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Cosentino G, Comi S, Maglionico MN, Marinò M. A case of carotid cavernous fistula mimicking Graves' orbitopathy. J Endocrinol Invest 2024; 47:255-256. [PMID: 37347382 DOI: 10.1007/s40618-023-02143-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/16/2023] [Indexed: 06/23/2023]
Affiliation(s)
- G Cosentino
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - S Comi
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - M N Maglionico
- Department of Surgical, Medical and Molecular Pathology, Ophthalmology Unit I, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - M Marinò
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
- Department of Clinical and Experimental Medicine, Endocrinology Unit I, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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Comi S, Lanzolla G, Cosentino G, Maglionico MN, Posarelli C, Menconi F, Santini F, Elisei R, Marinò M. IgG4 serum levels in Graves' orbitopathy. J Endocrinol Invest 2023:10.1007/s40618-023-02265-3. [PMID: 38127192 DOI: 10.1007/s40618-023-02265-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE IgG4-related disease (IgG4-RD) can involve many organs, including thyroid and orbital tissues. A link between IgG4, Graves' disease (GD) and Graves' orbitopathy (GO) has been proposed, but results are conflicting. Here we investigated the possible association between IgG4 and GO. METHODS Retrospective investigation in 297 patients with Graves' disease (GD), 152 with GO. PRIMARY OUTCOME prevalence of IgG4 ≥ 135 mg/dL (cut-off for IgG4-RD). SECONDARY OBJECTIVES (1) serum IgG4 concentrations; (2) IgG4/IgG ratio; (3) prevalence of IgG4/IgG ratio ≥ 8.0%; (4) relationship between IgG4 and eye features; (5) relationship between IgG4 and anti-TSH receptor antibodies (TRAbs). RESULTS Because GO patients had lower FT3 concentrations, we evaluated the main objectives in the second and third FT3 quartiles subpopulation, in which there were no relevant differences between patients with (n = 81) or without GO (n = 67) for baseline parameters. Within this population, the prevalence of IgG4 levels ≥ 135 mg/dL did not differ between patients without and with GO (17.9% vs 17.3%). No difference was observed concerning IgG4 concentrations, prevalence of IgG4/IgG ≥ 8.0%, and IgG4/IgG ratio. There was no relationship between IgG4 and eye features and no correlation between IgG4 levels and TRAb was found. CONCLUSIONS Our results suggest that, within GD, there is no relationship between serum IgG4 and GO.
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Affiliation(s)
- S Comi
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - G Lanzolla
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - G Cosentino
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - M N Maglionico
- Department of Surgical, Medical and Molecular Pathology, Ophthalmology Unit I, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - C Posarelli
- Department of Surgical, Medical and Molecular Pathology, Ophthalmology Unit I, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - F Menconi
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - F Santini
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - R Elisei
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - M Marinò
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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Piperno G, Ferrari A, Volpe S, Cattani F, Zaffaroni M, Comi S, Pansini F, Bergamaschi L, Mazzola GC, Ceci F, Colandrea M, Petralia G, Orecchia R, Jereczek-Fossa BA, Alterio D. Hypofractionated proton therapy for benign tumors of the central nervous system: A systematic review of the literature. Crit Rev Oncol Hematol 2023; 191:104114. [PMID: 37683814 DOI: 10.1016/j.critrevonc.2023.104114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/26/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
AIMS Aim of the present analysis was to report results of a systematic review of the literature in the setting of patients treated with hypoF PT for benign lesions of the central nervous system (CNS). METHODS The methodology complied with the PRISMA recommendations. PubMed, EMBASE and Scopus databases were interrogated in September 2022. RESULTS Twelve papers have been selected including patients treated for base of the skull meningiomas (6 papers), vestibular schwannoma (3 papers) and pituitary adenomas (3 papers). Clinical outcomes were evaluated with both radiologic images and clinical parameters. Long-term toxicity was reported in all but one series with an incidence ranging from 2 % to 7 % in patients treated for base of skull meningioma and 1-9 % for schwannoma. CONCLUSIONS HypoF PT is a safe and effective treatment in selected benign tumors of the CNS. Further dosimetric and clinical comparisons are required to better refine the patients' selection criteria.
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Affiliation(s)
- Gaia Piperno
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Annamaria Ferrari
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Stefania Volpe
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
| | - Federica Cattani
- Unit of Medical Physics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Stefania Comi
- Unit of Medical Physics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Floriana Pansini
- Unit of Medical Physics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Luca Bergamaschi
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | | | - Francesco Ceci
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Marzia Colandrea
- Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Daniela Alterio
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
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Lanzolla G, Di Matteo L, Comi S, Cosentino G, Menconi F, Maglionico MN, Posarelli C, Figus M, Marinò M. Absence of a relationship between vitamin D and Graves' orbitopathy. J Endocrinol Invest 2023; 46:1717-1721. [PMID: 36696067 DOI: 10.1007/s40618-023-02017-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/17/2023] [Indexed: 01/26/2023]
Affiliation(s)
- G Lanzolla
- Department of Clinical and Experimental Medicine, Endocrinology Unit II, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - L Di Matteo
- Department of Clinical and Experimental Medicine, Endocrinology Unit II, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - S Comi
- Department of Clinical and Experimental Medicine, Endocrinology Unit II, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - G Cosentino
- Department of Clinical and Experimental Medicine, Endocrinology Unit II, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - F Menconi
- Department of Clinical and Experimental Medicine, Endocrinology Unit II, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - M N Maglionico
- Department of Surgical, Medical and Molecular Pathology, Ophthalmology Unit I, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - C Posarelli
- Department of Surgical, Medical and Molecular Pathology, Ophthalmology Unit I, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - M Figus
- Department of Surgical, Medical and Molecular Pathology, Ophthalmology Unit I, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - M Marinò
- Department of Clinical and Experimental Medicine, Endocrinology Unit II, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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Cosentino G, Comi S, Coco B, Marinò M. Autoimmune hepatitis after high-dose intravenous glucocorticoids for Graves' orbitopathy. J Endocrinol Invest 2023; 46:849-850. [PMID: 36732467 DOI: 10.1007/s40618-023-02029-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023]
Affiliation(s)
- G Cosentino
- Department of Clinical and Experimental Medicine, Endocrinology Unit II, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - S Comi
- Department of Clinical and Experimental Medicine, Endocrinology Unit II, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - B Coco
- Hepatology Unit, University Hospital of Pisa, Pisa, Italy
| | - M Marinò
- Department of Clinical and Experimental Medicine, Endocrinology Unit II, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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Fiandra C, Cattani F, Leonardi M, Comi S, Zara S, Rossi L, Jereczek-Fossa B, Fariselli P, Ricardi U, Heijmen B. Machine learning for predicting clinician approval of treatment plans for left-sided whole breast radiotherapy. Adv Radiat Oncol 2023. [DOI: 10.1016/j.adro.2023.101228] [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: 03/31/2023] Open
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Lanzolla G, Puccinelli L, Giudetti M, Comi S, Menconi F, Maglionico MN, Posarelli C, Figus M, Marcocci C, Marinò M. Anti-nuclear autoantibodies in Graves' disease and Graves' orbitopathy. J Endocrinol Invest 2023; 46:337-344. [PMID: 36030301 PMCID: PMC9859920 DOI: 10.1007/s40618-022-01906-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/18/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE A relationship between thyroid and non-organ-specific autoimmunity could be relevant for Graves' orbitopathy (GO), which affects connective tissue. We investigated the association between GO and anti-nuclear antibodies (ANAs). METHODS Retrospective investigation was conducted in 265 patients with Graves' disease (GD), 158 with and 107 without GO. Primary outcome was: prevalence of ANAs in GO vs no-GO. Secondary outcomes were: (1) relationship between ANAs and GO features; (2) prevalence of ANAs in GD compared with non-autoimmune hyperthyroidism [(78 patients with toxic nodular goiter (TNG)]; (3) distribution of ANA patterns. RESULTS ANAs were detected in 212 (80%) GD patients, but prevalence did not differ between GO (79.7%) and no-GO (80.3%). Higher ANA titers (1:160) were more common in GO (51.5 vs 38.3%), but only nearly significantly (OR 0.5; 95% CI: 0.3-1; P = 0.059). Proptosis was lower in ANA-positive patients (mean difference: - 1.4 mm; 95% CI from - 2.5 to - 0.3; P = 0.011), in whom nearly significantly lower CAS (Mann-Whitney U: 1.5; P = 0.077) and eyelid aperture (mean difference: - 0.9 mm; 95% CI from - 2 to 0; P = 0.062) were observed. Prevalence of ANAs in GD was lower than in TNG (80 vs 91%; OR 0.3; 95% CI: 0.1-0.9; P = 0.028), but nuclear speckled pattern was more frequent (OR 22.9; 95% CI 1.3-381.3; P = 0.028). CONCLUSIONS Although ANAs are not more frequent in GO, they seem to exert a protective role on its severity and on development of GD. A switch of T cell population in ANA-positive patients, resulting in a different phenotype, may be responsible. Further studies are needed to investigate the mechanisms.
