1
|
Bergamaschi L, Vincini MG, Zaffaroni M, Pepa M, Angelicone I, Astone A, Bergamini C, Buonopane S, Conte M, De Rosa N, Deantoni C, Dell'Oca I, Di Gennaro D, Di Muzio N, Osti MF, Federico M, Ferini G, Franzese C, Gatti M, Grillo A, Iorio V, Manzo R, Marmiroli L, Martin G, Mazzuca F, Molinaro MA, Muto M, Pacelli R, Pepe A, Perillo A, Russo D, Salerno F, Spadaro P, Viola A, Iorio GC, Muto P, Ricardi U, Alterio D. Management of radiation-induced oral mucositis in head and neck cancer patients: a real-life survey among 25 Italian radiation oncology centers. Support Care Cancer 2023; 32:38. [PMID: 38110572 PMCID: PMC10728275 DOI: 10.1007/s00520-023-08185-5] [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: 07/19/2023] [Accepted: 11/12/2023] [Indexed: 12/20/2023]
Abstract
AIM Radiation-induced oral mucositis (RIOM) is the most frequent side effect in head and neck cancer (HNC) patients treated with curative radiotherapy (RT). A standardized strategy for preventing and treating RIOM has not been defined. Aim of this study was to perform a real-life survey on RIOM management among Italian RT centers. METHODS A 40-question survey was administered to 25 radiation oncologists working in 25 different RT centers across Italy. RESULTS A total of 1554 HNC patients have been treated in the participating centers in 2021, the majority (median across the centers 91%) with curative intent. Median treatment time was 41 days, with a mean percentage of interruption due to toxicity of 14.5%. Eighty percent of responders provide written oral cavity hygiene recommendations. Regarding RIOM prevention, sodium bicarbonate mouthwashes, oral mucosa barrier agents, and hyaluronic acid-based mouthwashes were the most frequent topic agents used. Regarding RIOM treatment, 14 (56%) centers relied on literature evidence, while internal guidelines were available in 13 centers (44%). Grade (G)1 mucositis is mostly treated with sodium bicarbonate mouthwashes, oral mucosa barrier agents, and steroids, while hyaluronic acid-based agents, local anesthetics, and benzydamine were the most used in mucositis G2/G3. Steroids, painkillers, and anti-inflammatory drugs were the most frequent systemic agents used independently from the RIOM severity. CONCLUSION Great variety of strategies exist among Italian centers in RIOM management for HNC patients. Whether different strategies could impact patients' compliance and overall treatment time of the radiation course is still unclear and needs further investigation.
Collapse
Affiliation(s)
- Luca Bergamaschi
- Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Maria Giulia Vincini
- Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy.
| | - Mattia Zaffaroni
- Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Matteo Pepa
- Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Ilaria Angelicone
- Radiotherapy Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonio Astone
- Division of Medical Oncology, Fatebenefratelli San Pietro Hospital, 00189, Rome, Italy
| | - Cristiana Bergamini
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sergio Buonopane
- Radiation Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Mario Conte
- Fondazione Muto Onlus, Casavatore, Naples, Italy
| | - Nicola De Rosa
- Centro Aktis Diagnostica e Terapia, Marano, Naples, Italy
| | - Chiara Deantoni
- Radiotherapy Department, IRCCS San Raffaele Scientific Institute, Vita Salute S. Raffaele University, Milan, Italy
| | - Italo Dell'Oca
- Radiotherapy Department, IRCCS San Raffaele Scientific Institute, Vita Salute S. Raffaele University, Milan, Italy
| | | | - Nadia Di Muzio
- Radiotherapy Department, IRCCS San Raffaele Scientific Institute, Vita Salute S. Raffaele University, Milan, Italy
| | - Mattia Falchetto Osti
- Radiotherapy Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Manuela Federico
- Casa di cura Macchiarella, U.O. Radioterapia Oncologica, Palermo, Italy
| | | | - Ciro Franzese
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Marco Gatti
- Radiotherapy Unit, Candiolo Cancer Institute, FPO-IRCCS, Torino, Italy
| | - Antonietta Grillo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Policlinico, Bari, Italy
| | | | - Roberto Manzo
- Radiation Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Luca Marmiroli
- U.O. Radioterapia, Ospedale Fatebenefratelli S. Giovanni Calibita, Isola Tiberina, 00186, Rome, Italy
| | | | - Federica Mazzuca
- Radiotherapy Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Matteo Muto
- Department of Onco-Hematological Diseases, U.O.C. Radiotherapy-Azienda Ospedaliera San Giuseppe Moscati-(AV), 83100, Avellino, Italy
| | - Roberto Pacelli
- Department of Advanced Biomedical Sciences, Federico II University School of Medicine, Naples, Italy
| | | | - Annarita Perillo
- Centro Aktis Diagnostica e Terapia, Marano, Naples, Italy
- Department of Radiation Oncology, San Pio Hospital, Benevento, Italia
| | | | | | - Pietro Spadaro
- U.O. di Oncologia ed Ematologia, Casa di Cura Villa Salus, Messina, Italy
| | - Anna Viola
- Fondazione IOM, Viagrande, Catania, Italy
| | | | - Paolo Muto
- Radiation Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - Daniela Alterio
- Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| |
Collapse
|
2
|
Spampinato S, Rancati T, Waskiewicz JM, Avuzzi B, Garibaldi E, Faiella A, Villa E, Magli A, Cante D, Girelli G, Gatti M, Noris Chiorda B, Rago L, Ferrari P, Piva C, Pavarini M, Valdagni R, Vavassori V, Munoz F, Sanguineti G, Di Muzio N, Kirchheiner K, Fiorino C, Cozzarini C. Patient-reported persistent symptoms after radiotherapy and association with quality of life for prostate cancer survivors. Acta Oncol 2023; 62:1440-1450. [PMID: 37801288 DOI: 10.1080/0284186x.2023.2259597] [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: 05/25/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE To evaluate the persistence of symptoms after radiotherapy (RT) for localised prostate cancer (PCa) and the association with quality of life (QOL). MATERIALS AND METHODS Prospective patient-reported outcome (PRO) from a multi-institutional study on PCa treated with radical RT (2010-2014) was analysed. Data was collected at baseline (BL) and follow-ups (FUPs) up to 5 years. Patients with BL and ≥3 late FUPs (≥6 months) were analysed. PRO was scored by means of the IPSS and ICIQ-SF (urinary), LENT-SOMA (gastrointestinal [GI]), and EORTC-C30 (pain, insomnia, fatigue, and QOL) questionnaires. Symptoms were defined 'persistent' if the median score over FUPs was ≥3 (urinary) or ≥2 (GI, pain, insomnia, and fatigue), and worse than BL. Different thresholds were chosen to have enough events for each symptom. QOL was linearly transformed on a continuous scale (0-100). Linear-mixed models were used to identify significant differences between groups with and without persistent symptoms including age, smoking status, previous abdominal surgery, and diabetes as confounders. Mean QOL differences between groups were evaluated longitudinally over FUPs. RESULTS The analysis included 293 patients. Persistent urinary symptoms ranged from 2% (straining) to 12% (weak stream, and nocturia). Gastrointestinal symptoms ranged from 7% (rectal pain, and incontinence) to 30% (urgency). Proportions of pain, insomnia, and fatigue were 6, 13, and 18%. Significant QOL differences of small-to-medium clinical relevance were found for urinary incontinence, frequency, urgency, and nocturia. Among GI symptoms, rectal pain and incontinence showed small-to-medium differences. Fatigue was associated with the largest differences. CONCLUSIONS The analysis showed that symptoms after RT for PCa occur with different persistence and their association with QOL varies in magnitude. A number of persistent urinary and GI symptoms showed differences in a comparable range. Urinary incontinence and frequency, rectal pain, and faecal incontinence more often had significant associations. Fatigue was also prevalent and associated with largely deteriorated QOL.
Collapse
Affiliation(s)
- Sofia Spampinato
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Tiziana Rancati
- Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Barbara Avuzzi
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Elisabetta Garibaldi
- Department of Radiotherapy, Ospedale Regionale Parini-AUSL Valle d'Aosta, Aosta, Italy
| | - Adriana Faiella
- Department of Radiotherapy, IRCCS Istituto Tumori 'Regina Elena', Rome, Italy
| | - Elisa Villa
- Department of Radiotherapy, Humanitas Gavazzeni, Bergamo, Italy
| | - Alessandro Magli
- Department of Radiotherapy, Azienda Ospedaliero Universitaria S. Maria della Misericordia, Udine, Italy
| | - Domenico Cante
- Department of Radiotherapy, ASL TO4 Ospedale di Ivrea, Ivrea, Italy
| | - Giuseppe Girelli
- Department of Radiotherapy, Ospedale degli Infermi, Biella, Italy
| | - Marco Gatti
- Department of Radiotherapy, Istituto di Candiolo - Fondazione del Piemonte per l'Oncologia IRCCS, Candiolo, Italy
| | - Barbara Noris Chiorda
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luciana Rago
- Department of Radiotherapy, IRCCS CROB, Rionero in Vulture, Italy
| | - Paolo Ferrari
- Department of Health Physics, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität
| | - Cristina Piva
- Department of Radiotherapy, ASL TO4 Ospedale di Ivrea, Ivrea, Italy
| | - Maddalena Pavarini
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Valdagni
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Fernando Munoz
- Department of Radiotherapy, Ospedale Regionale Parini-AUSL Valle d'Aosta, Aosta, Italy
| | - Giuseppe Sanguineti
- Department of Radiotherapy, IRCCS Istituto Tumori 'Regina Elena', Rome, Italy
| | - Nadia Di Muzio
- Department of Radiotherapy, San Raffaele Scientific Institute and Università Vita Salute San Raffaele, Milan, Italy
| | - Kathrin Kirchheiner
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Claudio Fiorino
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cesare Cozzarini
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
3
|
Campodonico E, Xue E, Piemontese S, Chiara A, Bruno A, Scorpio G, Nitti R, Sannipoli D, Orofino G, Fiore P, Quattrocchi MC, Diral E, Clerici D, Farina F, Corti C, Lunghi F, Lupo-Stanghellini MT, Di Muzio N, Ciceri F, Greco R, Peccatori J. Splenic irradiation prior to allogeneic transplant conditioning in myelofibrosis: A pilot experience. Curr Res Transl Med 2023; 71:103400. [PMID: 37331224 DOI: 10.1016/j.retram.2023.103400] [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: 04/05/2023] [Revised: 06/02/2023] [Accepted: 06/08/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION In the era of JAK inhibitors, allogeneic stem cell transplantation (HSCT) remains the only curative treatment for patients with Myelofibrosis (MF). Splenic irradiation (SI) may be used to reduce spleen size and related symptoms. METHODS We conducted a retrospective analysis on 14 patients with MF who underwent HSCT with SI from any donor source at our center between June 2016 and March 2021. All patients received a conditioning backbone based on treosulfan and fludarabine, with post-transplant cyclophosphamide (PTCy) and sirolimus as graft-versus-host disease (GvHD) prophylaxis. Patients received SI with 10 Gy involved-field radiotherapy in five 2-Gy fractions over the course of a week prior to the beginning of conditioning. RESULTS At transplant all patients were transfusion-dependent and had splenomegaly (median bipolar diameter by ultrasound: 20.75 cm). Overall, 12 patients had received ruxolitinib prior to transplant. Re-evaluation of spleen dimensions was available for 13 patients: median splenic bipolar diameter after at least 3 months from transplant decreased by a median of 25%. With a median post-transplant follow-up of 25 months, 6 patients remain in CR with full-donor chimerism, 3 patients died due to NRM. Overall, 4 patients relapsed. At last follow-up, nine patients are currently alive and achieved transfusion-independence. CONCLUSIONS In a small cohort of mostly ruxolitinib pre-treated patients, SI and treosulfan-based conditioning appeared a safe and effective tool to reduce spleen dimensions and ameliorate symptoms. Future prospective studies with adequate sample size are warranted to further investigate the usefulness and safety of this approach in MF.
Collapse
Affiliation(s)
- Edoardo Campodonico
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, via Olgettina 60, Milano 20132, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Elisabetta Xue
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, via Olgettina 60, Milano 20132, Italy
| | - Simona Piemontese
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, via Olgettina 60, Milano 20132, Italy
| | - Anna Chiara
- Department of radiotherapy, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alessandro Bruno
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, via Olgettina 60, Milano 20132, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Gianluca Scorpio
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, via Olgettina 60, Milano 20132, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Rosamaria Nitti
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, via Olgettina 60, Milano 20132, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Daniele Sannipoli
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, via Olgettina 60, Milano 20132, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Giorgio Orofino
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, via Olgettina 60, Milano 20132, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Paolo Fiore
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, via Olgettina 60, Milano 20132, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Maria Chiara Quattrocchi
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, via Olgettina 60, Milano 20132, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Elisa Diral
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, via Olgettina 60, Milano 20132, Italy
| | - Daniela Clerici
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, via Olgettina 60, Milano 20132, Italy
| | - Francesca Farina
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, via Olgettina 60, Milano 20132, Italy
| | - Consuelo Corti
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, via Olgettina 60, Milano 20132, Italy
| | - Francesca Lunghi
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, via Olgettina 60, Milano 20132, Italy
| | | | - Nadia Di Muzio
- Department of radiotherapy, IRCCS San Raffaele Hospital, Milan, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, via Olgettina 60, Milano 20132, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Raffaella Greco
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, via Olgettina 60, Milano 20132, Italy.
| | - Jacopo Peccatori
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, via Olgettina 60, Milano 20132, Italy
| |
Collapse
|
4
|
Archer P, Marvaso G, Detti B, Colombo F, Francolini G, Vandendorpe B, Thananayagam MA, Baty M, De Crevoisier R, Alongi F, Nicosia L, Scher N, Toledano A, Di Muzio N, Fodor A, Zilli T, Franzese C, Scorsetti M, Shelan M, Triggiani L, Aymes E, Le Deley MC, Jereczek-Fossa BA, Pasquier D. Salvage Stereotactic Reirradiation for Local Recurrence in the Prostatic Bed After Prostatectomy: A Retrospective Multicenter Study. Eur Urol Oncol 2023; 6:303-310. [PMID: 37012102 DOI: 10.1016/j.euo.2023.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 07/25/2022] [Revised: 03/01/2023] [Accepted: 03/11/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Management of local recurrence of prostate cancer (PCa) in the prostatic bed after radical prostatectomy (RP) and radiotherapy remains challenging. OBJECTIVE To assess the efficacy and safety of salvage stereotactic body radiotherapy (SBRT) reirradiation in this setting and evaluate prognostic factors. DESIGN, SETTING, AND PARTICIPANTS We conducted a large multicenter retrospective series that included 117 patients who were treated with salvage SBRT for local recurrence in the prostatic bed after RP and radiotherapy in 11 centers across three countries. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Progression-free survival (PFS; biochemical, clinical, or both) was estimated using the Kaplan-Meier method. Biochemical recurrence was defined as prostate-specific antigen nadir +0.2 ng/ml, confirmed by a second increasing measure. The cumulative incidence of late toxicities was estimated using the Kalbfleisch-Prentice method by considering recurrence or death as a competing event. RESULTS AND LIMITATIONS The median follow-up was 19.5 mo. The median SBRT dose was 35 Gy. The median PFS was 23.5 mo (95% confidence interval [95% CI], 17.6-33.2). In the multivariable models, the volume of the recurrence and its contact with the urethrovesical anastomosis were significantly associated with PFS (hazard ratio [HR]/10 cm3 = 1.46; 95% CI, 1.08-1.96; p = 0.01 and HR = 3.35; 95% CI, 1.38-8.16; p = 0.008, respectively). The 3-yr cumulative incidence of grade ≥2 late GU or GI toxicity was 18% (95% CI, 10-26). In the multivariable analysis, a recurrence in contact with the urethrovesical anastomosis and D2% of the bladder were significantly associated with late toxicities of any grade (HR = 3.65; 95% CI, 1.61-8.24; p = 0.002 and HR/10 Gy = 1.88; 95% CI, 1.12-3.16; p = 0.02, respectively). CONCLUSIONS Salvage SBRT for local recurrence in the prostate bed may offer encouraging control and acceptable toxicity. Therefore, further prospective studies are warranted. PATIENT SUMMARY We found that salvage stereotactic body radiotherapy after surgery and radiotherapy allows for encouraging control and acceptable toxicity in locally relapsed prostate cancer.
