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Russo S, Saez J, Esposito M, Bruschi A, Ghirelli A, Pini S, Scoccianti S, Hernandez V. Incorporating plan complexity into the statistical process control of volumetric modulated arc therapy pre-treatment verifications. Med Phys 2024. [PMID: 38630979 DOI: 10.1002/mp.17081] [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: 12/08/2023] [Revised: 03/14/2024] [Accepted: 03/30/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Statistical process control (SPC) is a powerful statistical tool for process monitoring that has been highly recommended in healthcare applications, including radiation therapy quality assurance (QA). The AAPM TG-218 report described the clinical implementation of SPC for Volumetric Modulated Arc Therapy (VMAT) pre-treatment verifications, pointing out the need to adjust tolerance limits based on plan complexity. However, the quantification of plan complexity and its integration into SPC remains an unresolved challenge. PURPOSE The primary aim of this study is to investigate the incorporation of plan complexity into the SPC framework for VMAT pre-treatment verifications. The study explores and evaluates various strategies for this incorporation, discussing their merits and limitations, and provides recommendations for clinical application. METHODS A retrospective analysis was conducted on 309 VMAT plans from diverse anatomical sites using the PTW OCTAVIUS 4D device for QA measurements. Gamma Passing Rates (GPR) were obtained, and lower control limits were computed using both the conventional Shewhart method and three heuristic methods (scaled weighted variance, weighted standard deviations, and skewness correction) to accommodate non-normal data distributions. The 'Identify-Eliminate-Recalculate' method was employed for robust analysis. Eight complexity metrics were analyzed and two distinct strategies for incorporating plan complexity into SPC were assessed. The first strategy focused on establishing control limits for different treatment sites, while the second was based on the determination of control limits as a function of individual plan complexity. The study extensively examines the correlation between control limits and plan complexity and assesses the impact of complexity metrics on the control process. RESULTS The control limits established using SPC were strongly influenced by the complexity of treatment plans. In the first strategy, a clear correlation was found between control limits and average plan complexity for each site. The second approach derived control limits based on individual plan complexity metrics, enabling tailored tolerance limits. In both strategies, tolerance limits inversely correlated with plan complexity, resulting in all highly complex plans being classified as in control. In contrast, when plans were collectively analyzed without considering complexity, all the out-of-control plans were highly complex. CONCLUSIONS Incorporating plan complexity into SPC for VMAT verifications requires meticulous and comprehensive analysis. To ensure overall process control, we advocate for stringent control and minimization of plan complexity during treatment planning, especially when control limits are adjusted based on plan complexity.
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Affiliation(s)
- Serenella Russo
- Medical Physics Unit, Azienda USL Toscana Centro, Florence, Italy
| | - Jordi Saez
- Department of Radiation Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marco Esposito
- Medical Physics Unit, Azienda USL Toscana Centro, Florence, Italy
- Medical Physics Program, The Abdus Salam International Centre for Theoretical Physics Trieste-Italy, Trieste, Italy
| | - Andrea Bruschi
- Medical Physics Unit, Azienda USL Toscana Centro, Florence, Italy
| | | | - Silvia Pini
- Medical Physics Unit, Azienda USL Toscana Centro, Florence, Italy
| | | | - Victor Hernandez
- Department of Medical Physics, Hospital Sant Joan de Reus, IISPV, Reus, Spain
- Universitat Rovira i Virgili (URV), Tarragona, Spain
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Ingrosso G, Ponti E, Francolini G, Caini S, Fondelli S, Santini R, Valeriani M, Rago L, Duroni G, Bruni A, Augurio A, Tramacere F, Trippa F, Russo D, Bottero M, Tamburo M, Parisi S, Borghesi S, Lancia A, Gomellini S, Scoccianti S, Stefanacci M, Vullo G, Statuto T, Miranda G, Santo B, Di Marzo A, Bellavita R, Vinciguerra A, Livi L, Aristei C, Bertini N, Orsatti C, Detti B. Image-guided moderately hypofractionated radiotherapy for localized prostate cancer: a multicentric retrospective study (IPOPROMISE). Radiol Med 2024; 129:643-652. [PMID: 38369638 PMCID: PMC11021246 DOI: 10.1007/s11547-024-01782-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/03/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Moderate hypofractionated radiotherapy is a treatment option for the cure of localized prostate cancer (PCa) patients based on the results of randomized prospective trials, but there is a clinical concern about the relatively short length of follow-up, and real-world results on outcome and toxicity based on cutting-edge techniques are lacking. The objective of this study is to present the long-term results of a large multicentric series. MATERIALS AND METHODS We retrospectively evaluated 1325 PCa patients treated with daily volumetric image-guided hypofractionated radiotherapy between 2007 and 2020 in 16 Centers. For survival endpoints, we used Kaplan-Meier survival curves and fitted univariate and multivariable Cox's proportional hazards regression models to study the association between the clinical variables and each survival type. RESULTS At the end of the follow-up, 11 patients died from PCa. The 15-year values of cancer-specific survival (CSS) and biochemical relapse-free survival (b-RFS) were 98.5% (95%CI 97.3-99.6%) and 85.5% (95%CI 81.9-89.4%), respectively. The multivariate analysis showed that baseline PSA, Gleason score, and the use of androgen deprivation therapy were significant variables for all the outcomes. Acute gastrointestinal (GI) and genitourinary (GU) toxicities of grade ≥ 2 were 7.0% and 16.98%, respectively. The 15-year late grade ≥ 2 GI and GU toxicities were 5% (95%CI 4-6%) and 6% (95%CI 4-8%), respectively. CONCLUSION Real-world long-term results of this multicentric study on cutting-edge techniques for the cure of localized PCa demonstrated an excellent biochemical-free survival rate of 85.5% at 15 years, and very low rates of ≥ G3 late GU and GI toxicity (1.6% and 0.9% respectively), strengthening the results of the available published trials.
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Affiliation(s)
- Gianluca Ingrosso
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Elisabetta Ponti
- Radiation Oncology Department, San Giovanni Addolorata Hospital, Rome, Italy
| | - Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139, Florence, Italy
| | - Simona Fondelli
- Radiation Oncology Unit, Department of Oncology, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Florence, Italy
| | - Roberto Santini
- Department of Radiation Oncology, Ospedale San Jacopo Pistoia, Pistoia, Italy
| | - Maurizio Valeriani
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Luciana Rago
- Radiation Oncology Unit, IRCCS -CROB, Rionero in Vulture, Potenza, Italy
| | - Giacomo Duroni
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139, Florence, Italy
| | - Alessio Bruni
- Radiation Therapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Antonietta Augurio
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Chieti, Italy
| | - Francesco Tramacere
- Department of Radiation Oncology, Azienda Sanitaria Locale, 72100, Brindisi, Italy
| | - Fabio Trippa
- Department of Radiotherapy, Saint Maria Hospital, Terni, Italy
| | | | - Marta Bottero
- Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maria Tamburo
- Radiotherapy Unit, Cannizzaro Hospital, Catania, Italy
| | - Silvana Parisi
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Simona Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, Arezzo, Italy
| | - Andrea Lancia
- Department of Radiation Oncology, Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy
| | - Sara Gomellini
- Radiation Oncology Department, San Giovanni Addolorata Hospital, Rome, Italy
| | - Silvia Scoccianti
- Radiation Oncology Unit, Department of Oncology, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Florence, Italy
| | - Marco Stefanacci
- Department of Radiation Oncology, Ospedale San Jacopo Pistoia, Pistoia, Italy
| | - Gianluca Vullo
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Teodora Statuto
- Radiation Oncology Unit, IRCCS -CROB, Rionero in Vulture, Potenza, Italy
| | - Giulia Miranda
- Radiation Therapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Bianca Santo
- Radiotherapy Unit, Ospedale "Vito Fazzi", Lecce, Italy
| | | | - Rita Bellavita
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Annamaria Vinciguerra
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Chieti, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Niccolò Bertini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Carolina Orsatti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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Caccese M, Desideri I, Villani V, Simonelli M, Buglione M, Chiesa S, Franceschi E, Gaviani P, Stasi I, Caserta C, Brugnara S, Lolli I, Bennicelli E, Bini P, Cuccu AS, Scoccianti S, Padovan M, Gori S, Bonetti A, Giordano P, Pellerino A, Gregucci F, Riva N, Cinieri S, Internò V, Santoni M, Pernice G, Dealis C, Stievano L, Paiar F, Magni G, De Salvo GL, Zagonel V, Lombardi G. REGOMA-OSS: a large, Italian, multicenter, prospective, observational study evaluating the efficacy and safety of regorafenib in patients with recurrent glioblastoma. ESMO Open 2024; 9:102943. [PMID: 38492275 PMCID: PMC10959650 DOI: 10.1016/j.esmoop.2024.102943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/02/2024] [Accepted: 02/16/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND In the randomized phase II REGOMA trial, regorafenib showed promising activity in patients with recurrent glioblastoma. We conducted a large, multicenter, prospective, observational study to confirm the REGOMA data in a real-world setting. PATIENTS AND METHODS The major inclusion criteria were histologically confirmed diagnosis of glioblastoma according to the World Health Organization (WHO) 2016 classification and relapse after radiotherapy with concurrent/adjuvant temozolomide treatment, good performance status [Eastern Cooperative Oncology Group performance status (ECOG PS 0-1)] and good liver function. Regorafenib was administered at the standard dose of 160 mg/day for 3 weeks on/1 week off. Brain magnetic resonance imaging was carried out within 14 days before starting regorafenib and every 8-12 weeks. The primary endpoint was overall survival (OS). The secondary endpoints were progression-free survival (PFS), objective response rate, disease control rate (DCR), safety and health-related quality of life. The Response Assessment in Neuro-Oncology (RANO) criteria were used for response evaluation and Common Terminology Criteria for Adverse Events (CTCAE) version 5 for assessment of adverse events (AEs). RESULTS From September 2020 to October 2022, 190 patients with recurrent glioblastoma were enrolled from 30 cancer centers in Italy: their median age was 58.5 years [interquartile range (IQR) 53-67 years], 68% were male and 85 (44.7%) were in optimal clinical condition (ECOG PS 0). The number of patients taking steroids at baseline was 113 (60%); the second surgery was carried out in 39 (20.5%). O6-methylguanine-DNA methyltransferase (MGMT) was methylated in 80 patients (50.3%) and 147 (92.4%) of the patients analyzed had isocitrate dehydrogenase (IDH) wild type. The median follow-up period was 20 months (IQR 15.6-25.5 months). The median OS was 7.9 months ([95% confidence interval (CI) 6.5-9.2 months] and the median PFS was 2.6 months (95% CI 2.3-2.9 months). Radiological response was partial response and stable disease in 13 (7.3%) and 26 (14.6%) patients, respectively, with a DCR of 21.9%. The median number of regorafenib cycles per patient was 3 (IQR 2.0-4.0). Grade 3-4 drug-related adverse events were reported in 22.6% of patients. A dose reduction due to AEs was required in 36% of patients. No deaths were considered as treatment-related AEs. CONCLUSIONS This large, real-world observational study showed similar OS with better tolerability of regorafenib in patients with relapsed glioblastoma compared with the REGOMA study.
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Affiliation(s)
- M Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua.
| | - I Desideri
- Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence
| | - V Villani
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome
| | - M Simonelli
- Department of Biomedical Sciences, Humanitas University, Milan; Humanitas Clinical and Research Center-IRCCS, Humanitas Cancer Center, Milan
| | - M Buglione
- Radiation Oncology Unit, ASST Spedali Civili of Brescia, Brescia
| | - S Chiesa
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - E Franceschi
- Nervous System Medical Oncology Department, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna
| | - P Gaviani
- Neuro-Oncological Unit, Istituto Neurologico Carlo Besta, Milan
| | - I Stasi
- Division of Medical Oncology, Civil Hospital, Livorno
| | - C Caserta
- Medical Oncology Department, Santa Maria Hospital, Terni
| | - S Brugnara
- Department of Medical Oncology, Santa Chiara Hospital, Trento
| | - I Lolli
- Oncology Unit of National Institute of Gastroenterology 'S. De Bellis', Research Hospital, Castellana Grotte, Bari
| | - E Bennicelli
- Ospedale Policlinico San Martino, Oncologia Medica 2, Genoa
| | - P Bini
- Neuroncology Unit, IRCCS 'C. Mondino Foundation', University of Pavia, Pavia
| | - A S Cuccu
- Medical Oncology, Sassari Hospital, Sassari
| | - S Scoccianti
- Radioterapia Oncologica, Ospedale Santa Maria Annunziata, Bagno a Ripoli, Florence
| | - M Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua
| | - S Gori
- Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella
| | - A Bonetti
- Department of Oncology, Mater Salutis Hospital, Legnago
| | - P Giordano
- Oncology Unit, Ospedale del Mare, Naples
| | - A Pellerino
- Division of Neuro-Oncology, Department of Neuroscience, City of Health and Science and University of Turin, Turin
| | - F Gregucci
- Department of Radiation Oncology, Miulli General Regional Hospital, Acquaviva delle Fonti
| | - N Riva
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola
| | - S Cinieri
- Oncology Unit, Ospedale Perrino, Brindisi
| | - V Internò
- Division of Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari
| | - M Santoni
- Oncology Unit, Macerata Hospital, Macerata
| | - G Pernice
- Oncology Unit, Fondazione Istituto G. Giglio, Cefalù
| | - C Dealis
- Health Directorate, Azienda Sanitaria dell'Alto Adige, Bolzano
| | - L Stievano
- Department of Oncology, Ospedale Civile, Rovigo
| | - F Paiar
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa
| | - G Magni
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - G L De Salvo
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - V Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua
| | - G Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua
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Gnerucci A, Esposito M, Ghirelli A, Pini S, Paoletti L, Barca R, Fondelli S, Alpi P, Grilli B, Rossi F, Scoccianti S, Russo S. Robustness analysis of surface-guided DIBH left breast radiotherapy: personalized dosimetric effect of real intrafractional motion within the beam gating thresholds. Strahlenther Onkol 2024; 200:71-82. [PMID: 37380796 DOI: 10.1007/s00066-023-02102-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 05/16/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE The robustness of surface-guided (SG) deep-inspiration breath-hold (DIBH) radiotherapy (RT) for left breast cancer was evaluated by investigating any potential dosimetric effects due to the residual intrafractional motion allowed by the selected beam gating thresholds. The potential reduction of DIBH benefits in terms of organs at risk (OARs) sparing and target coverage was evaluated for conformational (3DCRT) and intensity-modulated radiation therapy (IMRT) techniques. METHODS A total of 192 fractions of SGRT DIBH left breast 3DCRT treatment for 12 patients were analyzed. For each fraction, the average of the real-time displacement between the isocenter on the daily reference surface and on the live surface ("SGRT shift") during beam-on was evaluated and applied to the original plan isocenter. The dose distribution for the treatment beams with the new isocenter point was then calculated and the total plan dose distribution was obtained by summing the estimated perturbed dose for each fraction. Then, for each patient, the original plan and the perturbed one were compared by means of Wilcoxon test for target coverage and OAR dose-volume histogram (DVH) metrics. A global plan quality score was calculated to assess the overall plan robustness against intrafractional motion of both 3DCRT and IMRT techniques. RESULTS Target coverage and OAR DVH metrics did not show significant variations between the original and the perturbed plan for the IMRT techniques. 3DCRT plans showed significant variations for the left descending coronary artery (LAD) and the humerus only. However, none of the dose metrics exceeded the mandatory dose constraints for any of the analyzed plans. The global plan quality analysis indicated that both 3DCRT and IMRT techniques were affected by the isocenter shifts in the same way and, generally, the residual isocenter shifts more likely tend to worsen the plan in all cases. CONCLUSION The DIBH technique proved to be robust against residual intrafractional isocenter shifts allowed by the selected SGRT beam-hold thresholds. Small-volume OARs located near high dose gradients showed significant marginal deteriorations in the perturbed plans with the 3DCRT technique only. Global plan quality was mainly influenced by patient anatomy and treatment beam geometry rather than the technique adopted.
