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Detti B, Scoccianti S, Maragna V, Lucidi S, Ganovelli M, Teriaca MA, Caini S, Desideri I, Agresti B, Greto D, Buccoliero AM, Puppa AD, Sardi I, Livi L. Pleomorphic Xanthoastrocytoma: a single institution retrospective analysis and a review of the literature. Radiol Med 2022; 127:1134-1141. [PMID: 35951279 PMCID: PMC9512734 DOI: 10.1007/s11547-022-01531-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/22/2022] [Indexed: 11/30/2022]
Abstract
Background Pleomorphic xanthoastrocytoma (PXA) is a rare low-grade brain tumor. To date, limited studies have analyzed factors affecting survival outcomes and defined the therapeutic strategy. The aim of this retrospective analysis was to investigate the clinicopathologic characteristics of PXA and identify factors associated with outcomes. Methods We retrospectively analyzed a cohort of 16 adult and children patients with PXA who underwent primary resection from 1997 to 2019, referred to our Radiation Oncology Unit and to Meyer’s Paediatric Hospital. We also reviewed the relevant literature. Results All patients underwent primary surgical resection; 10 patients received adjuvant radiation treatment course, ranging from DTF 54 to 64 Gy; 8 of them received, in addition, concurrent adjuvant chemotherapy; 6 patients underwent only radiological follow-up. After a median follow up was 60 months: median OS was 34.9 months (95% CI 30–218), 1-year OS 87%, 5-years OS 50%, 10-years OS 50%; median PFS 24.4 months (95% CI 13–156), 1-year PFS 80%, 5-years PFS 33%, 10-years PFS 33%. A chi-square test showed a significant association between OS and recurrent disease (p = 0.002) and with chemotherapy adjuvant treatment (p = 0.049). A borderline statistical significant association was instead recognized with BRAF mutation (p = 0.058). Conclusions Despite our analysis did not reveal a strong prognostic or predictive factor able to address pleomorphic xanthoastrocytoma management; however, in selected patients could be considered the addition of adjuvant radiation chemotherapy treatment after adequate neurosurgical primary resection. Furthermore, recurrent disease evidenced a detrimental impact on survival.
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Affiliation(s)
- Beatrice Detti
- Radiation Oncology Unit, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, Italy.
| | - Silvia Scoccianti
- Radiation Oncology Unit, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, Italy
| | - Virginia Maragna
- Radiation Oncology Unit, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, Italy
| | - Sara Lucidi
- Radiation Oncology Unit, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, Italy
| | - Michele Ganovelli
- Radiation Oncology Unit, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, Italy
| | - Maria Ausilia Teriaca
- Radiation Oncology Unit, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, Italy
| | - Saverio Caini
- Epidemiology of Risk Factors and Lifestyles, Institute for Study, Prevention, and Oncology Network (ISPRO), Florence, Italy
| | - Isacco Desideri
- Radiation Oncology Unit, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, Italy
| | - Benedetta Agresti
- Radiation Oncology Unit, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, Italy
| | - Daniela Greto
- Radiation Oncology Unit, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, Italy
| | - Anna Maria Buccoliero
- Pathology Unit, Children's Hospital A. Meyer, University of Florence, Florence, Italy
| | - Alessandro Della Puppa
- Department of Neurosurgery, Careggi Hospital, University of Florence, Florence, Italy
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children's Hospital, Florence, Italy
| | - Iacopo Sardi
- Department of Neurosurgery, Careggi Hospital, University of Florence, Florence, Italy
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children's Hospital, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, Italy
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Becherini C, Banini M, Desideri I, Salvestrini V, Mariotti M, Caprara L, Scotti V, Agresti B, Garlatti P, Livi L, Bonomo P. Nivolumab in elderly patients with recurrent/metastatic head and neck squamous cell carcinoma: efficacy and safety data from a monocentric experience. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00352-0] [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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3
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Bonomo P, Cipressi S, Iermano C, Bonucci I, Masi L, Doro R, Favuzza V, Paiar F, Simontacchi G, Meattini I, Greto D, Agresti B, Livi L, Biti G. Salvage Stereotactic Re-irradiation with CyberKnife for Locally Recurrent Head and Neck Cancer: A Single Center Experience. Tumori Journal 2018. [DOI: 10.1177/1578.17202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Pierluigi Bonomo
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza (IFCA), Florence
| | - Samantha Cipressi
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza (IFCA), Florence
| | - Carmine Iermano
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza (IFCA), Florence
| | - Ivano Bonucci
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza (IFCA), Florence
| | - Laura Masi
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza (IFCA), Florence
| | - Raffaela Doro
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza (IFCA), Florence
| | - Virginia Favuzza
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza (IFCA), Florence
| | - Fabiola Paiar
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Icro Meattini
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Daniela Greto
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Benedetta Agresti
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Giampaolo Biti
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
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Desideri I, Scotti V, Topulli J, Baki M, Moroni C, Perna M, Muntoni C, Meacci F, Agresti B, Francolini G, Miele V, Livi L. PO-0868: Nivolumab in association with Radiation Therapy in patients with lung and kidney cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31178-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Scotti V, Meattini I, Franzese C, Saieva C, Bertocci S, Meacci F, Furfaro I, Scartoni D, Cecchini S, Desideri I, Ferrari K, Bruni A, De Luca Cardillo C, Bastiani P, Agresti B, Mangoni M, Livi L, Biti G. Radiotherapy Timing in the Treatment of Limited-stage Small Cell Lung Cancer: The Impact of Thoracic and Brain Irradiation on Survival. Tumori Journal 2018. [DOI: 10.1177/1578.17206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vieri Scotti
- Department of Radiation Oncology, University of Florence, Florence
| | - Icro Meattini
- Department of Radiation Oncology, University of Florence, Florence
| | - Ciro Franzese
- Department of Radiation Oncology, University of Florence, Florence
| | - Calogero Saieva
- Molecular and Nutritional Epidemiology Unit, Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Florence
| | - Silvia Bertocci
- Department of Radiation Oncology, University of Florence, Florence
| | - Fiammetta Meacci
- Department of Radiation Oncology, University of Florence, Florence
| | - Ilaria Furfaro
- Department of Radiation Oncology, University of Florence, Florence
| | - Daniele Scartoni
- Department of Radiation Oncology, University of Florence, Florence
| | - Sara Cecchini
- Department of Radiation Oncology, University of Florence, Florence
| | - Isacco Desideri
- Department of Radiation Oncology, University of Florence, Florence
| | - Katia Ferrari
- II Pneumology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence
| | - Alessio Bruni
- Department of Radiation Oncology, University of Modena, Modena
| | | | - Paolo Bastiani
- Department of RadiationOncology, Santa Maria Annunziata Hospital, Florence
| | | | - Monica Mangoni
- Department of Radiation Oncology, University of Florence, Florence
| | - Lorenzo Livi
- Radiotherapy Unit Santa Chiara, Univeristy of Florence, Florence, Italy
| | - Giampaolo Biti
- Department of Radiation Oncology, University of Florence, Florence
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Scotti V, Saieva C, Di Cataldo V, Bruni A, Desideri I, Bertocci S, Meattini I, Livi L, Simontacchi G, De Luca Cardillo C, Bendinelli B, Bastiani P, Mangoni M, Agresti B, Biti G. Vinorelbine-Based Chemo-Radiotherapy in Non-Small Cell Lung Cancer. Tumori 2018; 98:464-70. [DOI: 10.1177/030089161209800411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Aims and background Concomitant radio-chemotherapy improves survival of patients with locally advanced non-small cell lung cancer, with a better local-regional control. Methods and study design We report our experience with vinorelbine-based chemotherapy in neoadjuvant and radical settings in 43 patients. Regimens consisted of cisplatin plus vinorelbine in 74.4% patients and carboplatin plus vinorelbine in 14.0%; 11.6% underwent mono-chemotherapy with oral vinorelbine. We estimated the crude probability of death or local recurrence by the Kaplan-Meier method. Cox regression models were used to identify the main significant predictors of death or local recurrence. Results A significant effect of the response to treatment was shown on both local disease free-survival (P = 0.004) and overall survival (P <0.0001). Patients with progressive disease after primary treatment had a significantly higher risk of further relapse at both univariate (P = 0.046) and multivariate regression analysis (P = 0.014) than patients with a complete response. They also showed a significantly higher risk of death at both univariate (P = 0.0005) and multivariate regression analysis (P <0.0001) than patients with a complete response. The most common toxicity was hematologic and gastroenteric. We recorded grade III/IV leukopenia in 11%, anemia in 6%, and esophagitis in 14% of the patients. Conclusions Our experience showed that vinorelbine-based chemotherapy is an effective and safe regimen, in association with a platinum compound and thoracic radiotherapy.