Collapse
Affiliation(s)
- Paul Archer
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesca Colombo
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | | | - Manon Baty
- Department of Radiotherapy, Centre Eugène Marquis, Rennes, France
| | | | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy; University of Brescia, Brescia, Italy
| | - Luca Nicosia
- Advanced Radiation Oncology Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Nathaniel Scher
- Department of Radiotherapy, Hartmann Institute of Radiotherapy, Levallois-Perret, France; Integrative Oncology, Rafael Institute, Levallois-Perret, France
| | - Alain Toledano
- Department of Radiotherapy, Hartmann Institute of Radiotherapy, Levallois-Perret, France; Integrative Oncology, Rafael Institute, Levallois-Perret, France
| | - Nadia Di Muzio
- Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy; Faculty of Medicine, Vita-Salute S. Raffaele University, Milan, Italy
| | - Andrei Fodor
- Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Thomas Zilli
- Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Ciro Franzese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luca Triggiani
- Radiation Oncology Department, University and Spedali Civili, Brescia, Italy
| | - Estelle Aymes
- Methodology and Biostatistic Unit, Centre Oscar Lambret, Lille, France
| | | | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France; Univ. Lille, Centre de recherche en informatique, Signal et automatique de Lille, Cristal UMR 9189, Lille, France.
| |
Collapse
|
5
|
Fodor A, Brombin C, Mangili P, Fiorino C, Di Muzio N. In Regard to Zureick et al. Int J Radiat Oncol Biol Phys 2022; 114:554-555. [PMID: 36152645 DOI: 10.1016/j.ijrobp.2022.06.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/09/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Chiara Brombin
- University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Mangili
- Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Fiorino
- Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nadia Di Muzio
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
6
|
Gulletta S, Falasconi G, Cianfanelli L, Centola A, Paglino G, Cireddu M, Radinovic A, D’Angelo G, Marzi A, Sala S, Fierro N, Bisceglia C, Peretto G, Di Muzio N, Della Bella P, Vergara P, Dell’Oca I. Patients with Cardiac Implantable Electronic Device Undergoing Radiation Therapy: Insights from a Ten-Year Tertiary Center Experience. J Clin Med 2022; 11:jcm11174990. [PMID: 36078921 PMCID: PMC9457044 DOI: 10.3390/jcm11174990] [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: 07/12/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The number of patients with cardiac implantable electronic devices (CIEDs) receiving radiotherapy (RT) is increasing. The management of CIED-carriers undergoing RT is challenging and requires a collaborative multidisciplinary approach. Aim: The aim of the study is to report the real-world, ten-year experience of a tertiary multidisciplinary teaching hospital. Methods: We conducted an observational, real-world, retrospective, single-center study, enrolling all CIED-carriers who underwent RT at the San Raffaele University Hospital, between June 2010 and December 2021. All devices were MRI-conditional. The devices were programmed to an asynchronous pacing mode for patients who had an intrinsic heart rate of less than 40 beats per minute. An inhibited pacing mode was used for all other patients. All tachyarrhythmia device functions were temporarily disabled. After each RT session, the CIED were reprogrammed to the original settings. Outcomes included adverse events and changes in the variables that indicate lead and device functions. Results: Between June 2010 and December 2021, 107 patients were enrolled, among which 63 (58.9%) were pacemaker carriers and 44 (41.1%) were ICD carriers. Patients were subjected to a mean of 16.4 (±10.7) RT sessions. The most represented tumors in our cohort were prostate cancer (12; 11%), breast cancer (10; 9%) and lung cancer (28; 26%). No statistically significant changes in device parameters were recorded before and after radiotherapy. Generator failures, power-on resets, changes in pacing threshold or sensing requiring system revision or programming changes, battery depletions, pacing inhibitions and inappropriate therapies did not occur in our cohort of patients during a ten-year time span period. Atrial arrhythmias were recorded during RT session in 14 patients (13.1%) and ventricular arrhythmias were observed at device interrogation in 10 patients (9.9%). Conclusions: Changes in device parameters and arrhythmia occurrence were infrequent, and none resulted in a clinically significant adverse event.
Collapse
Affiliation(s)
- Simone Gulletta
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
- Correspondence:
| | - Giulio Falasconi
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Lorenzo Cianfanelli
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Alice Centola
- Centro Cardiologico Monzino, Via Carlo Parea 4, 20138 Milan, Italy
| | - Gabriele Paglino
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Manuela Cireddu
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Andrea Radinovic
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Giuseppe D’Angelo
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Alessandra Marzi
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Simone Sala
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Nicolai Fierro
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Caterina Bisceglia
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Giovanni Peretto
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Nadia Di Muzio
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Paolo Della Bella
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Pasquale Vergara
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Italo Dell’Oca
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| |
Collapse
|
7
|
Starace V, Cicinelli MV, Cavalleri M, Di Muzio N, Marchese A, Battista M, Bandello F, Miserocchi E, Modorati G. Ocular leukemic mass-like relapse treated with CyberKnife stereotactic radiosurgery. Acta Ophthalmol 2022; 100:e1036-e1038. [PMID: 34327856 DOI: 10.1111/aos.14986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/27/2021] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Vincenzo Starace
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
- School of Medicine Vita‐Salute San Raffaele University Milan Italy
| | - Michele Cavalleri
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
| | - Nadia Di Muzio
- Department of Radiotherapy IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
| | - Alessandro Marchese
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
- School of Medicine Vita‐Salute San Raffaele University Milan Italy
| | - Marco Battista
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
| | - Francesco Bandello
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
- School of Medicine Vita‐Salute San Raffaele University Milan Italy
| | - Elisabetta Miserocchi
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
| | - Giulio Modorati
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
| |
Collapse
|
8
|
Gagliardi F, De Domenico P, Snider S, Pompeo E, Roncelli F, Barzaghi LR, Bailo M, Piloni M, Spina A, Fodor A, Berzero G, Di Muzio N, Filippi M, Finocchiaro G, Mortini P. Gamma Knife radiosurgery as primary treatment of low-grade brainstem gliomas: A systematic review and metanalysis of current evidence and predictive factors. Crit Rev Oncol Hematol 2021; 168:103508. [PMID: 34678323 DOI: 10.1016/j.critrevonc.2021.103508] [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: 05/21/2021] [Revised: 10/05/2021] [Accepted: 10/10/2021] [Indexed: 10/20/2022] Open
Abstract
The current standard of care for surgically inaccessible low-grade brainstem gliomas (BS-LLGs) is external-beam radiotherapy (RT). Developments toward more innovative conformal techniques have focused on decreasing morbidity, by limiting radiation to surrounding tissues. Among these Gamma Knife radiosurgery (SRS-GK) has recently gained an increasingly important role in the treatment of these tumors. Although SRS-GK has not yet been compared with conventional RT in patients harboring focal BS-LGGs, clinical practice has been deeply influenced by trials performed on other tumors. This is the first meta-analysis on the topic, systematically reviewing the most relevant available evidence, comparing RT and SRS-GK as primary treatments of BS-LGGs, focusing on survival, clinical outcome, oncological control, and complications. Predictive factors have been systematically evaluated and analyzed according to statistical significance and clinical relevance.
Collapse
Affiliation(s)
- Filippo Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
| | - Pierfrancesco De Domenico
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Silvia Snider
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Edoardo Pompeo
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Francesca Roncelli
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Lina Raffaella Barzaghi
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Michele Bailo
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Martina Piloni
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Alfio Spina
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Andrei Fodor
- Department of Radiation Oncology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Giulia Berzero
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Nadia Di Muzio
- Department of Radiation Oncology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Massimo Filippi
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Gaetano Finocchiaro
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| |
Collapse
|
9
|
Jereczek-Fossa BA, Palazzi MF, Tonoli S, Zaffaroni M, Marvaso G, Ivaldi GB, Amadori M, Antognoni P, Arcangeli S, Buffoli A, Beltramo G, Bignardi M, Bracelli S, De Stefani A, Castiglioni S, Catalano G, Di Muzio N, Cerrotta A, Fariselli L, Filippi AR, Gramaglia A, Italia C, Massaro P, Magrini SM, Nava S, Orlandi E, Pasinetti N, Sbicego EL, Scandolaro L, Scorsetti M, Barbonetti C, Tortini R, Valdagni R, Vavassori V, Pepa M, Cazzaniga LF, Soatti CP. Almost one year of COVID-19 pandemic: how radiotherapy centers have counteracted its impact on cancer treatment in Lombardy, Italy. CODRAL/AIRO-L study. Tumori 2021; 108:177-181. [PMID: 33885350 DOI: 10.1177/03008916211009974] [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] [Indexed: 11/16/2022]
Abstract
Lombardy has represented the Italian and European epicenter of the coronavirus disease 2019 (COVID-19) pandemic. Although most clinical efforts within hospitals were diverted towards the care of virally infected patients, therapies for patients with cancer, including radiotherapy (RT), have continued. During both the first and second pandemic waves, several national and regional organizations provided Italian and Lombardian RT departments with detailed guidelines aimed at ensuring safe treatments during the pandemic. The spread of infection among patients and personnel was limited by adopting strict measures, including triage procedures, interpersonal distance, and adequate implementation of personal protective equipment (PPE). Screening procedures addressed to both the healthcare workforce and patients, such as periodic nasopharyngeal swabs, have allowed the early identification of asymptomatic or pauci-symptomatic COVID-19 cases, thus reducing the spread of the infection. Prevention of infection was deemed of paramount importance to protect both patients and personnel and to ensure the availability of a minimum number of staff members to maintain clinical activity. The choice of treating COVID-19-positive patients has represented a matter of debate, and the risk of oncologic progression has been weighted against the risk of infection of personnel and other patients. Such risk was minimized by creating dedicated paths, reserving time slots, applying intensified cleaning procedures, and supplying personnel and staff with appropriate PPE. Remote working of research staff, medical physicists, and, in some cases, radiation oncologists has prevented overcrowding of shared spaces, reducing infection spread.
Collapse
Affiliation(s)
- Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milano, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | | | - Sandro Tonoli
- Radiation Oncology Centre, ASST Cremona, Cremona, Lombardia, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milano, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milano, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | | | | | - Paolo Antognoni
- Radiation Oncology Centre, Ospedale di Circolo e Fondazione Macchi, ASST dei Sette Laghi, Varese, Italy
| | - Stefano Arcangeli
- Department of Radiation Oncology, Ospedale S. Gerardo and University of Milan Bicocca, Monza, Italy
| | - Alberto Buffoli
- Radiation Oncology Centre, Istituto Clinico S. Anna, Brescia, Italy
| | - Giancarlo Beltramo
- Radiation Oncology Centre, Centro Diagnostico Italiano (CDI), Milano, Italy
| | - Mario Bignardi
- Radiation Oncology Centre, Fondazione Poliambulanza, Brescia, Italy
| | | | - Agostina De Stefani
- Division of Radiation Oncology, Ospedale di Treviglio, Caravaggio di Treviglio, Italy
| | | | - Gianpiero Catalano
- Radiation Oncology Centre, IRCCS Multimedica, Sesto San Giovanni/Castellanza, Italy
| | - Nadia Di Muzio
- Radiation Oncology Centre, IRCCS Ospedale S. Raffaele and University Vita Salute, Milano, Italy
| | - Annamaria Cerrotta
- Division of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Laura Fariselli
- Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Andrea Riccardo Filippi
- Division of Radiotherapy, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | | | - Corrado Italia
- Radiation Oncology Centre, Istituti Ospedalieri Bergamaschi, Ponte S. Pietro-Zingonia, Italy
| | - Patrizia Massaro
- Radiotherapy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Stefano Maria Magrini
- Radiation Oncology Centre, Brescia University Radiation Oncology Department, O. Alberti Radium Institute, Spedali Civili Hospital, Brescia, Italy
| | - Simonetta Nava
- Radiation Oncology Centre, Istituti Clinici di Pavia e Vigevano, Vigevano, Italy
| | - Ester Orlandi
- Radiation Oncology Unit, Clinical Department, National Centre for Oncological Hadrontherapy, Fondazione CNAO, Pavia, Italy
| | - Nadia Pasinetti
- Radiation Oncology Department, Esine and University of Brescia, Esine, Italy
| | - Elena Lara Sbicego
- Radiation Oncology Centre, Istituto Clinico Sant'Ambrogio, Milano, Italy
| | - Luciano Scandolaro
- Radiation Oncology Centre, Ospedale Sant'Anna, ASST Lariana, Como, Italy
| | - Marta Scorsetti
- IRCCS Humanitas Research Hospital, Radiotherapy and Radiosurgery Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Claudio Barbonetti
- Radiation Oncology Centre, Ospedale di Sondrio, ASST Valtellina e Alto Lario, Sondrio, Italy
| | - Roberto Tortini
- Ospedale di Casalpusterlengo, Azienda Ospedaliera della Provincia di Lodi, Casalpusterlengo, Italy
| | - Riccardo Valdagni
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy.,Division of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | | | - Matteo Pepa
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milano, Italy
| | | | | |
Collapse
|
10
|
Mazzola R, Jereczek-Fossa BA, Antognoni P, Di Muzio N, Nicosia L, Lancia A, Fazio I, Chiesa S, Osti MF, Pergolizzi S, Franceschini D, Gentile P, Triggiani L, Alongi F. OLIGO-AIRO: a national survey on the role of radiation oncologist in the management of OLIGO-metastatic patients on the behalf of AIRO. Med Oncol 2021; 38:48. [PMID: 33761017 DOI: 10.1007/s12032-021-01493-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/09/2021] [Indexed: 12/15/2022]
Abstract
In the last years, several evidences demonstrated the role of stereotactic body radiotherapy (SBRT) in the oligometastatic disease and the possibility to increase survival in selected patients. In 2020 the study group "biology and treatment of the oligometastatic disease" of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) conducted a survey evaluating the attitude of physicians in treating the oligometastatic disease and the definition of it. An electronic questionnaire was administered online to the society members. 105 questionnaires were returned. 78% responders considered as oligometastatic a disease with ≤ 5 metastases. The majority of the responders (77%) treated > 50 patients in the last year, and 89% responders agreed in considering every oligometastatic tumor susceptible to local treatments. Regarding the clinical management of the oligometastatic disease, the majority of the responders (66%) suggested an interdisciplinary discussion. When choosing a treatment option for fit patients with a single oligometastatic focus, 52% of the responders agreed in proposing only SBRT. In the case of unfit patients with a single oligometastatic lesion the agreement was in favor of the SBRT alone (89%). In the oligoprogressive setting, 41% responders opted to continue the current systemic treatment and to add SBRT, while in the case of oligoresidual disease, 70% responders was in favor of adding SBRT and continuing the current systemic treatment. In conclusions, the survey illustrated the current agreement and prescribing attitude for oligometastatic patients in Italy. The non-homogenous agreement in some clinical scenarios suggest the need of more robust evidence.