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Affiliation(s)
- G Lanzolla
- Department of Clinical and Experimental Medicine, Endocrinology Unit I, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - L Puccinelli
- Department of Clinical and Experimental Medicine, Endocrinology Unit I, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - M Giudetti
- Department of Clinical and Experimental Medicine, Endocrinology Unit I, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - S Comi
- Department of Clinical and Experimental Medicine, Endocrinology Unit I, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - F Menconi
- Department of Clinical and Experimental Medicine, Endocrinology Unit I, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - M N Maglionico
- Department of Surgical, Medical and Molecular Pathology, Ophthalmology Unit I, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - C Posarelli
- Department of Surgical, Medical and Molecular Pathology, Ophthalmology Unit I, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - M Figus
- Department of Surgical, Medical and Molecular Pathology, Ophthalmology Unit I, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - C Marcocci
- Department of Clinical and Experimental Medicine, Endocrinology Unit I, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - M Marinò
- Department of Clinical and Experimental Medicine, Endocrinology Unit I, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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Leonardi MC, Cormio CF, Frassoni S, Dicuonzo S, Fodor C, Intra M, Zerella MA, Morra A, Cattani F, Comi S, Fusco N, Zaffaroni M, Galimberti V, Veronesi P, Dellapasqua S, De Lorenzi F, Ivaldi GB, Bagnardi V, Orecchia R, Rojas DP, Jereczek-Fossa BA. Ten-year results of hypofractionated whole breast radiotherapy and intraoperative electron boost in premenopausal women. Radiother Oncol 2022; 177:71-80. [PMID: 36377094 DOI: 10.1016/j.radonc.2022.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 11/13/2022]
Abstract
AIM To evaluate outcome of intraoperative electron boost (IOERT) and hypofractionated whole breast irradiation (HWBI) for breast cancer (BC) in young women. METHODS AND MATERIALS Women aged ≤ 48 with pT1-2 N0-1 BC received 12 Gy IOERT boost during conservative surgery followed by 3-dimensional conformal HWBI in 13 fractions (2.85 Gy/die). Local relapses (LR) and survival (disease-free, DFS; specific, BCSS; overall, OS) were analyzed. RESULTS 481 consecutive BC patients, mostly node negative, with median age of 42 were treated between 2004 and 2014. Median tumor size was 1.48 cm and median IOERT collimator was 4 cm. After 25-day mean interval, HWBI was delivered. At a median follow-up of 9.6 years, there were 23 LRs (4.8 %, 9 of which were in the boost region). Ten-year LR cumulative incidence was 4.1 % (95 %CI, 2.5-6.3). Over time, local control rate decreased for Luminal A and HER2 positive with negative hormonal receptors, while remained steady for triple negative. At multivariate analysis, LR predictors included age < 40, extensive intraductal component and the use of 4-cm IOERT collimator size. Ten-year survival outcomes were as follows: DFS 80.0 % (95 % CI, 75.8-83.5), BCSS 97.5 % (95 % CI, 95.5-98.6 %), OS 96.5 % (95 % CI, 94.3-97.9). Luminal B HER2 negative had the worse survival outcomes. Perioperative complications were uncommon (16.4 %), acute toxicity was mild (<2% Grade 3), but moderate/severe fibrosis was described in 40.8 % of the cases. Cosmesis was scored as excellent/good in 86 % of the cases. CONCLUSIONS ELIOT boost and HWBI achieved an excellent local control at the cost of tumor bed fibrosis. IOERT boost dose lower than 12 Gy is advisable.
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Affiliation(s)
| | - Chiara Fausta Cormio
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Samantha Dicuonzo
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Cristiana Fodor
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Intra
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Anna Morra
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Cattani
- Medical Physics Unit, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefania Comi
- Medical Physics Unit, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Nicola Fusco
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Viviana Galimberti
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paolo Veronesi
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Division of Breast Cancer Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Silvia Dellapasqua
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesca De Lorenzi
- Division of Plastic and Reconstructive Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Barbara Alicja Jereczek-Fossa
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Fiandra C, Cattani F, Leonardi M, Comi S, Zara S, Rossi L, Jereczek-Fossa B, Ricardi U, Heijmen B. Machine Learning to Predict the Quality of a Left-Sided Whole Breast Radiotherapy Treatment Plan. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2243] [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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Lanzolla G, Maglionico MN, Comi S, Menconi F, Piaggi P, Posarelli C, Figus M, Marcocci C, Marinò M. Sirolimus as a second-line treatment for Graves' orbitopathy. J Endocrinol Invest 2022; 45:2171-2180. [PMID: 35831587 PMCID: PMC9525329 DOI: 10.1007/s40618-022-01862-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/03/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES A beneficial effect of sirolimus in Graves' orbitopathy (GO) was reported, suggesting a possible use in clinical practice. We conducted an observational, single-centre, no-profit, clinical study to investigate the efficacy of sirolimus as a second-line treatment for moderate-to-severe, active GO compared with methylprednisolone. METHODS Data from consecutive patients given sirolimus (2 mg orally on first day, followed by 0.5 mg/day for 12 weeks) or methylprednisolone [500 mg iv/weekly (6 weeks), 250 mg/weekly (6 weeks)] as a second-line treatment were collected and compared. PRIMARY OBJECTIVE overall GO outcome at 24 weeks, based on a composite evaluation. Secondary objectives at 24 weeks: (1) improvement in quality of life, evaluated using a specific uestionnaire (GO-QoL); (2) reduction in proptosis; (3) reduction in the clinical activity score (CAS); (4) improvement of eye ductions; and (5) reduction in eyelid aperture. RESULTS Data from 30 patients (15 per group) treated between January 15, 2020, and June 15, 2021, were analysed. Proportion of GO responders (primary outcome) at 24 weeks was significantly greater in sirolimus group compared with methylprednisolone group (86.6% vs 26.6%; OR: 17.8; 95% CI from 2.7 to 116.8; P = 0.0026). GO-quality of life (GO-QoL) score was greater in sirolimus group. Proportion of proptosis responders was greater in sirolimus group, as well as proportion of clinical activity score (CAS) responders. No serious adverse events were observed, with no differences between groups. CONCLUSIONS Sirolimus seems to be an effective second-line treatment for GO. Further randomized clinical trials are needed to confirm our observations.
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Affiliation(s)
- G Lanzolla
- Endocrinology Unit I, Department of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - M N Maglionico
- Ophthalmopathy Unit I, Department of Surgical, Medical and Molecular Pathology, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - S Comi
- Endocrinology Unit I, Department of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - F Menconi
- Endocrinology Unit I, Department of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - P Piaggi
- Department of Information Engineering, University of Pisa and University Hospital of Pisa, Via G. Caruso 16, 56122, Pisa, Italy
| | - C Posarelli
- Ophthalmopathy Unit I, Department of Surgical, Medical and Molecular Pathology, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - M Figus
- Ophthalmopathy Unit I, Department of Surgical, Medical and Molecular Pathology, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - C Marcocci
- Endocrinology Unit I, Department of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - M Marinò
- Endocrinology Unit I, Department of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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Volpe S, Piperno G, Colombo F, Biffi A, Comi S, Mastroleo F, Maria Camarda A, Casbarra A, Cattani F, Corrao G, de Marinis F, Spaggiari L, Guckenberger M, Orecchia R, Alterio D, Alicja Jereczek-Fossa B. Hypofractionated proton therapy for non-small cell lung cancer: Ready for prime time? A systematic review and meta-analysis. Cancer Treat Rev 2022; 110:102464. [DOI: 10.1016/j.ctrv.2022.102464] [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] [Received: 07/12/2022] [Revised: 09/02/2022] [Accepted: 09/14/2022] [Indexed: 11/02/2022]
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Fiandra C, Zara S, Alparone A, Loi G, Roggio A, Ciarmatori A, Benvenuto I, Poggiu A, Di Dio A, Verdolino E, Rosica F, Ren Kaiser S, Strigari L, Reversi L, Pierpaoli E, Ferrari P, Placidi L, Comi S, Infusino E, Coeli M, Gino E, Licciardello T, Romeo N, Ciscognetti N, Deotto G, Cora S, Pesente S, Rossi L, Ricardi U, Heijmen B, Marrocco M. OC-0128 multi-institutional real-world validation of autoplanning for breast cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02504-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: 11/29/2022]
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13
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Pepa M, Corrao G, Morigi G, La Fauci F, Zaffaroni M, Vincini M, Augugliaro M, Mazzola G, Comi S, Mistretta F, Luzzago S, Gandini S, Musi G, Petralia G, De Cobelli O, Orecchia R, Cattani F, Marvaso G, Jereczek-Fossa B. PO-1482 Estimation of inter-fraction motion of pelvic organs in SBRT treatments of prostate oligometastases. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03446-6] [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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14
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Marvaso G, Vischioni B, Pepa M, Zaffaroni M, Volpe S, Patti F, Bellerba F, Gandini S, Comi S, Corrao G, Zerini D, Augugliaro M, Fodor C, Russo S, Molinelli S, Ciocca M, Ricotti R, Valvo F, Giandini T, Avuzzi B, Valdagni R, De Cobelli O, Cattani F, Orlandi E, Jereczek-Fossa BA, Orecchia R. Mixed-Beam Approach for High-Risk Prostate Cancer Carbon-Ion Boost Followed by Photon Intensity-Modulated Radiotherapy: Preliminary Results of Phase II Trial AIRC-IG-14300. Front Oncol 2021; 11:778729. [PMID: 34869026 PMCID: PMC8635961 DOI: 10.3389/fonc.2021.778729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose This study represents a descriptive analysis of preliminary results of a Phase II trial on a novel mixed beam radiotherapy (RT) approach, consisting of carbon ions RT (CIRT) followed by intensity-modulated photon RT, in combination with hormonal therapy, for high-risk prostate cancer (HR PCa) with a special focus on acute toxicity. Methods Primary endpoint was the evaluation of safety in terms of acute toxicity. Secondary endpoints were early and long-term tolerability of treatment, quality of life (QoL), and efficacy. Data on acute and late toxicities were collected according to RTOG/EORTC. QoL of enrolled patients was assessed by IPSS, EORTC QLQ-C30, EORTC QLQ-PR25, and sexual activity by IIEF-5. Results Twenty-six patients were enrolled in the study, but only 15 completed so far the RT course and were included. Immediately after CIRT, no patients experienced GI/GU toxicity. At 1 and 3 months from the whole course RT completion, no GI/GU toxicities greater than grade 2 were observed. QoL scores were overall satisfactory. Conclusions The feasibility of the proposed mixed treatment schedule was assessed, and an excellent acute toxicity profile was recorded. Such findings instil confidence in the continuation of this mixed approach, with evaluation of long-term tolerability and efficacy.
