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Cilla S, Deodato F, Romano C, Macchia G, Buwenge M, Morganti AG. Radiomics-based discriminant analysis of principal components to stratify the treatment response of lung metastases following stereotactic body radiation therapy. Phys Med 2024; 121:103340. [PMID: 38593628 DOI: 10.1016/j.ejmp.2024.103340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 03/08/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024] Open
Abstract
PURPOSE Discriminant analysis of principal components (DAPC) was introduced to describe the clusters of genetically related individuals focusing on the variation between the groups of individuals. Borrowing this approach, we evaluated the potential of DAPC for the evaluation of clusters in terms of treatment response to SBRT of lung lesions using radiomics analysis on pre-treatment CT images. MATERIALS AND METHODS 80 pulmonary metastases from 56 patients treated with SBRT were analyzed. Treatment response was stratified as complete, incomplete and null responses. For each lesion, 107 radiomics features were extracted using the PyRadiomics software. The concordance correlation coefficients (CCC) between the radiomics features obtained by two segmentations were calculated. DAPC analysis was performed to infer the structure of "radiomically" related lesions for treatment response assessment. The DAPC was performed using the "adegenet" package for the R software. RESULTS The overall mean CCC was 0.97 ± 0.14. The analysis yields 14 dimensions in order to explain 95 % of the variance. DAPC was able to group the 80 lesions into the 3 different clusters based on treatment response depending on the radiomics features characteristics. The first Linear Discriminant achieved the best discrimination of individuals into the three pre-defined groups. The greater radiomics loadings who contributed the most to the treatment response differentiation were associated with the "sphericity", "correlation" and "maximal correlation coefficient" features. CONCLUSION This study demonstrates that a DAPC analysis based on radiomics features obtained from pretreatment CT is able to provide a reliable stratification of complete, incomplete or null response of lung metastases following SBRT.
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Affiliation(s)
- Savino Cilla
- Medical Physics Unit, Responsible Research Hospital, Campobasso, Italy.
| | - Francesco Deodato
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
| | - Carmela Romano
- Medical Physics Unit, Responsible Research Hospital, Campobasso, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
| | - Milly Buwenge
- Radiation Oncology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessio G Morganti
- Radiation Oncology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; DIMEC, Alma Mater Studiorum, Bologna University, Bologna, Italy
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Kaganda Bomboka V, Galietta E, Donati CM, Cellini F, Rossi R, Buwenge M, Wondemagegnehu T, Deressa BT, Uddin AK, Sumon MA, Vadalà M, Maltoni M, Morganti AG. Assessing the effectiveness of palliative radiotherapy for painful bone metastases in low- and middle-income countries: A systematic review. J Med Imaging Radiat Oncol 2024. [PMID: 38577713 DOI: 10.1111/1754-9485.13647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
Palliative radiotherapy (RT) effectively relieves pain in patients with bone metastases (BMs). Furthermore, several clinical trials, in most cases conducted in high-income countries (HICs), proved that single-fraction RT is equally effective compared to multi-fractionated RT. However, the evidence is scarce regarding low/middle-income countries (LMICs), where the diagnosis of BMs could be later and RT techniques less advanced. Therefore, we conducted a systematic literature review to evaluate the efficacy of palliative RT of BMs in the LMIC setting. A literature search was performed independently by two authors on the PubMed, Cochrane and Scopus databases. Overall, 333 records were screened and after the selection process, 11 papers were included in the analysis. Complete pain response rates ranged from 11.5% to 37.1% (median: 22%) for single-fraction RT and from 0% to 35.1% (median: 19%) for multi-fractionated RT. Partial pain response rates ranged from 23.1% to 76.9% (median: 53.8%) for single fraction RT and from 23.8% to 84.6% (median: 65%) for multi-fractionated RT. Four randomized trials compared single-fraction RT with multiple-fraction RT and none of them showed significant differences in terms of pain relief. Our analysis showed that pain response rates after palliative RT recorded in LMIC are like those reported in studies performed in HIC. Even in this setting, RT in single fraction shows comparable pain response rates to multifractional RT.
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Affiliation(s)
- Von Kaganda Bomboka
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Bologna University, Bologna, Italy
| | - Erika Galietta
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Bologna University, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Costanza Maria Donati
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Bologna University, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Cellini
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC di Radioterapia, Roma, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Romina Rossi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Milly Buwenge
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Bologna University, Bologna, Italy
| | - Tigeneh Wondemagegnehu
- Radiotherapy Department, Tikur Anbessa Specialized Hospital, Department of Clinical Oncology, College of Medicine and Health Sciences, University of Gondar, Addis Ababa, Ethiopia
| | | | - Afm Kamal Uddin
- Department of Radiation Oncology, United Hospital Limited, Dhaka, Bangladesh
| | - Mostafa A Sumon
- Radiation Oncology, Kurmitola General Hospital, Dhaka, Bangladesh
| | - Maria Vadalà
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marco Maltoni
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Bologna University, Bologna, Italy
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessio Giuseppe Morganti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Bologna University, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Donati CM, Galietta E, Cellini F, Di Rito A, Portaluri M, De Tommaso C, Santacaterina A, Tamburella C, Mammini F, Di Franco R, Parisi S, Cossa S, Bianculli A, Ziccarelli P, Ziccarelli L, Genovesi D, Caravatta L, Deodato F, Macchia G, Fiorica F, Napoli G, Cammelli S, Cavallini L, Buwenge M, Rossi R, Maltoni M, Morganti AG, Cilla S. Further Clarification of Pain Management Complexity in Radiotherapy: Insights from Modern Statistical Approaches. Cancers (Basel) 2024; 16:1407. [PMID: 38611085 PMCID: PMC11010980 DOI: 10.3390/cancers16071407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The primary objective of this study was to assess the adequacy of analgesic care in radiotherapy (RT) patients, with a secondary objective to identify predictive variables associated with pain management adequacy using a modern statistical approach, integrating the Least Absolute Shrinkage and Selection Operator (LASSO) algorithm and the Classification and Regression Tree (CART) analysis. METHODS This observational, multicenter cohort study involved 1387 patients reporting pain or taking analgesic drugs from 13 RT departments in Italy. The Pain Management Index (PMI) served as the measure for pain control adequacy, with a PMI score < 0 indicating suboptimal management. Patient demographics, clinical status, and treatment-related factors were examined to discern the predictors of pain management adequacy. RESULTS Among the analyzed cohort, 46.1% reported inadequately managed pain. Non-cancer pain origin, breast cancer diagnosis, higher ECOG Performance Status scores, younger patient age, early assessment phase, and curative treatment intent emerged as significant determinants of negative PMI from the LASSO analysis. Notably, pain management was observed to improve as RT progressed, with a greater discrepancy between cancer (33.2% with PMI < 0) and non-cancer pain (73.1% with PMI < 0). Breast cancer patients under 70 years of age with non-cancer pain had the highest rate of negative PMI at 86.5%, highlighting a potential deficiency in managing benign pain in younger patients. CONCLUSIONS The study underscores the dynamic nature of pain management during RT, suggesting improvements over the treatment course yet revealing specific challenges in non-cancer pain management, particularly among younger breast cancer patients. The use of advanced statistical techniques for analysis stresses the importance of a multifaceted approach to pain management, one that incorporates both cancer and non-cancer pain considerations to ensure a holistic and improved quality of oncological care.
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Affiliation(s)
- Costanza Maria Donati
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Erika Galietta
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Francesco Cellini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (F.C.); (F.D.)
- Dipartimento Universitario Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessia Di Rito
- Radiotherapy Unit, IRCCS Istituto Tumori ‘Giovanni Paolo II’ Bari, 70124 Bari, Italy;
| | | | | | - Anna Santacaterina
- U.O. di Radioterapia AOOR PAPARDO PIEMONTE, 98121 Messina, Italy; (A.S.); (C.T.)
| | - Consuelo Tamburella
- U.O. di Radioterapia AOOR PAPARDO PIEMONTE, 98121 Messina, Italy; (A.S.); (C.T.)
| | - Filippo Mammini
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Rossella Di Franco
- Department of Radiation Oncology, Istituto Nazionale Tumori-IRCCS-Fodazione G. Pascale, 80131 Napoli, Italy;
| | - Salvatore Parisi
- Radioterapia Opera di S. Pio da Pietralcina, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (S.P.); (S.C.)
| | - Sabrina Cossa
- Radioterapia Opera di S. Pio da Pietralcina, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (S.P.); (S.C.)
| | - Antonella Bianculli
- Medical Physics Department, IRCCS-CROB—Centro di Riferimento Oncologico della Basilica, 85028 Rionero in Vulture, Italy
| | - Pierpaolo Ziccarelli
- U.O. Radioterapia Oncologica—S.O. Mariano Santo, 87100 Cosenza, Italy; (P.Z.); (L.Z.)
| | - Luigi Ziccarelli
- U.O. Radioterapia Oncologica—S.O. Mariano Santo, 87100 Cosenza, Italy; (P.Z.); (L.Z.)
| | - Domenico Genovesi
- Radiation Oncology Unit, SS Annunziata Hospital, G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (D.G.); (L.C.)
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D’Annunzio” University of Chieti-Pescara, 66013 Chieti, Italy
| | - Luciana Caravatta
- Radiation Oncology Unit, SS Annunziata Hospital, G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (D.G.); (L.C.)
| | - Francesco Deodato
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (F.C.); (F.D.)
- Radiation Oncology Unit, Responsible Research Hospital, 86100 Campobasso, Italy;
| | - Gabriella Macchia
- Radiation Oncology Unit, Responsible Research Hospital, 86100 Campobasso, Italy;
| | - Francesco Fiorica
- U.O.C.di Radioterapia e Medicina Nucleare, Ospedale Mater Salutis di Legnago, 37045 Verona, Italy; (F.F.); (G.N.)
| | - Giuseppe Napoli
- U.O.C.di Radioterapia e Medicina Nucleare, Ospedale Mater Salutis di Legnago, 37045 Verona, Italy; (F.F.); (G.N.)
| | - Silvia Cammelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Letizia Cavallini
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Milly Buwenge
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Romina Rossi
- Palliative Care Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Marco Maltoni
- Medical Oncology Unit, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy;
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Savino Cilla
- Medical Physics Unit, Responsible Research Hospital, 86100 Campobasso, Italy;
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Deodato F, Ferro M, Bonome P, Pezzulla D, Romano C, Buwenge M, Cilla S, Morganti AG, Macchia G. Stereotactic body radiotherapy (SIB-VMAT technique) to dominant intraprostatic lesion (DIL) for localized prostate cancer: a dose-escalation trial (DESTROY-4). Strahlenther Onkol 2024; 200:239-249. [PMID: 38180492 DOI: 10.1007/s00066-023-02189-0] [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: 07/27/2023] [Accepted: 12/03/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE DESTROY-4 (DOSE-ESCALATION STUDY OF STEREOTACTIC BODY RADIATION THERAPY) was a Phase I trial aimed to evaluate the safety and the feasibility of escalating doses of stereotactic body radiation therapy (SBRT) on MRI-defined Dominant Intraprostatic Lesion (DIL) in low- and intermediate-risk pCa patients using a simultaneous integrated boost-volumetric arc therapy (SIB-VMAT) technique. METHODS Eligible patients included those with low- and intermediate-risk prostate carcinoma (NCCN risk classes) and an International Prostatic Symptoms Score (IPSS) ≤ 15. No restriction about DIL and prostate volumes was set. Pretreatment preparation required an enema and the placement of intraprostatic gold fiducials. SBRT was delivered in five consecutive daily fractions. For the first three patients, the DIL radiation dose was set at 8 Gy per fraction up to a total dose of 40 Gy (PTV1) and was gradually increased in succeeding cohorts to total doses of 42.5 Gy, 45.0 Gy, 47.5 Gy, and finally, 50.0 Gy, while keeping the prescription of 35 Gy/7 Gy per fraction for the entire prostate gland. Dose-limiting toxicity (DLT) was defined as grade 3 or worse gastrointestinal (GI) or genitourinary (GU) toxicity occurring within 90 days of follow-up (Common Terminology Criteria of Adverse Events scale 4.0). Patients completed quality-of-life questionnaires at defined intervals. RESULTS Twenty-four patients with a median age of 75 (range, 58-89) years were enrolled. The median follow-up was 26.3 months (8.9-84 months). 66.7% of patients were classified as intermediate-risk groups, while the others were low-risk groups, according to the NCCN guidelines. Enrolled patients were treated as follows: 8 patients (40 Gy), 5 patients (42.5 Gy), 4 patients (45 Gy), 4 patients (47.5 Gy), and 3 patients (50 Gy). No severe acute toxicities were observed. G1 and G2 acute GU toxicities occurred in 4 (16%) and 3 patients (12.5%), respectively. Two patients (8.3%) and 3 patients (12.5%) experienced G1 and G2 GI toxicities, respectively. Since no DLTs were observed, 50 Gy in five fractions was considered the MTD. The median nadir PSA was 0.20 ng/mL. A slight improvement in QoL values was registered after the treatment. CONCLUSION This trial confirms the feasibility and safety of a total SIB-VMAT dose of 35 Gy on the whole gland and 50 Gy on DIL in 5 fractions daily administered in a well-selected low- and intermediate-risk prostate carcinoma population. A phase II study is ongoing to confirm the tolerability of the schedule and assess the efficacy.