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Affiliation(s)
- A Gnerucci
- Department of Physics and Astronomy, University of Florence, Florence, Italy.
| | - M Esposito
- Medical Physics Unit, Azienda USL Toscana Centro, Florence, Italy
| | - A Ghirelli
- Medical Physics Unit, Azienda USL Toscana Centro, Florence, Italy
| | - S Pini
- Medical Physics Unit, Azienda USL Toscana Centro, Florence, Italy
| | - L Paoletti
- Radiotherapy Unit, Azienda USL Toscana Centro, Florence, Italy
| | - R Barca
- Radiotherapy Unit, Azienda USL Toscana Centro, Florence, Italy
| | - S Fondelli
- Radiotherapy Unit, Azienda USL Toscana Centro, Florence, Italy
| | - P Alpi
- Radiotherapy Unit, Azienda USL Toscana Centro, Florence, Italy
| | - B Grilli
- Radiotherapy Unit, Azienda USL Toscana Centro, Florence, Italy
| | - F Rossi
- Radiotherapy Unit, Azienda USL Toscana Sud Est, Grosseto, Italy
| | - S Scoccianti
- Radiotherapy Unit, Azienda USL Toscana Centro, Florence, Italy
| | - S Russo
- Medical Physics Unit, Azienda USL Toscana Centro, Florence, Italy
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Esposito M, Mancosu P, Bruschi A, Ghirelli A, Pini S, Alpi P, Barca R, Paoli CD, Meacci F, Leonulli BG, Fondelli S, Paoletti L, Scoccianti S, Russo S. Correction to: The role of EPID in vivo dosimetry in the risk management of stereotactic lung treatments. Strahlenther Onkol 2024; 200:106. [PMID: 37923943 DOI: 10.1007/s00066-023-02168-5] [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: 11/06/2023]
Affiliation(s)
- Marco Esposito
- S. C. Fisica Sanitaria, Firenze-Azienda Sanitaria USL Toscana Centro, Via dell'Antella 58, 50012, Bagno a Ripoli, Firenze, Italy.
- International Center for Theoretical Physics, Strada Costiera, 11, 34151, Trieste, Italy.
| | - Pietro Mancosu
- Medical Physics Unit of Radiotherapy Dept., IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Andrea Bruschi
- S. C. Fisica Sanitaria, Firenze-Azienda Sanitaria USL Toscana Centro, Via dell'Antella 58, 50012, Bagno a Ripoli, Firenze, Italy
| | - Alessandro Ghirelli
- S. C. Fisica Sanitaria, Firenze-Azienda Sanitaria USL Toscana Centro, Via dell'Antella 58, 50012, Bagno a Ripoli, Firenze, Italy
| | - Silvia Pini
- S. C. Fisica Sanitaria, Firenze-Azienda Sanitaria USL Toscana Centro, Via dell'Antella 58, 50012, Bagno a Ripoli, Firenze, Italy
| | - Paolo Alpi
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Raffaella Barca
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Camilla Delli Paoli
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Fiammetta Meacci
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | | | - Simona Fondelli
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Lisa Paoletti
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Silvia Scoccianti
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Serenella Russo
- S. C. Fisica Sanitaria, Firenze-Azienda Sanitaria USL Toscana Centro, Via dell'Antella 58, 50012, Bagno a Ripoli, Firenze, Italy
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6
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Esposito M, Mancosu P, Bruschi A, Ghirelli A, Pini S, Alpi P, Barca R, Paoli CD, Meacci F, Leonulli BG, Fondelli S, Paoletti L, Scoccianti S, Russo S. The role of EPID in vivo dosimetry in the risk management of stereotactic lung treatments. Strahlenther Onkol 2023; 199:992-999. [PMID: 37256302 DOI: 10.1007/s00066-023-02081-x] [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: 09/30/2022] [Accepted: 03/26/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND OBJECTIVE In this work we report our experience with the use of in vivo dosimetry (IVD) in the risk management of stereotactic lung treatments. METHODS A commercial software based on the electronic portal imaging device (EPID) signal was used to reconstruct the actual planning target volume (PTV) dose of stereotactic lung treatments. The study was designed in two phases: i) in the observational phase, the IVD results of 41 consecutive patients were reviewed and out-of-tolerance cases were studied for root cause analysis; ii) in the active phase, the IVD results of 52 patients were analyzed and corrective actions were taken when needed. Moreover, proactive preventions were further introduced to reduce the risk of future failures. The error occurrence rate was analyzed to evaluate the effectiveness of proactive actions. RESULTS A total of 330 fractions were analyzed. In the first phase, 13 errors were identified. In the active phase, 12 errors were detected, 5 of which needed corrective actions; in 4 patients the actions taken corrected the error. Several preventions and barriers were introduced to reduce the risk of future failures: the planning checklist was updated, the procedure for vacuum pillows was improved, and use of the respiratory compression belt was optimized. A decrease in the failure rate was observed, showing the effectiveness of procedural adjustment. CONCLUSION The use of IVD allowed the quality of lung stereotactic body radiation therapy (SBRT) treatments to be improved. Patient-specific and procedural corrective actions were successfully taken as part of risk management, leading to an overall improvement in the dosimetric accuracy.
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Affiliation(s)
- Marco Esposito
- S. C. Fisica Sanitaria, Firenze-Azienda Sanitaria USL Toscana Centro, Via dell'Antella 58, 50012, Bagno a Ripoli, Firenze, Italy.
- International Center for Theoretical Physics, Strada Costiera, 11, 34151, Trieste, Italy.
| | - Pietro Mancosu
- Medical Physics Unit of Radiotherapy Dept., IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Andrea Bruschi
- S. C. Fisica Sanitaria, Firenze-Azienda Sanitaria USL Toscana Centro, Via dell'Antella 58, 50012, Bagno a Ripoli, Firenze, Italy
| | - Alessandro Ghirelli
- S. C. Fisica Sanitaria, Firenze-Azienda Sanitaria USL Toscana Centro, Via dell'Antella 58, 50012, Bagno a Ripoli, Firenze, Italy
| | - Silvia Pini
- S. C. Fisica Sanitaria, Firenze-Azienda Sanitaria USL Toscana Centro, Via dell'Antella 58, 50012, Bagno a Ripoli, Firenze, Italy
| | - Paolo Alpi
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Raffaella Barca
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Camilla Delli Paoli
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Fiammetta Meacci
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | | | - Simona Fondelli
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Lisa Paoletti
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Silvia Scoccianti
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Serenella Russo
- S. C. Fisica Sanitaria, Firenze-Azienda Sanitaria USL Toscana Centro, Via dell'Antella 58, 50012, Bagno a Ripoli, Firenze, Italy
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7
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Scoccianti S, Delli Paoli C, Infantino M, Paoletti L, Caini S, Meacci F, Russo S, Esposito M, Fondelli S, Grilli Leonulli B, Grossi V, Barca R, Alpi P, Furlan F, Perna M, Pino MS, Martella F, Manfredi M, Stefanacci M, Bassetti A, Casprini P, Fioretto L. Immunogenicity after two and three doses of mRNA vaccine in patients with cancer treated with exclusive radiotherapy. Int Immunopharmacol 2023; 122:110460. [PMID: 37392566 DOI: 10.1016/j.intimp.2023.110460] [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: 04/27/2023] [Revised: 05/26/2023] [Accepted: 06/04/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND AND PURPOSE Data on immunoresponse after SARS-CoV-2 vaccines for patients treated with exclusive radiotherapy (RT) are scarce. Since RT may affect the immune system, we conducted the MORA trial (Antibody response and cell-mediated immunity of MOderna mRNA-1273 vaccine in patients treated with RAdiotherapy). MATERIALS AND METHODS Data regarding humoral and cellular immune response of patients treated with RT were prospectively collected after the second and third dose of mRNA vaccines. RESULTS Ninety-two patients were enrolled. With a median of 147 days after the second dose, the median SARS-CoV-2 IgG titer was 300 BAU/mL: six patients were seronegative (Spike IgG titer ≤ 40 BAU/mL), whereas 24, 46 and 16 were poor responders (Spike IgG titer:41-200 BAU/mL), responders (Spike IgG titer:201-800 BAU/mL) and ultraresponders (Spike IgG titer > 800 BAU/mL), respectively. Among seronegative patients, two patients were negative also for cell mediated response, as tested with IFN-γ release Assay (IGRA) test. With a median of 85 days after the third dose, the median SARS-CoV-2 IgG titer was 1632 BAU/mL in 81 patients: only two patients were seronegative, whereas 16 and 63 patients were responders and ultraresponders, respectively. Among the 2 persistently seronegative patients, IGRA test was negative in one who had previously received anti-CD20 therapy. Documented paucisymptomatic (n = 3) or asymptomatic (n = 4) infection occurred after the third dose, during the Omicron wave. CONCLUSION In patients treated with exclusive RT, even during the Omicron breakthrough, robust humoral response and clinical protection from severe SARS-CoV-2 disease were achievable with three doses of mRNA vaccine.
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Affiliation(s)
- Silvia Scoccianti
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Camilla Delli Paoli
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Maria Infantino
- Immunology and Allergology Laboratory Unit, S. Giovanni Di Dio Hospital, Florence, Italy.
| | - Lisa Paoletti
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Saverio Caini
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
| | - Fiammetta Meacci
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Serenella Russo
- Medical Physics Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Marco Esposito
- Medical Physics Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Simona Fondelli
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | | | - Valentina Grossi
- Immunology and Allergology Laboratory Unit, S. Giovanni Di Dio Hospital, Florence, Italy
| | - Raffaella Barca
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Paolo Alpi
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Federica Furlan
- Direzione Sanitaria, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Marco Perna
- Oncology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Maria Simona Pino
- Oncology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | | | - Mariangela Manfredi
- Immunology and Allergology Laboratory Unit, S. Giovanni Di Dio Hospital, Florence, Italy
| | | | - Andrea Bassetti
- Direzione Sanitaria, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Patrizia Casprini
- Clinical Pathology Laboratory Unit, S. Giovanni Di Dio Hospital, Florence, Italy
| | - Luisa Fioretto
- Oncology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
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8
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Guidi M, Giunti L, Buccoliero AM, Fonte C, Scoccianti S, Censullo ML, Caporalini C, Tellini M, Di Nicola M, Castelli B, Greto D, Giordano F, Genitori L, Sardi I. Brief report: pediatric high-grade gliomas treated with vinorelbine and valproic acid added to temozolomide. Am J Cancer Res 2023; 13:3668-3678. [PMID: 37693163 PMCID: PMC10492125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/20/2023] [Indexed: 09/12/2023] Open
Abstract
Children and young adult with high grade gliomas (HGG) have dismal prognoses and treatment options remain limited. We present 19 patients diagnosed with anaplastic astrocytoma (AA) or glioblastoma (GBM) treated with concomitant and adjuvant 20-30 mg/m2/dose of vinorelbine and 30 mg/kg/day valproic acid (VA) in combination to consolidated TMZ and focal RT after maximal surgery. We evaluated the feasibility of treating children diagnosed with HGG. The median follow-up time was 51.4 months (range, 6.2-106.6 months). The 5-year OS was 57.9% (CI 95%, 33.2-76.3) and the 5-year PFS was 57.9% (CI 95%, 33.2-76.3). Eight patients (42.1%) have progressed so far, with a median time to progression of 9 months from diagnosis (range, 4.6-34.7 months). All of them died for disease progression. At time of analysis, 11 patients were still alive with no evidence of disease. It is notable that all events occurred within 35 months from the start of therapy. All 19 treated patients reported low-grade drug-related adverse events (AEs). The treatment was well tolerated in our limited cohort of patients without significant toxicity. Further studies of the efficacy and safety of combination of vinorelbine/VA to consolidated RT/TMZ therapy in children with HGG are underway in a clinical trial setting.
