metastases: a systematic review. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07845-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
17
|
Casà C, Tagliaferri L, Ferioli M, Lancellotta V, Boccardi M, Cerrotta A, Tortoreto F, Ippolito E, Laliscia C, Huscher A, Gribaudo S, Morganti A, Lazzari R, Garganese G, Macchia G. OC-0297 Preliminary results of the Italian Retrospective Study on exclusive radiotherapy for vulvar cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06844-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
18
|
Ashton NJ, Leuzy A, Karikari TK, Mattsson-Carlgren N, Dodich A, Boccardi M, Corre J, Drzezga A, Nordberg A, Ossenkoppele R, Zetterberg H, Blennow K, Frisoni GB, Garibotto V, Hansson O. The validation status of blood biomarkers of amyloid and phospho-tau assessed with the 5-phase development framework for AD biomarkers. Eur J Nucl Med Mol Imaging 2021; 48:2140-2156. [PMID: 33677733 PMCID: PMC8175325 DOI: 10.1007/s00259-021-05253-y] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE The development of blood biomarkers that reflect Alzheimer's disease (AD) pathophysiology (phosphorylated tau and amyloid-β) has offered potential as scalable tests for dementia differential diagnosis and early detection. In 2019, the Geneva AD Biomarker Roadmap Initiative included blood biomarkers in the systematic validation of AD biomarkers. METHODS A panel of experts convened in November 2019 at a two-day workshop in Geneva. The level of maturity (fully achieved, partly achieved, preliminary evidence, not achieved, unsuccessful) of blood biomarkers was assessed based on the Biomarker Roadmap methodology and discussed fully during the workshop which also evaluated cerebrospinal fluid (CSF) and positron emission tomography (PET) biomarkers. RESULTS Plasma p-tau has shown analytical validity (phase 2 primary aim 1) and first evidence of clinical validity (phase 3 primary aim 1), whereas the maturity level for Aβ remains to be partially achieved. Full and partial achievement has been assigned to p-tau and Aβ, respectively, in their associations to ante-mortem measures (phase 2 secondary aim 2). However, only preliminary evidence exists for the influence of covariates, assay comparison and cut-off criteria. CONCLUSIONS Despite the relative infancy of blood biomarkers, in comparison to CSF biomarkers, much has already been achieved for phases 1 through 3 - with p-tau having greater success in detecting AD and predicting disease progression. However, sufficient data about the effect of covariates on the biomarker measurement is lacking. No phase 4 (real-world performance) or phase 5 (assessment of impact/cost) aim has been tested, thus not achieved.
Collapse
Affiliation(s)
- N J Ashton
- Institute of Neuroscience & Physiology, Department of Psychiatry & Neurochemistry, Sahlgrenska Academy, University of Gothenburg, House V3/SU, SE-431 80, Mölndal, Sweden.
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - A Leuzy
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - T K Karikari
- Institute of Neuroscience & Physiology, Department of Psychiatry & Neurochemistry, Sahlgrenska Academy, University of Gothenburg, House V3/SU, SE-431 80, Mölndal, Sweden
| | - N Mattsson-Carlgren
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
| | - A Dodich
- NIMTlab - Neuroimaging and Innovative Molecular Tracers Laboratory, University of Geneva, Geneva, Switzerland
- Center for Neurocognitive Rehabilitation (CeRiN), CIMeC, University of Trento, Trento, Italy
| | - M Boccardi
- German Center for Neurodegenerative Diseases (DZNE), Rostock-Greifswald, Rostock, Germany
- LANVIE - Laboratory of Neuroimaging of Aging, University of Geneva, Geneva, Switzerland
| | - J Corre
- Centre National de la Recherche Scientifique, Montpellier, France
| | - A Drzezga
- Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - A Nordberg
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Aging, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - R Ossenkoppele
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - H Zetterberg
- Institute of Neuroscience & Physiology, Department of Psychiatry & Neurochemistry, Sahlgrenska Academy, University of Gothenburg, House V3/SU, SE-431 80, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
| | - K Blennow
- Institute of Neuroscience & Physiology, Department of Psychiatry & Neurochemistry, Sahlgrenska Academy, University of Gothenburg, House V3/SU, SE-431 80, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - G B Frisoni
- German Center for Neurodegenerative Diseases (DZNE), Rostock-Greifswald, Rostock, Germany
- Memory Clinic, Geneva University Hospitals, Geneva, Switzerland
| | - V Garibotto
- NIMTlab - Neuroimaging and Innovative Molecular Tracers Laboratory, University of Geneva, Geneva, Switzerland
- Diagnostic Department, University Hospitals of Geneva, Geneva, Switzerland
| | - O Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
- UK Dementia Research Institute at UCL, London, UK.
