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Sanguineti G, D'Urso P, Bottero M, Farneti A, Giannarelli D, Signori A, Landoni V. SBRT in 3 Fractions for T1 Glottic Cancer. Int J Radiat Oncol Biol Phys 2023; 117:S100. [PMID: 37784266 DOI: 10.1016/j.ijrobp.2023.06.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The purpose of this study was to report the results of a mature phase II study. MATERIALS/METHODS This was a prospective study at a single institution that were enrolling patients with T1 glottic cancer. The true vocal cords (TVCs) were divided into thirds and the third(s) containing disease prescribed 36 Gy in 3 fractions. The portions of the TVCs next to the involved one were planned to receive 30 Gy in 3 fxs. The remaining parts of the TVCs as well the rest of the larynx was tentatively spared. SBRT was delivered by a LINAC-based approach using multiple arcs (VMAT). Toxicity was scored by CTCAE and late events were considered those occurring 3 months after SBRT. Voice quality was investigated by the voice handicap index (VHI) at regular intervals. A generalized linear mixed model was used to analyze longitudinal functional data and the actuarial approach was used to report late toxicity prevalence rates. The planned sample size, 75 patients, was calculated to reject the hypothesis of a 2-yr local control (LC) of 85% against the alternative hypothesis of 95%. The median follow-up time is 40 months (IQR: 31.5-47.3 months). RESULTS Accrual was discontinued after 33 patients due to concerns on late toxicity rates on both the mucosa and the cartilages. Median age was 66 yrs (IQR: 60-71 yrs). T stage was as follows: T1a: 23 pts (69.7%); T1b: 10 pts (30.3%). Only two patients never smoked, while of the remaining ones, 13 (41.9%) kept smoking after SBRT despite appropriate counseling. At last, follow up, all patients are alive and without evidence of disease but one patient who died 21.3 months after SBRT for intercurrent causes. The observed local control rate of 100% allows to reject the null hypothesis because, according to the binomial distribution, the probability of not observing at least one recurrence out of the accrued 33 patients is <0.5% if a 2-yr LR ≤85% would be true. All but 5 patients developed transient confluent mucositis of the treated volume with a prevalence peak at 19 days after SBRT. Six patients (18.2%) developed soft tissue necrosis (N = 4) or cartilage necrosis (N = 2) after a median time of 14.9 months from SBRT (range: 9.1-24.5 months). The actuarial prevalence of any necrosis is 3.0%, 1.3% and 0.8% at 12, 24 and 36 months after SBRT, respectively, with a peak at 6.1% between 9.9 and 11.9 months. All 4 soft tissue events healed with conservative therapy after a median time of 2.5 months (range: 1-12.2 months). One patient with chondronecrosis refused total laryngectomy and is alive with persistent toxicity 22.9 months after its onset; the other patient underwent endoscopic removal of the necrotic arytenoid and he is alive without evidence of disease or further complications more than 2 years afterwards. Patient reported outcomes (VHI) will be presented as well. CONCLUSION SBRT to 36/30 Gy in 3 fractions is highly effective in controlling T1 true vocal cord carcinoma, but necrosis, though mostly transient, is a concern. Based on the present results, a reduction in total doses is justified and a novel phase II study is ongoing.
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Affiliation(s)
- G Sanguineti
- Department of Research and Advanced Technology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - P D'Urso
- IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - M Bottero
- IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - A Farneti
- IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - D Giannarelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - V Landoni
- Laboratory of Medical Physics and Expert Systems, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Bottero M, Avanzolini I, Marzi S, Landoni V, Faiella A, D'Urso P, Farneti A, Facondo G, Soriani A, Sanguineti G. DCE-MRI-Based Atlas for Prostate Bed Recurrence after Radical Prostatectomy: Consistency of CTV Delineation with the Available Contouring Guidelines. Int J Radiat Oncol Biol Phys 2023; 117:e368-e369. [PMID: 37785258 DOI: 10.1016/j.ijrobp.2023.06.2465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To create a magnetic resonance image (MRI)-based atlas of prostate bed recurrence for prostate cancer patients undergoing salvage radiotherapy (sRT) after radical prostatectomy and to evaluate the consistency of contouring guidelines for the prostatic fossa clinical target volume (PF-CTV) delineation. MATERIALS/METHODS Patients with biochemical recurrence and prostate bed lesions at MRI before sRT were included. A reference patient was identified and the lesion(s) of each patient was mapped by a deformable co-registration among T2 weighted (T2w) images. The structure sets were combined to create a 3D recurrence incidence map, overlapped on T2w reference set, then transferred to the planning CT. The volume and the location of the lesions were extracted. On the reference CT, 5 PF-CTV contouring strategies were implemented: Radiation Therapy Oncology Group (RTOG); European Organization for Research and Treatment of Cancer (EORTC); Francophone Group of Urological Radiotherapy (GFRU); Faculty of Radiation Oncology Genito-urinary Group (FROGG) and Princess Margaret Hospital (PMH). Coverage was assessed after identifying the centroid of each lesion: if the centroid was included in the PF-CTV, the coverage was considered complete (fully covered-FC), otherwise uncovered (UC). The coverage was evaluated for each contouring strategy and compared with the chi-squared test; the strength of the correlation was assessed with the phi coefficient. RESULTS A total of 112 patients with 124 recurrences were identified. The lesions were located at the vesicourethral anastomosis (VUA), around the bladder neck (BN) and beyond the bladder (RV) in 63, 36 and 25 cases. Regardless the contouring strategy, 89.1% of the lesions were FC. Coverage was higher (p<0.001) for BN (95.6%) over RV (83.2%) and VUA (73.7%) lesions. FC/UC rates were 66.1%/33.9%, 83.9%/16.1%, 89.5%/10.5%, 83.1%/16.9%, 87.1%/12.9% for EORTC, FROGG, GFRU, RTOG and PMH, respectively. At pair-wise comparison, the EORTC definition had lower coverage (p<0.001) and was poorly correlated to the other strategies (phi values ranging 0.385-0.540, p <0.001). Conversely, the correlations between the other definitions were >0.700, the highest between PMH-FROG (0.812, p<0.001). After selecting VUA lesions only (N = 63), the probability of FC was 60.3%, 74.6%, 82.5%, 71.4% and 79.4% for EORTC, FROGG, GFRU, RTOG and PMH, respectively. The EORTC definition performed poorly than GFRU (p = 0.006) and PMH (p = 0.020). When considering lesions above the VUA (N = 61), the performance improved (FC: 72.1%, 93.4%, 96.7%, 95.1% and 95.1% for EORTC, FROGG, GFRU, RTOG and PMH, respectively) but the EORTC was significantly less covering and its correlation with the others was ≤ 0.1. CONCLUSION According to the criterium of coverage our data do not support the use of the EORTC definition. Here we provide an MRI-based atlas of prostatic bed recurrence that can optimize sRT contours.
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Affiliation(s)
- M Bottero
- IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - I Avanzolini
- Medical Physics Laboratory, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - S Marzi
- Medical Physics Laboratory, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - V Landoni
- Laboratory of Medical Physics and Expert Systems, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - A Faiella
- Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - P D'Urso
- IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - A Farneti
- IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - G Facondo
- Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - A Soriani
- Laboratory of Medical Physics and Expert Systems, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - G Sanguineti
- Department of Research and Advanced Technology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Ianiro A, Infusino E, D’Andrea M, Marucci L, Farneti A, Sperati F, Cassano B, Ungania S, Soriani A. Multiple Brain Metastases Radiosurgery with CyberKnife Device: Dosimetric Comparison between Fixed/Iris and Multileaf Collimator Plans. J Med Phys 2023; 48:120-128. [PMID: 37576098 PMCID: PMC10419749 DOI: 10.4103/jmp.jmp_82_22] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose In our institution, stereotactic radiosurgery of multiple brain metastases is performed with the CyberKnife® (CK) device, using fixed/Iris collimators. In this study, nineteen fixed/Iris plans were recalculated with the multileaf collimator (MLC), to assess if it is possible to produce plans with comparable dosimetric overall quality. Materials and Methods For consistent comparisons, MLC plans were re-optimized and re-normalized in order to achieve the same minimum dose for the total planning target volume (PTVtot). Conformation number (CN), homogeneity index (HI) and dose gradient index (DGI) metrics were evaluated. The dose to the brain was evaluated as the volume receiving 12 Gy (V12) and as the integral dose (ID). The normal tissue complication probability (NTCP) for brain radionecrosis was calculated as a function of V12. Results The reoptimized plans were reviewed by the radiation oncologist and were found clinically acceptable according to the The American Association of Physicists in Medicine (AAPM) Task Group-101 protocol. However, fixed/Iris plans provided significantly higher CN (+8.6%), HI (+2.2%), and DGI (+44.0%) values, and significantly lower ID values (-35.9%). For PTVtot less than the median value of 2.58cc, fixed/Iris plans provided significantly lower NTCP values. On the other side, MLC plans provided significantly lower treatment times (-18.4%), number of monitor units (-33.3%), beams (-46.0%) and nodes (-21.3%). Conclusions CK-MLC plans for the stereotactic treatment of brain multi metastases could provide an important advantage in terms of treatment duration. However, to contain the increased risk for brain radionecrosis, it could be useful to calculate MLC plans only for patients with large PTVtot.