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Affiliation(s)
- Milena Guidi
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children’s Hospital IRCCSFlorence, Italy
| | - Laura Giunti
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children’s Hospital IRCCSFlorence, Italy
| | | | - Carla Fonte
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children’s Hospital IRCCSFlorence, Italy
| | - Silvia Scoccianti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of FirenzeFirenze, Italy
| | - Maria Luigia Censullo
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children’s Hospital IRCCSFlorence, Italy
| | | | - Marco Tellini
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children’s Hospital IRCCSFlorence, Italy
| | - Marco Di Nicola
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children’s Hospital IRCCSFlorence, Italy
| | - Barbara Castelli
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children’s Hospital IRCCSFlorence, Italy
| | - Daniela Greto
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of FirenzeFirenze, Italy
| | - Flavio Giordano
- Neurosurgery Unit, Meyer Children’s Hospital IRCCSFlorence, Italy
| | - Lorenzo Genitori
- Neurosurgery Unit, Meyer Children’s Hospital IRCCSFlorence, Italy
| | - Iacopo Sardi
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children’s Hospital IRCCSFlorence, Italy
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9
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Gnerucci A, Esposito M, Ghirelli A, Pini S, Paoletti L, Barca R, Fondelli S, Alpi P, Grilli B, Rossi F, Scoccianti S, Russo S. Surface-guided DIBH radiotherapy for left breast cancer: impact of different thresholds on intrafractional motion monitoring and DIBH stability. Strahlenther Onkol 2023; 199:55-66. [PMID: 36229656 DOI: 10.1007/s00066-022-02008-y] [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: 06/04/2022] [Accepted: 09/15/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To compare two left breast cancer patient cohorts (tangential vs. locoregional deep-inspiration breath-hold - DIBH treatment) with different predefined beam gating thresholds and to evaluate their impact on motion management and DIBH stability. METHODS An SGRT-based clinical workflow was adopted for the DIBH treatment. Intrafractional monitoring was performed by tracking both the respiratory signal and the real-time displacement between the isocenter on the daily reference surface and on the live surface ("SGRT shift"). Beam gating tolerances were 5 mm/4 mm for the SGRT shifts and 5 mm/3 mm for the gating window amplitude for breast tangential and breast + lymph nodes locoregional treatments, respectively. A total of 24 patients, 12 treated with a tangential technique and 12 with a locoregional technique, were evaluated for a total number of 684 fractions. Statistical distributions of SGRT shift and respiratory signal for each treatment fraction, for each patient treatment, and for the two population samples were generated. RESULTS Lateral cumulative distributions of SGRT shifts for both locoregional and tangential samples were consistent with a null shift, whereas longitudinal and vertical ones were slightly negative (mean values < 1 mm). The distribution of the percentage of beam on time with SGRT shift > 3 mm, > 4 mm, or > 5 mm was extended toward higher values for the tangential sample than for the locoregional sample. The variability in the DIBH respiration signal was significantly greater for the tangential sample. CONCLUSION Different beam gating thresholds for surface-guided DIBH treatment of left breast cancer can impact motion management and DIBH stability by reducing the frequency of the maximum SGRT shift and increasing respiration signal stability when tighter thresholds are adopted.
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Affiliation(s)
- A Gnerucci
- Department of Physics and Astronomy, University of Florence, Florence, Italy.
| | - M Esposito
- Medical Physics Unit, Azienda USL Toscana Centro, Florence, Italy
| | - A Ghirelli
- Medical Physics Unit, Azienda USL Toscana Centro, Florence, Italy
| | - S Pini
- Medical Physics Unit, Azienda USL Toscana Centro, Florence, Italy
| | - L Paoletti
- Radiotherapy Unit, Azienda USL Toscana Centro, Florence, Italy
| | - R Barca
- Radiotherapy Unit, Azienda USL Toscana Centro, Florence, Italy
| | - S Fondelli
- Radiotherapy Unit, Azienda USL Toscana Centro, Florence, Italy
| | - P Alpi
- Radiotherapy Unit, Azienda USL Toscana Centro, Florence, Italy
| | - B Grilli
- Radiotherapy Unit, Azienda USL Toscana Centro, Florence, Italy
| | - F Rossi
- Radiotherapy Unit, Azienda USL Toscana Sud Est, Grosseto, Italy
| | - S Scoccianti
- Radiotherapy Unit, Azienda USL Toscana Centro, Florence, Italy
| | - S Russo
- Medical Physics Unit, Azienda USL Toscana Centro, Florence, Italy
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10
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Detti B, Carnevale MG, Lucidi S, Burchini L, Caini S, Orsatti C, Bertini N, Roghi M, di Cataldo V, Fondelli S, Ingrosso G, Francolini G, Scartoni D, Sardaro A, Pisani A, Scoccianti S, Aristei C, Livi L. Choline PET/CT in recurrent prostate cancer. Front Oncol 2023; 13:1079808. [PMID: 37025599 PMCID: PMC10070677 DOI: 10.3389/fonc.2023.1079808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Purpose Biochemical recurrence (BR) occurs in up to 40% of patients with prostate cancer (PCa) treated with primary radical prostatectomy (RP). Choline PET/CT may show, in a single-step examination, the site of tumor recurrence earlier than traditional imaging methods, particularly at low prostate-specific antigen (PSA) levels, thus influencing subsequent treatment. Methods/patients Patients with recurrent and non-metastatic prostate cancer (nmPCa), who were assessed with choline PET/CT, were included in the analysis. Based on imaging results, the following therapeutic strategies were chosen: radiotherapy to the prostatic bed, androgen deprivation therapy (ADT), and chemotherapy or stereotactic body radiotherapy (SBRT) to either the pelvic lymph nodes or distant metastases. We assessed the impact of age, PSA levels, Gleason score (GS), and adjuvant therapy on oncological outcomes. Results Data from 410 consecutive nmPCa patients with BR who underwent RP as primary treatment were analyzed. One hundred seventy-six (42.9%) patients had a negative choline PET/CT, and 234 (57.1%) patients resulted positive. In the multivariate analysis, only chemotherapy and PSA at recurrence were significant independent prognostic factors on overall survival (OS). In the PET-positive subgroup, the number of relapses, PSA post-prostatectomy, and chemotherapy impacted on OS. PSA (post-surgery and at recurrence) affected progression-free survival (PFS) in the univariate analysis. In the multivariate analysis, GS, the number of relapse sites, and PSA (post-surgery and at recurrence) were significant prognostic factors for disease-free survival (DFS). Conclusion Choline PET/CT provides better accuracy than conventional imaging for the assessment of nmPCa with BR after prostatectomy, thereby enabling salvage strategies and improving quality of life.
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Affiliation(s)
- Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Maria Grazia Carnevale
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
| | - Sara Lucidi
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
| | - Luca Burchini
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
| | - Saverio Caini
- Institute for Cancer Research, Prevention and Clinical Network - Istituto per lo Studio e la Prevenzione Oncologia (ISPRO), Florence, Italy
| | - Carolina Orsatti
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
| | - Niccolò Bertini
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
| | - Manuele Roghi
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
- *Correspondence: Manuele Roghi,
| | - Vanessa di Cataldo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Simona Fondelli
- Struttura Organizzativa Complessa (SOC) Radioterapia Oncologica, Ospedale Santa Maria Annunziata, Bagno a Ripoli, Firenze, Azienda Unità Sanitaria Locale (USL) Toscana Centro, Florence, Italy
| | - Gianluca Ingrosso
- Radiation Oncology, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Daniele Scartoni
- Proton Therapy Center-Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | | | | | - Silvia Scoccianti
- Struttura Organizzativa Complessa (SOC) Radioterapia Oncologica, Ospedale Santa Maria Annunziata, Bagno a Ripoli, Firenze, Azienda Unità Sanitaria Locale (USL) Toscana Centro, Florence, Italy
| | - Cynthia Aristei
- Radiation Oncology, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
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11
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Cheli S, Pino MS, Goldzweig G, Scoccianti S, Fabbroni V, Giordano C, Cavalletti V, Bassetti A, Fioretto L. The Relationship Between Covid-19 Risk Perception and Vaccine Hesitancy in Cancer Patients: The Moderating Role of Externalizing Traits. Clin Neuropsychiatry 2022; 19:355-364. [PMID: 36627943 PMCID: PMC9807116 DOI: 10.36131/cnfioritieditore20220602] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective This mixed-methods study aimed to explore the role of externalizing traits in moderating the relationship between COVID-19 risk perception and vaccine hesitancy in patients diagnosed with cancer. A community-based participatory approach - comprising a preliminary qualitative inquiry and a subsequent cross-sectional research - was used to promote effective vaccination campaigns. Method 12 people diagnosed with cancer and 7 cancer professionals were recruited for the qualitative inquiry, 356 people either under cancer treatment or in follow-up care for the cross-sectional research.A phenomenological analysis explored the transcripts of two focus groups. The cross-sectional research tested the hypothesis emerged during the previous qualitative inquiry through self-reported questionnaires and moderated regression. Results Phenomenological analysis suggested a pivotal role of externalizing traits in vaccine hesitancy. Moderated regression revealed how the association between risk perception and vaccine hesitancy is moderated by externalizing traits, even when controlled for treatment adherence. Conclusions In the present study we found a stronger relationship between risk perception and vaccine hesitancy for patients with higher levels of externalizing traits. We suggest that vaccination campaigns should be personality-informed to offer individualized and effective solutions. Patients with externalizing traits may cope dysfunctionally with vaccination campaigns.
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Affiliation(s)
- Simone Cheli
- Center for Psychology and Health, Tages Charity, Florence, Italy, St. John’s University, Rome, Italy,Corresponding author Simone Cheli E-mail:
| | - Maria Simona Pino
- Medical Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, Italy
| | - Gil Goldzweig
- The Academic College of Tel Aviv Yaffo – Tel Aviv, Israel
| | - Silvia Scoccianti
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence
| | - Valentina Fabbroni
- Medical Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, Italy
| | - Clara Giordano
- Medical Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, Italy
| | | | - Andrea Bassetti
- Direzione Sanitaria Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, Italy
| | - Luisa Fioretto
- Medical Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, Italy
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12
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Matsui JK, Perlow HK, Facer BD, McCalla A, Marrazzo L, Detti B, Scorsetti M, Clerici E, Scoccianti S, Navarria P, Trifiletti DM, Gondi V, Bovi J, Huang J, Brown PD, Palmer JD. Radiotherapy for elderly patients with glioblastoma: an assessment of hypofractionation and modern treatment techniques. Chin Clin Oncol 2022; 11:38. [PMID: 36336897 DOI: 10.21037/cco-22-76] [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: 08/22/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Glioblastoma (GBM) is a disease with a poor prognosis. For decades, radiotherapy has played a critical role in the management of GBM. The standard of care radiation prescription is 60 Gy in 30 fractions, but landmark trials have historically excluded patients older than 70 years. Currently, there is considerable variation in the management of elderly patients with GBM. Shortened radiation treatment (hypofractionated) regimens have been explored since conventional treatment schedules are lengthy and many elderly patients have functional, cognitive, and social limitations. Clinical trials have demonstrated the effectiveness of hypofractionated radiotherapy (40 Gy in 15 fractions) to treat elderly or frail patients with GBM. Although previous studies have suggested these unique hypofractionation prescriptions effectively treat these patients, there are many avenues for improvement in this patient population. Herein, we describe the unique tumor biology of glioblastoma, key hypofractionated radiotherapy studies, and health-related quality of life (HRQOL) studies for elderly patients with GBM. Hypofractionated radiation has emerged as a shortened alternative and retrospective studies have suggested survival outcomes are similar for elderly patients with GBM. Prospective studies comparing hypofractionation with conventional treatment regiments are warranted. In addition to evaluating survival outcomes, HRQOL endpoints should be incorporated into future studies.
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Affiliation(s)
| | - Haley K Perlow
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Benjin D Facer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Aliah McCalla
- Central Michigan University, College of Medicine, Mt. Pleasant, MI, USA
| | - Livia Marrazzo
- Department of Medical Physics, Azienda Ospedaliera Universitaria, Florence, Italy
| | - Beatrice Detti
- Department of Radiation Oncology, Azienda Ospedaliera Universitaria, Florence, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Elena Clerici
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Silvia Scoccianti
- Department of Radiation Oncology, Azienda Ospedaliera Universitaria, Florence, Italy
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Vinai Gondi
- Department of Radiation Oncology, Northwestern Medicine Cancer Center and Proton Center, Warrenville, IL, USA
| | - Joseph Bovi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jiayi Huang
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Joshua D Palmer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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13
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Detti B, Scoccianti S, Maragna V, Lucidi S, Ganovelli M, Teriaca MA, Caini S, Desideri I, Agresti B, Greto D, Buccoliero AM, Puppa AD, Sardi I, Livi L. Pleomorphic Xanthoastrocytoma: a single institution retrospective analysis and a review of the literature. Radiol Med 2022; 127:1134-1141. [PMID: 35951279 PMCID: PMC9512734 DOI: 10.1007/s11547-022-01531-3] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/22/2022] [Indexed: 11/30/2022]
Abstract
Background Pleomorphic xanthoastrocytoma (PXA) is a rare low-grade brain tumor. To date, limited studies have analyzed factors affecting survival outcomes and defined the therapeutic strategy. The aim of this retrospective analysis was to investigate the clinicopathologic characteristics of PXA and identify factors associated with outcomes. Methods We retrospectively analyzed a cohort of 16 adult and children patients with PXA who underwent primary resection from 1997 to 2019, referred to our Radiation Oncology Unit and to Meyer’s Paediatric Hospital. We also reviewed the relevant literature. Results All patients underwent primary surgical resection; 10 patients received adjuvant radiation treatment course, ranging from DTF 54 to 64 Gy; 8 of them received, in addition, concurrent adjuvant chemotherapy; 6 patients underwent only radiological follow-up. After a median follow up was 60 months: median OS was 34.9 months (95% CI 30–218), 1-year OS 87%, 5-years OS 50%, 10-years OS 50%; median PFS 24.4 months (95% CI 13–156), 1-year PFS 80%, 5-years PFS 33%, 10-years PFS 33%. A chi-square test showed a significant association between OS and recurrent disease (p = 0.002) and with chemotherapy adjuvant treatment (p = 0.049). A borderline statistical significant association was instead recognized with BRAF mutation (p = 0.058). Conclusions Despite our analysis did not reveal a strong prognostic or predictive factor able to address pleomorphic xanthoastrocytoma management; however, in selected patients could be considered the addition of adjuvant radiation chemotherapy treatment after adequate neurosurgical primary resection. Furthermore, recurrent disease evidenced a detrimental impact on survival.
