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Donati CM, Galietta E, Cellini F, Di Rito A, Portaluri M, De Tommaso C, Santacaterina A, Tamburella C, Mammini F, Di Franco R, Parisi S, Cossa S, Bianculli A, Ziccarelli P, Ziccarelli L, Genovesi D, Caravatta L, Deodato F, Macchia G, Fiorica F, Napoli G, Cammelli S, Cavallini L, Buwenge M, Rossi R, Maltoni M, Morganti AG, Cilla S. Further Clarification of Pain Management Complexity in Radiotherapy: Insights from Modern Statistical Approaches. Cancers (Basel) 2024; 16:1407. [PMID: 38611085 PMCID: PMC11010980 DOI: 10.3390/cancers16071407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The primary objective of this study was to assess the adequacy of analgesic care in radiotherapy (RT) patients, with a secondary objective to identify predictive variables associated with pain management adequacy using a modern statistical approach, integrating the Least Absolute Shrinkage and Selection Operator (LASSO) algorithm and the Classification and Regression Tree (CART) analysis. METHODS This observational, multicenter cohort study involved 1387 patients reporting pain or taking analgesic drugs from 13 RT departments in Italy. The Pain Management Index (PMI) served as the measure for pain control adequacy, with a PMI score < 0 indicating suboptimal management. Patient demographics, clinical status, and treatment-related factors were examined to discern the predictors of pain management adequacy. RESULTS Among the analyzed cohort, 46.1% reported inadequately managed pain. Non-cancer pain origin, breast cancer diagnosis, higher ECOG Performance Status scores, younger patient age, early assessment phase, and curative treatment intent emerged as significant determinants of negative PMI from the LASSO analysis. Notably, pain management was observed to improve as RT progressed, with a greater discrepancy between cancer (33.2% with PMI < 0) and non-cancer pain (73.1% with PMI < 0). Breast cancer patients under 70 years of age with non-cancer pain had the highest rate of negative PMI at 86.5%, highlighting a potential deficiency in managing benign pain in younger patients. CONCLUSIONS The study underscores the dynamic nature of pain management during RT, suggesting improvements over the treatment course yet revealing specific challenges in non-cancer pain management, particularly among younger breast cancer patients. The use of advanced statistical techniques for analysis stresses the importance of a multifaceted approach to pain management, one that incorporates both cancer and non-cancer pain considerations to ensure a holistic and improved quality of oncological care.
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Affiliation(s)
- Costanza Maria Donati
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Erika Galietta
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Francesco Cellini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (F.C.); (F.D.)
- Dipartimento Universitario Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessia Di Rito
- Radiotherapy Unit, IRCCS Istituto Tumori ‘Giovanni Paolo II’ Bari, 70124 Bari, Italy;
| | | | | | - Anna Santacaterina
- U.O. di Radioterapia AOOR PAPARDO PIEMONTE, 98121 Messina, Italy; (A.S.); (C.T.)
| | - Consuelo Tamburella
- U.O. di Radioterapia AOOR PAPARDO PIEMONTE, 98121 Messina, Italy; (A.S.); (C.T.)
| | - Filippo Mammini
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Rossella Di Franco
- Department of Radiation Oncology, Istituto Nazionale Tumori-IRCCS-Fodazione G. Pascale, 80131 Napoli, Italy;
| | - Salvatore Parisi
- Radioterapia Opera di S. Pio da Pietralcina, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (S.P.); (S.C.)
| | - Sabrina Cossa
- Radioterapia Opera di S. Pio da Pietralcina, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (S.P.); (S.C.)
| | - Antonella Bianculli
- Medical Physics Department, IRCCS-CROB—Centro di Riferimento Oncologico della Basilica, 85028 Rionero in Vulture, Italy
| | - Pierpaolo Ziccarelli
- U.O. Radioterapia Oncologica—S.O. Mariano Santo, 87100 Cosenza, Italy; (P.Z.); (L.Z.)
| | - Luigi Ziccarelli
- U.O. Radioterapia Oncologica—S.O. Mariano Santo, 87100 Cosenza, Italy; (P.Z.); (L.Z.)
| | - Domenico Genovesi
- Radiation Oncology Unit, SS Annunziata Hospital, G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (D.G.); (L.C.)
