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DE Sanctis V, Facondo G, Vullo G, Anzellini D, Sanguineti G, Nardangeli A, Marmiroli L, Tortoreto F, Gentile P, Annessi I, Donato V, Chiostrini C, Tombolini V, DE Felice F, Valeriani M, Osti MF. Clinical Outcomes and Toxicity of CT-guided High Dose-rate Brachytherapy in Women With Locally-advanced Cervical Cancer. Cancer Diagn Progn 2023; 3:194-200. [PMID: 36875316 PMCID: PMC9949546 DOI: 10.21873/cdp.10201] [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] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/16/2022] [Indexed: 03/07/2023]
Abstract
BACKGROUND/AIM To evaluate the outcome and toxicities in patients with locally advanced cervical cancer (LACC) treated with radiochemotherapy and intracavitary brachytherapy. PATIENTS AND METHODS This study included 67 patients with LACC treated between 2010 and 2018. The most represented stage was FIGO IIB. The patients were treated with external beam radiotherapy (EBRT) to the pelvis and boost to the cervix and parametrials. Concomitant chemotherapy (CHT) with cisplatin (CDDP) 40 mg/mq was planned. Subsequently, the patients underwent CT-based endouterine brachytherapy (BT). The response was evaluated at 3 months with PET-CT and/or pelvic magnetic resonance imaging (MRI). Since then, the patients have been followed with clinical instrumental controls every 4 months for the first 2 years and every 6 months for the following 3 years. Local response was assessed with pelvic MRI and/or PET-CT scan at the end of intracavitary BT) according to RECIST 1.1 criteria. RESULTS The median duration of treatment was 55 days (range=40-73 days). The prescription dose to the planning target volume (PTV) was delivered in 25 to 30 (median 28) daily fractions. The EBRT median dose to the pelvis and gross tumor volume were 50.4 Gy (range=45-56.25) and 61.6 Gy (range=45-70.4), respectively. The 1-year, 2-year, 3-year, and 5-year overall survival rates were 92.44%, 80.81%, 78.84%, and 76.45% respectively. The actuarial 1-year, 2-year, 3-year, and 5-year disease-free survival rates were 89.5%, 83.6%, 81%, and 78.2% respectively. CONCLUSION This study analyzed acute and chronic toxicity, survival, and local control in cervical cancer patients treated with IMRT followed by CT-planned high dose rate-brachytherapy. Patients demonstrated satisfactory outcomes and incidence of acute and late toxicities.
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Affiliation(s)
- Vitaliana DE Sanctis
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Giuseppe Facondo
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Gianluca Vullo
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Dimitri Anzellini
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessia Nardangeli
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Luca Marmiroli
- U.O.C. Radiotherapy, S. Giovanni Calibita Fatebenefratelli Hospital - Amethyst Radioterapia Italia, Rome, Italy
| | - Francesca Tortoreto
- U.O.C. Radiotherapy, S. Giovanni Calibita Fatebenefratelli Hospital - Amethyst Radioterapia Italia, Rome, Italy
| | - Piercarlo Gentile
- Department of Radiation Oncology, San Pietro Fatebenefratelli (FBF), Rome, Italy
| | - Ivan Annessi
- Department of Radiation Oncology, San Pietro Fatebenefratelli (FBF), Rome, Italy
| | - Vittorio Donato
- Radiation Oncology Department, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Cinzia Chiostrini
- Radiation Oncology Department, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Vincenzo Tombolini
- Department of Radiotherapy, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Francesca DE Felice
- Department of Radiotherapy, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Maurizio Valeriani
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Mattia Falchetto Osti
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
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Anzellini D, DE Sanctis V, Valeriani M, Reverberi C, Marinelli L, Massaro M, Vullo G, Facondo G, Sigillo RC, Tosi E, Osti MF. Stereotactic and Hypofractionated Radiotherapy Associated With Immune Checkpoint Inhibitor Drugs: Analysis of Local Control, Toxicity, and Outcome in a Single Research Centre Case Study. Anticancer Res 2021; 41:5107-5116. [PMID: 34593461 DOI: 10.21873/anticanres.15327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/15/2021] [Accepted: 08/23/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM We evaluated local control and toxicity in patients receiving radiotherapy associated with immune check point inhibitors and analyzed which oligometastatic disease setting benefits the most from local ablation in terms of advantage in overall survival. PATIENTS AND METHODS We retrospectively identified 60 oligoprogressive patients treated with a PD-1 inhibitor in association with radiotherapy on the site of progression (119 lesions). RESULTS After a median follow-up of 11.7 months (range=1-39 months), we observed complete response (CR) in 45/119, partial response (RP) in 42/119, and stable disease (SD) in 30/119 patients. Nine radionecrotic events occurred. Two patients experienced grade 3 toxicities and 32 patients reported grade 2 toxicities. The number of radiologically evident metastatic organs in patients who received concomitant PD-1 inhibitors and radiotherapy showed a significant increase in survival (respectively, 73% after 12 months and 47% after 24 months) in patients with 0-3 metastatic organs compared to those with more than 3 organ sites involved (p<0.0001). CONCLUSION Radiotherapy associated with PD-1 inhibitors is overall safe and efficacious. Patients eligible for intensification of local treatments should have less or equal to 3 metastatic organ sites.