Collapse
Affiliation(s)
- Rosario Mazzola
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Paolo Antognoni
- Radiation Oncology Centre, Ospedale di Circolo e Fondazione Macchi, ASST Dei Sette Laghi, Varese, Italy
| | - Nadia Di Muzio
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Luca Nicosia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy.
| | - Andrea Lancia
- Radiation Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ivan Fazio
- Radiation Therapy Unit, Casa di Cura Macchiarella, Palermo, Italy
| | - Silvia Chiesa
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 1, 00168, Rome, Italy
| | - Mattia F Osti
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | | | - Davide Franceschini
- Department of Radiotherapy, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Piercarlo Gentile
- Radiation Oncology Unit, UPMC Hillman Cancer Center, San Pietro Hospital FBF, Rome, Italy
| | - Luca Triggiani
- Department of Radiation Oncology, Brescia University, Piazza Spedali Civili,1, 25100, Brescia, Italy
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
- University of Brescia, Brescia, Italy
| |
Collapse
|
11
|
Bresolin A, Faiella A, Garibaldi E, Munoz F, Cante D, Vavassori V, Waskiewicz JM, Girelli G, Avuzzi B, Villa E, Magli A, Noris Chiorda B, Gatti M, Ferella L, Maggio A, Landoni V, Aimonetto S, Sini C, Rancati T, Sanguineti G, Valdagni R, Di Muzio N, Fiorino C, Cozzarini C. Acute patient-reported intestinal toxicity in whole pelvis IMRT for prostate cancer: Bowel dose-volume effect quantification in a multicentric cohort study. Radiother Oncol 2021; 158:74-82. [PMID: 33639190 DOI: 10.1016/j.radonc.2021.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/07/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To assess bowel dose-volume relationships for acute patient-reported intestinal symptoms of patients treated with whole-pelvis intensity-modulated radiotherapy (WPRT) for prostate cancer. MATERIALS AND METHODS Complete data of 415 patients enrolled in a multi institute, prospective trial (#NCT02803086) treated with radical (31%), adjuvant (33%) and salvage (36%) intent at a median dose to pelvic nodes/lymph-nodal area of 53 Gy were available. The most severe changes between baseline and radiotherapy mid-point/end toxicity assessed by Inflammatory Bowel Disease Questionnaire (only Bowel Domain) were considered (ΔIBDQ). The 25th percentile values of these score variations were set as endpoints. DVHs of bowel loops for patients with/without toxicity were compared for each endpoint, having excluded patients with baseline scores <5 (rate ranging between 2% and 7% according to the endpoint): the resulting best dosimetric predictors were combined with selected clinical parameters through multivariate logistic regression (MVA) to derive predictive models. RESULTS ΔIBDQ ranged between 0.2-1.5 points considering separately each IBDQ symptom. Only four symptoms (IBDQ1 = frequency, IBDQ5 = diarrhea, IBDQ17 = gas passage, IBDQ24 = urgency) showed a median worsening ≥ 1; DVH predicted the risk of worse symptoms for IBDQ5, IBDQ24 and overall Bowel Domain. At multivariable analysis DVHs (best cut-off: V46Gy ≥80 cc) and baseline scores (Odd-Ratio:0.35-0.65) were independently associated to the three end-points. The resulting models were reliable (H&L test: 0.453-0.956), well calibrated (calibration plot: slope = 0.922-1.069, R2 = 0.725-0.875) and moderately discriminative (Area Under the Curve:0.628-0.669). A bootstrap-based validation confirmed their robustness. CONCLUSION Constraining the bowel loops (V46 < 80 cc) may reduce the risk of several moderate intestinal symptoms, with a much greater impact for patients with lower IBDQ baseline scores.
Collapse
Affiliation(s)
- Andrea Bresolin
- San Raffaele Scientific Institute, Milan, Italy; Fondazione Centro San Raffaele, Milan, Italy
| | - Adriana Faiella
- IRCCS Istituto Nazionale dei Tumori "Regina Elena", Rome, Italy
| | | | - Fernando Munoz
- Ospedale Regionale Parini-AUSL Valle d'Aosta, Aosta, Italy
| | | | | | | | | | - Barbara Avuzzi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisa Villa
- Cliniche Gavazzeni-Humanitas, Bergamo, Italy
| | - Alessandro Magli
- Azienda Ospedaliero Universitaria S. Maria della Misericordia, Udine, Italy
| | | | - Marco Gatti
- Istituto di Candiolo - FPO-IRCCS, Candiolo, Italy
| | | | | | - Valeria Landoni
- IRCCS Istituto Nazionale dei Tumori "Regina Elena", Rome, Italy
| | | | - Carla Sini
- San Raffaele Scientific Institute, Milan, Italy
| | - Tiziana Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy
| | | | - Riccardo Valdagni
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy
| | - Nadia Di Muzio
- San Raffaele Scientific Institute, Milan, Italy; Dept. of Oncology and Hemato-Oncology, University Vita-Salute San Raffaele, Milan, Italy
| | | | | |
Collapse
|
12
|
Zuppone S, Bresolin A, Spinelli AE, Fallara G, Lucianò R, Scarfò F, Benigni F, Di Muzio N, Fiorino C, Briganti A, Salonia A, Montorsi F, Vago R, Cozzarini C. Pre-clinical Research on Bladder Toxicity After Radiotherapy for Pelvic Cancers: State-of-the Art and Challenges. Front Oncol 2020; 10:527121. [PMID: 33194587 PMCID: PMC7642999 DOI: 10.3389/fonc.2020.527121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/15/2020] [Accepted: 08/31/2020] [Indexed: 01/01/2023] Open
Abstract
Despite the dramatic advancements in pelvic radiotherapy, urinary toxicity remains a significant side-effect. The assessment of clinico-dosimetric predictors of radiation cystitis (RC) based on clinical data has improved substantially over the last decade; however, a thorough understanding of the physiopathogenetic mechanisms underlying the onset of RC, with its variegated acute and late urinary symptoms, is still largely lacking, and data from pre-clinical research is still limited. The aim of this review is to provide an overview of the main open issues and, ideally, to help investigators in orienting future research. First, anatomy and physiology of bladder, as well as the current knowledge of dose and dose-volume effects in humans, are briefly summarized. Subsequently, pre-clinical radiobiology aspects of RC are discussed. The findings suggest that pre-clinical research on RC in animal models is a lively field of research with growing interest in the development of new radioprotective agents. The availability of new high precision micro-irradiators and the rapid advances in small animal imaging might lead to big improvement into this field. In particular, studies focusing on the definition of dose and fractionation are warranted, especially considering the growing interest in hypo-fractionation and ablative therapies for prostate cancer treatment. Moreover, improvement in radiotherapy plans optimization by selectively reducing radiation dose to more radiosensitive substructures close to the bladder would be of paramount importance. Finally, thanks to new pre-clinical imaging platforms, reliable and reproducible methods to assess the severity of RC in animal models are expected to be developed.
Collapse
Affiliation(s)
- Stefania Zuppone
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Fondazione Centro San Raffaele, Milan, Italy
| | - Andrea Bresolin
- Fondazione Centro San Raffaele, Milan, Italy.,Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonello E Spinelli
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Fallara
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Lucianò
- Unit of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Scarfò
- Unit of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Benigni
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nadia Di Muzio
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Claudio Fiorino
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Riccardo Vago
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Cesare Cozzarini
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
13
|
Slim N, Passoni P, Incerti E, Tummineri R, Gumina C, Cattaneo GM, De Nardi P, Canevari C, Fiorino C, Ronzoni M, Tamburini AM, Burgio V, Gianolli L, Di Muzio N. Impact of sentinel lymph-node biopsy and FDG-PET in staging and radiation treatment of anal cancer patients. Sci Rep 2020; 10:14613. [PMID: 32884036 PMCID: PMC7471696 DOI: 10.1038/s41598-020-71577-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 07/23/2020] [Indexed: 11/09/2022] Open
Abstract
To assess the role of sentinel lymph-node biopsy (SLNB) and FDG-PET in staging and radiation treatment (RT) of anal cancer patients. This retrospective study was performed on 80 patients (male: 32, female: 48) with a median age of 60 years (39-89 years) with anal squamous cell carcinoma who were treated from March 2008 to March 2018 at the IRCCS San Raffaele Hospital. Patients without clinical evidence of inguinal LNs metastases and/or with discordance between clinical evidence and imaging features were considered for SLNB. FDG-PET was performed in 69/80 patients. Patients with negative imaging in inguinal region and negative SLNB could avoid RT on groin to spare inguinal toxicity. CTV included GTV (primary tumour and positive LNs) and pelvic ± inguinal LNs. PTV1 and PTV2 corresponded to GTV and CTV, respectively, adding 0.5 cm. RT dose was 50.4 Gy/28 fractions to PTV2 and 64.8 Gy/36 fractions to PTV1, delivered with 3DCRT (n = 24) or IMRT (n = 56), concomitant to Mitomycin-C and 5-FU chemotherapy. FDG-PET showed inguinal uptake in 21/69 patients (30%) and was negative in 48/69 patients (70%). Lymphoscintigraphy was performed in 11/21 positive patients (4 patients SLNB confirmed inguinal metastases, 6 patients false positive and 1 patient SLN not found), and in 29/48 negative patients (5/29 showed metastases, 23/29 true negative and 1 SLN not found). Sensitivity, specificity, positive and negative predictive value of FDG-PET were 62%, 79%, 40% and 82%, respectively. Median follow-up time from diagnosis was 40.3 months (range: 4.6-136.4 months): 69 patients (86%) showed a complete response, 10 patients (13%) a partial response, 1 patient (1%) a stable disease. Patients treated on groin (n = 54) versus not treated (n = 26) showed more inguinal dermatitis (G1-G2: 50% vs. 12%; G3-G4: 17% vs. 0%, p < 0.05). For patients treated on groin, G3-G4 inguinal dermatitis, stomatitis and neutropenia were significantly reduced with IMRT against 3DCRT techniques (13% vs. 36%, p = 0.10; 3% vs. 36%, p = 0.003; 8% vs. 29%, p = 0.02, respectively). SLNB improves the FDG-PET inguinal LNs staging in guiding the decision to treat inguinal nodes. IMRT technique significantly reduced G3-G4 toxicities when patients are treated on groin.
Collapse
Affiliation(s)
- Najla Slim
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Passoni
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Elena Incerti
- Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Calogero Gumina
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Paola De Nardi
- Unit of Gastroenterology Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carla Canevari
- Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Fiorino
- Unit of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Monica Ronzoni
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Valentina Burgio
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Gianolli
- Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nadia Di Muzio
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
14
|
Bresolin A, Garibaldi E, Faiella A, Cante D, Vavassori V, Waskiewicz JM, Girelli G, Avuzzi B, Villa E, Magli A, Noris Chiorda B, Munoz F, Sanguineti G, Gabriele P, Gatti M, Rancati T, Valdagni R, Di Muzio N, Fiorino C, Cozzarini C. Predictors of 2-Year Incidence of Patient-Reported Urinary Incontinence After Post-prostatectomy Radiotherapy: Evidence of Dose and Fractionation Effects. Front Oncol 2020; 10:1207. [PMID: 32850354 PMCID: PMC7396712 DOI: 10.3389/fonc.2020.01207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/15/2020] [Accepted: 06/15/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate predictors of patient-reported urinary incontinence (PRUI) in the first 2 years after post-prostatectomy radiotherapy (PORT) with particular emphasis on possible dose-effect relationships. Patients and Methods: Two-hundred-thirteen patients, whose clinical and dosimetric data were prospectively collected within a registered multi-institutional cohort study, underwent PORT with adjuvant (n = 106) or salvage (n = 107) intent with conventional (n = 123, prescribed dose to the prostatic bed: 66.6–79.8Gy in 1.8–2.0Gy/fr) or moderately hypo- (n = 90, 65.8–76.8Gy in 2.1–2.7Gy/fr) fractionation during the period 2011–2017. PRUI was evaluated through the ICIQ-SF questionnaire filled in at baseline and every 6 months thereafter. The analysis focused on three ICIQ-based clinically relevant endpoints: (a) very frequent leakage (FREQUENCY, ICIQ3 score >3), (b) moderate to severe amount of urine loss (AMOUNT, ICIQ4>2) (c) objective severe symptoms (OBJECTIVE, ICIQ3+4>5). Predictors of the incidence within 2 years for the three endpoints were investigated focusing only on patients without endpoint symptoms at baseline. A uni-variable logistic regression analysis was performed in order to determine the best dose metrics describing PRUI risk in terms of 2-Gy equivalent dose (EQD2) calculated with different α/β values reported in the literature (0.8, 3, 5Gy), and to identify the most significant clinical variables. Variables showing p < 0.20 at uni-variable analysis were entered into a backward stepwise multi-variable logistic regression analysis. Lastly, the goodness of fit and model calibration were evaluated and internally validated. Results: Patients without symptoms at baseline experienced (a), (b), and/or (c) within 2 years in 41/130 (32%), 40/192 (21%), and 41/129 (32%) of the cases, respectively. EQD2 for α/β = 0.8Gy was the best dose metric associated with PRUI. Multi-variable analysis identified baseline incontinence levels as the strongest predictor for all endpoints (p < 0.006). Both FREQUENCY and OBJECTIVE were significantly influenced also by EQD2(α/β = 0.8Gy). The goodness of fit was excellent, as was the calibration; internal calibration confirmed apparent performance. Conclusion: Baseline mild urinary incontinence symptoms strongly modulate the 2-year risk of PRUI. In addition, FREQUENCY is characterized by a marked dose-effect relationship also influencing the trend of OBJECTIVE, with results more reliable than AMOUNT as an objective index. A strong impact of fractionation on severe PRUI after post-prostatectomy radiotherapy also emerged.
