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Aristei C, Kaidar-Person O, Boersma L, Leonardi MC, Offersen B, Franco P, Arenas M, Bourgier C, Pfeffer R, Kouloulias V, Bölükbaşı Y, Meattini I, Coles C, Luis AM, Masiello V, Palumbo I, Morganti AG, Perrucci E, Tombolini V, Krengli M, Marazzi F, Trigo L, Borghesi S, Ciabattoni A, Ratoša I, Valentini V, Poortmans P. The 2022 Assisi Think Tank Meeting: White paper on optimising radiation therapy for breast cancer. Crit Rev Oncol Hematol 2023:104035. [PMID: 37244324 DOI: 10.1016/j.critrevonc.2023.104035] [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: 02/23/2023] [Revised: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 05/29/2023] Open
Abstract
The present white paper, referring to the 4th Assisi Think Tank Meeting on breast cancer, reviews state-of-the-art data, on-going studies and research proposals. < 70% agreement in an online questionnaire identified the following clinical challenges: 1: Nodal RT in patients who have a) 1-2 positive sentinel nodes without ALND (axillary lymph node dissection); b) cN1 disease transformed into ypN0 by primary systemic therapy and c) 1-3 positive nodes after mastectomy and ALND. 2. The optimal combination of RT and immunotherapy (IT), patient selection, IT-RT timing, and RT optimal dose, fractionation and target volume. Most experts agreed that RT- IT combination does not enhance toxicity. 3: Re-irradiation for local relapse converged on the use of partial breast irradiation after second breast conserving surgery. Hyperthermia aroused support but is not widely available. Further studies are required to finetune best practice, especially given the increasing use of re-irradiation.
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Affiliation(s)
- C Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, Italy.
| | - O Kaidar-Person
- Breast Radiation Unit, Radiation Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - L Boersma
- Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - M C Leonardi
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - B Offersen
- Department of Experimental Clinical Oncology, Department of Oncology, Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - P Franco
- Depatment of Translational Medicine, University of Eastern Piedmont and Department of Radiation Oncology, 'Maggiore della Carita`' University Hospital, Novara, Italy
| | - M Arenas
- Universitat Rovira I Virgili, Radiation Oncology Department, Hospital Universitari Sant Hoan de Reus, IISPV, Spain
| | - C Bourgier
- Radiation Oncology, ICM-Val d' Aurelle, Univ Montpellier, Montpellier, France
| | - R Pfeffer
- Oncology Institute, Assuta Medical Center, Tel Aviv and Ben Gurion University Medical School, Israel
| | - V Kouloulias
- 2nd Department of Radiology, Radiotherapy Unit, Medical School, National and Kapodistrian University of Athens, Greece
| | - Y Bölükbaşı
- Koc University, Faculty of Medicine, Department of Radiation Oncology, Istanbul, Turkey
| | - I Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence & Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - C Coles
- Department of Oncology, University of Cambridge, UK
| | - A Montero Luis
- Department of Radiation Oncology, University Hospital HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - V Masiello
- Unità Operativa di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagine, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Gemelli IRCSS Roma, Italy
| | - I Palumbo
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - A G Morganti
- DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy; Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum Bologna University; Bologna, Italy
| | - E Perrucci
- Radiation Oncology Section, Perugia General Hospital, Perugia, Italy
| | - V Tombolini
- Radiation Oncology, Department of Radiological, Oncological and Pathological Science, University "La Sapienza", Roma, Italy
| | - M Krengli
- DISCOG, Università di Padova e Istituto Oncologico Veneto - IRCCS
| | - F Marazzi
- Unità Operativa di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagine, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Gemelli IRCSS Roma, Italy
| | - L Trigo
- Service of Brachytherapy, Department of Image and Radioncology, Instituto Português Oncologia Porto Francisco Gentil E.P.E., Portugal
| | - S Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, Italy