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Affiliation(s)
- Dimitri Anzellini
- Department of Medicine and Surgery and Translational Medicine, Radiation Oncology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Vitaliana DE Sanctis
- Department of Medicine and Surgery and Translational Medicine, Radiation Oncology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Maurizio Valeriani
- Department of Medicine and Surgery and Translational Medicine, Radiation Oncology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Chiara Reverberi
- Department of Medicine and Surgery and Translational Medicine, Radiation Oncology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Luca Marinelli
- Department of Medicine and Surgery and Translational Medicine, Radiation Oncology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Maria Massaro
- Department of Medicine and Surgery and Translational Medicine, Radiation Oncology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Gianluca Vullo
- Department of Medicine and Surgery and Translational Medicine, Radiation Oncology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Facondo
- Department of Medicine and Surgery and Translational Medicine, Radiation Oncology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Riccardo Carlo Sigillo
- Department of Medicine and Surgery and Translational Medicine, Radiation Oncology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Emanuele Tosi
- Department of Medicine and Surgery and Translational Medicine, Radiation Oncology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mattia Falchetto Osti
- Department of Medicine and Surgery and Translational Medicine, Radiation Oncology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Facondo G, Vullo G, DE Sanctis V, Valeriani M, Ascolese AM, Massaro M, Anzellini D, Osti MF. Stereotactic Body Radiation Therapy Boost in Patients With Cervical Cancer Ineligible for Brachytherapy. Cancer Diagn Progn 2021; 1:53-60. [PMID: 35403131 PMCID: PMC8962763 DOI: 10.21873/cdp.10008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 04/13/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Standard treatment for locally advanced cervical cancer is external beam radiotherapy followed by brachytherapy (BT). Stereotactic body radiation therapy (SBRT) is a possible option for treating patients ineligible for BT. PATIENTS AND METHODS From October 2012 to July 2020, nine women with cervical cancer received SBRT to high-risk volumes. The Kaplan-Meier method was used to estimate the rates of overall and disease-free survival. RESULTS The median age was 52 years; 88% of patients had squamous carcinoma. Reasons for forgoing BT were cervical canal stenosis, treatment refusal and hematological disease. The median boost dose was 18 Gy and the median dose per fraction was 6 Gy. Median follow-up was 16 months. The median survival was 24 months, the actuarial 2-year OS rate was 70%, and median disease-free survival was 11 months. One grade 3 late vaginal toxicity was reported. No acute nor late grade 4 toxicities were observed. CONCLUSION SBRT boost in patients with cervical cancer ineligible for BT led to acceptable survival outcomes and a safe toxicity profile.
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Affiliation(s)
- Giuseppe Facondo
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Gianluca Vullo
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Vitaliana DE Sanctis
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Maurizio Valeriani
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Anna Maria Ascolese
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Maria Massaro
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Dimitri Anzellini
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Mattia Falchetto Osti
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
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4
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DE Sanctis V, DI Rocco A, Cox MC, Valeriani M, Congedi FP, Anzellini D, Massaro M, Vullo G, Facondo G, DE Giacomo F, Alfò M, Prosperi D, Pizzichini P, Pelliccia S, Tafuri A, Martelli M, Osti MF. Residual Site Radiotherapy After Immunochemotherapy in Primary Mediastinal B-Cell Lymphoma: A Monoinstitutional Retrospective Study. In Vivo 2021; 34:1407-1413. [PMID: 32354938 DOI: 10.21873/invivo.11921] [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: 02/24/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 11/10/2022]
Abstract
AIM To evaluate the efficacy of residual site radiation therapy (RSRT) on local control (LC), progression-free (PFS) and overall (OS) survival in patients with primary mediastinal lymphoma (PMBCL), following rituximab and chemotherapy treatment (ICHT). PATIENTS AND METHODS The study included 34 patients with PMBCL treated between 2006 and 2014 with ICHT with/without autologous stem cell transplantation and RSRT. Between the end of ICHT/stem cell transplantation and RSRT, patients were evaluated with 18F-fluorodeoxyglucose positron-emission tomography. The gross tumor volume included morphological mediastinal residual disease after ICHT/SCT. The percentage of LC, PFS and OS were assessed. RESULTS All patients received RSRT with a median dose of 30 Gy. Median follow-up was 82 months. One patient out of 34 (3%) showed progressive disease 9 months from diagnosis. The 10-year PFS and OS were 97% and 97% respectively. CONCLUSION RSRT in patients with PMBCL treated with ICHT did not impact unfavorably on LC and patient survival.