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Affiliation(s)
- Beatrice Detti
- Radiation Oncology Unit, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, Italy.
| | - Silvia Scoccianti
- Radiation Oncology Unit, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, Italy
| | - Virginia Maragna
- Radiation Oncology Unit, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, Italy
| | - Sara Lucidi
- Radiation Oncology Unit, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, Italy
| | - Michele Ganovelli
- Radiation Oncology Unit, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, Italy
| | - Maria Ausilia Teriaca
- Radiation Oncology Unit, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, Italy
| | - Saverio Caini
- Epidemiology of Risk Factors and Lifestyles, Institute for Study, Prevention, and Oncology Network (ISPRO), Florence, Italy
| | - Isacco Desideri
- Radiation Oncology Unit, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, Italy
| | - Benedetta Agresti
- Radiation Oncology Unit, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, Italy
| | - Daniela Greto
- Radiation Oncology Unit, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, Italy
| | - Anna Maria Buccoliero
- Pathology Unit, Children's Hospital A. Meyer, University of Florence, Florence, Italy
| | - Alessandro Della Puppa
- Department of Neurosurgery, Careggi Hospital, University of Florence, Florence, Italy
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children's Hospital, Florence, Italy
| | - Iacopo Sardi
- Department of Neurosurgery, Careggi Hospital, University of Florence, Florence, Italy
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children's Hospital, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, Italy
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Pino MS, Cheli S, Perna M, Fabbroni V, Giordano C, Martella F, Lanini F, Ribecco AS, Scoccianti S, Bacci C, Baldazzi V, Bertolini I, Di Leonardo G, Fulignati C, Grifoni R, Molinara E, Rangan S, Tassi R, Furlan F, Goldzweig G, Bassetti A, Fioretto L. The national COVID-19 vaccination campaign targeting the extremely vulnerable: the Florence Medical Oncology Unit experience in patients with cancer. Eur J Cancer 2022; 170:149-157. [PMID: 35635936 PMCID: PMC9020512 DOI: 10.1016/j.ejca.2022.04.008] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/19/2022] [Accepted: 04/01/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND International and national oncology societies had released recommendations in favor of COVID-19 vaccination in cancer patients. In the context of the national vaccination campaign targeting the so called extremely vulnerable, we aimed to assess the safety and efficacy of the mRNA vaccines in a cohort of 623 patients. METHODS Between March 26 and April 04, 2021, the Pfizer and BioNTech BNT162b2 mRNA and the Moderna mRNA-1273 vaccines were given as a two-dose prime-boost regimen. Starting on September 25th 2021 a third dose was offered to patients in whom a suboptimal immunogenicity with COVID-19 vaccination could be expected. Safety assessments were performed by phone call 7 days after each dose. Electronic health records were accessed to review demographic information, disease history, treatment detail, and outcome events of participants patients'. FINDINGS No toxicities were reported in 63.7%, 54%, and in 48.7% patients with cancer after each dose. Mild-to-moderate pain at the injection site was the most commonly adverse event. After the second dose, 46% of the 610 patients reported toxicity, with more systemic side-effects observed. Fever was reported in 45% of patients, with a temperature ≥ 38 °C in 21.4% of them. Of the 335 patients receiving a third vaccine dose, 51% reported toxicity, with 13% of patients reporting more than one effect. Logistic regression analysis reported mixed results, with limited variables or categories reporting a significant odd ratio. The type of vaccine reported a significant value at first dose (OR = 0.12; CI 0.52, 0.26; p = 0.00). Thirty-four cases of COVID-19 infection were reported with only one patient requiring a short-term hospitalization for monitoring. INTERPRETATION The safety profile of the mRNA vaccines does not raise any specific concerns and support prioritization of vaccination for cancer patients.
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Affiliation(s)
- Maria S Pino
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy.
| | - Simone Cheli
- School of Human Health Sciences, University of Florence, Italy
| | - Marco Perna
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Valentina Fabbroni
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Clara Giordano
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Francesca Martella
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Fabio Lanini
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Angela S Ribecco
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Silvia Scoccianti
- Radiation Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Carlotta Bacci
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Valentina Baldazzi
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Ilaria Bertolini
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Greta Di Leonardo
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Chiara Fulignati
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Raffaella Grifoni
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Elena Molinara
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Sheila Rangan
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Renato Tassi
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
| | - Federica Furlan
- Direzione Sanitaria, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Italy
| | - Gil Goldzweig
- The Academic College of Tel Aviv - Yaffo, Tel Aviv, Israel
| | - Andrea Bassetti
- Direzione Sanitaria, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Italy
| | - Luisa Fioretto
- Medical Oncology Unit - Florence, Department of Oncology, Azienda USL Toscana Centro, Italy
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15
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Scoccianti S, Delli Paoli C, Paoletti L, Grilli Leonulli B, Russo S, Alpi P, Barca R, Fondelli S, Caini S, Infantino M, Manfredi M, Esposito M, Grossi V, Furlan F, Pino M, Martella F, Bassetti A, Casprini P, Fioretto L. PO-1067 Safety and Immunogenicity of Moderna COVID vaccine in radiotherapy patients. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03031-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Gnerucci A, Russo S, Esposito M, Ghirelli A, Pini S, Paoletti L, Barca R, Fondelli S, Alpi P, Grilli B, Rossi F, Scoccianti S. PO-1710 Robustness evaluation of surface guided DIBH breast radiotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03674-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: 11/30/2022]
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17
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Perlow HK, Prasad RN, Yang M, Klamer B, Matsui J, Marrazzo L, Detti B, Scorsetti M, Clerici E, Arnett A, Beyer S, Ammirati M, Chakravarti A, Raval RR, Brown PD, Navarria P, Scoccianti S, Grecula JC, Palmer JD. Accelerated hypofractionated radiation for elderly or frail patients with a newly diagnosed glioblastoma: A pooled analysis of patient-level data from 4 prospective trials. Cancer 2022; 128:2367-2374. [PMID: 35315512 DOI: 10.1002/cncr.34192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/14/2022] [Accepted: 02/28/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The standard of care for elderly or frail patients with glioblastoma (GBM) is 40 Gy in 15 fractions of radiotherapy. However, this regimen has a lower biological effective dose (BED) compared with the Stupp regimen of 60 Gy in 30 fractions. It is hypothesized that accelerated hypofractionated radiation of 52.5 Gy in 15 fractions (BED equivalent to Stupp) is safe and efficacious. METHODS Elderly or frail patients with GBM treated with 52.5 Gy in 15 fractions were pooled from 3 phase 1/2 studies and a prospective observational study. Overall survival (OS) and progression-free survival (PFS) were defined time elapsing between surgery/biopsy and death from any cause or progression of disease. RESULTS Sixty-two newly diagnosed patients were eligible for this pooled analysis of individual patient data. The majority (66%) had a Karnofsky performance status (KPS) score <70. The median age was 73 years. The median OS and PFS were 10.3 and 6.9 months, respectively. Patients with KPS scores ≥70 and <70 had a median OS of 15.3 and 9.5 months, respectively. Concurrent chemotherapy was an independent prognostic factor for improved PFS and OS. Grade 3 neurologic toxicity was seen in 2 patients (3.2%). There was no grade 4/5 toxicity. CONCLUSIONS This is the only analysis of elderly/frail patients with GBM prospectively treated with a hypofractionated radiation regimen that is isoeffective to the Stupp regimen. Treatment was well tolerated and demonstrated excellent OS and PFS compared with historical studies. This regimen gives the elderly/frail population an alternative to regimens with a lower BED. Randomized trials are needed to validate these results.
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Affiliation(s)
- Haley K Perlow
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Rahul N Prasad
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Mike Yang
- Ohio State University School of Medicine, Columbus, Ohio
| | - Brett Klamer
- Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | | | - Livia Marrazzo
- Department of Medical Physics, Azienda Ospedaliera Universitaria, Florence, Italy
| | - Beatrice Detti
- Department of Radiation Oncology, Azienda Ospedaliera Universitaria, Florence, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Elena Clerici
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Andrea Arnett
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sasha Beyer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Mario Ammirati
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Arnab Chakravarti
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Raju R Raval
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Silvia Scoccianti
- Department of Radiation Oncology, Azienda Ospedaliera Universitaria, Florence, Italy
| | - John C Grecula
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Joshua D Palmer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
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18
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De Giorgi V, Scarfì F, Trane L, Silvestri F, Venturi F, Zuccaro B, Spinelli G, Scoccianti S, De Rosa F, Dika E, Longo C. Treatment of Advanced Basal Cell Carcinoma with Hedgehog Pathway Inhibitors: A Multidisciplinary Expert Meeting. Cancers (Basel) 2021; 13:cancers13225706. [PMID: 34830860 PMCID: PMC8616316 DOI: 10.3390/cancers13225706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022] Open
Abstract
Despite recent progress and the publishing of several clinical guidelines on the management of advanced basal cell carcinoma, there is still no comprehensive set of clinical guidelines addressing the complexity inherent to the use of Hedgehog pathway inhibitors in the treatment of advanced basal cell carcinoma in real-world clinical practice. To develop practical and valuable tools that help specialists improve the clinical management of these patients, we sought the opinion of expert physicians with extensive knowledge and experience in the treatment of advanced basal cell carcinoma.
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Affiliation(s)
- Vincenzo De Giorgi
- Section of Dermatology, Department of Health Sciences, University of Florence, 50100 Florence, Italy; (F.S.); (F.S.); (F.V.); (B.Z.)
- Correspondence: ; Tel./Fax: +39-055-6939632
| | - Federica Scarfì
- Section of Dermatology, Department of Health Sciences, University of Florence, 50100 Florence, Italy; (F.S.); (F.S.); (F.V.); (B.Z.)
| | - Luciana Trane
- Cancer Research “AttiliaPofferi” Foundation, 50100 Pistoia, Italy;
| | - Flavia Silvestri
- Section of Dermatology, Department of Health Sciences, University of Florence, 50100 Florence, Italy; (F.S.); (F.S.); (F.V.); (B.Z.)
| | - Federico Venturi
- Section of Dermatology, Department of Health Sciences, University of Florence, 50100 Florence, Italy; (F.S.); (F.S.); (F.V.); (B.Z.)
| | - Biancamaria Zuccaro
- Section of Dermatology, Department of Health Sciences, University of Florence, 50100 Florence, Italy; (F.S.); (F.S.); (F.V.); (B.Z.)
| | - Giuseppe Spinelli
- Maxillofacial Surgery Department, Azienda Ospedaliero-Universitaria Careggi, 50100 Florence, Italy;
| | - Silvia Scoccianti
- Radiation Oncology Unit, Azienda Toscana Centro, 50100 Florence, Italy;
| | - Francesco De Rosa
- Immunotherapy-Cell Therapy and Biobank, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) “Dino Amadori” IRCCS, 47014 Meldola, Italy;
| | - Emi Dika
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy;
- Dermatology, IRCCS Policlinico di Sant’Orsola, Via Massarenti 9, 40138 Bologna, Italy
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, 42100 Modena, Italy;
- Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, 41121 Reggio Emilia, Italy
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19
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Perlow H, Yang M, Klamer B, Matsui J, Marrazzo L, Detti B, Scorrsetti M, Clerici E, Arnett A, Beyer S, Ammirati M, Chakravarti A, Raval R, Navarria P, Scoccianti S, Grecula J, Palmer J. CTNI-37. ISOEFFECTIVE HYPOFRACTIONATION FOR ELDERLY OR FRAIL PATIENTS WITH A NEWLY DIAGNOSED GLIOBLASTOMA: A POOLED INTERNATIONAL STUDY. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.262] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
PURPOSE
The standard of care (SOC) for elderly or frail glioblastoma (GBM) patients is 40 Gy in 15 fraction radiotherapy. However, this regimen has a lower BED compared to the Stupp regimen, 60 Gy in 30 fractions. We hypothesize that isoeffective hypofractionated radiation of 52.5 Gy in 15 fractions (BED equivalent to Stupp) will have superior survival compared to standard of care.
METHODS
Elderly GBM patients treated with 52.5 Gy in 15 fractions were pooled from 2 phase II studies, 1 phase 1 and a prospective observation study. Overall survival (OS) and progression free survival (PFS) were defined as the time elapsed between surgery/biopsy and death from any cause or progression. Univariate and multivariate analyses were performed.
RESULTS
62 newly-diagnosed patients were eligible for this analysis. Median follow-up was 10 months. The median OS and PFS was 10.3 and 6.9 mos, respectively. Patients with KPS ≥ 70 and < 70 had a median OS of 15.3 and 9.5 mos. No survival difference was seen between unmethylated and methylated patients with a median OS of 10.2 and 10.3 months, respectively. Multivariable analysis demonstrated that concurrent chemotherapy was an independent prognostic factor for improved PFS and OS. Grade 3 neurologic toxicity was seen in 2 patients (3.2%).
CONCLUSION
This is the first pooled, prospective analysis of elderly/frail GBM patients treated with dose-escalated hypofractionated radiation. Treatment was well tolerated and demonstrated excellent OS and PFS, exceeding that from prior elderly trials (Roa; 6.5 mo [poor KPS]/Perry; 9.3mo [good KPS]). This treatment regimen gives the elderly population an alternative to Stupp that is not de-escalating therapy. Future prospective trials are needed to validate these results.
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Affiliation(s)
- Haley Perlow
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Michael Yang
- Ohio State University School of Medicine, Columbus, USA
| | - Brett Klamer
- The Ohio State University, Center for Biostatistics, Columbus, USA
| | | | - Livia Marrazzo
- Department of Radiation Oncology, Azienda Ospedaliera Universitaria, Florence, Italy
| | - Beatrice Detti
- Department of Radiation Oncology, Azienda Ospedaliera Universitaria, Florence, Italy
| | - Marta Scorrsetti
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Elena Clerici
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Andrea Arnett
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Sasha Beyer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Mario Ammirati
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Arnab Chakravarti
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Raju Raval
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Silvia Scoccianti
- Department of Radiation Oncology, Azienda Ospedaliera Universitaria, Florence, Italy
| | - John Grecula
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Joshua Palmer
- The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, USA
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20
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Desideri I, Francolini G, Ciccone LP, Stocchi G, Salvestrini V, Aquilano M, Greto D, Bonomo P, Meattini I, Scotti V, Scoccianti S, Simontacchi G, Livi L. Correction to: Impact of COVID-19 on patient-doctor interaction in a complex radiation therapy facility. Support Care Cancer 2021; 30:1891-1892. [PMID: 34750667 PMCID: PMC8575545 DOI: 10.1007/s00520-021-06665-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Isacco Desideri
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 85, 50134, Florence, Italy.
| | - G Francolini
- Radiation Oncology Unit, University of Florence, Florence, Italy.,CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Florence, Italy.,Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - L P Ciccone
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 85, 50134, Florence, Italy
| | - G Stocchi
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 85, 50134, Florence, Italy
| | - V Salvestrini
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 85, 50134, Florence, Italy
| | - M Aquilano
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 85, 50134, Florence, Italy
| | - D Greto
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - P Bonomo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - I Meattini
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 85, 50134, Florence, Italy.,Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - V Scotti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - S Scoccianti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - G Simontacchi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - L Livi
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 85, 50134, Florence, Italy
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21
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Battista F, Muscas G, Scoccianti S, Buccoliero AM, Gadda D, Della Puppa A. Brain low-grade gliomas with high-grade spinal localization. Report of a clinical case and systematic literature review. J Neurosurg Sci 2021; 66:151-157. [PMID: 34545732 DOI: 10.23736/s0390-5616.21.05446-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Oncological aggressiveness and the ability to present distant localizations are known in high-grade gliomas (HGGs), but the knowledge about the possible aggressiveness of LGGs is scarce, especially concerning possible spinal localization. EVIDENCE ACQUISITION A systematic search of LGGs with spinal localization on the three primary online databases (PubMed/MEDLINE, Embase, and Cochrane) was conducted. We included adult patients with histological diagnosis of intracranial LGG and specified WHO grade showing a remote spinal localization during follow-up. Additionally, we present a case of a left temporal LGG presenting a spinal localization fourteen years after the first appearance. We compared the survival rates of LGGs in our series with those of LGGs without spinal localizations. EVIDENCE SYNTHESIS Seven articles dealing with the subject and eight patients were considered (including our case), with a mean age at diagnosis of 42.25 years (range 26-69 years). The mean latency between a diagnosis of intracranial LGGs and a spinal localization occurrence was 7.37 years (range 2-14 years), and an increased WHO grade of the spinal localization compared to the brain LGG was observed in all patients. There was no sign of intracranial progression at the time of spinal glioma diagnosis in four cases, including ours. Survival at ten years was 28% against a 10-year survival rate of 65-71% for LGGs without distant localization, as reported in the literature. CONCLUSIONS Spinal metastasis of intracranial LGGs is an adverse prognostic factor. Surgical violation of ventricles can play a role in the pathophysiology of CSF spread of tumor cells in LGGs.