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Affiliation(s)
- Giulia Marvaso
- Division of Radiotherapy, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Barbara Vischioni
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Matteo Pepa
- Division of Radiotherapy, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiotherapy, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Stefania Volpe
- Division of Radiotherapy, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Filippo Patti
- Division of Radiotherapy, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Federica Bellerba
- Department of Experimental Oncology, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Stefania Comi
- Medical Physics Unit, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giulia Corrao
- Division of Radiotherapy, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Dario Zerini
- Division of Radiotherapy, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Matteo Augugliaro
- Division of Radiotherapy, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Cristiana Fodor
- Division of Radiotherapy, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Stefania Russo
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Silvia Molinelli
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Mario Ciocca
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Rosalinda Ricotti
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Francesca Valvo
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Tommaso Giandini
- Medical Physics Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Barbara Avuzzi
- Department of Radiation Oncology 1, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Riccardo Valdagni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Department of Radiation Oncology 1, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Ottavio De Cobelli
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Division of Urology, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Federica Cattani
- Medical Physics Unit, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Ester Orlandi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiotherapy, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, Istituto Europeo di Oncologia (IEO), European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
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15
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la Fauci F, Marvaso G, Augugliaro M, Comi S, Pepa M, Zaffaroni M, Corrao G, Mistretta F, Gandini S, Petralia G, Cattani F, de Cobelli O, Orecchia R, Jereczek-Fossa B. Evaluation of effect on dose due to displacement of bowel and target volume in SBRT treatment for oligorecurrent crastation sensitive prostate cancer patients. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00425-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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16
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Russo S, Ricotti R, Molinelli S, Patti F, Barcellini A, Mastella E, Pella A, Paganelli C, Marvaso G, Pepa M, Comi S, Zaffaroni M, Avuzzi B, Giandini T, Pignoli E, Valdagni R, Baroni G, Cattani F, Ciocca M, Jereczek-Fossa BA, Orlandi E, Orecchia R, Vischioni B. Dosimetric Impact of Inter-Fraction Anatomical Changes in Carbon Ion Boost Treatment for High-Risk Prostate Cancer (AIRC IG 14300). Front Oncol 2021; 11:740661. [PMID: 34650922 PMCID: PMC8506150 DOI: 10.3389/fonc.2021.740661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/06/2021] [Indexed: 02/04/2023] Open
Abstract
Rectum and bladder volumes play an important role in the dose distribution reproducibility in prostate cancer adenocarcinoma (PCa) radiotherapy, especially for particle therapy, where density variation can strongly affect the dose distribution. We investigated the reliability and reproducibility of our image-guided radiotherapy (IGRT) and treatment planning protocol for carbon ion radiotherapy (CIRT) within the phase II mixed beam study (AIRC IG 14300) for the treatment of high-risk PCa. In order to calculate the daily dose distribution, a set of synthetic computed tomography (sCT) images was generated from the cone beam computed tomography (CBCT) images acquired in each treatment session. Planning target volume (PTV) together with rectum and bladder volume variation was evaluated with sCT dose-volume histogram (DVH) metric deviations from the planning values. The correlations between the bladder and rectum volumes, and the corresponding DVH metrics, were also assessed. No significant difference in the bladder, rectum, and PTV median volumes between the planning computed tomography (pCT) and the sCT was found. In addition, no significant difference was assessed when comparing the average DVHs and median DVH metrics between pCT and sCT. Dose deviations determined by bladder and rectum filling variations demonstrated that dose distributions were reproducible in terms of both target coverage and organs at risk (OARs) sparing.
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Affiliation(s)
- Stefania Russo
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Rosalinda Ricotti
- Bioengineering Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Silvia Molinelli
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Filippo Patti
- Radiotherapy Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.,Division of Radiotherapy, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Amelia Barcellini
- Radiotherapy Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Edoardo Mastella
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Andrea Pella
- Bioengineering Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Giulia Marvaso
- Division of Radiotherapy, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Matteo Pepa
- Division of Radiotherapy, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Stefania Comi
- Medical Physics Unit, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiotherapy, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Barbara Avuzzi
- Department of Radiation Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Tommaso Giandini
- Medical Physics Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Emanuele Pignoli
- Medical Physics Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Riccardo Valdagni
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Medical Physics Unit, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Guido Baroni
- Bioengineering Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Federica Cattani
- Medical Physics Unit, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mario Ciocca
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiotherapy, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Ester Orlandi
- Radiotherapy Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Roberto Orecchia
- Scientific Directorate, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Barbara Vischioni
- Radiotherapy Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
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17
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Fiandra C, Cattani F, Leonardi C, Comi S, Zara S, Rossi L, Jereczek-Fossa B, Ricardi U, Heijmen B. PO-1808 Machine learning to predict best clinical plan for left-sided whole breast radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08259-1] [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: 12/01/2022]
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18
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Marvaso G, Gugliandolo S, Comi S, Pepa M, Russo S, Vischioni B, Valvo F, Giandini T, Avuzzi B, Valdagni R, Ciardo D, Jereczek-Fossa B, Cattani F, Orecchia R. PO-1748: Carbon-ion boost followed by photon IMRT for PCa: dosimetric and geometric evaluations, AIRCIG. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01766-7] [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: 11/30/2022]
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19
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Arculeo S, Frassoni S, Cavallo I, Dicuonzo S, Gerardi M, Morra A, Dell'Acqua V, Cattani F, Comi S, Veronesi P, Pansini F, Galimberti V, Fodor C, Bagnardi V, Orecchia R, Leonardi M, Jereczek-Fossa B. PO-0937: Partial breast re-irradiation with IMRT for local recurrence after whole breast radiotherapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00954-3] [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: 11/24/2022]
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20
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Spoto R, Vavassori A, Dicuonzo S, Pepa M, Volpe S, Alessandro O, Gandini S, Di Venosa B, Miglietta E, Fodor C, Orsolini GM, Prestianni P, Cattani F, Comi S, Lazzari R, Renne G, De Pas T, Orecchia R, Pennacchioli E, Jereczek-Fossa BA. Adjuvant radiotherapy treatment for soft tissue sarcoma of extremities and trunk. A retrospective mono-institutional analysis. Neoplasma 2020; 67:1447-1455. [PMID: 32787436 DOI: 10.4149/neo_2020_200325n305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/05/2020] [Indexed: 11/08/2022]
Abstract
Soft tissue sarcomas (STS) are uncommon, heterogeneous malignant tumors of mesodermal origin. Other than conservative surgery (CS), neoadjuvant or adjuvant radiotherapy (RT) is recommended when the risk of local recurrence is high. The aim of this study is to present our Institutional experience in adjuvant RT for treatment of STS of extremities and trunk (with either brachytherapy (BRT), external beam RT (EBRT), or both) and to provide an insight of toxicity and oncological outcomes for each RT modality. According to the RT treatment approach, patients were divided into three categories: 1) BRT alone; 2) EBRT alone; 3) combined BRT+EBRT. Differences among the three groups were assessed by the Chi-squared test. Patients' follow-up was performed every 6 months for the first two years after the end of RT and then once a year. Data from 90 patients were analyzed. The overall 3-year distant relapse-free survival (DRFS), progression-free survival (PFS), and overall survival (OS) were 84%, 80%, and 97%, respectively. Acute erythema was the most frequent side effect, although severe grade 3 toxicity was present in 5 patients. Chronic toxicity of any grade was reported in 14 patients. The incidence of chronic toxicity did not show any association with treatment modality. Multivariate analysis suggested a significant correlation between acute toxicity and tumor size, RT modality, and RT dose. In conclusion, good local control and toxicity profile were observed, despite negative patients' selection at baseline. Further investigation on wider series is warranted in order to define the optimal combination with systemic therapy.
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Affiliation(s)
- R Spoto
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - A Vavassori
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - S Dicuonzo
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - M Pepa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - S Volpe
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - O Alessandro
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - S Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - B Di Venosa
- Division of Pathology and Laboratory Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - E Miglietta
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - C Fodor
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - G Marco Orsolini
- Program of Melanoma, Sarcoma and Rare Tumors, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - P Prestianni
- Program of Melanoma, Sarcoma and Rare Tumors, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - F Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - S Comi
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - R Lazzari
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - G Renne
- Division of Pathology and Laboratory Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - T De Pas
- Department of Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - R Orecchia
- Scientific Directorate, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - E Pennacchioli
- Program of Melanoma, Sarcoma and Rare Tumors, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - B Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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21
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Vavassori A, Riva G, Cavallo I, Spoto R, Dicuonzo S, Fodor C, Comi S, Cambria R, Cattani F, Morra A, Leonardi MC, Lazzari R, Intra M, Luini A, Galimberti VE, Veronesi P, Orecchia R, Jereczek-Fossa BA. High-dose-rate Brachytherapy as Adjuvant Local rEirradiation for Salvage Treatment of Recurrent breAst cancer (BALESTRA): a retrospective mono-institutional study. J Contemp Brachytherapy 2020; 12:207-215. [PMID: 32695191 PMCID: PMC7366017 DOI: 10.5114/jcb.2020.96860] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/13/2020] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate clinical results of catheter-based interstitial high-dose-rate (HDR) brachytherapy (BT) as adjuvant treatment in previously irradiated recurrent breast cancer. MATERIAL AND METHODS Between January 2011 and September 2015, 31 consecutive patients with histologically confirmed recurrent breast cancer after conservative surgery and conventional whole breast radiotherapy, were retreated with a second conservative surgical resection and reirradiated with adjuvant interstitial HDR-BT. None of the brachytherapy implant was performed during the quadrantectomy procedure. A dose of 34 Gy in 10 fractions, 2 fractions per day, with a minimal interval of 6 hours was delivered. RESULTS At the time of the implant, the median age of patients was 59.7 years (range, 39.3-74.9 years). The median time from first treatment until BT for local recurrence was 11.9 years (range, 2.5-27.8 years). The median interval between salvage surgery and BT was 3.6 months (range, 1-8.2 months). No acute epidermitis or soft tissue side effects higher than grade 2 were recorded, with good cosmetic results in all patients. Most of the patients presented grade 1-2 late side effects. Only one patient developed grade 3 liponecrosis. After a median follow-up of 73.7 months (range, 28.8-102.4 months), the overall survival and cancer specific survival were 87.1% and 90.3%, respectively; 5-year local control and 5-year progression-free survival rate were 90.3% and 83.9%, respectively. CONCLUSIONS Our preliminary analysis showed that HDR-BT is a feasible treatment for partial breast reirradiation offering very low complications rate and fast procedure. Higher patients' cohort is warranted in order to define the role of this treatment modality in the breast conservative management of local recurrence.