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Affiliation(s)
- Vitaliana DE Sanctis
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Alice DI Rocco
- Department of Translational and Precision Medicine, Hematology Institute, Sapienza University of Rome, Rome, Italy
| | - Maria Christina Cox
- Hematology Institute, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Maurizio Valeriani
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Francesca Perrone Congedi
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Dimitri Anzellini
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Maria Massaro
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Gianluca Vullo
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Giuseppe Facondo
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Flavia DE Giacomo
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Marco Alfò
- Department of Statistical Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniela Prosperi
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pizzichini
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Sabrina Pelliccia
- Hematology Institute, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Agostino Tafuri
- Hematology Institute, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy.,Department of Clinic and Molecular Medicine and Hematology, Sapienza, University of Rome and S. Andrea University Hospital of Rome, Rome, Italy
| | - Maurizio Martelli
- Department of Translational and Precision Medicine, Hematology Institute, Sapienza University of Rome, Rome, Italy
| | - Mattia Falchetto Osti
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
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5
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DE Sanctis V, Belgioia L, Cante D, LA Porta MR, Caspiani O, Guarnaccia R, Argenone A, Muto P, Musio D, DE Felice F, Maurizi F, Bunkhelia F, Ruo Redda MG, Reali A, Valeriani M, Osti MF, Alterio D, Bacigalupo A, Russi EG. Lactobacillus brevis CD2 for Prevention of Oral Mucositis in Patients With Head and Neck Tumors: A Multicentric Randomized Study. Anticancer Res 2019; 39:1935-1942. [PMID: 30952736 DOI: 10.21873/anticanres.13303] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Oropharyngeal mucositis occurs in virtually all patients with head and neck cancer receiving radiochemotherapy. The manipulation of the oral cavity microbiota represents an intriguing and challenging target. PATIENTS AND METHODS A total of 75 patients were enrolled to receive Lactobacillus brevis CD2 lozenges or oral care regimen with sodium bicarbonate mouthwashes. The primary endpoint was the incidence of grade 3 or 4 oropharyngeal mucositis during radiotherapy treatment. RESULTS There was no statistical difference in the incidence of grade 3-4 oropharyngeal mucositis between the intervention and control groups (40.6% vs. 41.6% respectively, p=0.974). The incidence of pain, dysphagia, body weight loss and quality of life were not different between the experimental and standard arm. CONCLUSION Our study was not able to demonstrate the efficacy of L. brevis CD2 lozenges in preventing radiation-induced mucositis in patients with head and neck cancer. Although modulating homeostasis of the salivary microbiota in the oral cavity seems attractive, it clearly needs further study.