| | - A Ciabattoni
- Department of Radiation Oncology, San Filippo Neri Hospital, ASL Rome 1, Rome, Italy
| | - I Ratoša
- Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - V Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore e Fondazione Policlinico Gemelli IRCSS Roma, Italy
| | - P Poortmans
- Department of Radiation Oncology, Iridium Kankernetwerk, Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium
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2
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Francolini G, Detti B, Becherini C, Caini S, Ingrosso G, Di Cataldo V, Stocchi G, Salvestrini V, Lancia A, Scartoni D, Giacomelli I, Sardaro A, Carbonara R, Borghesi S, Aristei C, Livi L. Toxicity after moderately hypofractionated versus conventionally fractionated prostate radiotherapy: A systematic review and meta-analysis of the current literature. Crit Rev Oncol Hematol 2021; 165:103432. [PMID: 34352361 DOI: 10.1016/j.critrevonc.2021.103432] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 07/06/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Moderately hypofractionated radiotherapy (RT) currently represents the standard RT approach for all prostate cancer (PCa) risk categories. We performed a systematic review and meta-analysis of available literature, focusing on acute and late genitourinary (GU) and gastrointestinal (GI) adverse events (AEs) of moderate hypofractionation for localized PCa. MATERIALS AND METHODS Literature search was performed and two independent reviewers selected the records according to the following Population (P) Intervention (I) Comparator (C) and Outcomes (O) (PICO) question: "In patients affected by localized PCa (P), moderately hypofractionated RT (defined as a treatment schedule providing a single dose per fraction of 3-4.5 Gy) (I) can be considered equivalent to conventionally fractionated RT (C) in terms of G > 2 GI and GU acute and late adverse events (O)?". Bias assessment was performed using Cochrane Cochrane Collaboration's Tool for Assessing Risk of Bias. RESULTS Thirteen records were identified and a meta-analysis was performed. Risk of acute GI and GU > 2 adverse events in the moderately hypofractionated arm was increased by 9.8 % (95 %CI 4.8 %-14.7 %; I2 = 57 %) and 1.5 % (95 % CI -1.5 %-4.4 %; I2 = 0%), respectively. DISCUSSION Overall, majority of trials included in our meta-analysis suggested that moderately hypofractionated RT is equivalent, in terms of GI and GU adverse events, to conventional fractionation. Pooled analysis showed a trend to increased GI toxicity after hypofractionated treatment, but this might be related to dose escalation rather than hypofractionation.
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Affiliation(s)
- G Francolini
- Radiation Oncology Unit, University of Florence, Florence, Italy
| | - B Detti
- Radiation Oncology Unit, University of Florence, Florence, Italy.
| | - C Becherini
- Radiation Oncology Unit, University of Florence, Florence, Italy
| | - S Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - G Ingrosso
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia, Italy
| | | | - G Stocchi
- Radiation Oncology Unit, University of Florence, Florence, Italy
| | - V Salvestrini
- Radiation Oncology Unit, University of Florence, Florence, Italy
| | - A Lancia
- Department of Medical Sciences and Infectious Disease, Radiation Oncology Unit, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | - D Scartoni
- Proton Treatment Center, Azienda Provinciale Per i Servizi Sanitari, Trento, Italy
| | - I Giacomelli
- Proton Treatment Center, Azienda Provinciale Per i Servizi Sanitari, Trento, Italy
| | - A Sardaro
- Section of Radiology and Radiation Oncology, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - R Carbonara
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, BA, Italy
| | - S Borghesi
- Radiotherapy Department, Azienda USL Toscana Sud Est, San Donato Hospital, Arezzo, Italy
| | - C Aristei
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia, Italy
| | - L Livi
- Radiation Oncology Unit, University of Florence, Florence, Italy
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3