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Affiliation(s)
- Vieri Scotti
- Department of Radiation-Oncology, University of Florence, Florence
| | - Calogero Saieva
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute, ISPO, Florence
| | | | - Alessio Bruni
- Department of Radiation-Oncology, University of Modena, Modena
| | - Isacco Desideri
- Department of Radiation-Oncology, University of Florence, Florence
| | - Silvia Bertocci
- Department of Radiation-Oncology, University of Florence, Florence
| | - Icro Meattini
- Department of Radiation-Oncology, University of Florence, Florence
| | - Lorenzo Livi
- Department of Radiation-Oncology, University of Florence, Florence
| | | | | | - Benedetta Bendinelli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute, ISPO, Florence
| | - Paolo Bastiani
- Radiotherapy Unit, Ospedale Santa Maria Annunziata, Florence, Italy
| | - Monica Mangoni
- Department of Radiation-Oncology, University of Florence, Florence
| | | | - Giampaolo Biti
- Department of Radiation-Oncology, University of Florence, Florence
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7
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Scotti V, Meattini I, Saieva C, Rampini A, De Luca Cardillo C, Bastiani P, Mangoni M, Agresti B, Santomaggio C, Di Cataldo V, Franzese C, Livi L, Magrini SM, Biti G. Limited-Stage Small-Cell Lung Cancer Treated with Early Chemo-Radiotherapy: The Impact of Effective Chemotherapy. Tumori 2018; 98:53-9. [DOI: 10.1177/030089161209800107] [Citation(s) in RCA: 3] [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] [Indexed: 11/16/2022]
Abstract
Aims and Background Small cell lung cancer is characterized by an aggressive clinical course and a high sensitivity to both chemotherapy and radiotherapy. We present the Florence University experience in concurrent early radio-chemotherapy in patients affected by limited-stage small cell lung cancer, with particular emphasis on treatment safety, disease outcome and prognostic factors. Methods and Study Design Fifty-seven patients were treated between June 2000 and February 2005. All patients underwent platinum-based chemotherapy, administered intravenously following two different regimens, for at least three cycles. Eighteen patients (31.6%) received epirubicin and ifosfamide in 3-week cycles alternating with etoposide and cisplatin, administered on day 1 to 3; 39 patients (68.4%) received etoposide and cisplatin. A total of 6 cycles were planned. Radiotherapy was administered concurrently to the first cycle of etoposide and cisplatin. Results Clinical stage (P = 0.036) and number of chemotherapy courses (P = 0.009) emerged as the only significant death predictors at univariate analysis. Number of chemotherapy courses persisted as a significant death predictor also at multivariate regression analysis, with a reduced death risk for 5–6 chemotherapy cycles in comparison to 3–4 cycles (hazard ratio, 0.44). At a mean follow up of 38.5 months (standard deviation, 3.24 years; range, 6–164 months), considering the best overall tumor response achieved at any time during the whole treatment period, we obtained 32 complete responses (56.1%), 23 partial responses (40.3%) and 2 stable diseases. Conclusions Our analysis showed that concurrent early radio-chemotherapy in limited-stage small cell lung cancer treatment represents a safe and effective approach in patients. We confirmed the relevant impact on overall survival of effective chemotherapy delivery.
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Affiliation(s)
- Vieri Scotti
- Department of Radiation-Oncology, University of Florence, Florence
| | - Icro Meattini
- Department of Radiation-Oncology, University of Florence, Florence
| | - Calogero Saieva
- Molecular and Nutritional Epidemiology Unit, ISPO, Cancer Prevention and Research Institute, Florence
| | | | | | - Paolo Bastiani
- Radiotherapy Unit, S. Maria Annunziata Hospital, Florence
| | - Monica Mangoni
- Department of Radiation-Oncology, University of Florence, Florence
| | | | | | | | - Ciro Franzese
- Department of Radiation-Oncology, University of Florence, Florence
| | - Lorenzo Livi
- Department of Radiation-Oncology, University of Florence, Florence
| | | | - Giampaolo Biti
- Department of Radiation-Oncology, University of Florence, Florence
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8
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Meattini I, Desideri I, Di Cataldo V, Francolini G, De Luca Cardillo C, Scotti V, Loi M, Detti B, Mangoni M, Agresti B, Baldazzi V, Greto D, Casella D, Bernini M, Sanchez LJ, Orzalesi L, Nori J, Fambrini M, Bianchi S, Livi L. Safety of eribulin mesylate and concomitant radiotherapy for metastatic breast cancer: a single-center experience. Future Oncol 2016; 12:1117-24. [DOI: 10.2217/fon-2015-0059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study evaluates, for the first time, the safety of eribulin in metastatic breast cancer patients concomitantly treated with palliative radiotherapy (RT). Patients & materials: A total of 17 patients were pretreated for metastatic breast cancer. Patients received eribulin mesylate and bone RT. Results: The most frequent grade 3 hematologic adverse events were neutropenia (56%) and anemia (20%). Mean pain score decreased from 2 (baseline) to 0.7 (end of observation). Analgesic score remained stable (1.8 vs 1.6). Bone pain scores dropped within a few weeks and remained below baseline values throughout the analysis. The overall response rate was 29%, and the clinical benefit rate was 59%. Conclusion: Eribulin is characterized by a manageable safety profile also when combined with palliative RT.
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Affiliation(s)
- Icro Meattini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Isacco Desideri
- Department of Clinical & Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Giulio Francolini
- Department of Clinical & Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Carla De Luca Cardillo
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Vieri Scotti
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Mauro Loi
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Monica Mangoni
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
- Department of Clinical & Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Benedetta Agresti
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Valentina Baldazzi
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Daniela Greto
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Donato Casella
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marco Bernini
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Luis Jose Sanchez
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lorenzo Orzalesi
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Jacopo Nori
- Senology Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Massimiliano Fambrini
- Department of Clinical & Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | | | - Lorenzo Livi
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
- Department of Clinical & Experimental Biomedical Sciences, University of Florence, Florence, Italy
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9
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Scotti V, Bruni A, Simontacchi G, Furfaro I, Loi M, Scartoni D, Gonfiotti A, Viggiano D, De Luca Cardillo C, Agresti B, Poggesi L, Olmetto E, Ferrari K, Perna M, Bastiani P, Paoletti L, Lastrucci L, Pernici P, Carta G, Borghesi S, Bertocci S, Giacobazzi P, Voltolini L, Livi L. PO-0695: Lobectomy vs Stereotactic Ablative Radiotherapy in NSCLC:a multicentric series in four centers. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31945-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Franceschini D, Paiar F, Saieva C, Bonomo P, Agresti B, Meattini I, Greto D, Mangoni M, Meacci F, Loi M, Zei G, Livi L, Biti G. Prognostic factors in patients with locally advanced head and neck cancer treated with concurrent radiochemotherapy. Radiol Med 2015; 121:229-37. [PMID: 26403512 DOI: 10.1007/s11547-015-0586-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 03/19/2014] [Indexed: 01/22/2023]
Abstract
PURPOSE This study was undertaken to evaluate the association of individual parameters and outcome in patients with unresectable locally advanced head and neck cancer treated with radiochemotherapy. MATERIALS AND METHODS We retrospectively reviewed data from 126 patients treated in our Institution between 1998 and 2010 for a locally advanced head and neck cancer. Sixteen individual parameters were evaluated for association with specific outcomes such as overall survival, persistence of disease, disease-specific survival and disease-free survival. RESULTS Six factors influenced overall survival on Kaplan-Meier survival analysis and on univariate Cox regression analysis: smoking, body mass index, site, haemoglobin (Hb) nadir, total dose of radiotherapy and comorbidities. On a multivariate logistic model with stepwise selection, comorbidities, body mass index, total dose and site maintained significance. A significant association for persistence of disease was found with smoking, Hb nadir and site of cancer on univariate and multivariate analysis. Disease-free survival was correlated with performance status, Hb nadir and comorbidities using Kaplan-Meier survival analysis and on univariate Cox regression analysis. Only performance status maintained the significance on multivariate analysis. Disease-specific survival was correlated with five parameters: body mass index, site, Hb nadir, therapy interruption and total dose; on multivariate analysis, Hb nadir, therapy interruption and site maintained a statistically significant association. CONCLUSIONS Hb nadir during treatment, body mass index, smoking, stage, comorbidities and performance status are prognostic factors of outcome and response to radical treatment with radiochemotherapy.