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Affiliation(s)
- Vitaliana DE Sanctis
- Department of Medicine and Surgery and Translational Medicine, Radiation Oncology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Liliana Belgioia
- Radiation Oncology, Policlinico San Martino and University, Genoa, Italy
| | - Domenico Cante
- Department of Radiation Oncology, ASL Turin 4, Ivrea Community Hospital, Ivrea, Italy
| | - Maria R LA Porta
- Department of Radiation Oncology, ASL Turin 4, Ivrea Community Hospital, Ivrea, Italy
| | | | | | - Angela Argenone
- Radiation Oncology, Istituto Nazionale Tumori-IRCCS-G. Pascale Foundation, Naples, Italy
| | - Paolo Muto
- Radiation Oncology, Istituto Nazionale Tumori-IRCCS-G. Pascale Foundation, Naples, Italy
| | - Daniela Musio
- Department of Radiological, Oncological and Anatomo-pathological Sciences, Radiation Oncology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Francesca DE Felice
- Department of Radiological, Oncological and Anatomo-pathological Sciences, Radiation Oncology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Francesca Maurizi
- Radiation Oncology, A.O. Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Feisal Bunkhelia
- Radiation Oncology, A.O. Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Maria Grazia Ruo Redda
- Department of Oncology, Radiation Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano, Italy
| | - Alessia Reali
- Department of Oncology, Radiation Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano, Italy
| | - Maurizio Valeriani
- Department of Medicine and Surgery and Translational Medicine, Radiation Oncology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mattia F Osti
- Department of Medicine and Surgery and Translational Medicine, Radiation Oncology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Daniela Alterio
- Radiation Oncology, European Institute of Oncology, Milan, Italy
| | | | - Elvio G Russi
- Radiation Oncology, A.S.O. S. Croce e Carle, Cuneo, Italy
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Valeriani M, Bonfili P, Reverberi C, Marinelli L, Ferella L, Minniti G, DE Sanctis V, Osti MF, Bonome P, Tronnolone L, Varrassi E, Gravina GL, Franzese P, Tombolini V, DI Staso M. Moderate Hypofractionation in Patients with Low-risk Prostate Cancer: Long-term Outcomes. Anticancer Res 2018; 38:1671-1676. [PMID: 29491101 DOI: 10.21873/anticanres.12400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/15/2018] [Accepted: 01/18/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To evaluate outcomes in patients with low-risk prostate cancer treated with hypofractionated radiotherapy (HyRT). PATIENTS AND METHODS Between April 2004 and December 2015, 175 patients with low-risk prostate cancer were treated with HyRT 60 Gy in 20 fractions with or without image guidance and reduction of margin from clinical target volume to planning target volume. RESULTS The median follow-up was 66 months. The 8-year overall survival for the whole patient cohort was 88.9%. The 8-year biochemical no evidence of disease was higher in patients treated with image-guided HyRT (98.8% vs. 88%, p=0.023). During treatment, patients treated with image-guided HyRT presented a lower rate of grade 1-2 gastrointestinal toxicity (25.3% vs. 42.2%, p=0.001). At the last follow-up, the grade 1 Gastro-intestinal toxicity rate was 4.0% and the grade 1-2 genito-urinary toxicity rate was 25.1%. CONCLUSION Our study demonstrated the efficacy of the schedule used with a low rate of acute and late toxicities. Therefore, reduction of margins with image-guided HyRT is safe.
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Affiliation(s)
- Maurizio Valeriani
- Department of Radiation Oncology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Pierluigi Bonfili
- Department of Radiation Oncology, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Chiara Reverberi
- Department of Radiation Oncology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Luca Marinelli
- Department of Radiation Oncology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Letizia Ferella
- Department of Radiation Oncology, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Giuseppe Minniti
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
| | - Vitaliana DE Sanctis
- Department of Radiation Oncology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mattia Falchetto Osti
- Department of Radiation Oncology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Paolo Bonome
- Department of Radiation Oncology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Lidia Tronnolone
- Department of Radiation Oncology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Emilia Varrassi
- Department of Radiation Oncology, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Giovanni Luca Gravina
- Department of Radiation Oncology, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Pietro Franzese
- Department of Radiation Oncology, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Vincenzo Tombolini
- Department of Radiation Oncology, Policlinico Umberto I Hospital, Sapienza, University of Rome, Rome, Italy
| | - Mario DI Staso
- Department of Radiation Oncology, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
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Agolli L, Valeriani M, Bracci S, Nicosia L, DE Sanctis V, Enrici RM, Osti MF. Hypofractionated Image-guided Radiation Therapy (3Gy/fraction) in Patients Affected by Inoperable Advanced-stage Non-small Cell Lung Cancer After Long-term Follow-up. Anticancer Res 2015; 35:5693-5700. [PMID: 26408745] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND We conducted long-term follow-up analysis of the outcomes for patients affected by advanced-stage non-small cell lung cancer (NSCLC) treated with hypofractionated radiotherapy (RT). MATERIALS AND METHODS Sixty patients with advanced-stage NSCLC (IIIA-IV) treated with hypofractionated radiotherapy (60Gy/20 fractions) were analyzed. Radiation was delivered using an image-guided RT technique to verify the correct position. Toxicities were graded according to the Common Toxicity Criteria for Adverse Effects v4.0 scale. RESULTS Overall, six patients achieved a complete response and 46 patients had a partial response (tumor response rate 86%). After a median follow-up of 30 months, locoregional progression occurred in 23 patients and distant progression occurred in 38. The 1-year and 2-years overall survival were 57% and 40%, respectively. The 1-year and 2-years progression-free survival (PFS) were 47.1% and 33.5%, respectively. The median duration of OS and PFS was 13 months and 12 months, respectively. The 2-year local PFS and metastases-free survival (MFS) were 53% and 40.3%, respectively. On univariate analysis, the T-size (≥5 cm), and type of response to RT (non-response/progressive disease) were significantly associated with worse OS. Type of response was identified as significant prognostic factors for PFS (p<0.01) local PFS (p=0.015) and MFS (p<0.01). Acute grade 3 esophagitis and pneumonitis occurred in three patients (5%) and four patients (6%), respectively. Late grade 3 esophagitis and pneumonitis occurred in 2% (one patient) and 3% (two patients), respectively. No patient experienced grade 4 acute or late RT-related toxicities. CONCLUSION Hypofractionated RT offers good disease control for patients with advanced-stage NSCLC with acceptable toxicity rates. Phase III randomized trials are necessary to compare hypofractionated RT with conventional RT.