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Bruni A, Mazzeo E, Triggiani L, Frassinelli L, Guarneri A, Bartoncini S, Antognoni P, Gottardo S, Greco D, Borghesi S, Nanni S, Ingrosso G, D’Angelillo R, Detti B, Francolini G, Magli A, Guerini A, Arcangeli S, Spiazzi L, Ricardi U, Lohr F, Magrini S. PO-1347 Prostate cancer RT pattern of practice in Italy between 2004-2011: an analysis by the AIRO database. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07798-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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4
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Buglione M, Bruni A, Bardoscia L, Borghesi S, Mazzeo E, Cozzaglio C, Mortellaro G, Triggiani L, Santini R, Lisi R, Valeriani M, Amara L, Cagna E, Fondelli S, Alitto A, Franzese C, Muto P, Corsini A, Livi L, Garibaldi E, Tartarelli M, Deatoni C, Baiguini A, Bertoni F, Magrini S. PO-1192: Elective Pelvic Nodes Irradiation in Patients with Prostate Cancer (PRO-EPI Study). Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01210-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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5
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Francolini G, Detti B, Bottero M, Zilli T, Lancia A, Bruni A, Borghesi S, Mariotti M, Castellucci P, Fanti S, Filippi AR, Teriaca MA, Maragna V, Aristei C, Mazzeo E, Livi L, Ingrosso G. Detection rate, pattern of relapse and influence on therapeutic decision of PSMA PET/CT in patients affected by biochemical recurrence after radical prostatectomy, a retrospective case series. Clin Transl Oncol 2020; 23:364-371. [PMID: 32602076 DOI: 10.1007/s12094-020-02427-2] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/10/2020] [Indexed: 12/24/2022]
Abstract
AIMS 68Ga-Prostate-specific membrane antigen (PSMA) PET/CT is widely used in patients with biochemical recurrence (BCR) after radical prostatectomy. We collected data about patients staged with PSMA PET/CT after BCR (PSA < 1 ng/ml) in four different institutes. Impact of baseline features (Gleason score, risk classification, PSA at recurrence, PSA doubling time and time to recurrence) was explored to understand predictive factors of (PSMA) PET/CT positivity. Impact of restaging on following treatment approaches was reported. RESULTS 92 patients were included. PSMA PET/CT detection rate was 56.5% and low-volume disease (≤ 3 non-visceral lesions) was detected in 52.2% of patients. After positive scan, 13.5% of patients still lies on observation, ADT alone was administered in 30.8% of cases, Stereotactic body RT (SBRT) alone was delivered to 44.2% of patients and 11.5% of patients underwent concomitant SBRT and ADT. Seven patients underwent conventional salvage prostate bed RT. Chi-squared test showed a higher rate of positive PSMA PET/CT for patients with Gleason score > 7 (p = 0.004) and TTR < 29.5 months (p = 0.003). CONCLUSIONS PSMA PET/CT showed a high detection rate. This influenced clinical management in a significant percentage of patients, allowing treatment tailoring on the basis of imaging.
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Affiliation(s)
- G Francolini
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy.
| | - B Detti
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - M Bottero
- Department of Radiation Oncology, Policlinico Tor Vergata, University of Rome, Rome, Italy
| | - T Zilli
- Radiation Oncology Division, Geneva University Hospital, Geneva, Switzerland
| | - A Lancia
- Radiation Oncology Unit, Department of Medical Sciences and Infectious Disease, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - A Bruni
- Radiotherapy Unit, University Hospital of Modena, Modena, Italy
| | - S Borghesi
- UOC Radiation Oncology Arezzo-Valdarno, Azienda USL Toscana Sud Est, Arezzo, Italy
| | - M Mariotti
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - P Castellucci
- Department of Nuclear Medicine, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - S Fanti
- Department of Nuclear Medicine, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - A R Filippi
- Radiation Oncology Unit, Department of Medical Sciences and Infectious Disease, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - M A Teriaca
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - V Maragna
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - C Aristei
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia, Perugia, Italy
| | - E Mazzeo
- Radiotherapy Unit, University Hospital of Modena, Modena, Italy
| | - L Livi
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - G Ingrosso
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia, Perugia, Italy