- Memory Clinic, Skåne University Hospital, SE-205 02, Malmö, Sweden.
| |
Collapse
|
19
|
Cilla S, Macchia G, Romano C, Morabito VE, Boccardi M, Picardi V, Valentini V, Morganti AG, Deodato F. Challenges in lung and heart avoidance for postmastectomy breast cancer radiotherapy: Is automated planning the answer? Med Dosim 2021; 46:295-303. [PMID: 33836910 DOI: 10.1016/j.meddos.2021.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 11/18/2022]
Abstract
Postmastectomy radiotherapy (PMRT) has been shown to improve the overall survival for invasive breast cancer patients. However, it represents a challenging treatment geometry and individualized planning strategies with complex field arrangements are usually adopted to decrease radiotoxicity to heart and lungs. Automated treatment planning has the potential to improve plan quality consistency and planning efficiency. Herein, we describe the application of the Pinnacle3 Autoplanning engine as a valuable technological resource able to allow the treatment of challenging patients theoretically unfit for radiotherapy for major cardiac and pulmonary comorbidities. Treatment was planned for three left-sided chest wall and regional lymph-nodes postmastectomy breast cancer patients. A deep inspiration breath-hold (DIBH) technique was used aiming to reduce the OARs irradiation. Three manually generated plans (hybrid-IMRT (HMRT), hybrid-VMAT (HVMAT) and full VMAT (MP-VMAT) and a fully automated plan created by the Autoplanning engine (AP-VMAT) were optimized in order to ensure a safe radiation therapy to the patients. The plans were evaluated based on planning target volumes (PTVs) coverage, dose homogeneity index (HI), conformity index (CN), dose to organs at risk (OARs) and normal tissue complication probabilities (NTCPs) of pericarditis, long term mortality and pneumonitis. Despite the use of deep moderated breath-hold, all human-driven plans failed to reach the stringent dose objectives for OARs. All plans provided an optimal coverage for chest wall and lymph-nodal area. AP-VMAT delivered the lowest mean dose to the heart (3.4 to 4.9 Gy) and ipsilateral lung (7.5 to 12.5 Gy) reporting the lowest NTCP for pneumonitis (<1%), confirming the only chance to comply the dose objectives. Moreover, AP-VMAT reported a decrease of the integral dose, which was lower by about 4-8% with respect to manual plans. AP-VMAT plan resulted in up to 58% increase of MUs with respect to manual plans, suggesting a more pronounced fluence modulation and plan complexity. A major difference was found for the planning time which was reduced to less than 30 minutes by using the Auto-Planning module. With improved planning quality and efficiency, Auto-planning is an effective tool to enable high-quality plans in challenging postmastectomy breast cancer radiotherapy.
Collapse
Affiliation(s)
- Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy.
| | - Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Carmela Romano
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | | | - Mariangela Boccardi
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Vincenzo Picardi
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Vincenzo Valentini
- Radiation Oncology Department, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy; Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy; DIMES, Alma Mater Studiorum, Bologna University, Bologna, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy; Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
20
|
Affiliation(s)
- Mariangela Boccardi
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Virginia Boccardi
- Section of Gerontology and Geriatrics, Santa Maria Della Misericordia Hospital, Perugia, Italy.
| |
Collapse
|
21
|
Ferro M, Ferro M, Macchia G, Cilla S, Buwenge M, Re A, Romano C, Boccardi M, Picardi V, Cammelli S, Cucci E, Mignogna S, Di Lullo L, Valentini V, Morganti AG, Deodato F. Post-Operative Accelerated-Hypofractionated Chemoradiation With Volumetric Modulated Arc Therapy and Simultaneous Integrated Boost in Glioblastoma: A Phase I Study (ISIDE-BT-2). Front Oncol 2021; 10:626400. [PMID: 33692944 PMCID: PMC7937791 DOI: 10.3389/fonc.2020.626400] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/31/2020] [Indexed: 11/24/2022] Open
Abstract
Background Glioblastoma Multiforme (GBM) is the most common primary brain cancer and one of the most lethal tumors. Theoretically, modern radiotherapy (RT) techniques allow dose-escalation due to the reduced irradiation of healthy tissues. This study aimed to define the adjuvant maximum tolerated dose (MTD) using volumetric modulated arc RT with simultaneous integrated boost (VMAT-SIB) plus standard dose temozolomide (TMZ) in GBM. Methods A Phase I clinical trial was performed in operated GBM patients using VMAT-SIB technique with progressively increased total dose. RT was delivered in 25 fractions (5 weeks) to two planning target volumes (PTVs) defined by adding a 5-mm margin to the clinical target volumes (CTVs). The CTV1 was the tumor bed plus the MRI enhancing residual lesion with 10-mm margin. The CTV2 was the CTV1 plus 20-mm margin. Only PTV1 dose was escalated (planned dose levels: 72.5, 75, 77.5, 80, 82.5, 85 Gy), while PTV2 dose remained unchanged (45 Gy/1.8 Gy). Concurrent and sequential TMZ was prescribed according to the EORTC/NCIC protocol. Dose-limiting toxicities (DLTs) were defined as any G ≥ 3 non-hematological acute toxicity or any G ≥ 4 acute hematological toxicities (RTOG scale) or any G ≥ 2 late toxicities (RTOG-EORTC scale). Results Thirty-seven patients (M/F: 21/16; median age: 59 years; median follow-up: 12 months) were enrolled and treated as follows: 6 patients (72.5 Gy), 10 patients (75 Gy), 10 patients (77.5 Gy), 9 patients (80 Gy), 2 patients (82.5 Gy), and 0 patients (85 Gy). Eleven patients (29.7%) had G1-2 acute neurological toxicity, while 3 patients (8.1%) showed G ≥ 3 acute neurological toxicities at 77.5 Gy, 80 Gy, and 82.5 Gy levels, respectively. Since two DLTs (G3 neurological: 1 patient and G5 hematological toxicity: 1 patient) were observed at 82.5 Gy level, the trial was closed and the 80 Gy dose-level was defined as the MTD. Two asymptomatic histologically proven radionecrosis were recorded. Conclusions According to the results of this Phase I trial, 80 Gy in 25 fractions accelerated hypofractionated RT is the MTD using VMAT-SIB plus standard dose TMZ in resected GBM.