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Affiliation(s)
- Anna Ianiro
- Department of Medical Physics, IRCCS Regina Elena National Cancer Institute – IFO, Rome, Italy
| | - Erminia Infusino
- Department of Medical Physics, IRCCS Regina Elena National Cancer Institute – IFO, Rome, Italy
| | - Marco D’Andrea
- Department of Medical Physics, IRCCS Regina Elena National Cancer Institute – IFO, Rome, Italy
| | - Laura Marucci
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute – IFO, Rome, Italy
| | - Alessia Farneti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute – IFO, Rome, Italy
| | - Francesca Sperati
- Department of Biostatistics and Bioinformatics, Clinical Trial Center, IRCCS San Gallicano Dermatological Institute – IFO, Rome, Italy
| | - Bartolomeo Cassano
- Department of Medical Physics, IRCCS Regina Elena National Cancer Institute – IFO, Rome, Italy
| | - Sara Ungania
- Department of Medical Physics, IRCCS Regina Elena National Cancer Institute – IFO, Rome, Italy
| | - Antonella Soriani
- Department of Medical Physics, IRCCS Regina Elena National Cancer Institute – IFO, Rome, Italy
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Dionisi F, Di Rito A, Errico A, Iaccarino G, Farneti A, D'Urso P, Nardangeli A, Bambace S, D'Onofrio I, D'Angelo E, De Felice F, Fanetti G, Belgioia L, Alterio D, Orlandi E, Merlotti A, Musio D, Sanguineti G. Nasopharyngeal cancer: the impact of guidelines and teaching on radiation target volume delineation. Radiol Med 2023; 128:362-371. [PMID: 36877421 DOI: 10.1007/s11547-023-01612-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/16/2023] [Indexed: 03/07/2023]
Abstract
Target volume delineation in the radiation treatment of nasopharyngeal cancer is challenging due to several reasons such as the complex anatomy of the site, the need for the elective coverage of definite anatomical regions, the curative intent of treatment and the rarity of the disease, especially in non-endemic areas. We aimed to analyze the impact of educational interactive teaching courses on target volume delineation accuracy between Italian radiation oncology centers. Only one contour dataset per center was admitted. The educational course consisted in three parts: (1) The completely anonymized image dataset of a T4N1 nasopharyngeal cancer patient was shared between centers before the course with the request of target volume and organs at risk delineation; (2) the course was held online with dedicated multidisciplinary sessions on nasopharyngeal anatomy, nasopharyngeal cancer pattern of diffusion and on the description and explanation of international contouring guidelines. At the end of the course, the participating centers were asked to resubmit the contours with appropriate corrections; (3) the pre- and post-course contours were analyzed and quantitatively and qualitatively compared with the benchmark contours delineated by the panel of experts. The analysis of the 19 pre- and post-contours submitted by the participating centers revealed a significant improvement in the Dice similarity index in all the clinical target volumes (CTV1, CTV2 and CTV3) passing from 0.67, 0.51 and 0.48 to 0.69, 0.65 and 0.52, respectively. The organs at risk delineation was also improved. The qualitative analysis consisted in the evaluation of the inclusion of the proper anatomical regions in the target volumes; it was conducted following internationally validated guidelines of contouring for nasopharyngeal radiation treatment. All the sites were properly included in target volume delineation by >50% of the centers after correction. A significant improvement was registered for the skull base, the sphenoid sinus and the nodal levels. These results demonstrated the important role that educational courses with interactive sessions could have in such a challenging task as target volume delineation in modern radiation oncology.
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Affiliation(s)
- Francesco Dionisi
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
| | - Alessia Di Rito
- Radiation Oncology Unit, Hospital "Mons. A.R. Dimiccoli", Barletta, Italy
| | - Angelo Errico
- Radiation Oncology Unit, Hospital "Mons. A.R. Dimiccoli", Barletta, Italy
| | - Giuseppe Iaccarino
- Laboratory of Medical Physics and Expert Systems, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessia Farneti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Pasqualina D'Urso
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessia Nardangeli
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Santa Bambace
- Radiation Oncology Unit, Hospital "Mons. A.R. Dimiccoli", Barletta, Italy
| | - Ida D'Onofrio
- Unit of Radiation Oncology, Ospedale del Mare, Naples, Italy
| | - Elisa D'Angelo
- Department of Radiation Oncology, University Hospital of Modena, Modena, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Giuseppe Fanetti
- Division of Radiotherapy, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Liliana Belgioia
- Department of Radiation Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Science (DISSAL), University of Genoa, Genoa, Italy
| | - Daniela Alterio
- Division of Radiation Oncology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Ester Orlandi
- Radiation Oncology, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Anna Merlotti
- Department of Radiation Oncology, S. Croce and Carle Teaching Hospital, Cuneo, Italy
| | - Daniela Musio
- Department of Radiotherapy, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Farneti A, Bottero M, Faiella A, Giannarelli D, Bertini L, Landoni V, Vici P, D’Urso P, Sanguineti G. The Prognostic Value of DCE-MRI Findings before Salvage Radiotherapy after Radical Prostatectomy. Cancers (Basel) 2023; 15:cancers15041246. [PMID: 36831588 PMCID: PMC9954112 DOI: 10.3390/cancers15041246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND To investigate the predictive role of dynamic contrast-enhanced-magnetic resonance imaging (DCE-MRI) findings before salvage radiotherapy after radical prostatectomy (RP). METHODS This retrospective study selected patients with biochemical failure (BF) after RP restaged with DCE-MRI. Patients underwent sRT in 30 fractions delivering 66-69 Gy and 73.5 Gy to the prostatic fossa and to the local failure as per DCE-MRI, respectively. Pelvic nodes were treated to 54 Gy in selected patients. The endpoint was BF after sRT. RESULTS In total, 236 patients were analyzed and 146 (61.9%) had presumed local failure at DCE-MRI: 54.8%, 23.8% and 21.4% were found at the vesico-urethral anastomosis (VUA), the bladder neck and the retro-vesical space, respectively. The presence of a local failure at DCE-MRI halved the risk of BF; VUA-only location and lesion volume were independently correlated with survival without evidence of biochemical failure (bNED) at multivariable analysis. For patients with VUA-only disease up to 0.4 cc, the 4-year-bNED was 94.6% (95%CI: 80.2-98.6%) as opposed to 80.9% (95%CI: 71.6-87.4%) and 73.7% (95%CI: 63.1-81.8%) for other lesions and no macrodisease, respectively. CONCLUSIONS DCE-MRI at restaging for BF after RP provides predictive and therapeutic information. Patients with small lesions at the VUA have an excellent prognosis after sRT.
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Affiliation(s)
- Alessia Farneti
- Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Marta Bottero
- Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Adriana Faiella
- Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Diana Giannarelli
- Biostatistics, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Luca Bertini
- Radiology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Valeria Landoni
- Physics, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Patrizia Vici
- Phase IV Studies, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Pasqualina D’Urso
- Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Giuseppe Sanguineti
- Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
- Correspondence:
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Landoni V, Farneti A, Faiella A, Sanguineti G. INTER AND INTRA-FRACTION MOTION IN 3-FRACTION SBRT FOR PROSTATE CANCER: DOSE DEVIATIONS IN ORGANS AT RISK. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)02508-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Sanguineti G, Farneti A, Bottero M, Faiella A, Giannarelli D, Bertini L, D'Urso P, Landoni V. The Prognostic Value of the Size and the Sub-Site of the Local Failure at DCE-MRI before Salvage Radiotherapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1219] [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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Bottero M, Faiella A, Giannarelli D, Farneti A, D'Urso P, Bertini L, Landoni V, Vici P, Sanguineti G. A prospective study assessing the pattern of response of local disease at DCE-MRI after salvage radiotherapy for prostate cancer. Clin Transl Radiat Oncol 2022; 35:21-26. [PMID: 35516461 PMCID: PMC9065465 DOI: 10.1016/j.ctro.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 10/29/2022] Open
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D’Urso P, Farneti A, Marucci L, Marzi S, Piludu F, Vidiri A, Sanguineti G. Predictors of Outcome after (Chemo)Radiotherapy for Node-Positive Oropharyngeal Cancer: The Role of Functional MRI. Cancers (Basel) 2022; 14:cancers14102477. [PMID: 35626084 PMCID: PMC9139324 DOI: 10.3390/cancers14102477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 02/04/2023] Open
Abstract
The prognosis of a subset of patients with locally advanced oropharyngeal cancer (LA-OPC) is still poor despite improvements in patient selection and treatment. Identifying specific patient- and tumor-related factors can help to select those patients who need intensified treatment. We aimed to assess the role of historical risk factors and novel magnetic resonance imaging (MRI) biomarkers in predicting outcomes in these patients. Patients diagnosed with LA-OPC were studied with diffusion-weighted imaging (DWI) and dynamic-contrast enhanced MRI at baseline and at the 10th radiotherapy (RT) fraction. Clinical information was collected as well. The endpoint of the study was the development of disease progression, locally or distantly. Of the 97 patients enrolled, 68 were eligible for analysis. Disease progression was recorded in 21 patients (11 had loco-regional progression, 10 developed distant metastases). We found a correlation between N diameter and disease control (p = 0.02); features such as p16 status and extranodal extension only showed a trend towards statistical significance. Among perfusion MRI features, higher median values of Kep both in primary tumor (T, p = 0.016) and lymph node (N, p = 0.003) and lower median values of ve (p = 0.018 in T, p = 0.004 in N) correlated with better disease control. Kep P90 and N diameter were identified by MRMR algorithm as the best predictors of outcome. In conclusion, the association of non-invasive MRI biomarkers and patients and tumor characteristics may help in predicting disease behavior and patient outcomes in order to ensure a more customized treatment.
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Affiliation(s)
- Pasqualina D’Urso
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (A.F.); (L.M.); (G.S.)
- Correspondence:
| | - Alessia Farneti
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (A.F.); (L.M.); (G.S.)
| | - Laura Marucci
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (A.F.); (L.M.); (G.S.)
| | - Simona Marzi
- Medical Physics Laboratory, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Francesca Piludu
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (F.P.); (A.V.)
| | - Antonello Vidiri
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (F.P.); (A.V.)
| | - Giuseppe Sanguineti
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (A.F.); (L.M.); (G.S.)
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Bottero M, Faiella A, Giannarelli D, Farneti A, Bertini L, Landoni V, Vici P, Sanguineti G. OC-0766 Response of local disease at magnetic resonance after salvage radiotherapy for prostate cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02672-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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Tanzilli A, Pace A, Prosperini L, Oppido PA, Telera S, Rasile F, Farneti A, Marucci L, Villani V. Multidomain and long-term cognitive evaluation in malignant glioma patients. Future Oncol 2022; 18:1839-1848. [PMID: 35196869 DOI: 10.2217/fon-2021-0963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Aim: We performed longitudinal evaluations of the neurocognitive status in glioma patients to describe possible variations over the course of illness. Materials and methods: Glioma patients underwent a complete battery of standardized neuropsychological tests pre-radiotherapy at 6, 12 and 24 months. Results: We enrolled 130 patients, 67.7% of whom had a deficit in at least one cognitive domain. The most affected domains included executive function (n = 68, 52.3%), long-term memory (n = 46, 35.3%) and short-term memory (n = 39, 30%). At follow-up, cognitive status worsened in 31.5%, remained unchanged in 38.4% and improved in 30.1% of patients. Conclusion: This is one of few studies investigating longitudinal neurocognitive status in a wide sample of patients to monitor neuropsychological changes due to tumor progression and treatment administration.