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D’Annunzio” University of Chieti-Pescara, 66013 Chieti, Italy
| | - Luciana Caravatta
- Radiation Oncology Unit, SS Annunziata Hospital, G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (D.G.); (L.C.)
| | - Francesco Deodato
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (F.C.); (F.D.)
- Radiation Oncology Unit, Responsible Research Hospital, 86100 Campobasso, Italy;
| | - Gabriella Macchia
- Radiation Oncology Unit, Responsible Research Hospital, 86100 Campobasso, Italy;
| | - Francesco Fiorica
- U.O.C.di Radioterapia e Medicina Nucleare, Ospedale Mater Salutis di Legnago, 37045 Verona, Italy; (F.F.); (G.N.)
| | - Giuseppe Napoli
- U.O.C.di Radioterapia e Medicina Nucleare, Ospedale Mater Salutis di Legnago, 37045 Verona, Italy; (F.F.); (G.N.)
| | - Silvia Cammelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Letizia Cavallini
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Milly Buwenge
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Romina Rossi
- Palliative Care Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Marco Maltoni
- Medical Oncology Unit, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy;
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Savino Cilla
- Medical Physics Unit, Responsible Research Hospital, 86100 Campobasso, Italy;
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Donati CM, Maggiore CM, Maltoni M, Rossi R, Nardi E, Zamagni A, Siepe G, Mammini F, Cellini F, Di Rito A, Portaluri M, De Tommaso C, Santacaterina A, Tamburella C, Di Franco R, Parisi S, Cossa S, Fusco V, Bianculli A, Ziccarelli P, Ziccarelli L, Genovesi D, Caravatta L, Deodato F, Macchia G, Fiorica F, Napoli G, Buwenge M, Morganti AG. Adequacy of Pain Management in Patients Referred for Radiation Therapy: A Subanalysis of the Multicenter ARISE-1 Study. Cancers (Basel) 2023; 16:109. [PMID: 38201537 PMCID: PMC10778440 DOI: 10.3390/cancers16010109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Pain is a prevalent symptom among cancer patients, and its management is crucial for improving their quality of life. However, pain management in cancer patients referred to radiotherapy (RT) departments is often inadequate, and limited research has been conducted on this specific population. This study aimed to assess the adequacy and effectiveness of pain management when patients are referred for RT. Moreover, we explored potential predictors of adequate pain management. METHODS This observational, prospective, multicenter cohort study included cancer patients aged 18 years or older who were referred to RT departments. A pain management assessment was conducted using the Pain Management Index (PMI), calculated by subtracting the pain score from the analgesic score (PMI < 0 indicated inadequate pain management). Univariate and multivariate analyses were performed to identify predictors of adequate pain management. RESULTS A total of 1042 cancer outpatients were included in the study. The analysis revealed that 42.9% of patients with pain did not receive adequate pain management based on PMI values. Among patients with pain or taking analgesics and referred to palliative or curative RT, 72% and 75% had inadequate or ineffective analgesic therapy, respectively. The odds of receiving adequate pain management (PMI ≥ 0) were higher in patients undergoing palliative RT (OR 2.52; p < 0.001), with worse ECOG-PS scores of 2, 3 and 4 (OR 1.63, 2.23, 5.31, respectively; p: 0.017, 0.002, 0.009, respectively) compared to a score of 1 for those with cancer-related pain (OR 0.38; p < 0.001), and treated in northern Italy compared to central and southern of Italy (OR 0.25, 0.42, respectively; p < 0.001). CONCLUSIONS In this study, a substantial proportion of cancer patients referred to RT departments did not receive adequate pain management. Educational and organizational strategies are necessary to address the inadequate pain management observed in this population. Moreover, increasing the attention paid to non-cancer pain and an earlier referral of patients for palliative RT in the course of the disease may improve pain response and treatment outcomes.