Collapse
Affiliation(s)
- Marica Ferro
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Milena Ferro
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Milly Buwenge
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy
| | - Alessia Re
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Carmela Romano
- Medical Physics Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Mariangela Boccardi
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Vincenzo Picardi
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Silvia Cammelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy
| | - Eleonora Cucci
- Radiology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Samantha Mignogna
- Medical Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Liberato Di Lullo
- Medical Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| |
Collapse
|
22
|
Deodato F, Ianiro A, Boccardi M, Macchia G, Romano C, Viola P, Picardi V, Ferro M, Ferro M, Pierro A, Scirocco E, Buwenge M, Cammelli S, Sacra C, De Filippo C, Valentini V, Morganti A, Cilla S. PO-1594: Impact of mean heart dose on acute coronary event excess cumulative risk in breath-hold breast IMRT. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01612-1] [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: 10/22/2022]
|
23
|
Re A, Cilla S, Ferro M, Ianiro A, Macchia G, Picardi V, Boccardi M, Cammelli S, Romano C, D'Addario D, Buwenge M, Mignogna S, Ferro M, Valentini V, Sallustio G, Morganti A, Deodato F. PO-0794: Induction chemotherapy followed by moderately accelerated IMRT in head and neck cancer patients. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00811-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
24
|
Romano C, Ianiro A, Deodato F, Macchia G, Boccardi M, Picardi V, Ferro M, Ferro M, Craus M, Pierro A, Scirocco E, Buwenge M, Cammelli S, Sacra C, De Filippo C, Valentini V, Morganti A, Cilla S. PO-1593: Impact of left ventricular V5 on acute coronary event cumulative risk in breath-hold breast IMRT. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01611-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: 10/22/2022]
|
25
|
Ferro M, Ianiro A, Re A, Macchia G, Cilla S, Picardi V, Boccardi M, Ferro M, Cammelli S, Romano C, Bisello S, Buwenge M, Mignogna S, Giglio G, Cucci E, Valentini V, Morganti A, Deodato F. OC-0091: SIB accelerated RT and concomitant TMZ in GBM patients: results of a phase I study (ISIDE BT-2). Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00117-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
26
|
Deodato F, Re A, Ianiro A, Ferro M, Macchia G, Picardi V, Boccardi M, Buwenge M, Assalone P, Berardinelli F, Maselli G, Cammelli S, Ferro M, Romano C, Mignogna S, Valentini V, Morganti A, Cilla S. PD-0667: Early analysis from two phase I trials on SBRT of isolated nodal recurrences in prostate patients. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00689-7] [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]
|
27
|
Ferioli M, Panni V, Galuppi A, Zamagni A, Buwenge M, Macchia G, Deodato F, Re A, Boccardi M, Cilla S, Fanti S, Morganti A, Cammelli S. PO-1134: 18F-FDG-PET/CT role in the adjuvant setting of endometrial cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01151-8] [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]
|
28
|
Re A, Picardi V, Deodato F, Ianiro A, Cilla S, Boccardi M, Ferro M, Arcelli A, Buwenge M, Cammelli S, Romano C, Restaino G, Ferro M, Specchia M, Guido A, Mignogna S, Valentini V, Morganti A, Macchia G. PO-1083: Efficacy and tolerance of VMAT-SIB intensified neoadjuvant chemoradiation in rectal cancer patients. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01100-2] [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: 10/22/2022]
|
29
|
Bracone F, De Curtis A, Di Castelnuovo A, Pilu R, Boccardi M, Cilla S, Macchia G, Deodato F, Costanzo S, Iacoviello L, de Gaetano G, Morganti AG, Petroni K, Tonelli C, Donati MB, Cerletti C. Skin toxicity following radiotherapy in patients with breast carcinoma: is anthocyanin supplementation beneficial? Clin Nutr 2020; 40:2068-2077. [PMID: 33051045 DOI: 10.1016/j.clnu.2020.09.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/05/2020] [Revised: 09/17/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The EU-supported ATHENA project stems from a previous study suggesting that moderate wine consumption reduced the side-effects of radiotherapy (RT) in breast cancer patients, an effect possibly due to non-alcoholic anthocyanin fractions of wine. OBJECTIVE To evaluate the role of anthocyanins on RT skin side effects in breast cancer patients. METHODS Randomized, controlled, double-blind clinical trial. Patients were assigned to an intensity modulated radiation therapy (IMRT) either for three or five weeks, then randomized to receive three times a day a water-soluble anthocyanin (125 mg)-rich extract of corn cob or a placebo. Supplementation started one week before till the end of RT. Skin characteristics were detected by a standardized, non-invasive Cutometer® dual-MPA580, providing quantitative indices of skin maximal distensibility (R0), elasticity (R2, R5, R7) and viscoelasticity (R6); a Mexameter® MX18 probe evaluated the skin erythema (Er) and melanin (M). Measures were performed before (T0), at the end of RT and of supplementation (T1), and 1, 6 and 12 months after RT (T2-T4). Acute and late skin toxicity were scored according to the RTOG/EORTG scale. Selected biomarkers were measured at T0 and T1. RESULTS 193 patients previously assigned to 3- or 5-week RT schedules were randomized to either anthocyanin (97) or placebo (96) supplementation. RT induced changes in skin parameters: R0, R2, R5 and R7 decreased, while R6 increased; the changes in R0 and R6 continued in the same direction up to one year, while the others recovered towards basal values; Er and M peaked at T1 and T2, respectively, and returned to basal values at T4. Comparable skin changes were apparent in anthocyanin and placebo groups. A moderate RT-induced increase in total and HDL cholesterol and triglycerides was prevented by anthocyanins. CONCLUSIONS Anthocyanin supplementation did not prevent RT-induced local skin toxicity. The supplementation was well tolerated and safe.