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Affiliation(s)
- Antonio Tanzilli
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, 00144, Italy
| | - Andrea Pace
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, 00144, Italy
| | - Luca Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, Rome, 00152, Italy
| | - Piero Andrea Oppido
- Division of Neurosurgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, 00144, Italy
| | - Stefano Telera
- Division of Neurosurgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, 00144, Italy
| | - Fabrizio Rasile
- Division of Neurosurgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, 00144, Italy
| | - Alessia Farneti
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, 00144, Italy
| | - Laura Marucci
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, 00144, Italy
| | - Veronica Villani
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, 00144, Italy
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Alterio D, De Berardinis R, Augugliaro M, D’Urso P, Volpe S, Maffini F, Bruschini R, Marvaso G, Riccio S, Tagliabue M, Turturici I, Farneti A, Calabrese L, Starzynska A, Ferrari A, Zaffaroni M, Jereczek-Fossa BA, Sanguineti G, Ansarin M. Indication to postoperative radiotherapy for oral cavity squamous cell carcinoma: what’s new in the Depth of Infiltration (DOI) era? Br J Radiol 2021; 95:20210705. [DOI: 10.1259/bjr.20210705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives: The last edition of the American Joint Committee on Cancer (AJCC eighth) has introduced the depth of infiltration (DOI) as a new prognostic parameter in oral cavity squamous cell carcinomas (OCSCCs). Aim of this study is to analyze the impact of stage migration on the indication to postoperative radiotherapy (PORT). Methods: OCSCCs treated at two Institutions between 2014 and 2019 were retrieved. Per the AJCC eighth, only pT3 primarily OCSCCs were considered; availability of the pathologic specimen was a further inclusion criterion. Risk factors considered for PORT were: pT3-pT4, nodal involvement, positive/close surgical margins, perineural and lymph vascular invasion. Results: One-hundred forty-nine patients staged as pT3 AJCC eighth were included. A four-fold increase in the number of patients staged as pT3 from the seventh to the eighth AJCC was found. Stage migration to pT3 was equally due to the downstaging from former pT4 (38%) and upstaging of former pT1-pT2 (35%). Considering the former pT1-pT2 53 patients, 13 (25%) had no risk factors for PORT other than DOI. Among 25 cases with former pT1-pT2 and negative lymph nodes no additional risk factors were found in 11 (44%). Conclusion: Ninety percent of patients had at least one risk factor besides DOI and would have received PORT also according to the AJCC seventh; notably, of former pT1-pT2N0, half of them have been upstaged to pT3 in the current TNM classification. The role of PORT in this cohort of patients has not been clarified yet. Advances in knowledge: Other-than-DOI risk factors leading to PORT indication are highly prevalent in OCSSC patients classified as pT3 per the latest AJCC TNM staging system and should therefore be considered for a comprehensive oncological assessment.
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Affiliation(s)
- Daniela Alterio
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Rita De Berardinis
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Matteo Augugliaro
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Pasqualina D’Urso
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Rome, 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
| | - Fausto Maffini
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Bruschini
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Stefano Riccio
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Marta Tagliabue
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Irene Turturici
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Alessia Farneti
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Luca Calabrese
- Division of Otorhinolaryngology, "San Maurizio" Hospital, Bolzano, Italy
| | - Anna Starzynska
- Department of Oral Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Annamaria Ferrari
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, 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
| | - Giuseppe Sanguineti
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
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Masi M, Landoni V, Faiella A, Farneti A, Marzi S, Guerrisi M, Sanguineti G. Comparison of rigid and deformable coregistration between mpMRI and CT images in radiotherapy of prostate bed cancer recurrence. Phys Med 2021; 92:32-39. [PMID: 34847400 DOI: 10.1016/j.ejmp.2021.11.010] [Citation(s) in RCA: 5] [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: 08/24/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate the accuracy of rigid coregistration between multiparametric magnetic resonance (mpMR) and computed tomography (CT) images for radiotherapy of prostate bed cancer recurrence. MATERIALS AND METHOD Fifty-three patients (59 nodules) accrued in a prospective study on salvage radiotherapy for prostatic bed recurrence were suitable for the analysis. Patients underwent a pre radiotherapy mpMR exam and a planning CT in the same treatment position and with control of organ filling. The site of recurrence was delineated on mpMR images and contours transferred on planning CT images using both rigid and deformable registrations. Coregistrations were evaluated by mathematical operators that quantify deformation (Jacobian determinant and vector curl) and similarity indices (Dice and Jaccard coefficients). Dose coverage was evaluated. RESULTS Deformable registration did not change volumes, (p = 0.92 MW test). The Jacobian coefficient and the vector curl revealed no important image deformations. Dice and Jaccard coefficients indicated dislocation of the nodule volumes. Dislocation magnitude was d = (5.6 ± 3.1) mm. Organ filling was not correlated with deformation or dislocation. Volumes were covered by the 95% isodose in 96% of cases when rigid registration was performed versus 75% of cases when deformed. CONCLUSIONS Rigid image coregistration is sufficiently accurate in this setting. The results indicate that the deformable registration tends to shrink the voxels and to dislocate the ROI, the adopted expansion for the recurrence volume adequately accounts for the observed deformation and dislocation, provided that organ filling is controlled.
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Affiliation(s)
- Marica Masi
- Department of Medical Physics, IRCSS Regina Elena National Cancer Institute, Rome, Italy; Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Valeria Landoni
- Department of Medical Physics, IRCSS Regina Elena National Cancer Institute, Rome, Italy.
| | - Adriana Faiella
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessia Farneti
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - Simona Marzi
- Department of Medical Physics, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - Maria Guerrisi
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
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Alterio D, D’Urso P, Volpe S, Tagliabue M, De Berardinis R, Augugliaro M, Gandini S, Maffini FA, Bruschini R, Turturici I, Riccio S, Calabrese L, Farneti A, Starzyńska A, Ferrari A, Jereczek-Fossa BA, Ansarin M, Sanguineti G. The Impact of Post-Operative Radiotherapy in Early Stage (pT1-pT2N0M0) Oral Tongue Squamous Cell Carcinoma in Era of DOI. Cancers (Basel) 2021; 13:cancers13194851. [PMID: 34638335 PMCID: PMC8507768 DOI: 10.3390/cancers13194851] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/17/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The aim of the present study was to clarify the role of depth of infiltration (DOI) as an independent prognosticator in early stage (T1-T2N0M0) oral cavity tumors. Moreover, whether patients upstaged to pT3 for DOI > 10 mm need postoperative radiotherapy (PORT) in the absence of other risk factors has not been established yet. The DOI alone was not sufficient to impact the prognosis and therefore other risk factors should be considered to indicate PORT indications in upstaged patients due to DOI > 10 mm. Abstract Background: This study investigated the role of depth of infiltration (DOI) as an independent prognosticator in early stage (T1-T2N0M0) oral cavity tumors and to evaluate the need of postoperative radiotherapy in the case of patients upstaged to pT3 for DOI > 10 mm in the absence of other risk factors. Methods: We performed a retrospective analysis on patients treated with surgery and re-staged according to the 8th edition of malignant tumors classification (TNM). The role of DOI as well as other clinical/pathological features was investigated at both univariable and multivariable analyses on overall survival (OS), disease free survival (DFS), relapse free survival (RFS), and local RFS. Results: Among the 94 included patients, 23 would have been upstaged to pT3 based on DOI. Multivariable analysis showed that DOI was not an independent prognostic factor for any of the considered outcomes. The presence of perineural invasion was associated with a significant worse RFS (p = 0.02) and LRFS (p = 0.04). PORT was found to be significantly associated with DFS (p = 0.04) and RFS (p = 0.06). Conclusions: The increasing DOI alone was not sufficient to impact the prognosis, and therefore, should not be sufficient to dictate PORT indications in early-stage patients upstaged on the sole basis of DOI.
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Affiliation(s)
- Daniela Alterio
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (D.A.); (M.A.); (I.T.); (A.F.); (B.A.J.-F.)
| | - Pasqualina D’Urso
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (P.D.); (A.F.); (G.S.)
| | - Stefania Volpe
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (D.A.); (M.A.); (I.T.); (A.F.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Correspondence: (S.V.); (M.T.)
| | - Marta Tagliabue
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy; (R.D.B.); (R.B.); (S.R.); (M.A.)
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
- Correspondence: (S.V.); (M.T.)
| | - Rita De Berardinis
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy; (R.D.B.); (R.B.); (S.R.); (M.A.)
| | - Matteo Augugliaro
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (D.A.); (M.A.); (I.T.); (A.F.); (B.A.J.-F.)
| | - Sara Gandini
- Department of Experimental Oncology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy;
| | | | - Roberto Bruschini
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy; (R.D.B.); (R.B.); (S.R.); (M.A.)
| | - Irene Turturici
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (D.A.); (M.A.); (I.T.); (A.F.); (B.A.J.-F.)
| | - Stefano Riccio
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy; (R.D.B.); (R.B.); (S.R.); (M.A.)
| | - Luca Calabrese
- Division of Otorhinolaryngology, San Maurizio Hospital, 39100 Bolzano, Italy;
| | - Alessia Farneti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (P.D.); (A.F.); (G.S.)
| | - Anna Starzyńska
- Department of Oral Surgery, Medical University of Gdańsk, 80-211 Gdańsk, Poland;
| | - Annamaria Ferrari
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (D.A.); (M.A.); (I.T.); (A.F.); (B.A.J.-F.)
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (D.A.); (M.A.); (I.T.); (A.F.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy; (R.D.B.); (R.B.); (S.R.); (M.A.)
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (P.D.); (A.F.); (G.S.)