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Affiliation(s)
- Davide Franceschini
- Department of Radiation-Oncology, University of Florence, Florence, Italy.
- Department of Radiotherapy, University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy.
| | - Fabiola Paiar
- Department of Radiation-Oncology, University of Florence, Florence, Italy
| | - Calogero Saieva
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Center (ISPO), Florence, Italy
| | - Pierluigi Bonomo
- Department of Radiation-Oncology, University of Florence, Florence, Italy
| | - Benedetta Agresti
- Department of Radiation-Oncology, University of Florence, Florence, Italy
| | - Icro Meattini
- Department of Radiation-Oncology, University of Florence, Florence, Italy
| | - Daniela Greto
- Department of Radiation-Oncology, University of Florence, Florence, Italy
| | - Monica Mangoni
- Department of Radiation-Oncology, University of Florence, Florence, Italy
| | - Fiammetta Meacci
- Department of Radiation-Oncology, University of Florence, Florence, Italy
| | - Mauro Loi
- Department of Radiation-Oncology, University of Florence, Florence, Italy
| | - Giacomo Zei
- Department of Radiation-Oncology, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Radiation-Oncology, University of Florence, Florence, Italy
| | - Giampaolo Biti
- Department of Radiation-Oncology, University of Florence, Florence, Italy
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Scotti V, Scartoni D, Furfaro I, Simontacchi G, De Luca Cardillo C, Agresti B, Talamonti C, Livi L. Definitive Concomitant Radiochemotherapy (RCT) Treatment for Locally Advanced (LA) Non Small Cell Lung Cancer (NSCLC): Evaluation of Hematological and Esophageal Toxicity in the Radiation Oncology Department of University of Florence Experience. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv049.11] [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: 11/12/2022] Open
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12
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Scotti V, Furfaro I, Scartoni D, Paoletti L, Loi M, Russo S, Pallotta S, Agresti B, Bastiani P, Livi L. Stereotactic Ablative Radiotherapy (SART) of Lung Lesion in Oligometastatic Patients: the Importance of High Doses Delivery. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv051.02] [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: 11/13/2022] Open
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Cardellicchio S, Farina S, Buccoliero AM, Agresti B, Genitori L, de Martino M, Fangusaro J, Sardi I. Successful treatment of metastatic βHCG-secreting germ cell tumor occurring 3 years after total resection of a pineal mature teratoma. Eur J Pediatr 2014; 173:1011-5. [PMID: 24556730 DOI: 10.1007/s00431-014-2282-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 12/30/2013] [Accepted: 02/10/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED Patients diagnosed with intracranial teratoma are at risk for developing a recurrent malignant germ cell tumor. We describe a 14-year-old boy initially diagnosed with a mature teratoma in the pineal region that recurred as a metastatic beta-human chorionic gonadotropin (βHCG)-secreting germ cell tumor 3 years after gross total resection. A surveillance brain MRI scan during follow-up demonstrated multiple lesions within the ventricular and subependymal area infiltrating the brain parenchyma along with concomitant elevated levels of βHCG in both the serum and cerebrospinal fluid. The patient underwent chemotherapy with PEI (cis-platinum, etoposide, ifosfamide) followed by radiation therapy according to the SIOP CNS GCT protocol. The patient is currently alive without evidence of disease 35 months after starting therapy. CONCLUSIONS A careful and long-term follow-up including scheduled tumor markers as well as surveillance MRI scans is required for patients with intracranial teratoma in an effort to detect and diagnose recurrent malignant disease, especially since multimodal therapy provides the potential for long-term cure.
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Affiliation(s)
- Stefania Cardellicchio
- Neuro-Oncology Unit, Department of Paediatric Medicine, Meyer Children's University Hospital, viale G. Pieraccini 24, 50139, Florence, Italy
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Scotti V, Meattini I, Franzese C, Saieva C, Bertocci S, Meacci F, Furfaro I, Scartoni D, Cecchini S, Desideri I, Ferrari K, Bruni A, De Luca Cardillo C, Bastiani P, Agresti B, Mangoni M, Livi L, Biti G. Radiotherapy timing in the treatment of limited-stage small cell lung cancer: the impact of thoracic and brain irradiation on survival. Tumori 2014; 100:289-95. [PMID: 25076240 DOI: 10.1700/1578.17206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND BACKGROUND Small cell lung cancer is an aggressive histologic subtype of lung cancer in which the role of chemotherapy and radiotherapy has been well established in limited-stage disease. We retrospectively reviewed a series of limited-stage small cell lung cancers treated with chemotherapy and thoracic and brain radiotherapy. METHODS AND STUDY DESIGN A total of 124 patients affected by limited-stage small cell lung cancer has been treated over 10 years in our Institute. Fifty-three patients (42.8%) had concomitant radio-chemotherapy treatment and 71 patients (57.2%) a sequential treatment. Eighty-eight patients (70.9%) underwent an association of a platinum-derived drug (cisplatinum or carboplatinum) and etoposide. Prophylactic cranial irradiation was planned in all patients with histologically proven complete response to primary radio-chemotherapy. RESULTS With a mean follow-up of 2.2 years, complete response was obtained in 50.8% of cases. We found a significant difference between different radio-chemotherapy association approaches (P = 0.007): percentages of overall survival were respectively 10.0%, 12.9% and 5.6% in early, late concomitant and sequential radio-chemotherapy timing. Cranial prophylaxis did not seem to influence overall survival (P = 0.21) or disease-free survival for local relapse (P = 0.34). CONCLUSIONS Concomitant radio-chemotherapy is the best approach according to our experience. Our results show a benefit of prophylactic cranial irradiation in distant metastasis-free survival.