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Affiliation(s)
- Andrea Vavassori
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Riva
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Iacopo Cavallo
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
- University of Milan, Department of Oncology and Hemato-Oncology, Milan, Italy
| | - Ruggero Spoto
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Samantha Dicuonzo
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Cristiana Fodor
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Stefania Comi
- Unit of Medical Physics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Raffaella Cambria
- Unit of Medical Physics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Anna Morra
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | | | - Roberta Lazzari
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Intra
- Department of Breast Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Alberto Luini
- Department of Breast Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy
| | | | - Paolo Veronesi
- Department of Breast Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
- University of Milan, Department of Oncology and Hemato-Oncology, Milan, Italy
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22
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Romanò C, De Marco P, Trivellato S, Ciardo D, Comi S, Marvaso G, Riva G, Jereczek-Fossa BA, Orecchia R, Cattani F. Influence of different urinary bladder filling levels and controlling regions of interest selection on deformable image registration algorithms. Phys Med 2020; 75:19-25. [PMID: 32473519 DOI: 10.1016/j.ejmp.2020.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/01/2020] [Accepted: 05/12/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Evaluation of Raystation ANAtomically CONstrained Deformation Algorithm (ANACONDA) performance to different urinary bladder filling levels in male pelvis anatomic site varying the controlling Regions Of Interest (ROIs). METHODS Different image datasets were obtained with ImSimQA (Oncology System Limited, Shrewsbury, UK) to evaluate ANACONDA performances (RaySearch Laboratories, Stockholm, Sweden). Deformation vector fields were applied to a synthetic man pelvis and a real patient computed tomography (CT) dataset (reference CTs) resulting in deformed CTs (target CTs) with various bladder filling levels. Different deformable image registrations (DIRs) were generated between each target CTs and reference CTs varying the controlling ROIs subset. Deformed ROIs were mapped from target CT to reference CT and then compared to reference ROIs. Evaluation was performed by Dice Similarity Coefficient (DSC), Correlation Coefficient (CC), Mean Distance to Agreement (MDA), maximum Distance to Agreement (maxDA) and with the introduction of global DSC (global_DSC) and global CC (global_CC) parameters. RESULTS In both synthetic and real patient CT cases, DSC scored less than 0.75 and MDA greater than 3 mm when no ROIs or only bladder were exploited as controlling ROI. DSC and CC increased by increasing the number of controlling ROIs selected whereas, an opposite behavior was observed for MDA and maxDA. CONCLUSIONS ANACONDA performances can be influenced by bladder filling fluctuation if no controlling ROIs are selected. Global_DSC and global_CC are useful parameters to quantitatively compare DIR algorithms. DIR performances improve by increasing the number of controlling ROIs selected, reaching a saturation level after a defined ROIs subset selection.
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Affiliation(s)
- Chiara Romanò
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, I 20132 Milan, Italy; Department of Physics, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy.
| | - Paolo De Marco
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, I 20132 Milan, Italy
| | - Sara Trivellato
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, I 20132 Milan, Italy
| | - Delia Ciardo
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, I 20132 Milan, Italy
| | - Stefania Comi
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, I 20132 Milan, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, I 20132 Milan, Italy
| | - Giulia Riva
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, I 20132 Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, I 20132 Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, I 20132 Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, I 20132 Milan, Italy
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23
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Fiandra C, Rossi L, Alparone A, Zara S, Vecchi C, Sardo A, Bartoncini S, Loi G, Pisani C, Gino E, Ruo Redda MG, Marco Deotto G, Tini P, Comi S, Zerini D, Ametrano G, Borzillo V, Strigari L, Strolin S, Savini A, Romeo A, Reccanello S, Rumeileh IA, Ciscognetti N, Guerrisi F, Balestra G, Ricardi U, Heijmen B. Automatic genetic planning for volumetric modulated arc therapy: A large multi-centre validation for prostate cancer. Radiother Oncol 2020; 148:126-132. [PMID: 32361572 DOI: 10.1016/j.radonc.2020.04.020] [Citation(s) in RCA: 3] [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: 02/08/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The first clinical genetic autoplanning algorithm (Genetic Planning Solution, GPS) was validated in ten radiotherapy centres for prostate cancer VMAT by comparison with manual planning (Manual). METHODS Although there were large differences among centres in planning protocol, GPS was tuned with the data of a single centre and then applied everywhere without any centre-specific fine-tuning. For each centre, ten Manual plans were compared with autoGPS plans, considering dosimetric plan parameters and the Clinical Blind Score (CBS) resulting from blind clinician plan comparisons. AutoGPS plans were used as is, i.e. there was no patient-specific fine-tuning. RESULTS For nine centres, all ten plans were clinically acceptable. In the remaining centre, only one plan was acceptable. For the 91% acceptable plans, differences between Manual and AutoGPS in target coverage were negligible. OAR doses were significantly lower in AutoGPS plans (p < 0.05); rectum D15% and Dmean were reduced by 8.1% and 17.9%, bladder D25% and Dmean by 5.9% and 10.3%. According to clinicians, 69% of the acceptable AutoGPS plans were superior to the corresponding Manual plan. In case of preferred Manual plans (31%), perceived advantages compared to autoGPS were minor. QA measurements demonstrated that autoGPS plans were deliverable. A quick configuration adjustment in the centre with unacceptable plans rendered 100% of plans acceptable. CONCLUSION A novel, clinically applied genetic autoplanning algorithm was validated in 10 centres for in total 100 prostate cancer patients. High quality plans could be generated at different centres without centre-specific algorithm tuning.
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Affiliation(s)
- Christian Fiandra
- University of Turin, Department of Oncology, Turin, Italy; School of Bioengineering and Medical-Surgical Sciences, Politecnico di Torino, Turin, Italy.
| | - Linda Rossi
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | | | | | - Anna Sardo
- Medical Physics Unit, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Sara Bartoncini
- Radiation Oncology, Department of Oncology, AOU Città della Salute e della Scienza, Turin, Italy
| | - Gianfranco Loi
- Department of Medical Physics, University Hospital Maggiore della Carità, Novara, Italy
| | - Carla Pisani
- Department of Radiotherapy, University Hospital Maggiore della Carità, Novara, Italy
| | - Eva Gino
- Medical Physics Department, A.O. Ordine Mauriziano di Torino, Turin, Italy
| | - Maria Grazia Ruo Redda
- University of Turin and Radiation Oncology Department, A.O. Ordine Mauriziano di Torino, Turin, Italy
| | | | - Paolo Tini
- Unit of Radiation Oncology, Oncology Department, University Hospital of Siena, Italy
| | - Stefania Comi
- Medical Physics Unit, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Dario Zerini
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gianluca Ametrano
- Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale", Naples, Italy
| | - Valentina Borzillo
- Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale", Naples, Italy
| | - Lidia Strigari
- Laboratory of Medical Physics and Expert Systems, IRCCS Regina Elena National Cancer Institute, IFO, Rome, Italy
| | - Silvia Strolin
- Laboratory of Medical Physics and Expert Systems, IRCCS Regina Elena National Cancer Institute, IFO, Rome, Italy
| | - Alessandro Savini
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Antonino Romeo
- Radiotherapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sonia Reccanello
- U.O.C. Fisica Medica, Dipartimento Radiologia Clinica, interventistica e delle Neuroscienze, Serenissima, Italy
| | - Imad Abu Rumeileh
- U.O.C. Radioterapia, Dipartimento Radiologia Clinica, interventistica e delle Neuroscienze, Serenissima, Italy
| | | | - Flavia Guerrisi
- Department of Radiation Oncology, Asl2 Savonese, Savona, Italy
| | - Gabriella Balestra
- Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Umberto Ricardi
- Radiation Oncology, Department of Oncology, School of Medicine, University of Turin, Turin, Italy
| | - Ben Heijmen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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24
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Alterio D, D’Ippolito E, Vischioni B, Fossati P, Gandini S, Bonora M, Ronchi S, Vitolo V, Mastella E, Magro G, Franco P, Ricardi U, Krengli M, Ivaldi G, Ferrari A, Fanetti G, Comi S, Tagliabue M, Verri E, Ricotti R, Ciardo D, Jereczek-Fossa BA, Valvo F, Orecchia R. Mixed-beam approach in locally advanced nasopharyngeal carcinoma: IMRT followed by proton therapy boost versus IMRT-only. Evaluation of toxicity and efficacy. Acta Oncol 2020; 59:541-548. [PMID: 32090645 DOI: 10.1080/0284186x.2020.1730001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To compare radiation-induced toxicity and dosimetry parameters in patients with locally advanced nasopharyngeal cancer (LANPC) treated with a mixed-beam (MB) approach (IMRT followed by proton therapy boost) with an historic cohort of patients treated with a full course of IMRT-only.Material and methods: Twenty-seven patients with LANPC treated with the MB approach were compared to a similar cohort of 17 patients treated with IMRT-only. The MB approach consisted in a first phase of IMRT up to 54-60 Gy followed by a second phase delivered with a proton therapy boost up to 70-74 Gy (RBE). The total dose for patients treated with IMRT-only was 69.96 Gy. Induction chemotherapy was administrated to 59 and 88% and concurrent chemoradiotherapy to 88 and 100% of the MB and IMRT-only patients, respectively. The worst toxicity occurring during the entire course of treatment (acute toxicity) and early-late toxicity were registered according to the Common Terminology Criteria Adverse Events V4.03.Results: The two cohorts were comparable. Patients treated with MB received a significantly higher median total dose to target volumes (p = .02). Acute grade 3 mucositis was found in 11 and 76% (p = .0002) of patients treated with MB and IMRT-only approach, respectively, while grade 2 xerostomia was found in 7 and 35% (p = .02) of patients treated with MB and IMRT-only, respectively. There was no statistical difference in late toxicity. Local progression-free survival (PFS) and progression-free survival curves were similar between the two cohorts of patients (p = .17 and p = .40, respectively). Local control rate was 96% and 81% for patients treated with MB approach and IMRT-only, respectively.Conclusions: Sequential MB approach for LANPC patients provides a significantly lower acute toxicity profile compared to full course of IMRT. There were no differences in early-late morbidities and disease-related outcomes (censored at two-years) but a longer follow-up is required to achieve conclusive results.