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Magli A, Farneti A, Faiella A, Ferriero M, Landoni V, Giannarelli D, Moretti E, de Paula U, Gomellini S, Sanguineti G. Toxicity at 1 Year After Stereotactic Body Radiation Therapy in 3 Fractions for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2021; 111:93-100. [PMID: 33745951 DOI: 10.1016/j.ijrobp.2021.03.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/20/2021] [Accepted: 03/14/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the toxicity profile of prostate cancer stereotactic body radiation therapy (SBRT) in 3 fractions. METHODS AND MATERIALS This was a prospective, multicenter phase 2 toxicity study enrolling patients with low to favorable intermediate-risk prostate cancer. Before simulation, 3 to 4 fiducial markers along with a rectal spacer were placed. The target (prostate only) was prescribed 40 Gy, whereas the maximum dose to the urethra was limited to 33 Gy with the highest priority at planning; less stringent objectives were placed on the bladder, the filling of which was controlled via a Foley catheter. Treatment was delivered every other day. Toxicity was prospectively scored with Common Terminology Criteria for Adverse Events, and several patient-reported outcomes were collected. The maximum allowed prevalence rate of grade 2+ genitourinary (GU) toxicity at 1 year was set at 15%, and the study was sized accordingly. RESULTS Between November 2015 and May 2019, 59 patients were enrolled by 3 participating institutions. Acute gastrointestinal toxicity was occasional and mild, whereas 11.9% of patients developed acute grade 2 GU toxicity and 1.7% developed acute grade 3 GU toxicity. No patient had persistent treatment-related grade 2+ GU toxicity at 12 months after SBRT; thus, the null hypothesis was rejected. We observed a clinically relevant worsening of both International Prostate Symptom Score (IPSS) and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scores at 12 months compared with baseline. Moreover, we found a strong association between all selected bladder dose/volume metrics at planning and ICIQ-SF worsening at 12 months, whereas for the IPSS, the correlation with bladder dose metrics was marginal. CONCLUSIONS The results suggest that at 12 months after treatment, the toxicity profile of SBRT in 3 fractions is acceptable.
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Affiliation(s)
- Alessandro Magli
- Radiation Oncology, Azienda Sanitaria-Universitaria Friuli Centrale, Udine, Italy
| | - Alessia Farneti
- Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Adriana Faiella
- Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Valeria Landoni
- Physics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Diana Giannarelli
- Biostatistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Eugenia Moretti
- Physics, Azienda Sanitaria-Universitaria Friuli Centrale, Udine, Italy
| | - Ugo de Paula
- Radiation Oncology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Sara Gomellini
- Radiation Oncology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Giuseppe Sanguineti
- Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
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Piludu F, Marzi S, Gangemi E, Farneti A, Marucci L, Venuti A, Benevolo M, Pichi B, Pellini R, Sperati F, Covello R, Sanguineti G, Vidiri A. Multiparametric MRI Evaluation of Oropharyngeal Squamous Cell Carcinoma. A Mono-Institutional Study. J Clin Med 2021; 10:jcm10173865. [PMID: 34501313 PMCID: PMC8432241 DOI: 10.3390/jcm10173865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/10/2021] [Accepted: 08/20/2021] [Indexed: 12/30/2022] Open
Abstract
The aim of this paper is to define the pre-treatment radiological characteristics of oropharyngeal squamous cell carcinoma (OPSCC) using morphological and non-morphological magnetic resonance imaging (MRI), based on HPV status, in a single-institution cohort. In total, 100 patients affected by OPSCC were prospectively enrolled in the present study. All patients underwent 1.5T MR with standard sequences, including diffusion-weighted imaging with and intravoxel incoherent motion (IVIM-DWI) technique and a dynamic contrast-enhanced (DCE) MRI. For all patients, human papillomavirus (HPV) status was available. No statistically significant differences in the volume of primary tumors (PTs) and lymph nodes (LNs) were observed based on HPV status. When comparing the two patient groups, no significant differences were found for the PT radiologic characteristics (presence of well-defined borders, exophytic growth, ulceration, and necrosis) and LN morphology (solid/cystic/necrotic). Tumor subsite, smoking status, and alcohol intake significantly differed based on HPV status, as well as ADC and Dt values of both PTs and LNs. We detected no significant difference in DCE-MRI parameters by HPV status. Based on a multivariate logistic regression model, the combination of clinical factors, such as tumor subsite and alcohol habits, with the perfusion-free diffusion coefficient Dt of LNs, may help to accurately discriminate OPSCC by HPV status.
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Affiliation(s)
- Francesca Piludu
- Department of Radiology and Diagnostic Imaging, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (F.P.); (E.G.)
| | - Simona Marzi
- Medical Physics Laboratory, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy;
| | - Emma Gangemi
- Department of Radiology and Diagnostic Imaging, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (F.P.); (E.G.)
- Center for Integrated Research, Departmental Faculty of Medicine and Surgery, University Campus Bio-Medico of Rome, Via Álvaro del Portillo, 33, 00128 Rome, Italy
| | - Alessia Farneti
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (A.F.); (L.M.); (G.S.)
| | - Laura Marucci
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (A.F.); (L.M.); (G.S.)
| | - Aldo Venuti
- HPV Unit (UOSD), Department of Tumor Immunology and Immunotherapy, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy;
| | - Maria Benevolo
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (M.B.); (R.C.)
| | - Barbara Pichi
- Department of Otolaryngology and Head and Neck Surgery, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (B.P.); (R.P.)
| | - Raul Pellini
- Department of Otolaryngology and Head and Neck Surgery, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (B.P.); (R.P.)
| | - Francesca Sperati
- Biostatistics-Scientific Direction, IRCCS San Gallicano Dermatological Institute, Via Elio Chianesi 53, 00144 Rome, Italy;
| | - Renato Covello
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (M.B.); (R.C.)
| | - Giuseppe Sanguineti
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (A.F.); (L.M.); (G.S.)
| | - Antonello Vidiri
- Department of Radiology and Diagnostic Imaging, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (F.P.); (E.G.)
- Correspondence: ; Tel.: +39-335-547-6057
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Abstract
Purpose The purpose of this study is to evaluate inter- and intra-fraction organ motion as well as to quantify clinical target volume (CTV) to planning target volume (PTV) margins to be adopted in the stereotactic treatment of early stage glottic cancer. Methods and materials Stereotactic body radiotherapy (SBRT) to 36 Gy in 3 fractions was administered to 23 patients with early glottic cancer T1N0M0. Patients were irradiated with a volumetric intensity modulated arc technique delivered with 6 MV FFF energy. Each patient underwent a pre-treatment cone beam computed tomography (CBCT) to correct the setup based on the thyroid cartilage position. Imaging was repeated if displacement exceeded 2 mm in any direction. CBCT imaging was also performed after each treatment arc as well as at the end of the delivery. Swallowing was allowed only during the beam-off time between arcs. CBCT images were reviewed to evaluate inter- and intra-fraction organ motion. The relationships between selected treatment characteristics, both beam-on and delivery times as well as organ motion were investigated. Results For the population systematic (Ʃ) and random (σ) inter-fraction errors were 0.9, 1.3 and 0.6 mm and 1.1, 1.3 and 0.7 mm in the left-right (X), cranio-caudal (Y) and antero-posterior (Z) directions, respectively. From the analysis of CBCT images acquired after treatment, systematic (Ʃ) and random (σ) intra-fraction errors resulted 0.7, 1.6 and 0.7 mm and 1.0, 1.5 and 0.6 mm in the X, Y and Z directions, respectively. Margins calculated from the intra-fraction errors were 2.4, 5.1 and 2.2 mm in the X, Y and Z directions respectively. A statistically significant difference was found for the displacement in the Z direction between patients irradiated with > 2 arcs versus ≤ 2 arcs, (MW test, p = 0.038). When analyzing mean data from CBCT images for the whole treatment, a significant correlation was found between the time of delivery and the three dimensional displacement vector (r = 0.489, p = 0.055), the displacement in the Y direction (r = 0.553, p = 0.026) and the subsequent margins to be adopted (r = 0.626, p = 0.009). Finally, displacements and the subsequent margins to be adopted in Y direction were significantly greater for treatments with more than 2 arcs (MW test p = 0.037 and p = 0.019, respectively). Conclusions In the setting of controlled swallowing during treatment delivery, intra-fraction motion still needs to be taken into account when planning with estimated CTV to PTV margins of 3, 5 and 3 mm in the X, Y and Z directions, respectively. Selected treatments may require additional margins.
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Affiliation(s)
- Annarita Perillo
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - Valeria Landoni
- Department of Medical Physics, IRCSS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Alessia Farneti
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
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Sanguineti G, Giannarelli D, Faiella A, Bottero M, Farneti A, Bertini L, Rea S, Landoni V, Ferriero M, Sciuto R. A prospective study assessing the post-prostatectomy detection rate of a presumed local failure at mpMR with 18F-choline, 64Cu-Cl2 or 64Cu-PSMA PET/CT. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01543-8] [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: 10/20/2022]
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Sanguineti G, Pellini R, Vidiri A, Marzi S, D'Urso P, Terrenato I, Farneti A, Fuga V, Ungania S, Landoni V. Stereotactic body radiotherapy for T1 glottic cancer: dosimetric data in 27 consecutive patients. Tumori 2021; 107:514-524. [PMID: 33821713 DOI: 10.1177/03008916211000440] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM Because the clinical feasibility of stereotactic body radiotherapy (SBRT) for early glottic cancer (T1) is controversial, we report dosimetric results in 27 consecutive patients from a prospective phase I and II study that started in 2017. METHODS In our approach, only the parts of the true vocal cord containing cancer and those immediately adjacent are planned to be treated to 36 Gy and 30 Gy, respectively, in 3 fractions. Several dosimetric metrics for both target volumes and organs at risk were extracted from individual plans and results were compared to those achieved by other authors in a similar setting. RESULTS Proper coverage was reached at planning in 2/3 of planning treatment volume 30 Gy, but only 4 planning treatment volume 36 Gy; conversely, the maximum dose objective was met for most of the patients on either arytenoid cartilage, but this was not the case for 51.9% and 96.3% of cricoid and thyroid cartilages, respectively. Our dosimetric results are similar to if not better than those achieved by others. CONCLUSION SBRT in 3 fractions for T1 glottic lesions is dosimetrically challenging. Clinical validation is awaited.