Collapse
Affiliation(s)
- Francesca Bracone
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy
| | - Amalia De Curtis
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy
| | | | - Roberto Pilu
- Department of Agricultural and Environmental Sciences - Production, Landscape, Agroenergy, Università degli Studi di Milano, Milano, Italy
| | | | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital Campobasso, Italy
| | | | | | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy; Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy
| | - Giovanni de Gaetano
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy
| | - Alessio Giuseppe Morganti
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Katia Petroni
- Department of Bioscience, Università degli Studi di Milano, Milano, Italy
| | - Chiara Tonelli
- Department of Bioscience, Università degli Studi di Milano, Milano, Italy
| | | | - Chiara Cerletti
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy.
| | | |
Collapse
|
30
|
Fusco FM, Pisaturo M, Iodice V, Bellopede R, Tambaro O, Parrella G, Di Flumeri G, Viglietti R, Pisapia R, Carleo MA, Boccardi M, Atripaldi L, Chignoli B, Maturo N, Rescigno C, Esposito V, Dell'Aversano R, Sangiovanni V, Punzi R. COVID-19 among healthcare workers in a specialist infectious diseases setting in Naples, Southern Italy: results of a cross-sectional surveillance study. J Hosp Infect 2020; 105:596-600. [PMID: 32565367 PMCID: PMC7301109 DOI: 10.1016/j.jhin.2020.06.021] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/15/2020] [Indexed: 01/12/2023]
Abstract
A coronavirus disease 2019 (COVID-19) surveillance study was performed in March–April 2020 among asymptomatic healthcare workers (HCWs) at a specialist infectious diseases hospital in Naples, Italy. All HCWs underwent two rounds of molecular and serological testing for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). One hundred and fifteen HCWs were tested; of these, two cases of infection were identified by reverse transcriptase polymerase chain reaction and two HCWs were SARS-CoV-2 immunoglobulin G seropositive. The overall prevalence of current or probable previous infection was 3.4%. The infection rate among HCWs was reasonably low. Most of the infected HCWs had been asymptomatic for the preceding 30 days, which supports the need for periodic screening of HCWs for COVID-19.
Collapse
Affiliation(s)
- F M Fusco
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy.
| | - M Pisaturo
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - V Iodice
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - R Bellopede
- UOC Pronto Soccorso Infettivologico ed Accettazione, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - O Tambaro
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - G Parrella
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - G Di Flumeri
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - R Viglietti
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - R Pisapia
- UOC Malattie Infettive ad Indirizzo Neurologico, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - M A Carleo
- UOC Immunodeficienze e Malattie Infettive di Genere, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - M Boccardi
- UOC Malattie Infettive ad Indirizzo Neurologico, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - L Atripaldi
- UOC Microbiologia e Virologia, AORN Ospedali dei Colli, P.O. Monaldi, Naples, Italy
| | - B Chignoli
- UOSD Medicina del Lavoro, AORN Ospedali dei Colli, Naples, Italy
| | - N Maturo
- UOC Pronto Soccorso Infettivologico ed Accettazione, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - C Rescigno
- UOC Malattie Infettive ad Indirizzo Neurologico, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - V Esposito
- UOC Immunodeficienze e Malattie Infettive di Genere, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - R Dell'Aversano
- UOC Direzione Medica di Ospedale, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - V Sangiovanni
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| | - R Punzi
- UOC Malattie Infettive ed Urgenze Infettivologiche, AORN Ospedali dei Colli, P.O. 'D. Cotugno', Naples, Italy
| |
Collapse
|
31
|
Boccardi M, Nicolosi V, Festari C, Bianchetti A, Cappa S, Chiasserini D, Falini A, Guerra UP, Nobili F, Padovani A, Sancesario G, Morbelli S, Parnetti L, Tiraboschi P, Muscio C, Perani D, Pizzini FB, Beltramello A, Salvini Porro G, Ciaccio M, Schillaci O, Trabucchi M, Tagliavini F, Frisoni GB. Italian consensus recommendations for a biomarker-based aetiological diagnosis in mild cognitive impairment patients. Eur J Neurol 2019; 27:475-483. [PMID: 31692118 DOI: 10.1111/ene.14117] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 02/25/2019] [Accepted: 11/04/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Biomarkers support the aetiological diagnosis of neurocognitive disorders in vivo. Incomplete evidence is available to drive clinical decisions; available diagnostic algorithms are generic and not very helpful in clinical practice. The aim was to develop a biomarker-based diagnostic algorithm for mild cognitive impairment patients, leveraging on knowledge from recognized national experts. METHODS With a Delphi procedure, experienced clinicians making variable use of biomarkers in clinical practice and representing five Italian scientific societies (neurology - Società Italiana di Neurologia per le Demenze; neuroradiology - Associazione Italiana di Neuroradiologia; biochemistry - Società Italiana di Biochimica Clinica; psychogeriatrics - Associazione Italiana di Psicogeriatria; nuclear medicine - Associazione Italiana di Medicina Nucleare) defined the theoretical framework, relevant literature, the diagnostic issues to be addressed and the diagnostic algorithm. An N-1 majority defined consensus achievement. RESULTS The panellists chose the 2011 National Institute on Aging and Alzheimer's Association diagnostic criteria as the reference theoretical framework and defined the algorithm in seven Delphi rounds. The algorithm includes baseline clinical and cognitive assessment, blood examination, and magnetic resonance imaging with exclusionary and inclusionary roles; dopamine transporter single-photon emission computed tomography (if no/unclear parkinsonism) or metaiodobenzylguanidine cardiac scintigraphy for suspected dementia with Lewy bodies with clear parkinsonism (round VII, votes (yes-no-abstained): 3-1-1); 18 F-fluorodeoxyglucose positron emission tomography for suspected frontotemporal lobar degeneration and low diagnostic confidence of Alzheimer's disease (round VII, 4-0-1); cerebrospinal fluid for suspected Alzheimer's disease (round IV, 4-1-0); and amyloid positron emission tomography if cerebrospinal fluid was not possible/accepted (round V, 4-1-0) or inconclusive (round VI, 5-0-0). CONCLUSIONS These consensus recommendations can guide clinicians in the biomarker-based aetiological diagnosis of mild cognitive impairment, whilst guidelines cannot be defined with evidence-to-decision procedures due to incomplete evidence.