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Affiliation(s)
- Francesco Deodato
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Milena Ferro
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy.
| | - Paolo Bonome
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
| | - Donato Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
| | - Carmela Romano
- Medical Physics Unit, Responsible Research Hospital, Campobasso, Italy
| | - Milly Buwenge
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Savino Cilla
- Medical Physics Unit, Responsible Research Hospital, Campobasso, 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, Responsible Research Hospital, Campobasso, Italy
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Medici F, Ferioli M, Cammelli S, Forlani L, Laghi V, Ma J, Cilla S, Buwenge M, Macchia G, Deodato F, Vadalà M, Malizia C, Tagliaferri L, Perrone AM, De Iaco P, Strigari L, Bazzocchi A, Rizzo S, Arcelli A, Morganti AG. Sarcopenic Obesity in Cervical Carcinoma: A Strong and Independent Prognostic Factor beyond the Conventional Predictors (ESTHER Study-AFRAID Project). Cancers (Basel) 2024; 16:929. [PMID: 38473291 DOI: 10.3390/cancers16050929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Locally advanced cervical cancer represents a significant treatment challenge. Body composition parameters such as body mass index, sarcopenia, and sarcopenic obesity, defined by sarcopenia and BMI ≥ 30 kg/m2, have been identified as potential prognostic factors, yet their overall impact remains underexplored. This study assessed the relationship between these anthropometric parameters alongside clinical prognostic factors on the prognosis of 173 cervical cancer patients. Survival outcomes in terms of local control (LC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) were analyzed using Kaplan regression methods-Meier and Cox. Older age, lower hemoglobin levels, higher FIGO (International Federation of Gynecology and Obstetrics) stages, and lower total radiation doses were significantly associated with worse outcomes. Univariate analysis showed a significant correlation between BMI and the outcomes examined, revealing that normal-weight patients show higher survival rates, which was not confirmed by the multivariate analysis. Sarcopenia was not correlated with any of the outcomes considered, while sarcopenic obesity was identified as an independent negative predictor of DFS (HR: 5.289, 95% CI: 1.298-21.546, p = 0.020) and OS (HR: 2.645, 95% CI: 1.275-5.488, p = 0.009). This study highlights the potential of sarcopenic obesity as an independent predictor of clinical outcomes. These results support their inclusion in prognostic assessments and treatment planning for patients with advanced cervical cancer.
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Affiliation(s)
- Federica Medici
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Martina Ferioli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Silvia Cammelli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Ludovica Forlani
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Viola Laghi
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Johnny Ma
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy
| | - Milly Buwenge
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 86100 Campobasso, Italy
| | - Francesco Deodato
- Radiotherapy Unit, Gemelli Molise Hospital, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 86100 Campobasso, Italy
| | - Maria Vadalà
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Claudio Malizia
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Luca Tagliaferri
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Anna Myriam Perrone
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Pierandrea De Iaco
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Lidia Strigari
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Stefania Rizzo
- Service of Radiology, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), CH-6500 Lugano, Switzerland
| | - Alessandra Arcelli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alessio Giuseppe Morganti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Ferioli M, Medici F, Forlani L, Cilla S, Fionda B, Cammelli S, Strigari L, Tagliaferri L, Morganti AG, Buwenge M. Augmented reality in brachytherapy: A narrative review. J Contemp Brachytherapy 2024; 16:57-66. [PMID: 38584890 PMCID: PMC10993895 DOI: 10.5114/jcb.2024.137779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/23/2024] [Indexed: 04/09/2024] Open
Abstract
Brachytherapy (BRT) plays a pivotal role in the treatment of tumors, offering precise radiation therapy directly to the affected area. However, this technique demands extensive training and skills development, posing challenges for widespread adoption and ensuring patient safety. This narrative review explored the utilization of augmented reality (AR) in BRT, seeking to summarize existing evidence, discuss key findings, limitations, and quality of research as well as outline future research directions. The review revealed promising findings regarding the integration of AR in BRT. Studies have suggested the feasibility and potential benefits of AR in education, training, intra-operative guidance, and treatment planning. However, the evidence remains limited and heterogeneous, with most studies in preliminary phases. Standardization, prospective clinical trials, patient-centered outcomes assessment, and cost-effectiveness analysis emerge as critical areas for future research. Augmented reality holds transformative potential for BRT by enhancing precision, safety, and training efficiency. To fully implement these benefits, the field requires standardized protocols, rigorous clinical trials, and in-depth patient-centered investigations. Policy-makers and healthcare providers should closely monitor developments in AR and consider its implementation in clinical practice, contingent and robust evidence, and cost-effectiveness analysis. The pro-active pursuit of evidence-based practices will contribute to optimizing patient care in BRT.
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Affiliation(s)
- Martina Ferioli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
| | - Federica Medici
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
| | - Ludovica Forlani
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital, Campobasso, Italy
| | - Bruno Fionda
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS; Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - Silvia Cammelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
| | - Lidia Strigari
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS; Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - Alessio G. Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
| | - Milly Buwenge
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
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7
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Donati CM, Maggiore CM, Maltoni M, Rossi R, Nardi E, Zamagni A, Siepe G, Mammini F, Cellini F, Di Rito A, Portaluri M, De Tommaso C, Santacaterina A, Tamburella C, Di Franco R, Parisi S, Cossa S, Fusco V, Bianculli A, Ziccarelli P, Ziccarelli L, Genovesi D, Caravatta L, Deodato F, Macchia G, Fiorica F, Napoli G, Buwenge M, Morganti AG. Adequacy of Pain Management in Patients Referred for Radiation Therapy: A Subanalysis of the Multicenter ARISE-1 Study. Cancers (Basel) 2023; 16:109. [PMID: 38201537 PMCID: PMC10778440 DOI: 10.3390/cancers16010109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Pain is a prevalent symptom among cancer patients, and its management is crucial for improving their quality of life. However, pain management in cancer patients referred to radiotherapy (RT) departments is often inadequate, and limited research has been conducted on this specific population. This study aimed to assess the adequacy and effectiveness of pain management when patients are referred for RT. Moreover, we explored potential predictors of adequate pain management. METHODS This observational, prospective, multicenter cohort study included cancer patients aged 18 years or older who were referred to RT departments. A pain management assessment was conducted using the Pain Management Index (PMI), calculated by subtracting the pain score from the analgesic score (PMI < 0 indicated inadequate pain management). Univariate and multivariate analyses were performed to identify predictors of adequate pain management. RESULTS A total of 1042 cancer outpatients were included in the study. The analysis revealed that 42.9% of patients with pain did not receive adequate pain management based on PMI values. Among patients with pain or taking analgesics and referred to palliative or curative RT, 72% and 75% had inadequate or ineffective analgesic therapy, respectively. The odds of receiving adequate pain management (PMI ≥ 0) were higher in patients undergoing palliative RT (OR 2.52; p < 0.001), with worse ECOG-PS scores of 2, 3 and 4 (OR 1.63, 2.23, 5.31, respectively; p: 0.017, 0.002, 0.009, respectively) compared to a score of 1 for those with cancer-related pain (OR 0.38; p < 0.001), and treated in northern Italy compared to central and southern of Italy (OR 0.25, 0.42, respectively; p < 0.001). CONCLUSIONS In this study, a substantial proportion of cancer patients referred to RT departments did not receive adequate pain management. Educational and organizational strategies are necessary to address the inadequate pain management observed in this population. Moreover, increasing the attention paid to non-cancer pain and an earlier referral of patients for palliative RT in the course of the disease may improve pain response and treatment outcomes.
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Affiliation(s)
- Costanza M. Donati
- Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.S.); (F.M.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
| | - Chiara Maria Maggiore
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
| | - Marco Maltoni
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Romina Rossi
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
- Palliative Care Unit, AUSL Romagna, 40121 Forlì, Italy
| | - Elena Nardi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40126 Bologna, Italy
| | - Alice Zamagni
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
| | - Giambattista Siepe
- Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.S.); (F.M.); (A.G.M.)
| | - Filippo Mammini
- Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.S.); (F.M.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
| | - Francesco Cellini
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, IRCCS, UOC di Radioterapia, Fondazione Policlinico Universitario A. Gemelli, 00168 Roma, Italy;
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Alessia Di Rito
- IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy;
| | | | | | - Anna Santacaterina
- U.O. di Radioterapia AOOR PAPARDO PIEMONTE, 98121 Messina, Italy; (A.S.); (C.T.)
| | - Consuelo Tamburella
- U.O. di Radioterapia AOOR PAPARDO PIEMONTE, 98121 Messina, Italy; (A.S.); (C.T.)
| | - Rossella Di Franco
- S.C. di Radioterapia dell’Istituto Nazionale Tumori Pascale, 80131 Napoli, Italy;
| | - Salvatore Parisi
- Radioterapia Opera di S. Pio da Pietralcina, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (S.P.); (S.C.)
| | - Sabrina Cossa
- Radioterapia Opera di S. Pio da Pietralcina, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (S.P.); (S.C.)
| | - Vincenzo Fusco
- IRCCS CROB, 85028 Rionero in Vulture, Italy; (V.F.); (A.B.)
| | | | - Pierpaolo Ziccarelli
- U.O. Radioterapia Oncologica, S.O. Mariano Santo, 87100 Cosenza, Italy; (P.Z.); (L.Z.)
| | - Luigi Ziccarelli
- U.O. Radioterapia Oncologica, S.O. Mariano Santo, 87100 Cosenza, Italy; (P.Z.); (L.Z.)
| | - Domenico Genovesi
- Radiation Oncology Unit, Università degli Studi G. D’Annunzio, 66100 Chieti, Italy; (D.G.); (L.C.)
| | - Luciana Caravatta
- Radiation Oncology Unit, Università degli Studi G. D’Annunzio, 66100 Chieti, Italy; (D.G.); (L.C.)
| | - Francesco Deodato
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Radiotherapy Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, 86100 Campobasso, Italy; (F.D.); (G.M.)
| | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, 86100 Campobasso, Italy; (F.D.); (G.M.)
| | - Francesco Fiorica
- U.O.C. di Radioterapia e Medicina Nucleare, Ospedale Mater Salutis di Legnago, 37045 Verona, Italy; (F.F.); (G.N.)
| | - Giuseppe Napoli
- U.O.C. di Radioterapia e Medicina Nucleare, Ospedale Mater Salutis di Legnago, 37045 Verona, Italy; (F.F.); (G.N.)
| | - Milly Buwenge
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
| | - Alessio G. Morganti
- Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.S.); (F.M.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
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8
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Buwenge M, Macchia G, Cavallini L, Cortesi A, Malizia C, Bianchi L, Ntreta M, Arcelli A, Capocaccia I, Natoli E, Cilla S, Cellini F, Tagliaferri L, Strigari L, Cammelli S, Schiavina R, Brunocilla E, Morganti AG, Deodato F. Unraveling the safety of adjuvant radiotherapy in prostate cancer: impact of older age and hypofractionated regimens on acute and late toxicity - a multicenter comprehensive analysis. Front Oncol 2023; 13:1281432. [PMID: 38192625 PMCID: PMC10773688 DOI: 10.3389/fonc.2023.1281432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/28/2023] [Indexed: 01/10/2024] Open
Abstract
Background The objective of this study was to assess the impact of age and other patient and treatment characteristics on toxicity in prostate cancer patients receiving adjuvant radiotherapy (RT). Materials and methods This observational study (ICAROS-1) evaluated both acute (RTOG) and late (RTOG/EORTC) toxicity. Patient- (age; Charlson's comorbidity index) and treatment-related characteristics (nodal irradiation; previous TURP; use, type, and duration of ADT, RT fractionation and technique, image-guidance systems, EQD2 delivered to the prostate bed and pelvic nodes) were recorded and analyzed. Results A total of 381 patients were enrolled. The median EQD2 to the prostate bed (α/β=1.5) was 71.4 Gy. The majority of patients (75.4%) were treated with intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT). Acute G3 gastrointestinal (GI) and genitourinary (GU) toxicity rates were 0.5% and 1.3%, respectively. No patients experienced >G3 acute toxicity. The multivariable analysis of acute toxicity (binomial logistic regression) showed a statistically significant association between older age (> 65) and decreased odds of G≥2 GI acute toxicity (OR: 0.569; 95%CI: 0.329-0.973; p: 0.040) and decreased odds of G≥2 GU acute toxicity (OR: 0.956; 95%CI: 0.918-0.996; p: 0.031). The 5-year late toxicity-free survival rates for G≥3 GI and GU toxicity were 98.1% and 94.5%, respectively. The only significant correlation found (Cox's regression model) was a reduced risk of late GI toxicity in patients undergoing hypofractionation (HR: 0.38; 95% CI: 0.18-0.78; p: 0.008). Conclusions The unexpected results of this analysis could be explained by a "response shift bias" concerning the protective effect of older age and by treatment in later periods (using IMRT/VMAT) concerning the favorable effect of hypofractionation. However, overall, the study suggests that age should not be a reason to avoid adjuvant RT and that the latter is well-tolerated even with moderately hypofractionated regimens.