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Bonomo P, Cipressi S, Iermano C, Bonucci I, Masi L, Doro R, Favuzza V, Paiar F, Simontacchi G, Meattini I, Greto D, Agresti B, Livi L, Biti G. Salvage stereotactic re-irradiation with CyberKnife for locally recurrent head and neck cancer: a single center experience. Tumori 2014; 100:278-83. [PMID: 25076238 DOI: 10.1700/1578.17202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND BACKGROUND We report the toxicity and preliminary clinical outcome in patients affected by locally recurrent head and neck cancer treated with stereotactic re-irradiation. METHODS Between February 2012 and August 2013, 17 patients were treated with CyberKnife as stereotactic re-irradiation for locally recurrent head and neck cancer. All patients had previously received a full dose radiation treatment with radical intent, with a median total dose of 66 Gy (range, 50-70) delivered with standard fractionation. The median interval between the primary radiotherapy and re-irradiation was 24 months (range, 10-168). RESULTS All patients completed the prescribed treatment, which was delivered in 5 fractions. The median tumor dose administered was 30 Gy (range, 25-35) prescribed to the 80% isodose line. Treatment sites were as follows: neck lymph nodes in 5 patients, paranasal sinuses in 5, oropharynx in 2, nasopharynx, and larynx, oral cavity, nasal fossa and parotid gland each in 1 patient. The median target volume treated was 58.7 cm3 (range, 8.5-211.3). Sixteen patients (94%) were evaluated for response. At a median follow-up of 7.5 months (range, 2-17), 4 patients achieved complete response (25%), 5 had partial response (31%) and 7 showed stable disease (44%). No patient showed in-field progression after re-irradiation. Grade 3 acute toxicity was noted in one patient only; no late side effect was observed during the follow-up. CONCLUSIONS Stereotactic re-irradiation with CyberKnife is an appealing non-surgical salvage treatment for selected patients with local-regionally recurrent head and neck cancer.
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16
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Scotti V, Marrazzo L, Saieva C, Agresti B, Meattini I, Desideri I, Cecchini S, Bertocci S, Franzese C, De Luca Cardillo C, Zei G, Loi M, Greto D, Mangoni M, Bonomo P, Livi L, Biti GP. Impact of a breathing-control system on target margins and normal-tissue sparing in the treatment of lung cancer: experience at the radiotherapy unit of Florence University. Radiol Med 2013; 119:13-9. [DOI: 10.1007/s11547-013-0307-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 04/16/2012] [Indexed: 12/25/2022]
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17
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Livi L, Meattini I, Cardillo CDL, Scotti V, Agresti B, Franzese C, Sanchez L, Nori J, Bertocci S, Cassani S, Bianchi S, Cataliotti L, Biti G. Use of Doxorubicin Plus Cyclophosphamide Followed by Docetaxel as Adjuvant Chemotherapy for Breast Cancer. J Chemother 2013; 23:36-9. [DOI: 10.1179/joc.2011.23.1.36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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18
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Franceschini D, Paiar F, Meattini I, Agresti B, Pasquetti EM, Greto D, Bonomo P, Marrazzo L, Casati M, Livi L, Biti G. Simultaneous integrated boost-intensity-modulated radiotherapy in head and neck cancer. Laryngoscope 2013; 123:E97-103. [PMID: 23775348 DOI: 10.1002/lary.24257] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/30/2013] [Accepted: 05/29/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To review toxicity and outcomes in patients with head and neck cancer treated with simultaneous integrated boost-intensity-modulated radiotherapy (SIB-IMRT). STUDY DESIGN Review of experience with the SIB-IMRT technique. METHODS Fifty patients were treated with the SIB-IMRT technique. Two possible schedules of radiation therapy (RT) were used: SIB 70 (70/60/54 in 33 fractions) and SIB 66 (66/60/54 in 33 fractions). Forty-one patients also received chemotherapy. RESULTS All but two patients completed treatment as prescribed. No G4 acute toxicity has been reported in our series. We did not observe any G3 to G4 chronic toxicity, apart from one case of cutaneous necrosis. After a median follow-up of 23.3 months (range, 1-60 months), 41 patients (82%) were alive and negative for disease, and one patient (2%) was alive with distant metastases. Eight patients (16%) died, seven because of progressive disease and one for other causes. CONCLUSIONS SIB-IMRT is a highly effective and safe technique of RT in the treatment of head and neck cancer.
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Affiliation(s)
- Davide Franceschini
- Department of Radiation Oncology, IFCA, University of Florence, Florence, Italy
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19
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Bonomo P, Livi L, Rampini A, Meattini I, Agresti B, Simontacchi G, Paiar F, Mangoni M, Bonucci I, Greto D, Masi L, Doro R, Marrazzo L, Biti G. Stereotactic body radiotherapy for cardiac and paracardiac metastases: University of Florence experience. Radiol Med 2013; 118:1055-65. [DOI: 10.1007/s11547-013-0932-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 02/14/2012] [Indexed: 12/25/2022]
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20
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Scotti V, Bastiani P, Loi M, Franzese C, Agresti B, Meacci F, De Luca Cardillo C, Paoletti L, Furfaro I, Biti G. 63P CISPLATIN–DOCETAXEL FOLLOWED BY WEEKLY DOCETAXEL IN ASSOCIATION WITH THORACIC RADIOTHERAPY IN LOCALLY ADVANCED NSCLC: PRELIMINARY RESULTS OF A PHASE II TRIAL. Lung Cancer 2013. [DOI: 10.1016/s0169-5002(13)70284-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Scoccianti S, Agresti B, Simontacchi G, Detti B, Cipressi S, Iannalfi A, Marrazzo L, Mangoni M, Paiar F, Livi L, Biti G. From a waiting list to a priority list: a computerized model for an easy-to-manage and automatically updated priority list in the booking of patients waiting for radiotherapy. Tumori 2013. [PMID: 23389359 DOI: 10.1700/1217.13496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND BACKGROUND Waiting time for radiotherapy is a major problem in clinical practice. We developed a model to create a priority list of patients waiting for radiotherapy according to clinical criteria, where booking of patients is not on a "first-come, first-served" basis and where prioritization has not been left up to individual discretion. METHODS The system is based on an algorithm that assigns to each patient a personal code (priority code, PC) that can be used as a continuous variable to have a priority list. PCpatient = D0patient + PWTsubgroup of treatment. Palliative treatments were categorized according to the clinical urgency. Radical treatments were stratified by primary tumors, by the setting of treatment (preoperative, curative, postoperative) and by the main prognostic factors. Each subgroup of patients has a "priority waiting time" (PWT subgroup of treatment). Calculation of the PC starts from a differentiated date according to clinical scenario [Reference date (D0)], which is taken from the clinical history of the patient. RESULTS Patients are differentiated according to clinical criteria and according to time elapsed from diagnosis. The priority list can be automatically updated day by day. Delays in patient referral or imaging availability are minimized. CONCLUSIONS The model represents a tool for an objective and automatic prioritization of the patients who are waiting for radiotherapy.
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Affiliation(s)
- Silvia Scoccianti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Viale Morgagni 85, Florence, Italy.
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22
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Bonomo P, Franceschini D, Paiar F, Loi M, Meattini I, Agresti B, Monteleone Pasquetti E, Greto D, Livi L, Biti G. PO-068: Simultaneous Integrated Boost-Intensity Modulated Radiotherapy (SIB-IMRT) in the Treatment of H&N Cancer. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)34687-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Greto D, Paiar F, Saieva C, Galardi A, Mangoni M, Livi L, Agresti B, Franceschini D, Bonomo P, Scotti V, Detti B, Tonelli F, Valeri A, Messerini L, Biti G. Neoadjuvant oxaliplatin and 5-fluorouracil with concurrent radiotherapy in patients with locally advanced rectal cancer: a singleinstitution experience. Radiol Med 2013; 118:570-82. [DOI: 10.1007/s11547-012-0909-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 02/14/2012] [Indexed: 12/12/2022]
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24
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Scoccianti S, Agresti B, Simontacchi G, Detti B, Cipressi S, Iannalfi A, Marrazzo L, Mangoni M, Paiar F, Livi L, Biti G. From a Waiting List to a Priority List: A Computerized Model for an Easy-to-Manage and Automatically Updated Priority List in the Booking of Patients Waiting for Radiotherapy. Tumori 2012; 98:728-35. [DOI: 10.1177/030089161209800609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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
Aims and background Waiting time for radiotherapy is a major problem in clinical practice. We developed a model to create a priority list of patients waiting for radiotherapy according to clinical criteria, where booking of patients is not on a “first-come, first-served” basis and where prioritization has not been left up to individual discretion. Methods The system is based on an algorithm that assigns to each patient a personal code (priority code, PC) that can be used as a continuous variable to have a priority list. PCpatient = D0patient + PWTsubgroup of treatment. Palliative treatments were categorized according to the clinical urgency. Radical treatments were stratified by primary tumors, by the setting of treatment (preoperative, curative, postoperative) and by the main prognostic factors. Each subgroup of patients has a “priority waiting time” (PWT subgroup of treatment). Calculation of the PC starts from a differentiated date according to clinical scenario [Reference date (D0)], which is taken from the clinical history of the patient. Results Patients are differentiated according to clinical criteria and according to time elapsed from diagnosis. The priority list can be automatically updated day by day. Delays in patient referral or imaging availability are minimized. Conclusions The model represents a tool for an objective and automatic prioritization of the patients who are waiting for radiotherapy.