Collapse
Affiliation(s)
- M Boccardi
- IRCCS Istituto Centro S.Giovanni di Dio-Fatebenefratelli, Brescia, Italy.,University of Geneva, Geneva, Switzerland
| | - V Nicolosi
- IRCCS Istituto Centro S.Giovanni di Dio-Fatebenefratelli, Brescia, Italy
| | - C Festari
- IRCCS Istituto Centro S.Giovanni di Dio-Fatebenefratelli, Brescia, Italy.,University of Brescia, Brescia, Italy
| | - A Bianchetti
- Istituto Clinico S. Anna, Brescia, Italy.,Italian Psychogeriatric Association (AIP), Brescia, Italy
| | - S Cappa
- IRCCS Istituto Centro S.Giovanni di Dio-Fatebenefratelli, Brescia, Italy.,University Institute of Higher Studies, Pavia, Italy.,Italian Society of Neurology for the Study of the Dementias (SINdem), Milan, Italy
| | - D Chiasserini
- University of Perugia, Perugia, Italy.,Italian Society of Clinical Biochemistry and Clinical Molecular Biology - Laboratory Medicine (SIBioC), Rimini, Italy
| | - A Falini
- IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Italian Association of Neuroradiology (AINR), Milan, Italy
| | - U P Guerra
- Poliambulanza Foundation, Brescia, Italy.,Italian Association of Nuclear Medicine (AIMN), Bari, Italy
| | - F Nobili
- Italian Association of Nuclear Medicine (AIMN), Bari, Italy.,University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - A Padovani
- Italian Society of Neurology for the Study of the Dementias (SINdem), Milan, Italy.,Brescia University Hospital, Brescia, Italy
| | - G Sancesario
- Italian Society of Clinical Biochemistry and Clinical Molecular Biology - Laboratory Medicine (SIBioC), Rimini, Italy.,IRCCS Santa Lucia Foundation, Neuroimmunology Unit Via Ardeatina 354, Rome, Italy
| | - S Morbelli
- University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - L Parnetti
- Ospedale S. Maria della Misericordia, University of Perugia, Perugia, Italy
| | | | - C Muscio
- IRCCS 'Carlo Besta', Milan, Italy
| | - D Perani
- IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | | | - A Beltramello
- Verona University Hospital, Verona, Italy.,IRCCS 'Sacro Cuore-Don Calabria', Negrar, Verona, Italy
| | | | - M Ciaccio
- Italian Society of Clinical Biochemistry and Clinical Molecular Biology - Laboratory Medicine (SIBioC), Rimini, Italy.,University of Palermo, Palermo, Italy
| | - O Schillaci
- University Tor Vergata, Rome, Italy.,IRCCS-Neuromed, Pozzilli, Italy
| | - M Trabucchi
- Italian Psychogeriatric Association (AIP), Brescia, Italy.,University Tor Vergata, Rome, Italy
| | | | - G B Frisoni
- IRCCS Istituto Centro S.Giovanni di Dio-Fatebenefratelli, Brescia, Italy.,University of Geneva, Geneva, Switzerland
| |
Collapse
|
32
|
Ianiro A, Boccardi M, Macchia G, Deodato F, Viola P, Craus M, Picardi V, Ferro M, Ferro M, Arena E, Pierro A, Buwenge M, Romani F, Angelini A, Valentini V, Morganti A, Cilla S. EP-1973 Cardiac dose sparing with active breath coordinator in breast radiotherapy: a dosimetric analysis. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32393-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
33
|
Zamagni A, Buwenge M, Siepe G, Arcelli A, Donati C, Bisello S, Macchia G, Deodato F, Cilla S, Ferro M, Picardi V, Boccardi M, Arena E, Ianiro A, Farina P, Pozzo C, Woldemariam A, Wondemagegnhu T, Frezza G, Morganti A, Cammelli S. EP-1576 Middle Half Body Radiotherapy in bone metastases from prostate cancer: a phase I study. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31996-6] [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: 11/29/2022]
|
34
|
Boccardi M, Bracone F, Deodato F, De Curtis A, Macchia G, Cilla S, Di Castelnuovo A, Ianiro A, Cerletti C, Morganti A, Donati M. EP-1287 Preliminary results of anthocyanin supplementation in breast cancer RT: impact on skin side effects. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31707-4] [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: 11/24/2022]
|
35
|
Deodato F, Cilla S, Ianiro A, Picardi V, Ferro M, Boccardi M, Tolento G, Cardano R, Cammelli S, Assalone P, Buwenge M, Mattiucci G, Valentini V, Morganti A, Macchia G. OC-0071 Stereotactic radiotherapy for nodal recurrences: an interim analysis from two phase I trials. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30491-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
36
|
Ferro M, Macchia G, Cilla S, Ianiro A, Picardi V, Boccardi M, Arena E, Ferro M, Cammelli S, Romani F, Riga S, Farina E, Buwenge M, Sumon M, Uddin AK, Assalone P, Valentini V, Morganti A, Deodato F. EP-1642 Short-course accelerated palliative EBRT for advanced head and neck cancer in elderly patients. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32062-6] [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: 11/15/2022]