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Affiliation(s)
- Milly Buwenge
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Letizia Cavallini
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Annalisa Cortesi
- Radiotherapy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Claudio Malizia
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Bianchi
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Ntreta
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandra Arcelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ilaria Capocaccia
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elena Natoli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital, Campobasso, Italy
| | - Francesco Cellini
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Silvia Cammelli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Riccardo Schiavina
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Eugenio Brunocilla
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessio Giuseppe Morganti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 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
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9
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Ferioli M, Perrone AM, Buwenge M, Arcelli A, Vadala’ M, Fionda B, Malato MC, De Iaco P, Zamagni C, Cammelli S, Tagliaferri L, Morganti AG. Combination of Electrochemotherapy with Radiotherapy: A Comprehensive, Systematic, PRISMA-Compliant Review of Efficacy and Potential Radiosensitizing Effects in Tumor Control. Curr Oncol 2023; 30:9895-9905. [PMID: 37999139 PMCID: PMC10670517 DOI: 10.3390/curroncol30110719] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/25/2023] Open
Abstract
Radiotherapy (RT) and electrochemotherapy (ECT) are established local treatments for cancer. While effective, both therapies have limitations, especially in treating bulky and poorly oxygenated tumors. ECT has emerged as a promising palliative treatment, raising interest in exploring its combination with RT to enhance tumor response. However, the potential benefits and challenges of combining these treatments remain unclear. A systematic review was conducted following PRISMA guidelines. PubMed, Scopus, and Cochrane libraries were searched. Studies were screened and selected based on predefined inclusion and exclusion criteria. Ten studies were included, comprising in vitro and in vivo experiments. Different tumor types were treated with ECT alone or in combination with RT. ECT plus RT demonstrated superior tumor response compared to that under single therapies or other combinations, regardless of the cytotoxic agent and RT dose. However, no study demonstrated a clear superadditive effect in cell survival curves, suggesting inconclusive evidence of specific ECT-induced radiosensitization. Toxicity data were limited. In conclusion, the combination of ECT and RT consistently improved tumor response compared to that with individual therapies, supporting the potential benefit of their combination. However, evidence for a specific ECT-induced radiosensitization effect is currently lacking. Additional investigations are necessary to elucidate the potential benefits of this combination therapy.
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Affiliation(s)
- Martina Ferioli
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (A.M.P.); (M.B.); (A.A.); (M.C.M.); (P.D.I.); (S.C.); (A.G.M.)
| | - Anna M. Perrone
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (A.M.P.); (M.B.); (A.A.); (M.C.M.); (P.D.I.); (S.C.); (A.G.M.)
- Division of Oncologic Gynaecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Milly Buwenge
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (A.M.P.); (M.B.); (A.A.); (M.C.M.); (P.D.I.); (S.C.); (A.G.M.)
| | - Alessandra Arcelli
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (A.M.P.); (M.B.); (A.A.); (M.C.M.); (P.D.I.); (S.C.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Maria Vadala’
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Bruno Fionda
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, 00168 Roma, Italy; (B.F.); (L.T.)
| | - Maria C. Malato
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (A.M.P.); (M.B.); (A.A.); (M.C.M.); (P.D.I.); (S.C.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Pierandrea De Iaco
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (A.M.P.); (M.B.); (A.A.); (M.C.M.); (P.D.I.); (S.C.); (A.G.M.)
- Division of Oncologic Gynaecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Claudio Zamagni
- Oncologia Medica Addarii, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Silvia Cammelli
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (A.M.P.); (M.B.); (A.A.); (M.C.M.); (P.D.I.); (S.C.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, 00168 Roma, Italy; (B.F.); (L.T.)
| | - Alessio G. Morganti
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (A.M.P.); (M.B.); (A.A.); (M.C.M.); (P.D.I.); (S.C.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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10
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Medici F, Ferioli M, Forlani L, Laghi V, Ma J, Cilla S, Buwenge M, Macchia G, Deodato F, Vadalà M, Malizia C, Tagliaferri L, Perrone AM, De Iaco P, Strigari L, Arcelli A, Morganti AG. Decoding the Complexity of Systemic Inflammation Predictors in Locally Advanced Cervical Cancer, with Hemoglobin as the Hidden Key (the ESTHER Study). Cancers (Basel) 2023; 15:5056. [PMID: 37894423 PMCID: PMC10605166 DOI: 10.3390/cancers15205056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Locally advanced cervical cancer (LACC) is treated with concurrent chemoradiation (CRT). Predictive models could improve the outcome through treatment personalization. Several factors influence prognosis in LACC, but the role of systemic inflammation indices (IIs) is unclear. This study aims to assess the correlation between IIs and prognosis in a large patient cohort considering several clinical data. We retrospectively analyzed pretreatment IIs (NLR, PLR, MLR, SII, LLR, COP-NLR, APRI, ALRI, SIRI, and ANRI) in 173 LACC patients. Patient, tumor, and treatment characteristics were also considered. Univariate and multivariate Cox's regressions were conducted to assess associations between IIs and clinical factors with local control (LC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS). Univariate analysis showed significant correlations between age, HB levels, tumor stage, FIGO stage, and CRT dose with survival outcomes. Specific pretreatment IIs (NLR, PLR, APRI, ANRI, and COP-NLR) demonstrated associations only with LC. The multivariate analysis confirmed Hb levels, CRT dose, and age as significant predictors of OS, while no II was correlated with any clinical outcome. The study findings contradict some prior research on IIs in LACC, emphasizing the need for comprehensive assessments of potential confounding variables.
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Affiliation(s)
- Federica Medici
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Martina Ferioli
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
| | - Ludovica Forlani
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Viola Laghi
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Johnny Ma
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy;
| | - Milly Buwenge
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
| | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 86100 Campobasso, Italy; (G.M.); (F.D.)
| | - Francesco Deodato
- Radiotherapy Unit, Gemelli Molise Hospital, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 86100 Campobasso, Italy; (G.M.); (F.D.)
| | - Maria Vadalà
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.V.); (C.M.)
| | - Claudio Malizia
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.V.); (C.M.)
| | - Luca Tagliaferri
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy;
| | - Anna Myriam Perrone
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Pierandrea De Iaco
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Lidia Strigari
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Alessandra Arcelli
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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11
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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.
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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
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12
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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.
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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
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13
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Ferioli M, Benini A, Malizia C, Forlani L, Medici F, Laghi V, Ma J, Galuppi A, Cilla S, Buwenge M, Macchia G, Zamagni C, Tagliaferri L, Perrone AM, De Iaco P, Strigari L, Morganti AG, Arcelli A. Classical Prognostic Factors Predict Prognosis Better than Inflammatory Indices in Locally Advanced Cervical Cancer: Results of a Comprehensive Observational Study including Tumor-, Patient-, and Treatment-Related Data (ESTHER Study). J Pers Med 2023; 13:1229. [PMID: 37623479 PMCID: PMC10456032 DOI: 10.3390/jpm13081229] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/12/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
Systemic inflammation indices were found to be correlated with therapeutic outcome in several cancers. This study retrospectively analyzes the predictive role of a broad range of systemic inflammatory markers in patients with locally advanced cervical cancer (LACC) including patient-, tumor-, and treatment-related potential prognostic factors. All patients underwent definitive chemoradiation and pretreatment values of several inflammatory indices (neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio, monocyte/lymphocyte ratio, systemic immune inflammation index (SII), leukocyte/lymphocyte ratio, combination of platelet count and NLR, aspartate aminotransferase/platelet ratio index, aspartate aminotransferase/lymphocyte ratio index, systemic inflammatory response index, and aspartate transaminase/neutrophil ratio index) were calculated. Their correlation with local control (LC), distant metastasis-free (DMFS), disease-free (DFS), and overall survival (OS) was analyzed. One hundred and seventy-three patients were included. At multivariable analysis significant correlations were recorded among clinical outcomes and older age, advanced FIGO stage, lower hemoglobin levels, larger tumor size, and higher body mass index values. The multivariate analysis showed only the significant correlation between higher SII values and lower DMFS rates (p < 0.01). Our analysis showed no significant correlation between indices and DSF or OS. Further studies are needed to clarify the role of inflammation indices as candidates for inclusion in predictive models in this clinical setting.
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Affiliation(s)
- Martina Ferioli
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (A.B.); (L.F.); (F.M.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.G.M.); (A.A.)
| | - Anna Benini
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (A.B.); (L.F.); (F.M.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.G.M.); (A.A.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Claudio Malizia
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Ludovica Forlani
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (A.B.); (L.F.); (F.M.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.G.M.); (A.A.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Federica Medici
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (A.B.); (L.F.); (F.M.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.G.M.); (A.A.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Viola Laghi
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (A.B.); (L.F.); (F.M.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.G.M.); (A.A.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Johnny Ma
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (A.B.); (L.F.); (F.M.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.G.M.); (A.A.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Andrea Galuppi
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy;
| | - Milly Buwenge
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (A.B.); (L.F.); (F.M.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.G.M.); (A.A.)
| | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 86100 Campobasso, Italy;
| | - Claudio Zamagni
- Addarii Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Luca Tagliaferri
- Gemelli ART (Advanced Radiation Therapy)—Interventional Oncology Center (IOC), Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Roma, Italy;
| | - Anna Myriam Perrone
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (A.B.); (L.F.); (F.M.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.G.M.); (A.A.)
- Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Pierandrea De Iaco
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (A.B.); (L.F.); (F.M.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.G.M.); (A.A.)
- Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Lidia Strigari
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Alessio Giuseppe Morganti
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (A.B.); (L.F.); (F.M.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.G.M.); (A.A.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Alessandra Arcelli
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (A.B.); (L.F.); (F.M.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.G.M.); (A.A.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
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14
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Ferioli M, Medici F, Galietta E, Forlani L, Tagliaferri L, Cilla S, Cammelli S, Morganti AG, Buwenge M. The role of training simulators in interventional radiation therapy (brachytherapy) training: A narrative review. J Contemp Brachytherapy 2023; 15:290-295. [PMID: 37799124 PMCID: PMC10548427 DOI: 10.5114/jcb.2023.131240] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/30/2023] [Indexed: 10/07/2023] Open
Abstract
Simulators have revolutionized medical education and training across various disciplines, offering unique advantages in skill acquisition and performance improvement. In the context of interventional radiation therapy (IRT), simulators have emerged as valuable tools for training healthcare professionals in these complex procedures. This narrative review summarized the available evidence on the use of simulators in IRT training, highlighting their impact on proficiency, engagement, and self-confidence as well as their benefits for medical physicists and radiation therapists. A systematic search was conducted in PubMed, resulting in inclusion of 10 papers published since 2009, with 5 of them published since 2020. Publications originated from centers in USA, Ireland, Switzerland, Canada, and Japan, covering a range of IRT settings, including general, prostate, and cervical IRT. The review demonstrated that simulators provide a controlled and realistic environment for skill acquisition, allowing healthcare professionals to practice procedures, optimize image quality, and enhance technical proficiency. The use of simulators addressed the barriers associated with limited caseload and procedural complexity, ultimately contributing to improved education and IRT training. While cost considerations may exist, simulators offer long-term cost-effective solutions, balancing the potential benefits in improving educational outcomes and patient care. Overall, simulators play a crucial role in IRT training, enhancing the skills and competence of healthcare providers and improving access to quality IRT care worldwide. Future research should focus on evaluating the long-term impact of simulation-based training on clinical outcomes and patient satisfaction, exploring different simulation models and training approaches, and addressing region-specific barriers to optimize the utilization of IRT.
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Affiliation(s)
- Martina Ferioli
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
| | - Federica Medici
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Erika Galietta
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ludovica Forlani
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luca Tagliaferri
- Gemelli ART (Advanced Radiation Therapy) – Interventional Oncology Center (IOC), Fondazione Policlinico Universitario «Agostino Gemelli» IRCCS, Rome, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital, Campobasso, Italy
| | - Silvia Cammelli
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessio G. Morganti
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Milly Buwenge
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
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15
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Arcelli A, Tarantino G, Cellini F, Buwenge M, Macchia G, Bertini F, Guido A, Deodato F, Cilla S, Scotti V, Rosetto ME, Djan I, Parisi S, Mattiucci GC, Fiore M, Bonomo P, Belgioia L, Niespolo RM, Gabriele P, Di Marco M, Simoni N, Ma J, Strigari L, Mazzarotto R, Morganti AG. Comparative Effectiveness of Chemotherapy Alone Versus Radiotherapy-Based Regimens in Locally Advanced Pancreatic Cancer: A Real-World Multicenter Analysis (PAULA-1). Curr Oncol 2023; 30:5690-5703. [PMID: 37366910 DOI: 10.3390/curroncol30060427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/30/2023] [Accepted: 06/04/2023] [Indexed: 06/28/2023] Open
Abstract
Different options for locally advanced pancreatic cancer (LAPC) are available based on international guidelines: chemotherapy (CHT), chemoradiation (CRT), and stereotactic body radiotherapy (SBRT). However, the role of radiotherapy is debated in LAPC. We retrospectively compared CHT, CRT, and SBRT ± CHT in a real-world setting in terms of overall survival (OS), local control (LC), and distant metastasis-free survival (DMFS). LAPC patients from a multicentric retrospective database were included (2005-2018). Survival curves were calculated using the Kaplan-Meier method. Multivariable Cox analysis was performed to identify predictors of LC, OS, and DMFS. Of the 419 patients included, 71.1% were treated with CRT, 15.5% with CHT, and 13.4% with SBRT. Multivariable analysis showed higher LC rates for CRT (HR: 0.56, 95%CI 0.34-0.92, p = 0.022) or SBRT (HR: 0.27, 95%CI 0.13-0.54, p < 0.001), compared to CHT. CRT (HR: 0.44, 95%CI 0.28-0.70, p < 0.001) and SBRT (HR: 0.40, 95%CI 0.22-0.74, p = 0.003) were predictors of prolonged OS with respect to CHT. No significant differences were recorded in terms of DMFS. In selected patients, the addition of radiotherapy to CHT is still an option to be considered. In patients referred for radiotherapy, CRT can be replaced by SBRT considering its duration, higher LC rate, and OS rate, which are at least comparable to that of CRT.