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Affiliation(s)
- Costanza M. Donati
- Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.S.); (F.M.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
| | - Chiara Maria Maggiore
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
| | - Marco Maltoni
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Romina Rossi
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
- Palliative Care Unit, AUSL Romagna, 40121 Forlì, Italy
| | - Elena Nardi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40126 Bologna, Italy
| | - Alice Zamagni
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
| | - Giambattista Siepe
- Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.S.); (F.M.); (A.G.M.)
| | - Filippo Mammini
- Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.S.); (F.M.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
| | - Francesco Cellini
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, IRCCS, UOC di Radioterapia, Fondazione Policlinico Universitario A. Gemelli, 00168 Roma, Italy;
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Alessia Di Rito
- IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy;
| | | | | | - Anna Santacaterina
- U.O. di Radioterapia AOOR PAPARDO PIEMONTE, 98121 Messina, Italy; (A.S.); (C.T.)
| | - Consuelo Tamburella
- U.O. di Radioterapia AOOR PAPARDO PIEMONTE, 98121 Messina, Italy; (A.S.); (C.T.)
| | - Rossella Di Franco
- S.C. di Radioterapia dell’Istituto Nazionale Tumori Pascale, 80131 Napoli, Italy;
| | - Salvatore Parisi
- Radioterapia Opera di S. Pio da Pietralcina, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (S.P.); (S.C.)
| | - Sabrina Cossa
- Radioterapia Opera di S. Pio da Pietralcina, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (S.P.); (S.C.)
| | - Vincenzo Fusco
- IRCCS CROB, 85028 Rionero in Vulture, Italy; (V.F.); (A.B.)
| | | | - Pierpaolo Ziccarelli
- U.O. Radioterapia Oncologica, S.O. Mariano Santo, 87100 Cosenza, Italy; (P.Z.); (L.Z.)
| | - Luigi Ziccarelli
- U.O. Radioterapia Oncologica, S.O. Mariano Santo, 87100 Cosenza, Italy; (P.Z.); (L.Z.)
| | - Domenico Genovesi
- Radiation Oncology Unit, Università degli Studi G. D’Annunzio, 66100 Chieti, Italy; (D.G.); (L.C.)
| | - Luciana Caravatta
- Radiation Oncology Unit, Università degli Studi G. D’Annunzio, 66100 Chieti, Italy; (D.G.); (L.C.)
| | - Francesco Deodato
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Radiotherapy Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, 86100 Campobasso, Italy; (F.D.); (G.M.)
| | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, 86100 Campobasso, Italy; (F.D.); (G.M.)
| | - Francesco Fiorica
- U.O.C. di Radioterapia e Medicina Nucleare, Ospedale Mater Salutis di Legnago, 37045 Verona, Italy; (F.F.); (G.N.)
| | - Giuseppe Napoli
- U.O.C. di Radioterapia e Medicina Nucleare, Ospedale Mater Salutis di Legnago, 37045 Verona, Italy; (F.F.); (G.N.)
| | - Milly Buwenge
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
| | - Alessio G. Morganti
- Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.S.); (F.M.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (C.M.M.); (M.M.); (R.R.); (A.Z.); (M.B.)