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Affiliation(s)
- Silvia Scoccianti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Benedetta Agresti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Samantha Cipressi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Alberto Iannalfi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Livia Marrazzo
- Medical Physics, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Monica Mangoni
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Fabiola Paiar
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Giampaolo Biti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
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Scotti V, Saieva C, Di Cataldo V, Bruni A, Desideri I, Bertocci S, Meattini I, Livi L, Simontacchi G, De Luca Cardillo C, Bendinelli B, Bastiani P, Mangoni M, Agresti B, Biti G. Vinorelbine-based chemo-radiotherapy in non-small cell lung cancer. Tumori 2012. [PMID: 23052163 DOI: 10.1700/1146.12641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND BACKGROUND Concomitant radio-chemotherapy improves survival of patients with locally advanced non-small cell lung cancer, with a better local-regional control. METHODS AND STUDY DESIGN We report our experience with vinorelbine-based chemotherapy in neoadjuvant and radical settings in 43 patients. Regimens consisted of cisplatin plus vinorelbine in 74.4% patients and carboplatin plus vinorelbine in 14.0%; 11.6% underwent mono-chemotherapy with oral vinorelbine. We estimated the crude probability of death or local recurrence by the Kaplan-Meier method. Cox regression models were used to identify the main significant predictors of death or local recurrence. RESULTS A significant effect of the response to treatment was shown on both local disease free-survival (P = 0.004) and overall survival (P <0.0001). Patients with progressive disease after primary treatment had a significantly higher risk of further relapse at both univariate (P = 0.046) and multivariate regression analysis (P = 0.014) than patients with a complete response. They also showed a significantly higher risk of death at both univariate (P = 0.0005) and multivariate regression analysis (P <0.0001) than patients with a complete response. The most common toxicity was hematologic and gastroenteric. We recorded grade III/IV leukopenia in 11%, anemia in 6%, and esophagitis in 14% of the patients. CONCLUSIONS Our experience showed that vinorelbine-based chemotherapy is an effective and safe regimen, in association with a platinum compound and thoracic radiotherapy.
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Affiliation(s)
- Vieri Scotti
- Department of Radiation-Oncology, University of Florence, Florence, Italy.
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26
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Meattini I, Livi L, Franceschini D, Saieva C, Scotti V, Casella D, Criscenti V, Zanna I, Meacci F, Gerlain E, Agresti B, Mangoni M, Paiar F, Simontacchi G, Greto D, Nori J, Bianchi S, Cataliotti L, Biti G. Treatment of invasive male breast cancer: a 40-year single-institution experience. Radiol Med 2012; 118:476-86. [PMID: 22872459 DOI: 10.1007/s11547-012-0867-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 12/04/2011] [Indexed: 10/28/2022]
Abstract
PURPOSE We conducted a retrospective analysis to evaluate the management and outcome of invasive male breast cancer treated in a single-institution over a period of 40 years. MATERIALS AND METHODS We reviewed the clinical and pathological features of 60 male patients affected by breast carcinoma treated at our Radiotherapy Unit between 1971 and 2011. Tumours were classified according to histological type and the updated 2010 TNM classification of malignant tumours. RESULTS At a median follow-up of 8.9 [range, 0.6-20; standard deviation (SD), 4.98] years, 32 patients (53.3%) were alive and 16 patients died (26.7%) due to disease progression and 12 (20%) due to other causes. At univariate analysis for overall survival, pathological tumour size (p=0.031), histological subtype (p=0.013) and nodal status (p=0.006) emerged as significant predictors of death. At multivariate analysis, independent death predictors were advanced pathological tumour size (p=0.016), positive nodal status (p=0.003) and invasive cribriform histological type (p=0.0003). CONCLUSIONS In consideration of the rarity of the disease, many issues are still being debated, and future collaborative studies are required. However, our experience confirms the prognostic role of greater pathological tumour size and positive nodal status as unfavourable features for survival in male breast cancer.
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Affiliation(s)
- Icro Meattini
- Radiotherapy Unit, Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy.
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27
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Scotti V, Meattini I, Saieva C, Rampini A, De Luca Cardillo C, Bastiani P, Mangoni M, Agresti B, Santomaggio C, Di Cataldo V, Franzese C, Livi L, Magrini SM, Biti G. Limited-stage small-cell lung cancer treated with early chemo-radiotherapy: the impact of effective chemotherapy. Tumori 2012. [PMID: 22495702 DOI: 10.1700/1053.11500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND BACKGROUND Small cell lung cancer is characterized by an aggressive clinical course and a high sensitivity to both chemotherapy and radiotherapy. We present the Florence University experience in concurrent early radio-chemotherapy in patients affected by limited-stage small cell lung cancer, with particular emphasis on treatment safety, disease outcome and prognostic factors. METHODS AND STUDY DESIGN Fifty-seven patients were treated between June 2000 and February 2005. All patients underwent platinum-based chemotherapy, administered intravenously following two different regimens, for at least three cycles. Eighteen patients (31.6%) received epirubicin and ifosfamide in 3-week cycles alternating with etoposide and cisplatin, administered on day 1 to 3; 39 patients (68.4%) received etoposide and cisplatin. A total of 6 cycles were planned. Radiotherapy was administered concurrently to the first cycle of etoposide and cisplatin. RESULTS Clinical stage (P = 0.036) and number of chemotherapy courses (P = 0.009) emerged as the only significant death predictors at univariate analysis. Number of chemotherapy courses persisted as a significant death predictor also at multivariate regression analysis, with a reduced death risk for 5-6 chemotherapy cycles in comparison to 3-4 cycles (hazard ratio, 0.44). At a mean follow up of 38.5 months (standard deviation, 3.24 years; range, 6-164 months), considering the best overall tumor response achieved at any time during the whole treatment period, we obtained 32 complete responses (56.1%), 23 partial responses (40.3%) and 2 stable diseases. CONCLUSIONS Our analysis showed that concurrent early radio-chemotherapy in limited-stage small cell lung cancer treatment represents a safe and effective approach in patients. We confirmed the relevant impact on overall survival of effective chemotherapy delivery.
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Affiliation(s)
- Vieri Scotti
- Department of Radiation-Oncology, University of Florence, Florence, Italy.
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28
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Paiar F, Di Cataldo V, Zei G, Pasquetti EM, Cecchini S, Meattini I, Mangoni M, Agresti B, Iermano C, Bonomo P, Biti G. Role of chemotherapy in nasopharyngeal carcinoma. Oncol Rev 2012; 6:e1. [PMID: 25992199 PMCID: PMC4419643 DOI: 10.4081/oncol.2012.e1] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 10/09/2011] [Accepted: 10/27/2011] [Indexed: 01/23/2023] Open
Abstract
Nasopharyngeal carcinoma (NPC) is a unique malignant head and neck cancer with clinical, demographic, and geographic features distinct from other head and neck epithelial malignancies. Non-keratinizing, poorly differentiated, and undifferentiated WHO types 2 and 3 is the most common subtypes of NPC. NPC is also characterized by its relatively high sensitivity to radiation, so that in the last decades radiotherapy (RT) has been the cornerstone of treatment. However, in the majority of cases NPC is discovered at locally advanced stage. The results are disappointing when RT alone is offered. The 5-year survival rates have been reported to be about 34-52%. The poor prognosis for advanced NPC led to increasing interests in exploring the use of chemotherapy (CT). NPC has been considered to be not only radiosensitive but also chemo-sensitive and has shown high response rate to various chemotherapeutic agents. Certainly, the treatment strategies for NPC will continue to change and evolve as a better understanding is gained of the molecular and immune mechanisms that drive this disease. We reviewed the current literature focusing on the role of CT and new-targeted agents.