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Affiliation(s)
- Alessandra Arcelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Giuseppe Tarantino
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Francesco Cellini
- Radioterapia Oncologica ed Ematologia, Dipartimento Universitario Diagnostica per Immagini, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Radioterapia Oncologica ed Ematologia, Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Milly Buwenge
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, 40138 Bologna, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy
| | - Federica Bertini
- Radiation Oncology Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Alessandra Guido
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Francesco Deodato
- Radioterapia Oncologica ed Ematologia, Dipartimento Universitario Diagnostica per Immagini, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy
| | | | | | - Igor Djan
- Institute of Oncology Vojvodina, Sremska Kamenica, Medical Faculty, University of Novi Sad, 21204 Novi Sad, Serbia
| | - Salvatore Parisi
- Radiotherapy Unit, Ospedale Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Gian Carlo Mattiucci
- Radioterapia Oncologica ed Ematologia, Dipartimento Universitario Diagnostica per Immagini, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Radiation Oncology, Mater Olbia Hospital, 07026 Olbia, Italy
| | - Michele Fiore
- Research Unit of Radiation Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
- Operative Research Unit of Radiation Oncology, Fondazione Policlinico Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, 50134 Florence, Italy
| | - Liliana Belgioia
- Department of Radiotherapy, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Health Science Departmente (DISSAL), University of Genoa, 16132 Genova, Italy
| | - Rita Marina Niespolo
- Radiation Oncology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Pietro Gabriele
- Department of Radiotherapy, Fondazione del Piemonte per l'Oncologia (FPO), IRCCS Candiolo, 10060 Candiolo, Italy
| | - Mariacristina Di Marco
- Oncology Unit, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Nicola Simoni
- Radiotherapy Unit, Azienda Ospedaliera Universitaria, 43126 Parma, Italy
| | - Johnny Ma
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, 40138 Bologna, Italy
| | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, 40138 Bologna, Italy
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Cilla S, Pistilli D, Romano C, Macchia G, Pierro A, Arcelli A, Buwenge M, Morganti AG, Deodato F. CT-based radiomics prediction of complete response after stereotactic body radiation therapy for patients with lung metastases. Strahlenther Onkol 2023:10.1007/s00066-023-02086-6. [PMID: 37256303 DOI: 10.1007/s00066-023-02086-6] [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: 02/06/2023] [Accepted: 04/11/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE Stereotactic body radiotherapy (SBRT) is a key treatment modality for lung cancer patients. This study aims to develop a machine learning-based prediction model of complete response for lung oligometastatic cancer patients undergoing SBRT. MATERIALS AND METHODS CT images of 80 pulmonary oligometastases from 56 patients treated with SBRT were analyzed. The gross tumor volumes (GTV) were contoured on CT images. Patients that achieved complete response (CR) at 4 months were defined as responders. For each GTV, 107 radiomic features were extracted using the Pyradiomics software. The concordance correlation coefficients (CCC) between the region of interest (ROI)-based radiomics features obtained by the two segmentations were calculated. Pairwise feature interdependencies were evaluated using the Spearman rank correlation coefficient. The association of clinical variables and radiomics features with CR was evaluated with univariate logistic regression. Two supervised machine learning models, the logistic regression (LR) and the classification and regression tree analysis (CART), were trained to predict CR. The models were cross-validated using a five-fold cross-validation. The performance of models was assessed by receiver operating characteristic curve (ROC) and class-specific accuracy, precision, recall, and F1-measure evaluation metrics. RESULTS Complete response was associated with four radiomics features, namely the surface to volume ratio (SVR; p = 0.003), the skewness (Skew; p = 0.027), the correlation (Corr; p = 0.024), and the grey normalized level uniformity (GNLU; p = 0.015). No significant relationship between clinical parameters and CR was found. In the validation set, the developed LR and CART machine learning models had an accuracy, precision, and recall of 0.644 and 0.750, 0.644 and 0.651, and 0.635 and 0.754, respectively. The area under the curve for CR prediction was 0.707 and 0.753 for the LR and CART models, respectively. CONCLUSION This analysis demonstrates that radiomics features obtained from pretreatment CT could predict complete response of lung oligometastases following SBRT.
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Affiliation(s)
- Savino Cilla
- Gemelli Molise Hospital, Medical Physics Unit, Largo Gemelli 1, 86100, Campobasso, Italy.
| | - Domenico Pistilli
- Gemelli Molise Hospital, Medical Physics Unit, Largo Gemelli 1, 86100, Campobasso, Italy
| | - Carmela Romano
- Gemelli Molise Hospital, Medical Physics Unit, Largo Gemelli 1, 86100, Campobasso, Italy
| | | | - Antonio Pierro
- Radiology Unit, Gemelli Molise Hospital, Campobasso, Italy
| | - Alessandra Arcelli
- Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Milly Buwenge
- 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, Diagnostic, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy
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Galietta E, Strolin S, Bisello S, Cellini F, Lovato L, Ravegnini G, Martignani C, Spadotto A, Buwenge M, Cammelli S, Strigari L, Morganti AG, Arcelli A. Stereotactic Arrhythmia Radioablation (STAR): A Multidisciplinary Narrative Minireview of Preclinical Studies. In Vivo 2023; 37:963-971. [PMID: 37103087 DOI: 10.21873/invivo.13170] [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: 02/06/2023] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 04/28/2023]
Abstract
The aim of this narrative review of the literature was to collect and analyze the results of the published preclinical studies on stereotactic arrhythmia radioablation (STAR) in the treatment of refractory cardiac arrhythmias. A literature search was conducted on PubMed using the following terms: ("stereotactic" OR "SBRT" OR "SABR" OR "radioablation" OR "radiosurgery") AND ("arrhythmia" OR "tachycardia"). Preclinical and pathological reports published in English without time limit, comprising studies of STAR in animal models and histological analyzes of explanted animal and human hearts were included. The analyzed studies confirm that doses lower than 25 Gy seem to produce sub-optimal therapeutic results whereas doses >35 Gy are less safe in terms of radiation-induced toxicity. However, long-term results (>1 year) are still missing and reporting outcomes based on low dose irradiation (≤15 Gy). Finally, STAR proved to be an effective therapy in the analyzed studies despite the irradiation of rather different cardiac targets. Therefore, additional studies are needed to: 1) compare the outcomes of STAR at doses of 25 Gy versus 30 Gy; 2) evaluate the long-term results (>1 year) in animal models irradiated at doses similar to those used in the clinic; 3) define the optimal target.
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Affiliation(s)
- Erika Galietta
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy;
- Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Silvia Strolin
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Silvia Bisello
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesco Cellini
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Luigi Lovato
- Cardio-Thoracic-Vascular Department, Cardio-Thoracic Radiology, Cardiovascular Section, AOU Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Gloria Ravegnini
- Department of Pharmacy and Biotechnology (FABIT), University of Bologna, Bologna, Italy
| | - Cristian Martignani
- Cardio-Thoracic-Vascular Department, Cardio-Thoracic Radiology, Cardiovascular Section, AOU Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Alberto Spadotto
- Cardio-Thoracic-Vascular Department, Cardio-Thoracic Radiology, Cardiovascular Section, AOU Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Milly Buwenge
- Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Silvia Cammelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Lidia Strigari
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessio G Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alessandra Arcelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Romano C, Viola P, Craus M, Macchia G, Ferro M, Bonome P, Pierro A, Buwenge M, Arcelli A, Morganti AG, Deodato F, Cilla S. Feasibility-guided automated planning for stereotactic treatments of prostate cancer. Med Dosim 2023:S0958-3947(23)00020-1. [PMID: 36990847 DOI: 10.1016/j.meddos.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/09/2023] [Accepted: 02/23/2023] [Indexed: 03/29/2023]
Abstract
Significant improvements in plan quality using automated planning have been previously demonstrated. The aim of this study was to develop an optimal automated class solution for stereotactic radiotherapy (SBRT) planning of prostate cancer using the new Feasibility module implemented in the pinnacle evolution. Twelve patients were retrospectively enrolled in this planning study. Five plans were designed for each patient. Four plans were automatically generated using the 4 proposed templates for SBRT optimization implemented in the new pinnacle evolution treatment planning systems, differing for different settings of dose-fallout (low, medium, high and veryhigh). Based on the obtained results, the fifth plan (feas) was generated customizing the template with the optimal criteria obtained from the previous step and integrating in the template the "a-priori" knowledge of OARs sparing based on the Feasibility module, able to estimate the best possible dose-volume histograms of OARs before starting optimization. Prescribed dose was 35 Gy to the prostate in 5 fractions. All plans were generated with a full volumetric-modulated arc therapy arc and 6MV flattening filter-free beams, and optimized to ensure the same target coverage (95% of the prescription dose to 98% of the target). Plans were assessed according to dosimetric parameters and planning and delivery efficiency. Differences among the plans were evaluated using a Kruskal-Wallis 1-way analysis of variance. The requests for more aggressive objectives for dose falloff parameters (from low to veryhigh) translated in a statistically significant improvement of dose conformity, but at the expense of a dose homogeneity. The best automated plans in terms of best trade-off between target coverage and OARs sparing among the 4 plans automatically generated by the SBRT module were the high plans. The veryhigh plans reported a significant increase of high-doses to prostate, rectum, and bladder that was considered dosimetrically and clinically unacceptable. The feas plans were optimized on the basis on high plans, reporting significant reduction of rectum irradiation; Dmean, and V18 decreased by 19% to 23% (p = 0.031) and 4% to 7% (p = 0.059), respectively. No statistically significant differences were found in femoral heads and penile bulb irradiation for all dosimetric metrics. feas plans showed a significant increase of MU/Gy (mean: 368; p = 0.004), reflecting an increased level of fluence modulation. Thanks to the new efficient optimization engines implemented in pinnacle evolution (L-BFGS and layered graph), mean planning time was decreased to less than 10 minutes for all plans and all techniques. The integration of dose-volume histograms a-priori knowledge provided by the feasibility module in the automated planning process for SBRT planning has shown to significantly improve plan quality compared to generic protocol values as inputs.
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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.
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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
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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.
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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
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Guido A, Cuicchi D, Castellucci P, Cellini F, Di Fabio F, Llimpe FLR, Strigari L, Buwenge M, Cilla S, Deodato F, Macchia G, Galietta E, Golfieri R, Ardizzoni A, Zagari RM, Fanti S, Poggioli G, Fuccio L, Morganti AG. Adaptive Individualized high-dose preoperAtive (AIDA) chemoradiation in high-risk rectal cancer: a phase II trial. Eur J Nucl Med Mol Imaging 2023; 50:572-580. [PMID: 36127416 PMCID: PMC9816267 DOI: 10.1007/s00259-022-05944-0] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/12/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE To evaluate the pathological complete response (pCR) rate of locally advanced rectal cancer (LARC) after adaptive high-dose neoadjuvant chemoradiation (CRT) based on 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG-PET/CT). METHODS The primary endpoint was the pCR rate. Secondary endpoints were the predictive value of 18 F-FDG-PET/CT on pathological response and acute and late toxicity. All patients performed 18 F-FDG-PET/CT at baseline (PET0) and after 2 weeks during CRT (PET1). The metabolic PET parameters were calculated both at the PET0 and PET1. The total CRT dose was 45 Gy to the pelvic lymph nodes and 50 Gy to the primary tumor, corresponding mesorectum, and to metastatic lymph nodes. Furthermore, a sequential boost was delivered to a biological target volume defined by PET1 with an additional dose of 5 Gy in 2 fractions. Capecitabine (825 mg/m2 twice daily orally) was prescribed for the entire treatment duration. RESULTS Eighteen patients (13 males, 5 females; median age 55 years [range, 41-77 years]) were enrolled in the trial. Patients underwent surgical resection at 8-9 weeks after the end of neoadjuvant CRT. No patient showed grade > 1 acute radiation-induced toxicity. Seven patients (38.8%) had TRG = 0 (complete regression), 5 (27.0%) showed TRG = 2, and 6 (33.0%) had TRG = 3. Based on the TRG results, patients were classified in two groups: TRG = 0 (pCR) and TRG = 1, 2, 3 (non pCR). Accepting p < 0.05 as the level of significance, at the Kruskal-Wallis test, the medians of baseline-MTV, interim-SUVmax, interim-SUVmean, interim-MTV, interim-TLG, and the MTV reduction were significantly different between the two groups. 18 F-FDG-PET/CT was able to predict the pCR in 77.8% of cases through compared evaluation of both baseline PET/CT and interim PET/CT. CONCLUSIONS Our results showed that a dose escalation on a reduced target in the final phase of CRT is well tolerated and able to provide a high pCR rate.