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Donati CM, Nardi E, Zamagni A, Siepe G, Mammini F, Cellini F, Di Rito A, Portaluri M, De Tommaso C, Santacaterina A, Tamburella C, Di Franco R, Parisi S, Cossa S, Fusco V, Bianculli A, Ziccarelli P, Ziccarelli L, Genovesi D, Caravatta L, Deodato F, Macchia G, Fiorica F, Napoli G, Buwenge M, Rossi R, Maltoni M, Morganti AG. Adequacy of Pain Treatment in Radiotherapy Departments: Results of a Multicenter Study on 2104 Patients (Arise). Cancers (Basel) 2022; 14:cancers14194660. [PMID: 36230582 PMCID: PMC9563985 DOI: 10.3390/cancers14194660] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/19/2022] Open
Abstract
Aim: The frequent inadequacy of pain management in cancer patients is well known. Moreover, the quality of analgesic treatment in patients treated with radiotherapy (RT) has only been rarely assessed. In order to study the latter topic, we conducted a multicenter, observational and prospective study based on the Pain Management Index (PMI) in RT Italian departments. Methods: We collected data on age, gender, tumor site and stage, performance status, treatment aim, and pain (type: CP—cancer pain, NCP—non-cancer pain, MP—mixed pain; intensity: NRS: Numeric Rating Scale). Furthermore, we analyzed the impact on PMI on these parameters, and we defined a pain score with values from 0 (NRS: 0, no pain) to 3 (NRS: 7−10: intense pain) and an analgesic score from 0 (pain medication not taken) to 3 (strong opioids). By subtracting the pain score from the analgesic score, we obtained the PMI value, considering cases with values < 0 as inadequate analgesic prescriptions. The Ethics Committees of the participating centers approved the study (ARISE-1 study). Results: Two thousand one hundred four non-selected outpatients with cancer and aged 18 years or older were enrolled in 13 RT departments. RT had curative and palliative intent in 62.4% and 37.6% patients, respectively. Tumor stage was non-metastatic in 57.3% and metastatic in 42.7% of subjects, respectively. Pain affected 1417 patients (CP: 49.5%, NCP: 32.0%; MP: 18.5%). PMI was < 0 in 45.0% of patients with pain. At multivariable analysis, inadequate pain management was significantly correlated with curative RT aim, ECOG performance status = 1 (versus both ECOG-PS3 and ECOG- PS4), breast cancer, non-cancer pain, and Central and South Italy RT Departments (versus Northern Italy).Conclusions: Pain management was less adequate in patients with more favorable clinical condition and stage. Educational and organizational strategies are needed in RT departments to reduce the non-negligible percentage of patients with inadequate analgesic therapy.
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Affiliation(s)
- Costanza M. Donati
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-051-2143564
| | - Elena Nardi
- Medical Statistics, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Alice Zamagni
- Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Giambattista Siepe
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Filippo Mammini
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Francesco Cellini
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, 00168 Roma, Italy
- Radioterapia Oncologica ed Ematologia, Dipartimento Universitario Diagnostica per Immagini, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Roma, Italy
| | - Alessia Di Rito
- IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy
| | | | | | | | | | - Rossella Di Franco
- S.C. di Radioterapia dell’Istituto Nazionale Tumori Pascale, 80131 Napoli, Italy
| | - Salvatore Parisi
- Radioterapia Opera di S. Pio da Pietralcina, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Sabrina Cossa
- Radioterapia Opera di S. Pio da Pietralcina, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | | | | | | | - Luigi Ziccarelli
- U.O. Radioterapia Oncologica-S.O. Mariano Santo, 87100 Cosenza, Italy
| | - Domenico Genovesi
- Radioterapia Università degli Studi G. D’Annunzio, 66100 Chieti, Italy
| | - Luciana Caravatta
- Radioterapia Università degli Studi G. D’Annunzio, 66100 Chieti, Italy
| | - Francesco Deodato
- Radioterapia Oncologica ed Ematologia, Dipartimento Universitario Diagnostica per Immagini, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Roma, Italy
- Radiotherapy Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, 86100 Campobasso, Italy
| | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, 86100 Campobasso, Italy
| | - Francesco Fiorica
- U.O.C.di Radioterapia e Medicina Nucleare, Ospedale Mater Salutis di Legnago, 37045 Verona, Italy
| | - Giuseppe Napoli
- U.O.C.di Radioterapia e Medicina Nucleare, Ospedale Mater Salutis di Legnago, 37045 Verona, Italy
| | - Milly Buwenge
- Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Romina Rossi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Marco Maltoni
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Alessio G. Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
