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Moscarella E, Di Brizzi EV, Alpi P, Arcelli A, Badellino S, Bossi P, Calzavara-Pinton PG, Di Stefani A, Dika E, Eibenschutz L, Fargnoli MC, Fionda B, Gravina GL, Leonulli BG, Longo C, Lospalluti L, Nardone V, Pimpinelli N, Quaglino P, Queirolo P, Rubegni P, Tagliaferri L, Troiani T, Vavassori A, Argenziano G. Indications for adjuvant radiotherapy in high-risk cutaneous squamous cell carcinoma with clear margins: a Delphi consensus. Br J Dermatol 2024; 190:578-579. [PMID: 38092023 DOI: 10.1093/bjd/ljad495] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/31/2023] [Accepted: 01/13/2024] [Indexed: 03/16/2024]
Abstract
The aim of this study was to provide indications for adjuvant radiotherapy in high-risk cutaneous squamous cell carcinoma.
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Affiliation(s)
- Elvira Moscarella
- Dermatology Unit, University of Campania L. Vanvitelli, Naples,Italy
| | | | - Paolo Alpi
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Alessandra Arcelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Esposito M, Mancosu P, Bruschi A, Ghirelli A, Pini S, Alpi P, Barca R, Paoli CD, Meacci F, Leonulli BG, Fondelli S, Paoletti L, Scoccianti S, Russo S. Correction to: The role of EPID in vivo dosimetry in the risk management of stereotactic lung treatments. Strahlenther Onkol 2024; 200:106. [PMID: 37923943 DOI: 10.1007/s00066-023-02168-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Affiliation(s)
- Marco Esposito
- S. C. Fisica Sanitaria, Firenze-Azienda Sanitaria USL Toscana Centro, Via dell'Antella 58, 50012, Bagno a Ripoli, Firenze, Italy.
- International Center for Theoretical Physics, Strada Costiera, 11, 34151, Trieste, Italy.
| | - Pietro Mancosu
- Medical Physics Unit of Radiotherapy Dept., IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Andrea Bruschi
- S. C. Fisica Sanitaria, Firenze-Azienda Sanitaria USL Toscana Centro, Via dell'Antella 58, 50012, Bagno a Ripoli, Firenze, Italy
| | - Alessandro Ghirelli
- S. C. Fisica Sanitaria, Firenze-Azienda Sanitaria USL Toscana Centro, Via dell'Antella 58, 50012, Bagno a Ripoli, Firenze, Italy
| | - Silvia Pini
- S. C. Fisica Sanitaria, Firenze-Azienda Sanitaria USL Toscana Centro, Via dell'Antella 58, 50012, Bagno a Ripoli, Firenze, Italy
| | - Paolo Alpi
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Raffaella Barca
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Camilla Delli Paoli
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Fiammetta Meacci
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | | | - Simona Fondelli
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Lisa Paoletti
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Silvia Scoccianti
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Serenella Russo
- S. C. Fisica Sanitaria, Firenze-Azienda Sanitaria USL Toscana Centro, Via dell'Antella 58, 50012, Bagno a Ripoli, Firenze, Italy
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Esposito M, Mancosu P, Bruschi A, Ghirelli A, Pini S, Alpi P, Barca R, Paoli CD, Meacci F, Leonulli BG, Fondelli S, Paoletti L, Scoccianti S, Russo S. The role of EPID in vivo dosimetry in the risk management of stereotactic lung treatments. Strahlenther Onkol 2023; 199:992-999. [PMID: 37256302 DOI: 10.1007/s00066-023-02081-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/26/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND OBJECTIVE In this work we report our experience with the use of in vivo dosimetry (IVD) in the risk management of stereotactic lung treatments. METHODS A commercial software based on the electronic portal imaging device (EPID) signal was used to reconstruct the actual planning target volume (PTV) dose of stereotactic lung treatments. The study was designed in two phases: i) in the observational phase, the IVD results of 41 consecutive patients were reviewed and out-of-tolerance cases were studied for root cause analysis; ii) in the active phase, the IVD results of 52 patients were analyzed and corrective actions were taken when needed. Moreover, proactive preventions were further introduced to reduce the risk of future failures. The error occurrence rate was analyzed to evaluate the effectiveness of proactive actions. RESULTS A total of 330 fractions were analyzed. In the first phase, 13 errors were identified. In the active phase, 12 errors were detected, 5 of which needed corrective actions; in 4 patients the actions taken corrected the error. Several preventions and barriers were introduced to reduce the risk of future failures: the planning checklist was updated, the procedure for vacuum pillows was improved, and use of the respiratory compression belt was optimized. A decrease in the failure rate was observed, showing the effectiveness of procedural adjustment. CONCLUSION The use of IVD allowed the quality of lung stereotactic body radiation therapy (SBRT) treatments to be improved. Patient-specific and procedural corrective actions were successfully taken as part of risk management, leading to an overall improvement in the dosimetric accuracy.