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Scoccianti S, Giordano F, Agresti B, Detti B, Cipressi S, Franceschini D, Greto D, Mussa F, Sardi I, Buccoliero A, Aricò M, Genitori L, Biti G. Pediatric primary anaplastic ganglioglioma: a case report and review of the literature. Pediatr Neurosurg 2012; 48:35-41. [PMID: 22922381 DOI: 10.1159/000340067] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 06/11/2012] [Indexed: 01/08/2023]
Abstract
Gangliogliomas with anaplastic features are classified as grade III tumors by the World Health Organization. The clinical course and optimal treatment of anaplastic gangliogliomas have not been well understood to date. We report a case of a primary pure anaplastic ganglioglioma in a 14-year-old male treated with surgery and radiotherapy, who is disease-free 6 years after the diagnosis. A review of primary pure anaplastic gangliogliomas in children (between 3 and 21 years of age) is presented. Gross total removal and focal radiotherapy with a total dose of 54 Gy are recommended. The addition of chemotherapy should be evaluated. Prospective studies are needed to identify an appropriate chemotherapy schedule and to define biological factors in order to select those patients with a poor prognosis, who are to be treated with a more aggressive therapy.
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Affiliation(s)
- Silvia Scoccianti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
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30
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Livi L, Meattini I, Scotti V, De Luca Cardillo C, Galardi A, Iermano C, Sanchez L, Nori J, Mangoni M, Franzese C, Orzalesi L, Bertocci S, Agresti B, Masoni T, Bianchi S, Cataliotti L, Biti G. Pegylated liposomal doxorubicin (Caelyx®) and oral vinorelbine in first-line metastatic breast cancer patients previously treated with anthracyclines. J Chemother 2011; 23:158-62. [PMID: 21742585 DOI: 10.1179/joc.2011.23.3.158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Doxorubicin is highly effective and widely used in breast cancer; however, its use is limited by cardiotoxicity related to its cumulative dose. In previous studies, pegylated liposomal doxorubicin (PLD) has shown an acceptable toxicity profile with minimal cardiotoxicity. Between June 2006 and October 2009, 27 metastatic breast cancer patients were treated with first-line PLD and vinorelbine at the University of Florence, Radiotherapy Unit. PLD (30 mg/m²) was administered on day 1, and oral vinorelbine (60 mg/m²) was administered on days 1 and 8 of a 4-week cycle. All patients were previously treated with anthracycline-based adjuvant chemotherapy. Median age was 52 years (range 38-69) and median time to metastasis was 78.5 months. There were no treatment interruptions or discontinuation for cardiac toxicity and no treatment-related deaths. Grade 3 hematological toxicity was observed in 18.6% of patients, and 3.7% had grade 3 non-hematological adverse events. With a median follow-up of 13.2 months (range 3-33), median response duration was 6.1 months, and median PFS was 5.3 months. The overall clinical benefit rate was 55.5%. Our experience adds to evidence supporting the activity and cardiac safety of PLD and vinorelbine in metastatic breast cancer patients previously treated with anthracycline-based adjuvant chemotherapy.
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Affiliation(s)
- L Livi
- Department of Radiation-Oncology, University of Florence, Florence, Italy
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Meattini I, Livi L, Saieva C, Agresti B, Scotti V, Nori J, Sanchez LJ, Vezzosi V, Bianchi S, Cataliotti L, Biti G. P2-12-14: Prognostic Value of HER2 Positivity and Negative Hormonal Status in Patients with Small Tumor (<1cm) and Node-Negative Breast Cancer. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p2-12-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction. Human epidermal growth factor receptor 2 (HER2) amplification has become the prototype biomarker to develop tailored biological treatment. Many studies suggested that HER2 positivity is an independent predictor of disease recurrence and breast cancer mortality. Trastuzumab has been introduced into clinical practice for high-risk HER2−positive patients who have completed the standard adjuvant treatment.
However, small (<1cm), node-negative tumors remain a subgroup of HER2−positive patients who are currently ineligible for trastuzumab treatment, as clinically they have been deemed to have no requirement for standard adjuvant chemotherapy.
The aim of our analysis was to evaluate the prognostic factors of local and distant recurrence in patients diagnosed with T1a-b, node-negative, HER-2 positive breast cancer.
Materials and methods. A total of 704 patients were diagnosed at Florence University between November 1999 and December 2008 with node-negative, invasive BC that were 1 cm or smaller. Patients with ductal carcinoma in situ, with recurrent BC at presentation and patients that received adjuvant chemotherapy were excluded from analysis.
Results. Mean follow-up was 4.9 years (0.5−10.8 years); we recorded a total of 19 recurrences, including 10 distant recurrences. Mean time to local relapse occurrence was 3.8 years (0.4−7.3 years); mean time to distant metastases diagnosis was 4.4 years (1.4−7.6 years). Among all patients, the recurrence-free survival (RFS) was 93.7%.
The only parameter that emerged as significant predictor of events is the age (p=0.02).
The distant recurrence-free survival (DRFS) rate was 96.5%. Patients who had HER2−positive BC had worse DRFS than patients who had HER2−negative BC (92.0% v 96.9%; p=0.045). In addition to HER2, also HR status was significantly associated with DRFS (p=0.026). Patients who had HR negative status had worse DRFS than patients who had HR positive status (91.4% v 97.4%; p=0.045).
Conclusions. Patients with T1a-b, node-negative, breast cancer have a low risk of distant and local recurrence. Women with HER2−positive and negative hormonal status have a significant risk of distant recurrence and should be considered for anti-HER2 adjuvant therapy.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-12-14.
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Affiliation(s)
- I Meattini
- 1Florence University, Florence, Italy; Cancer Prevention and Research Institute, Florence, Italy
| | - L Livi
- 1Florence University, Florence, Italy; Cancer Prevention and Research Institute, Florence, Italy
| | - C Saieva
- 1Florence University, Florence, Italy; Cancer Prevention and Research Institute, Florence, Italy
| | - B Agresti
- 1Florence University, Florence, Italy; Cancer Prevention and Research Institute, Florence, Italy
| | - V Scotti
- 1Florence University, Florence, Italy; Cancer Prevention and Research Institute, Florence, Italy
| | - J Nori
- 1Florence University, Florence, Italy; Cancer Prevention and Research Institute, Florence, Italy
| | - LJ Sanchez
- 1Florence University, Florence, Italy; Cancer Prevention and Research Institute, Florence, Italy
| | - V Vezzosi
- 1Florence University, Florence, Italy; Cancer Prevention and Research Institute, Florence, Italy
| | - S Bianchi
- 1Florence University, Florence, Italy; Cancer Prevention and Research Institute, Florence, Italy
| | - L Cataliotti
- 1Florence University, Florence, Italy; Cancer Prevention and Research Institute, Florence, Italy
| | - G Biti
- 1Florence University, Florence, Italy; Cancer Prevention and Research Institute, Florence, Italy
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Casamassima F, Livi L, Masciullo S, Menichelli C, Masi L, Meattini I, Bonucci I, Agresti B, Simontacchi G, Doro R. Stereotactic radiotherapy for adrenal gland metastases: university of Florence experience. Int J Radiat Oncol Biol Phys 2011; 82:919-23. [PMID: 21300473 DOI: 10.1016/j.ijrobp.2010.11.060] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 10/29/2010] [Accepted: 11/02/2010] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate a retrospective single-institution outcome after hypofractionated stereotactic body radiotherapy (SBRT) for adrenal metastases. METHODS AND MATERIALS Between February 2002 and December 2009, we treated 48 patients with SBRT for adrenal metastases. The median age of the patient population was 62.7 years (range, 43-77 years). In the majority of patients, the prescription dose was 36 Gy in 3 fractions (70% isodose, 17.14 Gy per fraction at the isocenter). Eight patients were treated with single-fraction stereotactic radiosurgery and forty patients with multi-fraction stereotactic radiotherapy. RESULTS Overall, the series of patients was followed up for a median of 16.2 months (range, 3-63 months). At the time of analysis, 20 patients were alive and 28 patients were dead. The 1- and 2-year actuarial overall survival rates were 39.7% and 14.5%, respectively. We recorded 48 distant failures and 2 local failures, with a median interval to local failure of 4.9 months. The actuarial 1-year disease control rate was 9%; the actuarial 1- and 2-year local control rate was 90%. CONCLUSION Our retrospective study indicated that SBRT for the treatment of adrenal metastases represents a safe and effective option with a control rate of 90% at 2 years.