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MESH Headings
- Adenocarcinoma/mortality
- Adenocarcinoma/radiotherapy
- Adenocarcinoma/secondary
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/radiotherapy
- Carcinoma, Non-Small-Cell Lung/secondary
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/secondary
- Dose Fractionation, Radiation
- Female
- Follow-Up Studies
- Humans
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Lung Neoplasms/radiotherapy
- Male
- Middle Aged
- Neoplasm Metastasis
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/radiotherapy
- Neoplasm Staging
- Prognosis
- Prospective Studies
- Radiotherapy, Image-Guided/mortality
- Survival Rate
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Affiliation(s)
- Linda Agolli
- Institute of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Maurizio Valeriani
- Institute of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Stefano Bracci
- Institute of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Luca Nicosia
- Institute of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Vitaliana DE Sanctis
- Institute of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | | | - Mattia Falchetto Osti
- Institute of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
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Valeriani M, Carnevale A, Osti MF, DE Sanctis V, Agolli L, Maurizi Enrici R. Image guided intensity modulated hypofractionated radiotherapy in high-risk prostate cancer patients treated four or five times per week: analysis of toxicity and preliminary results. Radiat Oncol 2014; 9:214. [PMID: 25260377 PMCID: PMC4261590 DOI: 10.1186/1748-717x-9-214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 09/15/2014] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate efficacy and toxicity of hypofractionated intensity-modulated simultaneous integrated boost (IMRT-SIB) and image-guided (IGRT) radiotherapy in the treatment of high-risk prostate cancer patients. Methods Eighty-two patients with high-risk prostate cancer were analysed. An IMRT treatment was planned delivering 68.75 Gy to the prostate, 55 Gy to the seminal vesicles and positive nodes and 45 Gy to the pelvis in 25 fractions. The first 59 patients received 4 weekly fractions whereas the last 23 patients received 5 weekly fractions. All patients were submitted to hormonal therapy. Results The median follow-up was 31 months. Acute grade 1–2 gastrointestinal (GI) toxicity rates were 13.4%. Grade 1–2 and grade 3 genitourinary (GU) toxicity rates were 22% and 1.2%, respectively. Grade 1 and 2 GI late toxicity rates were 1.2%. No grade ≥3 toxicity was recorded. Grade 1 GU late toxicity rate was 2.4%. No grade ≥2 toxicity was recorded. No significant difference was calculated in terms of acute and late toxicity between the group treated 4 or 5 times weekly. The actuarial 3-years Overall survival and Freedom from biochemical failure were 98.6% and 91.3%, respectively. Conclusions The present study demonstrated that hypofractionated IGRT-IMRT-SIB in patients with high-risk prostate cancer is efficient with acceptable toxicity profile. Outcome in terms of survival are promising, but longer follow-up is needed.
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Affiliation(s)
- Maurizio Valeriani
- Department of Radiation Oncology, La Sapienza" University, Sant'Andrea Hospital of Rome, Rome, Italy.