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Affiliation(s)
- Marco Esposito
- S. C. Fisica Sanitaria, Firenze-Azienda Sanitaria USL Toscana Centro, Via dell'Antella 58, 50012, Bagno a Ripoli, Firenze, Italy.
- International Center for Theoretical Physics, Strada Costiera, 11, 34151, Trieste, Italy.
| | - Pietro Mancosu
- Medical Physics Unit of Radiotherapy Dept., IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Andrea Bruschi
- S. C. Fisica Sanitaria, Firenze-Azienda Sanitaria USL Toscana Centro, Via dell'Antella 58, 50012, Bagno a Ripoli, Firenze, Italy
| | - Alessandro Ghirelli
- S. C. Fisica Sanitaria, Firenze-Azienda Sanitaria USL Toscana Centro, Via dell'Antella 58, 50012, Bagno a Ripoli, Firenze, Italy
| | - Silvia Pini
- S. C. Fisica Sanitaria, Firenze-Azienda Sanitaria USL Toscana Centro, Via dell'Antella 58, 50012, Bagno a Ripoli, Firenze, Italy
| | - Paolo Alpi
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Raffaella Barca
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Camilla Delli Paoli
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Fiammetta Meacci
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | | | - Simona Fondelli
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Lisa Paoletti
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Silvia Scoccianti
- S. C. Radioterapia, Firenze-Azienda Sanitaria USL Toscana Centro, Firenze, Italy
| | - Serenella Russo
- S. C. Fisica Sanitaria, Firenze-Azienda Sanitaria USL Toscana Centro, Via dell'Antella 58, 50012, Bagno a Ripoli, Firenze, Italy
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Scoccianti S, Delli Paoli C, Infantino M, Paoletti L, Caini S, Meacci F, Russo S, Esposito M, Fondelli S, Grilli Leonulli B, Grossi V, Barca R, Alpi P, Furlan F, Perna M, Pino MS, Martella F, Manfredi M, Stefanacci M, Bassetti A, Casprini P, Fioretto L. Immunogenicity after two and three doses of mRNA vaccine in patients with cancer treated with exclusive radiotherapy. Int Immunopharmacol 2023; 122:110460. [PMID: 37392566 DOI: 10.1016/j.intimp.2023.110460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/26/2023] [Accepted: 06/04/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND AND PURPOSE Data on immunoresponse after SARS-CoV-2 vaccines for patients treated with exclusive radiotherapy (RT) are scarce. Since RT may affect the immune system, we conducted the MORA trial (Antibody response and cell-mediated immunity of MOderna mRNA-1273 vaccine in patients treated with RAdiotherapy). MATERIALS AND METHODS Data regarding humoral and cellular immune response of patients treated with RT were prospectively collected after the second and third dose of mRNA vaccines. RESULTS Ninety-two patients were enrolled. With a median of 147 days after the second dose, the median SARS-CoV-2 IgG titer was 300 BAU/mL: six patients were seronegative (Spike IgG titer ≤ 40 BAU/mL), whereas 24, 46 and 16 were poor responders (Spike IgG titer:41-200 BAU/mL), responders (Spike IgG titer:201-800 BAU/mL) and ultraresponders (Spike IgG titer > 800 BAU/mL), respectively. Among seronegative patients, two patients were negative also for cell mediated response, as tested with IFN-γ release Assay (IGRA) test. With a median of 85 days after the third dose, the median SARS-CoV-2 IgG titer was 1632 BAU/mL in 81 patients: only two patients were seronegative, whereas 16 and 63 patients were responders and ultraresponders, respectively. Among the 2 persistently seronegative patients, IGRA test was negative in one who had previously received anti-CD20 therapy. Documented paucisymptomatic (n = 3) or asymptomatic (n = 4) infection occurred after the third dose, during the Omicron wave. CONCLUSION In patients treated with exclusive RT, even during the Omicron breakthrough, robust humoral response and clinical protection from severe SARS-CoV-2 disease were achievable with three doses of mRNA vaccine.