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Affiliation(s)
- Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Raul Pellini
- Department of Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Antonello Vidiri
- Department of Radiology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Simona Marzi
- Department of Physics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Pasqualina D'Urso
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Irene Terrenato
- Department of Statistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessia Farneti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Valentina Fuga
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Sara Ungania
- Department of Physics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Valeria Landoni
- Department of Physics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Donzelli S, Farneti A, Marucci L, Ganci F, Sacconi A, Strano S, Sanguineti G, Blandino G. Non-coding RNAs as Putative Biomarkers of Cancer-Associated Cachexia. Front Cell Dev Biol 2020; 8:257. [PMID: 32373612 PMCID: PMC7187787 DOI: 10.3389/fcell.2020.00257] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/27/2020] [Indexed: 01/06/2023] Open
Abstract
Cachexia is a complex metabolic syndrome that determines a severe body weight loss characterized by a marked reduction in muscle mass. About 80% of patients with advanced cancer develop cachexia due to both the tumor itself and cancer treatment (radiotherapy and/or chemotherapy), which is associated to a worse prognosis. Despite its clinical relevance, this syndrome is still under-diagnosed and it lacks effective treatments. Radio-chemotherapy treatment is essential in patients with advanced head and neck cancers (HNSCC). Although this treatment has improved patients' life expectancy, it has also dramatically increased their need for assistance and support. The management of adverse symptoms, including cachexia, is of great importance in order to avoid delays in therapy, reduction of dosages and hospitalizations. MicroRNAs (miRNAs) are small non-coding RNA molecules, which have emerged as powerful biomarkers in stratifying human cancers. Due to their high stability in body fluids, miRNAs might be excellent non-invasive biomarkers for the early detection and follow-up of cancer patients. Here, we will summarize the current knowledge and debate the strong need to identify circulating biomarkers for the early diagnosis of cachexia. We will propose circulating non-coding RNAs as biomarkers for detecting early cachexia and implementing specific treatment. We will also discuss the potential use of circulating miRNAs as biomarkers of cachexia in HNSCC patients' blood samples collected before and after radio-chemotherapy treatment. Our intent is to pave the way to the identification of specific circulating miRNAs associated to cachexia occurrence and to the design of specific interventions aimed at improving the quality of life of cancer patients.
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Affiliation(s)
- Sara Donzelli
- Oncogenomic and Epigenetic Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessia Farneti
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Marucci
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Federica Ganci
- Oncogenomic and Epigenetic Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Andrea Sacconi
- UOSD Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Sabrina Strano
- SAFU Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giovanni Blandino
- Oncogenomic and Epigenetic Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Sanguineti G, Bertini L, Faiella A, Ferriero MC, Marzi S, Farneti A, Landoni V. Response on DCE-MRI predicts outcome of salvage radiotherapy for local recurrence after radical prostatectomy. Tumori 2020; 107:55-63. [PMID: 32180511 DOI: 10.1177/0300891620908950] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the predictive role of response on dynamic contrast enhancement on magnetic resonance imaging (DCE-MRI) of visible local lesions in the setting of salvage radiotherapy (sRT) after radical prostatectomy. METHODS All patients referred for sRT for biochemical failure after radical prostatectomy from February 2014 to September 2016 were considered eligible if they had been restaged with DCE-MRI and had been found to have a visible lesion in the prostatic bed, but no distant/nodal disease on choline positron emission tomography (PET)-computed tomography (CT). Eligible patients were contacted during follow-up and offered reimaging with serial DCE-MRI until lesion resolution. Complete response (CR) was defined as the disappearance of the target lesion on DCE-MRI; prostate-specific antigen (PSA) recurrence was defined as a 0.2 ng/mL PSA rise above the nadir. Median follow-up after sRT was 41.5 months (range, 12.1-61.2 months). RESULTS Fifty-nine patients agreed to undergo repeated DCE-MRI for a total of 64 studied lesions. Overall, 57 lesions (89.1%) showed a CR after 1 (51 patients) or 2 (6 patients) scans, while 7 lesions did not show any change (no response [NR]). At 42 months, no evidence of biochemical disease (bNED) survival was 74.7±6.4% and 64.3±21.0% for patients with CR and NR lesions, respectively (hazard ratio [HR], 3.181; 95% confidence interval [CI], 0.157-64.364; p = 0.451). When only patients treated with sRT without androgen deprivation were selected (n = 41), bNED survival rates at 42 months were 72.1±8.0% and 0, respectively (HR, 52.830; 95% CI, 1.893-1474.110; p = 0.020). CONCLUSIONS Patients whose lesions disappear during follow-up have a better outcome than those with unchanged lesions after sRT alone.
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Affiliation(s)
- Giuseppe Sanguineti
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - Luca Bertini
- Department of Radiology and Diagnostic Imaging, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - Adriana Faiella
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Simona Marzi
- Medical Physics, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessia Farneti
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - Valeria Landoni
- Medical Physics, IRCSS Regina Elena National Cancer Institute, Rome, Italy
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Vidiri A, Gangemi E, Ruberto E, Pasqualoni R, Sciuto R, Sanguineti G, Farneti A, Benevolo M, Rollo F, Sperati F, Spasiano F, Pellini R, Marzi S. Correlation between histogram-based DCE-MRI parameters and 18F-FDG PET values in oropharyngeal squamous cell carcinoma: Evaluation in primary tumors and metastatic nodes. PLoS One 2020; 15:e0229611. [PMID: 32119697 PMCID: PMC7051076 DOI: 10.1371/journal.pone.0229611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/10/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To investigate the correlation between histogram-based Dynamic Contrast-Enhanced magnetic resonance imaging (DCE-MRI) parameters and positron emission tomography with 18F-fluorodeoxyglucose (18F-FDG-PET) values in oropharyngeal squamous cell carcinoma (OPSCC), both in primary tumors (PTs) and in metastatic lymph nodes (LNs). METHODS 52 patients with a new pathologically-confirmed OPSCC were included in the present retrospective cohort study. Imaging including DCE-MRI and 18F-FDG PET/CT scans were acquired in all patients. Both PTs and the largest LN, if present, were volumetrically contoured. Quantitative parameters, including the transfer constants, Ktrans and Kep, and the volume of extravascular extracellular space, ve, were calculated from DCE-MRI. The percentiles (P), P10, P25, P50, P75, P90, and skewness, kurtosis and entropy were obtained from the histogram-based analysis of each perfusion parameter. Standardized uptake values (SUV), SUVmax, SUVpeak, SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were calculated applying a SUV threshold of 40%. The correlations between all variables were investigated with the Spearman-rank correlation test. To exclude false positive results under multiple testing, the Benjamini-Hockberg procedure was applied. RESULTS No significant correlations were found between any parameters in PTs, while significant associations emerged between Ktrans and 18F-FDG PET parameters in LNs. CONCLUSIONS Evident relationships emerged between DCE-MRI and 18F-FDG PET parameters in OPSCC LNs, while no association was found in PTs. The complex relationships between perfusion and metabolic biomarkers should be interpreted separately for primary tumors and lymph-nodes. A multiparametric approach to analyze PTs and LNs before treatment is advisable in head and neck squamous cell carcinoma (HNSCC).
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Affiliation(s)
- Antonello Vidiri
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Emma Gangemi
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- Departmental Faculty of Medicine and Surgery, Center for Integrated Research, University Campus Bio-Medico of Rome, Rome, Italy
- * E-mail:
| | - Emanuela Ruberto
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Rosella Pasqualoni
- Department of Nuclear Medicine, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Rosa Sciuto
- Department of Nuclear Medicine, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessia Farneti
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maria Benevolo
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Rollo
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Sperati
- Biostatistics-Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Filomena Spasiano
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Raul Pellini
- Department of Otolaryngology & Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Simona Marzi
- Medical Physics Laboratory, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Sanguineti G, Faiella A, Farneti A, D'Urso P, Fuga V, Olivieri M, Giannarelli D, Marzi S, Iaccarino G, Landoni V. Refinement & validation of rectal wall dose volume objectives for prostate hypofractionation in 20 fractions. Clin Transl Radiat Oncol 2020; 21:91-97. [PMID: 32072030 PMCID: PMC7015822 DOI: 10.1016/j.ctro.2020.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/25/2020] [Accepted: 01/29/2020] [Indexed: 02/07/2023] Open
Abstract
LRB was correlated to irradiation technique and several % rectal wall cut points. The predictive role of dosimetric variables relates to the irradiation technique. Dose volume objectives for patients treated with IMRT/VMAT are reported.
Background and purpose Dose-volume objectives for the rectum have been proposed to limit long term toxicity after moderately hypofractionated radiotherapy (MHRT) for localized prostate cancer. The purpose of the present study is to validate and possibly refine dose volume objective for the rectal wall after 20-fraction MHRT. Materials and methods All patients treated by 20-fraction MHRT at a single Institution were identified and relative rectal wall (%RW) DVH retrieved. The endpoint of the study is the development of grade 2+ late rectal bleeding (LRB) according to a modified RTOG scale. Clinical and dosimetric predictors of LRB were investigated at both uni- and multi-variable analysis. Results 293 patients were identified and analyzed. Of them, 35 (12%) developed the endpoint. At univariable analysis, antithrombotic drug usage (yes vs no), technique (3DCRT vs IMRT/VMAT) and several %RW DVH cut-points were significantly correlated with LRB. However, within patients treated by 3DCRT (N = 106), a bi-variable model including anti-thrombotic drug usage and selected %RW dose/volume metrics failed to identify independent dosimetric predictors of LRB. Conversely, within patients treated with intensity modulation (N = 187), the same model showed a progressively higher impact of the percent of RW receiving doses above 40 Gy. Based on this model, we were able to confirm (V32), refine (V60) and identify a novel (V50) cut-point for the %RW. Conclusion We recommend the following dose volume objectives for the %RW in order to minimize the risk of LRB after 20-fraction MHRT: V32 ≤ 50%; V50 ≤ 25.8% and V60 ≤ 10%.
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Affiliation(s)
- Giuseppe Sanguineti
- Departments of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- Corresponding author at: Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy.
| | - Adriana Faiella
- Departments of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessia Farneti
- Departments of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Pasqualina D'Urso
- Departments of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Valentina Fuga
- Departments of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Michela Olivieri
- Departments of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Diana Giannarelli
- Departments of Statistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Simona Marzi
- Departments of Physics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Iaccarino
- Departments of Physics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Valeria Landoni
- Departments of Physics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Bergamini C, Cavalieri S, Sanguineti G, Farneti A, Licitra L. Treatment of HER2+ metastatic salivary ductal carcinoma in a pregnant woman: a case report. Oxf Med Case Reports 2019; 2019:omz102. [PMID: 31772741 PMCID: PMC6822604 DOI: 10.1093/omcr/omz102] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/13/2019] [Accepted: 08/28/2019] [Indexed: 11/12/2022] Open
Abstract
Salivary duct carcinoma (SDC) is a rare and aggressive malignancy with a high mortality and poor response to treatment in the advanced setting. Human epidermal growth factor 2 (HER2) can be amplified in a fraction of SDC. We describe the case of HER2+ metastatic SDC of the submandibular gland in a young pregnant woman treated by multimodal treatment (chemotherapy, radiotherapy and targeted therapy). During pregnancy, a 27-year-old woman developed SDC of the left submandibular gland with lung and bone metastases. Given the HER2 overexpression, she was treated with trastuzumab, paclitaxel and cisplatin. Since the tumor had arisen during pregnancy, triptorelin was administered after delivery. A complete remission was observed, and after eight cycles of chemotherapy, radiotherapy was started in association with trastuzumab and triptorelin. A prolonged disease control and complete visceral remission were observed. Multimodal therapy based on patient’s tumor characteristics showed good clinical efficacy in the treatment of metastatic SDC.