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Lastrucci L, Bertocci S, Nucciarelli S, Borghesi S, De Majo R, Pernici P, Rampini A, Gennari P. PO-0854: Elderly patient, radiotherapy, quality of life: is Vulnerable Elders Survey 13 a tool for frailty? Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31164-2] [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: 10/14/2022]
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Scotti V, Bruni A, Simontacchi G, Furfaro I, Loi M, Scartoni D, Gonfiotti A, Viggiano D, De Luca Cardillo C, Agresti B, Poggesi L, Olmetto E, Ferrari K, Perna M, Bastiani P, Paoletti L, Lastrucci L, Pernici P, Carta G, Borghesi S, Bertocci S, Giacobazzi P, Voltolini L, Livi L. PO-0695: Lobectomy vs Stereotactic Ablative Radiotherapy in NSCLC:a multicentric series in four centers. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31945-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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De Bari B, Vallati M, Gatta R, Simeone C, Girelli G, Ricardi U, Meattini I, Gabriele P, Bellavita R, Krengli M, Cafaro I, Cagna E, Bunkheila F, Borghesi S, Signor M, Di Marco A, Bertoni F, Stefanacci M, Pasinetti N, Buglione M, Magrini SM. Could machine learning improve the prediction of pelvic nodal status of prostate cancer patients? Preliminary results of a pilot study. Cancer Invest 2015; 33:232-40. [PMID: 25950849 DOI: 10.3109/07357907.2015.1024317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We tested and compared performances of Roach formula, Partin tables and of three Machine Learning (ML) based algorithms based on decision trees in identifying N+ prostate cancer (PC). 1,555 cN0 and 50 cN+ PC were analyzed. Results were also verified on an independent population of 204 operated cN0 patients, with a known pN status (187 pN0, 17 pN1 patients). ML performed better, also when tested on the surgical population, with accuracy, specificity, and sensitivity ranging between 48-86%, 35-91%, and 17-79%, respectively. ML potentially allows better prediction of the nodal status of PC, potentially allowing a better tailoring of pelvic irradiation.
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Affiliation(s)
- B De Bari
- 1Istituto del Radio "O. Alberti", Radiotherapy Department, Spedali Civili di Brescia and University of Brescia, Brescia, Italy
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9
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Azmi A, Dillon RA, Borghesi S, Dunne M, Power RE, Marignol L, O'Neill BDP. Active surveillance for low-risk prostate cancer: diversity of practice across Europe. Ir J Med Sci 2014; 184:305-11. [PMID: 24652265 DOI: 10.1007/s11845-014-1104-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 03/03/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Active surveillance (AS) is a recognised treatment option for low-risk prostate cancer (PCa). AIMS To review AS criteria in terms of patient selection, follow-up and indications for intervention. METHODS A total of 2,959 potential participants were identified and invited via email to complete an online survey. Only urologists practising in an EU country were eligible to participate. Statistical analyses were carried out using SPSS version 18.0. The χ (2) test was used to compare responses between those who do and do not follow an AS protocol. RESULTS Response rate was 8% (n = 226). Ninety-seven per cent urologists offer AS; 25% (n = 53/215) within a clinical trial and a further 28% (n = 60/215) using an official AS protocol. Gleason score ≤ 3 + 3 = 6 (87 %, n = 173/200) and prostate-specific antigen (PSA) ≤ 10 ng/ml (86%, n = 170/198) are the commonest selection criteria. There was a statistically significant association between having an AS protocol and using PSA as an eligibility criterion (p = 0.03). For urologists not following a protocol, 11% do not consider PSA as an eligibility criterion and 81% consider PSA ≤ 10 ng/ml to decide on AS, compared to 2 and 90%, respectively, who adhere to a protocol. Twenty-four per cent of urologists without a protocol do not re-biopsy in comparison to 11% with a protocol (p = 0.026). Gleason score progression trigger the most intervention (n = 168/192, 87%). CONCLUSIONS Urologists not adhering to an AS protocol or participating in a clinical trial appear to apply less rigorous criteria for both eligibility and monitoring in AS.