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Affiliation(s)
- Alessandra Guido
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Dajana Cuicchi
- Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paolo Castellucci
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Cellini
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Roma, Italy.
- Università Cattolica del Sacro Cuore, Dipartimento Universitario Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Largo Agostino Gemelli 8, 00168, Roma, Italy.
| | - Francesca Di Fabio
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Milly Buwenge
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Savino Cilla
- Medical Physics, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesco Deodato
- Università Cattolica del Sacro Cuore, Dipartimento Universitario Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Largo Agostino Gemelli 8, 00168, Roma, Italy
- Radiation Oncology, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Gabriella Macchia
- Radiation Oncology, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Erika Galietta
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Rita Golfieri
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Ardizzoni
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Rocco Maurizio Zagari
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Gastroenterology Unit, Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gilberto Poggioli
- Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Digestive Medicine and Surgery, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Lorenzo Fuccio
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Gastroenterology Unit, Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna, Bologna, Italy
| | - Alessio G Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
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22
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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.
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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.
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23
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Slotman DJ, Bartels MMTJ, Ferrer CJ, Bos C, Bartels LW, Boomsma MF, Phernambucq ECJ, Nijholt IM, Morganti AG, Siepe G, Buwenge M, Grüll H, Bratke G, Yeo SY, Blanco Sequeiros R, Minn H, Huhtala M, Napoli A, De Felice F, Catalano C, Bazzocchi A, Gasperini C, Campanacci L, Simões Corrêa Galendi J, Müller D, Braat MNGJA, Moonen C, Verkooijen HM. Focused Ultrasound and RadioTHERapy for non-invasive palliative pain treatment in patients with bone metastasis: a study protocol for the three armed randomized controlled FURTHER trial. Trials 2022; 23:1061. [PMID: 36582001 PMCID: PMC9798627 DOI: 10.1186/s13063-022-06942-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/17/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Cancer-induced bone pain (CIBP), caused by bone metastases, is a common complication of cancer and strongly impairs quality of life (QoL). External beam radiotherapy (EBRT) is the current standard of care for treatment of CIBP. However, approximately 45% of patients have no adequate pain response after EBRT. Magnetic resonance image-guided high-intensity focused ultrasound (MR-HIFU) may improve pain palliation in this patient population. The main objective of this trial was to compare MR-HIFU, EBRT, and MR-HIFU + EBRT for the palliative treatment of bone metastases. METHODS/DESIGN The FURTHER trial is an international multicenter, three-armed randomized controlled trial. A total of 216 patients with painful bone metastases will be randomized in a 1:1:1 ratio to receive EBRT only, MR-HIFU only, or combined treatment with EBRT followed by MR-HIFU. During a follow-up period of 6 months, patients will be contacted at eight time points to retrieve information about their level of pain, QoL, and the occurrence of (serious) adverse events. The primary outcome of the trial is pain response at 14 days after start of treatment. Secondary outcomes include pain response at 14 days after trial enrolment, pain scores (daily until the 21st day and at 4, 6, 12 and 24 weeks), toxicity, adverse events, QoL, and survival. Cost-effectiveness and cost-utility analysis will be conducted. DISCUSSION The FURTHER trial aims to evaluate the effectiveness and cost-effectiveness of MR-HIFU-alone or in combination with EBRT-compared to EBRT to relieve CIBP. The trial will be performed in six hospitals in four European countries, all of which are partners in the FURTHER consortium. TRIAL REGISTRATION The FURTHER trial is registered under the Netherlands Trials Register number NL71303.041.19 and ClinicalTrials.gov registration number NCT04307914. Date of trial registration is 13-01-2020.
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Affiliation(s)
- Derk J. Slotman
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands ,grid.452600.50000 0001 0547 5927Department of Radiology, Isala Hospital, Zwolle, The Netherlands
| | - Marcia M. T. J. Bartels
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Cyril J. Ferrer
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Clemens Bos
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lambertus W. Bartels
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Martijn F. Boomsma
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands ,grid.452600.50000 0001 0547 5927Department of Radiology, Isala Hospital, Zwolle, The Netherlands
| | - Erik C. J. Phernambucq
- grid.452600.50000 0001 0547 5927Department of Radiation Oncology, Isala Hospital, Zwolle, The Netherlands
| | - Ingrid M. Nijholt
- grid.452600.50000 0001 0547 5927Department of Radiology, Isala Hospital, Zwolle, The Netherlands
| | - Alessio G. Morganti
- grid.6292.f0000 0004 1757 1758DIMES, Alma Mater Studiorum - Bologna University, Bologna, Italy ,grid.6292.f0000 0004 1757 1758Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Giambattista Siepe
- grid.6292.f0000 0004 1757 1758Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Milly Buwenge
- grid.6292.f0000 0004 1757 1758DIMES, Alma Mater Studiorum - Bologna University, Bologna, Italy
| | - Holger Grüll
- grid.6190.e0000 0000 8580 3777Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Grischa Bratke
- grid.6190.e0000 0000 8580 3777Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sin Yuin Yeo
- grid.6190.e0000 0000 8580 3777Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Roberto Blanco Sequeiros
- grid.410552.70000 0004 0628 215XDepartment of Radiology, Turku University Hospital, Turku, Finland
| | - Heikki Minn
- grid.1374.10000 0001 2097 1371Department of Oncology, University of Turku and Turku University Hospital, Turku, Finland
| | - Mira Huhtala
- grid.1374.10000 0001 2097 1371Department of Oncology, University of Turku and Turku University Hospital, Turku, Finland
| | - Alessandro Napoli
- grid.7841.aDepartment of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesca De Felice
- grid.7841.aDepartment of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- grid.7841.aDepartment of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Alberto Bazzocchi
- grid.419038.70000 0001 2154 6641Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Chiara Gasperini
- grid.419038.70000 0001 2154 6641Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Laura Campanacci
- grid.419038.70000 0001 2154 66413Rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Julia Simões Corrêa Galendi
- grid.6190.e0000 0000 8580 3777Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Dirk Müller
- grid.6190.e0000 0000 8580 3777Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Manon N. G. J. A. Braat
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Chrit Moonen
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Helena M. Verkooijen
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
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24
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Donati CM, Macchia G, Siepe G, Zamagni A, Benini A, Cellini F, Buwenge M, Cilla S, Cammelli S, Rizzo S, Caravatta L, Wondemagegnhu T, Uddin AFMK, Deressa BT, Sumon MA, Lodi Rizzini E, Bazzocchi A, Morganti AG, Deodato F, Farina E. Short course palliative radiotherapy in advanced solid tumors: a pooled analysis (the SHARON project). Sci Rep 2022; 12:20978. [PMID: 36471159 PMCID: PMC9723107 DOI: 10.1038/s41598-022-25602-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 03/21/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Previous trials showed the tolerability and efficacy of a palliative radiotherapy (RT) regimen (SHARON) based on the 4 fractions delivered in 2 days in different oncological settings. In order to identify possible predictors of symptomatic response, the purpose of this study is to perform a pooled analysis of previous trials. We analyzed the impact on symptomatic response of the following parameters: tumor site, histological type, performance status (ECOG), dominant symptom, and RT dose using the Chi-square test and Fisher's exact test. One-hundred-eighty patients were analyzed. Median RT dose was 20 Gy (range: 14-20 Gy). The overall response rate was 88.8% (95% CI 83.3-92.7%) while pre- and post-treatment mean VAS was 5.3 (± 7.7) and 2.2 (± 2.2), respectively (p < 0.001). The overall response rate of pain, dyspnea, bleeding, dysphagia, and other symptoms was 86.2%, 90.9%, 100%, 87.5%, and 100%, respectively. Comparing the symptomatic effect based on the analyzed parameters no significant differences were recorded. However, patients with locally advanced disease showed a higher rate of symptomatic responses than metastatic ones (97.3% vs 83.0%; p = 0.021). Finally, the complete pain response rate was more than double in patients with mild to moderate (VAS: 4-7) compared to those with severe (VAS > 7) pain (36.0% vs 14.3%; p = 0.028). This pooled analysis showed high efficacy of the SHARON regimen in the relief of several cancer-related symptoms. The markedly and significantly higher complete pain response rate, in patients with mild-moderate pain, suggests early referral to palliative RT for patients with cancer-related pain.
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Affiliation(s)
- Costanza Maria Donati
- grid.6292.f0000 0004 1757 1758Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy ,grid.6292.f0000 0004 1757 1758IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Gabriella Macchia
- grid.8142.f0000 0001 0941 3192Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.8142.f0000 0001 0941 3192Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Giambattista Siepe
- grid.6292.f0000 0004 1757 1758IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Alice Zamagni
- grid.6292.f0000 0004 1757 1758Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Anna Benini
- grid.6292.f0000 0004 1757 1758Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy ,grid.6292.f0000 0004 1757 1758IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Francesco Cellini
- grid.8142.f0000 0001 0941 3192Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.8142.f0000 0001 0941 3192Università Cattolica del Sacro Cuore, Dipartimento Universitario Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy ,grid.8142.f0000 0001 0941 3192Istituto di Radiologia, Università Cattolica Sacro Cuore, Rome, Italy
| | - Milly Buwenge
- grid.6292.f0000 0004 1757 1758Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Savino Cilla
- grid.8142.f0000 0001 0941 3192Medical Physics Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Silvia Cammelli
- grid.6292.f0000 0004 1757 1758Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy ,grid.6292.f0000 0004 1757 1758IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Stefania Rizzo
- grid.469433.f0000 0004 0514 7845Service of Radiology, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Luciana Caravatta
- grid.412451.70000 0001 2181 4941Department of Radiation Oncology, Santissima Annunziata Hospital, Gabriele D’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Tigeneh Wondemagegnhu
- grid.59547.3a0000 0000 8539 4635Radiotherapy Department, Tikur Anbessa Specialized Hospital, Department of Clinical Oncology, College of Medicine and Health Sciences, University of Gondar, 9086 Addis Ababa, Ethiopia
| | | | - Biniyam Tefera Deressa
- grid.59547.3a0000 0000 8539 4635Radiotherapy Department, Tikur Anbessa Specialized Hospital, Department of Clinical Oncology, College of Medicine and Health Sciences, University of Gondar, 9086 Addis Ababa, Ethiopia
| | - Mostafa A. Sumon
- Department of Radiation Oncology, United Hospital Limited, Dhaka, Bangladesh
| | - Elisa Lodi Rizzini
- grid.6292.f0000 0004 1757 1758IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Alberto Bazzocchi
- grid.419038.70000 0001 2154 6641Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessio G. Morganti
- grid.6292.f0000 0004 1757 1758Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy ,grid.6292.f0000 0004 1757 1758IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Francesco Deodato
- grid.8142.f0000 0001 0941 3192Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.8142.f0000 0001 0941 3192Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Eleonora Farina
- grid.416315.4Radiotherapy Unit, Azienda Ospedaliero-Universitaria Di Ferrara, Ferrara, Italy
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25
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Zamagni A, Bonetti M, Buwenge M, Macchia G, Deodato F, Cilla S, Galietta E, Strigari L, Cellini F, Tagliaferri L, Cammelli S, Morganti AG. Stereotactic radiotherapy of nodal oligometastases from prostate cancer: a prisma-compliant systematic review. Clin Exp Metastasis 2022; 39:845-863. [PMID: 35980556 PMCID: PMC9637632 DOI: 10.1007/s10585-022-10183-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 08/04/2022] [Indexed: 12/25/2022]
Abstract
Androgen deprivation therapy (ADT) is the standard treatment of metastatic prostate cancer (PCa). However, metastases-directed therapies can delay the initiation or switch of systemic treatments and allow local control (LC) and prolonged progression-free survival (PFS), particularly in patients with lymph nodes (LN) oligometastases. We performed a systematic review on stereotactic body radiotherapy (SBRT) in this setting. Papers reporting LC and/or PFS were selected. Data on ADT-free survival, overall survival, and toxicity were also collected from the selected studies. Fifteen studies were eligible (414 patients), 14 of them were retrospective analyses. A high heterogeneity was observed in terms of patient selection and treatment. In one study SBRT was delivered as a single 20 Gy fraction, while in the others the median total dose ranged between 24 and 40 Gy delivered in 3-6 fractions. LC and PFS were reported in 15 and 12 papers, respectively. LC was reported as a crude percentage in 13 studies, with 100% rate in seven and 63.2-98.0% in six reports. Five studies reported actuarial LC (2-year LC: 70.0-100%). PFS was reported as a crude rate in 11 studies (range 27.3-68.8%). Actuarial 2-year PFS was reported in four studies (range 30.0-50.0%). SBRT tolerability was excellent, with only two patients with grade 3 acute toxicity and two patients with grade 3 late toxicity. SBRT for LN oligorecurrences from PCa in safe and provides optimal LC. However, the long-term effect on PFS and OS is still unclear as well as which patients are the best candidate for this approach.