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Affiliation(s)
- Cristiana Bergamini
- Head & Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Cavalieri
- Head & Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology IRCCS Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - Alessia Farneti
- Department of Radiation Oncology IRCCS Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - Lisa Licitra
- Head & Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Vidiri A, Marzi S, Gangemi E, Benevolo M, Rollo F, Farneti A, Marucci L, Spasiano F, Sperati F, Di Giuliano F, Pellini R, Sanguineti G. Intravoxel incoherent motion diffusion-weighted imaging for oropharyngeal squamous cell carcinoma: Correlation with human papillomavirus Status. Eur J Radiol 2019; 119:108640. [DOI: 10.1016/j.ejrad.2019.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/17/2019] [Accepted: 08/11/2019] [Indexed: 01/04/2023]
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Sanguineti G, Giannarelli D, Petrongari MG, Arcangeli S, Sangiovanni A, Saracino B, Farneti A, Faiella A, Conte M, Arcangeli G. Leukotoxicity after moderately Hypofractionated radiotherapy versus conventionally fractionated dose escalated radiotherapy for localized prostate Cancer: a secondary analysis from a randomized study. Radiat Oncol 2019; 14:23. [PMID: 30700317 PMCID: PMC6352380 DOI: 10.1186/s13014-019-1223-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/04/2018] [Accepted: 01/20/2019] [Indexed: 11/29/2022] Open
Abstract
Background To compare WBC counts during treatment of localized prostate cancer with either conventionally fractionated (CF) or moderately hypofractionated (HYPO) radiotherapy. Methods Weekly blood test results were extracted from the charts of patients treated within a phase III study comparing HYPO to CF. In order to compare WBC counts at the same nominal dose in both arms and thus to tease out the effect of fractionation, for each recorded WBC value the corresponding cumulative total dose was extracted as well. WBC counts were binned according to percentiles of the delivered dose and three dose levels were identified at median doses of 16, 34.1 and 52 Gy, respectively. A General Linear Model based on mixed design Analysis Of Variance (ANOVA) was used to test variation of WBC counts between the two treatment arms. Results Out of 168 randomized patients, 140 (83.3%) had at least one observation for each one of the selected dose levels and were included in the analysis. Mean counts were lower in the CF than the HYPO arm at all selected dose levels, reaching a statistically significant difference at dose level #3 (5397/mm3 vs 6038/mm3 for CF and HYPO, respectively, p = 0.004). The GLM model confirms that the impact of dose on WBC counts is significantly lower in the HYPO arm over the CF one (Greenhouse-Geisser test, p = 0.04). Interestingly, while WBC counts tend to drop throughout all dose levels in the CF arm, this is the case only in the earlier part of treatment in the HYPO arm. Conclusion This secondary analysis of a phase III study shows that dose fractionation is correlated to WBC drop during treatment of localized prostate cancer, favoring HYPO over CF. Electronic supplementary material The online version of this article (10.1186/s13014-019-1223-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Diana Giannarelli
- Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maria Grazia Petrongari
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Stefano Arcangeli
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Angelo Sangiovanni
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Biancamaria Saracino
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Alessia Farneti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Adriana Faiella
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Mario Conte
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Giorgio Arcangeli
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
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Landoni V, Faiella A, Marzi S, Farneti A, Petrongari M, Saracino B, Bertini L, Spasiano F, Sanguineti G. The Predictive Role of Multiparametric MR imaging after Salvage Radiation Therapy for Local Failure after Radical Prostatectomy. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Marzi S, Farneti A, Vidiri A, Di Giuliano F, Marucci L, Spasiano F, Terrenato I, Sanguineti G. Radiation-induced parotid changes in oropharyngeal cancer patients: the role of early functional imaging and patient-/treatment-related factors. Radiat Oncol 2018; 13:189. [PMID: 30285893 PMCID: PMC6167883 DOI: 10.1186/s13014-018-1137-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 04/23/2018] [Accepted: 09/24/2018] [Indexed: 02/08/2023] Open
Abstract
Background Functional magnetic resonance imaging may provide several quantitative indices strictly related to distinctive tissue signatures with radiobiological relevance, such as tissue cellular density and vascular perfusion. The role of Intravoxel Incoherent Motion Diffusion Weighted Imaging (IVIM-DWI) and Dynamic Contrast-Enhanced (DCE) MRI in detecting/predicting radiation-induced volumetric changes of parotids both during and shortly after (chemo)radiotherapy of oropharyngeal squamous cell carcinoma (SCC) was explored. Methods Patients with locally advanced oropharyngeal SCC were accrued within a prospective study offering both IVIM-DWI and DCE-MRI at baseline; IVIM-DWI was repeated at the 10th fraction of treatment. Apparent diffusion coefficient (ADC), tissue diffusion coefficient Dt, perfusion fraction f and perfusion-related diffusion coefficient D* were estimated both at baseline and during RT. Semi-quantitative and quantitative parameters, including the transfer constant Ktrans, were calculated from DCE-MRI. Parotids were contoured on T2-weighted images at baseline, 10th fraction and 8th weeks after treatment end and the percent change of parotid volume between baseline/10th fr (∆Vol10fr) and baseline/8th wk. (∆Volpost) computed. Correlations among volumetric changes and patient-, treatment- and imaging-related features were investigated at univariate analysis (Spearman’s Rho). Results Eighty parotids (40 patients) were analyzed. Percent changes were 18.2 ± 10.7% and 31.3 ± 15.8% for ∆Vol10fr and ∆Volpost, respectively. Among baseline characteristics, ∆Vol10fr was correlated to body mass index, patient weight as well as the initial parotid volume. A weak correlation was present between parotid shrinkage after the first 2 weeks of treatment and dosimetric variables, while no association was found after radiotherapy. Percent changes of both ADC and Dt at the 10th fraction were also correlated to ∆Vol10fr. Significant relationships were found between ∆Volpost and baseline DCE-MRI parameters. Conclusions Both IVIM-DWI and DCE-MRI can help to detect/predict early (during treatment) and shortly after treatment completion the parotid shrinkage. They may contribute to clarify the correlations between volumetric changes of parotid glands and patient−/treatment-related variables by assessing individual microcapillary perfusion and tissue diffusivity. Electronic supplementary material The online version of this article (10.1186/s13014-018-1137-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Simona Marzi
- Medical Physics Laboratory, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Alessia Farneti
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Antonello Vidiri
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Francesca Di Giuliano
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.,Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Laura Marucci
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Filomena Spasiano
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Irene Terrenato
- Biostatistics-Scientific Direction, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
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Pinnarò P, Giordano C, Farneti A, Faiella A, Iaccarino G, Landoni V, Giannarelli D, Vici P, Strigari L, Sanguineti G. Short course hypofractionated whole breast irradiation after conservative surgery: a single institution phase II study. J Exp Clin Cancer Res 2017; 36:191. [PMID: 29282078 PMCID: PMC5744389 DOI: 10.1186/s13046-017-0640-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 11/16/2017] [Indexed: 01/14/2023]
Abstract
Background To assess the oncologic outcomes of hypofractionated whole breast irradiation (Hypo-WBI). Methods Eligible patients had undergone breast conservative surgery for early breast cancer (pTis-2) and none/limited nodal involvement. Hypo-WBI consisted of 34 Gy in 10 daily fractions over 2 weeks to the whole breast three-dimensional conformal radiotherapy (3DCRT), followed by a single fraction of 8 Gy to the tumor bed after 1 week (electrons). Primary endpoint is freedom from ipsilateral breast tumor recurrence (IBTR). Minimum follow up for living & event-free patients is 3 yrs.; median follow up time of the whole analyzed patient population is 5.4 yrs. (range: 1.8–11.4 yrs). Results Two hundred fifty-one patients were accrued from 2004 to 2013. All patients underwent local excision of the primary tumor to negative margins. Four patients failed in the ipsilateral breast after a median time of 3.2 years (range: 1.7–5.7 yrs) for a 5-year IBTR-free survival of 98.7% (95%CI: 97.3%–100%). IBTR-free survival was significantly higher for patients with invasive cancer than for patients with intraductal carcinoma (p = 0.036). Within patients with invasive tumors, no clear trends or associations were detected between IBTR and age, grading, molecular subtype, pT or pN stage. At 5 years, the actuarial rates of GR2 fibrosis and GR2+ teleangectasia are 2.4% (95%CI: 0–6.5%) and 7.1% (95%CI: 0.4–13.7%), respectively. Cosmesis was scored as excellent/good by ≈95% of patients and ≈60% of clinicians. Conclusions Hypo-WBI in 3 weeks allows excellent oncologic outcomes for invasive breast cancer after conservative surgery. Patients with intraductal carcinoma should be treated with Hypo-WBI only within a controlled study. Trial registration IRE-IFO Ethical and Scientific Committee (cod. RS61/04).