Collapse
Affiliation(s)
- Andrea Bresolin
- IRCCS Istituto Scientifico Ospedale San Raffaele, Medical Physics, Milan, Italy
- Fondazione Centro San Raffaele, Milan, Italy
| | - Elisabetta Garibaldi
- Istituto di Candiolo—Fondazione del Piemonte per l'Oncologia IRCCS, Radiotherapy, Turin, Italy
| | - Adriana Faiella
- IRCCS Istituto Nazionale dei Tumori “Regina Elena,” Radiotherapy, Rome, Italy
| | | | | | | | | | - Barbara Avuzzi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Radiotherapy, Milan, Italy
| | - Elisa Villa
- Cliniche Gavazzeni-Humanitas, Radiotherapy, Bergamo, Italy
| | - Alessandro Magli
- Azienda Ospedaliero Universitaria S. Maria della Misericordia, Radiotherapy, Udine, Italy
| | | | - Fernando Munoz
- Ospedale Regionale Parini-AUSL Valle d'Aosta, Radiotherapy, Aosta, Italy
| | - Giuseppe Sanguineti
- IRCCS Istituto Nazionale dei Tumori “Regina Elena,” Radiotherapy, Rome, Italy
| | - Pietro Gabriele
- Istituto di Candiolo—Fondazione del Piemonte per l'Oncologia IRCCS, Radiotherapy, Turin, Italy
| | - Marco Gatti
- Istituto di Candiolo—Fondazione del Piemonte per l'Oncologia IRCCS, Radiotherapy, Turin, Italy
| | - Tiziana Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy
| | - Riccardo Valdagni
- Fondazione IRCCS Istituto Nazionale dei Tumori, Radiotherapy, Milan, Italy
- Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Nadia Di Muzio
- Istituto Scientifico Ospedale San Raffaele, Radiotherapy, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Claudio Fiorino
- IRCCS Istituto Scientifico Ospedale San Raffaele, Medical Physics, Milan, Italy
- *Correspondence: Claudio Fiorino
| | - Cesare Cozzarini
- Istituto Scientifico Ospedale San Raffaele, Radiotherapy, Milan, Italy
| |
Collapse
|
15
|
Viale G, Licata L, Sica L, Zambelli S, Zucchinelli P, Rognone A, Aldrighetti D, Di Micco R, Zuber V, Pasetti M, Di Muzio N, Rodighiero M, Panizza P, Sassi I, Petrella G, Cascinu S, Gentilini OD, Bianchini G. Personalized Risk-Benefit Ratio Adaptation of Breast Cancer Care at the Epicenter of COVID-19 Outbreak. Oncologist 2020; 25:e1013-e1020. [PMID: 32412693 PMCID: PMC7272798 DOI: 10.1634/theoncologist.2020-0316] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/06/2020] [Indexed: 12/26/2022] Open
Abstract
Northern Italy has been one of the European regions reporting the highest number of COVID-19 cases and deaths. The pandemic spread has challenged the National Health System, requiring reallocation of most of the available health care resources to treat COVID-19-positive patients, generating a competition with other health care needs, including cancer. Patients with cancer are at higher risk of developing critical illness after COVID-19 infection. Thus, mitigation strategies should be adopted to reduce the likelihood of infection in all patients with cancer. At the same time, suboptimal care and treatments may result in worse cancer-related outcome. In this article, we attempt to estimate the individual risk-benefit balance to define personalized strategies for optimal breast cancer management, avoiding as much as possible a general untailored approach. We discuss and report the strategies our Breast Unit adopted from the beginning of the COVID-19 outbreak to ensure the continuum of the best possible cancer care for our patients while mitigating the risk of infection, despite limited health care resources. IMPLICATIONS FOR PRACTICE: Managing patients with breast cancer during the COVID-19 outbreak is challenging. The present work highlights the need to estimate the individual patient risk of infection, which depends on both epidemiological considerations and individual clinical characteristics. The management of patients with breast cancer should be adapted and personalized according to the balance between COVID-19-related risk and the expected benefit of treatments. This work also provides useful suggestions on the modality of patient triage, the conduct of clinical trials, the management of an oncologic team, and the approach to patients' and health workers' psychological distress.
Collapse
Affiliation(s)
- Giulia Viale
- Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele HospitalMilanItaly
| | - Luca Licata
- Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele HospitalMilanItaly
| | - Lorenzo Sica
- Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele HospitalMilanItaly
| | - Stefania Zambelli
- Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele HospitalMilanItaly
| | - Patrizia Zucchinelli
- Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele HospitalMilanItaly
| | - Alessia Rognone
- Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele HospitalMilanItaly
| | - Daniela Aldrighetti
- Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele HospitalMilanItaly
| | - Rosa Di Micco
- Breast Surgery Unit, IRCCS San Raffaele HospitalMilanItaly
- Department of Clinical Medicine and Surgery, University of Naples Federico IINaplesItaly
| | - Veronica Zuber
- Breast Surgery Unit, IRCCS San Raffaele HospitalMilanItaly
| | | | - Nadia Di Muzio
- Radiotherapy Unit, IRCCS San Raffaele HospitalMilanItaly
- Vita‐Salute S. Raffaele UniversityMilanItaly
| | | | - Pietro Panizza
- Breast Imaging Unit, IRCCS San Raffaele HospitalMilanItaly
| | | | - Giovanna Petrella
- Department of Medical Oncology, IRCCS San Raffaele HospitalMilanItaly
| | - Stefano Cascinu
- Department of Medical Oncology, IRCCS San Raffaele HospitalMilanItaly
| | | | - Giampaolo Bianchini
- Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele HospitalMilanItaly
| |
Collapse
|
16
|
Deantoni CL, Fodor A, Cozzarini C, Fiorino C, Brombin C, Di Serio C, Calandrino R, Di Muzio N. Prostate cancer with low burden skeletal disease at diagnosis: outcome of concomitant radiotherapy on primary tumor and metastases. Br J Radiol 2020; 93:20190353. [PMID: 31971828 DOI: 10.1259/bjr.20190353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate toxicity and clinical outcome in synchronous bone only oligometastatic (≤2 lesions) prostate cancer patients, simultaneously irradiated to prostate/prostatic bed, lymph nodes and bone metastases. METHODS From 2/2009 to 6/2015, 39 bone only prostate cancer patients underwent radiotherapy (RT) at "radical" doses to bone metastases (median 2 Gy equivalent dose, EQD2>40Gy, α/β = 1,5), nodes, and prostate/prostatic bed, within the same RT course, in association with androgen deprivation therapy (ADT).Biochemical relapse-free survival, clinical relapse-free survival, freedom from distant metastases and overall survival were evaluated. RESULTS After a median follow-up of 46.5 (1.2-103.6) months, 5 patients died from disease progression, 10 experienced biochemical relapse, 19, still in ADT, presented undetectable prostate-specific antigen (PSA) at the last follow-up. Five patients who discontinued ADT after a median of 34 months (5.8-41) are free from biochemical relapse.The 4 year Kaplan-Meier estimates of biochemical relapse-free survival, clinical relapse-free survival, freedom from distant metastases and overall survival were 53.3%, 65.7%, 73.4% and 82.4% respectively.No Grade > 2 acute events and only two severe late urinary events were recorded, not due to the concomitant treatment of primary and metastatic disease. CONCLUSION Our results suggest that "radical" and synchronous irradiation of primitive tumor and metastatic disease may be a valid approach in synchronous bone only prostate cancer patients, showing mild toxicity profile and promising survival results. ADVANCES IN KNOWLEDGE To the best of our knowledge, this is the first analysis of clinical outcome in synchronous bone-only metastasis (neither nodal nor visceral) patients at diagnosis, treated with radical RT to all disease, associated to ADT.
Collapse
Affiliation(s)
| | - Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cesare Cozzarini
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Fiorino
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Brombin
- University Centre of Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Clelia Di Serio
- University Centre of Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Riccardo Calandrino
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nadia Di Muzio
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
17
|
Martini A, Fossati N, Karnes RJ, Boorjian SA, Boeri L, Bossi A, Di Muzio N, Cozzarini C, Noris Chiorda B, Gandaglia G, Robesti D, Bartkowiak D, Böhmer D, Shariat SF, Goldner G, Battaglia A, Joniau S, Berghen C, De Meerleer G, Fonteyne V, Ost P, Van Poppel H, Montorsi F, Wiegel T, Briganti A. Defining the Most Informative Intermediate Clinical Endpoints for Patients Treated with Salvage Radiotherapy for Prostate-specific Antigen Rise After Radical Prostatectomy. Eur Urol Oncol 2019; 4:301-304. [PMID: 31810893 DOI: 10.1016/j.euo.2019.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 10/05/2019] [Accepted: 11/09/2019] [Indexed: 11/19/2022]
Abstract
Intermediate clinical endpoints (ICEs) might aid in trial design and potentially expedite study results. However, little is known about the most informative ICE for patients receiving salvage radiation therapy (sRT) after radical prostatectomy. To investigate the most informative ICE for patients receiving sRT, we used a multi-institutional database encompassing patients treated at eight tertiary centers. Overall, 1301 men with node-negative disease who had not received any form of androgen deprivation therapy were identified. Associations of biochemical (BCR) and clinical recurrence (CR) within 1, 3, 5, and 7yr after surgery with the risk of overall mortality were evaluated using multivariable Cox regression analyses fitted at the landmark points of 1, 3, 5, and 7yr after sRT. The discriminative ability of each model for predicting overall survival (OS) was assessed using Harrell's c index. Median follow-up for survivors was 5.6yr (interquartile range 2.0-8.8). On multivariable analysis, progression to CR within 3yr from sRT (hazard ratio 4.19, 95% confidence interval 1.44-11.2; p= 0.008) was the most informative ICE for predicting OS (c index 0.78) compared to CR within 1, 5, and 7yr (c index 0.72, 0.75, and 0.71). In conclusion, progression to CR within 3yr after sRT, irrespective of the time of surgery, was the most informative ICE for prediction of OS. Our study is hypothesis-generating. If these results are confirmed in future prospective studies and surrogacy is met, this information could be applied for study design and could potentially expedite earlier release of results from ongoing randomized controlled trials. PATIENT SUMMARY: Clinical recurrence of prostate cancer within 3yr after salvage radiation therapy, irrespective of the time of radical prostatectomy, represents the most informative intermediate clinical endpoint for the prediction of overall survival. This information could be applied in the design of future studies and could potentially expedite earlier release of results from ongoing randomized controlled trials.
Collapse
Affiliation(s)
- Alberto Martini
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicola Fossati
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
| | | | | | - Luca Boeri
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Alberto Bossi
- Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France
| | - Nadia Di Muzio
- Department of Radiotherapy, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Cesare Cozzarini
- Department of Radiotherapy, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Giorgio Gandaglia
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Daniele Robesti
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Detlef Bartkowiak
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Dirk Böhmer
- Department of Radiation Oncology, Charité University Hospital, Berlin, Germany
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Gregor Goldner
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Charlien Berghen
- Department of Radiotherapy, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiotherapy, University Hospitals Leuven, Leuven, Belgium
| | - Valérie Fonteyne
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - Piet Ost
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - Hein Van Poppel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Francesco Montorsi
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Alberto Briganti
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| |
Collapse
|
18
|
Fossati N, Robesti D, Karnes RJ, Soligo M, Boorjian SA, Bossi A, Coraggio G, Di Muzio N, Cozzarini C, Noris Chiorda B, Gandaglia G, Scarcella S, Bartkowiak D, Böhmer D, Shariat S, Goldner G, Battaglia A, Joniau S, Haustermans K, De Meerleer G, Fonteyne V, Ost P, Van Poppel H, Montorsi F, Wiegel T, Briganti A. Assessing the Role and Optimal Duration of Hormonal Treatment in Association with Salvage Radiation Therapy After Radical Prostatectomy: Results from a Multi-Institutional Study. Eur Urol 2019; 76:443-449. [DOI: 10.1016/j.eururo.2019.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
|
19
|
Incerti E, Vanoli EG, Broggi S, Gumina C, Passoni P, Slim N, Fiorino C, Reni M, Mapelli P, Cattaneo M, Zanon S, Calandrino R, Gianolli L, Di Muzio N, Picchio M. Early variation of 18-fluorine-labelled fluorodeoxyglucose PET-derived parameters after chemoradiotherapy as predictors of survival in locally advanced pancreatic carcinoma patients. Nucl Med Commun 2019; 40:1072-1080. [PMID: 31365502 DOI: 10.1097/mnm.0000000000001065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate if early variation of PET-derived parameters after concomitant chemoradiotherapy (CRT) predicts overall survival (OS), local relapse free survival (LRFS), distant relapse free survival (DRFS) and progression free survival (PFS) in locally advanced pancreatic cancer (LAPC) patients. METHODS Fifty-two LAPC patients (median age: 61 years; range: 35-85) with available FDG PET/CT before and after RT (2-6 months, median: 2) were enrolled from May 2005 to June 2015. The predictive value of the percentage variation of mean/maximum standard uptake value (ΔSUVmean/max), metabolic tumour volume (ΔMTV) and total lesion glycolysis (ΔTLG), estimated considering different uptake thresholds (40-50-60%), was investigated between pre- and post-RT PET. The percentage difference between gastrointestinal cancer-associated antigen (ΔGICA) levels measured at the time of PET was also considered. Log-rank test and Cox regression analysis were performed to assess the prognostic value of considered PET-derived parameters on survival outcomes. RESULTS The median follow-up was 13 months (range: 4-130). At univariate analysis, ΔTLG50 showed borderline significance in predicting OS (P = 0.05) and was the most significant parameter correlated to LRFS and PFS (P = 0.001). Median LRFS was 4 and 33 months if ΔTLG50 was below or above 35% respectively (P = 0.0003); similarly, median PFS was 3 vs 6 months (P = 0.0009). No significant correlation was found between PET-derived parameters and DRFS, while the ΔGICA was the only borderline significant prognostic value for this endpoint (P = 0.05). CONCLUSION PET-derived parameters predict survival in LAPC patients; in particular, ΔTLG50 is the strongest predictor. The combination of these biochemical and imaging biomarkers is promising in identifying patients at higher risk of earlier relapse.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Michele Reni
- Department of Oncology, IRCCS San Raffaele Scientific Institute
| | - Paola Mapelli
- Unit of Nuclear Medicine
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Silvia Zanon
- Department of Oncology, IRCCS San Raffaele Scientific Institute
| | | | | | | | - Maria Picchio
- Unit of Nuclear Medicine
- Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
20
|
Di Micco R, Zuber V, Fiacco E, Carriero F, Gattuso MI, Nazzaro L, Panizza P, Gianolli L, Canevari C, Di Muzio N, Pasetti M, Sassi I, Zambetti M, Gentilini OD. Corrigendum to "Sentinel node biopsy after primary systemic therapy in node positive breast cancer patients: Time trend, imaging staging power and nodal downstaging according to molecular subtype" [Eur. J. Surg. Oncol. 45, (6) (2019) 969-975]. Eur J Surg Oncol 2019; 45:1754. [PMID: 31307816 DOI: 10.1016/j.ejso.2019.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Rosa Di Micco
- Breast Surgery Unit, San Raffaele Hospital, Milan, Italy; Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Veronica Zuber
- Breast Surgery Unit, San Raffaele Hospital, Milan, Italy
| | - Enrico Fiacco
- Breast Surgery Unit, San Raffaele Hospital, Milan, Italy
| | | | | | | | - Pietro Panizza
- Breast Radiology Unit, San Raffaele Hospital, Milan, Italy
| | - Luigi Gianolli
- Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy
| | - Carla Canevari
- Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy
| | | | | | | | | | | |
Collapse
|
21
|
Fossati* N, Jeffrey Karnes R, Boorjian SA, Boeri L, Bossi A, Di Muzio N, Cozzarini C, Chiorda BN, Mazzone E, Barletta F, Gandaglia G, Bartkowiak D, Böhmer D, Shariat S, Goldner G, Battaglia A, Joniau S, Devos G, Haustermans K, De Meerleer G, Fonteyne V, Ost P, Van Poppel H, Montorsi F, Wiegel T, Briganti A. MP22-01 WHAT IS THE BEST DEFINITION OF BIOCHEMICAL RESPONSE TO SALVAGE RADIATION THERAPY IN PROSTATE CANCER PATIENTS TREATED FOR PSA RISING AFTER RADICAL PROSTATECTOMY? RESULTS FROM A MULTI-INSTITUTIONAL SERIES. J Urol 2019. [DOI: 10.1097/01.ju.0000555585.98158.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
22
|
Mazzone* E, Fossati N, Karnes RJ, Boorjian SA, Boeri L, Bossi A, Muzio ND, Cozzarini C, Chiorda BN, Gandaglia G, Zaffuto E, Bartkowiak D, Böhmer D, Shariat S, Goldner G, Battaglia A, Joniau S, Devos G, Haustermans K, De Meerleer G, Fonteyne V, Ost P, Poppel HV, Montorsi F, Wiegel T, Briganti A. MP22-20 ASSESSING THE IMPACT AND PREDICTORS OF OTHER-CAUSE MORTALITY IN PATIENTS TREATED WITH POST-PROSTATECTOMY SALVAGE RADIATION THERAPY IN ORDER TO AVOID POSSIBLE OVERTREATMENT: RESULTS FROM A LARGE, MULTI-INSTITUTIONAL STUDY. J Urol 2019. [DOI: 10.1097/01.ju.0000555605.44314.bf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
23
|
Di Micco R, Zuber V, Fiacco E, Carriero F, Gattuso MI, Nazzaro L, Panizza P, Gianolli L, Canevari C, Di Muzio N, Pasetti M, Sassi I, Zambetti M, Gentilini OD. Sentinel node biopsy after primary systemic therapy in node positive breast cancer patients: Time trend, imaging staging power and nodal downstaging according to molecular subtype. Eur J Surg Oncol 2019; 45:969-975. [PMID: 30744944 DOI: 10.1016/j.ejso.2019.01.219] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 11/15/2018] [Revised: 01/20/2019] [Accepted: 01/29/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The management of axilla after Primary Systemic Therapy (PST) for breast cancer is a highly debated field. Despite the proven axillary downstaging occurring after PST, there is still some degree of reluctance in applying sentinel node biopsy (SNB) in the neoadjuvant setting. PATIENTS AND METHODS We performed a retrospective analysis on 181 PST patients with axillary positive nodes at presentation treated between 2005 and 2017 at San Raffaele Hospital in Milan. The aim was to observe the application time trend of SNB, to determine the imaging staging power and the axillary downstaging according to molecular subtypes. RESULTS Median follow-up after surgery was 32.5(IQR: 12-59) months. After PST, 119 (65.7%) patients had no clinically palpable nodes, 72 (39.7%) converted to N0 on final imaging and 34 (18.8%) underwent SNB with an increasing application trend. Axillary-US showed the highest accuracy (69.3%) in re-staging axilla after PST. Staging power of preoperative testing varied with tumour biology: Positive Predictive Value was higher in Luminal A (80% for clinical examination and 100% for axillary-US) and Luminal B (72% and 70.5%) tumours, whilst Negative Predictive Value was higher in HER2 positive (100% and 93.3%), and triple negative (71.4% and 93.3%) tumours. Ninety five (52.5%) patients experienced axillary downstaging after PST, by molecular subtype 15% (3/20) in Luminal A, 46.4% (45/97) in Luminal B, 90.9% (20/22) in HER2+ and 70.3% (26/37) in triple negative breast tumours. CONCLUSION SNB application after PST for breast cancer in node positive patients at presentation is increasing. Pre-operative axillary imaging and tumour biology help identify patients who might be candidates for SNB as a single staging procedure.