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Morganti AG, Trodella L, Valentini V, Doglietto GB, Ziccarelli P, Macchia G, Alfieri S, Smaniotto D, Luzi S, Brizi MG, Fadda G, Fiorino M, Di Gesù C, Cellini N. La Radiochemioterapia Preoperatoria Del Carcinoma Pancreatico: Risultati Preliminari. Tumori 2018. [DOI: 10.1177/030089169908501s08] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Alessio G. Morganti
- Istituto di Radiologia, Cattedra di Radioterapia; Istituto di Clinica Chirurgica, Roma
| | - Lucio Trodella
- Istituto di Radiologia, Cattedra di Radioterapia; Istituto di Clinica Chirurgica, Roma
| | - Vincenzo Valentini
- Istituto di Radiologia, Cattedra di Radioterapia; Istituto di Clinica Chirurgica, Roma
| | | | - Pierpaolo Ziccarelli
- Istituto di Radiologia, Cattedra di Radioterapia; Istituto di Clinica Chirurgica, Roma
| | - Gabriella Macchia
- Istituto di Radiologia, Cattedra di Radioterapia; Istituto di Clinica Chirurgica, Roma
| | | | - Daniela Smaniotto
- Istituto di Radiologia, Cattedra di Radioterapia; Istituto di Clinica Chirurgica, Roma
| | - Stefano Luzi
- Istituto di Radiologia, Cattedra di Radioterapia; Istituto di Clinica Chirurgica, Roma
| | - M. Gabriella Brizi
- Istituto di Radiologia, Cattedra di Radioterapia; Istituto di Clinica Chirurgica, Roma
| | | | | | - Cinzia Di Gesù
- Istituto di Radiologia, Cattedra di Radioterapia; Istituto di Clinica Chirurgica, Roma
| | - Numa Cellini
- Istituto di Radiologia, Cattedra di Radioterapia; Istituto di Clinica Chirurgica, Roma
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Piro F, Cosentino D, Indrieri P, Ziccarelli P, Ziccarelli L, Marafioti L. PO-249 HDR BRACHYTHERAPY BOOST IN GYNAECOLOGICAL CANCERS, WHAT'S THE PERFECT TIMING TO PREVENT VAGINAL STENOSIS? Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)72215-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Piro F, Siciliano R, Cosentino D, Indrieri P, Ziccarelli L, Ziccarelli P, Marafioti L. 948 poster HDR BRACHYTHERAPY IN SKIN CANCERS: TARGET DETERMINATION AND OUTCOME VERSUS CONVENTIONAL RADIOTHERAPY. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)71070-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Piro F, Ziccarelli L, Ziccarelli P, Indrieri P, Cosentino D, Marafioti L. HIGH DOSE RATE BRACHYTHERAPY AND 3D CONFORMAL THERAPY FOR GYNAECOLOGICAL CANCER:OUR EXPERIENCE. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)71816-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Morganti AG, Trodella L, Valentini V, Montemaggi P, Costamagna G, Smaniotto D, Luzi S, Ziccarelli P, Macchia G, Perri V, Mutignani M, Cellini N. Combined modality treatment in unresectable extrahepatic biliary carcinoma. Int J Radiat Oncol Biol Phys 2000; 46:913-9. [PMID: 10705013 DOI: 10.1016/s0360-3016(99)00487-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE Cancers of the extrahepatic biliary tract are rare. Surgical resection is considered the standard treatment, but is rarely feasible. Several reports of combined modality therapy, including external beam radiation, often combined with chemotherapy and intraluminal brachytherapy, have been published. The purpose of this study was to evaluate the effect of chemoradiation plus intraluminal brachytherapy on response, local control, survival, and symptom relief in patients with unresectable or residual extrahepatic biliary carcinoma. METHODS AND MATERIALS From February 1991 to December 1997, 20 patients (14 male, 6 female; mean age 61 +/- 12 years; median follow-up 71 months) with unresectable (16 patients) or residual (4 patients), nonmetastatic extrahepatic bile tumors (common bile duct, 8; gallbladder, 1; Klatskin, 11) received external beam radiation (39.6-50.4 Gy); in 19 patients, 5-fluorouracil (96-h continuous infusion, days 1-4 at 1,000 mg/m(2)/day) was also administered. Twelve patients received a boost by intraluminal brachytherapy using (192)Ir wires of 30-50 Gy, prescribed 1 cm from the source axis. RESULTS During external beam radiotherapy, 8 patients (40%) developed grade 1-2 gastrointestinal toxicity. Four patients treated with external-beam plus intraluminal brachytherapy had a clinical response (2 partial, 2 complete) after treatment. For the total patient group, the median survival and time to local progression was 21.2 and 33.1 months, respectively. Distant metastasis occurred in 10 (50%) patients. Two patients who received external beam radiation plus intraluminal brachytherapy developed late duodenal ulceration. Two patients with unresectable disease survived more than 5 years. CONCLUSION Our data suggest that chemoradiation plus intraluminal brachytherapy was relatively well-tolerated, and resulted in reasonable local control and median survival. Further follow-up and additional research is needed to determine the ultimate efficacy of this regimen. New chemoradiation combinations and/or new treatment strategies (neoadjuvant chemoradiation) may contribute, in the future, to improve these results.