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Affiliation(s)
- Alice Zamagni
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum - Bologna University, Bologna, Italy.
| | - Mattia Bonetti
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum - Bologna University, Bologna, Italy
| | - Milly Buwenge
- 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
| | - 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
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Erika Galietta
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum - Bologna University, Bologna, Italy
| | - Lidia Strigari
- Medical Physics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Cellini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica ed Ematologia, Rome, Italy
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - Silvia Cammelli
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum - Bologna University, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessio Giuseppe Morganti
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum - Bologna University, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Cilla S, Viola P, Romano C, Craus M, Macchia G, Buwenge M, Indovina L, Valentini V, Morganti AG, Deodato F. MACHINE LEARNING BASED PREDICTION AND CLASSIFICATION OF VMAT PLANS DOSIMETRIC ACCURACY USING PLAN COMPLEXITY AND LOG-FILES ANALYSIS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)02181-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Medici F, Rizzo S, Buwenge M, Arcelli A, Ferioli M, Macchia G, Deodato F, Cilla S, De Iaco P, Perrone AM, Strolin S, Strigari L, Ravegnini G, Bazzocchi A, Morganti AG. Everything You Always Wanted to Know about Sarcopenia but Were Afraid to Ask: A Quick Guide for Radiation Oncologists (Impact of Sarcopenia in Radiotherapy: The AFRAID Project). Curr Oncol 2022; 29:8513-8528. [PMID: 36354731 PMCID: PMC9689889 DOI: 10.3390/curroncol29110671] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/21/2022] [Accepted: 11/05/2022] [Indexed: 11/10/2022] Open
Abstract
Sarcopenia (SP) is a syndrome characterized by age-associated loss of skeletal muscle mass and function. SP worsens both acute and late radiation-induced toxicity, prognosis, and quality of life. Myosteatosis is a pathological infiltration of muscle tissue by adipose tissue which often precedes SP and has a proven correlation with prognosis in cancer patients. Sarcopenic obesity is considered a "hidden form" of SP (due to large fat mass) and is independently related to higher mortality and worse complications after surgery and systemic treatments with worse prognostic impact compared to SP alone. The evaluation of SP is commonly based on CT images at the level of the middle of the third lumbar vertebra. On this scan, all muscle structures are contoured and then the outlined surface area is calculated. Several studies reported a negative impact of SP on overall survival in patients undergoing RT for tumors of the head and neck, esophagus, rectum, pancreas, cervix, and lung. Furthermore, several appetite-reducing side effects of RT, along with more complex radiation-induced mechanisms, can lead to SP through, but not limited to, reduced nutrition. In particular, in pediatric patients, total body irradiation was associated with the onset of SP and other changes in body composition leading to an increased risk of cardiometabolic morbidity in surviving adults. Finally, some preliminary studies showed the possibility of effectively treating SP and preventing the worsening of SP during RT. Future studies should be able to provide information on how to prevent and manage SP before, during, or after RT, in both adult and pediatric patients.
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Affiliation(s)
- Federica Medici
- Department of Experimental, Radiation Oncology, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-051-214-3564
| | - Stefania Rizzo
- Service of Radiology, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland
| | - Milly Buwenge
- Department of Experimental, Radiation Oncology, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Alessandra Arcelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Martina Ferioli
- Department of Experimental, Radiation Oncology, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy
| | - Pierandrea De Iaco
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy
| | - Anna Myriam Perrone
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy
| | - Silvia Strolin
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Gloria Ravegnini
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alessio G. Morganti
- Department of Experimental, Radiation Oncology, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Scirocco E, Cellini F, Donati CM, Capuccini J, Rossi R, Buwenge M, Montanari L, Maltoni M, Morganti AG. Improving the Integration between Palliative Radiotherapy and Supportive Care: A Narrative Review. Curr Oncol 2022; 29:7932-7942. [PMID: 36290904 PMCID: PMC9601168 DOI: 10.3390/curroncol29100627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/03/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
Palliative radiotherapy (PRT) is known to be effective in relieving cancer related symptoms. However, many studies and clinical practice show several barriers hindering its use and worsening the quality of patient support during PRT. Various solutions were proposed to overcome these barriers: training on PRT for supportive and palliative care specialists and training on palliative care for radiation oncologists, and introduction of pathways and organizational models specifically dedicated to PRT. Evidence on innovative organizational models and mutual training experiences is few and sparse. Therefore, the aim of this literature review is to present a quick summary of the information available on improving the PRT quality through training, new pathways, and innovative organizational models. The majority of studies on the integration of PRT with other palliative and supportive therapies present low levels of evidence being mostly retrospective analyses. However, it should be emphasized that all reports uniformly showed advantages coming from the integration of PRT with supportive therapies. To actively participate in the integration of PRT and palliative care, providing comprehensive support to the needs of patients with advanced cancer, radiation oncologists should not only plan PRT but also: (i) assess and manage symptoms and stress, (ii) rapidly refer patients to specialists in management of more complex symptoms, and (iii) participate in multidisciplinary palliative care teams. To this end, improved education in palliative care both in residency schools and during professional life through continuous medical education is clearly needed. In particular, effective training is needed for radiotherapy residents to enable them to provide patients with comprehensive palliative care. Therefore, formal teaching of adequate duration, interactive teaching methods, attendance in palliative care services, and education in advanced palliative care should be planned in post-graduated schools of radiotherapy.
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Affiliation(s)
- Erica Scirocco
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-051-2143564
| | - Francesco Cellini
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00185 Roma, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00185 Roma, Italy
| | - Costanza Maria Donati
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Jenny Capuccini
- Palliative Care Unit, AUSL Romagna (Local Health Authority), 48022 Lugo, Italy
| | - Romina Rossi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Milly Buwenge
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Luigi Montanari
- Palliative Care Unit, AUSL Romagna (Local Health Authority), 48022 Lugo, Italy
| | - Marco Maltoni
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
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Donati CM, Nardi E, Zamagni A, Siepe G, Mammini F, Cellini F, Di Rito A, Portaluri M, De Tommaso C, Santacaterina A, Tamburella C, Di Franco R, Parisi S, Cossa S, Fusco V, Bianculli A, Ziccarelli P, Ziccarelli L, Genovesi D, Caravatta L, Deodato F, Macchia G, Fiorica F, Napoli G, Buwenge M, Rossi R, Maltoni M, Morganti AG. Adequacy of Pain Treatment in Radiotherapy Departments: Results of a Multicenter Study on 2104 Patients (Arise). Cancers (Basel) 2022; 14:cancers14194660. [PMID: 36230582 PMCID: PMC9563985 DOI: 10.3390/cancers14194660] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/19/2022] Open
Abstract
Aim: The frequent inadequacy of pain management in cancer patients is well known. Moreover, the quality of analgesic treatment in patients treated with radiotherapy (RT) has only been rarely assessed. In order to study the latter topic, we conducted a multicenter, observational and prospective study based on the Pain Management Index (PMI) in RT Italian departments. Methods: We collected data on age, gender, tumor site and stage, performance status, treatment aim, and pain (type: CP—cancer pain, NCP—non-cancer pain, MP—mixed pain; intensity: NRS: Numeric Rating Scale). Furthermore, we analyzed the impact on PMI on these parameters, and we defined a pain score with values from 0 (NRS: 0, no pain) to 3 (NRS: 7−10: intense pain) and an analgesic score from 0 (pain medication not taken) to 3 (strong opioids). By subtracting the pain score from the analgesic score, we obtained the PMI value, considering cases with values < 0 as inadequate analgesic prescriptions. The Ethics Committees of the participating centers approved the study (ARISE-1 study). Results: Two thousand one hundred four non-selected outpatients with cancer and aged 18 years or older were enrolled in 13 RT departments. RT had curative and palliative intent in 62.4% and 37.6% patients, respectively. Tumor stage was non-metastatic in 57.3% and metastatic in 42.7% of subjects, respectively. Pain affected 1417 patients (CP: 49.5%, NCP: 32.0%; MP: 18.5%). PMI was < 0 in 45.0% of patients with pain. At multivariable analysis, inadequate pain management was significantly correlated with curative RT aim, ECOG performance status = 1 (versus both ECOG-PS3 and ECOG- PS4), breast cancer, non-cancer pain, and Central and South Italy RT Departments (versus Northern Italy).Conclusions: Pain management was less adequate in patients with more favorable clinical condition and stage. Educational and organizational strategies are needed in RT departments to reduce the non-negligible percentage of patients with inadequate analgesic therapy.
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Affiliation(s)
- Costanza M. Donati
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-051-2143564
| | - Elena Nardi
- Medical Statistics, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Alice Zamagni
- Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Giambattista Siepe
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Filippo Mammini
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Francesco Cellini
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, 00168 Roma, Italy
- Radioterapia Oncologica ed Ematologia, Dipartimento Universitario Diagnostica per Immagini, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Roma, Italy
| | - Alessia Di Rito
- IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy
| | | | | | | | | | - Rossella Di Franco
- S.C. di Radioterapia dell’Istituto Nazionale Tumori Pascale, 80131 Napoli, Italy
| | - Salvatore Parisi
- Radioterapia Opera di S. Pio da Pietralcina, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Sabrina Cossa
- Radioterapia Opera di S. Pio da Pietralcina, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | | | | | | | - Luigi Ziccarelli
- U.O. Radioterapia Oncologica-S.O. Mariano Santo, 87100 Cosenza, Italy
| | - Domenico Genovesi
- Radioterapia Università degli Studi G. D’Annunzio, 66100 Chieti, Italy
| | - Luciana Caravatta
- Radioterapia Università degli Studi G. D’Annunzio, 66100 Chieti, Italy
| | - Francesco Deodato
- Radioterapia Oncologica ed Ematologia, Dipartimento Universitario Diagnostica per Immagini, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Roma, Italy
- Radiotherapy Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, 86100 Campobasso, Italy
| | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, 86100 Campobasso, Italy
| | - Francesco Fiorica
- U.O.C.di Radioterapia e Medicina Nucleare, Ospedale Mater Salutis di Legnago, 37045 Verona, Italy
| | - Giuseppe Napoli
- U.O.C.di Radioterapia e Medicina Nucleare, Ospedale Mater Salutis di Legnago, 37045 Verona, Italy
| | - Milly Buwenge
- Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Romina Rossi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Marco Maltoni
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Alessio G. Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
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Viola P, Romano C, Craus M, Macchia G, Buwenge M, Indovina L, Valentini V, Morganti AG, Deodato F, Cilla S. Prediction of VMAT delivery accuracy using plan modulation complexity score and log-files analysis. Biomed Phys Eng Express 2022; 8. [PMID: 35858537 DOI: 10.1088/2057-1976/ac82c6] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/20/2022] [Indexed: 11/12/2022]
Abstract
The purpose of this study was to develop a predictive model based on plan complexity metrics and linac log-files analysis to classify the dosimetric accuracy of VMAT plans. A total of 612 VMAT plans, corresponding to 1224 arcs, were analyzed. All VMAT arcs underwent pre-treatment verification that was performed by means of the dynamic log-files generated by the linac. The comparison of predicted (by TPS) and measured (by log-files) integral fluences was performed using γ-analysis in terms of the percentage of points with γ-value smaller than one (γ%) and using a stringent 2%(local)/2mm criteria. This γ-analysis was performed by a commercial software LinacWatch. The action limits (AL) were derived from the mean values, standard deviations and the confidence limit (CL) of the γ% distribution. A plan complexity metric, the modulation complexity score (MCS), based on the aperture beam area variability and leaf sequence variability was used as input variable of the model. A binary logistic regression (LR) model was developed to classify QA results as "pass" (γ%≥AL) or "fail" (γ%<AL). Receiver operator characteristics (ROC) curves were used to determine the optimal MCS threshold to flag "failed" plans that need to be re-optimized. The model reliability was evaluated stratifying the plans in training, validation and testing groups. The confidence and action limits for γ% were found 20.1% and 79.9%, respectively. The accuracy of the model for the training and testing dataset was 97.4% and 98.0%, respectively. The optimal MCS threshold value for the identification of failed plans was 0.142, providing a true positive rate able to flag the plans failing QA of 91%. In clinical routine, the use of this MCS threshold may allow the prompt identification of overly modulated plans, then reducing the number of QA failures and improving the quality of VMAT plans used for treatment.