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Affiliation(s)
- Silvia Scoccianti
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Camilla Delli Paoli
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Maria Infantino
- Immunology and Allergology Laboratory Unit, S. Giovanni Di Dio Hospital, Florence, Italy.
| | - Lisa Paoletti
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Saverio Caini
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
| | - Fiammetta Meacci
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Serenella Russo
- Medical Physics Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Marco Esposito
- Medical Physics Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Simona Fondelli
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | | | - Valentina Grossi
- Immunology and Allergology Laboratory Unit, S. Giovanni Di Dio Hospital, Florence, Italy
| | - Raffaella Barca
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Paolo Alpi
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Federica Furlan
- Direzione Sanitaria, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Marco Perna
- Oncology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Maria Simona Pino
- Oncology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | | | - Mariangela Manfredi
- Immunology and Allergology Laboratory Unit, S. Giovanni Di Dio Hospital, Florence, Italy
| | | | - Andrea Bassetti
- Direzione Sanitaria, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Patrizia Casprini
- Clinical Pathology Laboratory Unit, S. Giovanni Di Dio Hospital, Florence, Italy
| | - Luisa Fioretto
- Oncology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
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Scoccianti S, Delli Paoli C, Grilli Leonulli B, Paoletti L, Alpi P, Caini S, Barca R, Fondelli S, Russo S, Perna M, Pino MS, Martella F, Furlan F, Bassetti A, Fioretto L. Acute tolerance of Moderna mRNA-1273 vaccine against COVID-19 in patients with cancer treated with radiotherapy. Lancet Oncol 2021; 22:1212-1214. [PMID: 34388385 PMCID: PMC8354565 DOI: 10.1016/s1470-2045(21)00427-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/14/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Silvia Scoccianti
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, 50012, Italy.
| | - Camilla Delli Paoli
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, 50012, Italy
| | - Barbara Grilli Leonulli
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, 50012, Italy
| | - Lisa Paoletti
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, 50012, Italy
| | - Paolo Alpi
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, 50012, Italy
| | - Saverio Caini
- Institute for Cancer Research, Prevention and Clinical Network, Cancer Risk Factors and Life-Style Epidemiology Unit, Florence, Italy
| | - Raffaella Barca
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, 50012, Italy
| | - Simona Fondelli
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, 50012, Italy
| | - Serenella Russo
- Medical Physics Unit, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Firenze, Italy
| | - Marco Perna
- Medical Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, 50012, Italy
| | - Maria Simona Pino
- Medical Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, 50012, Italy
| | - Francesca Martella
- Medical Oncology Unit, San Giuseppe Hospital, Empoli and Breast Unit Firenze, Department of Oncology, Azienda USL Toscana Centro, Florence, Italy
| | - Federica Furlan
- Public Health and Preventive Medicine Residency, University of Florence, Florence, Italy
| | - Andrea Bassetti
- Direzione Sanitaria Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, 50012, Italy
| | - Luisa Fioretto
- Medical Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, 50012, Italy
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Esposito M, Ghirelli A, Pini S, Alpi P, Barca R, Fondelli S, Grilli Leonulli B, Paoletti L, Rossi F, Bastiani P, Russo S. Clinical implementation of 3D in vivo dosimetry for abdominal and pelvic stereotactic treatments. Radiother Oncol 2020; 154:14-20. [PMID: 32926910 DOI: 10.1016/j.radonc.2020.09.011] [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] [Received: 12/20/2019] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE To analyze results from three years of in vivo transit EPID dosimetry of abdominal and pelvic stereotactic radiotherapy and to establish tolerance levels for routine clinical use. MATERIAL 80 stereotactic VMAT treatments (152 fractions) targeting the abdomen or pelvis were analyzed. In vivo 3D doses were reconstructed with an EPID commercial algorithm. Gamma Agreement Index (GAI) and DVH differences in Planning Target Volume (PTV) and Clinical Target Volume (CTV) were evaluated. Initial tolerance level was set to GAI > 85% in PTV. Fractions Over Tolerance Level (OTL) were deemed to be due to set-up errors, incorrect use of immobilization devices, 4D errors, transit EPID algorithm errors and unknown/unidentified errors. Statistical Process Control (SPC) was applied to determine local tolerance levels. RESULTS Average GAI were (82.7 ± 20.9) % in PTV and (72.9 ± 29.7) % in CTV. 37.8% of fractions resulted OTL and were classified as: set-up errors (3.3%), incorrect use of immobilization devices (2.1%), 4D errors (2.1%), EPID transit algorithm errors (17.1%). OTL causes for the remaining 13.2% of fractions were not identified. The differences between PTV and CTV measured in vivo and calculated mean dose (average difference ± standard deviation) were (-3.3% ± 3.2%) and (-2.3% ± 3.0%). When tolerance levels based on SPC to PTV mean dose differences were applied, the percentage of OTL decreased to 7% and no EPID algorithm error occurred. One error was not identified. CONCLUSIONS The application of local tolerance levels to EPID in vivo dosimetry proved to be useful for detecting extra-lung SBRT treatment errors.