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Affiliation(s)
- Francesca Battista
- Department of Neurosurgery, Department of Neuroscience, Psychology, Drug Area and Child Health (NEUROFARBA), Careggi University Hospital, University of Florence, Florence, Italy -
| | - Giovanni Muscas
- Department of Neurosurgery, Department of Neuroscience, Psychology, Drug Area and Child Health (NEUROFARBA), Careggi University Hospital, University of Florence, Florence, Italy
| | - Silvia Scoccianti
- Department of Radiation Oncology, Santa Maria Annunziata Hospital, Florence, Italy
| | - Anna Maria Buccoliero
- Pathology Unit, Meyer Children's Hospital and University of Florence, Florence, Italy
| | - Davide Gadda
- Department of Neuroradiology, Careggi University Hospital and University of Florence, Florence, Italy
| | - Alessandro Della Puppa
- Department of Neurosurgery, Department of Neuroscience, Psychology, Drug Area and Child Health (NEUROFARBA), Careggi University Hospital, University of Florence, Florence, Italy
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22
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Scoccianti S, Delli Paoli C, Grilli Leonulli B, Paoletti L, Alpi P, Caini S, Barca R, Fondelli S, Russo S, Perna M, Pino MS, Martella F, Furlan F, Bassetti A, Fioretto L. Acute tolerance of Moderna mRNA-1273 vaccine against COVID-19 in patients with cancer treated with radiotherapy. Lancet Oncol 2021; 22:1212-1214. [PMID: 34388385 PMCID: PMC8354565 DOI: 10.1016/s1470-2045(21)00427-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/14/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Silvia Scoccianti
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, 50012, Italy.
| | - Camilla Delli Paoli
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, 50012, Italy
| | - Barbara Grilli Leonulli
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, 50012, Italy
| | - Lisa Paoletti
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, 50012, Italy
| | - Paolo Alpi
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, 50012, Italy
| | - Saverio Caini
- Institute for Cancer Research, Prevention and Clinical Network, Cancer Risk Factors and Life-Style Epidemiology Unit, Florence, Italy
| | - Raffaella Barca
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, 50012, Italy
| | - Simona Fondelli
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, 50012, Italy
| | - Serenella Russo
- Medical Physics Unit, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Firenze, Italy
| | - Marco Perna
- Medical Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, 50012, Italy
| | - Maria Simona Pino
- Medical Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, 50012, Italy
| | - Francesca Martella
- Medical Oncology Unit, San Giuseppe Hospital, Empoli and Breast Unit Firenze, Department of Oncology, Azienda USL Toscana Centro, Florence, Italy
| | - Federica Furlan
- Public Health and Preventive Medicine Residency, University of Florence, Florence, Italy
| | - Andrea Bassetti
- Direzione Sanitaria Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, 50012, Italy
| | - Luisa Fioretto
- Medical Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, 50012, Italy
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23
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De Giorgi V, Trane L, Pieretti G, Santoro N, Silvestri F, Venturi F, Scarfi F, Maio V, Spinelli G, Scoccianti S, Guerrini L, Massi D, Mazzini C, Doni L. Treatment of periocular advanced basal cell carcinoma with Hedgehog pathway inhibitors: a single-center study and a new dedicated therapeutic protocol. Dermatol Reports 2021; 13:9240. [PMID: 35003569 PMCID: PMC8672118 DOI: 10.4081/dr.2021.9240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/21/2021] [Indexed: 12/03/2022] Open
Abstract
The management of difficult-to-treat periocular basal cell carcinoma (BCC) becomes very challenging in cases of delayed diagnosis, leading to the development of locally advanced BCC. The aim of this study was to evaluate the outcomes of Hedgehog pathway inhibitors (vismodegib and sonidegib) treatment in patients affected by periocular locally advanced BCC. We focused on the common adverse events and their correlation with the administration schedule, to determine a management protocol specific for the periocular area. This observational prospective study included a single-center case series with patients who were histologically confirmed to have periocular or orbital locally advanced BCC, treated with Hedgehog pathway inhibitors. All patients benefitted in terms of regression or stabilization of the neoplasm. In the first months of treatment, the HPIs were well tolerated, and the first important side effects appeared after about 5 months of continuous use of the drug. These data could lead to a new type of therapeutic scheme where neoadjuvant therapy could be followed by pulse therapy as an adjuvant to surgery.
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Delli Paoli C, Esposito M, Grilli Leonulli B, Laghai I, Muscas G, Betti M, Perna M, Baldazzi V, Konze A, Della Puppa A, Sestini S, Russo S, Scoccianti S. PO-1048 FluorEthyl-l-Tyrosine PET in glioma radiotherapy planning: an isotoxic dose prescription approach. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07499-5] [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: 11/30/2022]
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Detti B, Scoccianti S, Teriaca MA, Maragna V, Lorenzetti V, Lucidi S, Bellini C, Greto D, Desideri I, Livi L. Bevacizumab in recurrent high-grade glioma: a single institution retrospective analysis on 92 patients. Radiol Med 2021; 126:1249-1254. [PMID: 34081269 PMCID: PMC8370943 DOI: 10.1007/s11547-021-01381-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 08/18/2020] [Accepted: 05/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND High-grade gliomas are among the most aggressive central nervous system primary tumors, with a high risk of recurrence and a poor prognosis. Re-operation, re-irradiation, chemotherapy are options in this setting. No-best therapy has been established. Bevacizumab was approved on the basis of two Phase 2 trials that evaluated its efficacy in patients with recurrent glioblastoma. MATERIALS AND METHODS We have retrospectively review data of patients with high-grade glioma treated at our institution that undergone radiological or histological progression after at least one systemic treatment for recurrent disease. Bevacizumab was administered alone or in combination with chemotherapy until disease progression or unacceptable toxicity. Bevacizumab regimen was analyzed to assess PFS and OS. Histological, molecular and clinical features of the entire cohort were collected. RESULTS We reviewed data from 92 patients, treated from April 2009 to November 2019, with histologically confirmed diagnosis of high-grade gliomas and recurrent disease. A PFS of 55.2%, 22.9% and 9.6% was observed at 6, 12 and 24 months, respectively. Performance status, age at diagnosis (< 65 or > 65 ys.) and use of corticosteroids during bevacizumab therapy were strongly associated with PFS. The OS was 74.9% at 6 months, 31.7% at 12 months, 10.1% at 24 months. In our cohort, 51.1% were long-term responders (PFS > 6 months). Globally, bevacizumab treatment was well tolerated. CONCLUSION Our analysis confirms the efficacy of bevacizumab in recurrent high-grade glioma patients with an acceptable toxicity profile, in keeping with its known safety in the literature.
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Affiliation(s)
- Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Silvia Scoccianti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Maria Ausilia Teriaca
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy.
| | - Virginia Maragna
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Victoria Lorenzetti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Sara Lucidi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Chiara Bellini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Daniela Greto
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Isacco Desideri
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
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Desideri I, Francolini G, Ciccone LP, Stocchi G, Salvestrini V, Aquilano M, Greto D, Bonomo P, Meattini I, Scotti V, Scoccianti S, Simontacchi G, Livi L. Impact of COVID-19 on patient-doctor interaction in a complex radiation therapy facility. Support Care Cancer 2021; 29:2931-2937. [PMID: 33006676 PMCID: PMC7531068 DOI: 10.1007/s00520-020-05793-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/18/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE In the last months, Italy faced a COVID-19 emergency and implemented preventive measures in order to protect patients and healthcare providers from a disease outbreak. The pandemic control strategies impacted patient experience directly. Questionnaires evaluating patients reported measures (PREMs) may assess critical issues and represent a helpful tool to measure the patient perception of healthcare service. Our aim was to prospectively assess patient satisfaction about doctor-patient interaction in a high-volume radiation therapy and oncology center during the COVID-19 pandemic. METHODS Cancer patients receiving either systemic and/or radiation treatment underwent a survey. Two validated questionnaires (EORTC QLQ-C30, FACIT-TS-G version 1) and 14 specific questions evaluating patients' perception of COVID-19 measures were administered. RESULTS One hundred twenty-five patients admitted to our department from 1-30 April 2020 completed the questionnaires. The majority (66.4%) of patients were women and the most common disease was breast cancer (40%). The average Global Health Status (GHS) of EORTC QLQ-C30 was 61.67. Emotional functioning, social, and cognitive domains obtained scores of 75.48, 80.13, and 84.67, respectively. FACIT-TS-G results revealed 120 patients rated the treatments effective and 108 patients thought the side effects were the same as expected or better. Most (89.6%) rated their treatment good, very good, or excellent. Concerning COVID-19-related questions, patients reported overall very good level of information. CONCLUSIONS Despite the introduction of strict COVID-19 control measures, there was a high level of cancer outpatient satisfaction. The satisfaction levels may influence compliance, continuity of treatments, and patient-doctor communication, impacting the quality of clinical care in the next phases of the pandemic.
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Affiliation(s)
- Isacco Desideri
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 85, 50134, Florence, Italy.
| | - G Francolini
- Radiation Oncology Unit, University of Florence, Florence, Italy
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Florence, Italy
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - L P Ciccone
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 85, 50134, Florence, Italy
| | - G Stocchi
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 85, 50134, Florence, Italy
| | - V Salvestrini
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 85, 50134, Florence, Italy
| | - M Aquilano
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 85, 50134, Florence, Italy
| | - D Greto
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - P Bonomo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - I Meattini
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 85, 50134, Florence, Italy
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - V Scotti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - S Scoccianti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - G Simontacchi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - L Livi
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 85, 50134, Florence, Italy
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Scoccianti S, Olmetto E, Pinzi V, Osti MF, Di Franco R, Caini S, Anselmo P, Matteucci P, Franceschini D, Mantovani C, Beltramo G, Pasqualetti F, Bruni A, Tini P, Giudice E, Ciammella P, Merlotti A, Pedretti S, Trignani M, Krengli M, Giaj-Levra N, Desideri I, Pecchioli G, Muto P, Maranzano E, Fariselli L, Navarria P, Ricardi U, Scotti V, Livi L. Immunotherapy in association with stereotactic radiotherapy for Non-Small Cell Lung Cancer brain metastases: results from a multicentric retrospective study on behalf of AIRO. Neuro Oncol 2021; 23:1750-1764. [PMID: 34050669 DOI: 10.1093/neuonc/noab129] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To define efficacy and toxicity of Immunotherapy (IT) with stereotactic radiotherapy (SRT) including radiosurgery (RS) or hypofractionated SRT (HFSRT) for brain metastases (BM) from Non-Small Cell Lung Cancer (NSCLC) in a multicentric retrospective study from AIRO (Italian Association of Radiotherapy and Clinical Oncology). METHODS NSCLC patients with BM receiving SRT+IT and treated in 19 Italian centers were analysed and compared with a control group of patients treated with exclusive SRT. RESULTS One hundred patients treated with SRT+IT and 50 patients treated with SRT-alone were included. Patients receiving SRT+IT had a longer intracranial Local Progression Free Survival (iLPFS) (propensity score-adjusted p=0.007). Among patients who, at the diagnosis of BM, received IT and had also extracranial progression (n=24), IT administration after SRT was shown to be related to a better overall survival (OS) (p=0.037). At multivariate analysis, non-adenocarcinoma histology, KPS =70 and use of HFSRT were associated with a significantly worse survival (p=0.019, p=0.017 and p=0.007 respectively). Time interval between SRT and IT ≤7 days (n=90) was shown to be related to a longer OS if compared to SRT-IT interval >7 days (n=10) (propensity score-adjusted p=0.008). The combined treatment was well tolerated. No significant difference in terms of radionecrosis between SRT+IT patients and SRT-alone patients was observed. Time interval between SRT and IT had no impact on toxicity rate. CONCLUSIONS Combined SRT+IT was a safe approach, associated with a better iLPFS if compared to exclusive SRT.