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Affiliation(s)
- Pietro Viola
- Gemelli Molise Hospital, Largo Gemelli 1, Campobasso, 86100, ITALY
| | - Carmela Romano
- Gemelli Molise Hospital, Largo Gemelli 1, Campobasso, 86100, ITALY
| | - Maurizio Craus
- Gemelli Molise Hospital, Largo Gemelli 1, Campobasso, 86100, ITALY
| | | | - Milly Buwenge
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Via Giuseppe Massarenti, 9, Bologna, Emilia-Romagna, 40138, ITALY
| | - Luca Indovina
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Via della Pineta Sacchetti, 217, Roma, Lazio, 00168, ITALY
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Via della Pineta Sacchetti, 217, Roma, Lazio, 00168, ITALY
| | - Alessio Giuseppe Morganti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Via Giuseppe Massarenti, 9, Bologna, Emilia-Romagna, 40138, ITALY
| | - Francesco Deodato
- Gemelli Molise Hospital, Largo A. Gemelli 1, Campobasso, 86100, ITALY
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital, Largo A. Gemelli 1, Campobasso, 86100, ITALY
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Deodato F, Pezzulla D, Cilla S, Ferro M, Romano C, Bonome P, Buwenge M, Zamagni A, Strigari L, Valentini V, Morganti AG, Macchia G. Stereotactic radiosurgery for bone metastases in oligometastatic prostate cancer patients: DESTROY-2 clinical trial subanalysis. Clin Transl Oncol 2022; 24:1177-1183. [PMID: 34984604 DOI: 10.1007/s12094-021-02764-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 10/23/2021] [Accepted: 12/20/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Aim of this analysis was to report toxicity and clinical outcomes in oligorecurrent prostate cancer (PCa) patients treated with single fraction stereotactic radiosurgery (SRS) for bone metastases. METHODS We separately analyzed clinical data of PCa patients with bone oligometastases enrolled in a prospective phase I trial (DESTROY-2). DESTROY-2 was based on SRS delivered using volumetric modulated arc therapy in patients with primary or metastatic tumors in several extra-cranial body sites. Acute and late toxicity, biochemical tumor response, local control (LC), distant metastases-free (DPFS), progression-free (PFS), time to next-line systemic treatment-free (NEST-FS), and overall survival (OS) were calculated. RESULTS Data on 37 PCa patients, carrying out 50 bone metastases, candidates for curative-intent treatment and treated with SRS at our Institution were collected. SRS dose ranged between 12 and 24 Gy. One grade 1 acute skin toxicity in one patient treated on the hip (24 Gy) and one grade 1 late skin toxicity in a patient with a scapular lesion (24 Gy) were recorded. No cases of bone fracture were registered in the treated population. With a median follow-up of 25 months (range 3-72 months) 2-year actuarial LC, DPFS, PFS, and OS were 96.7%, 58.1%, 58.1%, and 95.8%, respectively. Median and 2-year NEST-FS were 30 months (range 1-69 months) and 51.2%, respectively. CONCLUSIONS Data analysis showed few toxicity events, high local control rate and prolonged NEST-FS after linear accelerator-based radiosurgery of bone oligometastases from PCa. The possibility of postponing systemic treatments in patients with oligometastatic PCa by means of SRS should be taken into account. Further prospective studies on larger series are needed to confirm the reported results.
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Affiliation(s)
- F Deodato
- Radiation Oncology Unit, Gemelli Molise S.P.A. Hospital, Università Cattolica del S. Cuore, Largo A. Gemelli 1, 86100, Campobasso, Italy.,Radiology Institute, Università Cattolica del Sacro Cuore, 00135, Rome, Italy
| | - D Pezzulla
- Radiation Oncology Unit, Gemelli Molise S.P.A. Hospital, Università Cattolica del S. Cuore, Largo A. Gemelli 1, 86100, Campobasso, Italy.
| | - S Cilla
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - M Ferro
- Radiation Oncology Unit, Gemelli Molise S.P.A. Hospital, Università Cattolica del S. Cuore, Largo A. Gemelli 1, 86100, Campobasso, Italy
| | - C Romano
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - P Bonome
- Radiation Oncology Unit, Gemelli Molise S.P.A. Hospital, Università Cattolica del S. Cuore, Largo A. Gemelli 1, 86100, 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
| | - A Zamagni
- Radiotherapy Department, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Giuseppe Massarenti, Bologna, Italy
| | - L Strigari
- Medical Physics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - V Valentini
- Radiology Institute, Università Cattolica del Sacro Cuore, 00135, 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 University, Bologna, Italy
| | - G Macchia
- Radiation Oncology Unit, Gemelli Molise S.P.A. Hospital, Università Cattolica del S. Cuore, Largo A. Gemelli 1, 86100, Campobasso, Italy
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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.
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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
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Medici F, Bazzocchi A, Buwenge M, Zamagni A, Macchia G, Deodato F, Cilla S, De Iaco P, Perrone AM, Strigari L, Rizzo S, Morganti AG. Impact and Treatment of Sarcopenia in Patients Undergoing Radiotherapy: A Multidisciplinary, AMSTAR-2 Compliant Review of Systematic Reviews and Metanalyses. Front Oncol 2022; 12:887156. [PMID: 35692790 PMCID: PMC9177942 DOI: 10.3389/fonc.2022.887156] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/26/2022] [Indexed: 12/11/2022] Open
Abstract
Background Sarcopenia (SP) is defined as the quantitative and functional impairment of skeletal muscles. SP is commonly related to older age and is frequent in patients with cancer. To provide an overview of SP in patients treated with radiotherapy (RT) and to evaluate the current evidence, we analyzed the available systematic reviews and meta-analyses. Methods Reviews were identified using PubMed, Scopus, and Cochrane library databases, without date restriction. Only systematic reviews and meta-analyses on the prognostic impact of SP and on any treatments aimed at reducing SP effect, in patients undergoing RT, were included in this review. The analyses not separately reporting the results in patients treated with RT were excluded. The quality assessment was performed using AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews). Results From the 84 papers identified, five reviews met the inclusion criteria with four reports mainly including non-randomized trials. Three reviews on the effect of SP showed a significantly negative impact on overall survival in patients undergoing RT and/or chemoradiation for H&N cancers (HR: 1.63-2.07). Two reviews on interventional studies showed the possibility of 1) improving physical functions through nutritional and physical interventions and 2) avoiding muscle wasting by means of sufficient protein intake. The quality assessment of the included review showed that two and three analyses are classifiable as having low and moderate overall confidence rating, respectively. Conclusions The analyzed reviews uniformly confirmed the negative impact of SP in patients with H&N tumors undergoing RT and the possibility of improving muscle mass and function through nutritional and physical interventions. These results justify further research on this topic based on a more uniform SP definition and on a complete evaluation of the potentially confounding parameters.
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Affiliation(s)
- Federica Medici
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
- *Correspondence: Federica Medici,
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Milly Buwenge
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alice Zamagni
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gabriella Macchia
- 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
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Pierandrea De Iaco
- Division of Oncologic Gynecology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, Bologna, Italy
| | - Anna Myriam Perrone
- Division of Oncologic Gynecology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, Bologna, Italy
| | - Lidia Strigari
- Medical Physics Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefania Rizzo
- Service of Radiology, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Alessio G. Morganti
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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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]
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35
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Romano C, Viola P, Craus M, Macchia G, Ferro M, Bonome P, Indovina L, Buwenge M, Cammelli S, Valentini V, Morganti A, Deodato F, Cilla S. PO-1744 Feasibility-guided automation of prostate SBRT planning: the power of DVHs a-priori knowledge. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03708-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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36
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Ferioli M, Perrone AM, Castellucci P, Panni V, Benini A, Macchia G, Galuppi A, Buwenge M, Lodi Rizzini E, Strigari L, Tagliaferri L, Zamagni C, De Iaco P, Fanti S, Morganti AG. Adjuvant radiotherapy of endometrial cancer: role of 18F-FDG-PET/CT in treatment modulation. EUR J GYNAECOL ONCOL 2022. [DOI: 10.31083/j.ejgo4302028] [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: 11/06/2022]
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37
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Buwenge M, Arcelli A, Cellini F, Deodato F, Macchia G, Cilla S, Galietta E, Strigari L, Malizia C, Cammelli S, Morganti AG. Pain Relief after Stereotactic Radiotherapy of Pancreatic Adenocarcinoma: An Updated Systematic Review. Curr Oncol 2022; 29:2616-2629. [PMID: 35448188 PMCID: PMC9032429 DOI: 10.3390/curroncol29040214] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/23/2022] [Accepted: 04/06/2022] [Indexed: 02/07/2023] Open
Abstract
Severe pain is frequent in patients with locally advanced pancreatic ductal adenocarcinoma (PDCA). Stereotactic body radiotherapy (SBRT) provides high local control rates in these patients. The aim of this review was to systematically analyze the available evidence on pain relief in patients with PDCA. We updated our previous systematic review through a search on PubMed of papers published from 1 January 2018 to 30 June 2021. Studies with full available text, published in English, and reporting pain relief after SBRT on PDCA were included in this analysis. Statistical analysis was carried out using the MEDCALC statistical software. All tests were two-sided. The I2 statistic was used to quantify statistical heterogeneity (high heterogeneity level: >50%). Nineteen papers were included in this updated literature review. None of them specifically aimed at assessing pain and/or quality of life. The rate of analgesics reduction or suspension ranged between 40.0 and 100.0% (median: 60.3%) in six studies. The pooled rate was 71.5% (95% CI, 61.6−80.0%), with high heterogeneity between studies (Q2 test: p < 0.0001; I2 = 83.8%). The rate of complete response of pain after SBRT ranged between 30.0 and 81.3% (median: 48.4%) in three studies. The pooled rate was 51.9% (95% CI, 39.3−64.3%), with high heterogeneity (Q2 test: p < 0.008; I2 = 79.1%). The rate of partial plus complete pain response ranged between 44.4 and 100% (median: 78.6%) in nine studies. The pooled rate was 78.3% (95% CI, 71.0−84.5%), with high heterogeneity (Q2 test: p < 0.0001; I2 = 79.4%). A linear regression with sensitivity analysis showed significantly improved overall pain response as the EQD2α/β:10 increases (p: 0.005). Eight papers did not report any side effect during and after SBRT. In three studies only transient acute effects were recorded. The results of the included studies showed high heterogeneity. However, SBRT of PDCA resulted reasonably effective in producing pain relief in these patients. Further studies are needed to assess the impact of SBRT in this setting based on Patient-Reported Outcomes.
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Affiliation(s)
- Milly Buwenge
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.A.); (E.G.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic and Specialty Medicine—DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Alessandra Arcelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.A.); (E.G.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic and Specialty Medicine—DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Francesco Cellini
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.C.); (F.D.)
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC di Radioterapia, 00168 Roma, Italy
| | - Francesco Deodato
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.C.); (F.D.)
- Radiotherapy Unit, Gemelli Molise Hospital, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 1, 86100 Campobasso, Italy;
| | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 1, 86100 Campobasso, Italy;
| | - Savino Cilla
- Medical Physic Unit, Gemelli Molise Hospital, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 1, 86100 Campobasso, Italy;
| | - Erika Galietta
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.A.); (E.G.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic and Specialty Medicine—DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Lidia Strigari
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Claudio Malizia
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Silvia Cammelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.A.); (E.G.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic and Specialty Medicine—DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Alessio G. Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.A.); (E.G.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic and Specialty Medicine—DIMES, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
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Morganti AG, Macchia G, Cellini F, Deodato F, Zamagni A, Siepe G, Buwenge M. A "SHort course Accelerated RadiatiON therapy" (SHARON) During and Beyond the COVID-19 Pandemic. Front Oncol 2022; 12:823445. [PMID: 35280809 PMCID: PMC8904873 DOI: 10.3389/fonc.2022.823445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/11/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Alessio G Morganti
- Radiation Oncology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy.,Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES), Alma Mater Studiorum - Bologna University, Bologna, Italy
| | - Gabriella Macchia
- Gemelli Molise Hospital, Radiotherapy Unit, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesco Cellini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.,Dipartimento Universitario Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Deodato
- Gemelli Molise Hospital, Radiotherapy Unit, Università Cattolica del Sacro Cuore, Campobasso, Italy.,Dipartimento Universitario Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alice Zamagni
- Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES), Alma Mater Studiorum - Bologna University, Bologna, Italy
| | - Giambattista Siepe
- Radiation Oncology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy
| | - Milly Buwenge
- Radiation Oncology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy.,Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES), Alma Mater Studiorum - Bologna University, Bologna, Italy
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Galietta E, Gaiani L, Giannini C, Sambri A, Buwenge M, Macchia G, Deodato F, Cilla S, Strigari L, Fiore M, Cammelli S, De Paolis M, Morganti AG. Prophylactic Radiotherapy of Hip Heterotopic Ossification: A Narrative Mini Review. In Vivo 2022; 36:533-542. [PMID: 35241504 DOI: 10.21873/invivo.12735] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 11/10/2022]
Abstract
Evidence on prophylactic radiotherapy (RT) in hip heterotopic ossification (HO) is sparse and conflicting. The aim of this literature review was to collect and summarize the available data on RT efficacy in preventing hip HO. The results of this review show that RT is effective in the prevention of hip HO, albeit with large variability across series. Effective prophylactic RT requires optimal treatment fields and time intervals with surgery. On the contrary, there is no clear evidence on the optimal timing (post-operative versus pre-operative RT). Comparisons between prophylactic RT and use of non-steroidal anti-inflammatory drugs showed conflicting results, although most were in favor of RT. In conclusion, RT is an established prophylactic treatment for hip HO. However, optimal dose, technique and timing remain unclear, as does the usefulness of combining RT with drugs.