Collapse
Affiliation(s)
- Rosa Di Micco
- Breast Surgery Unit, San Raffaele Hospital, Milan, Italy; Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Veronica Zuber
- Breast Surgery Unit, San Raffaele Hospital, Milan, Italy
| | - Enrico Fiacco
- Breast Surgery Unit, San Raffaele Hospital, Milan, Italy
| | | | | | | | - Pietro Panizza
- Breast Radiology Unit, San Raffaele Hospital, Milan, Italy
| | - Luigi Gianolli
- Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy
| | - Carla Canevari
- Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy
| | | | | | | | | | | |
Collapse
|
24
|
Dinapoli N, Barbaro B, Gatta R, Chiloiro G, Casà C, Masciocchi C, Damiani A, Boldrini L, Gambacorta MA, Dezio M, Mattiucci GC, Balducci M, van Soest J, Dekker A, Lambin P, Fiorino C, Sini C, De Cobelli F, Di Muzio N, Gumina C, Passoni P, Manfredi R, Valentini V. Magnetic Resonance, Vendor-independent, Intensity Histogram Analysis Predicting Pathologic Complete Response After Radiochemotherapy of Rectal Cancer. Int J Radiat Oncol Biol Phys 2018; 102:765-774. [PMID: 29891200 DOI: 10.1016/j.ijrobp.2018.04.065] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/13/2018] [Accepted: 04/23/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The objective of this study is finding an intensity based histogram (IBH) signature to predict pathologic complete response (pCR) probability using only pre-treatment magnetic resonance (MR) and validate it externally in order to create a workflow for the external validation of an MR IBH signature and to apply the model out of the environment where it has been tuned. The impact of pCR and the final predictors on the survival outcome were also evaluated. METHODS AND MATERIALS Three centers using different MR scanners were involved in this retrospective study. The first center recruited 162 patients for model training, and the second and third centers provided 34 plus 25 patients for external validation. Patients provided written consent. Accrual period was from May 2008 to December 2014. After surgery pathologic response was defined. T2-weighted MR scans acquired before chemoradiation therapy (CRT) were used for analysis addressed on primary lesions. Images were pre-processed using Laplacian of Gaussian (LoG) filter with multiple σ, and first order intensity histogram-based features (kurtosis, skewness, and entropy) were extracted. Features selection was performed using Mann-Whitney test. Tumor staging (cT, cN) was added to build a logistic regression model and predict pCR. Model performance was evaluated with internal and external validation using area under the curve (AUC) of the receiver operator characteristic (ROC) and calibration with Hosmer-Lemeshow test. The linear cross-correlation matrix (Pearson's coefficient) and the variance inflation factor (VIF) were used to check the correlation and the co-linearity among the final predictors. The amount of the information added through the radiomics features was estimated by using the DeLong's test, and the impact of pCR and the final predictors on survival outcomes were evaluated through the Kaplan-Meier curves by using the log-rank test and the multivariate Cox model. RESULTS Candidate-to-analysis features were skewness (σ = 0.485, P value = .01) and entropy (σ = 0.344, P value < .05). Logistic regression analysis showed as significant covariates cT (P value < .01), skewness-σ = 0.485 (P value = .01), and entropy-σ = 0.344 (P value < .05). Model AUCs were 0.73 (internal) and 0.75 (external). CONCLUSIONS This MR-based, vendor-independent model can be helpful for predicting pCR probability in locally advanced rectal cancer (LARC) patients only using pre-treatment imaging.
Collapse
Affiliation(s)
- Nicola Dinapoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italia
| | - Brunella Barbaro
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Istituto di Radiologia, Roma, Italia
| | - Roberto Gatta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italia
| | - Giuditta Chiloiro
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Istituto di Radiologia, Roma, Italia
| | - Calogero Casà
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Istituto di Radiologia, Roma, Italia
| | - Carlotta Masciocchi
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Istituto di Radiologia, Roma, Italia.
| | - Andrea Damiani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italia
| | - Luca Boldrini
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Istituto di Radiologia, Roma, Italia
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Istituto di Radiologia, Roma, Italia
| | - Michele Dezio
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Istituto di Radiologia, Roma, Italia
| | - Gian Carlo Mattiucci
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Istituto di Radiologia, Roma, Italia
| | - Mario Balducci
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Istituto di Radiologia, Roma, Italia
| | - Johan van Soest
- Department of Radiation Oncology MAASTRO Clinic GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, The Netherlands
| | - Andre Dekker
- Department of Radiation Oncology MAASTRO Clinic GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, The Netherlands
| | - Philippe Lambin
- Department of Radiation Oncology MAASTRO Clinic GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, The Netherlands
| | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - Carla Sini
- Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | | | - Nadia Di Muzio
- Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
| | - Calogero Gumina
- Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Passoni
- Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Manfredi
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Istituto di Radiologia, Roma, Italia
| | - Vincenzo Valentini
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Istituto di Radiologia, Roma, Italia
| |
Collapse
|
25
|
Fodor A, Broggi S, Incerti E, Dell'Oca I, Fiorino C, Samanes Gajate AM, Pasetti M, Cattaneo MG, Passoni P, Gianolli L, Calandrino R, Picchio M, Di Muzio N. Moderately Hypofractionated Helical IMRT, FDG-PET/CT-guided, for Progressive Malignant Pleural Mesothelioma in Patients With Intact Lungs. Clin Lung Cancer 2018; 20:e29-e38. [PMID: 30253920 DOI: 10.1016/j.cllc.2018.08.019] [Citation(s) in RCA: 6] [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: 01/31/2018] [Revised: 08/21/2018] [Accepted: 08/29/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The objective of this study was to present the outcomes of moderately hypofractionated helical intensity-modulated radiation therapy (HT) with/without simultaneous integrated boost (SIB) on fluorodeoxyglucose-positron emission tomography (FDG-PET) positive areas (gross tumor volume [GTV]-PET) for patients with progressive malignant pleural mesothelioma (MPM) after previous treatments. METHODS AND MATERIALS From May 2006 to April 2014, 51 patients with a median age of 68.8 years (range, 38.6-82 years) were treated. There were 41 men and 10 women; 43 epithelioid MPM and 8 sarcomatoid, involving the left pleura in 25 patients and the right pleura in 26 patients. The initial stage was: I, 11 patients; II, 14 patients; III, 17 patients; and IV, 9 patients. Chemotherapy was prescribed for 46 patients, for 6 cycles (range, 0-18 cycles). Eighteen patients had pleurectomy/decortication, and 33 had talc pleurodesis. FDG-PET was used for target identification. A median dose of 56 Gy/25 fractions was prescribed to the involved pleura, and SIB to 62.5 Gy to GTV-PET was added in 38 patients. RESULTS The median survival from diagnosis was 25.8 months (range, 8.4-99.0 months). One patient, treated with SIB, was alive at the October 2017 follow-up. Two cases of grade 5 radiation pneumonitis were registered. A GTV-PET ≤ 205 cc was predictive of late ≥ grade 2 lung toxicity, but also of better survival in stage III and IV disease: 5.9 versus 11.7 months (P = .04). A GTV-PET ≥ 473 cc was predictive of early death (P = .001). CONCLUSIONS Moderately hypofractionated, FDG-PET guided salvage HT in patients with progressive MPM after previous treatments showed acceptable toxicity and outcome results similar to adjuvant radiotherapy after pleurectomy/decortication, suggesting that the delay of radiotherapy is not detrimental to survival, and has the associated benefit of postponing inherent toxicity.
Collapse
Affiliation(s)
- Andrei Fodor
- Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy.
| | - Sara Broggi
- Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - Elena Incerti
- Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Italo Dell'Oca
- Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Fiorino
- Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | | | - Marcella Pasetti
- Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro G Cattaneo
- Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Passoni
- Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Gianolli
- Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Calandrino
- Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - Maria Picchio
- Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy; Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Nadia Di Muzio
- Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
26
|
Fossati N, Parker WP, Karnes RJ, Colicchia M, Bossi A, Seisen T, Di Muzio N, Cozzarini C, Noris Chiorda B, Fiorino C, Gandaglia G, Bartkowiak D, Wiegel T, Shariat S, Goldner G, Battaglia A, Joniau S, Haustermans K, De Meerleer G, Fonteyne V, Ost P, Van Poppel H, Montorsi F, Briganti A, Boorjian SA. More Extensive Lymph Node Dissection at Radical Prostatectomy is Associated with Improved Outcomes with Salvage Radiotherapy for Rising Prostate-specific Antigen After Surgery: A Long-term, Multi-institutional Analysis. Eur Urol 2018; 74:134-137. [DOI: 10.1016/j.eururo.2018.02.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/26/2018] [Indexed: 11/26/2022]
|
27
|
Palazzi MF, Soatti C, Jereczek-Fossa BA, Cazzaniga LF, Antognoni P, Gardani G, Amadori M, Baio A, Beltramo G, Bignardi M, Bracelli S, Buffoli A, Castiglioni S, Catalano G, Di Muzio N, Fallai C, Fariselli L, Frata P, Gramaglia A, Italia C, Ivaldi G, Lombardi F, Magrini SM, Nava S, Sarti E, Scandolaro L, Scorsetti M, Stiglich F, Tortini R, Valdagni R, Valvo F, Vavassori V, Sbicego EL, Tonoli S, Orecchia R. Equipment, staffing, and provision of radiotherapy in Lombardy, Italy: Results of three surveys performed between 2012 and 2016. Tumori 2018; 104:352-360. [PMID: 29986637 DOI: 10.1177/0300891618784800] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION: Several efforts are being implemented at the European level to measure provision of up-to-date radiation treatments across the continent. METHODS: A snapshot survey involving all radiation oncology centers within Lombardy, Italy, was performed in 2012 and repeated in 2014 and 2016, in cooperation with regional governmental officers. Centers were asked to provide detailed information concerning all individual patients being treated on the index day, and to report data on available local resources. RESULTS: We observed an increase in the number of centers and of megavoltage units (MVU) (from 76 to 87, i.e., 8.7 MVU per million inhabitants in 2016). Mean number of MVU per center was 2.5. Average age of MVU increased from 5.3 to 7.5 years and patients on the waiting list also increased. Conformal 3D radiotherapy (RT) treatments decreased from 56% to 42% and were progressively replaced by intensity-modulated RT treatments (from 39% to 49%). Waiting times were overall satisfactory. Radiation oncologists treated on average 152 and radiation therapists 100 RT courses per year. Average reimbursement per course was €4,879 (range €2,476-€8,014). CONCLUSIONS: The methodology of snapshot survey proved feasible and provided valuable information about radiation oncology provision and accessibility in Lombardy.