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Osti MF, Carnevale A, Bracci S, Amanti C, Lombardi A, Maggi S, DE Sanctis V, Valeriani M, Enrici RM. Exclusive electron intraoperative radiotherapy in early-stage breast cancer: a monoinstitutional experience. Anticancer Res 2013; 33:1229-1235. [PMID: 23482807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM To evaluate the effectiveness of intra-operative radiotherapy (IORT) in breast cancer in terms of local control, esthetic results and disease-free survival. PATIENTS AND METHODS From June 2007 to October 2011, 110 patients with early-stage breast cancer were submitted to quadrantectomy and IORT. A total dose of 21 Gy prescribed at 90-100% isodose was delivered in all cases. Patients were evaluated after surgery for early and late complications. RESULTS Median follow-up was 27 (range: 2-54) months. In 10 patients (9.1%), breast ultrasound showed liponecrosis. Six patients (5.5%) developed grade 2 fibrosis. Disease-free survival rates at 2 and 3 years were 96.8% and 92.9 %. Three patients (2.7%) developed local recurrence, two patients (1.8%) distant metastasis. Two patients died. The 2- and 3-year overall survival rates were 100% and 97.3%, respectively. CONCLUSION IORT could be an appropriate therapeutic alternative in selected patients although it remains investigational; longer follow-up to confirm these results is required.
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Affiliation(s)
- Mattia Falchetto Osti
- Sant'Andrea Hospital, Department of Radiation Oncology, Via di Grottarossa 1035, 00189 Roma, Italy
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Frega A, Sopracordevole F, Assorgi C, Lombardi D, DE Sanctis V, Catalano A, Matteucci E, Milazzo GN, Ricciardi E, Moscarini M. Vaginal intraepithelial neoplasia: a therapeutical dilemma. Anticancer Res 2013; 33:29-38. [PMID: 23267125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Vaginal intraepithelial neoplasia (VaIN) represents a rare and asymptomatic pre-neoplastic lesion. Its natural history and potential evolution into invasive cancer are uncertain. VaIN can occur alone or as a synchronous or metachronous lesion with cervical and vulvar HPV-related intra epithelial or invasive neoplasia. Its association with cervical intraepithelial neoplasia is found in 65% of cases, with vulvar intraepithelial neoplasia in 10% of cases, while for others, the association with concomitant cervical or vulvar intraepithelial neoplasias is found in 30-80% of cases. VaIN is often asymptomatic and its diagnosis is suspected in cases of abnormal cytology, followed by colposcopy and colposcopically-guided biopsy of suspicious areas. In the past, high-grade VaIN and multifocal VaIN have been treated by radical surgery, such as total or partial upper vaginectomy associated with hysterectomy and radiotherapy. The need to maintain the integrity of reproductive capacity has determined the transition from radical therapies to conservative ones, according to the different patients' characteristics.
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Affiliation(s)
- Antonio Frega
- Department of Gynecological, Obstetric and Urological Sciences, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
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Valeriani M, Monaco F, Osti MF, DE Sanctis V, Minniti G, Enrici RM. Hypofractionated radiotherapy with or without IGRT in prostate cancer: preliminary report of acute toxicity. Anticancer Res 2011; 31:3555-3558. [PMID: 21965777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND To evaluate the acute tolerance to hypofractionated schedule of patients with prostate cancer. PATIENTS AND METHODS We treated 62 patients with intermediate risk prostate cancer. All patients were treated with a total dose of 43.8 Gy on seminal vesicles and 54.75 Gy on prostate, 3.65 Gy per fraction, three times a week for a total of 5 weeks. All patients underwent neoadjuvant, concomitant and adjuvant hormonal therapy. Thirty-six patients were submitted to image-guided radiation therapy (IGRT). RESULTS Median follow-up was 15 months (range 3-33 months). Toxicities during the treatment were: grade 1-2 gastrointestinal (GI) toxicity, 22.6%; grade 1-2 genitourinary (GU) toxicity, 51.6%. Toxicities 3 months after the end of the treatment were grade 1-2 GI 6.5%, grade 1-2 GU 9.7%. No statistical difference was observed comparing acute toxicity in patients treated with or without IGRT. CONCLUSION This study showed that the hypofractionation schedule used is well tolerated, with a low rate of acute grade 1-2 GI toxicity and without major grade (≥3) acute toxicity. Longer follow-up is needed to determine if this low rate of acute toxicity will be translated in a low rate of late toxicity.
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Affiliation(s)
- Maurizio Valeriani
- S. Andrea Hospital, La Sapienza University of Rome, via di Grottarossa 1035, 00189 Rome, Italy.
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