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Affiliation(s)
- A Azmi
- St. Luke's Radiation Oncology Centre, Beaumont Hospital, Dublin, Ireland,
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10
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Livi L, Borghesi S, Meattini I, Saieva C, Cardillo CDL, Scotti V, Mangoni M, Galardi A, Cataliotti L, Paiar F, Bianchi S, Biti G. Adjuvant Trastuzumab in Breast Cancer: Experience from the University of Florence. J Chemother 2013; 22:115-8. [DOI: 10.1179/joc.2010.22.2.115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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11
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Cutuli B, Wiazzane N, Radicchia V, Barbieri P, Guenzi M, Huscher A, Borghesi S, Iannone T, Vianello E, Rosetto M. Carcinome canalaire in situ du sein : résultats du traitement radiochirurgical conservateur, analyse de 821 cas. Cancer Radiother 2012. [DOI: 10.1016/j.canrad.2012.07.022] [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: 10/27/2022]
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12
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Azmi A, Dillon R, Borghesi S, Dunne M, Power R, Marignol R, O'Neill B. PO-0673 ACTIVE SURVEILLANCE FOR LOW-RISK PROSTATE CANCER: PRACTICE AMONGST UROLOGISTS FROM FOUR EUROPEAN COUNTRIES. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71006-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Lucchini R, Somenzi V, Mossini E, Tieghi S, Borghesi S. [Development of the agricultural sector in Italy: need to harmonize production and health protection]. G Ital Med Lav Ergon 2010; 32:396-399. [PMID: 21438307] [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: 05/30/2023]
Abstract
Epidemiological data show excess of respiratory, dermatological, infectious, carcinogenic and musculoskeletal disorders among agricultural workers. Nevertheless, the national rates of reported cases do not correspond to the expected epidemiological data. In 2009, 3.914 cases of occupational diseases were reported to the national work compensation Institute (INAIL), as related to 1,200.000 agricultural workers employed in Italy. About 71% of these cases were related to musculoskeletal disorders. This shows a relevant difference between observed and expected cases, even more evident than in other sectors like constructions. More efficient preventive intervention is needed to improve this situation of under-reporting, through the implementation of epidemiological surveillance based on multiple sources of information. These sources should include the periodical health surveillance of active workers, the databank of General Practitioners, the hospital admission charts, and the case-lists of patients admitted to the Institutes of Occupational Health, according to a systematic active search of occupational cases.
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Affiliation(s)
- R Lucchini
- Dipartimento di Medicina Sperimentale e Applicata, Sezione di Medicina del Lavoro, Brescia, Italy.
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14
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Livi L, Meattini I, Saieva C, Borghesi S, Scotti V, Petrucci A, Rampini A, Marrazzo L, Di Cataldo V, Bianchi S, Cataliotti L, Biti G. The impact of young age on breast cancer outcome. Eur J Surg Oncol 2010; 36:639-645. [PMID: 20635464] [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: 05/29/2023]
Abstract
AIMS We conducted a retrospective analysis in order to evaluate the impact of age on women aged less than 35 years affected by breast cancer. MATERIALS AND METHODS Between January 1972 and December 2006, 346 patients aged less than 35 years underwent adjuvant treatment at Florence University. The mean age of the patient population was 32 years (range 22-35): 76 patients were under 30 years old, the remaining were above 30 years old. RESULTS In our series, 215 patients received adjuvant radiotherapy to whole breast after conservative surgery, 131 patients underwent mastectomy without subsequent radiation therapy and 323 patients had lymphadenectomy; 191 patients received adjuvant chemotherapy, 73 with anthracycline-containing regimen. With a median time of 2.5 years (range 6 months to 27.6 years) local relapses were observed in 67 cases (19.4%). At the multivariate analysis of local disease-free survival, ductal and ductal plus lobular histotypes, having more than 3 positive nodes, and age emerged as independent significant relapse predictors (p = 0.018, p = 0.0005, p = 0.003 and p = 0.024, respectively). For the DSS analysis, the median follow-up was 6.8 years (range 0.6-36.7 years). At the multivariate analysis, age (p = 0.0038), positive nodes (p = 0.0035) and distant metastases (p < 0.0001) resulted to be independent death predictors. Patients younger than 30 had a worse prognosis. At the univariate analysis also local relapse resulted to be statistically significant (p = 0.0004). CONCLUSIONS Anthracycline-based chemotherapy seems to improve the outcome of these patients. However, there is an urgent need for tailored treatment investigations within the framework of randomized, controlled clinical trials.