Collapse
Affiliation(s)
- Mauro F Palazzi
- 1 Radiation Oncology Center, Grande Ospedale Metropolitano Niguarda Milan, Italy
| | - Carlo Soatti
- 2 Radiation Oncology Center, Ospedale Manzoni, Lecco, Italy
| | - Barbara A Jereczek-Fossa
- 3 Department of Oncology and Hemato‑oncology, University of Milan, and Division of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Luigi F Cazzaniga
- 4 Radiation Oncology Center, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Antognoni
- 5 Radiation Oncology Center, Ospedale di Circolo e Fondazione Macchi, ASST dei Sette Laghi, Varese, Italy
| | | | | | - Ambrogia Baio
- 8 Radiation Oncology Center, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Giancarlo Beltramo
- 9 Radiation Oncology Center, Centro Diagnostico Italiano (CDI), Milan, Italy
| | - Mario Bignardi
- 10 Radiation Oncology Center, Fondazione Poliambulanza, Brescia, Italy
| | | | - Alberto Buffoli
- 12 Radiation Oncology Center, Istituto Clinico S. Anna, Brescia, Italy
| | | | - Gianpiero Catalano
- 14 Radiation Oncology Center, IRCCS Ospedale Multimedica, Sesto San Giovanni/Castellanza, Italy
| | - Nadia Di Muzio
- 15 Radiation Oncology Center, IRCCS Ospedale S. Raffaele, Milano, Italy
| | - Carlo Fallai
- 16 Radiation Oncology Center, Istituto Nazionale Tumori, Milan, Italy
| | - Laura Fariselli
- 17 Radiation Oncology Center, Fondazione Istituto Neurologico Besta, Milan, Italy
| | - Paolo Frata
- 18 Radiation Oncology Center, Ospedale di Esine, ASST di Valcamonica, Esine, Italy
| | | | - Corrado Italia
- 20 Radiation Oncology Center, Istituti Ospedalieri Bergamaschi, Ponte S. Pietro, Zingonia (BG), Italy
| | - Giovanni Ivaldi
- 21 Radiation Oncology Center, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Fabrizio Lombardi
- 22 Radiation Oncology Center, Ospedale San Donato, San Donato Milanese, Italy
| | - Stefano M Magrini
- 23 Radiation Oncology Center, Brescia University Radiation Oncology Department, O. Alberti Radium Institute, Spedali Civili Hospital, Brescia, Italy
| | - Simonetta Nava
- 24 Radiation Oncology Center, Istituti Clinici di Pavia e Vigevano, Vigevano, Italy
| | - Enrico Sarti
- 25 Radiation Oncology Center, Ospedale, Treviglio, Italy
| | - Luciano Scandolaro
- 26 Radiation Oncology Center, Ospedale Sant'Anna, ASST Lariana, Como, Italy
| | - Marta Scorsetti
- 27 Radiation Oncology Center, Humanitas Clinical and Research Center and Humanitas University, Milano-Rozzano, Italy
| | | | - Roberto Tortini
- 29 Radiation Oncology Center, Presidio di Casalpusterlengo, ASST Lodi, Italy
| | - Riccardo Valdagni
- 30 Radiation Oncology Center, Istituto Nazionale Tumori and Università degli Studi di Milano, Milan, Italy
| | | | - Vittorio Vavassori
- 32 Radiation Oncology Center, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Elena L Sbicego
- 33 Radiation Oncology Center, Istituto Clinico S. Ambrogio, Milan, Italy
| | - Sandro Tonoli
- 34 Radiation Oncology Center, Ospedale, Cremona, Italy
| | - Roberto Orecchia
- 35 Radiation Oncology Center, IEO Scientific Direction, Milan, Italy
| |
Collapse
|
28
|
Alongi P, Iaccarino L, Losa M, Del Vecchio A, Gerevini S, Plebani V, Di Muzio N, Mortini P, Gianolli L, Perani D. PET Evaluation of Late Cerebral Effect in Advanced Radiation Therapy Techniques for Cranial Base Tumors. Curr Radiopharm 2018; 11:86-91. [PMID: 29804540 DOI: 10.2174/1874471011666180525134301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/17/2018] [Accepted: 05/22/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Even though the benefits of radiation therapy are well established, it is important to recognize the broad spectrum of radiation-induced changes, particularly in the central nervous system. The possible damage to the brain parenchyma may have clinical consequences and in particular cognitive impairment might be one of the major complications of radiotherapy. To date, no studies have investigated the effects of focal radiation therapy on brain structure and function together with the assessment of their clinical outcomes at a long follow-up. METHODS In this prospective study, we evaluated in six patients the possible brain late effects after radiation therapy, using a standardized neuropsychological battery, MRI and 18F-FDG PET using SPM and semi-quantitative methods, in patients affected by cranial base tumors who underwent gamma knife or tomotherapy. RESULTS Neuropsychological examinations showed no cognitive impairment after the treatment. In all patients, both MRI assessment and 18F-FDG-PET did not reveal any local or distant anatomical and metabolic late effects. CONCLUSION The present study support the safety of advanced radiation therapy techniques. 18F-FDGPET, using SPM and semi-quantitative methods, might be a valuable tool to evaluate the cerebral radiotoxicity in patients treated for brain neoplasms.
Collapse
Affiliation(s)
- Pierpaolo Alongi
- Department of Radiological Sciences, Nuclear Medicine Unit, San Raffaele G.Giglio Institute, Contrada Pietrapollastra- Pisciotto, Cefalu, Italy
| | - Leonardo Iaccarino
- Vita-Salute San Raffaele University and Division of Neuroscience, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy
| | - Marco Losa
- Pituitary Unit of the Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milano, Italy
| | - Antonella Del Vecchio
- Department of Radiotherapy, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy
| | - Simonetta Gerevini
- Department of Neuroradiology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy
| | - Valentina Plebani
- Division of Neuroscience, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy
| | - Nadia Di Muzio
- Department of Radiotherapy, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy
| | - Pietro Mortini
- Department of Neurosurgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy
| | - Luigi Gianolli
- Department of Nuclear Medicine, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy
| | - Daniela Perani
- Vita-Salute San Raffaele University and Division of Neuroscience, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy.,Pituitary Unit of the Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milano, Italy.,Department of Radiotherapy, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy.,Department of Neuroradiology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy.,Division of Neuroscience, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy.,Department of Neurosurgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy.,Department of Nuclear Medicine, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy
| |
Collapse
|
29
|
Assanelli AA, Lorentino F, Marcatti M, Chiara A, Lupo Stanghellini MT, Giglio F, Clerici D, Greco R, Broggi S, Cattaneo M, Peccatori J, Ferreri AJ, Ciceri F, Di Muzio N. Total marrow irradiation (TMI) combined with treosulfan and fludarabine conditioning regimen for chemosensitive advanced multiple myeloma (MM) patients undergoing matched allogeneic stem-cell transplantation: First results of a phase I/II prospective monocentric study (TrRaMM TMI). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e19019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Andrea A. Assanelli
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Francesca Lorentino
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Magda Marcatti
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Anna Chiara
- Radiotherapy, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | | | - Fabio Giglio
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Daniela Clerici
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Raffaella Greco
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Sara Broggi
- Radiotherapy, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Mauro Cattaneo
- Radiotherapy, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Jacopo Peccatori
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | | | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Nadia Di Muzio
- Radiotherapy, IRCCS San Raffaele Scientific Institute, Milano, Italy
| |
Collapse
|
30
|
Belli ML, Mori M, Broggi S, Cattaneo GM, Bettinardi V, Dell'Oca I, Fallanca F, Passoni P, Vanoli EG, Calandrino R, Di Muzio N, Picchio M, Fiorino C. Quantifying the robustness of [ 18 F]FDG-PET/CT radiomic features with respect to tumor delineation in head and neck and pancreatic cancer patients. Phys Med 2018; 49:105-111. [PMID: 29866335 DOI: 10.1016/j.ejmp.2018.05.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/08/2018] [Accepted: 05/10/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the robustness of PET radiomic features (RF) against tumour delineation uncertainty in two clinically relevant situations. METHODS Twenty-five head-and-neck (HN) and 25 pancreatic cancer patients previously treated with 18F-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT)-based planning optimization were considered. Seven FDG-based contours were delineated for tumour (T) and positive lymph nodes (N, for HN patients only) following manual (2 observers), semi-automatic (based on SUV maximum gradient: PET_Edge) and automatic (40%, 50%, 60%, 70% SUV_max thresholds) methods. Seventy-three RF (14 of first order and 59 of higher order) were extracted using the CGITA software (v.1.4). The impact of delineation on volume agreement and RF was assessed by DICE and Intra-class Correlation Coefficients (ICC). RESULTS A large disagreement between manual and SUV_max method was found for thresholds ≥50%. Inter-observer variability showed median DICE values between 0.81 (HN-T) and 0.73 (pancreas). Volumes defined by PET_Edge were better consistent with the manual ones compared to SUV40%. Regarding RF, 19%/19%/47% of the features showed ICC < 0.80 between observers for HN-N/HN-T/pancreas, mostly in the Voxel-alignment matrix and in the intensity-size zone matrix families. RFs with ICC < 0.80 against manual delineation (taking the worst value) increased to 44%/36%/61% for PET_Edge and to 69%/53%/75% for SUV40%. CONCLUSIONS About 80%/50% of 72 RF were consistent between observers for HN/pancreas patients. PET_edge was sufficiently robust against manual delineation while SUV40% showed a worse performance. This result suggests the possibility to replace manual with semi-automatic delineation of HN and pancreas tumours in studies including PET radiomic analyses.
Collapse
Affiliation(s)
| | - Martina Mori
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Sara Broggi
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | | | | | - Italo Dell'Oca
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | | | - Paolo Passoni
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | | | | | - Nadia Di Muzio
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Maria Picchio
- Nuclear Medicine, San Raffaele Scientific Institute, Milano, Italy
| | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy.
| |
Collapse
|
31
|
Alongi F, Aniko MD, Ferreri AJM, Rosso A, Cozzarini C, Fallanca F, Berardi G, Schipani S, Gianolli L, Guazzoni G, Di Muzio N. Consolidation Radiotherapy for a Rare Case of Extranodal Mucosa-Associated Lymphoid Tissue Non-Hodgkin's Lymphoma Synchronous with Prostate Adenocarcinoma. Tumori 2018; 96:498-502. [DOI: 10.1177/030089161009600322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nongastric primary extranodal mucosa-associated lymphoid tissue (MALT) lymphomas are uncommon, with around 0.1% occurring in the prostate. Even less frequent is the presence of MALT lymphoma synchronous with another type of neoplasm in the same organ, especially the prostate. Only a single case of concurrent adenocarcinoma and MALT lymphoma of the prostate has been reported in the literature. We report a rare case of primary extranodal marginal zone MALT lymphoma incidentally diagnosed during radical prostatectomy for an adenocarcinoma of the prostate in a 53-year-old patient. Fourteen months later a recurrence of the MALT lymphoma involving both sides of the diaphragm was found and was treated with chemoimmunotherapy. High-dose radiotherapy was delivered to residual bulky disease in the pelvic region. At 18 months from the end of radiation treatment the patient was without signs of relapse of MALT lymphoma. This preliminary result confirms that rare cases of MALT lymphoma of the prostate should be discussed and treated under the collaborative supervision of hematologists and medical and radiation oncologists. In fact, at an advanced stage of the disease, a chemotherapy regimen with additional consolidation radiotherapy could be an effective strategy, as in all other lymphomas.
Collapse
Affiliation(s)
- Filippo Alongi
- Radiotherapy Unit, Scientific Institute H San Raffaele, Milan, Italy
- IBFM-CNR, Italy; Centro di Bioimmagini e Radioterapia, LATO HSR-Giglio, Cefalù, Italy
| | - Maria Deli Aniko
- Radiotherapy Unit, Scientific Institute H San Raffaele, Milan, Italy
| | | | - Alberto Rosso
- Medical Oncology Unit, Scientific Institute H San Raffaele, Milan, Italy
| | - Cesare Cozzarini
- Radiotherapy Unit, Scientific Institute H San Raffaele, Milan, Italy
| | - Federico Fallanca
- Nuclear Medicine Unit, Scientific Institute H San Raffaele, Milan, Italy
| | - Genoveffa Berardi
- Radiotherapy Unit, Scientific Institute H San Raffaele, Milan, Italy
| | - Stefano Schipani
- Radiotherapy Unit, Scientific Institute H San Raffaele, Milan, Italy
| | - Luigi Gianolli
- Nuclear Medicine Unit, Scientific Institute H San Raffaele, Milan, Italy
| | | | - Nadia Di Muzio
- Radiotherapy Unit, Scientific Institute H San Raffaele, Milan, Italy
| |
Collapse
|
32
|
Alongi F, Fodor A, Maggio A, Cozzarini C, Fiorino C, Broggi S, Alongi P, Calandrino R, Di Muzio N. Megavoltage CT Images of Helical Tomotherapy Unit for Radiation Treatment Simulation: Impact on Feasibility of Treatment Planning in a Prostate Cancer Patient with Bilateral Femoral Prostheses. Tumori 2018; 97:221-4. [DOI: 10.1177/030089161109700215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Metal prosthesis artefacts on CT images can be a significant problem in the definition of volumes of interest, dose calculation and patient setup in modern radiotherapy. We experienced considerable difficulties in defining the organs at risk and treatment volumes on kVCT images of standard CT simulation in a prostate cancer patient due to the presence of bilateral femoral prostheses causing artefacts. As shown in the current case, MVCT images of the patient in the treatment position obtained using a helical tomotherapy unit can provide sufficient morphological information to define the pelvic anatomic structures for radical prostate treatment planning. The patient completed the planned treatment and at 90 days after the end of treatment no severe side effects were recorded. Since there have been few reports on the use of MVCT images to overcome the problem of hip prosthesis artefacts, a brief literature review was also carried out.
Collapse
Affiliation(s)
- Filippo Alongi
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center, IRCCS Istituto Clinico Humanitas, Rozzano (Milan)
| | - Andrei Fodor
- Radiotherapy Department, IRCCS Scientific Institute San Raffaele, Milan
| | - Angelo Maggio
- Medical Physics, Istituto per la Ricerca e la Cura del Cancro di Candiolo, Turin
| | - Cesare Cozzarini
- Radiotherapy Department, IRCCS Scientific Institute San Raffaele, Milan
| | - Claudio Fiorino
- Medical Physics, IRCCS Scientific Institute San Raffaele, Milan
| | - Sara Broggi
- Medical Physics, IRCCS Scientific Institute San Raffaele, Milan
| | - Pierpaolo Alongi
- Nuclear Medicine, IRCCS Scientific Institute San Raffaele, Milan, Italy
| | | | - Nadia Di Muzio
- Radiotherapy Department, IRCCS Scientific Institute San Raffaele, Milan
| |
Collapse
|
33
|
Motta M, Alongi F, De Martin E, Fiorino C, Maggiulli E, Rigoni L, Landoni C, Broggi S, Deli AM, Calandrino R, Di Muzio N. Helical Tomotherapy for Scalp Recurrence of Primary Eccrine Mucinous Adenocarcinoma. Tumori 2018; 95:832-5. [DOI: 10.1177/030089160909500632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary cutaneous mucinous carcinomas originating from sweat glands are rare tumors with patterns of spread that are difficult to predict. We present a case of a five times recurring eccrine mucinous adenocarcinoma of the scalp, previously treated with surgery and adjuvant radiation therapy. After magnetic resonance imaging (MRI) and 18F-fluoro-2-deoxyglucose positron-emission tomography/computed tomography (18FDG-PET/CT), which documented local recurrence, the patient was considered eligible for salvage irradiation of the scalp. We decided to use helical tomotherapy, which combines conformity of dose delivery with the possibility of daily control of the setup accuracy. Forty gray (2Gy/fraction) to the planning target volume and 50 Gy (2.5Gy/fraction) to the biological target volume defined on the basis of 18FDGPET/CT was prescribed with a simultaneous integrated boost technique. After 12 fractions the patient was submitted to intermediate evaluation by 18FDG-PET/CT, which showed a partial response to the treatment. After 2, 4, 8, and 12 months, 18FDG-PET/CT showed a complete metabolic local response. This experience suggests a possible role of 18FDG-PET/CT-guided helical tomotherapy as an alternative to repeated and frequently demolitive surgery approaches.