|
37
|
Ferro M, Deodato F, Cilla S, Ianiro A, Picardi V, Boccardi M, Arena E, Cammelli S, Galofaro E, Panni V, Arcelli A, Buwenge M, Sumon M, Uddin AK, Angelini A, Riga S, Valentini V, Morganti A, Macchia G. EP-1645 Short-course accelerated palliative radiotherapy for advanced skin cancer in elderly patients. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32065-1] [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]
|
38
|
Galofaro E, Panni V, Buwenge M, Guido A, Macchia G, Deodato F, Picardi V, Boccardi M, Mignogna S, Pozzo C, Di Fabio F, Morganti A, Cammelli S. EP-1466 Preoperative chemoradiation with raltitrexed in locally advanced rectal cancer: a systematic review. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31886-9] [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]
|
39
|
Boccardi M, Boccardi V. Psychological Wellbeing and Healthy Aging: Focus on Telomeres. Geriatrics (Basel) 2019; 4:geriatrics4010025. [PMID: 31023993 PMCID: PMC6473912 DOI: 10.3390/geriatrics4010025] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/09/2019] [Accepted: 02/18/2019] [Indexed: 12/15/2022] Open
Abstract
Stress and depression are known to modulate the aging process, and might also affect telomere biology. In fact, exposure to some biochemical pathways involved in stress-related depression may contribute to an ‘‘accelerated aging” phenotype, as well as the incidence of age-related diseases, including metabolic disorders and dementia. Basic studies support the notion that the telomere and telomerase system plays a pivotal role in the aging process and disease promotion. Interestingly, short and dysfunctional telomeres are associated with reduced lifespan, as shown in animal models. In this context, telomeres are very sensitive to stress, mindset, and lifestyle, and their rescue may be sufficient to restore cell and organism viability. This mini-review discusses conceptual models of healthy and active aging and their relationship with telomere biology and mental health.
Collapse
Affiliation(s)
- Mariangela Boccardi
- Department of Psychiatry, University of Campania Luigi Vanvitelli, 80138 Naples, Italy.
| | - Virginia Boccardi
- Section of Gerontology and Geriatrics, Santa Maria della Misericordia Hospital, 60132 Perugia, Italy.
| |
Collapse
|
40
|
Macchia G, Ferro M, Cilla S, Buwenge M, Ianiro A, Boccardi M, Picardi V, Ferro M, Arena E, Zamagni A, Cammelli S, Valentini V, Morganti AG, Deodato F. Efficacy and safety of 3D-conformal half body irradiation in patients with multiple bone metastases. Clin Exp Metastasis 2018; 35:747-752. [PMID: 30251079 DOI: 10.1007/s10585-018-9939-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 09/20/2018] [Indexed: 11/28/2022]
Abstract
Half-body irradiation (HBI) represented a standard treatment for multiple painful bone metastases (BMs). However, its use has progressively reduced due to the associated toxicity rates. The aim of this paper was to evaluate HBI delivered by conformal radiotherapy (RT) technique in a large patients population with widespread BMs. HBI was delivered in 3 Gy fractions, bid, ≥ 6 h apart, on 2 consecutive days (total dose: 12 Gy) using 3-dimensional conformal RT (3D-CRT) box technique. The target included pelvic bones, lumbar-sacral vertebrae and upper third of femurs. Acute and late toxicity was scored based on RTOG and EORTC-RTOG scales, respectively. Pain was evaluated using the Pain-Drug scores and the Visual Analog Scale (VAS). One hundred and eighty patients were eligible for inclusion in this retrospective analysis. Grade 3 and 4 acute toxicity rates were 1.1% and 0.0%, respectively. Mean VAS before and after HBI was 5.3 versus 2.7, respectively (p: 0.0001). Based on VAS, 37.5% of patients showed complete pain relief (VAS: 0) while 38.1% had partial response (≥ 2-point VAS reduction). Overall, Pain and Drug Score reduction was observed in 76.3% and 50.4% of patients, respectively. 1-, 2-, and 3-year pain progression free survival was 77.0%, 63.4%, and 52.7%, respectively. Thirty patients (16.7%) underwent RT retreatment on the same site with median 15.9 months interval (range 2-126 months). HBI delivered with 3D-CRT technique is safe and effective. It provides long lasting pain control in patients with multiple BMs with negligible rates of relevant toxicity.