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Affiliation(s)
- L Livi
- Department of Radiation-Oncology, University of Florence, Viale Morgagni 85, 50134 Florence, Italy
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Livi L, Meattini I, Saieva C, Borghesi S, Scotti V, Petrucci A, Rampini A, Marrazzo L, Di Cataldo V, Bianchi S, Cataliotti L, Biti G. The impact of young age on breast cancer outcome. Eur J Surg Oncol 2010; 36:S0748-7983(10)00124-1. [PMID: 20965114 DOI: 10.1016/j.ejso.2010.05.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 04/12/2010] [Accepted: 05/04/2010] [Indexed: 11/29/2022]
Abstract
AIMS: We conducted a retrospective analysis in order to evaluate the impact of age on women aged less than 35 years affected by breast cancer. MATERIALS AND METHODS: Between January 1972 and December 2006, 346 patients aged less than 35 years underwent adjuvant treatment at Florence University. The mean age of the patient population was 32 years (range 22-35): 76 patients were under 30 years old, the remaining were above 30 years old. RESULTS: In our series, 215 patients received adjuvant radiotherapy to whole breast after conservative surgery, 131 patients underwent mastectomy without subsequent radiation therapy and 323 patients had lymphadenectomy; 191 patients received adjuvant chemotherapy, 73 with anthracycline-containing regimen. With a median time of 2.5 years (range 6 months to 27.6 years) local relapses were observed in 67 cases (19.4%). At the multivariate analysis of local disease-free survival, ductal and ductal plus lobular histotypes, having more than 3 positive nodes, and age emerged as independent significant relapse predictors (p=0.018, p=0.0005, p=0.003 and p=0.024, respectively). For the DSS analysis, the median follow-up was 6.8 years (range 0.6-36.7 years). At the multivariate analysis, age (p=0.0038), positive nodes (p=0.0035) and distant metastases (p<0.0001) resulted to be independent death predictors. Patients younger than 30 had a worse prognosis. At the univariate analysis also local relapse resulted to be statistically significant (p=0.0004). CONCLUSIONS: Anthracycline-based chemotherapy seems to improve the outcome of these patients. However, there is an urgent need for tailored treatment investigations within the framework of randomized, controlled clinical trials.
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Affiliation(s)
- L Livi
- Department of Radiation-Oncology, University of Florence, Viale Morgagni 85, 50134 Florence, Italy
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16
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Livi L, Saieva C, Borghesi S, De Luca Cardillo C, Scotti V, Mangoni M, Greto D, Cataliotti L, Paiar F, Bianchi S, Biti GP. Doxorubicin and cyclophosphamide versus cyclophosphamide, methotrexate, and 5-fluorouracil as adjuvant chemotherapy in breast cancer. J Chemother 2009; 21:558-65. [PMID: 19933048 DOI: 10.1179/joc.2009.21.5.558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This study evaluated whether doxorubicin and cyclophosphamide are superior to cyclophosphamide, methotrexate and 5-fluorouracil as adjuvant chemotherapy in breast cancer patients. Between July 1976 and December 2004, 1045 breast cancer patients received adjuvant chemotherapy at the Radiotherapy Unit of the University of florence. 927 were administered i.v. CMF (cyclophosphamide 600 mg/m(2), methotrexate 40 mg/m(2) and 5-fluorouracil 600 mg/m(2) on days 1 and 8, repeated every 28 days for a total of six cycles) and 118 i.v. DC (doxorubicin 60 mg/m(2) and cyclophosphamide 600 mg/m(2) on day 1 repeated every 21 days for a total of four cycles). All patients underwent adjuvant radiotherapy as well. The survival analysis, stratified according to treatment, did not show any significant difference in metastasis occurrence between the two groups (log rank test p=0.42). According to multivariate analysis four parameters emerged as independent prognostic factors for distant metastases in patients treated with the Cmf regimen: pt (p=0.0005), number of positive axillary lymph nodes (p=<0.0001), tamoxifen use (p=0.0109) and local relapses (p=<0.0001). Only number of positive axillary lymph nodes and local relapses were significant predictors of metastases occurrence according to multivariate analysis in the DC group, 17 and p=0.028, respectively. No significant difference between the two regimens was observed with regards to number of involved nodes. DC and CMF produced similar outcome in breast cancer patients.