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Affiliation(s)
- Daniela Alterio
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Emma D’Ippolito
- Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Barbara Vischioni
- Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Piero Fossati
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
- Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Maria Bonora
- Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Sara Ronchi
- Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Viviana Vitolo
- Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Edoardo Mastella
- Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Giuseppe Magro
- Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy, Pavia, Italy
| | | | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Torino, Turin, Italy
| | - Marco Krengli
- Department of Translational Medicine, Novara, University of Piemonte Orientale, Vercelli, Italy
| | - Giovanni Ivaldi
- Unit of Radiation Oncology, ICS Maugeri, IRCSS, Pavia, Italy
| | - Annamaria Ferrari
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppi Fanetti
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Stefania Comi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Marta Tagliabue
- Department of Head and Neck Surgery and Otorhinolaryngology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Elena Verri
- Department of Medical Oncology, European Institute of Oncology, Milan, Italy
| | - Rosalinda Ricotti
- Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Delia Ciardo
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Francesca Valvo
- Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Roberto Orecchia
- Scientific Direction, European Institute of Oncology IRCCS, Milan, Italy
- Scientific Direction, National Center of Oncological Hadrontherapy, Pavia, Italy
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25
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Lazzari R, Riva G, Augugliaro M, Vavassori A, Dicuonzo S, Cattani F, Comi S, Colombo N, Jereczek-Fossa BA. Intensity modulated radiation therapy boost in locally-advanced cervical cancer in the absence of brachytherapy. Int J Gynecol Cancer 2020; 30:607-612. [PMID: 32188626 DOI: 10.1136/ijgc-2019-000735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/21/2019] [Accepted: 12/10/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Standard treatment in locally-advanced cervical cancer is external beam radiotherapy concomitant with platinum-based chemotherapy, followed by brachytherapy. The goal of our study was to determine whether an intensity modulated radiation therapy (IMRT) boost is feasible in patients unfit for brachytherapy. METHODS We retrospectively analyzed data of 25 patients unfit for brachytherapy with median age 55 years (range, 30-82) with locally-advanced/metastatic cervical cancer who underwent external beam radiotherapy to pelvis ±para-aortic lymph nodes and sequential IMRT boost between July 2014 and December 2017. Total dose of 45-50.4 Gy in 25-28 fractions (1.8 Gy/fraction) was administered to the cervix, uterus, parametria, ovaries, vaginal tissues (based on vaginal extension), involved lymph nodes, or relevant draining lymph-nodal groups. Para-aortic nodes were included if involved at radiological staging or if common iliac nodes were positive. The IMRT boost included all residual tumor after external beam radiotherapy identified on MRI. The Kaplan-Meier method was used to calculate 2 years' overall survival, 2 years' progression-free survival, and 2 years' local control. Overall survival- and progression-free survival were calculated considering the starting of radiotherapy or neo-adjuvant chemotherapy if prescribed, while local control was calculated from the end of radiotherapy. RESULTS Median radiation dose to pelvis ±para-aortic lymph nodes was 50.4 Gy (45-50.4), boost treatment was homogeneously performed to a total dose of 25 Gy in five fractions every other day.After a median follow-up of 26 months (range, 4-77), tumor persistence at cervix at 6 months from the end of radiotherapy or local recurrence occurred in five women (20%), eight (32%) experienced a further distant progression (two of them had also tumor persistence). Two-year local control and overall survival rates for all stages were 78% and 67%, respectively. According to Common Terminology Criteria for Adverse Events v.4 scoring criteria, 10 patients experienced gastrointestinal and/or genitourinary grade G1-2 acute toxicity. G2 rectal late toxicity requiring laser-coagulation was registered in two patients, there were no gastrointestinal and/or genitourinary acute or late toxicities≥G3. CONCLUSION The combination of external beam radiotherapy and brachytherapy remains the standard of care, however our preliminary data show the feasibility of IMRT boost in terms of toxicity with promising results in terms of local control and overall survival.
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Affiliation(s)
- Roberta Lazzari
- Department of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Riva
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Matteo Augugliaro
- Department of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Andrea Vavassori
- Department of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Samantha Dicuonzo
- Department of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefania Comi
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Nicoletta Colombo
- Medical Gynecologic Oncology Unit, IEO European Institute of Oncology, IRCCS and University of Milan-Bicocca, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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26
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Arculeo S, Miglietta E, Nava F, Morra A, Leonardi MC, Comi S, Ciardo D, Fiore MS, Gerardi MA, Pepa M, Gugliandolo SG, Livi L, Orecchia R, Jereczek-Fossa BA, Dicuonzo S. The emerging role of radiation therapists in the contouring of organs at risk in radiotherapy: analysis of inter-observer variability with radiation oncologists for the chest and upper abdomen. Ecancermedicalscience 2020; 14:996. [PMID: 32153651 PMCID: PMC7032938 DOI: 10.3332/ecancer.2020.996] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Indexed: 12/25/2022] Open
Abstract
Aims To compare the contouring of organs at risk (OAR) between a clinical specialist radiation therapist (CSRT) and radiation oncologists (ROs) with different levels of expertise (senior–SRO, junior–JRO, fellow–FRO). Methods On ten planning computed tomography (CT) image sets of patients undergoing breast radiotherapy (RT), the observers independently contoured the contralateral breast, heart, left anterior descending artery (LAD), oesophagus, kidney, liver, spinal cord, stomach and trachea. The CSRT was instructed by the JRO e SRO. The inter-observer variability of contoured volumes was measured using the Dice similarity coefficient (DSC) (threshold of ≥ 0.7 for good concordance) and the centre of mass distance (CMD). The analysis of variance (ANOVA) was performed and a p-value < 0.01 was considered statistically significant. Results Good overlaps (DSC > 0.7) were obtained for all OARs, except for LAD (DSC = 0.34 ± 0.17, mean ± standard deviation) and oesophagus (DSC = 0.66 ± 0.06, mean ± SD). The mean CMD < 1 cm was achieved for all the OARs, but spinal cord (CMD = 1.22 cm). By pairing the observers, mean DSC > 0.7 and mean CMD < 1 cm were achieved in all cases. The best overlaps were seen for the pairs JRO-CSRT(DSC = 0.82; CMD = 0.49 cm) and SRO-JRO (DSC = 0.80; CMD = 0.51 cm). Conclusions Overall, good concordance was found for all the observers. Despite the short training in contouring, CSRT obtained good concordance with his tutor (JRO). Great variability was seen in contouring the LAD, due to its difficult visualization and identification of CT scans without contrast.
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Affiliation(s)
- Simona Arculeo
- Division of Radiation Oncology, European Institute of Oncology IRCCS (IEO), Via Ripamonti 435, 20141 Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Eleonora Miglietta
- Division of Radiation Oncology, European Institute of Oncology IRCCS (IEO), Via Ripamonti 435, 20141 Milan, Italy
| | - Fabrizio Nava
- Division of Radiation Oncology, European Institute of Oncology IRCCS (IEO), Via Ripamonti 435, 20141 Milan, Italy
| | - Anna Morra
- Division of Radiation Oncology, European Institute of Oncology IRCCS (IEO), Via Ripamonti 435, 20141 Milan, Italy
| | - Maria Cristina Leonardi
- Division of Radiation Oncology, European Institute of Oncology IRCCS (IEO), Via Ripamonti 435, 20141 Milan, Italy
| | - Stefania Comi
- Unit of Medical Physics, European Institute of Oncology IRCCS (IEO), 20141 Milan, Italy
| | - Delia Ciardo
- Division of Radiation Oncology, European Institute of Oncology IRCCS (IEO), Via Ripamonti 435, 20141 Milan, Italy
| | - Massimo Sarra Fiore
- Division of Radiation Oncology, European Institute of Oncology IRCCS (IEO), Via Ripamonti 435, 20141 Milan, Italy
| | - Marianna Alessandra Gerardi
- Division of Radiation Oncology, European Institute of Oncology IRCCS (IEO), Via Ripamonti 435, 20141 Milan, Italy
| | - Matteo Pepa
- Division of Radiation Oncology, European Institute of Oncology IRCCS (IEO), Via Ripamonti 435, 20141 Milan, Italy
| | - Simone Giovanni Gugliandolo
- Division of Radiation Oncology, European Institute of Oncology IRCCS (IEO), Via Ripamonti 435, 20141 Milan, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Piero Palagi 1, 50139 Florence, Italy
| | - Roberto Orecchia
- Scientific Directorate, European Institute of Oncology IRCCS (IEO), 20141 Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, European Institute of Oncology IRCCS (IEO), Via Ripamonti 435, 20141 Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Samantha Dicuonzo
- Division of Radiation Oncology, European Institute of Oncology IRCCS (IEO), Via Ripamonti 435, 20141 Milan, Italy
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Marvaso G, Ciardo D, Gandini S, Riva G, Frigo E, Volpe S, Fodor C, Zerini D, Rojas DP, Comi S, Cambria R, Cattani F, Musi G, De Cobelli O, Orecchia R, Jereczek-Fossa BA. Comparison of Outcomes and Toxicity Between Extreme and Moderate Radiation Therapy Hypofractionation in Localized Prostate Cancer: A Propensity Score Analysis. Int J Radiat Oncol Biol Phys 2019; 105:735-744. [PMID: 31377161 DOI: 10.1016/j.ijrobp.2019.07.027] [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] [Received: 03/15/2019] [Revised: 07/12/2019] [Accepted: 07/21/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE To compare clinical outcomes and toxicities of 2 radiation therapy (RT) schemes for localized prostate cancer (PCa): extreme hypofractionation (EH; fractions of 6.5-7 Gy to a total dose of 32.5-35 Gy) and the moderate hypofractionation (MH; 26 fractions of 2.7 Gy to a total dose of 70.2 Gy). A propensity score method was used to compare the EH-RT and MH-RT groups. METHODS AND MATERIALS Our analysis included a total of 421 patients divided in 2 groups: 227 treated with MH-RT and 194 treated with EH-RT (43 and 30 months median follow-up, respectively). Propensity matching created comparable cohorts. Statistical evaluations were performed on the whole cohort, stratifying the analyses by risk strata factors identified with the propensity scores, and on a subgroup of patients matched by propensity score. Multivariate proportional hazard Cox models were used to compare the 2 groups, mainly for gastrointestinal and genitourinary toxicity and secondarily for clinical progression-free survival, biochemical progression-free survival, and overall survival. RESULTS Considering the whole population, acute genitourinary and gastrointestinal greater than grade 1 was significantly more frequent in the whole MH-RT group (P < .001 and P < .002, respectively). A borderline significantly greater late genitourinary was confirmed with the multivariate analysis (P = .07). Concerning tumor outcome, no statistically significant differences were observed. After propensity score matching, 226 patients were included in the analysis. The 2 obtained propensity score matched groups did not differ for any of the clinical and pathologic variables considered for the analysis, resulting in well-balanced cohorts. The results obtained on the whole population were confirmed in the matched groups. CONCLUSIONS EH-RT yields a decreased risk of acute or late toxicities compared with MH-RT, and oncologic outcomes were comparable. Our data indicate that EH-RT might be considered as a treatment modality of choice for select patients with PCa.