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Affiliation(s)
- Silvia Scoccianti
- Radiation Oncology Unit, Ospedale Santa Maria Annunziata, Department of Oncology, Bagno a Ripoli, Florence, Italy
| | - Emanuela Olmetto
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Florence, Italy
| | - Valentina Pinzi
- U.O Radioterapia, Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Neurosurgery, Milan, Italy
| | - Mattia Falchetto Osti
- U.O.C Radioterapia, A.O.U Sant'Andrea Facoltà Medicina e Psicologia Università Sapienza, Department of Medicine,Surgery and Translational Medicine,Rome, Italy
| | - Rossella Di Franco
- Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, Department of Radiotherapy, Naples, Italy
| | - Saverio Caini
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Cancer Risk Factors and Life-Style Epidemiology Unit, Florence, Italy
| | - Paola Anselmo
- Radiotherapy Oncology Center, S. Maria Hospital, Department of Oncology, Terni, Italy
| | - Paolo Matteucci
- Radioterapia Oncologica, Campus Biomedico, Department of Radiation Oncology, Rome, Italy
| | - Davide Franceschini
- Humanitas Research Hospital, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | | | - Giancarlo Beltramo
- Cyberknife Centro Diagnostico Italiano, Department of Radiology, Milan, Italy
| | - Francesco Pasqualetti
- Radiation Oncology, Azienda Ospedaliero Universitaria Pisana, Department of Translational Medicine, Pisa, Italy
| | - Alessio Bruni
- Radiotherapy Unit, University Hospital of Modena, Department of Oncology and Hematology, Modena, Italy
| | - Paolo Tini
- Radiotherapy Unit, University of Siena, Department of Radiotherapy and Oncology, Siena, Italy
| | - Emilia Giudice
- UOC di Radioterapia, Policlinico Universitario Tor Vergata, Department of Onco-Haematology, Rome, Italy
| | - Patrizia Ciammella
- Radioterapia Oncologica "G. Prodi", AO-IRCCS Arcispedale S. Maria Nuova, Department of Oncology and Advanced Technology, Reggio Emilia, Italy
| | - Anna Merlotti
- Radiation Oncology A.S.O. S.Croce e Carle, Department of Radiation Oncology, Cuneo, Italy
| | - Sara Pedretti
- U.O. Radioterapia oncologica, Department of Radiation Oncology, ASST Spedali Civili di Brescia e Università degli studi di Brescia, Brescia, Italy
| | - Marianna Trignani
- U.O.C. Radioterapia Oncologica, Ospedale Clinicizzato SS Annunziata- Università Chieti G. D'Annunzio, Department of Radiation Oncology, Chieti, Italy
| | - Marco Krengli
- Radiation Oncology, University Hospital Maggiore della Carità, Department of Translational Medicine, Novara, Italy
| | - Niccolò Giaj-Levra
- IRCCS Ospedale Sacro Cuore Don Calabria, Department of Advanced Radiation Oncology, Verona, Italy
| | - Isacco Desideri
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Florence, Italy
| | - Guido Pecchioli
- Neurosurgery Unit, Azienda Ospedaliero Universitaria Careggi, Department of Neurosurgery, Florence, Italy
| | - Paolo Muto
- Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, Department of Radiotherapy, Naples, Italy
| | - Ernesto Maranzano
- Radiotherapy Oncology Center, S. Maria Hospital, Department of Oncology, Terni, Italy
| | - Laura Fariselli
- U.O Radioterapia, Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Neurosurgery, Milan, Italy
| | - Piera Navarria
- Humanitas Research Hospital, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | | | - Vieri Scotti
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Florence, Italy
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Singh R, Lehrer EJ, Wang M, Perlow HK, Zaorsky NG, Trifiletti DM, Bovi J, Navarria P, Scoccianti S, Gondi V, Brown PD, Palmer JD. Dose Escalated Radiation Therapy for Glioblastoma Multiforme: An International Systematic Review and Meta-Analysis of 22 Prospective Trials. Int J Radiat Oncol Biol Phys 2021; 111:371-384. [PMID: 33991621 DOI: 10.1016/j.ijrobp.2021.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/06/2021] [Accepted: 05/01/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Limited evidence is available on the utility of dose-escalated radiation therapy (DE-RT) with or without temozolomide (TMZ) versus standard-of-care radiation therapy (SoC-RT) for patients with newly diagnosed glioblastoma multiforme. We performed a systematic review/meta-analysis to compare overall survival (OS) and progression-free survival (PFS) between DE-RT and SoC-RT. METHODS AND MATERIALS We used a Population, Intervention, Control, Outcomes, Study Design/Preferred Reporting Items for Systematic Reviews and Meta-analyses/Meta-analysis of Observational Studies in Epidemiology selection criterion to identify studies. The primary and secondary outcomes were 1-year OS and 1-year PFS, respectively. Outcomes and comparisons were subdivided based on receipt of TMZ and MGMT status. DE-RT was defined based on equivalent dose calculations. Random effects meta-analyses using the Knapp-Hartung correction, arcsine transformation, and restricted maximum likelihood method were conducted. Meta-regression was used to compare therapeutic (eg, DE-RT or TMZ) and pathologic characteristics (eg, MGMT methylation status) using the Wald-type test. RESULTS Across 22 published studies, 2198 patients with glioblastoma multiforme were included; 507 received DE-RT. One-year OS after DE-RT alone was higher than SoC-RT alone (46.3% vs 23.4%; P = .02) as was 1-year PFS (17.9% vs 5.3%; P = .02). No significant difference in 1-year OS (73.2% vs 64.4%; P = .23) or 1-year PFS (44.5% vs 44.3%; P = .33) between DE-RT + TMZ and SoC-RT + TMZ was noted. No difference in 1-year OS was noted between DE-RT + TMZ and SoC-RT + TMZ in either MGMT methylated (83.2% vs 73.2%; P = .23) or MGMT unmethylated (72.6% vs 50.6%; P = .16) patients. CONCLUSIONS DE-RT alone resulted in superior PFS and OS versus SoC-RT alone. DE-RT + TMZ did not lead to improved outcomes versus SoC-RT + TMZ. No differential benefit based on MGMT status was found. Future studies are warranted to define which subgroups benefit most from DE-RT.
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Affiliation(s)
- Raj Singh
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ming Wang
- Department of Public Health Sciences, Penn State University, Hershey, Pennsylvania
| | - Haley K Perlow
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nicholas G Zaorsky
- Department of Public Health Sciences, Penn State University, Hershey, Pennsylvania; Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | | | - Joseph Bovi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy
| | - Silvia Scoccianti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Vinai Gondi
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Joshua D Palmer
- Department of Radiation Oncology and Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia.
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Francolini G, Desideri I, Stocchi G, Ciccone LP, Salvestrini V, Garlatti P, Aquilano M, Greto D, Bonomo P, Meattini I, Scotti V, Scoccianti S, Simontacchi G, Livi L. Impact of COVID-19 on workload burden of a complex radiotherapy facility. Radiol Med 2021; 126:717-721. [PMID: 33646520 PMCID: PMC7917169 DOI: 10.1007/s11547-021-01338-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 02/07/2021] [Indexed: 12/12/2022]
Abstract
Background and purpose COVID-19 constitutes a worldwide threat, prompting Italian Government to implement specific measures on March 8, 2020, to protect patients and health workers from disease transmission. The impact of preventive measures on daily activity of a radiotherapy facility may hamper the ability to fulfill normal workload burden. Thus, we assessed the number of delivered treatments in a specific observation period after the adoption of preventive measures (since March 11 to April 24, 2020) and compared it with the corresponding period of the year 2019. Materials and methods Overall number of delivered fractions was related to actual time of platform daily activity and reported as a ratio between number of delivered fractions and activity hours (Fr/Hrs). Fr/Hrs were calculated and compared for two different periods of time, March 11–April 24, 2019 (Fr/Hrs1), and March 11–April 24, 2020 (Fr/Hrs2). Results Fr/Hrs1 and Fr/Hrs2 were 2.66 and 2.54 for year 2019 and 2020, respectively, for a Fr/Hrsratio of 1.07 (95% CI 1.03–1.12, p = 0.0005). Fr/Hrs1 was significantly higher than Fr/Hrs2 for SliR and PreciseR, with Fr/Hrsratio of 1.92 (95% CI 1.66–2.23, p < 0.0001) and 1.11 (95% CI 1.03–1.2, p = 0.003), respectively. No significant difference was reported for SynergyR and CyberknifeR with Fr/Hrsratio of 0.99 (95% CI 0.91–1.08, p = 0.8) and 0.9 (95% CI 0.77–1.06, p = 0.2), respectively. Fr/Hrs1 was significantly lower than Fr/Hrs2 for TomotherapyR, with Fr/Hrsratio of 0.88 (95% CI 0.8–0.96, p = 0.007). Conclusion Preventive measures did not influence workload burden performed. Automation in treatment delivery seems to compensate effectively for health workers number reduction.
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Affiliation(s)
- Giulio Francolini
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Radiation Oncology Unit, University of Florence, Florence, Italy. .,Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.
| | - Isacco Desideri
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Giulia Stocchi
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Lucia Pia Ciccone
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Viola Salvestrini
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Pietro Garlatti
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Michele Aquilano
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Daniela Greto
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy
| | - Pierluigi Bonomo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy
| | - Icro Meattini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.,Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Vieri Scotti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy
| | - Silvia Scoccianti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy
| | - Lorenzo Livi
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
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30
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Detti B, Scoccianti S, Lucidi S, Maragna V, Teriaca MA, Ganovelli M, Desideri I, Lorenzetti V, Scoccimarro E, Greto D, Livi L. Regorafenib in glioblastoma recurrence: A case report. Cancer Treat Res Commun 2020; 26:100263. [PMID: 33338858 DOI: 10.1016/j.ctarc.2020.100263] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/13/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
GBM (glioblastoma multiforme) is the most common and aggressive brain tumor. To date, treatment options for glioblastoma recurrence are lacking. Recently, REGOMA trial showed the superiority of regorafenib to lomustine in patients with first glioblastoma recurrence. We report an excellent response to three months treatment with regorafenib, in a patient who presented a rapid progression after the end of post operative radio-chemotherapy and after only one cycle of adjuvant TMZ (Temozolomide).
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Affiliation(s)
- Beatrice Detti
- Azienda Ospedaliero-Universitaria Careggi, Radiation Oncology Unit, Florence, Italy.
| | - Silvia Scoccianti
- Azienda Ospedaliero-Universitaria Careggi, Radiation Oncology Unit, Florence, Italy
| | - Sara Lucidi
- Azienda Ospedaliero-Universitaria Careggi, Radiation Oncology Unit, Florence, Italy
| | - Virginia Maragna
- Azienda Ospedaliero-Universitaria Careggi, Radiation Oncology Unit, Florence, Italy
| | | | - Michele Ganovelli
- Azienda Ospedaliero-Universitaria Careggi, Radiation Oncology Unit, Florence, Italy
| | - Isacco Desideri
- Azienda Ospedaliero-Universitaria Careggi, Radiation Oncology Unit, Florence, Italy
| | - Victoria Lorenzetti
- Azienda Ospedaliero-Universitaria Careggi, Radiation Oncology Unit, Florence, Italy
| | - Erika Scoccimarro
- Azienda Ospedaliero-Universitaria Careggi, Radiation Oncology Unit, Florence, Italy
| | - Daniela Greto
- Azienda Ospedaliero-Universitaria Careggi, Radiation Oncology Unit, Florence, Italy
| | - Lorenzo Livi
- Azienda Ospedaliero-Universitaria Careggi, Radiation Oncology Unit, Florence, Italy
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Meattini I, Marrazzo L, Saieva C, Desideri I, Scotti V, Simontacchi G, Bonomo P, Greto D, Mangoni M, Scoccianti S, Lucidi S, Paoletti L, Fambrini M, Bernini M, Sanchez L, Orzalesi L, Nori J, Bianchi S, Pallotta S, Livi L. Accelerated Partial-Breast Irradiation Compared With Whole-Breast Irradiation for Early Breast Cancer: Long-Term Results of the Randomized Phase III APBI-IMRT-Florence Trial. J Clin Oncol 2020; 38:4175-4183. [DOI: 10.1200/jco.20.00650] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To report the long-term results of external-beam accelerated partial-breast irradiation (APBI) intensity-modulated radiation therapy (IMRT) Florence phase III trial comparing whole-breast irradiation (WBI) to APBI in early-stage breast cancer. PATIENTS AND METHODS The primary end point was to determine the 5-year difference in ipsilateral breast tumor recurrence (IBTR) between 30 Gy in 5 once-daily fractions (APBI arm) and 50 Gy in 25 fractions with a tumor bed boost (WBI arm) after breast-conserving surgery. RESULTS Five hundred twenty patients, more than 90% of whom had characteristics associated with low recurrence risk, were randomly assigned (WBI, n = 260; APBI, n = 260) between 2005 and 2013. Median follow-up was 10.7 years. The 10-year cumulative incidence of IBTR was 2.5% (n = 6) in the WBI and 3.7% (n = 9) in the APBI arm (hazard ratio [HR], 1.56; 95% CI, 0.55 to 4.37; P = .40). Overall survival at 10 years was 91.9% in both arms (HR, 0.95; 95% CI, 0.50 to 1.79; P = .86). Breast cancer–specific survival at 10 years was 96.7% in the WBI and 97.8% in the APBI arm (HR, 0.65; 95% CI, 0.21 to 1.99; P = .45). The APBI arm showed significantly less acute toxicity ( P = .0001) and late toxicity ( P = .0001) and improved cosmetic outcome as evaluated by both physician ( P = .0001) and patient ( P = .0001). CONCLUSION The 10-year cumulative IBTR incidence in early breast cancer treated with external APBI using IMRT technique in 5 once-daily fractions is low and not different from that after WBI. Acute and late treatment-related toxicity and cosmesis outcomes were significantly in favor of APBI.
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Affiliation(s)
- Icro Meattini
- University of Florence, Florence, Italy
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | - Livia Marrazzo
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | - Calogero Saieva
- Istituto per lo Studio la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy
| | - Isacco Desideri
- University of Florence, Florence, Italy
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | - Vieri Scotti
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | | | | | - Daniela Greto
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | - Monica Mangoni
- University of Florence, Florence, Italy
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | | | | | - Lisa Paoletti
- Ospedale Santa Maria Annunziata–Azienda Usl Toscana Centro, Florence, Italy
| | - Massimiliano Fambrini
- University of Florence, Florence, Italy
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | - Marco Bernini
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | - Luis Sanchez
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | - Lorenzo Orzalesi
- University of Florence, Florence, Italy
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | - Jacopo Nori
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | - Simonetta Bianchi
- University of Florence, Florence, Italy
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | - Stefania Pallotta
- University of Florence, Florence, Italy
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | - Lorenzo Livi
- University of Florence, Florence, Italy
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
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Scoccianti S, Perna M, Olmetto E, Delli Paoli C, Terziani F, Ciccone LP, Detti B, Greto D, Simontacchi G, Grassi R, Scoccimarro E, Bonomo P, Mangoni M, Desideri I, Di Cataldo V, Vernaleone M, Casati M, Pallotta S, Livi L. Local treatment for relapsing glioblastoma: A decision-making tree for choosing between reirradiation and second surgery. Crit Rev Oncol Hematol 2020; 157:103184. [PMID: 33307416 DOI: 10.1016/j.critrevonc.2020.103184] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/27/2020] [Revised: 05/21/2020] [Accepted: 11/23/2020] [Indexed: 12/22/2022] Open
Abstract
In case of circumscribed recurrent glioblastoma (rec-GBM), a second surgery (Re-S) and reirradiation (Re-RT) are local strategies to consider. The aim is to provide an algorithm to use in the daily clinical practice. The first step is to consider the life expectancy in order to establish whether the patient should be a candidate for active treatment. In case of a relatively good life expectancy (>3 months) and a confirmed circumscribed disease(i.e. without multiple lesions that are in different lobes/hemispheres), the next step is the assessment of the prognostic factors for local treatments. Based on the existing prognostic score systems, patients who should be excluded from local treatments may be identified; based on the validated prognostic factors, one or the other local treatment may be preferred. The last point is the estimation of expected toxicity, considering patient-related, tumor-related and treatment-related factors impacting on side effects. Lastly, patients with very good prognostic factors may be considered for receiving a combined treatment.