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Affiliation(s)
- Marco Esposito
- S. C. Fisica Sanitaria, Firenze - Azienda USL Toscana Centro, Italy.
| | | | - Silvia Pini
- S. C. Fisica Sanitaria, Firenze - Azienda USL Toscana Centro, Italy
| | - Paolo Alpi
- S. C. Radioterapia, Firenze - Azienda USL Toscana Centro, Italy
| | - Raffaella Barca
- S. C. Radioterapia, Firenze - Azienda USL Toscana Centro, Italy
| | - Simona Fondelli
- S. C. Radioterapia, Firenze - Azienda USL Toscana Centro, Italy
| | | | - Lisa Paoletti
- S. C. Radioterapia, Firenze - Azienda USL Toscana Centro, Italy
| | - Francesca Rossi
- S. C. Radioterapia, Firenze - Azienda USL Toscana Centro, Italy
| | - Paolo Bastiani
- S. C. Radioterapia, Firenze - Azienda USL Toscana Centro, Italy
| | - Serenella Russo
- S. C. Fisica Sanitaria, Firenze - Azienda USL Toscana Centro, Italy
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Scoccianti S, Detti B, Meattini I, Iannalfi A, Sardaro A, Leonulli BG, Martinelli F, Bordi L, Pellicanò G, Biti G. Symptomatic Leptomeningeal and Intramedullary Metastases from Intracranial Glioblastoma Multiforme: A Case Report. Tumori 2018; 94:877-81. [DOI: 10.1177/030089160809400620] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Glioblastoma multiforme infrequently metastasizes to the leptomeninges and even more rarely to the spinal cord. Moreover, very few patients with intracranial glioblastoma develop symptoms from spinal dissemination, with most patients not surviving long enough for spinal disease to become clinically evident. Case Report We present a rare case of symptomatic diffuse spinal leptomeningeal metastases simultaneously to an intramedullary lesion from an intracranial glioblastoma multiforme. After the diagnosis of spinal metastases the patient was treated with limited-field spinal radiotherapy (30 Gy in 3-Gy fractions). Results Radiotherapy on the main spinal lesions provided either relief from pain or mild improvement of neurological deficits. The patient died due to intracranial progression 4 months after diagnosis of spinal seeding and 17 months after diagnosis of the primary disease. We analyzed leptomeningeal and spinal metastases from glioblastoma multiforme with reference to the literature. Conclusions Radiotherapy for spinal disease may provide important symptom relief but the prognosis of these patients remains dramatically poor. As the local control of primary glioblastoma multiforme has improved with recent therapeutic advances, distant metastasis from high-grade gliomas is likely to become a more common clinical problem and such patients need to be included in clinical trials to evaluate new therapeutic approaches.
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Affiliation(s)
| | - Beatrice Detti
- Department of Radiotherapy, University of Florence, Florence
| | - Icro Meattini
- Department of Radiotherapy, University of Florence, Florence
| | | | - Angela Sardaro
- Department of Internal Medicine, Institute of Radiology, University of Bari, Bari
| | | | | | - Lorenzo Bordi
- Department of Neurological Surgery, Careggi Hospital, Florence, Italy
| | | | - Giampaolo Biti
- Department of Radiotherapy, University of Florence, Florence
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Gujral DM, Hawkins MA, Leonulli BG, Ashley S, Chau I, Cunningham D, Tait D. Nonsurgical Management of Esophageal Adenocarcinoma. Clin Colorectal Cancer 2011; 10:165-70. [DOI: 10.1016/j.clcc.2011.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 11/22/2010] [Accepted: 12/06/2010] [Indexed: 11/15/2022]
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