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Affiliation(s)
- Franco Casamassima
- Clinical Radiobiological Institute, University of Florence, Florence, Italy.
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Sardi I, Giordano F, Paolicchi O, Buccoliero AM, Basile M, Agresti B, Mussa F, Aricò M, Genitori L. Metastatic spread outside the central nervous system of anaplastic medulloblastoma associated with a spinal-peritoneal shunt immediately after radiotherapy. Pediatr Neurosurg 2011; 47:235-7. [PMID: 22213777 DOI: 10.1159/000334259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 09/25/2011] [Indexed: 11/19/2022]
Affiliation(s)
- Iacopo Sardi
- Department of Pediatric Hematology-Oncology, AUO Anna Meyer, Florence, Italy. i.sardi @ meyer.it
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Scotti V, Borghesi S, Meattini I, Saieva C, Rossi F, Petrucci A, Galardi A, Livi L, Agresti B, Fambrini M, Marchionni M, Biti G. Postoperative radiotherapy in stage I/II endometrial cancer: retrospective analysis of 883 patients treated at the University of Florence. Int J Gynecol Cancer 2010; 20:1540-1548. [PMID: 21370597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
INTRODUCTION The efficacy of postoperative radiotherapy (RT) in the treatment of early-stage endometrial carcinoma (EC) is still under debate. This study was aimed to review the outcome and adverse effects in patients treated for EC with postoperative RT at a single center. METHODS A total of 883 patients with pathological stages I to II EC were retrospectively analyzed. Surgery consisted of total abdominal hysterectomy and bilateral salpingo-oophorectomy, or vaginal hysteroannessiectomy in 532 patients (60.2%) with pelvic lymphadenectomy in 351 patients (39.8%). Seven hundred forty-seven patients (84.6%) underwent whole pelvic RT (WPRT) and 136 (15.4%) combined WPRT and vaginal brachytherapy (BT) boost. RESULTS At a median follow-up of 9 years (range, 1.2-27.6 years), we observed 10.6% disease relapse. Forty-seven patients experienced local recurrence (LR), and 38 patients experienced distant metastases (DMs). At univariate analysis, age at diagnosis (P < 0.0001), stage (P < 0.04), and histological subtype (P < 0.0001) resulted in significant prognostic factors. At multivariate analysis, histotype emerged as an independent relapse predictor (P = 0.0001). Acute WPRT-related toxicity was mild; diarrhea was the most common adverse effect (19.8%). We recorded long-term adverse effects in 7.8% of the patients. CONCLUSIONS Our study showed that patients with early-stage EC have a good outcome in overall survival and disease-free survival. In our experience, standard surgery (including hysterectomy and bilateral salpingo-oophorectomy followed by WPRT with or without BT) showed an acceptable toxicity profile.
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Affiliation(s)
- Vieri Scotti
- Department of Radiation Oncology, University of Florence, Florence, Italy.
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Livi L, Meattini I, Di Cataldo V, Cardillo CDL, Scotti V, Sanchez L, Nori J, Agresti B, Iermano C, Pasquetti EM, Bianchi S, Cataliotti L, Biti G. Postmastectomy radiotherapy in breast cancer adjuvant treatment. MINERVA CHIR 2010; 65:527-536. [PMID: 21081864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Radiotherapy (RT) plays an important role in the management of locally advanced breast cancer (BC). Postmastectomy RT has been shown to significantly reduce the risk of loco-regional failure and to improve disease free survival in high-risk women with BC. Many trials have shown a significant benefit in local control, disease-free and overall survival with the addition of RT for patients with stage II and III breast cancer. New perspectives are evaluating multiple biological variables that nowadays should be considered in clinical oncology for the prescription of postmastectomy radiation therapy. Tailored randomized trials are now ongoing to clarify the "grey zone" represented by the intermediate-risk group of patients (1-3 lymph nodes involved). We reviewed the major studies offered by literature with emphasis on the principal debated issues.
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Affiliation(s)
- L Livi
- Department of Radiation-Oncology, University of Florence, Florence, Italy
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Livi L, Scotti V, Saieva C, Meattini I, Detti B, Simontacchi G, Cardillo CD, Paiar F, Mangoni M, Marrazzo L, Agresti B, Cataliotti L, Bianchi S, Biti G. Outcome After Conservative Surgery and Breast Irradiation in 5,717 Patients With Breast Cancer: Implications for Supraclavicular Nodal Irradiation. Int J Radiat Oncol Biol Phys 2010; 76:978-83. [DOI: 10.1016/j.ijrobp.2009.03.001] [Citation(s) in RCA: 23] [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: 11/26/2008] [Revised: 02/26/2009] [Accepted: 03/02/2009] [Indexed: 11/26/2022]
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Livi L, Buonamici FB, Simontacchi G, Scotti V, Fambrini M, Compagnucci A, Paiar F, Scoccianti S, Pallotta S, Detti B, Agresti B, Talamonti C, Mangoni M, Bianchi S, Cataliotti L, Marrazzo L, Bucciolini M, Biti G. Accelerated partial breast irradiation with IMRT: new technical approach and interim analysis of acute toxicity in a phase III randomized clinical trial. Int J Radiat Oncol Biol Phys 2009; 77:509-15. [PMID: 19700248 DOI: 10.1016/j.ijrobp.2009.04.070] [Citation(s) in RCA: 64] [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: 02/26/2009] [Revised: 04/27/2009] [Accepted: 04/27/2009] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate with a randomized clinical trial the possibility of treating the index quadrant with external intensity-modulated radiotherapy (IMRT) in a selected group of patients with early-stage breast cancer and to analyze the acute toxicity. METHODS AND MATERIALS From September 2005, a randomized Phase III clinical trial has been conducted to compare conventional (tangential field) fractionated whole breast treatment (Arm A) with accelerated partial breast irradiation plus intensity-modulated radiotherapy (Arm B). For intensity-modulated radiotherapy, the clinical target volume was drawn with a uniform 1-cm margin around the surgical clips in three dimensions. The ipsilateral and contralateral breast, ipsilateral and contralateral lung, heart, and spinal cord were contoured as organs at risk. All the regions of interest were contoured according to the International Commission on Radiation Units and Measurements reports 50 and 62 recommendations. RESULTS In September 2008, 259 patients were randomized and treated. The mean clinical target volume in Arm B was 44 cm(3) and the mean planning target volume was 123 cm(3). The mean value of the ratio between the planning target volume and the ipsilateral breast volume was 21%. The rate of Grade 1 and Grade 2 acute skin toxicity was 22% and 19% in Arm A (Radiation Therapy Oncology Group scale), respectively. The tolerance in Arm B was excellent with only 5% Grade 1 and 0.8% Grade 2 acute skin toxicity. The planning constraints were fully satisfied in most patients. In a very few cases, this was not possible because of very unfavorable anatomy. Quality assurance procedures were performed according to our internal quality assurance protocol, with excellent results. CONCLUSION In the present preliminary analysis, we have demonstrated that accelerated partial breast irradiation is feasible, with very low acute toxicity.