Collapse
Affiliation(s)
- Gabriella Macchia
- Radiotherapy Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Largo A. Gemelli 1, 86100, Campobasso, Italy
| | - Milena Ferro
- Radiotherapy Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Largo A. Gemelli 1, 86100, Campobasso, Italy.
| | - Savino Cilla
- Medical Physics Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Campobasso, Italy
| | - Milly Buwenge
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Anna Ianiro
- Medical Physics Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Campobasso, Italy
| | - Mariangela Boccardi
- Radiotherapy Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Largo A. Gemelli 1, 86100, Campobasso, Italy
| | - Vincenzo Picardi
- Radiotherapy Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Largo A. Gemelli 1, 86100, Campobasso, Italy
| | - Marica Ferro
- Radiotherapy Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Largo A. Gemelli 1, 86100, Campobasso, Italy
| | - Eleonora Arena
- Radiotherapy Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Largo A. Gemelli 1, 86100, Campobasso, Italy
| | - Alice Zamagni
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Silvia Cammelli
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Vincenzo Valentini
- Radiotherapy Department, Policlinico Universitario "A. Gemelli", Catholic University of Sacred Heart, Rome, Italy
| | - Alessio G Morganti
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesco Deodato
- Radiotherapy Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Largo A. Gemelli 1, 86100, Campobasso, Italy
| |
Collapse
|
41
|
Nobili F, Arbizu J, Bouwman F, Drzezga A, Agosta F, Nestor P, Walker Z, Boccardi M. European Association of Nuclear Medicine and European Academy of Neurology recommendations for the use of brain 18 F-fluorodeoxyglucose positron emission tomography in neurodegenerative cognitive impairment and dementia: Delphi consensus. Eur J Neurol 2018; 25:1201-1217. [PMID: 29932266 DOI: 10.1111/ene.13728] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [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: 03/13/2018] [Accepted: 06/20/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Recommendations for using fluorodeoxyglucose positron emission tomography (FDG-PET) to support the diagnosis of dementing neurodegenerative disorders are sparse and poorly structured. METHODS Twenty-one questions on diagnostic issues and on semi-automated analysis to assist visual reading were defined. Literature was reviewed to assess study design, risk of bias, inconsistency, imprecision, indirectness and effect size. Critical outcomes were sensitivity, specificity, accuracy, positive/negative predictive value, area under the receiver operating characteristic curve, and positive/negative likelihood ratio of FDG-PET in detecting the target conditions. Using the Delphi method, an expert panel voted for/against the use of FDG-PET based on published evidence and expert opinion. RESULTS Of the 1435 papers, 58 papers provided proper quantitative assessment of test performance. The panel agreed on recommending FDG-PET for 14 questions: diagnosing mild cognitive impairment due to Alzheimer's disease (AD), frontotemporal lobar degeneration (FTLD) or dementia with Lewy bodies (DLB); diagnosing atypical AD and pseudo-dementia; differentiating between AD and DLB, FTLD or vascular dementia, between DLB and FTLD, and between Parkinson's disease and progressive supranuclear palsy; suggesting underlying pathophysiology in corticobasal degeneration and progressive primary aphasia, and cortical dysfunction in Parkinson's disease; using semi-automated assessment to assist visual reading. Panellists did not support FDG-PET use for pre-clinical stages of neurodegenerative disorders, for amyotrophic lateral sclerosis and Huntington disease diagnoses, and for amyotrophic lateral sclerosis or Huntington-disease-related cognitive decline. CONCLUSIONS Despite limited formal evidence, panellists deemed FDG-PET useful in the early and differential diagnosis of the main neurodegenerative disorders, and semi-automated assessment helpful to assist visual reading. These decisions are proposed as interim recommendations.