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Affiliation(s)
- Silvia Scoccianti
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy.
| | - Marco Perna
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Emanuela Olmetto
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Camilla Delli Paoli
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Francesca Terziani
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Lucia Pia Ciccone
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Beatrice Detti
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Daniela Greto
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Gabriele Simontacchi
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Roberta Grassi
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Erika Scoccimarro
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Pierluigi Bonomo
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Monica Mangoni
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Isacco Desideri
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Vanessa Di Cataldo
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Marco Vernaleone
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
| | - Marta Casati
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Medical Physics Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Stefania Pallotta
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Medical Physics Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Oncology Department, University of Florence, Florence, Italy
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33
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Navarria P, Clerici E, Comito T, Cozzi S, Pinzi V, Ciammella P, Scoccianti S, Borzillo V, Anselmo P, Maranzano E, Dell'acqua V, Jereczek-Fossa B, Levra NG, Minniti G, Podlesko A, Giudice E, di Monale e Bastia MB, Pedretti S, Bruni A, Zanetti IB, Borgesi S, Busato F, Scorsetti M. PO-0880: SRS in brain metastases from colorectalcancer. A Radiation Oncology Italian Association study. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00897-5] [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: 11/24/2022]
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34
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Olmetto E, Scoccianti S, Di Franco R, Anselmo P, Beltramo G, Mantovani C, Osti M, Pinzi V, Giaj-Levra N, Bruni A, Matteucci P, Pedretti S, Giudice E, Tini P, Krengli M, Ciammella P, Pasqualetti F, Trignani M, Merlotti A, Borzillo V, Franceschini D, Maranzano E, Umberto R, Pierina N, Scotti V. PD-0175: TTIRS trial:a retrospective analysis of the association between TT or IT and RS for BM from NSCLC. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00199-7] [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: 11/29/2022]
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35
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Simontacchi G, Peruzzi A, Stocchi G, Mariotti M, Guerrieri B, Salvestrini V, Talamonti C, Pallotta S, Marrazzo L, Desideri I, Scoccianti S, Livi L. PO-0923: Total irradiation of the scalp and face in patients with cutaneous lymphomas. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00940-3] [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: 10/22/2022]
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36
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Gronchi G, Scoccianti S, Peru A. Cognitive Decline After Cranial Irradiation: Hoping for a Systematic Application of the Reliable Change Index. Front Psychol 2020; 11:573919. [PMID: 33123053 PMCID: PMC7572852 DOI: 10.3389/fpsyg.2020.573919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/24/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Giorgio Gronchi
- Department of Neuroscience, Psychology, Drug Research and Child's Health - Section of Psychology, University of Firenze, Firenze, Italy
| | - Silvia Scoccianti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Firenze, Firenze, Italy
| | - Andrea Peru
- Department of Neuroscience, Psychology, Drug Research and Child's Health - Section of Psychology, University of Firenze, Firenze, Italy
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Navarria P, Minniti G, Clerici E, Comito T, Cozzi S, Pinzi V, Fariselli L, Ciammella P, Scoccianti S, Borzillo V, Anselmo P, Maranzano E, Dell'acqua V, Jereczek-Fossa B, Giaj Levra N, Podlesko AM, Giudice E, Buglione di Monale E Bastia M, Pedretti S, Bruni A, Bossi Zanetti I, Borghesi S, Busato F, Pasqualetti F, Paiar F, Scorsetti M. Brain metastases from primary colorectal cancer: is radiosurgery an effective treatment approach? Results of a multicenter study of the radiation and clinical oncology Italian association (AIRO). Br J Radiol 2020; 93:20200951. [PMID: 33035077 DOI: 10.1259/bjr.20200951] [Citation(s) in RCA: 7] [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: 02/01/2023] Open
Abstract
OBJECTIVES The prognosis of brain metastatic colorectal cancer patients (BMCRC) is poor. Several local treatments have been used, but the optimal treatment choice remains an unresolved issue. We evaluated the clinical outcomes of a large series of BMCRC patients treated in several Italian centers using stereotactic radiosurgery (SRS). METHODS 185 BMCRC patients for a total of 262 lesions treated were evaluated. Treatments included surgery followed by post-operative SRS to the resection cavity, and SRS, either single-fraction, then hypofractionated SRS (HSRS). Outcomes was measured in terms of local control (LC), toxicities, brain distant failure (BDF), and overall survival (OS). Prognostic factors influencing survival were assed too. RESULTS The median follow-up time was 33 months (range 3-183 months). Surgery plus SRS have been performed in 28 (10.7%) cases, SRS in 141 (53.8%), and HSRS in 93 (35.5%). 77 (41.6%) patients received systemic therapy. The main total dose and fractionation used were 24 Gy in single fraction or 24 Gy in three daily fractions. Local recurrence occurred in 32 (17.3%) patients. Median, 6 months,1-year-LC were 86 months (95%CI 36-86), 87.2% ± 2.8, 77.8% ± 4.1. Median,6 months,1-year-BDF were 23 months (95%CI 9-44), 66.4% ± 3.9, 55.3% ± 4.5. Median,6 months,1-year-OS were 7 months (95% CI 6-9), 52.7% ± 3.6, 33% ± 3.5. No severe neurological toxicity occurred. Stage at diagnosis, Karnofsky Performance Status (KPS), presence and number of extracranial metastases, and disease-specific-graded-prognostic-assessment (DS-GPA) score were observed as conditioning survival. CONCLUSION SRS/HSRS have proven to be an effective local treatment for BMCRC. A careful evaluation of prognostic factors as well as a multidisciplinary evaluation is a valid aid to manage the optimal therapeutic strategy for CTC patients with BMs. ADVANCES IN KNOWLEDGE The prognosis of BMCRC is poor. Several local treatments was used, but optimal treatment choice remains undefined. Radiosurgery has proven to be an effective local treatment for BMCRC. A careful evaluation of prognostic factors and a multidisciplinary evaluation needed.
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Affiliation(s)
- Pierina Navarria
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy
| | | | - Elena Clerici
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy
| | - Tiziana Comito
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy
| | - Salvatore Cozzi
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy
| | - Valentina Pinzi
- Radiotherapy Unit, Istituto Neurologico Fondazione "Carlo Besta", Milan, Italy
| | - Laura Fariselli
- Radiotherapy Unit, Istituto Neurologico Fondazione "Carlo Besta", Milan, Italy
| | - Patrizia Ciammella
- Radiation Therapy Unit, Department of Oncology and Advanced Technology, Azienda Ospedaliera Arcispedale S Maria Nuova, Reggio Emilia, Italy
| | - Silvia Scoccianti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Valentina Borzillo
- UOC Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione "Giovanni Pascale", Milan, Italy
| | - Paola Anselmo
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | | | - Veronica Dell'acqua
- Department of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Barbara Jereczek-Fossa
- Department of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Niccolò Giaj Levra
- Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | | | - Emilia Giudice
- Radiation Therapy unit, Policlinico Universitario Tor Vergata, Roma, Italy
| | | | - Sara Pedretti
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | | | | | | | | | - Francesco Pasqualetti
- Department of Radiation Oncology, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Fabiola Paiar
- Department of Radiation Oncology, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Giusti F, Martos M, Scoccianti S, Neamtiu L, Randi G, Flego M, Dyba T, De Carvalho RN, Dimitrova N, Nicholson N, Bettio M. 365MO Exploring changes in glioblastoma treatment patterns in Europe and the USA with population-based cancer registry data. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.474] [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] Open
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Desideri I, Becherini C, Visani L, Stocchi G, Scoccimarro E, Mariotti M, Salvestrini V, Scoccianti S, Greto D, Bonomo P, Pecchioli G, Bordi L, Della Puppa A, Francolini G, Meattini I, Livi L. Outcome and prognostic factors for older patients undergoing radiosurgery for brain metastases. J Geriatr Oncol 2020; 11:1103-1107. [DOI: 10.1016/j.jgo.2020.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 12/16/2019] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
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40
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Loi M, Caini S, Scoccianti S, Bonomo P, De Vries K, Francolini G, Simontacchi G, Greto D, Desideri I, Meattini I, Nuyttens J, Livi L. Stereotactic reirradiation for local failure of brain metastases following previous radiosurgery: Systematic review and meta-analysis. Crit Rev Oncol Hematol 2020; 153:103043. [PMID: 32650217 DOI: 10.1016/j.critrevonc.2020.103043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 01/30/2020] [Revised: 06/23/2020] [Accepted: 06/29/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Local failure (LF) following stereotactic radiosurgery (SRS) of brain metastases (BM) may be treated with a second course of SRS (SRS2), though this procedure may increase the risk of symptomatic radionecrosis (RN). METHODS A literature search was conducted according to PRISMA to identify studies reporting LF, overall survival (OS) and RN rates following SRS2. Meta-analysis was performed to identify predictors of RN. RESULTS Analysis included 11 studies (335 patients,389 metastases). Pooled 1-year LF was 24 %(CI95 % 19-30 %): heterogeneity was acceptable (I2 = 21.4 %). Median pooled OS was 14 months (Confidence Interval 95 %, CI95 % 8.8-22.0 months). Cumulative crude RN rate was 13 % (95 %CI 8 %-19 %), with acceptable heterogeneity (I2 = 40.3 %). Subgroup analysis showed higher RN incidence in studies with median patient age ≥59 years (13 % [95 %CI 8 %-19 %] vs 7 %[95 %CI 3 %-12 %], p = 0.004) and lower incidence following prior Whole Brain Radiotherapy (WBRT, 19 %[95 %CI 13 %-25 %] vs 7%[95 %CI 3 %-13 %], p = 0.004). CONCLUSIONS SRS2 is an effective strategy for in-site recurrence of BM previously treated with SRS.
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Affiliation(s)
- Mauro Loi
- Radiotherapy Department, University of Florence, Florence, Italy.
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | | | - Pierluigi Bonomo
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Kim De Vries
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | | | - Daniela Greto
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Isacco Desideri
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Icro Meattini
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Joost Nuyttens
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Lorenzo Livi
- Radiotherapy Department, University of Florence, Florence, Italy
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41
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Scoccianti S, Simontacchi G, Greto D, Perna M, Terziani F, Talamonti C, Teriaca MA, Caramia G, Lo Russo M, Olmetto E, Delli Paoli C, Grassi R, Carfora V, Saieva C, Bonomo P, Detti B, Mangoni M, Desideri I, Francolini G, Di Cataldo V, Marrazzo L, Pallotta S, Livi L. Dosimetric Predictors of Acute and Chronic Alopecia in Primary Brain Cancer Patients Treated With Volumetric Modulated Arc Therapy. Front Oncol 2020; 10:467. [PMID: 32322558 PMCID: PMC7156544 DOI: 10.3389/fonc.2020.00467] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/16/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose: To determine dose constraints that correlate with alopecia in patients treated with photon-based Volumetric Modulated Arc Therapy (VMAT) for primary brain tumors. Methods: During the treatment planning process, the scalp was drawn as a region of interest. Dose received by 0.1 cc (D0.1cc), mean dose (Dmean), absolute volumes receiving different doses (V16Gy, V20Gy, V25Gy, V30Gy, V35Gy, V40Gy, and V43Gy) were registered for the scalp. Alopecia was assessed according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Receiver operating characteristics (ROC) curve analysis was used to identify parameters associated with hair-loss. Results: One-hundred and one patients were included in this observational study. At the end of radiotherapy (RT), 5 patients did not develop alopecia (Dmean scalp 3.1 Gy). The scalp of the patients with G1 (n = 11) and G2 (n = 85) alopecia received Dmean of 10.6 Gy and 11.8 Gy, respectively. At ROC analysis, V16Gy20Gy ≥ 5.2 cc were the strongest predictors of acute alopecia risk. Chronic hair-loss assessment was available for 74 patients: median time to recovery from G2 alopecia was 5, 9 months. The actuarial rate of hair regrowth was 98.1% at 18 months after the end of RT. At ROC analysis, V40Gy43Gy ≥2.2 cc were the strongest predictors of chronic G2-alopecia risk. V20Gy, V40Gy, and D0,1cc were shown to be independent variables according to correlation coefficient r. Conclusions: V20Gy and V40Gy were the strongest predictors for acute and chronic G2 hair-loss, respectively. The low-dose bath typical of VMAT corresponds to large areas of acute but transient alopecia. However, the steep dose gradient of VMAT allows to reduce the areas of the scalp that receive higher doses, minimizing the risk of permanent alopecia. The application of our dosimetric findings for the scalp may help in reducing the alopecia risk and also in estimating the probability of hair-loss during patient counseling before starting radiotherapy.
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Affiliation(s)
- Silvia Scoccianti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Daniela Greto
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Marco Perna
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Francesca Terziani
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Cinzia Talamonti
- Medical Physics Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio," Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Maria Ausilia Teriaca
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Giorgio Caramia
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Monica Lo Russo
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Emanuela Olmetto
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Camilla Delli Paoli
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Roberta Grassi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Vincenzo Carfora
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Calogero Saieva
- SC Epidemiology of Risk Factors and Lifestyles, Institute for Study, Prevention, and Oncology Network (ISPRO), Florence, Italy
| | - Pierluigi Bonomo
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Monica Mangoni
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Isacco Desideri
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Livia Marrazzo
- Medical Physics Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio," Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Stefania Pallotta
- Medical Physics Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio," Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
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Lancia A, Becherini C, Detti B, Bottero M, Baki M, Cancelli A, Ferlosio A, Scoccianti S, Sun R, Livi L, Ingrosso G. Radiotherapy for papillary tumor of the pineal region: A systematic review of the literature. Clin Neurol Neurosurg 2019; 190:105646. [PMID: 31896492 DOI: 10.1016/j.clineuro.2019.105646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 09/05/2019] [Revised: 11/10/2019] [Accepted: 12/19/2019] [Indexed: 11/29/2022]
Abstract
Papillary tumor of the pineal region (PTPR) is a rare neuroepithelial brain tumor, characterized by a high risk of local recurrence (greater than 70 % at 6 years). The aim of our study was to review the available literature on radiotherapy for PTPR in order to evaluate timings, schedules, outcomes and toxicities of this treatment modality. In our review, 72.4 % (84) of the patients diagnosed with PTPR received radiation therapy. There is heterogeneity in the dose prescription, ranging from 45 Gy (25 × 1.8 Gy) to 60 Gy (30 × 2 Gy) for 3D Conformal Radiation Therapy and from 12 Gy to 36 Gy for Stereotactic Radiosurgery. Being considered as a grade II or III tumor, PTPR should receive higher total radiation dose in the adjuvant setting. Our analysis showed a very limited treatment-related toxicity with an expected 10-y OS of 72.5 %. At 5-years from the diagnosis, about 60 % of the patients experienced a local recurrence, whereas at 10 years the rate is higher than 80 %. In the literature, conflicting data about radiotherapy for PTPR are reported, in particular regarding disease progression. Although radiotherapy represents a fundamental treatment in the management of PTPR, prospective studies are required to better define its impact on overall survival and progression-free survival.