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Affiliation(s)
- Giulia Marvaso
- Department of Radiation Oncology, European Institute of Oncology, IRCCS, Milan, Italy.
| | - Delia Ciardo
- Department of Radiation Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Riva
- Department of Radiation Oncology, European Institute of Oncology, IRCCS, Milan, Italy; Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hematoncology, University of Milan, Milan, Italy
| | - Emanuele Frigo
- Department of Oncology and Hematoncology, University of Milan, Milan, Italy
| | - Stefania Volpe
- Department of Radiation Oncology, European Institute of Oncology, IRCCS, Milan, Italy; Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hematoncology, University of Milan, Milan, Italy
| | - Cristiana Fodor
- Department of Radiation Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Dario Zerini
- Department of Radiation Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Stefania Comi
- Unit of Medical Physics, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Raffaella Cambria
- Unit of Medical Physics, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Ottavio De Cobelli
- Department of Oncology and Hematoncology, University of Milan, Milan, Italy; Unit of Medical Physics, IEO, European Institute of Oncology, IRCCS, Milan, Italy; Department of Urology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara A Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology, IRCCS, Milan, Italy; Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hematoncology, University of Milan, Milan, Italy
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Riva G, Andrea V, Spoto R, Durante S, Ciardo D, Comi S, Cattani F, Lazzari R, Jereczek-Fossa B. EP-2131 Venezia: New Advanced Brachytherapy Gynecological Applicator in cervical cancer. Our preliminary data. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32551-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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Romanò C, Trivellato S, De Marco P, Comi S, Bazani A, Marvaso G, Ciardo D, Jereczek-Fossa B, Orecchia R, Cattani F. EP-2066 Evaluation of ANACONDA performances varying the exploited subset of controlling ROIs (AIRC IG-14300). Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32486-7] [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: 11/30/2022]
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30
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Marvaso G, Ciardo D, Gandini S, Riva G, Frigo E, Zerini D, Comi S, Cambria R, De Cobelli O, Orecchia R, Jereczek-Fossa B. PO-0854 Extreme vs moderate hypofractionation for localized Pca: a Propensity Score Matching Analisys. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31274-5] [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: 11/28/2022]
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31
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Augugliaro M, Marvaso G, Ciardo D, Zerini D, Riva G, Rondi E, Vigorito S, Comi S, Cobelli OD, Orecchia R, Jereczek-Fossa BA. Recurrent oligometastatic transitional cell bladder carcinoma: is there room for radiotherapy? Neoplasma 2019; 66:160-165. [DOI: 10.4149/neo_2018_180522n333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/24/2018] [Indexed: 11/08/2022]
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32
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Mambretti M, Romanò C, Marvaso G, Comi S, Cambria R, Emiro F, Jereczek-Fossa B, Cattani F. 29. Ultra-hypofractionated prostate cancer radiotherapy: A global Unified Dosimetry Index (gUDI) for treatment plans evaluation (AIRC, grant: IG-13218). Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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33
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Comi S, Bazani A, Emiro F, Piperno G, Baldini F, Jereczek-Fossa B, Cattani F. 173. Dosimetrical evaluation of interplay effect for lung cancer treatments with Vero system: Comparison between three different techniques. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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34
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Volpe S, Jereczek-Fossa BA, Zerini D, Rojas DP, Fodor C, Vavassori A, Romanelli P, Vigorito S, Rondi E, Comi S, Cambria R, Cattani F, Dicuonzo S, De Marco P, Beltramo G, Musi G, De Cobelli O, Marvaso G, Orecchia R. Case series on multiple prostate re-irradiation for locally recurrent prostate cancer: something ventured, something gained. Neoplasma 2018; 66:308-314. [PMID: 30509110 DOI: 10.4149/neo_2018_180723n520] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/16/2018] [Indexed: 11/08/2022]
Abstract
The aim is to present the technical feasibility and efficacy of multiple re-irradiation (re-EBRT) for local recurrence of prostate cancer (PCa) using retrospective analysis of an updated series of patients who received ablative re-EBRT with stereotactic image-guided technique for isolated local recurrence of PCa. Eight patients received three RT courses (2 re-RTs); of those 2 received 4 RT courses (3 re-RTs). Local relapse in the prostate was assessed by multiparametric magnetic resonance and/ or choline positron emission tomography. Before treatment planning, all patients had been evaluated for late toxicity from previous RT according to RTOG/EORTC. Biochemical control was assessed according to Phoenix definition. Mean age at the third RT course was 68 (standard deviation, SD: 7.2); all patients had a good performance status. At diagnosis, four cases were classified as high risk PCa, three as intermediate and one as low per NCCN 2017. Biochemical progression free interval after first and second RT-course were 74 (IQR: 59.3-133.6) months and 33 (IQR: 20.8-53.1) months, respectively. Biochemical and radiological response was registered in all patients. At present, seven out of eight patients are disease free. Overall toxicity profile was good; no severe acute or late genitourinary or gastrointestinal events were recorded. Multiple RT courses with high precision technology and image guidance can be proposed as a possible salvage therapy for locally recurrent, low-burden PCa recurrence in adequately selected patients. Deeper understanding of radiobiological effects of hypofractionation and larger series of patients are warranted to fully evaluate the applicability of multiple RT courses in the setting of locally recurrent PCa.
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Affiliation(s)
- S Volpe
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - B Alicja Jereczek-Fossa
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - D Zerini
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - D Patricia Rojas
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - C Fodor
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - A Vavassori
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - P Romanelli
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - S Vigorito
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - E Rondi
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - S Comi
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - R Cambria
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - F Cattani
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - S Dicuonzo
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - P De Marco
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | | | - G Musi
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - O De Cobelli
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - G Marvaso
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - R Orecchia
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Scientific Directorate, European Institute of Oncology, Milan, Italy
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35
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Jereczek-Fossa BA, Muto M, Durante S, Ferrari A, Piperno G, Fodor C, Comi S, Ricotti R, Garibaldi C, Dicuonzo S, Mazza S, Golino F, Spaggiari L, De Marinis F, Orecchia R, Ciardo D, Fossati P. Stereotactic body radiation therapy for mediastinal lymph node metastases: how do we fly in a 'no-fly zone'? Acta Oncol 2018; 57:1532-1539. [PMID: 30280618 DOI: 10.1080/0284186x.2018.1486040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the treatment-induced toxicity (as primary endpoint) and the efficacy (as secondary endpoint) of stereotactic body radiation therapy (SBRT) in the treatment of mediastinal lymph nodes (LNs) in the so-called no-fly zone (NFZ) in cancers with various histology. MATERIAL AND METHODS Forty-two patients were retrospectively analyzed. Institutional dose/volume constraints for organs at risk (OARs) derived by published data were strictly respected. The correlation between treatment-related variables and toxicity was investigated by logistic regression, Chi-squared test or Fisher's exact test. Overall survival (OS), cause-specific survival (CSS), progression-free survival (PFS) and local control (LC) were collected from the follow-up reports. The impact of potential predictive factors on LC, PFS and OS were estimated by Cox proportional-hazard regression. RESULTS Median follow-up time was 16 months (range 1-41). Four patients had esophageal G1 toxicity. Ten and six patients had G1 and G2 pulmonary toxicity, respectively. Treatment site and irradiation technique were significantly correlated with G ≥ 2 and G ≥ 1 toxicity, respectively. OS probability at 19 months was 88.3% and corresponded to CSS. LC probability at 16 months was 66.3% (median LC duration: 22 months, range 1-41). Fifteen patients (35.7%) were disease-free at 25 months (median time, range 1-41). The biologically effective dose (BED) and the target dose coverage indexes were significantly correlated with LC. CONCLUSIONS SBRT can be considered as a safe treatment option for selected patients with oligo-metastases/recurrences in the NFZ, if strict dose/volume constraints are applied.
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Affiliation(s)
- Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Matteo Muto
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
- Department of Clinical Medicine and Surgery, Federico II University School of Medicine, Naples, Italy
| | - Stefano Durante
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Annamaria Ferrari
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Gaia Piperno
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Cristiana Fodor
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Stefania Comi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Rosalinda Ricotti
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | | | - Samantha Dicuonzo
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Stefano Mazza
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Federica Golino
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Filippo De Marinis
- Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy
| | - Roberto Orecchia
- Scientific Direction, European Institute of Oncology, Milan, Italy
| | - Delia Ciardo
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Piero Fossati
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- Clinical Division, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
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36
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Mambretti M, Romanò C, Marvaso G, Comi S, Cambria R, Ciardo D, Emiro F, Fodor C, Zerini D, Riva G, Petralia G, De Cobelli O, Orecchia R, Cattani F, Jereczek-Fossa BA. A global Unified Dosimetry Index (gUDI) to evaluate simultaneous integrated boost radiotherapy plans in prostate cancer. Radiother Oncol 2018; 128:315-320. [DOI: 10.1016/j.radonc.2018.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/22/2018] [Accepted: 06/01/2018] [Indexed: 12/30/2022]
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37
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Fanetti G, Marvaso G, Ciardo D, Rese A, Ricotti R, Rondi E, Comi S, Cattani F, Zerini D, Fodor C, de Cobelli O, Orecchia R, Jereczek-Fossa BA. Stereotactic body radiotherapy for castration-sensitive prostate cancer bone oligometastases. Med Oncol 2018; 35:75. [PMID: 29671075 DOI: 10.1007/s12032-018-1137-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 03/19/2018] [Accepted: 04/13/2018] [Indexed: 02/06/2023]
Abstract
To evaluate outcome in patients treated with stereotactic body radiotherapy (SBRT) on bone oligometastases from castration-sensitive prostate cancer after primary treatment. We retrospectively collected data of patients with less than five lesions at time of SBRT and hormone-naïve disease at the first extra-regional localization, treated between 03/2012 and 11/2016. Prostate-specific antigen (PSA) was measured every 3 months after SBRT. Imaging was performed in case of progression. Survival analysis was performed with Kaplan-Meier (log-rank test) approach. Fifty-five patients were treated on 77 bone oligometastases. Median age, initial PSA and pre-SBRT PSA were 72 years, 9.12 and 3.5 ng/mL, respectively. Twenty-five patients (45%) received SBRT alone while the remaining 30 patients (55%) received concomitant ADT. Median follow-up was 24.6 months (range 3.0-67.2 months). No acute or late toxicity of grade > 1 was reported. Clinical progression was observed in 38 (69%) patients. 1-year biochemical progression-free survival (b-PFS), clinical progression-free survival (c-PFS), prostate-specific survival (PCSS) and local control (LC) rates were 51, 56, 100 and 83%, respectively. Comparing patients treated with SBRT alone and with concomitant ADT, no significant differences were found for those outcomes. SBRT is safe and allows high 1-year LC rate (83%) with low toxicity profile. No significant improvement in outcomes was registered with the addition of ADT to SBRT.