Collapse
Affiliation(s)
- Micaela Motta
- Radiotherapy Department, Scientific Institute San Raffaele, Milan
| | - Filippo Alongi
- Radiotherapy Department, Scientific Institute San Raffaele, Milan
- IBFM-CNR (Istituto di Bioimaging e Fisiologia Molecolare-Consiglio Nazionale delle Ricerche); Responsabile Radioterapia Intraoperatoria, LATO HSR-Giglio, Cefalù
| | | | | | | | - Lara Rigoni
- Radiotherapy Department, Scientific Institute San Raffaele, Milan
| | - Claudio Landoni
- Nuclear Medicine Department, Scientific Institute San Raffaele, Milan, Italy
| | - Sara Broggi
- Medical Physics, Scientific Institute San Raffaele, Milan
| | - Aniko Maria Deli
- Radiotherapy Department, Scientific Institute San Raffaele, Milan
| | | | - Nadia Di Muzio
- Radiotherapy Department, Scientific Institute San Raffaele, Milan
| |
Collapse
|
34
|
Alongi F, Schipani S, Gajate AMS, Rosso A, Cozzarini C, Fiorino C, Alongi P, Picchio M, Gianolli L, Messa C, Di Muzio N. [11C]choline-PET-guided Helical Tomotherapy and Estramustine in a Patient with Pelvic-Recurrent Prostate Cancer: Local Control and Toxicity Profile after 24 Months. Tumori 2018; 96:613-7. [DOI: 10.1177/030089161009600416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
[11C]choline positron emission tomograhy can be useful to detect metastatic disease and to localize isolated lymph node relapse after primary treatment in case of prostate-specific antigen failure. In case of lymph node failure in prostate cancer patients, surgery or radiotherapy can be proposed with a curative intent. Some reports have suggested that radiotherapy could have a role in local control of oligometastatic lymph node disease. This is the first reported case of [11C]choline positron emission tomography-guided helical tomotherapy concomitant with estramustine for the treatment of pelvic-recurrent prostate cancer. At 24 months after the end of helical tomotherapy, prostate-specific antigen was undetectable and no late toxicities were recorded. A disease-free survival of 24 months, in the absence of any type of systemic therapy, is uncommon in metastatic prostate cancer. The therapeutic approach of the case report is discussed and a literature review on the issue is presented.
Collapse
Affiliation(s)
- Filippo Alongi
- Radiotherapy Department, San Raffaele Scientific Institute, Milan, Italy
- Istituto di Bioimmagini e Fisiologia Molecolare, Consiglio Nazionale delle Ricerche, Milan, Italy
- Intraoperative Radiotherapy and Image-Guided High-Focused Technologies, LATO, Hospital San Raffaele G. Giglio, Cefalù, Italy
| | - Stefano Schipani
- Radiotherapy Department, San Raffaele Scientific Institute, Milan, Italy
| | | | - Alberto Rosso
- Radiotherapy Department, San Raffaele Scientific Institute, Milan, Italy
| | - Cesare Cozzarini
- Radiotherapy Department, San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Fiorino
- Medical Physics, Scientific Institute San Raffaele, Milan, Italy
| | - Pierpaolo Alongi
- Medicine and Surgery School, University of Palermo, Palermo, Italy
| | - Maria Picchio
- Nuclear Medicine Department, Nuclear Medicine, H. San Gerardo, Monza, Italy
| | - Luigi Gianolli
- Nuclear Medicine Department, Nuclear Medicine, H. San Gerardo, Monza, Italy
| | - Cristina Messa
- Milano-Bicocca University, Nuclear Medicine, H. San Gerardo, Monza, Italy
| | - Nadia Di Muzio
- Radiotherapy Department, San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
35
|
Giovacchini G, Picchio M, Schipani S, Landoni C, Gianolli L, Bettinardi V, Di Muzio N, Gilardi MC, Fazio F, Messa C. Changes in Glucose Metabolism during and after Radiotherapy in Non-Small Cell Lung Cancer. Tumori 2018; 95:177-84. [DOI: 10.1177/030089160909500208] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Aims and background Evaluation of the metabolic response to radiotherapy in non-small cell lung cancer patients is commonly performed about three months after the end of radiotherapy. The aim of the present study was to assess with positron emission tomography/computed tomography (PET/CT) and [18F]fluorodeoxyglucose changes in glucose metabolism during and after radiotherapy in non-small cell lung cancer patients. Methods and study design In 6 patients, PET/CT scans with [18F]fluorodeoxyglucose were performed before (PET0), during (PET1; at a median of 14 days before the end of radiotherapy) and after the end of radiotherapy (PET2 and PET3, at a median of 28 and 93 days, respectively). The metabolic response was scored according to visual and semiquantitative criteria. Results Standardize maximum uptake at PET1 (7.9 ± 4.8), PET2 (5.1 ± 4.1) and PET3 (2.7 ± 3.1) were all significantly (P <0.05; ANOVA repeated measures) lower than at PET0 (16.1 ± 10.1). Standardized maximum uptake at PET1 was significantly higher than at both PET2 and PET3. There were no significant differences in SUVmax between PET2 and PET3. PET3 identified 4 complete and 2 partial metabolic responses, whereas PET1 identified 6 partial metabolic responses. Radiotherapy-induced increased [18F]fluorodeoxyglucose uptake could be visually distinguished from tumor uptake based on PET/CT integration and was less frequent at PET1 (n = 2) than at PET3 (n = 6). Conclusions In non-small cell lung cancer, radiotherapy induces a progressive decrease in glucose metabolism that is greater 3 months after the end of treatment but can be detected during the treatment itself. Glucose avid, radiotherapy-induced inflammation is more evident after the end of radiotherapy than during radiotherapy and does not preclude the interpretation of [18F]fluorodeoxyglucose images, particularly when using PET/CT.
Collapse
Affiliation(s)
| | - Maria Picchio
- Department of Nuclear Medicine, Scientific Institute San Raffaele, Milan, Italy
| | - Stefano Schipani
- Department of Radiation Oncology, Scientific Institute San Raffaele, Milan, Italy
| | - Claudio Landoni
- University of Milano-Bicocca, Milan, Italy
- Department of Nuclear Medicine, Scientific Institute San Raffaele, Milan, Italy
| | - Luigi Gianolli
- Department of Nuclear Medicine, Scientific Institute San Raffaele, Milan, Italy
| | | | - Nadia Di Muzio
- Department of Radiation Oncology, Scientific Institute San Raffaele, Milan, Italy
| | - Maria Carla Gilardi
- University of Milano-Bicocca, Milan, Italy
- Department of Nuclear Medicine, Scientific Institute San Raffaele, Milan, Italy
- Institute for Bioimaging and Molecular Physiology, National Research Council, Milan, Italy
| | | | - Cristina Messa
- University of Milano-Bicocca, Milan, Italy
- Department of Nuclear Medicine, San Gerardo Hospital, Monza, Italy
- Institute for Bioimaging and Molecular Physiology, National Research Council, Milan, Italy
| |
Collapse
|
36
|
Affiliation(s)
- Filippo Alongi
- Radioterapia e Radiochirurgia, Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Nadia Di Muzio
- Radioterapia, Istituto Scientifico San Raffaele, Milan, Italy
| | - Marta Scorsetti
- Radioterapia e Radiochirurgia, Istituto Clinico Humanitas, Rozzano, Milan, Italy
| |
Collapse
|
37
|
Alongi F, Cozzarini C, Di Muzio N, Scorsetti M. Postoperative Radiotherapy in Prostate Cancer: Acquired Certainties and Still Open Issues. A Review of Recent Literature. Tumori 2018; 97:1-8. [DOI: 10.1177/030089161109700101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is recognized that radiation therapy can eradicate microscopic tumor disease, even in postoperative prostate cancer patients, when extracapsular extension, positive surgical margins or increased prostate-specific antigen is found in surgical specimens. This review of recent literature analyzes and discusses acquired certainties and still open questions regarding type, timing, doses, techniques, toxicities, and associated hormonal therapies of radiotherapy prescribed after radical prostatectomy. Free full text available at www.tumorionline.it
Collapse
Affiliation(s)
- Filippo Alongi
- Radiotherapy and Radiosurgery, IRCCS Istituto Clinico Humanitas, Rozzano (Milano)
| | - Cesare Cozzarini
- Radiotherapy, IRCCS Istituto Scientifico San Raffaele, Milano, Italy
| | - Nadia Di Muzio
- Radiotherapy, IRCCS Istituto Scientifico San Raffaele, Milano, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery, IRCCS Istituto Clinico Humanitas, Rozzano (Milano)
| |
Collapse
|
38
|
Alongi F, Di Muzio N, Motta M, Broggi S, De Martin E, Bolognesi A, Cattaneo M, Calandrino R, Fazio F. Adenoid Cystic Carcinoma of Trachea Treated with Adjuvant Hypofractionated Tomotherapy. Case Report and Literature Review. Tumori 2018; 94:121-5. [DOI: 10.1177/030089160809400122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adenoid cystic carcinoma, also called cylindroma, is the second most common histological type of tracheal malignancy but represents 1% of all respiratory tract cancers. We report a case of a 59-year-old patient submitted to an incomplete resection of the trachea and subsequently treated with adjuvant tomotherapy. There have been no reports in the literature regarding intensity-modulated radiation therapy with linac or tomotherapy systems in adenoid cystic carcinoma of the trachea. The present clinical case demonstrates the feasibility of adjuvant intensity-modulated radiation therapy techniques for optimizing the dose coverage of the tumor bed while sparing surrounding normal tissues. A dosimetric comparison between the tomotherapy plan and a 3-dimensional conformal radiotherapy plan is also reported. We demonstrate that tomotherapy permits an increase in the dose per fraction without important acute adverse effects. At 24 months’ follow-up, our patient shows no evidence of disease with negative histological findings.
Collapse
Affiliation(s)
- Filippo Alongi
- Department of Radiation Oncology, Istituto Scientifico Fondazione San Raffaele, Milan
| | - Nadia Di Muzio
- Department of Radiation Oncology, Istituto Scientifico Fondazione San Raffaele, Milan
| | - Micaela Motta
- Department of Radiation Oncology, Istituto Scientifico Fondazione San Raffaele, Milan
| | - Sara Broggi
- Department of Medical Physics, Istituto Scientifico Fondazione San Raffaele, Milan
| | - Elena De Martin
- Department of Medical Physics, Istituto Scientifico Fondazione San Raffaele, Milan
| | - Angelo Bolognesi
- Department of Radiation Oncology, Istituto Scientifico Fondazione San Raffaele, Milan
| | - Mauro Cattaneo
- Department of Medical Physics, Istituto Scientifico Fondazione San Raffaele, Milan
| | - Riccardo Calandrino
- Department of Medical Physics, Istituto Scientifico Fondazione San Raffaele, Milan
| | - Ferruccio Fazio
- Department of Radiation Oncology, Istituto Scientifico Fondazione San Raffaele, Milan
- Department of Nuclear Medicine, Istituto Scientifico Fondazione San Raffaele, Milan
- University of Milano-Bicocca, Milan
- IBFM-CNR, Milan, Italy
| |
Collapse
|
39
|
Picchio M, Giovannini E, Passoni P, Busnardo E, Landoni C, Giovacchini G, Bettinardi V, Crivellaro C, Gianolli L, Di Muzio N, Messa C. Role of PET/CT in the Clinical Management of Locally Advanced Pancreatic Cancer. Tumori 2018; 98:643-51. [DOI: 10.1177/030089161209800516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Aim To evaluate the role of 18F-fluorodeoxyglucose (FDG) PET/CT in: a) the selection of patients with locally advanced pancreatic cancer for helical tomotherapy with concurrent chemotherapy (HTT-ChT); b) monitoring HTT-ChT treatment efficacy in comparison with contrast-enhanced CT (c.e.CT). Methods Forty-two consecutive patients with unresectable locally advanced pancreatic cancer referred for HTT-ChT were enrolled in the study. All patients were pretreated with induction ChT. Before the beginning of HTT-ChT treatment patients underwent diagnostic c.e.CT (CT0) and FDG PET/CT (PET/CT0) for staging. After staging, patients received HTT-ChT. Three months after the end of HTT-ChT a control c.e.CT (CT1) was done. FDG PET/CT (PET/CT1) was repeated only in patients with positive PET/CT0. PET/CT1 and CT1 were compared with baseline imaging results to assess treatment efficacy. Results In 31/42 cases (74%) PET/CT0 documented pathological uptake in pancreatic lesions, while in the remaining 11/42 cases it showed no uptake. In 7/42 (17%) patients, PET/CT0 also detected distant metastases, prompting a change in the therapeutic approach. Compared to PET/CT0, PET/CT1 (n = 18) documented 3 complete metabolic responses, 9 partial metabolic responses, 2 instances of stable metabolic disease, and 4 instances of progressive metabolic disease. In the same group of 18 patients, CT1 showed 0 complete responses, 3 partial responses, 8 instances of stable disease, and 7 instances of progressive disease compared to CT0. Concordance between PET/CT and CT response was seen in 33% of cases. In 50% of cases, PET/CT1 documented a response to therapy that was not evident on CT. Conclusions PET/CT influenced the treatment strategy by detecting distant metastases not documented by CT, thus accurately selecting patients for HTT-ChT after induction ChT. In monitoring treatment efficacy, PET/CT can detect a metabolic response to treatment not identified by CT.