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Affiliation(s)
- Paola Pinnarò
- Departments of Radiation Oncology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Carolina Giordano
- Departments of Radiation Oncology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Alessia Farneti
- Departments of Radiation Oncology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Adriana Faiella
- Departments of Radiation Oncology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Giuseppe Iaccarino
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy
| | - Valeria Landoni
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy
| | - Diana Giannarelli
- Departments of Statistics, Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Departments of Clinical Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Lidia Strigari
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Departments of Radiation Oncology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
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Marucci L, Farneti A, Di Ridolfi P, Pinnaro P, Pellini R, Giannarelli D, Vici P, Conte M, Landoni V, Sanguineti G. Double-blind randomized phase III study comparing a mixture of natural agents versus placebo in the prevention of acute mucositis during chemoradiotherapy for head and neck cancer. Head Neck 2017; 39:1761-1769. [DOI: 10.1002/hed.24832] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/09/2017] [Accepted: 04/17/2017] [Indexed: 11/06/2022] Open
Affiliation(s)
- Laura Marucci
- Department of Radiation Oncology; Regina Elena National Cancer Institute; Rome Italy
| | - Alessia Farneti
- Department of Radiation Oncology; Regina Elena National Cancer Institute; Rome Italy
| | - Paolo Di Ridolfi
- Department of Radiation Oncology; Regina Elena National Cancer Institute; Rome Italy
| | - Paola Pinnaro
- Department of Radiation Oncology; Regina Elena National Cancer Institute; Rome Italy
| | - Raul Pellini
- Department of Head and Neck Surgery; Regina Elena National Cancer Institute; Rome Italy
| | - Diana Giannarelli
- Department of Statistics; Regina Elena National Cancer Institute; Rome Italy
| | - Patrizia Vici
- Department of Medical Oncology 2; Regina Elena National Cancer Institute; Rome Italy
| | - Mario Conte
- Department of Radiation Oncology; Regina Elena National Cancer Institute; Rome Italy
| | - Valeria Landoni
- Department of Physics; Regina Elena National Cancer Institute; Rome Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology; Regina Elena National Cancer Institute; Rome Italy
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Marzi S, Piludu F, Sanguineti G, Marucci L, Farneti A, Terrenato I, Pellini R, Benevolo M, Covello R, Vidiri A. The prediction of the treatment response of cervical nodes using intravoxel incoherent motion diffusion-weighted imaging. Eur J Radiol 2017. [PMID: 28624026 DOI: 10.1016/j.ejrad.2017.05.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE To investigate the predictive role of Intravoxel Incoherent Motion Diffusion-Weighted Imaging (IVIM-DWI) parameters on cervical nodal response to chemo-radiotherapy (CRT) of head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS Patients with pathologically confirmed HNSCC were included in the present prospective study, having at least one positive cervical lymph node (LN). They received concomitant CRT and underwent three serial IVIM-DWI investigations: before, at mid-treatment and after treatment completion. Tissue diffusion coefficient D, perfusion-related diffusion coefficient D* and perfusion fraction f were calculated by a bi-exponential fit. The two-sided Mann-Whitney rank test was used to compare the imaging parameters of patients with regional failure (RF) and regional control (RC). A p value lower than 0.05 was considered to be statistically significant. RESULTS Thirty-four patients were accrued. Twenty-four out of 34 LN (70.6%) showed persistent RC after a median follow-up time of 27.6 months (range: 12.0-50.2 months), while ten cases of RF (29.4%) were confirmed with a median time of 6.8 months (range: 1.5-19.5 months). Patients with RC showed significantly lower pre-treatment D values compared to the RF patients (p=0.038). At mid-treatment, the patients with RF showed significantly higher D values (p=0.025), and exhibited larger percent reductions in f and the product D*×f from the baseline (p=0.008 and <0.001, respectively). No additional information was provided by the examination at the end of treatment. CONCLUSION Pre-treatment and mid-treatment IVIM-DWI showed potential for prediction of treatment response of cervical LN in HNSCC patients.
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Affiliation(s)
- Simona Marzi
- Medical Physics Laboratory, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy.
| | - Francesca Piludu
- Radiology and Diagnostic Imaging Department, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiotherapy, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Laura Marucci
- Department of Radiotherapy, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Alessia Farneti
- Department of Radiotherapy, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Irene Terrenato
- Biostatistics-Scientific Direction, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Raul Pellini
- Department of Otolaryngology & Head and Neck Surgery, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Maria Benevolo
- Department of Pathology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Renato Covello
- Department of Pathology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Antonello Vidiri
- Radiology and Diagnostic Imaging Department, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
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32
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Pota M, Scalco E, Sanguineti G, Farneti A, Cattaneo GM, Rizzo G, Esposito M. Early prediction of radiotherapy-induced parotid shrinkage and toxicity based on CT radiomics and fuzzy classification. Artif Intell Med 2017; 81:41-53. [PMID: 28325604 DOI: 10.1016/j.artmed.2017.03.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [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: 03/01/2017] [Accepted: 03/03/2017] [Indexed: 10/19/2022]
Abstract
MOTIVATION Patients under radiotherapy for head-and-neck cancer often suffer of long-term xerostomia, and/or consistent shrinkage of parotid glands. In order to avoid these drawbacks, adaptive therapy can be planned for patients at risk, if the prediction is obtained timely, before or during the early phase of treatment. Artificial intelligence can address the problem, by learning from examples and building classification models. In particular, fuzzy logic has shown its suitability for medical applications, in order to manage uncertain data, and to build transparent rule-based classifiers. In previous works, clinical, dosimetric and image-based features were considered separately, to find different possible predictors of parotid shrinkage. On the other hand, a few works reported possible image-based predictors of xerostomia, while the combination of different types of features has been little addressed. OBJECTIVE This paper proposes the application of a novel machine learning approach, based on both statistics and fuzzy logic, aimed at the classification of patients at risk of i) parotid gland shrinkage and ii) 12-months xerostomia. Both problems are addressed with the aim of individuating predictors and models to classify respective outcomes. METHODS Knowledge is extracted from a real dataset of radiotherapy patients, by means of a recently developed method named Likelihood-Fuzzy Analysis, based on the representation of statistical information by fuzzy rule-based models. This method enables to manage heterogeneous variables and missing data, and to obtain interpretable fuzzy models presenting good generalization power (thus high performance), and to measure classification confidence. Numerous features are extracted to characterize patients, coming from different sources, i.e. clinical features, dosimetric parameters, and radiomics-based measures obtained by texture analysis of Computed Tomography images. A learning approach based on the composition of simple models in a more complicated one allows to consider the features separately, in order to identify predictors and models to use when only some data source is available, and obtaining more accurate results when more information can be combined. RESULTS Regarding parotid shrinkage, a number of good predictors is detected, some already known and confirmed here, and some others found here, in particular among radiomics-based features. A number of models are also designed, some using single features and others involving models composition to improve classification accuracy. In particular, the best model to be used at the initial treatment stage, and another one applicable at the half treatment stage are identified. Regarding 12-months toxicity, some possible predictors are detected, in particular among radiomics-based features. Moreover, the relation between final parotid shrinkage rate and 12-months xerostomia is evaluated. The method is compared to the naïve Bayes classifier, which reveals similar results in terms of classification accuracy and best predictors. The interpretable fuzzy rule-based models are explicitly presented, and the dependence between predictors and outcome is explained, thus furnishing in some cases helpful insights about the considered problems. CONCLUSION Thanks to the performance and interpretability of the fuzzy classification method employed, predictors of both parotid shrinkage and xerostomia are detected, and their influence on each outcome is revealed. Moreover, models for predicting parotid shrinkage at initial and half radiotherapy stages are found.
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Affiliation(s)
- Marco Pota
- National Research Council of Italy - Institute for High Performance Computing and Networking (ICAR), Via P. Castellino 111, 80131 Naples, Italy.
| | - Elisa Scalco
- National Research Council of Italy - Institute of Molecular Bioimaging and Physiology (IBFM), Via F.lli Cervi 93, 20090 Segrate, MI, Italy
| | | | - Alessia Farneti
- Radiotherapy, Istituto Nazionale Tumori Regina Elena, Roma, Italy
| | | | - Giovanna Rizzo
- National Research Council of Italy - Institute of Molecular Bioimaging and Physiology (IBFM), Via F.lli Cervi 93, 20090 Segrate, MI, Italy
| | - Massimo Esposito
- National Research Council of Italy - Institute for High Performance Computing and Networking (ICAR), Via P. Castellino 111, 80131 Naples, Italy
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Pinnaro P, Giordano C, Farneti A, Rambone R, Sanguineti G. Short-Course Hypofractionated Whole-Breast Radiation Therapy After Conservative Surgery: A Single-Institution Prospective Study. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.521] [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: 10/20/2022]
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34
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Scalco E, Marzi S, Vidiri A, Sanguineti G, Farneti A, Rizzo G. EP-1859: Tumor control assessment on cervical lymph nodes using texture analysis on CT and T2w-MRI images. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33110-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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35
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Pinnarò P, Giordano C, Farneti A, Strigari L, Landoni V, Marucci L, Petrongari MG, Sanguineti G. Impact of Sequencing Radiation Therapy and Chemotherapy on Long-Term Local Toxicity for Early Breast Cancer: Results of a Randomized Study at 15-Year Follow-Up. Int J Radiat Oncol Biol Phys 2016; 95:1201-9. [PMID: 27209504 DOI: 10.1016/j.ijrobp.2016.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 03/07/2016] [Accepted: 03/11/2016] [Indexed: 01/08/2023]
Abstract
PURPOSE To compare long-term late local toxicity after either concomitant or sequential chemoradiation therapy after breast-conserving surgery. METHODS AND MATERIALS From 1997 to 2002, women aged 18 to 75 years who underwent breast-conserving surgery and axillary dissection for early breast cancer and in whom CMF (cyclophosphamide, methotrexate, and 5-fluorouracil) chemotherapy was planned were randomized between concomitant and sequential radiation therapy. Radiation therapy was delivered to the whole breast through tangential fields to 50 Gy in 20 fractions over a period of 4 weeks, followed by an electron boost. Surviving patients were tentatively contacted and examined between March and September 2014. Patients in whom progressive disease had developed or who had undergone further breast surgery were excluded. Local toxicity (fibrosis, telangiectasia, and breast atrophy or retraction) was scored blindly to the treatment received. A logistic regression was run to investigate the effect of treatment sequence after correction for several patient-, treatment-, and tumor-related covariates on selected endpoints. The median time to cross-sectional analysis was 15.7 years (range, 12.0-17.8 years). RESULTS Of 206 patients randomized, 154 (74.8%) were potentially eligible. Of these, 43 (27.9%) refused participation and 4 (2.6%) had been lost to follow-up, and for 5 (3.2%), we could not restore planning data; thus, the final number of analyzed patients was 102. No grade 4 toxicity had been observed, whereas the number of grade 3 toxicity events was low (<8%) for each item, allowing pooling of grade 2 and 3 events for further analysis. Treatment sequence (concomitant vs sequential) was an independent predictor of grade 2 or 3 fibrosis according to both the National Cancer Institute Common Terminology Criteria for Adverse Events (odds ratio [OR], 4.05; 95% confidence interval [CI], 1.34-12.2; P=.013) and the SOMA (Subjective, Objective, Management and Analytic) scale (OR, 3.75; 95% CI, 1.19-11.79; P=.018), as well as grade 2 or 3 breast atrophy or retraction (OR, 3.87; 95% CI, 1.42-10.56; P=.008). No effect on telangiectasia was detected. CONCLUSIONS At long-term follow-up, concomitant chemoradiation therapy has a detrimental effect on both fibrosis and retraction with an approximately 4-fold increase in the odds of grade 2 or 3 toxicity.