Collapse
Affiliation(s)
- F Nobili
- Department of Neuroscience (DINOGMI), University of Genoa and Polyclinic San Martino Hospital, Genoa, Italy
| | - J Arbizu
- Department of Nuclear Medicine, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - F Bouwman
- Department of Neurology and Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - A Drzezga
- Department of Nuclear Medicine, University Hospital of Cologne, University of Cologne and German Center for Neurodegenerative Diseases (DZNE), Cologne, Germany
| | - F Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - P Nestor
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Z Walker
- Division of Psychiatry, Essex Partnership University NHS Foundation Trust, University College London, London, UK
| | - M Boccardi
- Department of Psychiatry, Laboratoire du Neuroimagerie du Vieillissement (LANVIE), University of Geneva, Geneva, Switzerland
| | | |
Collapse
|
42
|
Boccardi M, Macchia G, Cilla S, Ianiro A, Viola P, Donati C, Panni V, Zamagni A, Ferioli M, Ammendolia I, Tolento G, Smaniotto D, Missere M, Alexopoulou E, Cammelli S, Frezza G, Valentini V, Morganti A, Deodato F. EP-1280: MARA-3 trial: a whole breast irradiation with simultaneous integrated boost in low risk patients. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31590-1] [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: 11/30/2022]
|
43
|
Cilla S, Deodato F, Ianiro A, Boccardi M, Viola P, Craus M, Romanella M, Djan I, Buwenge M, Frakulli R, Siepe G, Arcelli A, Cammelli S, Smaniotto D, Frezza G, Valentini V, Morganti A, Macchia G. EP-1970: Hybrid-IMRT as an optimal class solution for whole breast planning with boost to lumpectomy area. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32279-5] [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]
|
44
|
Deodato F, Cilla S, Macchia G, Ianiro A, Boccardi M, Arena E, Restaino G, Carabellese B, Grivet M, Tolento G, Zamagni A, Donati C, Ronchi L, Ferioli M, Cammelli S, Morganti A. PV-0470: Extracranial SBRT: impact of functional response on local control. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30780-1] [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: 10/14/2022]
|
45
|
Macchia G, Cilla S, Ianiro A, Boccardi M, Cammelli S, Smaniotto D, Cucci E, Angelini A, Frakulli R, Zamagni A, Dionisi V, Panni V, Ammendolia I, Tolento G, Frezza G, Morganti A, Deodato F. EP-1281: MARA 4 trial: a whole breast irradiation with SIB using an hybrid IMRT class solution. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31591-3] [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: 11/25/2022]
|
46
|
Cilla S, Ianiro A, Viola P, Craus M, Macchia G, Ferro M, Picardi V, Boccardi M, Compagnone G, Buwenge M, Cammelli S, Valentini V, Morganti A, Deodato F. EP-2200: Statistical process control for VMAT quality assurance: an eight-year retrospective study. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32509-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: 10/14/2022]
|
47
|
Zamagni A, Macchia G, Boccardi M, Cammelli S, Ferro M, Cilla S, Ammendolia I, Tolento G, Bertini F, Galofaro E, Ciabatti S, Dionisi V, Ferioli M, Siepe G, Cortesi A, Smaniotto D, Deodato F, Frezza G, Morganti A. EP-1278: Postoperative radiotherapy on the breast and influence on acute haematological toxicity. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31588-3] [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: 12/01/2022]
|
48
|
Nuzzo M, Macchia G, Conte T, Cilla S, Boccardi M, Ferioli M, Galuppi A, Frakulli R, Buwenge M, Siepe G, Ciabatti S, Ronchi L, Cortesi A, Alexopoulou E, Perrone M, De Iaco P, Cammelli S, Morganti A, Deodato F. EP-1513: Systematic review about the role of chemoradiotherapy in locally advanced vulvar carcinoma. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31822-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
49
|
Prisco V, Iannaccone T, Tusciano A, Boccardi M, Perris F, Capuano A, Catapano F, Fabrazzo M. [Drug safety warnings in psychiatry: adverse drug reactions' signaling from 2002 to 2014]. Riv Psichiatr 2017; 51:96-103. [PMID: 27362820 DOI: 10.1708/2304.24792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Monitoring drug-related side effects in psychiatric patients is highly recommended. In fact, frequent exposure to long-term polipharmacotherapy, poor compliance to pharmachological treatment and comorbidity with organic illnesses requiring the prescription of other drugs are causes of pharmacokinetic/pharmacodynamic interactions. These vulnerability factors result in a certain increase in adverse drug reactions (ADRs). METHODS This study performes an analysis of Italian Medicine Agency data, in the section "signal analysis", to attempt an assessment of the safety warnings among the different psychotropic drug classes, belonging to the ATC class: N03 (antiepileptics), N05 (antipsychotics), N06 (psycho-analectic drugs). Then we analysed, in a descriptive way, the different association between the drug and the related ADR, evaluating the different safety profiles, in relation to experimental studies, supporting the importance of the signal. RESULTS In the last years, among the new 25 ADRs, 10 were related to antidepressant drugs (8 SSRI, 1 mirtazapine, 1 agomelatine). In relation to antipsychotic drugs, 6 new correlations were found between drug and ADR onset, mainly among atypical antispychotics. Other correlations (6 above all) were found among antiepileptic drugs. Among benzodiazepines, a signal linked to rabdomylysis onset was found. It is also recommended an evaluation of safety profile in relation to zolpidem prescription. DISCUSSION The results of our systematic review are a motivational input, considering the continuous increase of safety warnings, to attentively monitor drug's prescription. Spontaneous ADRs' signaling is a classical system to provide the required attention in relation to a potential risk. The clinician in charge must report this because he is the key figure in the drugs' safety process. CONCLUSIONS In psychiatry, in which a long-term pharmachological therapy is frequent, clinicians are requested to find and signal ADRs to the competent authority.
Collapse
Affiliation(s)
- Vincenzo Prisco
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università di Napoli SUN
| | - Teresa Iannaccone
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università di Napoli SUN
| | - Adriano Tusciano
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università di Napoli SUN
| | - Mariangela Boccardi
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università di Napoli SUN
| | - Francesco Perris
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università di Napoli SUN
| | | | - Francesco Catapano
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università di Napoli SUN
| | - Michele Fabrazzo
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università di Napoli SUN
| |
Collapse
|
50
|
Buwenge M, Macchia G, Ferioli M, Giaccherini L, Arcelli A, Galuppi A, Cammelli S, Perrone A, De Iaco P, Boccardi M, Tagliaferri L, Ferrandina G, Deodato F, Cilla S, Frezza G, Morganti A. EP-1298: Radiotherapy in invasive vaginal carcinoma: a systematic review. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31733-4] [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: 11/26/2022]
|