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Affiliation(s)
- L Livi
- Radiotherapy Unit, University of Florence, Italy.
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17
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Borghesi S, Carta A, Lucchini R. [Upper limb work-related disorders: description of an Italian hospital based case study]. G Ital Med Lav Ergon 2007; 29:590-591. [PMID: 18409848] [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: 05/26/2023]
Abstract
Using the Hospital computerized database, individual variables including referral source, gender; age, life style, work sector, clinical and work history, final clinical diagnosis and work-relatedness evaluation were retrieved and analysed. The results of this survey showed a significant increase of number of cases, especially from 1999 to 2006. Shoulder disorders showed a significant increase in the latest years of the observation period, while the other upper limb districts remained constant. The work sectors mostly affected were textile, construction, metalmechanical and food industry. The findings of this study indicates an increasing demand for clinical assessment of work-related musculoskeletal disorders of the upper limb. Therefore, it is important that a standardized diagnostic procedure is applied together with an accurate evaluation of biomechanical overload.
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Affiliation(s)
- S Borghesi
- Sezione di Medicina del Lavoro e Igiene Industriale, Università degli Studi di Brescia
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18
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Livi L, Stefanacci M, Scoccianti S, Dicosmo D, Borghesi S, Nosi F, Simontacchi G, Mangoni M, Paiar F, Ponticelli P, Nori J, Chiavacci A, Biti GP. Adjuvant hypofractionated radiation therapy for breast cancer after conserving surgery. Clin Oncol (R Coll Radiol) 2007; 19:120-4. [PMID: 17355107 DOI: 10.1016/j.clon.2006.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [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: 11/18/2022]
Abstract
AIMS To evaluate the incidence of locoregional recurrence (LRR) and the cosmetic results in a group of patients with breast cancer treated with a hypofractionated schedule of adjuvant radiotherapy after conservative surgery. MATERIALS AND METHODS In total, 539 patients with pTis-pT1-pT2 breast cancer underwent radiotherapy treatment after conservative surgery at the University of Florence and at the Pistoia Hospital. The dose delivered was 44 Gy (2.75 Gy daily fraction). The tumour bed boost (10 Gy) was given by electrons. RESULTS At the time of the analysis, 1.8% of patients (10/539) had breast relapse. No patients developed nodal recurrence (supraclavicular, axillary and internal mammary nodes). The 3- and 5-year actuarial rates for LRR were 1.2% (+/- 0.5% standard error) and 2.1% (+/- 0.6% standard error), respectively. Considering the late toxicity, we found that 412 (76.4%) patients had grade 0 or grade 1 late toxicity, 113 patients (20.9%) had grade 2 late toxicity and 14 patients (2.5%) had grade 3 late toxicity. No patients developed grade 4 toxicity. CONCLUSION This type of approach resulted in an effective treatment in terms of local control in patients with negative or one to three positive axillary nodes and negative surgical margins. Patients treated with a hypofractionated schedule showed very good cosmesis.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Axilla
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/radiotherapy
- Carcinoma, Lobular/secondary
- Carcinoma, Lobular/surgery
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Dose Fractionation, Radiation
- Female
- Follow-Up Studies
- Humans
- Lymph Node Excision
- Mastectomy, Segmental
- Menopause
- Middle Aged
- Neoplasm Recurrence, Local
- Neoplasm Staging
- Radiotherapy Dosage
- Radiotherapy, Adjuvant
- Survival Rate
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Affiliation(s)
- L Livi
- Radiotherapy Department, Florence University, Florence, Italy.