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Affiliation(s)
- Paola Pinnarò
- Department of Radiation Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Carolina Giordano
- Department of Radiation Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Alessia Farneti
- Department of Radiation Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Lidia Strigari
- Department of Physics, Regina Elena National Cancer Institute, Rome, Italy
| | - Valeria Landoni
- Department of Physics, Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Marucci
- Department of Radiation Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Giuseppe Sanguineti
- Department of Radiation Oncology, Regina Elena National Cancer Institute, Rome, Italy.
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36
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Landoni V, Arcidiacono F, Saracino B, Farneti A, Petrongari M, Sanguineti G. Macroscopic Hematuria After Conventional or Hypofractionated Radiation Therapy: Results From a Prospective Phase 3 Study. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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37
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Sanguineti G, Farneti A, Binbin W, McNutt T, Fiorino C. PO-0633: Parotid shrinkage during IMRT for oropharyngeal cancer as a signal of gland reactivity: a longitudinal study. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40625-5] [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: 10/23/2022]
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38
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Aristei C, Palumbo I, Capezzali G, Farneti A, Bini V, Falcinelli L, Margaritelli M, Lancellotta V, Zucchetti C, Perrucci E. Outcome of a phase II prospective study on partial breast irradiation with interstitial multi-catheter high-dose-rate brachytherapy. Radiother Oncol 2013; 108:236-41. [PMID: 24044802 DOI: 10.1016/j.radonc.2013.08.005] [Citation(s) in RCA: 14] [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: 06/15/2012] [Revised: 07/23/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE Partial breast irradiation (PBI) is an alternative to whole-breast irradiation after breast-conserving surgery in selected patients. Until the results of randomized phase III studies are available, phase II studies inform about PBI. We report the 5 year results of a phase II prospective study with PBI using interstitial multi-catheter high-dose-rate brachytherapy (ClinicalTrials.gov Identifier: NCT00499057). METHODS Hundred patients received PBI (4 Gy, twice a day for 4 days, until 32 Gy). Inclusion criteria were: age ≥ 40years, infiltrating carcinoma without lobular histology, ductal in situ carcinoma, tumor size ≤ 2.5 cm, negative surgical margins and axillary lymph nodes. RESULTS At a median follow-up of 60 months late toxicity occurred in 25 patients; the 5-year probability of freedom from late toxicity was 72.6% (95% CI: 63.7-81.7). Tamoxifen was the only significant risk factor for late toxicity. Cosmetic results, judged by physicians and patients, were good/excellent in 98 patients. Three local relapses (1 true, 2 elsewhere) and 1 regional relapse occurred. The 5-year probability of local or regional relapse-free survival was 97.7% (95% CI: 91.1-99.4) and 99.0% (95% CI: 92.9-99.8), respectively. CONCLUSION PBI with interstitial multi-catheter brachytherapy is associated with low relapse and late toxicity rates.
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Affiliation(s)
- Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Santa Maria della Misericordia Hospital, Italy.
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Perrucci E, Lancellotta V, Bini V, Farneti A, Falcinelli L, Palumbo I, Zucchetti C, Capezzali G, Aristei C. EP-1045: Quality of life and cosmetic results in breast cancer patients after whole breast or partial breast irradiation. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33351-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: 10/23/2022]
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40
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Aristei C, Falcinelli L, Bini V, Palumbo I, Farneti A, Petitto RP, Gori S, Perrucci E. Expander/implant breast reconstruction before radiotherapy: outcomes in a single-institute cohort. Strahlenther Onkol 2012; 188:1074-9. [PMID: 23111470 DOI: 10.1007/s00066-012-0231-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 08/27/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Radiotherapy (RT) of reconstructed breasts was associated with major complications and poor cosmetic outcome. The present study assessed complication rates, the link between risk factors and prosthesis removal, as well as cosmetic outcomes. PATIENTS AND METHODS From 1997 to 2009, 101 consecutive patients received RT after breast reconstruction because of risk factors for relapse (92) or because relapse had occurred (9). At RT, 90 patients had temporary tissue expanders and 11 had permanent implants. Twelve patients underwent neo-adjuvant chemotherapy; all patients received adjuvant chemo- and/or hormone therapy. RESULTS At a median follow-up of 50 months, late toxicities occurred in 28 patients: pain in 7, lymphedema in 6, G1 cutaneous toxicity in 5, and subcutaneous toxicity in 19 (2G1, 9G2, 7G3, 1G4), with more than one side effect in 12. In 8 patients the prosthesis ruptured (3), was displaced (3), was displaced and ruptured (1), or lost shape (1). Capsular contracture was classified in 89 patients as IA in 14, IB in 47, II in 10, III in 11, and IV in 7. Twelve prostheses (11.9%) were removed. The only significant factor for prosthesis removal was age (p = 0.007). Judgments of cosmetic results were available from 81 physicians and 84 patients. Outcome was excellent/good in 58/81 physician judgments and in 57/84 patient evaluations. Overall inter-rater agreement on outcome was good (κ-value 0.64; 95% CI: 0.48-0.79). CONCLUSION RT to reconstructed breasts was associated with low rates of late toxicity and prosthesis removal. Cosmetic outcomes were, on the whole, good to excellent.
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Affiliation(s)
- C Aristei
- Radiation Oncology Section, Department of Surgery, Radiology and Dentistry, University of Perugia and Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, 06156, Perugia, Italy.
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41
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Bellavita R, Massetti M, Abraha I, Lupattelli M, Mearini L, Falcinelli L, Farneti A, Palumbo I, Porena M, Aristei C. Conformal postoperative radiotherapy in patients with positive resection margins and/or pT3-4 prostate adenocarcinoma. Int J Radiat Oncol Biol Phys 2012; 84:e299-304. [PMID: 22572075 DOI: 10.1016/j.ijrobp.2012.04.002] [Citation(s) in RCA: 8] [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] [Received: 04/07/2011] [Revised: 03/03/2012] [Accepted: 04/02/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate outcome and toxicity of high-dose conformal radiotherapy (RT) after radical prostatectomy. METHODS AND MATERIALS Between August 1998 and December 2007, 182 consecutive patients with positive resection margins and/or pT3-4, node-negative prostate adenocarcinoma underwent postoperative conformal RT. The prescribed median dose to the prostate/seminal vesicle bed was 66.6 Gy (range 50-70). Hormone therapy (a luteinizing hormone-releasing hormone analogue and/or antiandrogen) was administered to 110/182 (60.5%) patients with high-risk features. Biochemical relapse was defined as an increase of more than 0.2 ng/mL over the lowest postoperative prostate-specific antigen (PSA) value measured on 3 occasions, each at least 2 weeks apart. RESULTS Median follow-up was 55.6 months (range 7.6-141.9 months). The 3- and 5-year probability of biochemical relapse-free survival were 87% and 81%, respectively. In univariate analysis, more advanced T stages, preoperative PSA values ≥10 ng/mL, and RT doses <70 Gy were significant factors for biochemical relapse. Pre-RT PSA values >0.2 ng/mL were significant for distant metastases. In multivariate analysis, risk factors for biochemical relapse were higher preoperative and pre-RT PSA values, hormone therapy for under 402 days and RT doses of <70 Gy. Higher pre-RT PSA values were the only independent predictor of distant metastases. Acute genitourinary (GU) and gastrointestinal (GI) toxicities occurred in 72 (39.6%) and 91 (50%) patients, respectively. There were 2 cases of Grade III GI toxicity but no cases of Grade IV. Late GU and GI toxicities occurred in 28 (15.4%) and 14 (7.7%) patients, respectively: 11 cases of Grade III toxicity: 1 GI (anal stenosis) and 10 GU, all urethral strictures requiring endoscopic urethrotomy. CONCLUSIONS Postoperative high-dose conformal RT in patients with high-risk features was associated with a low risk of biochemical relapse as well as minimal morbidity.
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Affiliation(s)
- Rita Bellavita
- Institute of Radiation Oncology, General Hospital and Perugia University, Perugia, Italy.
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42
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Palumbo I, Farneti A, Perrucci E, Barberini F, Rulli A, Aristei C. Partial breast irradiation with interstitial high dose-rate brachytherapy in elderly patients: results of a phase II prospective study. BMC Geriatr 2009. [PMCID: PMC4290975 DOI: 10.1186/1471-2318-9-s1-a6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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43
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Farneti A, Piga A. [Not Available]. Kos 1999:58-63. [PMID: 11639063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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44
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Cecchi F, Pavan P, Bassetti A, Farneti A, Barbaresi U. [Anaerobic co-digestion of RSU and macro-algae in the Venice lagoon. Preliminary results]. Boll Chim Farm 1991; 130:256-8. [PMID: 1756009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In these last few years in the lagoon of Venice the phenomenon of eutrophization has increased. The possibility of turning to an anaerobic digestion of the biomass seems to be interesting. In this view, the following experiment describes a study on the co-digestion of mechanically selected algaebiomass and organic fraction of solid urban waste. The results relevant to both yield parameters and process stability are reported, which have been obtained by monitoring a 3 m3 pilot digestor during a running period of about 85 days, under different working conditions.
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Affiliation(s)
- F Cecchi
- Dipartimento Scienze Ambientali, Università di Venezia
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45
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Farneti A, Grandi M. [Not Available]. Kos 1989; 5:25-9. [PMID: 11637875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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46
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Farneti A. [Medico-legal aspects in oral implantology]. Riv Odontostomatol Implantoprotesi 1983:23-4. [PMID: 6577375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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47
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Marozzi E, Farneti A. [Recent experience with poisoning with apiol and related compounds. Contribution of gas chromatography to the chemical toxicologic ascertainment]. Zacchia 1968; 4:563-80. [PMID: 5737756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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48
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Farneti A. [The medico-legal diagnosis of silicosis in histological tests in cases of lung diseases with suspect silico-tuberculous lesions]. Ann Med Leg Criminol Police Sci Toxicol 1967; 47:584-6. [PMID: 5632594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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49
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Falzi G, Farneti A, Pozzato R. [Sudden deaths caused by lesions of the cardiovascular system]. Minerva Medicoleg 1967; 87:75-95. [PMID: 5602527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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50
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Mangili F, Farneti A. [The detection of recent myocardial infarct with the dye method, using tetrazolium salts]. Minerva Medicoleg 1967; 87:96-100. [PMID: 5602528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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