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Affiliation(s)
- Andrea Lancia
- Radiation Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | - Beatrice Detti
- Radiotherapy Unit, Department of Oncology, AOU Careggi, Florence, Italy.
| | - Marta Bottero
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
| | - Muhammed Baki
- Radiotherapy Unit, Department of Oncology, AOU Careggi, Florence, Italy
| | - Alessandro Cancelli
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
| | - Amedeo Ferlosio
- Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Silvia Scoccianti
- Radiotherapy Unit, Department of Oncology, AOU Careggi, Florence, Italy
| | - Roger Sun
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 94800, Villejuif, France
| | - Lorenzo Livi
- Radiotherapy Unit, Department of Oncology, AOU Careggi, Florence, Italy
| | - Gianluca Ingrosso
- Radioterapia Oncologica, Dipartimento di Scienze Chirurgiche e Biomediche, Università degli Studi di Perugia, ospedale S. Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy
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Livi L, Paiar F, Meldolesi E, Simontacchi G, Amunni G, Barca R, Villanucci A, Scoccianti S, Piperno G, Biti G. Treatment of Uterine Sarcoma at the University of Florence from 1980-2001. Tumori 2019; 91:139-43. [PMID: 15948541 DOI: 10.1177/030089160509100207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To correlate the treatment used in uterine sarcoma with outcome. The prognostic importance of pathology, clinical parameters and treatment are analyzed. Patients and methods Forty patients (median age, 59 years; range, 37-85) with histologically verified uterine sarcoma were identified from a database compiled at the University of Florence from 1980 to 2001. Patients were followed for a median of 54 months (range, 3 months to 10 years). Twenty-four patients had leiomyosarcoma, 12 patients had mixed mullerian tumors, and 3 patients had endometrial stromal sarcoma. Stage I, II, III and IV tumors were identified in 22, 2, 9 and 7 patients, respectively. High, intermediate, low and unspecified grade sarcoma occurred in 9, 4, 5 and 22 patients, respectively. Results At the time of analysis, 58% of patients had died and 42% were alive, with a median survival of 2 years from the initial diagnosis. Cause-specific survival for the entire group was 81%, 41% and 25% at 1, 3 and 5 years, respectively. In our series, univariate analysis for cause-specific survival did not demonstrate statistical significance for histology, grade, stage or age. There appeared to be a significant impact for postoperative radiotherapy in reducing local recurrence with a total dose higher than 50 Gy. Conclusions Our data favor treatment for uterine sarcoma with radical surgery plus irradiation, even in elderly patients.
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Affiliation(s)
- Lorenzo Livi
- Radiotherapy Department, Florence University, Florence, Italy.
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Pedretti S, Masini L, Turco E, Triggiani L, Krengli M, Meduri B, Pirtoli L, Borghetti P, Pegurri L, Riva N, Gatta R, Fusco V, Scoccianti S, Bruni A, Ricardi U, Santoni R, Magrini SM, Buglione M. Hypofractionated radiation therapy versus chemotherapy with temozolomide in patients affected by RPA class V and VI glioblastoma: a randomized phase II trial. J Neurooncol 2019; 143:447-455. [PMID: 31054101 DOI: 10.1007/s11060-019-03175-2] [Citation(s) in RCA: 5] [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: 02/13/2019] [Accepted: 04/25/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION In RPA V-VI glioblastoma patients both hypofractionated radiotherapy and exclusive temozolomide can be used; the purpose of this trial is to compare these treatment regimens in terms of survival and quality of life. METHODS Patients with histologic diagnosis of glioblastoma were randomized to hypofractionated radiotherapy (RT-30 Gy in 6 fractions) and exclusive chemotherapy (CHT-emozolomide 200 mg/m2/day 5 days every 28 days). Overall (OS) and progression free survival (PFS) were evaluated with Kaplan Maier curves and correlated with prognostic factors. Quality- adjusted survival (QaS) was evaluated according to the Murray model (Neurological Sign and Symptoms-NSS) RESULTS: From 2010 to 2015, 31 pts were enrolled (CHT: 17 pts; RT: 14pts). Four pts were excluded from the analysis. RPA VI (p = 0.048) and absence of MGMT methylation (p = 0.001) worsened OS significantly. Biopsy (p = 0.048), RPA class VI (p = 0.04) and chemotherapy (p = 0.007) worsened PFS. In the two arms the initial NSS scores were overlapping (CHT: 12.23 and RT: 12.30) and progressively decreased in both group and became significantly worse after 5 months in CHT arm (p = 0.05). Median QaS was 104 days and was significantly better in RT arm (p = 0.01). CONCLUSIONS The data obtained are limited by the poor accrual. Both treatments were well tolerated. Patients in RT arm have a better PFS and QaS, without significant differences in OS. The deterioration of the NSS score would seem an important parameter and coincide with disease progression rather than with the toxicity of the treatment.
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Affiliation(s)
- Sara Pedretti
- Radiation Oncology Department, ASST Spedali Civili Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Laura Masini
- Radiation Oncology Department, AOU Maggiore Della Carità, East Piedmont University, viale Mazzini 18, 28100, Novara, Italy
| | - Enrico Turco
- Radiation Oncology Department, AOU Policlinico Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Luca Triggiani
- Radiation Oncology Department, Brescia University, Piazzale Spedali Civili 1, 23123, Brescia, Italy.
| | - Marco Krengli
- Radiation Oncology Department, AOU Maggiore Della Carità, East Piedmont University, viale Mazzini 18, 28100, Novara, Italy
| | - Bruno Meduri
- Radiation Oncology Department, AOU Policlinico Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Luigi Pirtoli
- Radiation Oncology Department, AOUS, Siena University, Viale Mario Bracci, 53100, Siena, Italy
| | - Paolo Borghetti
- Radiation Oncology Department, ASST Spedali Civili Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Ludovica Pegurri
- Radiation Oncology Department, ASST Spedali Civili Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Nada Riva
- Radiation Oncology Department, IRST IRCSS, Via Piero Maroncelli, 40, 47014, Meldola, FC, Italy
| | - Roberto Gatta
- Radiation Oncology Department, ASST Spedali Civili Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Vincenzo Fusco
- Radiation Oncology Departmenti, IRCSS, via S. Pio 1, 85028, Rionero in Vulture, PZ, Italy
| | - Silvia Scoccianti
- Radiation Oncology Department, Florence University and AUOC Ospedale Careggi, Largo Brambilla, 3, 50134, Firenze, Italy
| | - Alessio Bruni
- Radiation Oncology Department, AOU Policlinico Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Umberto Ricardi
- Radiation Oncology Department, AO Città Della Salute E Della Scienza, Via Genova 3, 10126, Turin, Italy
| | - Riccardo Santoni
- Radiation Oncology Department, Fondazione Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Stefano M Magrini
- Radiation Oncology Department, Brescia University, Piazzale Spedali Civili 1, 23123, Brescia, Italy
| | - Michela Buglione
- Radiation Oncology Department, Brescia University, Piazzale Spedali Civili 1, 23123, Brescia, Italy
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Olmetto E, Paoli CD, Ciccone L, Perna M, Grassi R, Erika S, Scoccianti S, Greto D, Desideri I, Simontacchi G, Marrazzo L, Arilli C, Casati M, Compagnucci A, Pecchioli G, Pallotta S, Livi L. OC-0276 Stereotactic radiosurgery plus immunotherapy or targeted therapy for brain metastases from NSCLC. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30696-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Scoccianti S, Grassi R, Marco P, Terziani F, Simontacchi G, Talamonti C, Caramia G, Russo ML, Teriaca M, Scoccimarro E, Saieva C, Cosi L, Pallotta S, Livi L. PO-0750 VMAT for CNS Tumors and alopecia:results of an observational study and new constraints for the SCALP. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31170-3] [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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Zani M, Marrazzo L, Calusi S, Talamonti C, Scoccianti S, Greto D, Livi L, Pallotta S. EP-2090 Helical tomography radiation therapy for multiple brain lesions: in-phantom accuracy assessment. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32510-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zani M, Marrazzo L, Calusi S, Talamonti C, Scoccianti S, Greto D, Desideri I, Fusi F, Pallotta S. TomoTherapy treatments of multiple brain lesions: an in-phantom accuracy evaluation. Phys Med Biol 2019; 64:025020. [PMID: 30561374 DOI: 10.1088/1361-6560/aaf977] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aim of the present study was to evaluate the accuracy which can be obtained with helical TomoTherapy® (HT, Accuray) systems in the case of multiple intracranial targets treatments. Set-up accuracy was measured, for different registration options and MegaVoltage CT (MVCT) slice thickness, by applying known misalignments to an ad-hoc developed phantom. End-to-end (E2E) tests were performed to assess the delivery accuracy in phantoms containing multiple targets by using radiochromic films: measured dose distribution centroids were compared with physical and calculated target positions on axial and coronal planes. A Gamma index analysis was carried out on planned and measured planar dose maps. The bone and tissue algorithm with the fine MVCT reconstruction grid gave the best results among the automatic options. The most accurate registration modality resulted to be the manual one with a sub-voxel accuracy shifts and a capability in the detection of rotations within 0.3°. For the E2E along the coronal plane (six targets), a mean deviation between measured dose distribution centroids and physical barycenters of 0.6 mm (range 0.1 mm-1.3 mm) was observed. Along the axial plane (five targets), a mean deviation of 1.2 mm (range 0.7 mm-2.1 mm) was found for the centroids shifts. Gamma index (5%, 1 mm, local) passing rates higher than 87.5% between planned and delivered dose distributions were measured. These results demonstrate that multiple brain lesion HT treatments are feasible with an accuracy at least comparable to frameless linac-based delivery, when a set-up capable to assure angular corrections and a reliable patient immobilization is employed.
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Affiliation(s)
- M Zani
- Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', Viale Morgagni, 50, 50134 Firenze. Author to whom any correspondence should be addressed
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Navarria P, Minniti G, Clerici E, Tomatis S, Pinzi V, Ciammella P, Galaverni M, Amelio D, Scartoni D, Scoccianti S, Krengli M, Masini L, Draghini L, Maranzano E, Borzillo V, Muto P, Ferrarese F, Fariselli L, Livi L, Pasqualetti F, Fiorentino A, Alongi F, di Monale MB, Magrini S, Scorsetti M. Re-irradiation for recurrent glioma: outcome evaluation, toxicity and prognostic factors assessment. A multicenter study of the Radiation Oncology Italian Association (AIRO). J Neurooncol 2018; 142:59-67. [PMID: 30515706 DOI: 10.1007/s11060-018-03059-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 09/18/2018] [Accepted: 11/21/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The prognosis of glioma is dismal, and almost all patients relapsed. At recurrence time, several treatment options are considered, but to date there is no a standard of care. The Neurooncology Study Group of the Italian Association of Radiation Oncology (AIRO) collected clinical data regarding a large series of recurrent glioma patients who underwent re-irradiation (re-RT) in Italy. METHODS Data regarding 300 recurrent glioma patients treated from May 2002 to November 2017, were analyzed. All patients underwent re-RT. Surgical resection, followed by re-RT with concomitant and adjuvant chemotherapy was performed. Clinical outcome was evaluated by neurological examination and brain MRI performed, 1 month after radiation therapy and then every 3 months. RESULTS Re-irradiation was performed at a median interval time (IT) of 16 months from the first RT. Surgical resection before re-RT was performed in 19% of patients, concomitant temozolomide (TMZ) in 16.3%, and maintenance chemotherapy in 29%. Total doses ranged from 9 Gy to 52.5 Gy, with a median biological effective dose of 43 Gy. The median, 1, 2 year OS were 9.7 months, 41% and 17.7%. Low grade glioma histology (p ≪ 0.01), IT > 12 months (p = 0.001), KPS > 70 (p = 0.004), younger age (p = 0.001), high total doses delivered (p = 0.04), and combined treatment performed (p = 0.0008) were recorded as conditioning survival. CONCLUSION our data underline re-RT as a safe and feasible treatment with limited rate of toxicity, and a combined ones as a better option for selected patients. The identification of a BED threshold able to obtain a greater benefit on OS, can help in designing future prospective studies.
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Affiliation(s)
- Pierina Navarria
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy.
| | | | - Elena Clerici
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Stefano Tomatis
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Valentina Pinzi
- Radiotherapy Unit, Istituto Neurologico Fondazione "Carlo Besta", Milan, Italy
| | - Patrizia Ciammella
- Radiation Therapy Unit, Department of Oncology and Advanced Technology, Azienda Ospedaliera Arcispedale S Maria Nuova, Reggio Emilia, Italy
| | - Marco Galaverni
- Radiation Therapy Unit, Department of Oncology and Advanced Technology, Azienda Ospedaliera Arcispedale S Maria Nuova, Reggio Emilia, Italy
| | - Dante Amelio
- Proton Therapy Center, Azienda Provinciale per I Servizi Sanitari (APSS), Trento, Italy
| | - Daniele Scartoni
- Proton Therapy Center, Azienda Provinciale per I Servizi Sanitari (APSS), Trento, Italy
| | - Silvia Scoccianti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Marco Krengli
- Radiotherapy Unit, Department of Translation Medicine, University of Piemonte Orientale, Novara, Italy
| | - Laura Masini
- Radiotherapy Unit, Department of Translation Medicine, University of Piemonte Orientale, Novara, Italy
| | - Lorena Draghini
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | | | - Valentina Borzillo
- UOC Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori -Fondazione "Giovanni Pascale", Naples, Italy
| | - Paolo Muto
- UOC Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori -Fondazione "Giovanni Pascale", Naples, Italy
| | - Fabio Ferrarese
- Radiation Therapy, Ospedale Ca' Foncello di Treviso, Treviso, Italy
| | - Laura Fariselli
- Radiotherapy Unit, Istituto Neurologico Fondazione "Carlo Besta", Milan, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | | | - Alba Fiorentino
- Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - Filippo Alongi
- Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | | | - Stefano Magrini
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Navarria P, Minniti G, Pinzi V, Draghini L, Borzillo V, Ciammella P, Scoccianti S, Amelio D, Krengli M, Buglione di Monale M. P01.069 Re-irradiation for recurrent glioma: outcome evaluation, toxicity and prognostic factors assessment. A multicenter retrospective study by the Brain-Study-Group of the Radiation Oncology Italian Association (AIRO). Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.111] [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: 11/12/2022] Open
Affiliation(s)
| | | | - V Pinzi
- Istituto Neurologico C.Besta, Milano, Italy
| | - L Draghini
- Azienda Ospedaliera S.Maria, Terni, Italy
| | - V Borzillo
- Istituto Nazionale per lo studio e la cura dei tumori, Napoli, Italy
| | - P Ciammella
- Arcispedale di S.M. Nuova azienda ospedaliera, Reggio Emila, Italy
| | | | - D Amelio
- Presidio Ospedaliero Santa Chiara, Trento, Italy
| | - M Krengli
- A.O.U. Maggiore della Carità, Novara, Italy
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