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19
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Sala E, Albini E, Borghesi S, Gullino A, Romano C, Apostoli P. [Work-related musculoskeletal disorders of the upper extremity in spinning: lack of risk or of adequate methods for assessing risk?]. G Ital Med Lav Ergon 2005; 27:8-20. [PMID: 15915670] [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: 05/02/2023]
Abstract
The existence of a risk of musculoskeletal disorders work-related of the upper extremity (UEWMSDs) in the textile industry, specifically in particular working phases as spinning, appears today controversial. The upper limb disorders, sometimes described, have not a location ever plausible with the level of the biomechanical overload, as when carpal tunnel syndromes are signalled during activities in which the shoulder is the only segment eventually interested. Moreover these findings are shown in workers appointed at tasks or actions not clearly identified at risk. For example the spinning activity, that requires the movement of shuttles of modest weight, sometimes on levels above the shoulder line, is organized with cyclical cadences sometimes as repetitive tasks concentrated in a short period, sometimes in longer during the entire shift. Distribution and number of the actions, would however allow a sufficient biomechanical recovery. The identification of the single technical action may result difficult, due to interindividual variability of actions, of their speed and complexity. Furthermore the other possible activities, alternate with specific spinning activities, can require strength or not correct posture even if they may have short duration. In this paper we present and discuss the results of the ergonomic survey for risk assessment of musculoskeletal disorders work-related of the upper limb. These analysis have been carried out in two textile plants, in which some cases of disorders of the upper limb in workers employed in spinning activities have been described by occupational health physicians. In addition to assessment of possible risk for UEWMSDs in spinning activities, we founded the capability of usual methods for ergonomic analysis to adequately examine work situations like spinning, in which the hazardous actions are diluted over the entire shift or concentrate in a short period and in which there is a specific biomechanically overloaded segment i.e. the shoulder. Finally attention was paid to evaluate psychosocial factors which appear to be important when biomechanical factors are low-lying.
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Affiliation(s)
- E Sala
- Dipartimento di Medicina Sperimentale ed Applicata, Medicina del Lavoro e Igiene Industriale, Università degli Studi di Brescia, Italy
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20
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Lucchini R, Benedetti L, Borghesi S, Garattini S, Parrinello G, Alessio L. [Exposure to neurotoxic metals and prevalence of parkinsonian syndrome in the area of Brescia]. G Ital Med Lav Ergon 2003; 25 Suppl:88-9. [PMID: 14979098] [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: 04/29/2023]
Abstract
The prevalence of parkinsonian syndromes was studied in the province of Brescia (Northern Italy), in order to verify its possible increase in the surroundings of ferroalloy plants located in a valley of the pre-Alps. A case-list of subjects affected by these disturbances was identified using four different sources of information: a) registers from local medical clinics; b) admission charts from local hospitals; c) consumption of levodopa; d) NHS list of exemption from prescription payment, due to the illness. Exploratory data show a frequency of parkinsonian disturbances among the residents in the surroundings of the ferroalloy plants and downwind (crude prevalence = 358/100,000 population, standardized for age and sex = 438) significantly higher (s.m.r, = 1.58; C.I. = 1.41-1.76) than the entire Province (crude prevalence 246/100,000). This preliminary result could indicate the interaction of prolonged environmental exposure to heavy metals, such as manganese, and genetic factors, potentially relevant in this mountain population.
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Affiliation(s)
- R Lucchini
- Cattedra di Medicina del Lavoro, Università degli Studi di Brescia
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