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Affiliation(s)
- Giuseppe Fanetti
- Division of Radiotherapy, European Institute of Oncology, Ripamonti 435, 20141, Milan, Italy. .,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
| | - Giulia Marvaso
- Division of Radiotherapy, European Institute of Oncology, Ripamonti 435, 20141, Milan, Italy
| | - Delia Ciardo
- Division of Radiotherapy, European Institute of Oncology, Ripamonti 435, 20141, Milan, Italy
| | - Annaisabel Rese
- Division of Radiotherapy, A.O.U. Federico II, Naples, Italy.,University of Naples, Naples, Italy
| | - Rosalinda Ricotti
- Division of Radiotherapy, European Institute of Oncology, Ripamonti 435, 20141, Milan, Italy
| | - Elena Rondi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Stefania Comi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Dario Zerini
- Division of Radiotherapy, European Institute of Oncology, Ripamonti 435, 20141, Milan, Italy
| | - Cristiana Fodor
- Division of Radiotherapy, European Institute of Oncology, Ripamonti 435, 20141, Milan, Italy
| | - Ottavio de Cobelli
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Division of Urology, European Institute of Oncology, Milan, Italy
| | - Roberto Orecchia
- Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Milan, Italy
| | - Barbara A Jereczek-Fossa
- Division of Radiotherapy, European Institute of Oncology, Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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38
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Lazzari R, Ronchi S, Gandini S, Surgo A, Volpe S, Piperno G, Comi S, Pansini F, Fodor C, Orecchia R, Tomao F, Parma G, Colombo N, Jereczek-Fossa BA. Stereotactic Body Radiation Therapy for Oligometastatic Ovarian Cancer: A Step Toward a Drug Holiday. Int J Radiat Oncol Biol Phys 2018; 101:650-660. [PMID: 29893277 DOI: 10.1016/j.ijrobp.2018.03.058] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/18/2018] [Accepted: 03/28/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate stereotactic body radiation therapy (SBRT) for metachronous oligometastatic ovarian cancer patients in terms of local control, delay of systemic treatment, survival outcomes, and toxicity. METHODS AND MATERIALS Retrospective data collection from a single institution was performed. The inclusion criteria were as follows: (1) oligorecurrent or oligoprogressive disease in ovarian cancer patients during or after systemic therapy; (2) surgery or other local therapies not feasible; and (3) relative contraindication to systemic therapy for reasons such as unavailability of additional chemotherapy lines or refusal of the patient. Tumor response and toxicity were evaluated using the Response Evaluation Criteria in Solid Tumors and the Common Terminology Criteria for Adverse Events version 4.03, respectively. A new systemic therapy regimen was started after an SBRT treatment course in 57 of 109 cases (52.3%). Local progression-free survival, progression-free survival, and overall survival were calculated via the Kaplan-Meier method. The systemic treatment-free interval was calculated in cases without concomitant systemic therapy. RESULTS Between May 2012 and December 2016, 82 patients (156 lesions) underwent SBRT with a median dose of 24 Gy in 3 fractions. The median follow-up period was 17.4 months. Patients received a median of 3 systemic therapy regimens prior to SBRT. Concomitant systemic therapy was performed for 29 lesions (18.6%). Among 152 evaluable lesions, a complete radiologic response, partial response, stabilization, and progressive disease were observed in 91 (60%), 26 (17%), 24 (16%), and 11 (7%), respectively. No grade 3 or 4 acute or late toxicities were observed. The median systemic treatment-free interval after SBRT was 7.4 months, and 1 of 3 patients was disease free at 1 year after SBRT. The actuarial 2-year local progression-free survival, progression-free survival, and overall survival rates were 68%, 18%, and 71%, respectively. The pattern of failure was predominantly out of field. CONCLUSIONS SBRT for oligometastatic ovarian cancer showed good local control and a good toxicity profile. It might be an appealing alternative to other invasive local therapies to delay systemic therapy in the case of chemorefractory disease or intolerance to systemic agents.
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Affiliation(s)
- Roberta Lazzari
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Sara Ronchi
- Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy
| | - Sara Gandini
- Division of Epidemiology and Biostatistics Unit, European Institute of Oncology, Milan, Italy
| | - Alessia Surgo
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Stefania Volpe
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
| | - Gaia Piperno
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Stefania Comi
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Floriana Pansini
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Cristiana Fodor
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Roberto Orecchia
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Scientific Directorate, European Institute of Oncology, Milan, Italy
| | - Federica Tomao
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University, Rome, Italy
| | - Gabriella Parma
- Department of Gynecology, European Institute of Oncology, Milan, Italy
| | - Nicoletta Colombo
- Department of Gynecology, European Institute of Oncology, Milan, Italy; University of Milano-Bicocca, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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39
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Volpe S, Jereczek Fossa B, Zerini D, Rojas D, Fodor C, Vavassori A, Romanelli P, Vigorito S, Rondi E, Comi S, Cambria R, Cattani F, Di Cuonzo S, De Marco P, Beltramo G, Musi G, De Cobelli O, Marvaso G, Orecchia R. EP-1555: Multiple re-irradiation for locally recurrent prostate cancer: proof of concept and clinical outcome. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31864-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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40
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Lazzari R, Riva G, Alessandro O, Francia C, Augugliaro M, Damaris Patricia R, Vavassori A, Spoto R, Comi S, Cattani F, Orecchia R, Jereczek-Fossa B. EP-1526: IMRT boost in cervical cancer: is it a feasible alternative when Brachytherapy is not practicable? Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31835-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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41
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Cattani F, Vavassori A, Comi S, Gherardi F, Russo S, Orecchia R, Jereczek-Fossa BA. Can the Day 0 CT-scan predict the post-implant scanning? Results from 136 prostate cancer patients. Phys Med 2017; 40:66-71. [DOI: 10.1016/j.ejmp.2017.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 07/07/2017] [Accepted: 07/12/2017] [Indexed: 11/24/2022] Open
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42
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Ricotti R, Ciardo D, Pansini F, Bazani A, Comi S, Spoto R, Noris S, Cattani F, Baroni G, Orecchia R, Vavassori A, Jereczek-Fossa BA. Dosimetric characterization of 3D printed bolus at different infill percentage for external photon beam radiotherapy. Phys Med 2017; 39:25-32. [PMID: 28711185 DOI: 10.1016/j.ejmp.2017.06.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/09/2017] [Accepted: 06/09/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE 3D printing is rapidly evolving and further assessment of materials and technique is required for clinical applications. We evaluated 3D printed boluses with acrylonitrile butadiene styrene (ABS) and polylactide (PLA) at different infill percentage. MATERIAL AND METHODS A low-cost 3D printer was used. The influence of the air inclusion within the 3D printed boluses was assessed thoroughly both with treatment planning system (TPS) and with physical measurements. For each bolus, two treatment plans were calculated with Monte Carlo algorithm, considering the computed tomography (CT) scan of the 3D printed bolus or modelling the 3D printed bolus as a virtual bolus structure with a homogeneous density. Depth dose measurements were performed with Gafchromic films. RESULTS High infill percentage corresponds to high density and high homogeneity within bolus material. The approximation of the bolus in the TPS as a homogeneous material is satisfying for infill percentages greater than 20%. Measurements performed with PLA boluses are more comparable to the TPS calculated profiles. For boluses printed at 40% and 60% infill, the discrepancies between calculated and measured dose distribution are within 5%. CONCLUSIONS 3D printing technology allows modulating the shift of the build-up region by tuning the infill percentage of the 3D printed bolus in order to improve superficial target coverage.
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Affiliation(s)
- Rosalinda Ricotti
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Delia Ciardo
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy.
| | - Floriana Pansini
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Alessia Bazani
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Stefania Comi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Ruggero Spoto
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Samuele Noris
- Corso di Laurea in Tecniche di radiologia medica, per immagini e radioterapia, University of Milan, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Guido Baroni
- Dipartimento di Elettronica Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy; Bioengineering Unit, Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Roberto Orecchia
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Milan, Italy
| | - Andrea Vavassori
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Jereczek-Fossa BA, Fanetti G, Fodor C, Ciardo D, Santoro L, Francia CM, Muto M, Surgo A, Zerini D, Marvaso G, Timon G, Romanelli P, Rondi E, Comi S, Cattani F, Golino F, Mazza S, Matei DV, Ferro M, Musi G, Nolè F, de Cobelli O, Ost P, Orecchia R. Salvage Stereotactic Body Radiotherapy for Isolated Lymph Node Recurrent Prostate Cancer: Single Institution Series of 94 Consecutive Patients and 124 Lymph Nodes. Clin Genitourin Cancer 2017; 15:e623-e632. [PMID: 28185875 DOI: 10.1016/j.clgc.2017.01.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/23/2016] [Accepted: 01/03/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND The purpose of the study was to evaluate the prostate serum antigen (PSA) response, local control, progression-free survival (PFS), and toxicity of stereotactic body radiotherapy (SBRT) for lymph node (LN) oligorecurrent prostate cancer. PATIENTS AND METHODS Between May 2012 and October 2015, 124 lesions were treated in 94 patients with a median dose of 24 Gy in 3 fractions. Seventy patients were treated for a single lesion and 25 for > 1 lesion. In 34 patients androgen deprivation (AD) was combined with SBRT. We evaluated biochemical response according to PSA level every 3 months after SBRT: a 3-month PSA decrease from pre-SBRT PSA of more than 10% identified responder patients. In case of PSA level increase, imaging was performed to evaluate clinical progression. Toxicity was assessed every 6 to 9 months after SBRT. RESULTS Median follow-up was 18.5 months. In 13 patients (14%) Grade 1 to 2 toxicity was reported without any Grade 3 to 4 toxicity. Biochemical response, stabilization, and progression were observed in 64 (68%), 10 (11%), and 20 (21%) of 94 evaluable patients. Clinical progression was observed in 31 patients (33%) after a median time of 8.1 months. In-field progression occurred in 12 lesions (9.7%). Two-year local control and PFS rates were 84% and 30%, respectively. Age older than 75 years correlated with better biochemical response rate. Age older than 75 years, concomitant AD administered up to 12 months, and pelvic LN involvement correlated with longer PFS. CONCLUSION SBRT is safe and offers good in-field control. At 2 years after SBRT, 1 of 3 patients is progression-free. Further investigation is warranted to identify patients who benefit most from SBRT and to define the optimal combination with AD.