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Affiliation(s)
- Erika Galietta
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy;
| | - Luca Gaiani
- U.O. Ortopedia e Traumatologia, AUSL Imola, Imola, Italy
| | | | - Andrea Sambri
- UOC Ortopedia e Traumatologia, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | - Milly Buwenge
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gabriella Macchia
- 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
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Lidia Strigari
- Medical Physics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Silvia Cammelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Massimiliano De Paolis
- UOC Ortopedia e Traumatologia, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
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40
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Cilla S, Cellini F, Romano C, Macchia G, Pezzulla D, Viola P, Buwenge M, Indovina L, Valentini V, Morganti AG, Deodato F. Personalized Automation of Treatment Planning for Linac-Based Stereotactic Body Radiotherapy of Spine Cancer. Front Oncol 2022; 12:824532. [PMID: 35186757 PMCID: PMC8848468 DOI: 10.3389/fonc.2022.824532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/05/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose/Objective(s) Stereotactic ablative body radiotherapy (SBRT) for vertebral metastases is a challenging treatment process. Planning automation has recently reported the potential to improve plan quality and increase planning efficiency. We performed a dosimetric evaluation of the new Personalized engine implemented in Pinnacle3 for full planning automation of SBRT spine treatments in terms of plan quality, treatment efficiency, and delivery accuracy. Materials/Methods The Pinnacle3 treatment planning system was used to reoptimize six patients with spinal metastases, employing two separate automated engines. These two automated engines, the existing Autoplanning and the new Personalized, are both template-based algorithms that employ a wishlist to construct planning goals and an iterative technique to replicate the planning procedure performed by skilled planners. The boost tumor volume (BTV) was defined as the macroscopically visible lesion on RM examination, and the planning target volume (PTV) corresponds with the entire vertebra. Dose was prescribed according to simultaneous integrated boost strategy with BTV and PTV irradiated simultaneously over 3 fractions with a dose of 30 and 21 Gy, respectively. Dose-volume histogram (DVH) metrics and conformance indices were used to compare clinically accepted manual plans (MP) with automated plans developed using both Autoplanning (AP) and Personalized engines (Pers). All plans were evaluated for planning efficiency and dose delivery accuracy. Results For similar spinal cord sparing, automated plans reported a significant improvement of target coverage and dose conformity. On average, Pers plans increased near-minimal dose D98% by 10.4% and 8.9% and target coverage D95% by 8.0% and by 4.6% for BTV and PTV, respectively. Automated plans provided significantly superior dose conformity and dose contrast by 37%–47% and by 4.6%–5.7% compared with manual plans. Overall planning times were dramatically reduced to about 15 and 23 min for Pers and AP plans, respectively. The average beam-on times were found to be within 3 min for all plans. Despite the increased complexity, all plans passed the 2%/2 mm γ-analysis for dose verification. Conclusion Automated planning for spine SBRT through the new Pinnacle3 Personalized engine provided an overall increase of plan quality in terms of dose conformity and a major increase in efficiency. In this complex anatomical site, Personalized strongly reduce the tradeoff between optimal accurate dosimetry and planning time.
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Affiliation(s)
- Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesco Cellini
- Radiation Oncology Department, Fondazione Policlinico Universitario A. Gemelli - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carmela Romano
- 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
| | - Donato Pezzulla
- Radiation Oncology 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
| | - Milly Buwenge
- Radiation Oncology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale (DIMES), Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Luca Indovina
- Medical Physics Unit, 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
| | - Alessio G Morganti
- Radiation Oncology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale (DIMES), Alma Mater Studiorum Università di Bologna, 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
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Medici F, Siepe G, Strigari L, Massari F, Buwenge M, Bisello S, Castellucci P, Fanti S, Cammelli S, Morganti A. CARE‑compliant stereotactic radiotherapy of urothelial nodal metastases: A case report. Mol Clin Oncol 2022; 16:85. [PMID: 35251636 PMCID: PMC8892461 DOI: 10.3892/mco.2022.2518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/13/2022] [Indexed: 12/02/2022] Open
Abstract
The aim of the present study was to report the case of a 58-year-old male patient with ureteral carcinoma who underwent ureteroileostomy treatment. At 2 years following surgery, six lymph node metastases (LNMs) were detected in the patient's para-aortic and pelvic regions using 18F-labeled fluoro-2-deoxyglucose (FDG) positron emission tomography (PET)/CT. All LNMs were treated using stereotactic body radiotherapy (SBRT; 35-40 Gy/5 fractions). At 3 months after radiotherapy, 18F-FDG-PET/CT examination revealed a complete radiological and metabolic response of all targeted treatment sites in the patient. In the 2 years following radiotherapy, another three same-dose SBRT treatments were performed on single or multiple LNMs, which were all detected in the abdomen and pelvis of the patient. Overall, a total of 11 LNMs were targeted in the patient and all exhibited complete radiological and metabolic response following treatment. The only treatment side effect reported by the patient was a slight and temporary loss of appetite. In patients with lymph node oligometastases there are two options for radiotherapy: i) Irradiation focusing on LNMs alone; and ii) prophylactic irradiation of the entire lymph node area combined with a boost on macroscopic lesions. In the patient discussed in the present study, the choice of irradiation focusing on LNMs alone made it possible to postpone systemic therapies and instead use an optimally tolerated treatment. The treatment outcome in this patient indicated that there was no radioresistance of urothelial LNMs.
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Affiliation(s)
- Federica Medici
- Radiation Oncology Unit, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum Bologna University, I-40138 Bologna, Italy
| | - Giambattista Siepe
- Radiation Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero‑Universitaria di Bologna, I-40138 Bologna, Italy
| | - Lidia Strigari
- Medical Physics Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero‑Universitaria di Bologna, I-40138 Bologna, Italy
| | - Francesco Massari
- Medical Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero‑Universitaria di Bologna, I-40138 Bologna, Italy
| | - Milly Buwenge
- Radiation Oncology Unit, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum Bologna University, I-40138 Bologna, Italy
| | - Silvia Bisello
- Radiation Oncology Unit, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum Bologna University, I-40138 Bologna, Italy
| | - Paolo Castellucci
- Nuclear Medicine Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero‑Universitaria di Bologna, I-40138 Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero‑Universitaria di Bologna, I-40138 Bologna, Italy
| | - Silvia Cammelli
- Radiation Oncology Unit, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum Bologna University, I-40138 Bologna, Italy
| | - Alessio Morganti
- Radiation Oncology Unit, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum Bologna University, I-40138 Bologna, Italy
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Scirocco E, Cellini F, Zamagni A, Macchia G, Deodato F, Cilla S, Strigari L, Buwenge M, Rizzo S, Cammelli S, Morganti AG. Clinical Studies on Ultrafractionated Chemoradiation: A Systematic Review. Front Oncol 2021; 11:748200. [PMID: 34868948 PMCID: PMC8635188 DOI: 10.3389/fonc.2021.748200] [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: 07/27/2021] [Accepted: 10/25/2021] [Indexed: 01/08/2023] Open
Abstract
Aim The efficacy of low-dose fractionated radiotherapy (LDFRT) and chemotherapy (CHT) combination has large preclinical but little clinical evidence. Therefore, the aim of this review was to collect and analyze the clinical results of LDRT plus concurrent CHT in patients with advanced cancers. Methods A systematic literature search was conducted on PubMed using the PRISMA methodology. Only studies based on the combination of LDFRT (< 1 Gy/fraction) and CHT were included. Endpoints of the analysis were tumor response, toxicity, and overall survival, with particular focus on any differences between LDFRT-CHT and CHT alone. Results Twelve studies (307 patients) fulfilled the selection criteria and were included in this review. Two studies were retrospective, one was a prospective pilot trial, six were phase II studies, two were phase I trials, and one was a phase I/II open label study. No randomized controlled trials were found. Seven out of eight studies comparing clinical response showed higher rates after LDFRT-CHT compared to CHT alone. Three out of four studies comparing survival reported improved results after combined treatment. Three studies compared toxicity of CHT and LDFRT plus CHT, and all of them reported similar adverse events rates. In most cases, toxicity was manageable with only three likely LDFRT-unrelated fatal events (1%), all recorded in the same series on LDFRT plus temozolomide in glioblastoma multiforme patients. Conclusion None of the analyzed studies provided level I evidence on the clinical impact of LDFRT plus CHT. However, it should be noted that, apart from two small series of breast cancers, all studies reported improved therapeutic outcomes and similar tolerability compared to CHT alone. Systematic Review Registration www.crd.york.ac.uk/prospero/, identifier CRD42020206639.
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Affiliation(s)
- Erica Scirocco
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine-Alma Mater Studiorum Bologna University, Bologna, Italy
| | - Francesco Cellini
- Università Cattolica del Sacro Cuore, Dipartimento Universitario Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy.,Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
| | - Alice Zamagni
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine-Alma Mater Studiorum Bologna University, Bologna, Italy
| | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso, Italy
| | - Francesco Deodato
- Radiotherapy Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso, Italy
| | - Savino Cilla
- Medical Physic Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso, Italy
| | - Lidia Strigari
- Medical Physics Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Milly Buwenge
- Department of Experimental, Diagnostic and Specialty Medicine-Alma Mater Studiorum Bologna University, Bologna, Italy
| | - Stefania Rizzo
- Service of Radiology, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Silvia Cammelli
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine-Alma Mater Studiorum Bologna University, Bologna, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine-Alma Mater Studiorum Bologna University, Bologna, Italy
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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.
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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
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Galofaro E, Malizia C, Ammendolia I, Galuppi A, Guido A, Ntreta M, Siepe G, Tolento G, Veraldi A, Scirocco E, Arcelli A, Buwenge M, Ferioli M, Zamagni A, Strigari L, Cammelli S, Morganti AG. COVID-19 Pandemic-Adapted Radiotherapy Guidelines: Are They Really Followed? Curr Oncol 2021; 28:3323-3330. [PMID: 34590595 PMCID: PMC8482258 DOI: 10.3390/curroncol28050288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In our department, we provided guidelines to the radiation oncologists (ROs) regarding the omission, delay, or shortening of radiotherapy (RT). The purpose was to reduce the patients' exposure to the hospital environment and to minimize the departmental overcrowding. The aim was to evaluate the ROs' compliance to these guidelines. METHODS ROs were asked to fill out a data collection form during patients' first visits in May and June 2020. The collected data included the ROs' age and gender, patient age and residence, RT purpose, treated tumor, the dose and fractionation that would have been prescribed, and RT changes. The chi-square test and binomial logistic regression were used to analyze the correlation between the treatment prescription and the collected parameters. RESULTS One hundred and twenty-six out of 205 prescribed treatments were included in this analysis. Treatment was modified in 61.1% of cases. More specifically, the treatment was omitted, delayed, or shortened in 7.9, 15.9, and 37.3% of patients, respectively. The number of delivered fractions was reduced by 27.9%. A statistically significant correlation (p = 0.028) between younger patients' age and lower treatment modifications rate was recorded. CONCLUSION Our analysis showed a reasonably high compliance of ROs to the pandemic-adapted guidelines. The adopted strategy was effective in reducing the number of admissions to our department.
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Affiliation(s)
- Elena Galofaro
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-3409328999
| | - Claudio Malizia
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Ilario Ammendolia
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
| | - Andrea Galuppi
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
| | - Alessandra Guido
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
| | - Maria Ntreta
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
| | - Giambattista Siepe
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
| | - Giorgio Tolento
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
| | - Antonio Veraldi
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
| | - Erica Scirocco
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Alessandra Arcelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Milly Buwenge
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Martina Ferioli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Alice Zamagni
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Lidia Strigari
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Silvia Cammelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
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45
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Bisello S, Arcelli A, Deodato F, Dominsky N, Tarantino G, Ntreta M, Cilla S, Siepe G, Cavallini L, Pezzulla D, Alitto A, Cammelli S, Cortesi A, Romeo A, Frezza G, Morganti A, Macchia G, Buwenge M. PO-1391 Curative radiotherapy of prostate cancer: a risk stratification system based on prognostic factors. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07842-7] [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: 11/28/2022]
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46
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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]
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47
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Scirocco E, Cellini F, Zamagni A, Medici F, Bellarosa C, Macchia G, Deodato F, Cilla S, Picardi V, Strigari L, Buwenge M, Rizzo S, Cammelli S, Morganti A. PO-1503 A systematic review on ultra fractionated chemoradiation. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07954-8] [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: 10/20/2022]
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48
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Cilla S, Romano C, Morabito V, Viola P, Macchia G, Buwenge M, Cammelli S, Strigari L, Morganti A, Valentini V, Deodato F. PD-0746 Autoplanning and Personalized treatment planning automation in prostate cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07025-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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49
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Bisello S, Arcelli A, Deodato F, Dominsky N, Tarantino G, Ntreta M, Cilla S, Siepe G, Cavallini L, Pezzulla D, Alitto A, Re A, Cammelli S, Cortesi A, Romeo A, Frezza G, Morganti A, Macchia G, Buwenge M. PO-1392 Salvage radiotherapy of prostate cancer: a risk stratification system based on prognostic factors. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07843-9] [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]
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50
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Ferioli M, Perrone A, Buwenge M, Arcelli A, Zamagni A, Macchia G, Deodato F, Cilla S, Tagliaferri L, De Terlizzi F, De Iaco P, Zamagni C, Morganti A. PO-1510 Electrochemotherapy as a radiosensitizer in preclinical and clinical settings: a systematic review. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07961-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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