Collapse
Affiliation(s)
- Maria Picchio
- Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
- Institute for Bioimaging and Molecular Physiology, National Research Council (IBFM-CNR), Milan, Italy
| | | | - Paolo Passoni
- Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Elena Busnardo
- Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Landoni
- Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
- Tecnomed Foundation, University of Milano-Bicocca, Milan, Italy
| | - Giampiero Giovacchini
- Tecnomed Foundation, University of Milano-Bicocca, Milan, Italy
- Nuclear Medicine Department, Stadtspital Triemli, Zurich, Switzerland
| | - Valentino Bettinardi
- Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
- Institute for Bioimaging and Molecular Physiology, National Research Council (IBFM-CNR), Milan, Italy
| | | | - Luigi Gianolli
- Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Nadia Di Muzio
- Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Messa
- Institute for Bioimaging and Molecular Physiology, National Research Council (IBFM-CNR), Milan, Italy
- Tecnomed Foundation, University of Milano-Bicocca, Milan, Italy
- Nuclear Medicine, San Gerardo Hospital, Monza, Italy
| |
Collapse
|
40
|
Affiliation(s)
- Filippo Alongi
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Italy
- Radiotherapy, Scientific institute San Raffaele, Milan, Italy
- Intraoperative Radiotherapy, Breast Unit, San Raffaele-G. Giglio Foundation, Cefalù, Italy
| | - Nadia Di Muzio
- Radiotherapy, Scientific institute San Raffaele, Milan, Italy
| |
Collapse
|
41
|
Alongi F, Bolognesi A, Gajate AMS, Motta M, Landoni C, Berardi G, Alongi P, Gianolli L, Di Muzio N. Inflammatory Pseudotumor of Mediastinum Treated with Tomotherapy and Monitored with FDG-PET/CT: Case Report and Literature Review. Tumori 2018; 96:322-6. [DOI: 10.1177/030089161009600222] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mediastinal inflammatory pseudotumor is a rare disease with reactive pseudoneoplastic features and a proven capacity for local invasion. The radiographic appearance of inflammatory pseudotumor is quite non-specific and the definitive diagnosis is based on the histological evaluation of tissue specimens. Resection of the lesion is the treatment of choice. However, nonsurgical treatments such as radiotherapy and steroids have been employed in the setting of incomplete surgical resection, tumor recurrence, and patients being unfit for surgery. The case described here is being reported because of the rare mediastinal location and atypical treatment approach including salvage irradiation and monitoring with FDG-PET/CT. Because of the irregular target volume inside the mediastinum as defined by FDG-PET/CT and the significant pulmonary comorbidity, it was deemed necessary to optimize dose delivery with intensity-modulated radiation therapy (IMRT). A possible gain by means of daily control of patient setup with image-guided radiation therapy was also hypothesized and we used tomotherapy to irradiate the lesion. The first FDG-PET/CT after treatment confirmed further reduction of the metabolic activity followed by stable disease in the mediastinum, with no new occurrence of disease 16, 24 and 30 months after tomotherapy.
Collapse
Affiliation(s)
- Filippo Alongi
- Institute of Molecular Bioimaging and Physiology-National Research Council (IBFM-CNR), Milan
- Radiotherapy Unit, Scientific Institute H San Raffaele, Milan
- Intraoperative Radiotherapy Unit, LATO HSR-G Giglio, Cefalù
| | | | | | - Micaela Motta
- Radiotherapy Unit, Scientific Institute H San Raffaele, Milan
| | - Claudio Landoni
- Nuclear Medicine Unit, Scientific Institute H San Raffaele, Milan
| | | | | | - Luigi Gianolli
- Nuclear Medicine Unit, Scientific Institute H San Raffaele, Milan
| | - Nadia Di Muzio
- Intraoperative Radiotherapy Unit, LATO HSR-G Giglio, Cefalù
| |
Collapse
|
42
|
Incerti E, Gangemi V, Mapelli P, Deantoni CL, Giovacchini G, Fallanca F, Fodor A, Ciarmiello A, Baldari S, Gianolli L, Di Muzio N, Picchio M. 11C-Choline PET/CT based Helical Tomotherapy as Treatment Approach for Bone Metastases in Recurrent Prostate Cancer Patients. Curr Radiopharm 2017; 10:195-202. [DOI: 10.2174/1874471010666170919162517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/07/2017] [Accepted: 09/08/2017] [Indexed: 11/22/2022]
Affiliation(s)
- Elena Incerti
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Gangemi
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Paola Mapelli
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Federico Fallanca
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Sergio Baldari
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Luigi Gianolli
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nadia Di Muzio
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Picchio
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy
| |
Collapse
|
43
|
Fossati N, Karnes RJ, Colicchia M, Boorjian SA, Bossi A, Seisen T, Di Muzio N, Cozzarini C, Noris Chiorda B, Fiorino C, Gandaglia G, Dell'Oglio P, Shariat SF, Goldner G, Joniau S, Battaglia A, Haustermans K, De Meerleer G, Fonteyne V, Ost P, Van Poppel H, Wiegel T, Montorsi F, Briganti A. Impact of Early Salvage Radiation Therapy in Patients with Persistently Elevated or Rising Prostate-specific Antigen After Radical Prostatectomy. Eur Urol 2017; 73:436-444. [PMID: 28779974 DOI: 10.1016/j.eururo.2017.07.026] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 07/20/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Salvage radiation therapy (SRT) is a recommended treatment option for biochemical recurrence after radical prostatectomy (RP). However, its effectiveness may be limited to specific categories of patients. OBJECTIVE We aimed to identify the optimal candidates for early SRT after RP. DESIGN, SETTING, AND PARTICIPANTS The study included 925 node-negative patients treated with SRT after RP at seven institutions. Patients received SRT for either prostate-specific antigen (PSA) rising, or PSA persistence after RP that was defined as PSA level ≥0.1 ng/ml at 1 mo after surgery. All patients received local radiation to the prostate and seminal vesicle bed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome measured was distant metastasis after SRT. Regression tree analysis was used to develop a risk-stratification tool. Multivariable Cox regression analysis and nonparametric curve fitting methods were used to explore the relationship between PSA level at SRT and the probability of metastasis-free survival at 8 yr. RESULTS AND LIMITATIONS At a median follow-up of 8.0 yr, 130 patients developed distant metastasis. At multivariable analysis, pre-SRT PSA level was significantly associated with distant metastasis (hazard ratio: 1.06, p<0.0001). However, when patients were stratified into five risk groups using regression tree analysis (area under the curve: 85%), early SRT administration provided better metastasis-free survival in three groups only: (1) low risk: undetectable PSA after RP, Gleason score ≤7, and tumour stage ≥pT3b, (2) intermediate risk: undetectable PSA after RP with Gleason score ≥8, (3) high risk: PSA persistence after RP with Gleason score ≤7. CONCLUSIONS We developed an accurate risk stratification tool to facilitate the individualised recommendation for early SRT based on prostate cancer characteristics. Early SRT proved to be beneficial only in selected groups of patients who are more likely to be affected by clinically significant but not yet systemic recurrence at the time of salvage treatment administration. PATIENT SUMMARY In patients affected by prostate cancer recurrence after radical prostatectomy, the early administration of salvage radiation therapy is beneficial only for selected subgroups of patients. In this study, these groups of patients were identified.
Collapse
Affiliation(s)
- Nicola Fossati
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | | | | | | | - Alberto Bossi
- Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France
| | - Thomas Seisen
- Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France
| | - Nadia Di Muzio
- Department of Radiotherapy, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Cesare Cozzarini
- Department of Radiotherapy, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Claudio Fiorino
- Department of Medical Physics, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Dell'Oglio
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Gregor Goldner
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Karin Haustermans
- Department of Radiotherapy, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiotherapy, University Hospitals Leuven, Leuven, Belgium
| | - Valérie Fonteyne
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - Piet Ost
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | | | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| |
Collapse
|
44
|
Fiorino C, Broggi S, Fossati N, Cozzarini C, Goldner G, Wiegel T, Hinkelbein W, Karnes RJ, Boorjian SA, Haustermans K, Joniau S, Palorini F, Shariat S, Montorsi F, Van Poppel H, Di Muzio N, Calandrino R, Briganti A. Predicting the 5-Year Risk of Biochemical Relapse After Postprostatectomy Radiation Therapy in ≥PT2, pN0 Patients With a Comprehensive Tumor Control Probability Model. Int J Radiat Oncol Biol Phys 2016; 96:333-340. [DOI: 10.1016/j.ijrobp.2016.06.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 05/23/2016] [Accepted: 06/10/2016] [Indexed: 11/26/2022]
|
45
|
Cozzarini C, Noris Chiorda B, Sini C, Fiorino C, Briganti A, Montorsi F, Di Muzio N. Hematologic Toxicity in Patients Treated With Postprostatectomy Whole-Pelvis Irradiation With Different Intensity Modulated Radiation Therapy Techniques Is Not Negligible and Is Prolonged: Preliminary Results of a Longitudinal, Observational Study. Int J Radiat Oncol Biol Phys 2016; 95:690-5. [DOI: 10.1016/j.ijrobp.2016.01.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 01/12/2016] [Accepted: 01/14/2016] [Indexed: 10/22/2022]
|
46
|
Cozzarini C, Briganti A, Fossati N, Montorsi F, Di Muzio N, Fiorino C. Dose Escalation in Salvage Radiation Therapy and Urinary Toxicity: A Small Price to Pay for a Significant Prospective Benefit. J Clin Oncol 2016; 34:1704-5. [PMID: 26951317 DOI: 10.1200/jco.2016.66.7139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Alberto Briganti
- Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
| | - Nicola Fossati
- Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
| | | | | |
Collapse
|
47
|
Cozzarini C, Noris Chiorda B, Deantoni CL, Briganti A, Fiorino C, Gandaglia G, Fossati N, Freschi M, Sini C, Montironi R, Montorsi F, Di Muzio N. MP14-10 DETRIMENTAL ROLE OF PRE-PROSTATECTOMY NEOADJUVANT ANDROGEN DEPRIVATION IN NODE-NEGATIVE PATIENTS TREATED WITH ADJUVANT RT. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
48
|
Belli ML, Broggi S, Scalco E, Cattaneo GM, Dell'Oca I, Logghe G, Moriconi S, Sanguineti G, Valentini V, Di Muzio N, Fiorino C, Calandrino R. Analysis of serial CT images for studying the RT effects in head-neck cancer patients. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:5235-8. [PMID: 26737472 DOI: 10.1109/embc.2015.7319572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Images taken during and after RT for head and neck cancer have the potential to quantitatively assess xerostomia. Image information may be used as biomarkers of RT effects on parotid glands with significant potential to support adaptive treatment strategies. We investigated the possibility to extract information based on in-room CT images (kVCT, MVCT), acquired for daily image-guided radiotherapy treatment of head-and-neck cancer patients, in order to predict individual response in terms of toxicity. Follow-up MRI images were also used in order to investigate long term parotid gland deformation.
Collapse
|
49
|
Sini C, Fiorino C, Perna L, Noris Chiorda B, Deantoni CL, Bianchi M, Sacco V, Briganti A, Montorsi F, Calandrino R, Di Muzio N, Cozzarini C. Dose-volume effects for pelvic bone marrow in predicting hematological toxicity in prostate cancer radiotherapy with pelvic node irradiation. Radiother Oncol 2015; 118:79-84. [PMID: 26702990 DOI: 10.1016/j.radonc.2015.11.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [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: 07/09/2015] [Revised: 11/20/2015] [Accepted: 11/23/2015] [Indexed: 01/06/2023]
Abstract
PURPOSE To prospectively identify clinical/dosimetric predictors of acute/late hematologic toxicity (HT) in chemo-naÏve patients treated with whole-pelvis radiotherapy (WPRT) for prostate cancer. MATERIAL AND METHODS Data of 121 patients treated with adjuvant/salvage WPRT were analyzed (static-field IMRT n=19; VMAT/Rapidarc n=57; Tomotherapy n=45). Pelvic bone marrow (BM) was delineated as ilium (IL), lumbosacral, lower and whole pelvis (WP), and the relative DVHs were calculated. HT was graded both according to CTCAE v4.03 and as variation in percentage relative to baseline. Logistic regression was used to analyze association between HT and clinical/DVHs factors. RESULTS Significant differences (p<0.005) in the DVH of BM volumes between different techniques were found: Tomotherapy was associated with larger volumes receiving low doses (3-20 Gy) and smaller receiving 40-50 Gy. Lower baseline absolute values of WBC, neutrophils and lymphocytes (ALC) predicted acute/late HT (p ⩽ 0.001). Higher BM V40 was associated with higher risk of acute Grade3 (OR=1.018) or late Grade2 lymphopenia (OR=1.005). Two models predicting lymphopenia were developed, both including baseline ALC, and BM WP-V40 (AUC=0.73) and IL-V40+smoking (AUC=0.904) for acute/late respectively. CONCLUSIONS Specific regions of pelvic BM predicting acute/late lymphopenia, a risk factor for viral infections, were identified. The 2-variable models including specific constraints to BM may help reduce HT.
Collapse
Affiliation(s)
- Carla Sini
- Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy.
| | - Claudio Fiorino
- Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - Lucia Perna
- Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Marco Bianchi
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Sacco
- Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy
| | | | - Riccardo Calandrino
- Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - Nadia Di Muzio
- Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
| | - Cesare Cozzarini
- Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
50
|
Incerti E, Fodor A, Mapelli P, Fiorino C, Alongi P, Kirienko M, Giovacchini G, Busnardo E, Gianolli L, Di Muzio N, Picchio M. Radiation Treatment of Lymph Node Recurrence from Prostate Cancer: Is 11C-Choline PET/CT Predictive of Survival Outcomes? J Nucl Med 2015; 56:1836-42. [PMID: 26405166 DOI: 10.2967/jnumed.115.163741] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/28/2015] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED PET/CT is a valuable tool to detect lymph node (LN) metastases in patients with biochemical failure after primary treatment for prostate cancer (PCa). The aim was to assess the predictive role of imaging parameters derived by (11)C-choline PET/CT on survival outcomes-overall survival, locoregional relapse-free survival, clinical relapse-free survival (cRFS), and biochemical relapse-free survival (bRFS)-in patients treated with helical tomotherapy (HTT) for LN recurrence. METHODS This retrospective study included 68 patients affected by PCa (mean age, 68 y; age range, 51-81 y) with biochemical recurrence after primary treatment (median prostate-specific antigen values obtained at the time of PET/CT scan, 2.42 ng/mL; range, 0.61-27.56 ng/mL) who underwent (11)C-choline PET/CT from January 2005 to January 2013 and were treated with HTT in correspondence of the pathologic choline LN uptake. PET-derived parameters, including maximum/mean standardized uptake value (SUVmax and SUVmean, respectively) and metabolic tumor volume (MTV) with a threshold of 40%, 50%, and 60% were calculated. The best cutoff values of PET-derived parameters discriminating between patients with and without relapse, after treatment guided by PET, were assessed by receiver-operating-characteristic (ROC) curve analysis. Univariate and multivariate Cox regression analysis including the most predictive PET-derived parameters and survival outcomes were performed. RESULTS The median follow-up was 20 mo (mean, 26 mo; range, 3-97 mo). (11)C-choline PET/CT showed pathologic LN uptake in 4 patients at the pelvic level, in 5 at the abdominal level, in 13 at both the pelvic and the abdominal level, and in 46 at the abdominal or pelvic or other sites. The 2-y overall survival, locoregional relapse-free survival, cRFS, and bRFS were 87%, 91%, 51%, and 40%, respectively. On the basis of ROC curves, the most discriminative cutoff value for MTV values was an MTV threshold of 60% (MTV60) of greater than 0.64 cm(3). No significant cutoff values were found for SUVmax or SUVmean at univariate analysis, whereas MTV60 was confirmed as an independent predictor in multivariate analysis and significantly correlated with bRFS and cRFS. MTV60 and extrapelvic disease well predict the risk of cRFS. CONCLUSION (11)C-choline PET/CT performed as a guide for HTT on LN recurrence is predictive of survival. In particular, MTV60 and extrapelvic disease were the best predictors of tumor response for bRFS and cRFS in PCa patients with LN recurrence after primary treatment. This information may be useful in emerging treatment strategies.
Collapse
Affiliation(s)
- Elena Incerti
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrei Fodor
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Mapelli
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Fiorino
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pierpaolo Alongi
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Giampiero Giovacchini
- Department of Radiology and Nuclear Medicine, Stadtspital Triemli, Zurich, Switzerland
| | - Elena Busnardo
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Gianolli
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nadia Di Muzio
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Picchio
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|