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Affiliation(s)
- Barbara Alicja Jereczek-Fossa
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Giuseppe Fanetti
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
| | - Cristiana Fodor
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Delia Ciardo
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Luigi Santoro
- Department of Epidemiology and Statistics, European Institute of Oncology, Milan, Italy
| | - Claudia Maria Francia
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Matteo Muto
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Alessia Surgo
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Dario Zerini
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Giulia Marvaso
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Giorgia Timon
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Paola Romanelli
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Elena Rondi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Stefania Comi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Federica Golino
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Stefano Mazza
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | | | - Matteo Ferro
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Franco Nolè
- Division of Urogenital and Head and Neck Tumours, Department of Medical Oncology, European Institute of Oncology, Milan, Italy
| | | | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Roberto Orecchia
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Scientific Directorate, European Institute of Oncology, Milan, Italy
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Orecchia R, Surgo A, Muto M, Ferrari A, Piperno G, Gerardi MA, Comi S, Garibaldi C, Ciardo D, Bazani A, Golino F, Pansini F, Fodor C, Romanelli P, Maestri D, Scroffi V, Mazza S, Jereczek-Fossa BA. VERO® radiotherapy for low burden cancer: 789 patients with 957 lesions. Ecancermedicalscience 2016; 10:677. [PMID: 27729942 PMCID: PMC5045299 DOI: 10.3332/ecancer.2016.677] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Indexed: 12/04/2022] Open
Abstract
Purpose The aim of this retrospective study is to evaluate patient profile, feasibility, and acute toxicity of RadioTherapy (RT) delivered by VERO® in the first 20 months of clinical activity. Methods Inclusion criteria: 1) adult patients; 2) limited volume cancer (M0 or oligometastatic); 3) small extracranial lesions; 4) treatment between April 2012 and December 2013 and 5) written informed consent. Two techniques were employed: intensity modulated radiotherapy (IMRT) and stereotactic body radiotherapy (SBRT). Toxicity was evaluated using Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer (RTOG/EORTC) criteria. Results Between April 2012 and December 2013, 789 consecutive patients (957 lesions) were treated. In 84% of them one lesion was treated and in 16% more than one lesion were treated synchronously/metachronously; first radiotherapy course in 85%, re-irradiation in 13%, and boost in 2% of cases. The treated region included pelvis 46%, thorax 38%, upper abdomen 15%, and neck 1%. Radiotherapy schedules included <5 and >5 fractions in 75% and 25% respectively. All patients completed the planned treatment and an acceptable acute toxicity was observed. Conclusions RT delivered by VERO® was administrated predominantly to thoracic and pelvic lesions (lung and urologic tumours) using hypofractionation. It is a feasible approach for limited burden cancer offering short and well accepted treatment with favourable acute toxicity profile. Further investigation including dose escalation and other available VERO® functionalities such as real-time dynamic tumour tracking is warranted in order to fully evaluate this innovative radiotherapy system.
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Affiliation(s)
- R Orecchia
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Haemato-oncology, University of Milan, Milan, Italy; Equally contributed to the article
| | - A Surgo
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Equally contributed to the article; Affiliation at the time of the study
| | - M Muto
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Affiliation at the time of the study
| | - A Ferrari
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - G Piperno
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - M A Gerardi
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - S Comi
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - C Garibaldi
- Unit of Radiation Research, European Institute of Oncology, Milan, Italy
| | - D Ciardo
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - A Bazani
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - F Golino
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - F Pansini
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - C Fodor
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - P Romanelli
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - D Maestri
- University of Milan, Milan, Italy; Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - V Scroffi
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - S Mazza
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - B A Jereczek-Fossa
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Haemato-oncology, University of Milan, Milan, Italy
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Timon G, Zerini D, Fodor C, Bazzani F, Maucieri A, Ronchi S, Rojas D, Volpe S, Vavassori A, Cattani F, Garibaldi C, Comi S, Cambria R, De Cobelli O, Orecchia R, Jereczek-Fossa B. EP-1372: Salvage image-guided stereotactic re-irradiation of local recurrence in prostate cancer. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32622-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jereczek-Fossa B, Ciardo D, Colangione S, Fodor C, Zerini D, Cecconi A, Surgo A, Gerardi M, Muto M, Timon G, Comi S, Pansini F, Bazani A, Maestri D, Garioni M, Scroffi V, Cattani F, Cambria R, De Cobelli O, Orecchia R. OC-0448: Give me five: extreme hypofractionated IG-IMRT for organ confined prostate cancer. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31697-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bazani A, Pansini F, Garibaldi C, Comi S, Rondi E, Piperno G, Ferrari A, Jereczek-Fossa B, Cattani F. A comparison between different patient QA devices for IMRT treatments on VERO system. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Garibaldi C, Bazani A, Pansini F, Ricotti R, Ciardo D, Comi S, Piperno G, Ferrari A, Cremonesi M, Jereczek-Fossa B, Orecchia R. Impact of auto beam-off and 4D model automatic update on tracking accuracy of the VERO system. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Ciardo D, Alterio D, Jereczek-Fossa BA, Riboldi M, Zerini D, Santoro L, Preve E, Rondi E, Comi S, Serafini F, Laudati A, Ansarin M, Preda L, Baroni G, Orecchia R. Set-up errors in head and neck cancer patients treated with intensity modulated radiation therapy: Quantitative comparison between three-dimensional cone-beam CT and two-dimensional kilovoltage images. Phys Med 2015; 31:1015-1021. [PMID: 26459318 DOI: 10.1016/j.ejmp.2015.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/13/2015] [Accepted: 08/01/2015] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To compare the patient set-up error detection capabilities of three-dimensional cone beam computed tomography (3D-CBCT) and two-dimensional orthogonal kilovoltage (2D-kV) techniques. METHODS 3D-CBCT and 2D-kV projections were acquired on 29 head-and-neck (H&N) patients undergoing Intensity Modulated Radiotherapy (IMRT) on the first day of treatment (time 0) and after the delivery of 40 Gy and 50 Gy. Set-up correction vectors were analyzed after fully automatic image registration as well as after revision by radiation oncologists. The dosimetric effects of the different sensitivities of the two image guidance techniques were assessed. RESULTS A statistically significant correlation among detected set-up deviations by the two techniques was found along anatomical axes (0.60 < ρ < 0.72, p < 0.0001); no correlation was found for table rotation (p = 0.41). No evidence of statistically significant differences between the indications provided along the course of the treatment was found; this was also the case when full automatic versus manually refined correction vectors were compared. The dosimetric effects analysis revealed slight statistically significant differences in the median values of the maximum relative dose to mandible, spinal cord and its 5 mm Planning Organ at Risk Volume (0.95%, 0.6% and 2.45%, respectively), with higher values (p < 0.01) observed when 2D-kV corrections were applied. CONCLUSION A similar sensitivity to linear set-up errors was observed for 2D-kV and 3D-CBCT image guidance techniques in our H&N patient cohort. Higher rotational deviations around the table vertical axis were detected by the 3D-CBCT with respect to the 2D-kV method, leading to a consistent better sparing of organs at risk.
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Affiliation(s)
- Delia Ciardo
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy.
| | - Daniela Alterio
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy; Department of Health Sciences, University of Milan, via Festa del Perdono 7, Milano 20122, Italy
| | - Marco Riboldi
- Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano, Italy; Centro Nazionale di Adroterapia Oncologica (CNAO), Strada Campeggi 53, Pavia 27100, Italy
| | - Dario Zerini
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy
| | - Luigi Santoro
- Division of Epidemiology and Biostatistics, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
| | - Eleonora Preve
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy
| | - Elena Rondi
- Unit of Medical Physics, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
| | - Stefania Comi
- Unit of Medical Physics, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
| | - Flavia Serafini
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy
| | - Antonio Laudati
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy
| | - Mohssen Ansarin
- Division of Head and Neck Surgery, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
| | - Lorenzo Preda
- Department of Radiology, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
| | - Guido Baroni
- Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano, Italy; Centro Nazionale di Adroterapia Oncologica (CNAO), Strada Campeggi 53, Pavia 27100, Italy
| | - Roberto Orecchia
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy; Department of Health Sciences, University of Milan, via Festa del Perdono 7, Milano 20122, Italy
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Zerini D, Jereczek-Fossa BA, Fodor C, Bazzani F, Maucieri A, Ronchi S, Ferrario S, Colangione SP, Gerardi MA, Caputo M, Cecconi A, Gherardi F, Vavassori A, Comi S, Cambria R, Garibaldi C, Cattani F, De Cobelli O, Orecchia R. Salvage image-guided intensity modulated or stereotactic body reirradiation of local recurrence of prostate cancer. Br J Radiol 2015; 88:20150197. [PMID: 26055506 DOI: 10.1259/bjr.20150197] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To retrospectively evaluate external beam reirradiation (re-EBRT) delivered to the prostate/prostatic bed for local recurrence, after radical or adjuvant/salvage radiotherapy (RT). METHODS 32 patients received re-EBRT between February 2008 and October 2013. All patients had clinical/radiological local relapse in the prostate or prostatic bed and no distant metastasis. re-EBRT was delivered with selective RT technologies [stereotactic RT including CyberKnife(TM) (Accuray, Sunnyvale, CA); image-guidance and intensity-modulated RT etc.]. Toxicity was evaluated using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. Biochemical control was assessed according to the Phoenix definition (NADIR + 2 ng ml(-1)). RESULTS Acute urinary toxicity: G0, 24 patients; G1, 6 patients; G2, 2 patients. Acute rectal toxicity: G0, 28 patients; G1, 2 patients; and G2, 1 patient. Late urinary toxicity (evaluated in 30 cases): G0, 23 patients; G1, 6 patients; G2, 1 patient. Late renal toxicity: G0, 25 patients; G1, 5 patients. A mean follow-up of 21.3 months after re-EBRT showed that 13 patients were free of cancer, 3 were alive with biochemical relapse and 12 patients were alive with clinically evident disease. Four patients had died: two of disease progression and two of other causes. CONCLUSION re-EBRT using modern technology is a feasible approach for local prostate cancer recurrence offering 2-year tumour control in about half of the patients. Toxicity of re-EBRT is low. Future studies are needed to identify the patients who would benefit most from this treatment. ADVANCES IN KNOWLEDGE Our series, based on experience in one hospital alone, shows that re-EBRT for local relapse of prostate cancer is feasible and offers a 2-year cure in about half of the patients.
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Affiliation(s)
- D Zerini
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - B A Jereczek-Fossa
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - C Fodor
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - F Bazzani
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - A Maucieri
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - S Ronchi
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - S Ferrario
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - S P Colangione
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - M A Gerardi
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - M Caputo
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - A Cecconi
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - F Gherardi
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - A Vavassori
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - S Comi
- 3 Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - R Cambria
- 3 Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - C Garibaldi
- 3 Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - F Cattani
- 3 Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - O De Cobelli
- 2 Department of Health Sciences, University of Milan, Milan, Italy.,4 Department of Urology, European Institute of Oncology, Milan, Italy
| | - R Orecchia
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy.,5 Clinical Division of the National Center of Oncological Hadrontherapy, Pavia, Italy
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