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Affiliation(s)
- A G Morganti
- Cattedra di Radioterapia, Universita' Cattolica del Sacro Cuore, Roma, Italy
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Morganti AG, Trodella L, Valentini V, Doglietto GB, Ziccarelli P, Macchia G, Alfieri S, Smaniotto D, Luzi S, Brizi MG, Fadda G, Fiorino M, Di Gesú C, Cellini N. [Preoperative radiochemotherapy in pancreatic cancer: preliminary results]. Tumori 1999; 85:S27-32. [PMID: 10235077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
AIMS AND BACKGROUND The prognosis of pancreatic cancer remains poor. Surgery, when feasible, is rarely curative. Radiation therapy (RT) and concomitant 5-fluorouracil (5-FU) have been shown to improve survival in locally advanced pancreatic cancer. In an attempt to improve resectability and disease control, we used preoperative chemoradiation in a combined modality therapy protocol. The purpose of this study was to evaluate our initial results in terms of acute toxicity and response. METHODS From October 1995 to May 1998, 20 patients (11 males, 9 females; mean age, 60.1 years; median follow-up, 28 months) with unresectable (12 patients) or resectable (8 patients) non-metastatic pancreatic tumors, received external beam radiation (39.6 Gy) plus 5-FU (96 hours continuous infusion, days 1-4 at 1000 mg/m2/day). After 4 weeks, patients were evaluated for surgical resection. In resected patients, electron-beam intraoperative radiation therapy (10 Gy) was given before reconstruction. Thereafter, in resected patients, adjuvant chemotherapy was prescribed (6 courses: 5-FU, mitomycin C, adriamicine). RESULTS During chemoradiation, no patients developed grade 3-4 acute toxicity. Three out of twelve (25%) patients with unresectable tumors had tumor downstaging. No patients showed partial or complete responses. Four out of twenty patients (20%) had minimal tumor response. Three patients showed disease progression after chemoradiation (liver or peritoneal metastases). Nine patients underwent surgical resection and IORT, with 1 postoperative death. The median survival time for the 20 patients was 9.4 (18.5 and 8.3 months in resected and unresected patients, respectively). CONCLUSION Our preliminary results suggest that preoperative 5-FU chemoradiation was well tolerated and may result in tumor downstaging but the response-rate is still low. Based on the impact of surgical resection on survival, an improvement in local response rate is necessary.
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Affiliation(s)
- A G Morganti
- Istituto di Radiologia, Cattedra di Radioterapia, Roma
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Marmiroli L, Nardone L, Salvi G, Ziccarelli P, Fiorentino G, Ausili-Cèfaro G. Chemoradiotherapy with carboplatin in continuous infusion in the locoregional control of advanced head and neck cancer. Rays 1998; 23:549-54. [PMID: 9932473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Because of the difficulty to achieve and maintain locoregional control in head and neck cancer, many clinical trials were focused on the addition of chemotherapy to locoregional treatments in advanced head and neck cancer patients. In particular, concomitant chemoradiotherapy resulted in high response rate and improved local control, sometimes with increased toxicity. In the effort to improve local control a phase II study on chemoradiotherapy with carboplatin in prolonged continuous infusion for 14 days (420 mg/m2 total dose) during standard radiotherapy, was performed. 45 patients were evaluable for response: CR 62.5% (global response 96%). After a mean follow-up of 48 months 9/28 patients with CR were still alive with no evidence of disease; two additional patients were alive but with locoregional disease. As for deceased patients, one died from non-tumor related causes, 13 from locoregional disease and 2 for metastatic disease. If the entire population of Crs is analyzed, it is observed that 13 patients (46.5% of CRs and 29% of the entire series) maintained a durable locoregional control. In most patients recurrence was detectable both in the primary tumor and in the neck.