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Affiliation(s)
- Lorenzo Livi
- Radiotherapy Unit, University of Florence, Florence, Italy.
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Marrazzo L, Simontacchi G, Agresti B, Buonamici FB, Cintolesi V, Compagnucci A, Meattini I, Paiar F, Pallotta S, Scoccianti S, Talamonti C, Biti G, Bucciolini M. EVALUATION OF A SURFACE ACQUISITION SYSTEM FOR CHECKING PATIENT POSITIONING. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72782-2] [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] [Indexed: 11/24/2022]
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Livi L, Borghesi S, Saieva C, Meattini I, Rampini A, Petrucci A, Detti B, Bruni A, Paiar F, Mangoni M, Marrazzo L, Agresti B, Cataliotti L, Bianchi S, Biti G. Radiotherapy timing in 4,820 patients with breast cancer: university of florence experience. Int J Radiat Oncol Biol Phys 2008; 73:365-9. [PMID: 18715726 DOI: 10.1016/j.ijrobp.2008.04.066] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 04/18/2008] [Accepted: 04/22/2008] [Indexed: 11/27/2022]
Abstract
PURPOSE To analyze the relationship between a delay in radiotherapy (RT) after breast-conserving surgery and ipsilateral breast recurrence (BR). METHODS AND MATERIALS We included in our analysis 4,820 breast cancer patients who had undergone postoperative RT at the University of Florence. The patients were categorized into four groups according to the interval between surgery and RT (T1, <60 days; T2, 61-120 days; T3, 121-180 days; and T4, >180 days). RESULTS On multivariate analysis, the timing of RT did not reach statistical significance in patients who received only postoperative RT (n = 1,935) or RT and hormonal therapy (HT) (n = 1,684) or RT, chemotherapy (CHT), and HT (n = 529). In the postoperative RT-only group, age at presentation, surgical margin status, and a boost to the tumor bed were independent prognostic factors for BR. In the RT plus HT group, age at presentation and boost emerged as independent prognostic factors for BR (p = 0.006 and p = 0.049, respectively). Finally, in the RT, CHT, and HT group, only multifocality was an independent BR predictor (p = 0.01). Only in the group of patients treated with RT and CHT (n = 672) did multivariate analysis with stepwise selection show RT timing as an independent prognostic factor (hazard ratio, 1.59; 95% confidence interval, 1.01-2.52; p = 0.045). Analyzing this group of patients, we found that most patients included had worse prognostic factors and had received CHT consisting of cyclophosphamide, methotrexate, and 5-fluorouracil before undergoing RT. CONCLUSION The results of our study have shown that the timing of RT itself does not affect local recurrence, which is mainly related to prognostic factors. Thus, the "waiting list" should be thought of as a "programming list," with patients scheduled for RT according to their prognostic factors.
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Affiliation(s)
- Lorenzo Livi
- Radiotherapy Unit, University of Florence, Florence, Italy
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Livi L, Paiar F, Saieva C, Scoccianti S, Dicosmo D, Borghesi S, Agresti B, Nosi F, Orzalesi L, Santini R, Barca R, Biti GP. Survival and breast relapse in 3834 patients with T1-T2 breast cancer after conserving surgery and adjuvant treatment. Radiother Oncol 2007; 82:287-93. [PMID: 17188382 DOI: 10.1016/j.radonc.2006.11.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Revised: 11/03/2006] [Accepted: 11/14/2006] [Indexed: 11/22/2022]
Abstract
PURPOSE The aim of the present analysis is to determine the long-term results in terms of breast relapse and specific survival in patients treated with conserving surgery and adjuvant treatment for early breast cancer. METHODS From January 1980 to December 2001, 3834 patients with pT1-T2 breast cancer were treated consecutively at the University of Florence. The median age of the patient population was 55 years (range 30-80). All patients were followed for a median of 7.4 years (range 0.6 year to 22.5 years). The crude probability of survival (or local recurrence) was estimated by using Kaplan-Meier method, and survival (or local recurrence) comparisons were carried out using Cox proportional hazard regression models. RESULTS The Cox regression model by stepwise selection showed some parameters, such as chemotherapy (HR 1.53; CI 1.19-1.95), pT status (HR 1.62, CI 1.31-2.01), positive axillary lymph nodes (HR 1.92, CI 1.66-2.22), and local recurrence (HR 4.58; CI 3.66-5.73), as independent prognostic factors for breast cancer death. Moreover, we found lower rate survival among patients treated before 1991 in comparison to women treated after 1991 (p=0.0001) probably due to inadequate treatment. For local disease free survival, age at presentation (HR 0.47; CI 0.35-0.63), use of tamoxifen (HR 0.42; CI 0.25-0.71), surgical margins (HR 2.00; CI 1.21-3.30), and chemotherapy (HR 0.53; CI 0.31-0.91) emerged by multivariate analyses as significant breast relapse predictors. CONCLUSION In our experience breast conserving surgery followed by adjuvant radiotherapy treatment gives high rates of local control in women with early breast cancer. The use of routinely adjuvant chemotherapy and hormone therapy lowered the local recurrence and probably the modification of therapeutic approach in the last decades also improved the specific survival.
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Affiliation(s)
- Lorenzo Livi
- Department of Radiation Oncology, University of Florence, Italy.
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Livi L, Paiar F, Santini R, De Luca Cardillo C, Galardi A, Di Cosmo D, Borghesi S, Agresti B, Nosi F, Gavilli S, Biti GP. Alternating intravenous and oral vinorelbine plus epirubicin with pegfilgrastim as neoadjuvant treatment of locally advanced breast cancer. Anticancer Drugs 2006; 17:1081-5. [PMID: 17001182 DOI: 10.1097/01.cad.0000231478.22901.6e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In order to downstage locally advanced breast cancer, neoadjuvant chemotherapy consisting of intravenous vinorelbine 25 mg/m plus epirubicin 75 mg/m given on day 1 and oral vinorelbine 60 mg/m on day 8 was administered every 3 weeks for four courses. On day 2, all patients received a single subcutaneous injection of pegfilgrastim (6 mg). From March 2004 to June 2005, 22 patients were enrolled. Patients characteristics were: median age, 53 years (range: 39-70 years); postmenopausal, 7/22; clinical TNM stage, T2 (n=14), T3 (n=8), N0 (n=17) and N1 (n=5). The median number of courses was four (range: two to six courses) with full dose intensity. National Cancer Institute grade 3 haematological toxicities observed were neutropenia in 9% of patients, anaemia in 13% of patients and thrombocytopenia in 9% of patients; no toxicity grade 4 occurred. Two patients (9%) registered grade 2 polyneuropathy; no cardiac failure was observed. Conservative surgery was performed in 14 patients (63%). All patients were evaluable for response: complete pathological response was documented in three patients (13.6%); three patients (13.6%) obtained more than 75% of tumour size reduction; 11 other patients (50%) had 50% of tumour size reduction; stable disease was observed in five patients (22.7%). The present findings indicate that vinorelbine in combination with epirubicin is an effective and safe treatment in locally advanced breast cancer: this regimen obtained more than 50% of tumour size reduction in 77% of patients; the use of pegfilgrastim allowed full dose intensity. Oral vinorelbine on day 8 offers greater convenience to the patient by reducing the need for intravenous injection and the time spent in hospital.
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Affiliation(s)
- Lorenzo Livi
- Department of Radiotherapy-Oncology, Radiotherapy Unit, University of Florence, Florence, Italy.
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