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Affiliation(s)
- L Marmiroli
- Cattedra di Radioterapia, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Roma, Italy
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Cellini N, Trodella L, Valentini V, Doglietto GB, Morganti AG, Ziccarelli P, Alfieri S, Bossola M, Brizi MG, Crucitti F. Radiotherapy, local control and survival in carcinomas of the exocrine pancreas. Rays 1998; 23:528-34. [PMID: 9932470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Local recurrence affects approximately 50% of patients undergoing surgery for pancreatic adenocarcinoma. To lower the incidence of locoregional recurrence, the combination with surgery of adjuvant radiotherapy has been proposed. The latter is based on external radiotherapy (ERT), intraoperative radiotherapy (IORT) or their combination. To evaluate the impact on local control and survival, results achieved in a a group of patients undergoing surgical resection and combined adjuvant radiotherapy, are analyzed. 17 patients with adenocarcinoma of the exocrine pancreas were treated with a therapeutic protocol based on pancreatectomy and intraoperative radiotherapy (IORT) to the tumor bed (10 Gy) followed by postoperative radiotherapy (50 Gy); 9 patients underwent also preoperative radiotherapy (5 Gy) to the pancreas and liver. With a median follow-up of 45 months, in 3 patients (17.6%) local recurrence was observed while 12 patients (70.6%) showed liver metastases or peritoneal spread. Median survival was 17.5 months and actuarial survival at 2 and 5 years was 41.2% and 11.2%, respectively. As compared to a moderate local control, the prognosis of patients undergoing surgical resection remained disappointing. Thus, the effort of improving results with new therapeutic modalities as preoperative radiochemotherapy and adjuvant chemotherapy, seems justified.
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Affiliation(s)
- N Cellini
- Cattedra di Radioterapia, Università Cattolica del S. Cuore, Policlinico A. Gemelli, Roma, Italy
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Montemaggi P, Smaniotto O, Morganti A, Costamagna G, Valentine V, Mutignani M, Luzi S, Ziccarelli P, Gambacorta M, Cellini N. 112Treatment of unresectable pancreatic carcinoma by intraluminal brachytherapy in the Wirsung duct: A feasibility study. Radiother Oncol 1998. [DOI: 10.1016/s0167-8140(98)80117-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Marmiroli L, Fiorentino G, Salvi G, Ziccarelli P, Genovesi D, Gentile PC, Nardone L, Ausili-Cèfaro G. Advanced bladder carcinoma (BC): an organ-sparing approach with concomitant radio-chemotherapy. Cancer Radiother 1997. [DOI: 10.1016/s1278-3218(97)89630-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cellini N, Morganti AG, Ziccarelli P, Marucci L, Smaniotto D. Organ preservation in the management of pancreatic cancer. Rays 1997; 22:484-9. [PMID: 9446955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Over a 5-year period, 6 patients with potentially resectable (cT2) pancreatic adenocarcinoma underwent exclusive radiotherapy. Surgery was ruled out because of the patients' age (> 75 years) in 5 cases and for contraindication for anesthesia in the remaining one. Four patients underwent intraluminal brachytherapy (50 Gy) with linear 192Ir sources; the remaining two underwent concomitant radiochemotherapy (39.6 and 50.4 Gy respectively) followed by a boost dose (50 and 20 Gy respectively) of intraluminal brachytherapy. All patients completed the treatment without relevant acute side-effects. One patient undergoing combined treatment showed gastric ulcer 8 months after treatment. Two patients showed local progression of the disease and two distant metastases. In one of the two patients with local progression, digestive by-pass was required. All patients died. Median survival was of 14 months. Actuarial survival at 1, 2 and 3 years was 66%, 33% and 16% respectively. No patient showed pain during follow-up. The fairly good quality of life observed in these patients undergoing conservative treatment and the rate of survival, comparable with that of surgical series, suggest that irradiation should be considered in those patients in whom radical surgery in contraindicated.
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Affiliation(s)
- N Cellini
- Cattedra di Radioterapia, Università Cattolica del S.Cuore, Policlinico A. Gemelli, Roma, Italy
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